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Practice Recommendations (practice + recommendation)

Distribution by Scientific Domains
Medical Sciences85%

Kinds of Practice Recommendations

  • clinical practice recommendation
    		•

    Selected Abstracts

    Changing aspirin use in patients with Type 2 diabetes in the UKPDS

    DIABETIC MEDICINE, Issue 12 2004
    C. A. Cull
    Abstract Aims To examine the proportion of UK Prospective Diabetes Study (UKPDS) patients with Type 2 diabetes taking aspirin regularly for the primary and secondary prevention of cardiovascular disease (CVD) before and after publication of the 1997 American Diabetes Association (ADA) Clinical Practice Recommendations and the 1998 Joint British Recommendations on the Prevention of Coronary Disease in Clinical Practice. Methods UKPDS annual review data from 1996/7 (n = 3190) and 2000/1 (n = 2467) were used to determine the prevalence of patients taking aspirin regularly in relation to known CVD risk factors and pre-existing CVD. Results Patients taking aspirin regularly were more often male than female (24 vs. 20%, P = 0.0033), older (66 ± 8 vs. 62 ± 9 years, P < 0.0001) and less often Afro-Caribbean than White Caucasian or Indian Asian (11 vs. 23 vs. 22%, respectively, P < 0.0001). Between 1996/7 and 2000/1 aspirin use in patients without pre-existing CVD increased from 17 to 31% (P < 0.0001) and for those with pre-existing CVD from 76 to 82% (P = 0.032). Conclusion The majority of patients with pre-existing CVD were taking aspirin regularly. Although aspirin use in those without pre-existing CVD approximately doubled after publication of the ADA and Joint British Recommendations, less than two-thirds of these high-risk patients were being treated according to guidelines. This may relate to a lack of convincing evidence for primary CVD prevention or failure to adhere to guidelines. It may be that more trial data is needed to convince clinicians of the value of aspirin therapy in Type 2 diabetes. [source]

    Meeting the Health Care Needs of a Rural Hispanic Migrant Population With Diabetes

    THE JOURNAL OF RURAL HEALTH, Issue 3 2004
    Loretta Heuer PhD
    ABSTRACT: Context: There is a need for models of health care that provide accessible, culturally appropriate, quality services to the population of Hispanic migrant farmworkers at risk for or diagnosed with diabetes. Purposes: The purposes of this study were to describe the Migrant Health Service, Inc (MHSI), Diabetes Program, the conceptual model on which it is based, and 4 types of outcomes achieved over a 3-year period. Methods: Types and amounts of medical services and education were studied. Qualitative data obtained from program records and documents were analyzed to determine the nature of the program. Quantitative data were used to measure outcomes of the program. Findings: The multiplecomponent MHSI Diabetes Program is addressing economic, cultural, and language barriers experienced by the target population. The program provides a continuum of health services and education that meet American Diabetes Association (ADA) Clinical Practice Recommendations on diabetes. The program exposes regional health care professionals and university students from numerous academic disciplines to Hispanic farmworker culture. Conclusions: Evidence-based program management, patient care, and program evaluation are traits of this program, which offers accessible, culturally appropriate, quality health services and education to Hispanic farmworkers. The multicomponent program model has high potential for positively impacting the health of the target population. [source]

    The Effects of Staffing on In-Bed Times of Nursing Home Residents

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2004
    Barbara M. Bates-Jensen PhD, CWOCN
    Objectives: To examine the effect of staffing level on time observed in bed during the daytime in nursing home (NH) residents. Design: Descriptive, cross-sectional study. Setting: Thirty-four southern California NHs. Participants: A total of 882 NH residents: 837 had hourly observation data, 777 had mealtime observations, 837 completed interviews, and 817 completed a physical performance test. Measurements: Cross-sectional data collected from participants at each NH site included direct observations (hourly and mealtime), resident interviews, medical record review, and physical performance tests. Results: In multivariate analyses, staffing level remained the strongest predictor of time observed in bed after controlling for resident functional measures (odds ratio=4.89; P=.042). Residents observed in bed during the daytime in more than 50% of hourly observations were observed also to experience increased daytime sleeping (P<.001) and less social engagement (P=.026) and consumed less food and fluids during mealtimes than those observed in bed in less than 50% of observations, after adjusting for resident function (P<.001). Conclusion: In this sample of NHs, resident functional measures and NH staffing level predicted observed time in bed according to hourly observations, with staffing level the most powerful predictor. Neither of these predictors justifies the excessive in-bed times observed in this study. Staff care practices relevant to encouraging residents to be out of bed and resident preferences for being in bed should be examined and improved. Practice recommendations regarding in-bed time should be considered, and further research should seek to inform the development of such recommendations. [source]

    Caregiver Understanding of Adolescent Development in Residential Treatment

    JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 4 2002
    Susan Kools PhD
    PROBLEM Caretaker knowledge and understanding of adolescent development and its application to clinical practice with severely emotionally disturbed adolescents in residential treatment. METHODS Twenty child-care workers and registered nurses participated in semistructured interviews analyzed using dimensional analysis, a grounded theory method. FINDINGS Three distinct categories of caregivers were identified based on level of expertise and engagement in developmentally appropriate treatment practices: inexperienced, party-liners, and transcenders. Developmental issues identified included lack of resident preparation for puberty and staff discomfort with adolescent sexuality. CONCLUSIONS Caregiver, institutional, and social barriers to developmentally sensitive practice were identified. Practice recommendations include direct preparation of children and adolescents in residential treatment for pubertal changes and sexual development, and carefkl discernment of age-appropriate and psycho-pathological adolescent behaviors. [source]

    Clinical review of Crohn's disease

    JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 8 2007
    APRN-BC, Brenda Ruthruff MSN, CWOCN (Adult Nurse Practitioner, Continence Nurse), Ostomy, Wound
    Abstract Purpose: This clinical review presents proposed theories regarding the etiology of Crohn's disease (CD), the pathophysiology of the disorder, and current diagnostic methods. Data sources: Pertinent publications in the literature, the Crohn's and Colitis Foundation web page, and relevant texts regarding pathophysiology of the gastrointestinal system. Conclusions: CD can be a devastating disease and difficult to diagnose. The advanced practice nurse (APRN) should be aware of the etiology, pathophysiology, diagnostic methods, and current treatment options of this disorder. Implications for practice: In collaboration with a gastroenterologist, APRNs can provide much needed information to the patient with CD. Practice recommendations include patient education, pain management, and support for quality of life issues. [source]

    State of the art in restless legs syndrome therapy: Practice recommendations for treating restless legs syndrome

    MOVEMENT DISORDERS, Issue S18 2007
    Wolfgang H. Oertel MD
    Abstract Dopaminergic agents are the best-studied agents and are considered first-line treatment of restless legs syndrome (RLS). Extensive data are available for levodopa, pramipexole, and ropinirole, which have approval for the indication RLS, and to a smaller extent for cabergoline, pergolide, and rotigotine. Apart from one recent study, comparing two active drugs (levodopa and cabergoline), no comparative studies have been published. The individual treatment regimen with the most appropriate agent concerning efficacy and side effects has to be selected by the treating physician. On the basis of these clinical trials and expert opinion of the authors, a treatment algorithm is proposed to support the search for the optimal individual treatment. Opioids and anticonvulsants such as gabapentine are second-line options in individual patients. Iron substitution is justified in people with iron deficiency related RLS (ferritin concentration lower than 50 ,g/L). © 2007 Movement Disorder Society [source]

    Evaluating conflicts of interest in research presented in CME venues

    THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2008
    Nancy L. Davis PhD
    Abstract Introduction: There is much in the literature regarding the potential for commercial bias in clinical research and in continuing medical education (CME), but no studies were found regarding the potential for bias in reporting original research in CME venues. This pilot study investigated the presence of perceived bias in oral and print content of research findings presented in certified CME activities. Methods: Research presentations at two national primary care CME activities, where authors had self-reported potential conflicts of interest, were peer reviewed and monitored for perceived commercial bias. Blinded and unblinded peer reviewers' and monitors' analyses of bias were compared to assess whether knowledge of potential conflicts of interest affected perceptions of bias. Results: Knowledge of potential conflicts of interest appeared to increase awareness of potential commercial bias with regard to use of a single product in care and assurance that there was reasonable evidence to support the practice recommendation. A perception of the presenter's strong opinion regarding care did not appear to be influenced by knowledge of a potential conflict of interest. Discussion: While limited, by study design, this research detected subjectivity and variability in perceiving commercial bias within research findings presented in CME venues. Further study of these questions is required to guide the resolution of conflicts of interest in research and CME. [source]

    Empirically informed approaches to topics in suicide risk assessment

    BEHAVIORAL SCIENCES & THE LAW, Issue 5 2004
    LaRicka R. Wingate M.S.
    The purpose of this article is to approach topics in suicide risk assessment from a scientifically informed standpoint. We summarize and elaborate a general framework for an empirically supported best practice recommendation in evaluating suicide potential and minimizing risk. This risk assessment framework provides a concise heuristic for assessment of suicidal symptoms, points the way to relatively routinized clinical decision-making and activity, and is compatible with best practices relevant to the legalities of suicide risk assessment. Having established a general and scientifically based framework for risk assessment, we go on to address the other questions noted above, with reference to the framework and to our ongoing scientific work. We conclude by summarizing all the work and providing clear and concise clinical recommendations based thereon. Copyright © 2004 John Wiley & Sons, Ltd. [source]

    Clinical practice recommendations for depression

    ACTA PSYCHIATRICA SCANDINAVICA, Issue 2009
    G. S. Malhi
    Objective:, To provide clinically relevant evidence-based recommendations for the management of depression in adults that are informative, easy to assimilate and facilitate clinical decision making. Method:, A comprehensive literature review of over 500 articles was undertaken using electronic database search engines (e.g. MEDLINE, PsychINFO and Cochrane reviews). In addition articles, book chapters and other literature known to the authors were reviewed. The findings were then formulated into a set of recommendations that were developed by a multidisciplinary team of clinicians who routinely deal with mood disorders. The recommendations then underwent consultative review by a broader advisory panel that included experts in the field, clinical staff and patient representatives. Results:, The clinical practice recommendations for depression (Depression CPR) summarize evidence-based treatments and provide a synopsis of recommendations relating to each phase of the illness. They are designed for clinical use and have therefore been presented succinctly in an innovative and engaging manner that is clear and informative. Conclusion:, These up-to-date recommendations provide an evidence-based framework that incorporates clinical wisdom and consideration of individual factors in the management of depression. Further, the novel style and practical approach should promote uptake and implementation. [source]

    Clinical practice recommendations for bipolar disorder

    ACTA PSYCHIATRICA SCANDINAVICA, Issue 2009
    G. S. Malhi
    Objective:, To provide clinically relevant evidence-based recommendations for the management of bipolar disorder in adults that are informative, easy to assimilate and facilitate clinical decision-making. Method:, A comprehensive literature review of over 500 articles was undertaken using electronic database search engines (e.g. MEDLINE, PsychINFO and Cochrane reviews). In addition articles, book chapters and other literature known to the authors were reviewed. The findings were then formulated into a set of recommendations that were developed by a multidisciplinary team of clinicians who routinely deal with mood disorders. These preliminary recommendations underwent extensive consultative review by a broader advisory panel that included experts in the field, clinical staff and patient representatives. Results:, The clinical practice recommendations for bipolar disorder (bipolar CPR) summarise evidence-based treatments and provide a synopsis of recommendations relating to each phase of the illness. They are designed for clinical use and have therefore been presented succinctly in an innovative and engaging manner that is clear and informative. Conclusion:, These up-to-date recommendations provide an evidence-based framework that incorporates clinical wisdom and consideration of individual factors in the management of bipolar disorder. Further, the novel style and practical approach should promote their uptake and implementation. [source]

    A Clinical Review of Infected Wound Treatment with Vacuum Assisted Closure® (V.A.C.®) Therapy: Experience and Case Series

    INTERNATIONAL WOUND JOURNAL, Issue 2009
    Allen Gabriel
    ABSTRACT Over the last decade Vacuum Assisted Closure® (KCI Licensing, Inc., San Antonio, TX) has been established as an effective wound care modality for managing complex acute and chronic wounds. The therapy has been widely adopted by many institutions to treat a variety of wound types. Increasingly, the therapy is being used to manage infected and critically colonized, difficult-to-treat wounds. This growing interest coupled with practitioner uncertainty in using the therapy in the presence of infection prompted the convening of an interprofessional expert advisory panel to determine appropriate use of the different modalities of negative pressure wound therapy (NPWT) as delivered by V.A.C.® Therapy and V.A.C. Instill® with either GranuFoamÔ or GranuFoam SilverÔ Dressings. The panel reviewed infected wound treatment methods within the context of evidence-based medicine coupled with experiential insight using V.A.C.® Therapy Systems to manage a variety of infected wounds. The primary objectives of the panel were 1) to exchange state-of-practice evidence, 2) to review and evaluate the strength of existing data, and 3) to develop practice recommendations based on published evidence and clinical experience regarding use of the V.A.C.® Therapy Systems in infected wounds. These recommendations are meant to identify which infected wounds will benefit from the most appropriate V.A.C.® Therapy System modality and provide an infected wound treatment algorithm that may lead to a better understanding of optimal treatment strategies. [source]

    Evaluation of the impact of restructuring wound management practices in a community care provider in Niagara, Canada

    INTERNATIONAL WOUND JOURNAL, Issue 2 2008
    Theresa Hurd
    Abstract The burden of chronic wounds is substantial, and this burden is set to increase as the population ages. The challenge for community health services is significant. Wound care is labour intensive, and demand for services is set to increase at a time when the availability of nursing resources is likely to be severely limited. In March 2005, the Niagara community health care provider implemented a radical reorganisation of wound management practices designed to ensure that available resources, particularly nurse time, were being used in the most efficient way. An evaluation of the impact of the reorganisation has shown improvements in clinical practice and better patient outcomes. The use of traditional wound care products reduced from 75% in 2005 to 20% in 2007 in line with best practice recommendations, and frequency of daily dressing changes reduced from 48% in 2005 to 15% in 2007. In a comparison of patients treated in 2005 and 2006, average time to healing was 51·5 weeks in 2005 compared with 20·9 weeks in 2006. Total treatment cost was lower in 2006 by $10 700 (75%) per patient. Overall, improvements in wound management practice led to a net saving of $3·8 million in the Niagara wound care budget. [source]

    Vignettes in Osteoporosis: A Road Map to Successful Therapeutics,

    JOURNAL OF BONE AND MINERAL RESEARCH, Issue 1 2004
    Clifford J Rosen
    Abstract The diagnosis and management of osteoporosis have become increasingly more complex as new drugs enter the marketplace and meta-analyses of randomized trials with "other" agents become more prolific. We describe five common clinical scenarios encountered in the practice of osteoporosis medicine and various road maps that could lead to successful therapy. Introduction: The diagnosis and treatment of osteoporosis have changed dramatically in the last decade. Advances in diagnostic technologies and a range of newer treatment options have provided the clinician with a wide array of choices for treating this chronic disease. Despite the issuance of several "guidelines" and practice recommendations, there still remains confusion among clinicians about basic approaches to the management of osteoporosis. This paper should be used as a case-based approach to define optimal therapeutic choices. Materials and Methods: Five representative cases were selected from two very large clinical practices (Bangor, ME; Pittsburgh, PA). Diagnostic modalities and treatment options used in these cases were selected on an evidence-based analysis of respective clinical trials. Subsequent to narrative choices by two metabolic bone disease specialists (SG and CR), calculation of future fracture risk and selection of potential alternative therapeutic regimens were reviewed and critiqued by an epidemiologist (DB). Results: A narrative about each case and possible management choices for each of the five cases are presented with references to justify selection of the various therapeutic options. Alternatives are considered and discussed based on literature and references through July 2003. The disposition of the individual patient is noted at the end of each case. Conclusions: A case-based approach to the management of osteoporosis provides a useful interface between guidelines, evidence-based meta-analyses, and clinical practice dilemmas. [source]

    A Selective Review of Maternal Sleep Characteristics in the Postpartum Period

    JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2009
    Lauren P. Hunter
    ABSTRACT Objective: To determine the current knowledge of postpartum womens' sleep patterns, sleep disturbances, consequences of sleep disturbances, and known strategies for prevention in order to provide best practice recommendations for health care providers. Data Sources: A literature search from 1969 through February 2008 was conducted using the CINHL, Index of Allied Health Literature, Ovid, PsycINFO, and PubMed electronic databases in addition to reference lists from selected articles and other key references. Search terms included sleep, postpartum, sleep deprivation, and sleep disturbance. Study Selection: A critical review of all relevant articles from the data sources was conducted with attention to the needs of postpartum womens' sleep and implications for health care providers. Data Extraction: Literature was reviewed and organized into groups with similar characteristics. Data Synthesis: An integrative review of the literature summarized the current state of research related to sleep alterations in postpartum women. Conclusions: Postpartum women experience altered sleep patterns that may lead to sleep disturbances. The most common reasons for sleep disturbances are related to newborn sleep and feeding patterns. Although present, the relationships among sleep disturbance, fatigue, and depression in postpartum women lack clarity due to their ambiguous definitions and the variety of the studies conducted. Providers should encourage prenatal education that assists the couple in developing strategies for decreasing postpartum sleep deprivation. Alterations of in-hospital care and home care should be incorporated to improve the new family's sleep patterns. [source]

    Modifying Women's Risk for Cardiovascular Disease

    JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 2 2007
    Kathleen M. McCauley
    Objective:, To present current recommendations for cardiovascular disease risk reduction in women. Data Sources:, Medline databases were searched from 1990 to 2006 using keywords women and cardiovascular risk, hypertension, cholesterol, and hormone replacement therapy, as well as Web sites from scientific associations such as the American Heart Association, American College of Cardiology, Agency for Health Research and Quality, and the Centers for Disease Control for relevant scientific statements and guidelines. Study Selection:, Randomized controlled trials, particularly those that have influenced current practice recommendations, scientific statements, and clinical practice guidelines were selected. Data Extraction and Synthesis:, Factors contributing to women's particular risk and current practice recommendations. Conclusions:, Current research has clarified the importance of regular exercise (at least 30 minutes/day most days of the week); abstinence from smoking; a diet focused on whole grains, fruits, vegetables, and low-fat protein sources; and maintenance of normal weight. This lifestyle combined with a partnership with a health care provider to maintain a normal blood pressure (115/75 mm Hg) and optimal lipoproteins through pharmacotherapy when indicated can prevent 82% of cardiovascular disease events in women. JOGNN, 36, 116-124; 2007. DOI: 10.1111/J.1552-6909.2007.00125.x [source]

    VENOUS NEEDLE DISLODGEMENT: HOW TO MINIMISE THE RISKS

    JOURNAL OF RENAL CARE, Issue 4 2008
    Jean-Pierre Van Waeleghem
    SUMMARY Although haemodialysis (HD) has become a routine treatment, adverse side effects, and occasionally life threatening clinical complications, still happen. Venous needle dislodgment (VND) is one of the most serious accidents that can occur during HD. If the blood pump is not stopped, either by activation of the protective system of the dialysis machine or manually, the patient can bleed to death within minutes. Fatal and near-fatal blood loss due to VND have been described in the literature (ECRI 1998; Sandroni 2005; Mactier & Worth 2007), but published reports represent only the tip of the ice berg, as such incidents are normally handled at a local or national level. The European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA) has produced 12 practice recommendations to help reduce the risk of VND and detect blood leakage as early as possible. A poster summarising these recommendations has been created (Van Waeleghem et al. 2008). [source]

    Paramedical treatment in primary dystonia: A systematic review,

    MOVEMENT DISORDERS, Issue 15 2009
    Cathérine C.S. Delnooz MD
    Abstract Dystonia is a disabling movement disorder with a significant impact on quality of life. The current therapeutic armamentarium includes various drugs, botulinum toxin injections, and occasionally (neuro)surgery. In addition, many patients are referred for paramedical (including allied health care) interventions. An enormous variation in the paramedical treatment is provided, largely because evidence-based, accepted treatment regimes are not available. We have conducted a systematic review of studies that explored the effect of various paramedical interventions in primary dystonia. Only studies that have used clinical outcome measures were included. There were no class A1 or A2 studies and therefore, level 1 or 2 practice recommendations for a specific intervention could not be deducted. Many papers were case reports, mostly with a very limited number of patients and a clear publication bias for beneficial effects of a particular paramedical intervention. Some potentially interesting interventions come from class B studies, which include physical therapy in addition to botulinum toxin injections (BoNT-A) in cervical dystonia; sensorimotor training and transcutaneous electrical nerve stimulation (TENS) in writer's cramp; and speech therapy added to BoNT-A injections in laryngeal dystonia. Good quality clinical studies are therefore warranted, which should have the aim to be generally applicable. A design in which the paramedical intervention is added to a current gold standard, for example, BoNT-A injections in cervical dystonia, is recommended. © 2009 Movement Disorder Society [source]

    When Immigration Is Trauma: Guidelines for the Individual and Family Clinician

    AMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 2 2001
    RoseMarie Perez Foster Ph.D.
    This paper considers two pertinent strands in the contemporary immigrant mental health literature: 1) the distinction made between stressors that are endemic to most immigrant experiences vs. those migration stressors that precipitate trauma per se; and 2) clinical guidelines that continue to refine the assessment of immigrants' presenting mental health problems, given the provision of services in institutions that are foreign to both the language and idioms of distress of the populations being served. Case vignettes highlight the research findings and practice recommendations. [source]

    Assessing violence risk in Tarasoff situations: a fact-based model of inquiry,

    BEHAVIORAL SCIENCES & THE LAW, Issue 3 2001
    Randy Borum Psy.D.
    Although significant advances in risk assessment research and practice have been made in recent years, there has not been any analysis in the professional literature regarding how and whether the emerging practice recommendations apply in Tarasoff -type situations. We suggest that, when faced with a Tarasoff -type situation, the appraisal of risk should be guided by a method that is primarily fact-based and deductive, rather than by the more inductive risk assessment approach for general violence recidivism, which is guided primarily by base rates and historical risk factors. We review the principles underlying a fact-based, or threat assessment, approach and outline six areas of inquiry that can guide the appraisal of risk: A,attitudes that support or facilitate violence, C,capacity, T,thresholds crossed, I,intent, O,other's reactions, and N,noncompliance with risk reduction interventions. Copyright © 2001 John Wiley & Sons, Ltd. [source]

    Vitamin D and Cardiovascular Prevention

    CARDIOVASCULAR THERAPEUTICS, Issue 4 2010
    M. Adnan Nadir
    Vitamin D has been known to medical science for almost a century. Yet, it is only in the last 15 years that we have realized that the biological effects of vitamin D extend far beyond the control of calcium metabolism. Recent observational evidence suggests strong links between low vitamin D levels and a range of cardiovascular conditions, including stroke, myocardial infarction, hypertension, and diabetes. Interventional studies are beginning to explore whether vitamin D supplementation can modify vascular health and prevent cardiovascular disease. This article reviews the physiology and function of vitamin D, examines the current observational and intervention data in cardiovascular disease, and discusses future research and current practice recommendations. [source]

    The implications of adoption for donor offspring following donor-assisted conception

    CHILD & FAMILY SOCIAL WORK, Issue 4 2001
    Eric Blyth
    ABSTRACT In this paper the authors, all experienced social workers with research and practice interests in assisted conception, review practices concerning access to genetic origins information in adoption, and consider to what extent these may be relevant for practice in donor-assisted conception. The paper concludes with policy and practice recommendations that take account of the views of donor offspring and their desire for increased information about their genetic heritage. [source]