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]

CIRSE Guidelines: Quality Improvement Guidelines for Endovascular Treatment of Traumatic Hemorrhage.Cardiovasc Intervent Radiol. 2012 Jan 20;Authors: Chakraverty S, Flood K, Kessel D, McPherson S, Nicholson T, Ray CE, Robertson I, van Delden OMPMID: 22271075 [PubMed - as supplied by publisher]

RE: Gall bladder polyps in primary sclerosing cholangitis- adhere to the guidelines HEP-11-2164.Hepatology. 2012 Jan 19;Authors: Gores G, Lindor KD, Razumilava NPMID: 22262471 [PubMed - as supplied by publisher]

Impact of a region wide antimicrobial stewardship guideline on urinary tract infection prescription patterns.Int J Clin Pharm. 2012 Jan 18;Authors: Slekovec C, Leroy J, Vernaz-Hegi N, Faller JP, Sekri D, Hoen B, Talon D, Bertrand XAbstract

Background Fluoroquinolones are frequently prescribed for non complicated urinary tract infection treatments and have a negative ecological impact. We aimed to substitute them by antibiotics with narrower activity spectrum in order to preserve fluoroquinolone activity in complicated hospital infections. Objective To assess the impact of a multi-modal approach that combines the dispatching of antibiotic prescription guidelines and voluntary attendance at educational sessions on general practitioners’ (GP) antibiotic prescription habits. Setting This study was led in Franche-Comté, a French eastern region, where GPs were given a guideline recommending a restricted use of fluoroquinolones for urinary tract infections. Method Segmented regression analysis of interrupted time series was used to assess changes in antibiotic prescription. Main outcome measure: The antibiotic prescription data of nitrofurantoin, fosfomycin-trometamol and fluoroquinolones for women aged 15-65 years were obtained from the regional agency of health insurance. Results Twenty months after intervention, the number of nitrofurantoin and fosfomycintrometamol prescriptions increased by 36.8% (95% CI: 30.6-42.2) and 28.5% (95% CI: 22.9-35.4), respectively, while that of norfloxacin decreased by 9.1% (95% CI: -15.3 to -3.5). Conclusion This study suggests that the dispatch of the guideline on urinary tract infection had a moderate impact on antibiotic prescriptions.
PMID: 22252772 [PubMed - as supplied by publisher]

Audit of Physicians’ Adherence to the Antibiotic Policy Guidelines in Kuwait.Med Princ Pract. 2012 Jan 12;Authors: Aly NY, Omar AA, Badawy DA, Al-Mousa HH, Sadek AAAbstract

Objective: To audit physicians’ adherence to the local antibiotic policy guidelines in government hospitals in Kuwait. Materials and Methods: The study was a retrospective review of patient records in nine hospitals between July 1 and December 31, 2008. Clinical notes and medication charts of the latest hospital admissions were checked for antibiotic prescribing. On the audit form, aspects of the prescribed antibiotic were benchmarked to the hospital antibiotic policy guidelines to evaluate adherence. Results: Of 2,232 reviewed records, 1,112 (49.8%) patients had 1,528 antibiotic prescriptions. Patients who received antibiotics were significantly younger than those who did not (median age: 26.3 vs. 29.8 years, p < 0.001) and their hospital stay was significantly longer (median: 4 vs. 2 days, p < 0.001). The choice of an antibiotic was appropriate and matched the policy in 806 (52.7%) prescriptions. Of such appropriate antibiotics, adherence to route of administration was observed in 768/806 (95.3%), to dose in 758 (94%), to frequency in 746 (92.6%) and to duration in 608 (75.4%). Full adherence to all aspects of antibiotic choice, dose, route, frequency and duration was achieved in 464 (30.4%) prescriptions. In 382 (25%), the antibiotics administered were not indicated. Conclusion: There was low adherence to the local antibiotic policy guidelines. Physicians’ antibiotic prescribing practices should be optimized. Adherence to, and update of, the policy is recommended.
PMID: 22236835 [PubMed - as supplied by publisher]

Impact of the European Paediatric Life Support Course on knowledge of Resuscitation Guidelines among Austrian emergency care providers.Minerva Anestesiol. 2012 Jan 12;Authors: Schebesta K, Rössler B, Kimberger O, Hüpfl MAbstract
BACKGROUND: Even though anaesthetists do not resuscitate children on a daily basis, they need to perform paediatric life support regularly due to their different duties. As the knowledge of international guidelines varies widely, highly standardized European Paediatric Life Support (EPLS) courses have been introduced to improve standards of care. This national survey among Austrian anaesthetists and EPLS course participants evaluated the impact of this course at the end of the guideline period 2005-2010. METHODS: After approval by the institutional review board an online survey about paediatric resuscitation guidelines was sent to EPLS course participants of the guideline period 2005 (EPLS group) and members of the Austrian Society of Anaesthesia, Resuscitation and Intensive Care (ÖGARI) two weeks before publication of the resuscitations guidelines 2010. Respondents without an EPLS course were assigned to the non-EPLS group. RESULTS: Of 333 respondents 247 finished the survey. One hundred eighty five persons were assigned to EPLS group and 62 to the non-EPLS group. Members of the EPLS group performed significantly better than the non-EPLS group (76±19% correct answers EPLS group vs. 63±18% correct answers non-EPLS group, p<0.0001). Furthermore, the EPLS group performed better than anesthetists with regular resuscitation training and or resuscitation experience but without an EPLS course. CONCLUSION:The attendance of an EPLS course within the guideline period 2005 significantly increased the theoretical knowledge of paediatric resuscitation guidelines.PMID: 22240622 [PubMed - as supplied by publisher]

Evidence-based guideline: Antiepileptic drug selection for people with HIV/AIDS: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Ad Hoc Task Force of the Commission on Therapeutic Strategies of the International League Against Epilepsy.Neurology. 2012 Jan 10;78(2):139-45Authors: Birbeck GL, French JA, Perucca E, Simpson DM, Fraimow H, George JM, Okulicz JF, Clifford DB, Hachad H, Levy RHAbstract

OBJECTIVE: To develop guidelines for selection of antiepileptic drugs (AEDs) among people with HIV/AIDS. METHODS: The literature was systematically reviewed to assess the global burden of relevant comorbid entities, to determine the number of patients who potentially utilize AEDs and antiretroviral agents (ARVs), and to address AED-ARV interactions. Results and Recommendations: AED-ARV administration may be indicated in up to 55% of people taking ARVs. Patients receiving phenytoin may require a lopinavir/ritonavir dosage increase of ?50% to maintain unchanged serum concentrations (Level C). Patients receiving valproic acid may require a zidovudine dosage reduction to maintain unchanged serum zidovudine concentrations (Level C). Coadministration of valproic acid and efavirenz may not require efavirenz dosage adjustment (Level C). Patients receiving ritonavir/atazanavir may require a lamotrigine dosage increase of ?50% to maintain unchanged lamotrigine serum concentrations (Level C). Coadministration of raltegravir/atazanavir and lamotrigine may not require lamotrigine dosage adjustment (Level C). Coadministration of raltegravir and midazolam may not require midazolam dosage adjustment (Level C). Patients may be counseled that it is unclear whether dosage adjustment is necessary when other AEDs and ARVs are combined (Level U). It may be important to avoid enzyme-inducing AEDs in people on ARV regimens that include protease inhibitors or nonnucleoside reverse transcriptase inhibitors, as pharmacokinetic interactions may result in virologic failure, which has clinical implications for disease progression and development of ARV resistance. If such regimens are required for seizure control, patients may be monitored through pharmacokinetic assessments to ensure efficacy of the ARV regimen (Level C).
PMID: 22218281 [PubMed - in process]

Sub-optimal achievement of guideline-derived lipid goals in management of diabetic patients with atherosclerotic cardiovascular disease, despite high use of evidence-based therapies.Diab Vasc Dis Res. 2012 Jan 10;Authors: Deguzman PB, Akosah KO, Simpson AG, Barbieri KE, Megginson GC, Goldberg RI, Beller GAAbstract

Guidelines recommend aggressive goals for lipid and blood pressure reduction for high risk patients with diabetes mellitus and atherosclerotic coronary disease. However, it remains unclear how many patients achieve treatment goals versus the number of people merely placed on treatment. We conducted an observational study in an academic cardiology clinic. A total of 926 patients with atherosclerotic cardiovascular disease and concomitant diabetes mellitus met criteria. Mean age was 68.4 ± 10.2, 65.6% were male, and 86.8% were Caucasian. By the last visit a high percentage of patients were receiving recommended medications. Mean LDL-cholesterol achieved was 80.4 mg/dl with 40.9% reaching ? 70 mg/dl, and 61.7% reaching SBP ? 130 mmHg. Many patients with diabetes mellitus and atherosclerotic cardiovascular disease are prescribed recommended medications; however, few achieve guidelines-specified therapeutic goals for LDL-cholesterol and blood pressure. Studies evaluating performance improvement should include percentage of patients reaching treatment goals. Mechanisms underlying the treatment gap need to be identified and addressed.
PMID: 22234950 [PubMed - as supplied by publisher]

Improved guideline compliance after a 3-year audit of multidisciplinary colorectal cancer care in the western part of the Netherlands.J Surg Oncol. 2012 Jan 10;Authors: van der Geest LG, Krijnen P, Wouters MW, Erkelens WG, Marinelli AW, Nortier HJ, Tollenaar RA, Struikmans H,Abstract

BACKGROUND: From 2006 to 2008, an audit of the multidisciplinary diagnosis and treatment of colorectal cancer patients in the western part of the Netherlands was carried out. We evaluated whether compliance with guidelines had improved. METHODS: All patients with newly diagnosed and surgically treated colon (n?=?1,667) and rectal cancer (n?=?544) stage I-III were evaluated. Nine quality indicators were derived from the evidence-based guidelines. In order to compare hospital performances, hospital results were adjusted for casemix differences between hospitals. RESULTS: Colon cancer patients showed an increase in the examination of 10 or more lymph nodes (from 53% to 78%, P?< ?0.0001). For rectal cancer patients there was an increase in preoperative visualisation of the total colon (63-74%, P?=?0.02), MRI (73-85%, P?=?0.003), radiotherapy (from 82% to 93% for patients <75 years, P?=?0.01) and examination of at least 10 lymph nodes (40-55%, P?=?0.004). In 2006, standardised hospital performances differed widely for all quality indicators. Two years later, hospital performances for some quality indicators were more similar. CONCLUSIONS: After the feedback of benchmark information, compliance with guidelines for diagnosis and treatment of colorectal cancer patients improved, and differences between individual hospitals decreased. Although secular trends cannot be ruled out, it is highly likely that these results can be attributed to the audit. J. Surg. Oncol © 2012 Wiley Periodicals, Inc.
PMID: 22234959 [PubMed - as supplied by publisher]