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Quality Improvement Guidelines for Bone Tumour Management.

Cardiovasc Intervent Radiol. 2010 Feb 12;

Authors: Gangi A, Tsoumakidou G, Buy X, Quoix E

PMID: 20151138 [PubMed - as supplied by publisher]

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Developing WHO guidelines with pragmatic, structured, evidence-based processes: A case study.

Glob Public Health. 2010 Feb 10;:1-18

Authors: Chang LW, Kennedy CE, Kennedy GE, Lindegren ML, Marston BJ, Kaplan JE, Sweat MD, Bunnell RE, O'Reilly K, Rutherford GW, Mermin JH

Many guidelines, including those produced by the World Health Organisation (WHO), have failed to adhere to rigorous methodological standards. Operational examples of guideline development processes may provide important lessons learned to improve the rigour and quality of future guidelines. To this end, this paper describes the process of developing WHO guidelines on prevention and care interventions for adults and adolescents living with HIV. Using a pragmatic, structured, evidence-based approach, we created an organising committee, identified topics, conducted systematic reviews, identified experts and distributed evidence summaries. Subsequently, 55 global HIV experts drafted and anonymously submitted guideline statements at the beginning of a conference. During the conference, participants voted on statements using scales evaluating appropriateness of the statements, strength of recommendation and level of evidence. After review of voting results, open discussion, re-voting and refinement of statements, a draft version of the guidelines was completed. A post-conference writing team refined the guidelines based on pre-determined guideline writing principles and incorporated external comments into a final document. Successes and challenges of the guideline development process were identified and are used to highlight current issues and debates in developing guidelines with a focus on implications for future guideline development at WHO.

PMID: 20155547 [PubMed - as supplied by publisher]

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Adapting clinical practice guidelines to local context and assessing barriers to their use.

CMAJ. 2010 Feb 9;182(2):E78-84

Authors: Harrison MB, Légaré F, Graham ID, Fervers B

PMID: 19969563 [PubMed - in process]

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A Qualitative Study to Understand Barriers to Implementation of National Guidelines for Prehospital Termination of Unsuccessful Resuscitation Efforts.

Prehosp Emerg Care. 2010 Feb 9;

Authors: Sasson C, Forman J, Krass D, Macy M, Hegg AJ, McNally BF, Kellermann AL

Abstract Background. The American Heart Association's (AHA's) Advanced Cardiac Life Support guidelines act as the national standards for termination of resuscitation (TOR) in cases of refractory out-of-hospital cardiac arrest. However, local emergency medical services (EMS) implementation of these guidelines has been nonuniform. Objective. To identify the operational issues within local EMS systems that may serve as barriers or facilitators to full acceptance of national guidelines for prehospital TOR in appropriate circumstances. Methods. We conducted three focus groups at the January 2008 National Association of EMS Physicians (NAEMSP) annual meeting. Snowball sampling was used to recruit 19 physicians, two EMS providers, one research director, one nurse, and one medical student attending the conference. Two reviewers analyzed the data in an iterative process to identify recurrent and unifying themes. Results. We identified three distinct stakeholder groups whose current beliefs and practices may influence local implementation of TOR: EMS providers with variations in education and work culture; EMS medical directors with responsibility but little authority; and online medical control physicians who do not communicate effectively with the other groups. Our focus group participants suggested that national organizations, such as the AHA and the American College of Emergency Physicians, may serve a role in overcoming the overarching barriers of communication, standardized educational requirements, and coordination of local services. Conclusion. We have identified operational barriers that may impede implementation of TOR guidelines. Three influential stakeholder groups will need to work with national organizations to overcome these local barriers.

PMID: 20144019 [PubMed - as supplied by publisher]

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The evaluation of a Taiwanese training program in smoking cessation and the trainees' adherence to a practice guideline.

BMC Public Health. 2010 Feb 18;10(1):77

Authors: Guo FR, Hung LY, Chang CJ, Leung KK, Chen CY

ABSTRACT: BACKGROUND: The Taiwanese government began reimbursement for smoking cessation in 2002. Certification from a training program was required for physicians who wanted reimbursement. The program certified 6,009 physicians till 2007. The objective of this study is to evaluate the short and long term efficacy of the training program. METHODS: For short term evaluation, all trainees in 2007 were recruited. For long term evaluation, computer randomly selected 2,000 trainees who received training from 2002 to 2006 were recruited. Course satisfaction, knowledge, confidence in providing smoking cessation services and the adherence to a practice guideline were evaluated by questionnaires. RESULTS: Trainees reported high satisfaction with the training program. There was significant difference between pre- and post-test scores in knowledge. Confidence in providing services was lower in the long term evaluation compared to short term evaluation. For adherence to a practice guideline, 86% asked the status of smoking, 88% advised the smokers to quit, 76% assessed the smoker's willingness to quit, 59% assisted the smokers to quit, and 60% arranged follow-up visits for smokers. The incentive of reimbursement was the most significant factor affecting confidence and adherence. CONCLUSIONS: The training program was satisfactory and effective. Adherence to a practice guideline in our study was better than studies without physician training in other countries.

PMID: 20163745 [PubMed - as supplied by publisher]

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A critical assessment of the ICH guideline on photostability testing of new drug substances and products (Q1B): Recommendation for revision.

J Pharm Sci. 2010 Feb 4;

Authors: Baertschi SW, Alsante KM, Tønnesen HH

The ICH guideline on photostability (ICH Topic Q1B) was published in November 1996 and has been implemented in all three regions (US, EU, and Japan). The guideline describes a useful basic protocol for testing of new drug substances and associated drug products for manufacturing, storage, and distribution, but it does not cover the photostability of drugs under conditions of patient use. The pharmaceutical industry now has considerable experience in designing and carrying out photostability studies within the context of this guideline, and issues have been identified that would benefit from the revision process. The purpose of this commentary is to accomplish the following: (i) highlight issues proposed for consideration in the ICH revision process, (ii) offer a rationale for why these issues may compromise the design of a testing protocol and/or the results of the testing program, and (iii) provide recommendations for clarification of the guideline. (c) 2010 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci.

PMID: 20135694 [PubMed - as supplied by publisher]

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Impact of international consensus guidelines on antiviral therapy of chronic hepatitis C patients in Switzerland.

Swiss Med Wkly. 2010 Feb 3;

Authors: Overbeck K, Dufour JF, Müllhaupt B, Helbling B, Borovicka J, Malinverni R, Heim M, Moradpur D, Cerny A, Rickenbach M, Negro F

AIM OF THE STUDY: To assess the impact of international consensus conference guidelines on the attitude of Swiss specialists when facing the decision to treat chronic hepatitis C patients. METHODS: Questionnaires focusing on the personal situation and treatment decisions were mailed to 165 patients who were newly diagnosed with hepatitis C virus (HCV) infection and enrolled into the Swiss Hepatitis C Cohort Study during the years 2002-2004. RESULTS: Survey respondents (n = 86, 52.1%) were comparable to non-respondents with respect to severity of liver disease, history of substance abuse and psychiatric co-morbidities. Seventy percent of survey respondents reported having been offered antiviral treatment. Patients deferred from treatment had less advanced liver fibrosis, were more frequently infected with HCV genotypes 1 or 4 and presented more often with a history of depression. There were no differences regarding age, socio-economic background, alcohol abuse, intravenous drug abuse or methadone treatment when compared with patients to whom treatment was proposed. Ninety percent of eligible patients agreed to undergo treatment. Overall, 54.6% of respondents and 78.3% of those considered eligible had actually received antiviral therapy by 2007. Ninety-five percent of patients reported high satisfaction with their own hepatitis C management. CONCLUSIONS: Consistent with latest international consensus guidelines, patients enrolled in the Swiss Hepatitis C Cohort with a history of substance abuse were not withheld antiviral treatment. A multidisciplinary approach is warranted to provide antiviral treatment to patients suffering from depression.

PMID: 20131123 [PubMed - as supplied by publisher]

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Performance of GDx and HRT in the Finnish Evidence-Based Guideline for Open-Angle Glaucoma.

Eye (Lond). 2010 Feb;24(2):297-303

Authors: Pablo LE, Larrosa JM, Polo V, Ferreras A, Alías EG, Honrubia FM

AIM: To compare the performance of Heidelberg retina tomograph (HRT) and scanning laser polarimetry (GDx) with photographic evaluation of the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) in the application of the Finnish Evidence-Based Guideline for Open-Angle Glaucoma. METHODS: A total of 41 control participants and 312 patients referred for glaucoma evaluation were included in the study. All the participants underwent ophthalmic evaluation, ONH stereophotography, monochromatic RNFL photography, HRT, optical coherence tomography, and GDx evaluation. Participants were classified on the basis of stereophotographic or imaging device results based by applying the Finnish Guideline. RESULTS: Agreement between the stereophotographic evaluation and that on the basis of the imaging devices was 52.9%. Classification of patients with similar management advice on the basis of these evaluations had 56.4% agreement. The specificity of the Finnish guideline for detecting normal patients was 78% (stereophotography) and 83% (imaging devices). Optic disc size interfered with the diagnosis in patients evaluated using the HRT3 glaucoma probability score. Structural changes were more frequently detected before functional changes. CONCLUSION: The Finnish Evidence-Based Guideline for Open-Angle Glaucoma is useful for classifying normal participants and patients with suspected glaucoma or glaucoma through either conventional stereophotographic evaluation of the neuroretinal structures or with the new imaging devices.

PMID: 19407841 [PubMed - in process]

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Automated reminders increase adherence to guidelines for administration of prophylaxis for postoperative nausea and vomiting.

Eur J Anaesthesiol. 2010 Feb;27(2):187-91

Authors: Kooij FO, Klok T, Hollmann MW, Kal JE

BACKGROUND AND OBJECTIVE: Correct identification of patients at high risk for postoperative nausea and vomiting (PONV), prescription of PONV prophylaxis and correct administration of medication are all important for effective PONV prophylaxis. This has been acknowledged by development of guidelines throughout the world. We studied the effect of introducing patient-specific automated reminders on timely administration of PONV prophylaxis medication during general anaesthesia. METHODS: During the visit to the preoperative screening clinic, patients at high risk for PONV were identified and PONV prophylaxis was prescribed. To study the effect of patient-specific decision support [a pop-up window reminding the (nurse) anaesthetist that PONV prophylaxis had been prescribed for this particular patient] on the timely administration of PONV medication, we queried our database to extract data on all patients for three consecutive periods: 6 weeks before decision support (control), 12 weeks during decision support and 6 weeks after discontinuation of decision support (postdecision support) and studied how often PONV prophylaxis was administered correctly. RESULTS: Between November 2005 and May 2006, 1727, 2594 and 1331 patients presented for elective surgery in the control, decision support and postdecision support periods, respectively. In the control period, 236 patients receiving general anaesthesia were scheduled to receive PONV prophylaxis. Of these, 93 (39%) received both dexamethasone and granisetron in the correct timeframe. This increased to 464 (79%) out of 591 patients in the decision support period and decreased back to 99 (41%) out of 243 patients in the postdecision support period (P < 0.001). CONCLUSION: Decision support is effective in improving administration and timing of PONV prophylaxis medication. After withdrawal of decision support, adherence decreased to predecision support levels.

PMID: 19478673 [PubMed - in process]

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High prevalence of soil-transmitted helminths in Western Kenya: failure to implement deworming guidelines in rural Nyanza Province.

J Trop Pediatr. 2010 Feb;56(1):60-2

Authors: Riesel JN, Ochieng' FO, Wright P, Vermund SH, Davidson M

Soil-transmitted helminth (STH) infections affect an estimated 2 billion people world wide. Children experience the greatest morbidity, limiting their potential in academic and physical endeavors. Our study assessed the prevalence of STH infections in primary school-aged children in a rural village in the Nyanza Province of Kenya. Over two-thirds (68%) of the sampled population tested positive using a direct smear microscopic analysis of single stool samples. Only heavy worm infections would be detected with this technique; thus 68% is a minimum estimate of prevalence. Prior to our study, there were no deworming programs in this village, despite WHO and Kenyan government guidelines supporting regular deworming programs. Our study demonstrates the significant burden of STH infections in a rural Kenyan village and highlights the need for deworming programs in similar venues. We also demonstrate that with basic infrastructure and community involvement, regular deworming can be implemented effectively in remote, rural communities.

PMID: 19502602 [PubMed - in process]

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