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Quality improvement guidelines for angiography, angioplasty, and stent placement for the diagnosis and treatment of renal artery stenosis in adults.

J Vasc Interv Radiol. 2010 Apr;21(4):421-30; quiz 230

Authors: Martin LG, Rundback JH, Wallace MJ, Cardella JF, Angle JF, Kundu S, Miller DL, Wojak JC,

PMID: 20188590 [PubMed - in process]

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Quality of care of Egyptian asthmatic children: clinicians adherence to asthma guidelines.

Ital J Pediatr. 2010 Apr 21;36(1):33

Authors: Salama AA, Mohammed AA, Elokda EE, Said RM

ABSTRACT: BACKGROUND: Despite the development and dissemination of guidelines for the diagnosis and management of asthma, a gap remains between current recommendations and actual practice. Objectives: To assess the physicians attitude towards asthma guidelines and their adherence to its recommendations. METHODS: Three hundred and fifty two clinicians (101 General practitioners, 131 pediatric specialists, 35 pediatric consultants and 85 doctors did not report the qualification) engaged in direct childhood asthma care in Cairo, Egypt were subjected to a self-administered questionnaire with 35 questions of which most were multiple choices, aiming at assessment of three important aspects about the involved physicians; physician's knowledge, practice and attitude. 165 of the clinicians were working in governmental hospitals, 68 clinicians work in private clinics and 119 clinicians work in both RESULTS: Agreement with asthma guidelines was present in 76.2% of the studied physicians, however those who not in agreement with the guidelines claimed that this was mainly due to patient factors, firstly the poor socioeconomic standard of the patient (18.1%) and secondly due to poor patient compliance (16%). Poor knowledge was found in 28.5%, poor practice was found in 43.6% and poor attitude was found in 14.4% of the studied physicians. There was positive highly significant correlation between qualification and knowledge, (p<0.01), positive highly significant correlation between qualification and practice, (p<0.01), and positive highly significant correlation between qualification and attitude, (p<0.01). CONCLUSION: The attitude of the studied physicians revealed agreement of their majority with the guidelines, while the disagreement was mainly explained by the poor socioeconomic standard of the patients. The degree of poor practice is more marked than that of poor knowledge or poor attitude reflecting resources limitations and applications obstacles in the physician's practice.

PMID: 20406498 [PubMed - as supplied by publisher]

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General practitioner's adherence to the COPD GOLD guidelines: baseline data of the Swiss COPD Cohort Study.

Swiss Med Wkly. 2010 Apr 21;

Authors: Jochmann A, Neubauer F, Miedinger D, Schafroth S, Tamm M, Leuppi JD

PRINCIPLES: Chronic obstructive pulmonary disease (COPD) is a major burden on patients and healthcare systems. Diagnosis and the management of COPD are often administered by general practitioners (GPs). This analysis investigated the adherence of GPs in Switzerland to the Global Initiative for Chronic Obstructive Lung Diseases (GOLD) guidelines. METHODS: As part of an ongoing investigation into the effect of GPs prescriptions on the clinical course of COPD, 139 GPs submitted a standardised questionnaire for each COPD patient recruited. Information requested included spirometric parameters, management and demographic data. Participating GPs were provided with and received instruction on a spirometer with automatic feedback on quality. Patients were grouped by the investigators into the GOLD COPD severity classifications, based on spirometric data provided. Data from the questionnaires were compared between the groups and management was compared with the recommendations of GOLD. RESULTS: Of the 615 patients recruited, 44% did not fulfil GOLD criteria for COPD. Pulmonary rehabilitation was prescribed to 5% of all patients and less than one-third of patients exercised regularly. Less than half the patients in all groups used short-acting bronchodilators. Prescribing long-acting bronchodilators or inhaled corticosteroids conformed to GOLD guidelines in two-thirds of patients with GOLD stage III or IV disease, and approximately half of the less severe patients. Systemic steroids were inappropriately prescribed during stable disease in 6% of patients. CONCLUSIONS: Adherence to GOLD (COPD) guidelines is low among GPs in Switzerland and COPD is often misdiagnosed or treated inappropriately. This is probably due to poor knowledge of disease definitions.

PMID: 20407960 [PubMed - as supplied by publisher]

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Patterns in the use of benzodiazepines in British Columbia: Examining the impact of increasing research and guideline cautions against long-term use.

Health Policy. 2010 Apr 20;

Authors: Cunningham CM, Hanley GE, Morgan S

OBJECTIVE: We examined changes in patterns of benzodiazepine use in British Columbia over a period of increasing evidence of harms associated with long-term use. METHODS: Using linked administrative databases for the years 1996 and 2006, we performed logistic regression to examine how socio-economic and health factors affect the likelihood of benzodiazepine use and long-term use, and to test for changes in rates of use and long-term use over time. RESULTS: In 2006, 8.4% of British Columbians used benzodiazepines, 3.5% long-term. Use was positively related with being female, lower income, older, and of poorer health status. Long-term use was positively associated with being in the lowest income quintile, of poorest health, and over the age of 65. While the rate of long-term use decreased from 1996 to 2006 for those over age 70, it increased in middle-aged populations. CONCLUSIONS: Our results suggest, despite increased awareness of and cautions regarding risks associated with long-term use of benzodiazepines, rates of potentially inappropriate use have changed very little over a decade. Given that early use of benzodiazepines is positively associated with later long-term use, policies targeting populations younger than conventionally studied (i.e. those under age 65) may be needed to decrease rates of long-term use.

PMID: 20413177 [PubMed - as supplied by publisher]

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Guidelines for better harm reduction: Evaluating implementation of best practice recommendations for needle and syringe programs (NSPs).

Int J Drug Policy. 2010 Apr 20;

Authors: Strike C, Watson TM, Lavigne P, Hopkins S, Shore R, Young D, Leonard L, Millson P

BACKGROUND: The objective of this study was to evaluate needle and syringe program (NSP) policies and procedures before and after the dissemination of a set of best practice recommendations. METHODS: An on-line survey of 32 core NSP managers (100% response rate) and 62 satellite NSP managers (63% response rate). The survey included items about the distribution of needles/syringes, other injection-related equipment and inhalation equipment, and use of a best practice recommendations document. RESULTS: The majority of NSPs reported following needle and syringe best practice recommendations. Most core NSPs (88%, n=28) and satellite NSPs (84%, n=52) distributed cookers following the dissemination of the document. All core NSPs (100%, n=32) and nearly all satellite NSPs (97%, n=60) distributed sterile water ampoules in 2008, many more than in 2006. Although more NSPs distributed safer inhalation equipment in 2008, the majority did not distribute these items. More satellite NSPs (44%, n=27) distributed glass stems than the core NSPs (16%, n=5). Commonly cited implementation barriers included funding, senior management and decision-making. CONCLUSION: Our findings demonstrate that NSPs will implement empirically based best practice recommendations and welcome such guidance. The managers we surveyed not only reported increased implementation of practices that have been empirically shown to help reduce disease transmission among injection drug users (IDUs), they also used the best practices document for additional purposes, such as planning and advocacy, and expressed interest in having sets of recommendations developed for other areas of harm reduction. Ensuring high-quality and consistent NSP services is essential to prevent transmission of HIV among people who inject drugs and others in the community. Best practice recommendations can assist in achieving these goals.

PMID: 20413288 [PubMed - as supplied by publisher]

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The Current Evidence-Based Guidelines Regarding Prophylaxis of Venous Thrombembolism and their Relevance for Plastic Surgery.

Handchir Mikrochir Plast Chir. 2010 Apr 19;

Authors: Jokuszies A, Niederbichler A, Herold C, Dodic T, Vogt PM

INTRODUCTION: In Germany, clinically and experimentally proven, evidence-based guidelines for the perioperative prophylaxis of thromboembolism in plastic surgery have not yet been developed. The ever-expanding complexity of microsurgical reconstructive procedures associated with the immense technical progress in the medical field have once more highlighted the urgent need for evidence-based guidelines. Moreover, this urgency is underlined by more and more complex reconstructive procedures needing to be performed in elderly patients presenting with grave comorbidities and the related high risk for thromboembolic events. These facts prompted us to review and discuss the relevance of the updated S3-guidelines on prophylaxis of venous thromboembolic events for the field of plastic and reconstructive surgery . MATERIAL AND METHODS: The existing S3-guidelines represent the result of a consensus between 27 medical societies and organisations. Delegates of the German Society of Plastic, Reconstructive and Aesthetic Surgery (DGPRAEC) also participated in this consensus process and the development of the guidelines, which provide evidence-based and clinically oriented recommendations for the prophylaxis of venous thromboembolism for operative and non-operative as well as outpatient and inpatient settings. In the results section of this paper, general and specific recommendations with regard to plastic and reconstructive surgery are outlined. RESULTS: Indications for the pharmacological prophylaxis of thromboembolic events are oriented on the specific risk categories for surgical interventions with regard to the dispositional individual risk factors. Furthermore, the recommendations for the field of plastic and reconstructive surgery are subdivided into the various regions of the body. DISCUSSION: Evidence-based recommendations for perioperative prophylaxis of venous thromboembolism in plastic surgery are not available yet. The establishment of an algorithm to screen and estimate the procedure-associated risks for thromboembolism is needed. The discussed S3-guidelines of the AWMF Society on the prophylaxis of venous thromboembolism meet these formal requirements. Gathering of evidence-based data and the generation of recommendations leading to a reduction of the perioperative risk of thromboembolic events is a pivotal element to improve patient outcomes and safety in microsurgery.

PMID: 20405373 [PubMed - as supplied by publisher]

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[Osteoporosis diagnosis and therapy according to the 2010 guidelines.]

Z Rheumatol. 2010 Apr 18;

Authors: Braun J, Pfeilschifter J

Osteoporotic fractures are a frequent cause of disability and loss of quality of life in old age. Maintaining muscle function and balance, a daily calcium intake of 1000 mg, sufficient vitamin D and prudent use of drugs associated with falls and osteoporosis are key components to fracture prevention. The German guideline recommends that a specific long-term osteoporosis medication be initiated in individuals with a 30% 10-year risk for hip fractures and vertebral fractures.

PMID: 20401487 [PubMed - as supplied by publisher]

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Proportion of patients needing an implantable cardioverter defibrillator on the basis of current guidelines: impact on healthcare resources in Italy and the USA. Data from the ALPHA study registry.

Europace. 2010 Apr 17;

Authors: Pedretti RF, Curnis A, Massa R, Morandi F, Tritto M, Manca L, Occhetta E, Molon G, De Ferrari GM, Sarzi Braga S, Raciti G, Klersy C, Salerno-Uriarte JA,

Aims Implantable cardioverter defibrillators (ICD) improve survival in selected patients with left ventricular dysfunction or heart failure (HF). The objective is to estimate the number of ICD candidates and to assess the potential impact on public health expenditure in Italy and the USA. Methods and results Data from 3513 consecutive patients (ALPHA study registry) were screened. A model based on international guidelines inclusion criteria and epidemiological data was used to estimate the number of eligible patients. A comparison with current ICD implant rate was done to estimate the necessary incremental rate to treat eligible patients within 5 years. Up to 54% of HF patients are estimated to be eligible for ICD implantation. An implantation policy based on guidelines would significantly increase the ICD number to 2671 implants per million inhabitants in Italy and to 4261 in the USA. An annual increment of prophylactic ICD implants of 20% in the USA and 68% in Italy would be necessary to treat all indicated patients in a 5-year timeframe. Conclusion Implantable cardioverter defibrillator implantation policy based on current evidence may have significant impact on public health expenditure. Effective risk stratification may be useful in order to maximize benefit of ICD therapy and its cost-effectiveness in primary prevention.

PMID: 20400768 [PubMed - as supplied by publisher]

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Neuroscience. New guidelines aim to improve studies of traumatic brain injury.

Science. 2010 Apr 16;328(5976):297

Authors: Miller G

PMID: 20395488 [PubMed - indexed for MEDLINE]

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Is there new scientific evidence to justify reconsideration of the current WHO guidelines for particulate matter during dust intrusions?

Sci Total Environ. 2010 Apr 15;408(10):2283-4

Authors: Linares C, Tobías A, Díaz J

PMID: 20189223 [PubMed - in process]

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