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Use of Psychotropic Medication Guidelines at Child-Serving Community Mental Health Centers as Assessed by Clinic Directors.

Community Ment Health J. 2010 Sep 29;

Authors: Stevens J, Kelleher KJ, Wang W, Schoenwald SK, Hoagwood KE, Landsverk J,

This study assessed the proportion of large, child-serving community mental health centers that used medication guidelines. Two hundred clinic directors from across the country completed an hour-long semi-structured interview, and 152 of these directors answered whether or not medication guidelines were used at their clinics. Half of these clinics' directors reported that their prescribers followed any form of medication guidelines. Governmental agencies and professional medical societies were among the most common sources of information regarding which specific guidelines to follow. Utilization of standardized child outcome measures, but not the employment of a child psychiatrist, was related to following medication guidelines. Despite the mental health field's recent emphasis on disseminating evidence-base practice, many directors reported their clinics did not use any pediatric medication guidelines.

PMID: 20878547 [PubMed - as supplied by publisher]

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Improved pharmacological therapy of chronic heart failure in primary care: a randomized Study of NT-proBNP Guided Management of Heart Failure - SIGNAL-HF (Swedish Intervention study - Guidelines and NT-proBNP AnaLysis in Heart Failure).

Eur J Heart Fail. 2010 Sep 28;

Authors: Persson H, Erntell H, Eriksson B, Johansson G, Swedberg K, Dahlström U

AIMS: Treatment of chronic heart failure (CHF) guided by natriuretic peptides has been studied in clinical trials with conflicting results. The aim of this study was to investigate if N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided therapy in symptomatic heart failure patients in primary care would improve clinical outcomes over and above treatment according to guidelines. METHODS AND RESULTS: SIGNAL-HF was a 9 month, randomized, single-blind, parallel group study in patients with CHF in NYHA class II-IV, ejection fraction (EF) <50% and elevated NT-proBNP levels (males >800, females >1000 ng/L). All investigators underwent a pre-study educational programme about current CHF guidelines. A control group managed by non-trained investigators was considered not possible for ethical and practical reasons. Patients were randomized to structured treatment of CHF according to guidelines with or without NT-proBNP monitoring. The choice and dose of therapy for CHF was at the investigator's discretion. The primary outcome variable was the composite endpoint of days alive, days out of hospital, and symptom score from the Kansas City Cardiomyopathy Questionnaire. In all, 252 patients were randomized. The allocation groups were well balanced with regards to age, NT-proBNP, and EF. Treatment doses of beta-blockers and blockers of the renin-angiotensin-aldosterone system were markedly increased towards target doses and to a similar degree in both groups. There were no differences between the groups concerning either the primary endpoint (P = 0.28) or its components [cardiovascular (CV) death, P = 0.93; CV hospitalization, P = 0.88; or symptom score, P = 0.28]. CONCLUSION: NT-proBNP-guided CHF treatment did not result in important improvements in clinical outcomes in patients with CHF in primary care above and beyond what could be achieved by education and structured CHF treatment according to guidelines.

PMID: 20876734 [PubMed - as supplied by publisher]

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The Role of Nursing Best Practice Champions in Diffusing Practice Guidelines: A Mixed Methods Study.

Worldviews Evid Based Nurs. 2010 Sep 28;

Authors: Ploeg J, Skelly J, Rowan M, Edwards N, Davies B, Grinspun D, Bajnok I, Downey A

Background: While the importance of nursing best practice champions has been widely promoted in the diffusion of evidence-based practice, there has been little research about their role. By learning more about what champions do in guideline diffusion, the nursing profession can more proactively manage and facilitate the role of champions while capitalizing on their potential to be effective leaders of the health care system. Aim: To determine how nursing best practice champions influence the diffusion of Best Practice Guideline recommendations. Methods: A mixed method sequential triangulation design was used involving two phases: (1) key informant interviews with 23 champions between February and July 2006 and (2) a survey of champions (N= 191) and administrators (N= 41) from September to October 2007. Qualitative findings informed the development of surveys and were used in interpreting quantitative information collected in phase 2. Results: Most interview and survey participants were female, employed full-time, and had worked in practice for over 20 years. Qualitative and quantitative findings suggest that champions influence the use of Best Practice Guideline recommendations most readily through: (1) dissemination of information about clinical practice guidelines, specifically through education and mentoring; (2) being persuasive practice leaders at interdisciplinary committees; and (3) tailoring the guideline implementation strategies to the organizational context. Conclusions and Implications: Our research suggests that nursing best practice champions have a multidimensional role that is well suited to navigating the complexities of a dynamic health system to create positive change. Understanding of this role can help service organizations and the nursing profession more fully capitalize on the potential of champions to influence and implement evidence-based practices to advance positive patient, organizational, and system outcomes.

PMID: 20880009 [PubMed - as supplied by publisher]

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Using Simulation to Improve the Use of Evidence-Based Practice Guidelines.

West J Nurs Res. 2010 Sep 27;

Authors: Aebersold M

Nurses in health care today need to practice from an evidence base. There are many models to guide nurses in using the evidence in their practice; however, often nurses rely on their own mental processes to deliver care and do not rely on protocols or guidelines. The challenge often is not to teach the correct evidence-based practice guideline but to support the nurse to incorporate the guidelines into daily practice. Simulation is a method that can be used in an overall strategy to diffuse evidence-based practice guidelines at the point of care delivery.

PMID: 20876552 [PubMed - as supplied by publisher]

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[Prevention of early-onset group B Streptococcus infections. 2. Efficiency of the ANAES guidelines.]

J Gynecol Obstet Biol Reprod (Paris). 2010 Sep 27;

Authors: Muris C, Lemonnier M, Herlicoviez M, Dreyfus M

OBJECTIVES: To examine the efficiency on early-onset neonatal infections of the ANAES guidelines for early-onset infections prophylaxis, based on a systematic prenatal vaginal swab aiming Group B Streptococcus and/or infection risk factors during delivery. PATIENTS AND METHODS: This is a retrospective cohort study of early-onset infections during a period of 28 months (6125 deliveries) compared to an earlier period (6141 deliveries). RESULTS: The number of newborns admitted for suspected infection and the rate of sepsis have been unchanged. But the total number of infections has decreased (1.50 vs 2.02 %, p=0,024), without increase of the number of infections due to other germs such as Escherichia coli. Furthermore, a strategy based only on risk factors would not have allowed the early screening and treatment of 23 Streptococcus B infected newborns. CONCLUSION: We have proved the efficiency of the protocol in terms of prevention of early-onset infections. However, it has led to a dramatic increase in the consumption of antibiotics, which is worrying concerning maternal and neonatal bacterial ecology.

PMID: 20880636 [PubMed - as supplied by publisher]

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Implementation of cardiovascular secondary prevention guidelines in clinical practice: A nationwide survey in Italy.

Nutr Metab Cardiovasc Dis. 2010 Sep 26;

Authors: Perrone-Filardi P, Poli A, Ambrosio G, Proto C, Chimini C, Chiariello M

AIMS: To report the implementation of cardiovascular secondary prevention guidelines following a cardiovascular event in Italy. METHODS AND RESULTS: Data were collected from 878 consecutive patients, who had suffered a cardiovascular event requiring hospitalisation in the preceding 12-24 months and who presented at 49 outpatient clinics across Italy. Cardiovascular risk markers were assessed through clinical examination, interview and reviewing of patients' charts; in addition, we collected information on changes in prevalence of selected risk factors that occurred since the time of index event. At the time of evaluation, increased body mass index (BMI) was observed in 35% of patients, with 20% being obese; 26% had diabetes and 21% uncontrolled hypertension. Although 91% of patients were on statins, no measurement of low-density lipoprotein (LDL)-cholesterol was available in the previous 6 months in 27% of patients and 16% had no knowledge of any lipid parameter in the same period. In the remaining patients, LDL was <100 mg dl(-1) in 57% and <70 mg dl(-1) in 20% of them. From the time of index event to interview, prevalence of uncontrolled hypertension remained stable, from 24% to 21% of patients; according to the patients' self-reporting, smoking had declined from 32% to 13% of patients and physical inactivity from 43% to 33% of patients. CONCLUSIONS: This survey shows, in a large national cohort, a suboptimal implementation of lifestyle changes and inadequate lipid control in patients at high cardiovascular risk after a cardiovascular event. Reinforcement of patients and physicians, implementation and adherence to guidelines is needed to reduce the burden of cardiovascular disease.

PMID: 20875948 [PubMed - as supplied by publisher]

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An evaluation of the Danish national clinical guidelines for Von Hippel-Lindau (VHL).

Acta Neurochir (Wien). 2010 Sep 25;

Authors: Bertelsen M, Kosteljanetz M

PURPOSE: Von Hippel-Lindau (VHL) is a rare hereditary and potentially fatal cancer syndrome. Because of its unpredictable manifestations in various organ systems, surveillance is not linked to a single department and may therefore be incomplete. Denmark published national guidelines for the surveillance of patients with manifest and possible VHL in 2005 and was one of the first countries to do so. The present study is the first of its kind; patients with suspected and manifest VHL were followed at a single institution according to the national guidelines. The purpose was to evaluate (1) to what extent the guidelines were being followed and (2) what findings were disclosed. METHODS: The study included 27 individuals with diagnosed (14 patients) or suspected (13 patients) VHL, observing the Danish VHL guidelines at the Department of Neurosurgery, Rigshospitalet, Denmark, from October 2002 to April 2008. The data were collected by reviewing patient records. RESULTS: Manifestations that influenced the treatment were revealed in 48% of the patients, and 26% of the patients demonstrated asymptomatic manifestations. All investigations were conducted at a lower frequency than recommended. Individuals diagnosed with VHL were subjected to more clinical testing than individuals with suspected VHL. CONCLUSIONS: This study shows that the national clinical guidelines were not being fully complied with. The investigations revealing the most serious VHL manifestations were those carried out with a frequency closest to the recommendations. Many investigations led to clinical consequences. Therefore, we recommend that all patients with suspected or manifest VHL are monitored according to structured clinical guidelines.

PMID: 20865287 [PubMed - as supplied by publisher]

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[Evolution of adherence to guidelines for prevention of group B streptococcal infections.]

J Gynecol Obstet Biol Reprod (Paris). 2010 Sep 24;

Authors: Cortet M, Dupont C, Prunaret-Julien V, Fernandez MP, Peigne E, Huissoud C, Rudigoz RC,

OBJECTIVE: Assess the evolution in implementation of neonatal group B streptococcal infections prevention program in the Aurore network, between 2004 and 2009. PATIENTS AND METHODS: A cross-sectional study was conducted during oneweek in the whole maternity units of the Aurore network about implementation of the neonatal streptococcal infection prevention program. Deliveries occurring after 37weeks of gestation were included. Every stage required by the prevention program was registered for every delivery. Results obtained during this study were compared with those obtained in 2004. RESULTS: Seven hundred and forty-four patients were included in 2004 and 618 in 2009. Vaginal swab rate was 96.3% in 2009 and 91.1% in 2004 (P<0.001), with a positive rate of 10.2 and 14.2%, respectively (P=0.041). Antibiotic infusion rates during delivery did not increase significantly. Clinical and biological surveillance of exposed newborns was significantly increased (P<0.001). No neonatal infection was observed during the study among newborns included in the program. CONCLUSION: Sensitization of caregivers about neonatal streptococcal infection prevention seems to be efficient to increase the application of the prevention program written by the Aurore network.

PMID: 20870364 [PubMed - as supplied by publisher]

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European Palliative Care Research collaborative pain guidelines. Central side-effects management: what is the evidence to support best practice in the management of sedation, cognitive impairment and myoclonus?

Palliat Med. 2010 Sep 24;

Authors: Stone P, Minton O

This is a systematic review examining the management of opioid-induced central side effects. It has been conducted as part of a larger European Palliative Care Research collaborative review into the use and role of opioids in cancer pain. The review process identified 26 studies that met the inclusion criteria. The overall quality of the data was low and the few recommendations that can be made are weak and require confirmatory studies. The main central side effects examined were sedation, cognitive failure, sleep disturbance and myoclonus. Overall there is limited evidence for the use of methylphenidate in counteracting opioid-induced sedation and cognitive disturbance. No clear recommendations can be made concerning other individual drugs for the management of any of the central side effects examined. Given the lack of available data from this review there need to be further prospective controlled trials to confirm or refute these findings.

PMID: 20870687 [PubMed - as supplied by publisher]

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An aquatic toxicological evaluation of sulphate: the case for considering hardness as a modifying factor in setting water quality guidelines.

Environ Toxicol Chem. 2010 Sep 24;

Authors: Elphick JR, Davies M, Gilron G, Canaria EC, Lo B, Bailey HC

Elevated concentrations of sulphate occur commonly in anthropogenically-impacted and natural waters. However, water quality guidelines (WQG) have not been developed in many jurisdictions, and chronic toxicity data are scarce for this anion. A variety of test organisms, including species of invertebrate, fish, algae, moss and an amphibian were tested for chronic toxicity to develop a robust dataset which could be used to develop WQGs. As an example of how these data might be used to establish guidelines, calculations were performed using two standard procedures: a species sensitivity distribution (SSD) approach, following methods employed in developing Canadian WQGs, and a safety factor approach, according to procedures typically used in the development of provincial WQGs in British Columbia. The interaction of sulphate toxicity and water hardness was evaluated and incorporated into the calculations, resulting in separate values for: soft (10 to 40 mg/L), moderately hard (80 to 100 mg/L) and hard water (160 to 250 mg/L). The resulting values were: 129, 644 and 725 mg/L sulphate, respectively, following the SSD approach, and 75, 625 and 675 mg/L sulphate, following the safety factor approach. © 2010 SETAC.

PMID: 20872896 [PubMed - as supplied by publisher]

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