Impact of B-cell count and imaging screening in cMBL: any need to revise the current guidelines?Leukemia. 2012 Jan 30;Authors: Montillo MPMID: 22285997 [PubMed - as supplied by publisher]

Asthma guidelines implementation: a guide to the translation of GINA guidelines into improved care.Eur Respir J. 2012 Jan 26;Authors: Boulet LP, Fitzgerald JM, Levy ML, Cruz AA, Pedersen S, Haahtela T, Bateman EDAbstract

In 1995 the Global Initiative on Asthma (GINA) published an evidence-based workshop report as a guide to clinicians managing asthma patients, and has updated it annually to ensure that recommendations remain current. Although the report has been widely disseminated and influenced clinical practice and research, its major objective, of forming the basis for local and country initiatives to improve services for asthma patients, remains to be achieved. Over recent years, the science of guideline implementation has progressed, and encouraging examples of successful asthma programmes published. This report is intended to draw on this experience and assist with the translation of asthma guideline recommendations into quality programmes for patients with asthma using current knowledge translation principles. It also provides examples of successful initiatives in various socio-economic settings.
PMID: 22282546 [PubMed - as supplied by publisher]

Dental Trauma Guide: A source of evidence-based treatment guidelines for dental trauma.Dent Traumatol. 2012 Jan 25;Authors: Andreasen JO, Lauridsen E, Gerds TA, Ahrensburg SSAbstract

Abstract?-? Diagnosis and treatment for traumatic dental injuries are very complex owing to the multiple trauma entities represented by six luxation types and nine fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and luxation injuries are often combined, the result is that more than 100 trauma scenarios exist, when the two dentitions are combined. Each of these trauma scenarios has a specific treatment demand and prospect for healing. With such a complexity in diagnosis and treatment, it is obvious that even experienced practitioners may have problems in selecting proper treatment for some of these trauma types. To remedy this situation, an Internet-based knowledge base consisting of 4000 dental trauma cases with long-term follow up is now available to the public and the professions on the Internet using the address http://www.DentalTraumaGuide.org. It is the aspiration that the use of this Guide may lead the practitioner to offer an evidence-based diagnosis and treatment.
PMID: 22272918 [PubMed - as supplied by publisher]

[Changing the treatment goal at the end of life: effects of a guideline at a hospital.]Dtsch Med Wochenschr. 2012 Jan 25;Authors: Jox RJ, Winkler EC, Borasio GDAbstract
Background and objective: Deciding about treatment goals at the end of life is a frequent and difficult challenge to medical staff. As more health care institutions issue ethico-legal guidelines to their staff the effects of such a guideline should be investigated in a pilot project.Participants and methods: Prospective evaluation study using the pre-post method. Physicians and nurses working in ten intensive care units of a university medical center in Germany answered a specially designed questionnaire before and one year after issuance of the guideline.Results: 197 analyzable answers were obtained from the first (pre-guideline) and 251 from the second (post-guideline) survey (54?% and 58?% response rate, respectively). Initially the clinicians expressed their need for guidelines, advice on ethical problems, and continuing education. One year after introduction of the guideline one third of the clinicians was familiar with the guideline’s content and another third was aware of its existence. 90% of those who knew the document welcomed it. Explanation of the legal aspects was seen as its most useful element. The pre- and post-guideline comparison demonstrated that uncertainty in decision making and fear of legal consequences were reduced, while knowledge of legal aspects and the value given to advance directives increased. The residents had derived the greatest benefit.Conclusion: By promoting the knowledge of legal aspects and ethical considerations, guidelines given to medical staff can lead to more certainty when making in end of life decision.PMID: 22278719 [PubMed - as supplied by publisher]

Endocrine clinical practice guidelines in North America. A systematic assessment of quality.J Clin Epidemiol. 2012 Jan 25;Authors: Bancos I, Cheng T, Prokop LJ, Montori VM, Murad MHAbstract

OBJECTIVE: To assess the quality of endocrine guidelines developed in North America. STUDY DESIGN AND SETTING: A systematic review of the literature was conducted to identify all endocrine clinical practice guidelines developed in North America and published between January 1, 2007 and January 13, 2010. Two independent reviewers used the Appraisal of Guidelines, Research and Evaluation instrument to evaluate the quality of the guidelines in six domains: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence. RESULTS: One hundred eligible endocrine guidelines had high scores in the scope-and-purpose (mean pooled standardized score [MPSD] of 82±14) and clarity domains (MPSD=64±17) and low scores in the stakeholder-involvement (MPSD of 36±12) and editorial independence domains (MPSD=36±36). Only 29% of guidelines scored above 60% for more than three domains. Rigor-of-development domain score was significantly higher in guidelines using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach, nondiabetes guidelines, and in published in-print vs. online publications. CONCLUSIONS: The quality of endocrine guidelines published in 2007-2009 is moderate and can be improved by (1) using methodologically sound development frameworks, (2) increasing stakeholder involvement, and (3) paying more attention to resource implications of guideline implementation.
PMID: 22280992 [PubMed - as supplied by publisher]

Quality Assessment of Clinical Practice Guidelines for the Prescription of Antidepressant Drugs During Pregnancy.Curr Clin Pharmacol. 2012 Jan 25;Authors: Santos F, Sola I, Rigau D, Arevalo-Rodriguez I, Seron P, Alonso-Coello P, Bérard A, Bonfill XAbstract
Antidepressant use during the gestational period remains a controversial issue. The objective of this study was to appraise the quality of the available clinical practice guidelines (CPGs) that includes recommendations for antidepressant use during pregnancy. We systematically searched for documents published between January 2000 and September 2010 in MEDLINE / TRIP database and on clearinghouses and main scientific societies’ websites. Four appraisers evaluated each guideline using the Appraisal of Guidelines for Research and Evaluation tool (AGREE II). Intra-class correlation coefficients (ICC) with 95% confidence intervals (CI) were calculated as an overall indicator of agreement. Twelve CPGs were included from a total of 539 references. Only two guidelines were specifically addressed to pregnant women. The overall agreement among reviewers was high (ICC: 0.94, 95%CI: 0.86-0.98). The mean scores and standard deviation (SD) for each of the AGREE II domains were: scope and purpose: 84.4% (12); stakeholder involvement: 67.4% (29.8); rigor of development: 68.6% (19.8); clarity and presentation: 83.4% (17.4); applicability: 44% (37.3); and editorial independence: 62.1% (30.4). After standardizing the scores of the 12 guidelines, 5 were considered as being “recommended”, 5 as “recommended with modifications, and 2 as “not recommended”. Among the five recommended guidelines, two were specifically conceived to the gestational period. CPGs containing recommendations for antidepressant use during pregnancy were of moderate to high quality. Future guidelines should take into account the observed drawbacks in some domains, and specifically focus a more in depth approach of depression during pregnancy.PMID: 22283613 [PubMed - as supplied by publisher]

Quality Improvement Guidelines for Transhepatic Arterial Chemoembolization, Embolization, and Chemotherapeutic Infusion for Hepatic Malignancy.J Vasc Interv Radiol. 2012 Jan 25;Authors: Brown DB, Nikolic B, Covey AM, Nutting CW, Saad WE, Salem R, Sofocleous CT, Sze DYPMID: 22284821 [PubMed - as supplied by publisher]

Cost implications of implementing NICE guideline on chest pain in rapid access chest pain clinics: an audit and cost analysis.J Public Health (Oxf). 2012 Jan 22;Authors: Ghosh A, Qasim A, Woollcombe K, Mechery AAbstract
BACKGROUND: Implementing the recently published National Institute for Health and Clinical Excellence (NICE) clinical guideline on chest pain (CG95) in rapid access chest pain clinics (RACPCs) could significantly impact on overall cost, while introducing new technology like cardiac computed tomography (CT) scanning. With the National Health Service (NHS) under pressure to make £20 billion savings, applying CG95 in RACPCs could be challenging. An audit enabled us to assess the cost implications. METHODS: A retrospective audit was performed of 204 consecutive cases attending Croydon RACPC from 13 July to 21 September 2010, on risk factors, demographics and planned first-line investigations. CG95 and three alternative strategies were mapped on the sample, and the estimated cost and volume of first-line investigations were compared with actual RACPC activities and costs. RESULTS: Application of CG95 resulted in significant increases in cost and volume of functional testing, cardiac CT scan angiography and invasive coronary angiography, with 42-43% overall cost increases. The application of three alternative strategies resulted in annual cost increases ranging from 0.1 to 33%. An alternative cost analysis showed annual savings of up to 24%. CONCLUSIONS: Implementing NICE CG95 can significantly increase the cost of RACPCs but alternative strategies could enable the introduction of new technology without significant cost increases and even significant savings.PMID: 22271838 [PubMed - as supplied by publisher]

Vitamin D supplementation: guidelines and evidence for subclinical deficiency.Curr Opin Gastroenterol. 2012 Jan 21;Authors: Pramyothin P, Holick MFAbstract

PURPOSE OF REVIEW: To summarize recommendations from the 2011 US Institute of Medicine report (on vitamin D) and the new guideline from the US Endocrine Society with emphasis on treating and preventing vitamin D deficiency, including patients with inflammatory bowel disease and prior gastric bypass. RECENT FINDINGS: The US Institute of Medicine Recommended Dietary Allowance of vitamin D is 400?IU per day for children younger than 1 year of age, 600?IU per day for children at least 1 year of age and adults up to 70 years, and 800?IU per day for older adults. The US Institute of Medicine concluded that serum 25-hydroxyvitamin D [25(OH)D] of 20?ng/ml or more will cover the requirements of 97.5% of the population. The US Endocrine Society’s Clinical Practice Guideline suggested that 400-1000?IU per day may be needed for children aged less than 1 year, 600-1000?IU per day for children aged 1 year or more, and 1500-2000?IU per day for adults aged 19 years or more to maintain 25(OH)D above the optimal level of 30?ng/ml. Patients with inflammatory bowel disease even in a quiescent state and those with gastric bypass malabsorb vitamin D and need more vitamin D to sustain their vitamin D status. SUMMARY: Difference in the recommendations from the US Institute of Medicine and the US Endocrine Society’s Practice Guideline reflects different goals and views on current evidence. Significant gaps remain in the literature, and studies of vitamin D treatment assessing changes in outcomes at different 25(OH)D levels are needed.
PMID: 22274617 [PubMed - as supplied by publisher]

Adherence to the u.s. Preventive services task force 2002 osteoporosis screening guidelines in academic primary care settings.

J Womens Health (Larchmt). 2012 Jan;21(1):50-3

Authors: Powell H, O’Connor K, Greenberg D

Abstract
Abstract Background: Osteoporosis is very common in older women in the United States. Osteoporotic fractures cause significant morbidity and mortality, as well as high healthcare costs. Since 2002, the United States Preventive Services Task Force (USPSTF) has recommended screening for osteoporosis of all women aged ?65. Our objective was to determine adherence to osteoporosis screening guidelines by primary care internists in a large academic medical center and to assess if adherence varies based on provider gender or practice location. Methods: This was a retrospective electronic medical record (EMR) review. All women aged ?65 who were seen in the General Internal Medicine Center (GIMC) or the Women’s Health Care Center (WHCC) at the University of Washington Medical Center by internal medicine attending physicians between January 1, 2006, and February 2, 2008, were included in the study. We determined if the patient had a dual energy x-ray absorptiometry (DEXA) study in the EMR database. We calculated the percentage of patients screened per provider and also compared the rate of screening for male vs. female providers and for GIMC vs. WHCC providers. Results: Of the 1363 women included in the study, 70% had documentation of a DEXA study. Adherence to screening recommendations for individual providers varied from 33% to 100%. Screening was more likely to occur in the WHCC than in the GIMC (79.2% vs. 66.7%, p<0.001). Although women providers were more likely to screen than their male counterparts (72.2% vs. 66.1%, p=0.023), this relationship did not hold true after excluding women providers from the WHCC. Conclusions: We found good adherence to the USPSTF 2002 guidelines for osteoporosis screening in women aged ?65 years by primary care physicians in a large urban academic medical center. The practice site and not gender of the provider resulted in significantly different screening rates.

PMID: 22150154 [PubMed - in process]