Future Guidelines (future + guideline)

Distribution by Scientific Domains

Selected Abstracts

Teaching paediatric residents about learning disorders: use of standardised case discussion versus multimedia computer tutorial

Carolyn Frazer Bridgemohan
Background, We developed a standardised case-based educational exercise on the topic of childhood learning disorders, and a multimedia computerised adaptation of this exercise, as part of a national curriculum project based on the Bright Futures guidelines. Objective, To explore resident perceptions of the facilitated case discussion (FCD) and the computerised tutorial (CT). Design, Quasi-randomised comparison of two educational interventions. Setting, Preclinic teaching conferences at a large urban children's hospital. Participants, A total of 46 paediatric residents years 1,3 assigned to either FCD (n = 21) or CT (n = 25). Interventions, FCD residents met in groups of 8,12 with a trained facilitator for a structured case discussion, while CT residents worked in groups of 2,3 at a computer station linked to an interactive website. Outcome Measures, Participant responses during semistructured focus group interviews. Analysis, Focus group transcripts, field notes and computer logs were analysed simultaneously using qualitative grounded theory methodology. Results, Residents experienced CT as fun, offering flexibility, greater auditory and visual appeal and more opportunities for active learning. FCD allowed greater contact with expert faculty and made the material more relevant to clinical practice. FCD participants emphasised the clinical skills gleaned and stated that the learning experience would change their future patient management. Both groups reported that case discussion was more interactive than computer learning. Median time spent on learning was slightly shorter for the CT group. All groups of learners arrived at the correct final diagnosis. Conclusions, FCD and CT stimulate different types of learning among paediatric residents. Future studies are needed to determine how to integrate these two techniques to meet the learning needs of residents in diverse settings. [source]

Current guidelines applicable for the approval of topically applied dermatological drugs in the EU

Myrjam Dorothea Straube
Abstract Dermatologicals as well as other medicinal products are submitted to the rules governing medicinal products in the European Union (EU) (Directive 2001/83/EC). With appreciation of the EU enlargement those regulatories deserve a recent consideration with special regard to the peculiarities of external dermatological therapy, recently passed novel and future guidelines. As regards the criteria for authorization of a medicinal product it is set out in Regulation (EEC) 2309/93 Article 11(1) that a marketing authorization shall be refused if it appears that the quality, the safety or efficacy of the medicinal product have not been adequately or sufficiently demonstrated by the applicant. Article 26(1) of Council Directive 2001/83/EC is worded a little differently but the criteria are the same irrespective of the procedure for the marketing authorization. For the final evaluation of the benefit/risk profile of a topically applied dermatological medicinal product not only the active agent but the whole galenic formulation as well has to be taken into account as the extent of penetration of the active compound might be influenced by changing the non-active substances. Furthermore the vehicle itself , independent of the active agent , influence the dermatological disorder, often in dependence on the stage of the dermatopathy. With special concern to safety/tolerability the (photo)toxic and (photo)allergic potential of the dermatological drug have to be taken into consideration too. In case of total body therapy in children the differing percutaneous resorption due to another body surface/body weight relation deserves special concern. The following review gives a survey of the current most important EU-guidelines for the evaluation of the benefit/risk profile of topically applied dermatological medicinal drugs and an outlook on further developments. As systemically applied dermatological medicinal products are assessed like other systemically applied drugs they are not treated in the following contribution. [source]

Ionic dialysance: Principle and review of its clinical relevance for quantification of hemodialysis efficiency

Lucile Mercadal
Ionic dialysance (D) is an online measured variable now available on several dialysis monitors to evaluate small-solute clearance. Based on conductivity measurements in the inlet and outlet dialysate, the principle of the measurement and the different measurement methods are described. Studies that have evaluated the reliability of ionic dialysance to assess dialysis efficiency are discussed. These studies are divided into two groups: the first comparing ionic dialysance to urea clearance and the second comparing Dt/V to Kt/Vurea, in which the uncertainties of the measurement of Vurea could have misrepresented the relationship between Dt/V and Kt/Vurea. When Kt/Vurea via the Daugirdas second-generation equation taking the rebound into account is considered, slight,even nonsignificant,differences are evidenced between Kt/Vurea and Dt/V. Therefore, ionic dialysance should be considered as a valid measure in future guidelines for dialysis efficiency. [source]

Evaluating evidence-based practice within critical care

Helen O'Neal
Abstract Background and Aims:, Between 2002-2005 the Trust undertook an action research project to evaluate a corporate practice development strategy. During this period clinicians became practitioner-researchers utilising a variety of methods to evaluate the influence of practice development. One aspect of this focused upon evaluation of evidence based guidelines. This article concentrates upon this process and the learning from this within critical care. Method:, Within critical care it was recognised that the standard of guidelines and protocols varied in terms of the amount of evidence used to underpin decision making. A group was set up to evaluate and appraise these using a structured format such as the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. Findings:, The initial evaluation (cycle 1) highlighted learning associated with the process of using the instrument within critical care, as well as where the quality of the guidelines could be improved. The second cycle of evaluation demonstrated that implementation of the action plans as a consequence of cycle 1 resulted in an improvement in the quality of the guidelines. It also resulted in streamlining the process of undertaking guideline appraisal across a Trust. Discussion and Conclusions:, Action resulting from analysis of the findings of cycle 1 led to a cultural change in which the structure of a tool such as the AGREE instrument could be beneficial in the development of future guidelines. This has been sustained both within critical care and Trust wide with various initiatives such as the establishment of critical care multidisciplinary guideline development groups and a Trust wide electronic library management system. [source]

Characteristics of patients with coronary artery disease and hypertension: A report from INVEST

Serap Erdine M.D.
Abstract In all, 22,599 patients with coexisting hypertension and coronary artery disease (CAD) from around the world are enrolled in the INternational VErapamil SR/trandolapril STudy (INVEST). As a result, much will be learned regarding the use of treatment strategies using verapamil SR and atenolol with and without trandolapril and/or hydrochlororthiazide in patients with hypertension and CAD, all of whom are at high risk for adverse cardiovascular outcomes. This trial will provide meaningful data on optimal treatment strategies for hypertension, especially among patients who are elderly, have diabetes, have left ventricular hypertrophy, or who are dyslipidemic. This trial will be the first to use Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) guidelines as blood pressure goals to determine the relative benefits of a calcium antagonist versus a beta-blocker strategy in reducing morbidity and mortality. In addition, women and Hispanic patients participating in INVEST will provide the largest controlled experience in the management of hypertensive patients with CAD, facilitating the development of future guidelines. [source]