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Appropriate discard of "best" practice guidelines for acute low back pain.

Arch Intern Med. 2010 Jun 28;170(12):1087-8; author reply 1088

Authors: Geller AS

PMID: 20585081 [PubMed - indexed for MEDLINE]

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Overcoming barriers to guideline implementation: the case of cardiac rehabilitation.

Qual Saf Health Care. 2010 Jun 27;

Authors: Fernandez RS, Davidson P, Griffiths R, Salamonson Y

Aims This study explored the strategies used by cardiac rehabilitation (CR) coordinators to overcome the obstacles to implementation of the evidence-based Reducing Risk in Heart Disease guidelines. Methods The study design used qualitative, semistructured in-depth interviews with 20 CR coordinators from New South Wales, Australia, to explore the strategies used to facilitate guideline implementation. Non-probability sampling was used to recruit CR coordinators to obtain a broad understanding of the issues. Interviews were transcribed and thematic content analysis was undertaken to identify common themes. Results Coordinators addressed the barriers to implementing guidelines through their commitment to best practice and striving to overcome the odds through providing opportunistic health education, alternate methods of secondary prevention, and partnering and engaging with local communities. Conclusions Although CR coordinators face multiple barriers to implementing evidence-based guidelines for patients with coronary heart disease, they use strategies such as harnessing community capacity and using available resources creatively. The development of a more integrated, multifactorial and coordinated approach to improving use of guidelines in clinical practice to improve the treatment and secondary prevention of coronary heart disease is urgently needed.

PMID: 20584704 [PubMed - as supplied by publisher]

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National swine flu adult assessment guidelines: retrospective validation of objective criteria in three proxy datasets.

Emerg Med J. 2010 Jun 26;

Authors: Challen K, Bentley A, Bright J, Gray J, Walter D

Objectives To validate the objective criteria in the Department of Health Adult Swine Flu Assessment Tool against proxy datasets for pandemic influenza. Design Comparative validation study with 3 datasets. Setting Urban Emergency Department (group 1) and prehospital care (groups 2 and 3). Participants Adults with community-acquired pneumonia (group 1, n=281), shortness of breath (group 2, n=211) or any respiratory diagnosis (group 3, n=300). Outcome measures Hospital admission (group 1), hospital admission or intravenous therapy (group 2) and transfer to emergency department (group 3). Results Sensitivity and specificity of the tool were 0.73 (95% CI 0.67 to 0.8) and 0.83 (0.72 to 0.9) in group 1, 0.64 (0.55 to 0.71) and 0.63 (0.52 to 0.73) in group 2 and 0.84 (0.75 to 0.9) and 0.55 (0.48 to 0.62) in group 3. Analysis of individual components of the tool and a summative score is presented. Conclusions The objective criteria of the proposed DH assessment tool do not perform particularly well in predicting relevant clinical outcomes in feasible proxy conditions for pandemic influenza.

PMID: 20581387 [PubMed - as supplied by publisher]

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Beneficial effects of implementing guidelines on microbiology and costs of infected diabetic foot ulcers.

Diabetologia. 2010 Jun 23;

Authors: Sotto A, Richard JL, Combescure C, Jourdan N, Schuldiner S, Bouziges N, Lavigne JP

AIMS/HYPOTHESIS: In 2003, guidelines for management of diabetic foot infection (DFI) were written by the authors' team according to the guidelines of the International Working Group on the Diabetic Foot. The effects of implementing these guidelines on the microbiology and costs of infected diabetic foot ulcers were assessed. METHODS: From 2003 to 2007, potential beneficial effects of implementing these guidelines were assessed by comparison over time of bacteriological data (number of bacterial samples, number of microorganisms isolated in cultures, prevalence of multidrug-resistant organisms [MDRO] and colonising flora), and costs related to use of antimicrobial agents and microbiology laboratory workload. RESULTS: The study included 405 consecutive diabetic patients referred to the Diabetic Foot Unit for a suspected DFI. From 2003 to 2007, a significant decrease was observed in the median number of bacteria species per sample (from 4.1 to 1.6), prevalence of MDRO (35.2% vs 16.3%) and methicillin-resistant Staphylococcus aureus (52.2% vs 18.9%) (p < 0.001). Moreover, prevalence of pathogens considered as colonisers dramatically fell from 23.1% to 5.8% of all isolates (p < 0.001). In parallel, implementation of guidelines was associated with a saving of 14,914 (US$20,046) related to a reduced microbiology laboratory workload and 109,305 (US$147,536) due to reduced prescription of extended-spectrum antibiotic agents. CONCLUSIONS/INTERPRETATION: Implementation of guidelines for obtaining specimens for culture from patients with DFI is cost-saving and provides interesting quality indicators in the global management of DFI.

PMID: 20571753 [PubMed - as supplied by publisher]

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Letter to the Editor Re: PanCanadian Evaluation of Irreversible Compression Ratios ("Lossy" Compression) for Development of National Guidelines.

J Digit Imaging. 2010 Jun 23;

Authors: Norman G, Bak P, Matos A, Koff DA

PMID: 20571849 [PubMed - as supplied by publisher]

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Evaluation of evidence-based literature and formation of recommendations for the Clinical Preventive Guidelines for Immigrants and Refugees in Canada.

CMAJ. 2010 Jun 23;

Authors: Tugwell P, Pottie K, Welch V, Ueffing E, Chambers A, Feightner J

BACKGROUND: This article describes the evidence review and guideline development method developed for the Clinical Preventive Guidelines for Immigrants and Refugees in Canada by the Canadian Collaboration for Immigrant and Refugee Health Guideline Committee. METHODS: The Appraisal of Guidelines for Research and Evaluation (AGREE) best-practice framework was combined with the recently developed Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to produce evidence-based clinical guidelines for immigrants and refugees in Canada. RESULTS: A systematic approach was designed to produce the evidence reviews and apply the GRADE approach, including building on evidence from previous systematic reviews, searching for and comparing evidence between general and specific immigrant populations, and applying the GRADE criteria for making recommendations. This method was used for priority health conditions that had been selected by practitioners caring for immigrants and refugees in Canada. INTERPRETATION: This article outlines the 14-step method that was defined to standardize the guideline development process for each priority health condition.

PMID: 20573711 [PubMed - as supplied by publisher]

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Avoiding Twisted Pixels: Ethical Guidelines for the Appropriate Use and Manipulation of Scientific Digital Images.

Sci Eng Ethics. 2010 Jun 22;

Authors: Cromey DW

Digital imaging has provided scientists with new opportunities to acquire and manipulate data using techniques that were difficult or impossible to employ in the past. Because digital images are easier to manipulate than film images, new problems have emerged. One growing concern in the scientific community is that digital images are not being handled with sufficient care. The problem is twofold: (1) the very small, yet troubling, number of intentional falsifications that have been identified, and (2) the more common unintentional, inappropriate manipulation of images for publication. Journals and professional societies have begun to address the issue with specific digital imaging guidelines. Unfortunately, the guidelines provided often do not come with instructions to explain their importance. Thus they deal with what should or should not be done, but not the associated 'why' that is required for understanding the rules. This article proposes 12 guidelines for scientific digital image manipulation and discusses the technical reasons behind these guidelines. These guidelines can be incorporated into lab meetings and graduate student training in order to provoke discussion and begin to bring an end to the culture of "data beautification".

PMID: 20567932 [PubMed - as supplied by publisher]

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Assessing pregnant women's compliance with different alcohol guidelines: an 11-year prospective study.

Med J Aust. 2010 Jun 21;192(12):690-3

Authors: Powers JR, Loxton DJ, Burns LA, Shakeshaft A, Elliott EJ, Dunlop AJ

OBJECTIVE: To assess women's compliance with different Australian guidelines on alcohol intake during pregnancy and examine factors that might influence compliance. DESIGN, SETTING AND PARTICIPANTS: We analysed prospective, population-based data on women aged 22-33 years who were pregnant before October 2001, when guidelines recommended zero alcohol (n = 419), or were first pregnant after October 2001, when guidelines recommended low alcohol intake (n = 829). Data were obtained from surveys conducted in 1996, 2000, 2003 and 2006 as part of the Australian Longitudinal Study on Women's Health. MAIN OUTCOME MEASURES: Relative risks (RRs) for zero alcohol intake, low alcohol intake and compliance with alcohol guidelines, estimated by a modified Poisson regression model with robust error variance. RESULTS: About 80% of women consumed alcohol during pregnancy under zero and low alcohol guidelines. Compliance with zero alcohol guidelines or low alcohol guidelines (up to two drinks per day and less than seven drinks per week) was the same for women who were pregnant before October 2001 and women who were first pregnant after October 2001 (20% v 17% for compliance with zero alcohol guidelines, P > 0.01; 75% v 80% for compliance with low alcohol guidelines, P > 0.01). Over 90% of women drank alcohol before pregnancy and prior alcohol intake had a strong effect on alcohol intake during pregnancy, even at low levels (RR for zero alcohol, 0.21 [95% CI, 0.16-0.28]; RR for low alcohol, 0.91 [95% CI, 0.86-0.96]). RR for compliance with guidelines was 3.54 (95% CI, 2.85-4.40) for women who were pregnant while low alcohol intake was recommended, compared with those who were pregnant while zero alcohol guidelines were in place. CONCLUSION: The October 2001 change in alcohol guidelines does not appear to have changed behaviour. Risks associated with different levels of alcohol intake during pregnancy need to be clearly established and communicated.

PMID: 20565346 [PubMed - in process]

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Automating the Consensus Guidelines in Diabetes Care May Impact on Clinical Inertia.

Endocr Pract. 2010 Jun 21;:1-25

Authors: Albisser AM, Inhaber F

Objective - Consensus guidelines and mandated targets (CG&MT) govern clinical management in diabetes. Glycemic control is crucial to the prevention of long-term eye, nerve and kidney complications. Yet, current practice largely fails to meet mandated targets in glycemia, A1c, and body weight while often increasing rates of hypoglycemia. A tendency to over-treatment may lead to body weight gain or frustrate attempts at its reduction. Our objective was to rectify this by automating the CG&MT.Methods - (i) A simplified method for capturing diabetes outcomes at home was devised. (ii) Relevant portions of the CG&MT were translated into computer code and automated. (iii) Algorithms were applied to transform SMBG data into circadian profiles and A1c levels. (iv) The resulting procedures were integrated into a USB memory drive for use by providers at the point-of-care.Results - (i) Input from Patients - A simple form is used to capture diabetes outcomes data including SMBG, medication, and life-style events in a structured fashion.(ii) Input from Providers - At each encounter, the patients' data are transferred into the device and become available to assist in identifying where mandated targets are unmet, significant hypoglycemia is risked, and what prescription changes are indicated.(iii) Outcomes - Observations from a community support group dedicated to glycemic control are summarized.Conclusions - Acting on the gathered information, the automation supports the provider at the point-of-care to achieve better, safer outcomes and practice evidence-based medicine entirely in lockstep with the CG&MT. This overcomes clinical inertia.

PMID: 20570811 [PubMed - as supplied by publisher]

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Best Practice Guidelines for use of OSCEs: Maximising value for student learning.

Nurse Educ Today. 2010 Jun 21;

Authors: Nulty DD, Mitchell ML, Jeffrey CA, Henderson A, Groves M

Objective structured clinical examinations (OSCEs) are a regular component of Bachelor of Nursing (BN) programs within Australia and internationally. OSCEs are a valuable strategy to assess 'fitness to practice' at the students' expected level of clinical practice within a nursing context where the importance of accurate patient assessment is paramount. This report discusses the integration of seven proposed 'Best Practice Guidelines' (BPG) into an undergraduate BN program in Queensland, Australia. A range of learning and assessment strategies was introduced in accordance with the adoption of these guidelines to maximise student engagement. There is some evidence that these strategies have directly assisted in enhanced student confidence around clinical practice and provide preliminary evidence of the effectiveness of BPG for OSCEs within nursing programs internationally.

PMID: 20573427 [PubMed - as supplied by publisher]

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