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Clinical practice guidelines

Livvi Li Wei Sim, Kenneth Hon Kim Ban, Tin Wee Tan, Sunil Kumar Sethi, Tze Ping Loh
Management of complex chronic diseases such as diabetes requires the assimilation and interpretation of multiple laboratory test results. Traditional electronic health records tend to display laboratory results in a piecemeal and segregated fashion. This makes the assembly and interpretation of results related to diabetes care challenging. We developed a diabetes-specific clinical decision support system (Diabetes Dashboard) interface for displaying glycemic, lipid and renal function results, in an integrated form with decision support capabilities, based on local clinical practice guidelines...
2017: PloS One
Gail L McGlothlen, Lori Rodriguez
OBJECTIVES: This study describes the training, experience with pocket fills, and life-long learning behaviors in a national sample of health care professionals who perform the reservoir refill procedure and compares results with intraspinal drug delivery morbidity and mortality clinical practice guidelines to demonstrate the need for standardized training. METHODS: Using a cross-sectional, descriptive design and a 23-item questionnaire administered via social media, 65 health care professionals who performed the reservoir refill procedure within the last year were surveyed...
February 24, 2017: Neuromodulation: Journal of the International Neuromodulation Society
Marilyn Karam, Christine Holland, Zi Yang, Kiela Samuels, Georgiana Sanders
BACKGROUND: Our previous pilot study conducted at the University of Michigan Health Services showed that fewer than 25% of the non-university allergen immunotherapy (AIT) prescribers adhered to AIT labeling guidelines which impacted both patients and healthcare personnel involved in AIT administration. OBJECTIVES: We expand our study to characterize AIT labeling compliance and impact of practice variability at the "Big 10" University Health Services, and investigate prescribers motives for nonadherence to practice parameter guidelines...
March 1, 2017: Allergy and Asthma Proceedings:
Esther Calje, Joan Skinner
BACKGROUND: Early recognition and management of low maternal iron status is associated with improved maternal, fetal, and neonatal outcomes. However, existing international guidelines for the testing and management of maternal iron-deficiency anemia are variable, with no national guideline for New Zealand midwives. Clinical management is complicated by normal physiological hemodilution, and complicated further by the effects of inflammation on iron metabolism, especially in populations with a high prevalence of obesity or infection...
February 24, 2017: Birth
Estelle C Nijssen, Roger J Rennenberg, Patty J Nelemans, Brigitte A Essers, Marga M Janssen, Marja A Vermeeren, Vincent van Ommen, Joachim E Wildberger
BACKGROUND: Intravenous saline is recommended in clinical practice guidelines as the cornerstone for preventing contrast-induced nephropathy in patients with compromised renal function. However, clinical-effectiveness and cost-effectiveness of this prophylactic hydration treatment in protecting renal function has not been adequately studied in the population targeted by the guidelines, against a group receiving no prophylaxis. This was the aim of the AMACING trial. METHODS: AMACING is a prospective, randomised, phase 3, parallel-group, open-label, non-inferiority trial of patients at risk of contrast-induced nephropathy according to current guidelines...
February 20, 2017: Lancet
Javier Suela, Isabel López-Expósito, María Eugenia Querejeta, Rosa Martorell, Esther Cuatrecasas, Lluis Armengol, Eugenia Antolín, Elena Domínguez Garrido, María José Trujillo-Tiebas, Jordi Rosell, Javier García Planells, Juan Cruz Cigudosa
Microarray technology, recently implemented in international prenatal diagnosis systems, has become one of the main techniques in this field in terms of detection rate and objectivity of the results. This guideline attempts to provide background information on this technology, including technical and diagnostic aspects to be considered. Specifically, this guideline defines: the different prenatal sample types to be used, as well as their characteristics (chorionic villi samples, amniotic fluid, fetal cord blood or miscarriage tissue material); variant reporting policies (including variants of uncertain significance) to be considered in informed consents and prenatal microarray reports; microarray limitations inherent to the technique and which must be taken into account when recommending microarray testing for diagnosis; a detailed clinical algorithm recommending the use of microarray testing and its introduction into routine clinical practice within the context of other genetic tests, including pregnancies in families with a genetic history or specific syndrome suspicion, first trimester increased nuchal translucency or second trimester heart malformation and ultrasound findings not related to a known or specific syndrome...
February 20, 2017: Medicina Clínica
Andrew Reisner, Thomas G Burns, Larry B Hall, Shabnam Jain, Brad C Weselman, Ton J De Grauw, Kim E Ono, Laura S Blackwell, Joshua J Chern
OBJECTIVE: To evaluate the potential impact of a concussion management education program on community-practicing pediatricians. STUDY DESIGN: We prospectively surveyed 210 pediatricians before and 18 months after participation in an evidence-based, concussion education program. Pediatricians were part of a network of 38 clinically integrated practices in metro-Atlanta. Participation was mandatory for at least 1 pediatrician in each practice. We assessed pediatricians' self-reported concussion knowledge, use of guidelines, and comfort level, as well as self-reported referral patterns for computed tomography (CT) and/or emergency department (ED) evaluation of children who sustained concussion...
February 20, 2017: Journal of Pediatrics
C Liebetrau, C W Hamm
Acute coronary syndrome without persistent ST-segment elevation (non-ST segment elevation myocardial infarction and instable angina pectoris NSTEMI-ACS) is common and is associated with a high mortality. In addition to 12-channel echocardiograph (ECG) assessment, measurement of cardiac troponins I and T are important for risk stratification and diagnosis. The introduction of high-sensitivity cardiac troponin assays and their implementation into clinical practice has influenced risk stratification and treatment of these patients...
February 23, 2017: Herz
Christine Vincent, Zohar Lederman
Many families of patients hold the view that it is their right to be present during a loved one's resuscitation, while the majority of patients also express the comfort and support they would feel by having them there. Currently, family presence is more commonly accepted in paediatric cardiopulmonary resuscitation (CPR) than adult CPR. Even though many guidelines are in favour of this practice and recognise potential benefits, healthcare professionals are hesitant to support adult family presence to the extent that paediatric family presence is supported...
February 23, 2017: Journal of Medical Ethics
Paul A Brunton, Amna Ghazali, Zahidah H Tarif, Carolina Loch, Christopher Lynch, Nairn Wilson, Igor R Blum
OBJECTIVES: To evaluate the teaching and operative techniques for the repair and/or replacement of direct resin-based composite restorations (DCRs) in dental schools in Oceania. METHODS: A 14-item questionnaire was mailed to the heads of operative dentistry in 16 dental schools in Oceania (Australia, New Zealand, Fiji and Papua New Guinea). The survey asked whether the repair of DCRs was taught within the curriculum; the rationale behind the teaching; how techniques were taught, indications for repair, operative techniques, materials used, patient acceptability, expected longevity and recall systems...
February 20, 2017: Journal of Dentistry
Amir Shlaifer, Avraham Yitzhak, Erez N Baruch, Avi Shina, Alexandra Satanovsky, Amiram Shovali, Ofer Almog, Elon Glassberg
BACKGROUND: Hemorrhage is a leading cause of preventable death on the battlefield. Timely tourniquet application to massively bleeding extremity wounds is critical for casualty survival albeit with reported adverse effects to extremity integrity. The aim of this study was to describe the immediate and short term outcomes of point of injury (POI) tourniquet applications during 'Operation Protective Edge' (OPE). METHODS: A case series study regarding tourniquet application at the POI during OPE was collected...
February 23, 2017: Journal of Trauma and Acute Care Surgery
Francesco Franchi, Fabiana Rollini, Dominick J Angiolillo
Antithrombotic therapy, including antiplatelet and anticoagulant agents, is the cornerstone of pharmacological treatment to optimize clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Intravenous anticoagulant drugs available for PPCI include the indirect thrombin inhibitors unfractionated heparin and low-molecular-weight heparin, and the direct thrombin inhibitor bivalirudin. Intravenous antiplatelet drugs mainly include glycoprotein IIb/IIIa inhibitors and the P2Y12-receptor inhibitor cangrelor...
February 23, 2017: Nature Reviews. Cardiology
A Alcantara-Montero
INTRODUCTION: Desvenlafaxine is the third antidepressant within the group of serotonin-norepinephrine reuptake inhibitors. The latest clinical practice guidelines consulted agree that tricyclic antidepressants, dual (venlafaxine/duloxetine) and gabapentin/pregabalin antiepileptics, are the first-line drugs in the treatment of neuropathic pain, being tramadol, lidocaine 5% patches and capsaicin 8% patches of second-line drugs, while strong opioids constitute a third line treatment. The interaction between the binomial pain and depression is very frequent, being the psychological complication more frequent in patients with chronic pain...
March 1, 2017: Revista de Neurologia
Ali S Al-Qahtani
The aim of this study was to benchmark our guidelines of prevention of venous thromboembolism (VTE) in ENT surgical population against ENT.UK guidelines, and also to encourage healthcare providers to utilize benchmarking as an effective method of improving performance. The study design is prospective descriptive analysis. The setting of this study is tertiary referral centre (Assir Central Hospital, Abha, Saudi Arabia). In this study, we are benchmarking our practice guidelines of the prevention of VTE in the ENT surgical population against that of ENT...
February 22, 2017: European Archives of Oto-rhino-laryngology
Homam Ibrahim, Sunil V Rao
Oral Antiplatelet Drugs (OAD) have a proven track record in the risk reduction of major cardiovascular events in patients with cardiovascular disease and normal kidney function. However, major gaps exist in our understanding of their effects on thrombosis and bleeding in chronic kidney disease (CKD). Clinical practice guidelines are ambiguous about use of such drugs in CKD patients, because patients with moderate to severe CKD were systematically excluded from clinical trials evaluating the efficacy and safety of OAD...
February 22, 2017: Journal of Thrombosis and Thrombolysis
Rudolf W Poolman, Thomas Agoritsas, Reed A C Siemieniuk, Ian A Harris, Inger B Schipper, Brent Mollon, Maureen Smith, Alexandra Albin, Sally Nador, Will Sasges, Stefan Schandelmaier, Lyubov Lytvyn, Ton Kuijpers, Loes W A H van Beers, Michael H J Verhofstad, Per Olav Vandvik
No abstract text is available yet for this article.
February 21, 2017: BMJ: British Medical Journal
Jūratė Barysienė, Aistė Žebrauskaitė, Dovilė Petrikonytė, Germanas Marinskis, Sigita Aidietienė, Audrius Aidietis
BACKGROUND: To evaluate a diagnostic value of transoesophageal echocardiogram (TEE) in appropriately anticoagulated patients with a non-valvular atrial fibrillation (AF) and to establish possible additional indications for TEE; to evaluate the incidence of left atrial (LA) thrombi in appropriately anticoagulated patients in daily clinical practice. METHODS: This retrospective study analyses data of 432 patients who had been anticoagulated by means of oral anticoagulants (OACs) prior to planned cardioversion during the period from 2012 to 2015...
February 23, 2017: BMC Cardiovascular Disorders
Stephen P Messier, Leigh F Callahan, Daniel P Beavers, Kate Queen, Shannon L Mihalko, Gary D Miller, Elena Losina, Jeffrey N Katz, Richard F Loeser, Sara A Quandt, Paul DeVita, David J Hunter, Mary F Lyles, Jovita Newman, Betsy Hackney, Joanne M Jordan
BACKGROUND: Recently, we determined that in a rigorously monitored environment an intensive diet-induced weight loss of 10% combined with exercise was significantly more effective at reducing pain in men and women with symptomatic knee osteoarthritis (OA) than either intervention alone. Compared to previous long-term weight loss and exercise trials of knee OA, our intensive diet-induced weight loss and exercise intervention was twice as effective at reducing pain intensity. Whether these results can be generalized to less intensively monitored cohorts is unknown...
February 22, 2017: BMC Musculoskeletal Disorders
Alan D Kaye, Mark R Jones, Adam M Kaye, Juan G Ripoll, Donald E Jones, Vincent Galan, Burton D Beakley, Frank Calixto, Jamie L Bolden, Richard D Urman, Laxmaiah Manchikanti
Chronic pain and prescription opioid abuse are extremely prevalent in the United States and worldwide. The consequences of opioid misuse can be life-threatening with significant morbidity and mortality, exacting a heavy toll on patients, physicians, and society. The risk for misuse of prescribed opioids is much higher in patients with chronic pain, especially those with concurrent substance use and /or mental health disorders. Several reasons can account for the occurrence of opioid abuse and misuse, including self-medication, use for reward, compulsive use related to addiction, and diversion for profit...
February 2017: Pain Physician
Alan D Kaye, Mark R Jones, Adam M Kaye, Juan G Ripoll, Vincent Galan, Burton D Beakley, Frank Calixto, Jamie L Bolden, Richard D Urman, Laxmaiah Manchikanti
Chronic pain and prescription opioid abuse are extremely prevalent both in this country and worldwide. Consequences of opioid misuse can be life-threatening with significant morbidity and mortality, exacting a heavy toll on patients, physicians, and society. Individuals with chronic pain and co-occurring substance use disorders and/or mental health disorders, are at a higher risk for misuse of prescribed opioids. Opioid abuse and misuse occurs for a variety of reasons, including self-medication, use for reward, compulsive use because of addiction, and diversion for profit...
February 2017: Pain Physician
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