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Clinical practice guideline

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https://www.readbyqxmd.com/read/28550759/venous-thromboembolism-in-the-elderly-a-narrative-review
#1
REVIEW
T Tritschler, D Aujesky
Persons aged ≥65years not only account for over 60% of venous thromboembolism (VTE) events, they have also a higher mortality and VTE-related morbidity than younger patients, including anticoagulation-related bleeding and the postthrombotic syndrome. However, only few studies have focused specifically on VTE in older persons and practice guidelines commonly extrapolate study results from younger healthier patients to the multimorbid elderly. Evidence suggests that the clinical presentation is more subtle in the elderly with VTE and that commonly used diagnostic modalities, including clinical prediction rules, D-dimer tests, and planar ventilation-perfusion scans are less specific and efficient in older persons...
May 17, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28550029/pulmonary-function-changes-after-radiotherapy-for-lung-or-esophageal-cancer-a-systematic-review-focusing-on-dose-volume-parameters
#2
Anne G H Niezink, Renske A de Jong, Christina T Muijs, Johannes A Langendijk, Joachim Widder
BACKGROUND: Despite technical developments in treatment delivery, radiation-induced lung toxicity (RILT) remains a crucial problem in thoracic radiotherapy. Clinically based RILT scores have their limitations, and more objective measures such as pulmonary functions tests (PFTs) might help to improve treatment strategies. PURPOSE: To summarize the available evidence about the effect of dose to the lung in thoracic radiotherapy on forced expiratory volume in one second (FEV1) and diffusion capacity (DLCO) in patients with lung and esophageal cancer treated with curative intent...
May 26, 2017: Oncologist
https://www.readbyqxmd.com/read/28549669/the-iscreen-electronic-diabetes-dashboard-a-tool-to-improve-knowledge-and-implementation-of-clinical-practice-guidelines
#3
Stacy Zahanova, Alexandra Tsouka, Mark R Palmert, Farid H Mahmud
OBJECTIVES: Clinical practice guidelines (CPG) provide evidence-based recommendations for patient care but may not be optimally applied in clinical settings. As a pilot study, we evaluated the impact of a computerized, point-of-care decision support system (CDSS) on guideline knowledge and adherence in our diabetes clinic. METHODS: iSCREEN, a CDSS, integrated with a province-wide electronic health record, was designed based on the Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada...
May 23, 2017: Canadian Journal of Diabetes
https://www.readbyqxmd.com/read/28549563/no-346-advanced-reproductive-age-and-fertility
#4
Kimberly E Liu, Allison Case
OBJECTIVE: To improve awareness of the natural age-related decline in female and male fertility with respect to natural fertility and assisted reproductive technologies (ART), provide recommendations for their management, and to review investigations in the assessment of ovarian aging. OPTIONS: This guideline reviews options for the assessment of ovarian reserve and fertility treatments using ART with women of advanced reproductive age presenting with infertility...
May 23, 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/28549445/fibrinogen-early-in-severe-trauma-study-feisty-study-protocol-for-a-randomised-controlled-trial
#5
James Winearls, Martin Wullschleger, Elizabeth Wake, Catherine Hurn, Jeremy Furyk, Glenn Ryan, Melita Trout, James Walsham, Anthony Holley, Jeremy Cohen, Megan Shuttleworth, Wayne Dyer, Gerben Keijzers, John F Fraser, Jeffrey Presneill, Don Campbell
BACKGROUND: Haemorrhage is a leading cause of death in severe trauma. Fibrinogen plays a critical role in maintaining haemostasis in traumatic haemorrhage. Early fibrinogen replacement is recommended by several international trauma guidelines using either fibrinogen concentrate (FC) or cryoprecipitate (Cryo). There is limited evidence to support one product over the other with widespread geographic and institutional variation in practice. This pilot trial is the first randomised controlled trial comparing FC to Cryo in traumatic haemorrhage...
May 26, 2017: Trials
https://www.readbyqxmd.com/read/28549336/evaluation-of-a-new-random-access-hbv-dna-molecular-assay-the-veris-hbv-assay
#6
Slim Fourati, Dominique Challine, Jean-Dominique Poveda, Syria Laperche, Sandrine Rallier, Jean-Michel Pawlotsky, Stéphane Chevaliez
BACKGROUND: Detection and quantification of HBV DNA are essential to diagnose chronic HBV infection, monitor the virological response to treatment and the possible selection of resistant viruses in order to tailor therapy. The VERIS/MDx System HBV Assay is a random-access system that quantifies HBV DNA in clinical samples using unique single sample and reagent access during the workflow process without the need to reload other tests and delivers results within 1.2h following sampling...
May 17, 2017: Journal of Clinical Virology: the Official Publication of the Pan American Society for Clinical Virology
https://www.readbyqxmd.com/read/28549221/preventing-underfeeding-and-overfeeding-a-clinician-s-guide-to-the-acquisition-and-implementation-of-indirect-calorimetry
#7
Amy K Ladd, Heather E Skillman, Matthew A Haemer, Peter M Mourani
BACKGROUND: In critically ill patients, indirect calorimetry (IC) is the gold standard to determine energy needs, as the use of predictive equations can result in underfeeding or overfeeding. The aim of this quality improvement (QI) initiative was to describe the rationale for and implementation of a process to target energy provision according to IC measurements in a tertiary academic medical center pediatric intensive care unit (PICU). MATERIALS AND METHODS: To justify the purchase of an indirect calorimeter for clinical use, a needs assessment was conducted, followed by a training and implementation period...
May 1, 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28548896/implementation-of-asthma-clinical-practice-guidelines-in-primary-care-a-cross-sectional-study-based-on-the-knowledge-to-action-cycle
#8
Myriam E Gagné, Louis-Philippe Boulet
OBJECTIVE: Based on the Knowledge-to-Action Cycle, we assessed the self-reported implementation and perception of asthma clinical practice guideline (CPG) recommendations in primary care physicians (PCPs), along with the barriers and facilitators to CPG use in primary care. METHODS: We conducted a cross-sectional study. Using the extended Asthma Physicians' Practice Assessment Questionnaire(©), PCPs self-reported the following: their knowledge of 15 key asthma CPG recommendations, the perceived usefulness of each of these recommendations, their motivation to apply these recommendations, and their agreement with the content of these recommendations...
May 26, 2017: Journal of Asthma: Official Journal of the Association for the Care of Asthma
https://www.readbyqxmd.com/read/28548543/systematic-review-of-clinical-guidance-documents-for-autism-spectrum-disorder-diagnostic-assessment-in-select-regions
#9
Melanie Penner, Evdokia Anagnostou, Lana Y Andoni, Wendy J Ungar
Clinical guidance documents play an important role in ensuring access to high-quality autism spectrum disorder diagnostic assessment practices. The objective was to perform a systematic review of professional association and government clinical guidance documents for autism spectrum disorder diagnostic assessment, analyzing their quality and content. The government search was limited to English-speaking, single-payer, publicly funded health systems. A quality appraisal was conducted by two appraisers using the Appraisal of Guidelines Research and Evaluation, second edition tool...
May 1, 2017: Autism: the International Journal of Research and Practice
https://www.readbyqxmd.com/read/28548368/developing-minimum-clinical-standards-for-physiotherapy-in-south-african-icus-a-qualitative-study
#10
Heleen van Aswegen, Shane Patman, Natascha Plani, Susan Hanekom
RATIONALE, AIMS, AND OBJECTIVES: Physiotherapists are integral members of the intensive care unit (ICU) team. Clinicians working in ICU are dependent on their own experience when making decisions regarding individual patient management thus resulting in variation in clinical practice. No formalized clinical practice guidelines or standards exist for the educational profile or scope of practice requirements for ICU physiotherapy. This study explored perceptions of physiotherapists on minimum clinical standards that ICU physiotherapists should adhere to for delivering safe, effective physiotherapy services to critically ill patients...
May 26, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28548315/aapm-medical-physics-practice-guideline-8-a-linear-accelerator-performance-tests
#11
Koren Smith, Peter Balter, John Duhon, Gerald A White, David L Vassy, Robin A Miller, Christopher F Serago, Lynne A Fairobent
PURPOSE: The purpose of this guideline is to provide a list of critical performance tests in order to assist the Qualified Medical Physicist (QMP) in establishing and maintaining a safe and effective quality assurance (QA) program. The performance tests on a linear accelerator (linac) should be selected to fit the clinical patterns of use of the accelerator and care should be given to perform tests which are relevant to detecting errors related to the specific use of the accelerator. METHODS: A risk assessment was performed on tests from current task group reports on linac QA to highlight those tests that are most effective at maintaining safety and quality for the patient...
May 26, 2017: Journal of Applied Clinical Medical Physics
https://www.readbyqxmd.com/read/28547682/adherence-to-clinical-guidelines-and-the-potential-economic-benefits-of-admission-avoidance-for-acute-uncomplicated-diverticulitis
#12
I S Reynolds, E O'Connell, R M Heaney, W Khan, I Z Khan, R Waldron, K Barry
BACKGROUND: The treatment paradigm for acute diverticulitis is changing. There is an increasing trend towards managing patients with uncomplicated diverticulitis in the community. AIMS: The aim of this study was to analyse how acute diverticulitis is managed in our institution and also to analyse national data pertaining to treatment of acute diverticulitis. METHODS: A prospective database of all patients admitted to our institution over a 2-year period (2014-2016) with acute diverticulitis was maintained...
May 25, 2017: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/28547563/poor-adherence-to-national-clinical-management-guidelines-a-population-based-cross-sectional-study-of-the-surgical-management-of-melanoma-in-new-south-wales-australia
#13
Alexander H R Varey, Christine M Madronio, Anne E Cust, Chris Goumas, Graham J Mann, Bruce K Armstrong, Richard A Scolyer, Austin M Curtin, John F Thompson
BACKGROUND: Standardization of the clinical management of melanoma through the formulation of national guidelines, based on interpretation of the existing evidence and consensus expert opinion, seeks to improve quality of care; however, adherence to national guidelines has not been well studied. METHODS: A population-based, cross-sectional study of the clinical management of all patients with newly notified primary melanomas in the state of New South Wales, Australia, during 2006/2007 was conducted using cancer registry identification and questionnaires completed by treating physicians...
May 25, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28546858/quality-indicators-for-the-acute-and-long-term-management-of-anaphylaxis-a-systematic-review
#14
REVIEW
Sangeeta Dhami, Aadam Sheikh, Antonella Muraro, Graham Roberts, Susanne Halken, Monserat Fernandez Rivas, Margitta Worm, Aziz Sheikh
BACKGROUND: The quality of acute and long-term anaphylaxis management is variable and this contributes to the poor outcomes experienced by many patients. Clinical practice guidelines have the potential to improve outcomes, but implementing guideline recommendations in routine practice is challenging. Quality indicators have the potential to support guideline implementation efforts. OBJECTIVE: To identify quality indicators to support the acute and long-term management of anaphylaxis...
2017: Clinical and Translational Allergy
https://www.readbyqxmd.com/read/28546850/knowledge-and-management-of-chronic-spontaneous-urticaria-in-latin-america-a-cross-sectional-study-in-ecuador
#15
A Cherrez, M Maurer, K Weller, J C Calderon, D Simancas-Racines, I Cherrez Ojeda
BACKGROUND: The current EAACI/GA(2)LEN/EDF/WAO guideline for urticaria provide specific recommendations for the diagnostic workup and treatment of patients with chronic spontaneous urticaria (CsU). This study explored if physicians in Ecuador know these recommendations and implement them in their actual clinical practice for CsU. METHODS: We investigated physicians who treat CsU patients in a cross-sectional study using a standardized questionnaire. Descriptive statistics were employed, adjusted logistic regression was performed to assess the link of guideline knowledge and use of therapy...
2017: World Allergy Organization Journal
https://www.readbyqxmd.com/read/28546594/patient-safety-reducing-the-risk-of-wrong-tooth-extraction
#16
P Cullingham, A Saksena, M N Pemberton
Over recent years there has been an increased emphasis on improving patient safety in all branches of medicine, with reducing wrong tooth extraction being a priority in dentistry. The true incidence of wrong tooth extraction is unknown but it is considered an avoidable harm and is a significant source of dental litigation. Interventions to reduce wrong tooth extraction include educational programmes encompassing human factor training, patient assisted identification, the use of checklists, marking of surgical sites and implementation of patient safety guidelines...
May 26, 2017: British Dental Journal
https://www.readbyqxmd.com/read/28545945/mindfulness-and-acceptance-based-interventions-for-psychosis-our-current-understanding-and-a-meta-analysis
#17
REVIEW
Stephanie Louise, Molly Fitzpatrick, Clara Strauss, Susan L Rossell, Neil Thomas
In promoting optimal recovery in persons with psychosis, psychological interventions have become a key element of treatment, with cognitive behavioural therapy being widely recommended in clinical practice guidelines. One key area of development has been the trialling of "third wave" cognitive behavioural interventions, which promote mindfulness, acceptance and compassion as means of change. Trials to date have demonstrated encouraging findings, with beneficial effects observed on measures of psychotic symptoms...
May 22, 2017: Schizophrenia Research
https://www.readbyqxmd.com/read/28545679/selective-use-of-radioactive-iodine-rai-in-thyroid-cancer-no-longer-one-size-fits-all
#18
REVIEW
J L Marti, L G T Morris, A S Ho
A remarkable, evidence-based trend toward de-escalation has reformed the practice of radioactive iodine (RAI) administration for thyroid cancer patients. Updated guidelines have supported both decreased RAI doses for select populations, as well as expanded definitions of low-risk and intermediate-risk patients that may not require RAI. Correspondingly, there is now increased flexibility for hemithyroidectomy without need for RAI, and relaxed TSH suppression targets for low-risk thyroidectomy patients. Clinical judgment remains indispensable where multiple risk factors co-exist that individually are not indications for RAI...
May 3, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28544750/unexpected-ethical-dilemmas-in-sex-assignment-in-46-xy-dsd-due-to-5-alpha-reductase-type-2-deficiency
#19
Heather M Byers, Lauren H Mohnach, Patricia Y Fechner, Ming Chen, Inas H Thomas, Linda A Ramsdell, Margarett Shnorhavorian, Elizabeth A McCauley, Anne-Marie E Amies Oelschlager, John M Park, David E Sandberg, Margaret P Adam, Catherine E Keegan
Sex assignment at birth remains one of the most clinically challenging and controversial topics in 46,XY disorders of sexual development (DSD). This is particularly challenging in deficiency of 5-alpha reductase type 2 given that external genitalia are typically undervirilized at birth but typically virilize at puberty to a variable degree. Historically, most individuals with 5-alpha reductase deficiency were raised females. However, reports that over half of patients who underwent a virilizing puberty adopted an adult male gender identity have challenged this practice...
May 25, 2017: American Journal of Medical Genetics. Part C, Seminars in Medical Genetics
https://www.readbyqxmd.com/read/28544474/breast-cancer-and-transplantation
#20
Germaine Wong, Eric Au, Sunil V Badve, Wai H Lim
Breast cancer is an important cancer among solid organ transplant recipients. While the incidence of breast cancer in solid organ transplant recipients is comparable to the age matched general population, the outcomes are generally poor. Interventions such as cancer screening which preclude the development of late stage disease through early detection are not well-studied, and clinical practice guidelines for cancer screening rely solely on recommendations from the general population. Among those with a prior breast cancer history, disease recurrence after transplantation is a rare but fearful event...
May 19, 2017: American Journal of Transplantation
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