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Guideline implementation

Douglas J Robertson, Jeffrey K Lee, C Richard Boland, Jason A Dominitz, Francis M Giardiello, David A Johnson, Tonya Kaltenbach, David Lieberman, Theodore R Levin, Douglas K Rex
The use of the fecal occult blood test (FOBT) for colorectal cancer (CRC) screening is supported by randomized trials demonstrating effectiveness in cancer prevention and widely recommended by guidelines for this purpose. The fecal immunochemical test (FIT), as a direct measure of human hemoglobin in stool has a number of advantages relative to conventional FOBT and is increasingly used relative to that test. This review summarizes current evidence for FIT in colorectal neoplasia detection and the comparative effectiveness of FIT relative to other commonly used CRC screening modalities...
October 18, 2016: American Journal of Gastroenterology
Joachim D Pleil
Biomarker datasets often include entries 'below the level of quantitation' (LoQ) wherein the instrumentation is no longer able to provide values that meet required analytical quality standards, a phenomenon referred to as 'left-censored' data. Generally, some form of imputation for missing values is required to allow calculating distributions and summary statistics for comparing datasets to each other. This article discusses the available options for imputing (modeling) left-censored data, presents the methods for implementing different procedures, and provides examples and guidelines using realistic data to assess relative performance...
October 18, 2016: Journal of Breath Research
Wen-Juan Zhou, Zhen-Ni Luo, Chang-Min Tang, Xiao-Xu Zou, Lu Zhao, Peng-Qian Fang
The improvement of antibiotic rational use in China was studied by usage analysis of combination antibiotic therapy for type I incisions in 244 hospitals. Five kinds of hospitals, including general hospital, maternity hospital, children's hospital, stomatological hospital and cancer hospital, from 30 provinces were surveyed. A systematic random sampling strategy was employed to select outpatient prescriptions and inpatient cases in 2011 and 2012. A total of 29 280 outpatient prescriptions and 73 200 inpatient cases from 244 hospitals in each year were analyzed...
October 2016: Journal of Huazhong University of Science and Technology. Medical Sciences
Gianantonio Rosti, Fausto Castagnetti, Gabriele Gugliotta, Michele Baccarani
The therapeutic armamentarium for chronic myeloid leukaemia (CML) comprises mainly tyrosine kinase inhibitors (TKIs), with several agents available for frontline treatment, or for the treatment of disease resistance or intolerance to the first-choice or second-choice drug. The availability of different drugs is a major achievement, but means that choices must be made - which can be difficult and questionable at times. The most important end point considered in decision-making regarding treatment for any cancer is overall survival, but additional factors (such as age, prognostic category, safety, or the possibility of achieving treatment-free remission) should be considered when selecting an agent for frontline treatment...
October 18, 2016: Nature Reviews. Clinical Oncology
Catherine McParlin, Ruth Bell, Stephen C Robson, Colin R Muirhead, Vera Araújo-Soares
OBJECTIVE: to investigate barriers and facilitators to physical activity (PA) guideline implementation for midwives when advising obese pregnant women. DESIGN: a cross-sectional, self-completion, anonymous questionnaire was designed using the Theoretical Domains Framework. this framework was developed to evaluate the implementation of guidelines by health care professionals. A total of 40 questions were included. These were informed by previous research on pregnant women's and midwives views, knowledge and attitudes to PA, and supported by national evidence based guidelines...
September 28, 2016: Midwifery
Christine Culpepper, Kendra Hendrickson, Susan Marshall, Jessica Benes, Theresa R Grover
BACKGROUND: Growth and nutrition are critical in neonatal care. Whether feeding guidelines improve growth and nutrition and reduce morbidity is unknown. PURPOSE: Feeding guidelines for very low birth-weight (VLBW) infants were implemented in our neonatal intensive care unit (NICU) to start and achieve full enteral feeds sooner, and increase weight gain over the first month. METHODS: Feeding guidelines for VLBW infants were implemented in January 2014, stratified by birth weight (<750, 750-1000, and 1000-1500 g)...
October 7, 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Seul Gi Lee, Woo Kyung Lee, Hye Sun Lee, Jieun Moon, Cho Rok Lee, Sang Wook Kang, Jong Ju Jeong, Kee-Hyun Nam, Woong Youn Chung, Young Suk Jo, Jandee Lee
BACKGROUND: The 2015 American Thyroid Association (ATA) management guidelines for adult patients with differentiated thyroid cancer (DTC) propose the use of the modified initial risk stratification and response to therapy re-stratification systems. This study was conducted to validate the practicality of the revised guidelines for predicting tumor recurrence in patients with DTC. METHODS: Patients with papillary thyroid cancer (n=2425) who underwent total thyroidectomy with central neck node dissection with or without modified radical neck node dissection at a single institution between October 1985 and July 2009 were retrospectively enrolled...
October 17, 2016: Thyroid: Official Journal of the American Thyroid Association
Christopher A Benner, Erika Mora, Emily Mueller, F Jacob Seagull, Kelly Walkovich, Kaleena Johnson, Schuyler Halverson, Ed Rothman, George Hucks, John G Younger, Michele M Nypaver
OBJECTIVES: Febrile neutropenic pediatric patients are at heightened risk for serious bacterial infections, and rapid antibiotic administration (in <60 minutes) improves survival. Our objectives were to reduce the time-to-antibiotic (TTA) administration and to evaluate the effect of overall emergency department (ED) busyness on TTA. METHODS: This study was a quality improvement initiative with retrospective chart review to reduce TTA in febrile children with underlying diagnosis of cancer or hematologic immunodeficiency who visited the pediatric ED...
October 4, 2016: Pediatric Emergency Care
Michelle L Pickett, Marlene D Melzer-Lange, Melissa K Miller, Seema Menon, Alexis M Vistocky, Amy L Drendel
OBJECTIVES: There is limited literature about physicians' adherence to 2010 Centers for Disease Control and Prevention (CDC) Sexually Transmitted Diseases Treatment Guidelines specific to specimen collection testing methods in adolescent females in the emergency setting is limited. The objectives are to (1) determine physician adherence to CDC guidelines for specimen collection/testing for chlamydia and gonorrhea, (2) determine physician characteristics associated with guideline adherence, and (3) describe physicians' knowledge of expedited partner therapy (EPT) laws...
October 4, 2016: Pediatric Emergency Care
Dazhi Fan, Song Wu, Wen Wang, Lihong Xin, Guo Tian, Li Liu, Jinping Feng, Xiaoling Guo, Zhengping Liu
BACKGROUND: Placenta previa is characterized by the abnormal placenta overlying the endocervical os, and it is known as one of the most feared adverse maternal and fetal-neonatal complications in obstetrics. OBJECTIVES: We aimed to obtain overall and regional estimates of placenta previa prevalence among deliveries in Mainland China. METHODS: The research was performed a systematic review, following the Meta-analysis of observational studies in epidemiology (MOOSE) guidelines for systematic reviews of observational studies, and the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement for reporting systematic reviews and meta-analysis...
October 2016: Medicine (Baltimore)
Katja Bohner
Transitions Theory (TT) states that change and transition are phenomena that make humans more vulnerable to health risks. Transitions Theory was evaluated through a text analysis of 4 publications, 3 nursing expert focus group interviews in Switzerland, and a mapping review of the transition literature of the last 5 years. Although the implementation of TT into Swiss nursing practice seems problematic due to conceptual deficiencies, transition is a meaningful nursing topic. The connection between TT, research, and practice is weak...
October 3, 2016: ANS. Advances in Nursing Science
Michelle K Haas, Kristen Dalton, Bryan C Knepper, Sarah A Stella, Lilia Cervantes, Connie S Price, William J Burman, Philip S Mehler, Timothy C Jenkins
Background.  Syndrome-specific interventions are a recommended approach to antibiotic stewardship, but additional data are needed to understand their potential impact. We implemented an intervention to improve the management of inpatient community-acquired pneumonia (CAP) and evaluated its effects on antibiotic and resource utilization. Methods.  A stakeholder group developed and implemented a clinical practice guideline and order set for inpatient, non-intensive care unit CAP recommending a short course (5 days) of a fluoroquinolone-sparing antibiotic regimen in uncomplicated cases...
October 2016: Open Forum Infectious Diseases
A Arturo Leis, Dobrivoje S Stokic
Worldwide concern over Zika virus causing Guillain-Barre syndrome (GBS) soared after recent reports that Zika-related weakness was due to GBS. A global strategic response plan was initiated with recommendations for at-risk countries to prepare for GBS. This plan has major economic implications, as nations with limited resources struggle to implement costly immunotherapy. Since confirmation of causality is prerequisite to providing specific management recommendations, it is prudent to review data endorsing a GBS diagnosis...
2016: Frontiers in Neurology
Rohan A Ramasubbu, Benjamin M Ramasubbu
BACKGROUND: Management of open tibial fractures is well documented in adults, with existing protocols outlining detailed treatment strategies. No clear guidelines exist for children. Surgical stabilization of tibial fractures in the pediatric population requires implants that do not disrupt the open epiphyses (growth plate). Both elastic stable intramedullary nails and external fixation can be used. The objective of this study was to identify the optimal method of surgical stabilization in the treatment of open tibial fractures in children...
September 2016: Indian Journal of Orthopaedics
Megan Simmons, Lucia Guerra-Reyes, Beth Meyerson, Kristin Adams, Stephanie Sanders
BACKGROUND: In 2014, the Centers for Disease Control and Prevention and the Office of Population Affairs released a document entitled Providing Quality Family Planning Services (QFP), which outlined recommendations for delivery of family planning services using a client-centered approach. These aimed to standardize service provision and address numerous reproductive health challenges. To date, little is known about QFP implementation or the factors influencing its adoption by clinicians...
October 13, 2016: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
Tamara Bucher, Megan E Rollo, Shamus P Smith, Moira Dean, Hannah Brown, Mingui Sun, Clare Collins
Large portion sizes contribute to weight gain in western societies. Portion-size interventions, aids and education can be effective in helping prevent weight gain, but consumers are unsure what appropriate portions are and express confusion about existing guidelines. A lack of clarity about suggested serving size recommendations is a major barrier to food portion-size control. Therefore, standardised measurement units and unambiguous terminologies are required. This position paper summarises the evidence regarding the impact and importance of portion-size education and estimation, and outlines strategies for improving consumer understanding and application of this through the development of an international food measurement system and a range of appropriate portion control tools...
October 13, 2016: Health Promotion Journal of Australia
Valentina Barletta, Francesco Profili, Rosa Gini, Leonardo Grilli, Carla Rampichini, Daniela Matarrese, Paolo Francesconi
BACKGROUND: In 2010, Tuscany (Italy) implemented the Chronic Care Model (CCM), to improve general practitioner (GP) management of chronic diseases. AIM: assessing how the introduction of CCM affected GPs' compliance with standards of care for diabetes patients. METHODS: A controlled before-after study was performed. Two exposed groups of GPs, one entering the study in 2010 and one in 2011, were considered. Patients with diabetes assisted by GPs of the groups were identified through the healthcare administrative data of the Regional Healthcare System and followed up from 2009 to 2012...
October 15, 2016: European Journal of Public Health
Emilio Bouza, José Martínez-Alarcón, Emilio Maseda, Mercedes Palomar, Rafael Zaragoza, María Jesús Pérez-Granda, Patricia Muñoz, Almudena Burillo
INTRODUCTION: Current guidelines for the microbiological diagnosis of ventilator-associated pneumonia (VAP) are imprecise. Based on data provided by intensive care specialists (ICS) and microbiologists, this study defines the clinical practices and microbiological techniques currently used for an aetiological diagnosis of VAP and pinpoints deficiencies. METHODS: Eighty hospitals in the national health network with intensive care and microbiology departments were sent two questionnaires, one for each department, in order to collect data on VAP diagnosis for the previous year...
October 13, 2016: Enfermedades Infecciosas y Microbiología Clínica
Julie-Anne Quinn, Flor M Munoz, Bernard Gonik, Lourdes Frau, Clare Cutland, Tamala Mallett-Moore, Aimee Kissou, Frederick Wittke, Manoj Das, Tony Nunes, Savia Pye, Wendy Watson, Ana-Maria Alguacil Ramos, Jose F Cordero, Wan-Ting Huang, Sonali Kocchar, Jim Buttery
Preterm birth is commonly defined as any birth before 37 weeks completed weeks of gestation. An estimated 15 million infants are born preterm globally, disproportionately affecting low and middle income countries (LMIC). It contributes directly to estimated one million neonatal deaths annually and is a significant contributor to childhood morbidity. However, in many clinical settings, the information available to calculate completed weeks of gestation varies widely. Accurate dating of the last menstrual period (LMP), as well as access to clinical and ultrasonographic evaluation are important components of gestational age assessment antenatally...
October 13, 2016: Vaccine
Thomas Ebenhan, Isabel Schoeman, Daniel D Rossouw, Anne Grobler, Biljana Marjanovic-Painter, Judith Wagener, Hendrik G Kruger, Mike M Sathekge, Jan Rijn Zeevaart
PURPOSE: Radiopharmaceuticals containing the motive tripeptide arginyl-glycyl-asparatic acid (RGD) are known to target ανβ3 integrins during tumor angiogenesis. A more generic kit radiolabeling procedure accommodating Ga-68 from different generators was developed for NOTA-RGD and evaluated for its versatile use and safety in subsequent in vivo applications. The [(68)Ga]NOTA-RGD kit was further verified for its expected biodistribution and pharmacokinetics in nonhuman primates and its clinical sensitivity to detect solitary pulmonary nodules (SPN) in cancer patients...
October 14, 2016: Molecular Imaging and Biology: MIB: the Official Publication of the Academy of Molecular Imaging
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