Effect of revised IOM weight gain guidelines on perinatal outcomes.

J Matern Fetal Neonatal Med. 2011 Mar;24(3):397-401

Authors: Halloran DR, Wall TC, Guild C, Caughey AB

We sought to examine perinatal outcomes in women with a body mass index (BMI) of 25 kg/m(2) comparing those whose weight gain met 2009 IOM guidelines to women meeting 1990 IOM guidelines.

PMID: 20593973 [PubMed - in process]

The relationship between the medical director and the executive director: guidelines for success.

Psychiatr Q. 2011 Mar;82(1):23-31

Authors: Gabel S

The positional leadership of mental health care organizations commonly is in the hands of an executive director who has had administrative experience, but who may or may not have had clinical experience. The medical director of the mental health organization is a psychiatrist who reports to the executive director despite their different backgrounds and areas of expertise. The relationship between these two leaders is the responsibility of both, and is crucial to the success of the organization. This paper is concerned specifically with approaches that can be taken by the medical director to foster a successful working alignment with the executive director. The situation has some similarities (and significant differences) with that described by Gabarro and Kotter in “Managing Your Boss” (1993). A series of guidelines to enhance the potential success of the medical director in this supervisor/supervisee relationship is presented.

PMID: 20640599 [PubMed - in process]

Radiotherapy-induced nausea and vomiting (RINV): MASCC/ESMO guideline for antiemetics in radiotherapy: update 2009.

Support Care Cancer. 2011 Mar;19 Suppl 1:S5-14

Authors: Feyer PC, Maranzano E, Molassiotis A, Roila F, Clark-Snow RA, Jordan K

Radiation-induced nausea and vomiting (RINV) are still often underestimated by radiation oncologists. However, as many as 50-80% of patients undergoing radiotherapy (RT) will experience nausea and/or vomiting, depending on the site of irradiation. Fractionated RT may involve up to 40 fractions over a 6-8-week period, and prolonged symptoms of nausea and vomiting affect quality of life. Furthermore, uncontrolled nausea and vomiting may result in patients delaying or refusing further radiotherapy. Incidence and severity of nausea and vomiting depend on RT-related factors (irradiated site, single and total dose, fractionation, irradiated volume, radiotherapy techniques) and patient-related factors (gender, general health of the patient, age, concurrent or recent chemotherapy, psychological state, tumor stage). The new proposed guideline from the Multinational Association of Supportive Care in Cancer and European Society of Clinical Oncology summarises the updated data from the literature and takes into consideration the existing guidelines. According to the irradiated area (the most frequently studied risk factor), the proposed guideline divided these areas into four levels of emetogenic risk: high, moderate, low and minimal. In fact, the emetogenicity of radiotherapy regimens and recommendations for the appropriate use of antiemetics including 5-hydroxytryptamine receptor antagonists and steroids are given in regard to the applied radiotherapy or radiochemotherapy regimen. This updated guideline offers guidance to the treating physicians for effective antiemetic therapies in RINV.

PMID: 20697746 [PubMed - in process]

Guidelines for the control of nausea and vomiting with chemotherapy of low or minimal emetic potential.

Support Care Cancer. 2011 Mar;19 Suppl 1:S33-6

Authors: Olver I, Clark-Snow RA, Ballatori E, Espersen BT, Bria E, Jordan K

The purpose of this study is to update the guidelines for antiemetic therapy to be used with anticancer agents of low to minimal emetic potential.

PMID: 20803222 [PubMed - in process]

Poor adherence to antibiotic prescribing guidelines in acute otitis media-obstacles, implications, and possible solutions.

Eur J Pediatr. 2011 Mar;170(3):323-32

Authors: Haggard M

Many countries now have guidelines on the clinical management of acute otitis media. In almost all, the public health goal of containing acquired resistance in bacteria through reduced antibiotic prescribing is the main aim and basis for recommendations. Despite some partial short-term successes, clinical activity databases and opinion surveys suggest that such restrictive guidelines are not followed closely, so this aim is not achieved. Radical new solutions are needed to tackle irrationalities in healthcare systems which set the short-term physician-patient relationship against long-term public health. Resolving this opposition will require comprehensive policy appraisal and co-ordinated actions at many levels, not just dissemination of evidence and promotion of guidelines. The inappropriate clinical rationales that underpin non-compliance with guidelines can be questioned by evidence, but also need specific developments promoting alternative solutions, within a framework of whole-system thinking. Promising developments would be (a) physician training modules on age-appropriate analgesia and on detection plus referral of rare complications like mastoiditis, and (b) vaccination against the most common and serious bacterial pathogens.

PMID: 20862492 [PubMed - in process]

Adherence to chronic hepatitis B treatment guideline recommendations for laboratory monitoring of patients who are not receiving antiviral treatment.

J Gen Intern Med. 2011 Mar;26(3):239-44

Authors: Juday T, Tang H, Harris M, Powers AZ, Kim E, Hanna GJ

Hepatitis B virus (HBV) DNA and alanine aminotransferase (ALT) levels predict future complications in chronic hepatitis B (CHB) patients. To determine when to initiate antiviral therapy, treatment guidelines recommend monitoring of HBV DNA and ALT levels at least annually. This study aimed to assess adherence to treatment guideline-recommended monitoring of CHB patients not receiving antiviral treatment and to identify predictors of laboratory monitoring and subsequent initiation of antiviral therapy.

PMID: 20978862 [PubMed - in process]

Treatment of pneumothoraces at a tertiary centre: are we following the current guidelines?

Interact Cardiovasc Thorac Surg. 2011 Mar;12(3):430-3

Authors: Elsayed H, Kent W, McShane J, Page R, Shackcloth M

The American College of Chest Physicians (ACCP) in 2001 and British Thoracic Society (BTS) in 1993 and 2003 published guidelines for the treatment of pneumothorax. Here, we review our experience of managing pneumothorax patients, comparing standards of management before and after the publication of the guidelines in 2003. One hundred and twenty patients were transferred to our care for management of pneumothorax between October 2001 and September 2006. One hundred and one patients underwent pleurectomy [28 by video-assisted thoracic surgery (VATS)]. There were 69 males and 32 females with a median age of 47 years (range 15-86 years). 24% (n=24) of patients had evidence of intrapleural infection at time of operation. This was more likely if the time to pleurectomy was >14 days (P=0.03). The median time of referral for patients in the pre-guideline group was 12 days [interquartile range (IQR) 9-12] while post guidelines it was 10 days (IQR 6-13). There was no statistical significance (P=0.09) between these groups in terms of time taken to refer patients. The ACCP and BTS guidelines are not being followed. Pneumothoraces should be managed by chest physicians who are aware of the current guidelines. Impact of delayed referral in the form of increased incidence of morbidity and financial burdens on hospitals needs to be recognized.

PMID: 21051384 [PubMed - in process]

Evaluation of compliance with the EGS Guidelines in Spain, using Achievable Benchmarks of Care (ABC®) methodology: The IMCA Study.

Eur J Ophthalmol. 2011 Mar-Apr;21(2):149-55

Authors: Castejón-Cervero MA, Jiménez-Parras R, Fernandez-Arias I, Teus-Guezala MA,

Purpose. To evaluate compliance with diagnostic and therapeutic recommendations of the European Glaucoma Society (EGS) for the management of glaucoma in Spain, as determined using the Achievable Benchmarks of Care approach. Methods. A panel of 3 experts extracted quality and process-of-care indicators from the EGS guidelines. Investigators from all over the country, representative of Spanish ophthalmologists, were invited to participate in the study, completing a questionnaire on quality indicators (pertaining to the center) and process-of-care indicators (pertaining to all patients) for the first, diagnostic visit (retrospective) and the study visit. Results. A total of 495 Spanish ophthalmologists included 5,060 patients with glaucoma or intraocular hypertension. The treatment was initiated with monotherapy in 88.5% of the patients. Overall, the percentage compliance with diagnostic examinations was 84.6% for intraocular pressure measurement, 96.3% for optic nerve head evaluation, 76.6% for visual field evaluation, 29.5% for central corneal thickness evaluation, and 49.3% at the study visit. The benchmark performance was close to 100% for most examinations. Only 32.8% of the centres had a written protocol for the management of the patients with glaucoma, and in these centers the recommendations of the EGS were followed in a higher proportion (p<0.0001) than in the rest. Conclusions. The use of local protocols for the management of glaucoma seems to enhance compliance. Benchmark performance was close to 100% in most indicators, suggesting that EGS recommendations are attainable in Spain. The overall performance suggests that certain diagnostic procedures are, in practice, not as widely used as recommended.

PMID: 21058273 [PubMed - in process]

Awareness of hypertension guidelines in Taiwanese nurses: a questionnaire survey.

J Cardiovasc Nurs. 2011 Mar-Apr;26(2):129-36

Authors: Chen HL, Liu PF, Liu PW, Tsai PS

Nurses play an important role in hypertension prevention and management because of their unique positions in patient education. However, the effectiveness of patient education relies largely on the nurse’s level of awareness of the current hypertension guidelines. The purpose of this study was to examine the level of awareness of hypertension guidelines and associated factors among nurses in Taiwan.

PMID: 21076310 [PubMed - in process]

Does nurse case management improve implementation of guidelines for cardiovascular disease risk reduction?

J Cardiovasc Nurs. 2011 Mar-Apr;26(2):145-67

Authors: Berra K

Over the last 5 decades, research has demonstrated that cardiovascular risk reduction mediated through medical and surgical therapies, as well as lifestyle change, reduces morbidity and mortality from diseases of the vascular system. Based on this extensive research, government and professional organizations publish evidence-based guidelines for the management of patients with, or at risk of developing, cardiovascular disease. However, recommended interventions are frequently neither initiated nor adhered to, and when appropriate therapies are initiated, patient adherence is poor. This review sought to evaluate how nurse-based case management (NCM) according to recommended guidelines improves patient outcomes and enhances cardiovascular risk reduction.

PMID: 21076315 [PubMed - in process]