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Association Guidelines (association + guideline)
Kinds of Association Guidelines Selected AbstractsUpdated Japanese Urological Association Guidelines on prostate-specific antigen-based screening for prostate cancer in 2010INTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2010The Committee for Establishment of the Guidelines on Screening for Prostate Cancer Abstract The exposure rate of screening for prostate cancer using prostate-specific antigen (PSA) in Japan is still very low compared with that in the USA or western Europe. The mortality rate of prostate cancer will increase in the future and in 2020 it will be 2.8-fold higher than in 2000. Therefore, there is an urgent need to determine the best available countermeasures to decrease the rate of prostate cancer death. PSA screening, which can reduce the risk of death as a result of prostate cancer, should be offered to all men at risk of developing prostate cancer with fact sheets showing updated benefits and drawbacks of screening for prostate cancer. [source] Meeting American Diabetes Association Guidelines In Endocrinologist PracticeJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 2 2000C.D. Miller OBJECTIVE,To determine whether American Diabetes Association (ADA) guidelines can be met in the context of routine endocrinology practice. RESEARCH DESIGN AND METHODS,Charts were reviewed for a group of patients who were examined in 1998, followed for greater than or equal to 1 year, and had two or more visits during that year. Process measures and metabolic outcomes were studied for patients with type 2 diabetes, and glycemic control was assessed for patients with type 1 diabetes. RESULTS,A total of 1.21 patients with type 2 diabetes had a mean age of 63 years, a mean BMI of 31 kg/m(2), and a mean duration of diabetes of 12 years. Many had comorbidities or complications: 80% had hypertension, 64% had hyperlipidemia, 78% had neuropathy, 22% had retinopathy, and 21% had albuminuria. Management of type 2 diabetic patients was complex: 38% used oral hypoglycemic agents alone (54% of these were using two or more agents), 31% used oral hypoglycemic agents and insulin, and 26% used insulin alone, 42% of patients taking insulin therapy injected insulin three or more times per day. Within 12 months, 74% of patients had dilated eye examinations, 70% had lipid profiles, and 55% had urine albumin screening. Of the patients, 87% had a foot examination at their last visit. Blood pressure levels averaged 133/72 mmHg, cholesterol levels averaged 4.63 mmol/l, triglyceride levels averaged 1.99 mmol/l. HDL cholesterol levels averaged 1.24 mmol/l, and LDL cholesterol levels averaged 2.61. mmol/l. Random blood glucose levels averaged 8.0 mmol/l, and HbA(1c) levels averaged 6.9 +/, 0.1%. A total of 87% of patients had HbA(1c) levels less than or equal to 8.0%. A total of 30 patients with type 1 diabetes had mean age of 44 years, a mean BMI of 26 kg/m(2), and a mean duration of diabetes of 20 years. All type 1 diabetic patients used insulin and averaged 3.4 injections a day, their average HbA(1c) level was 7.1 +/, 0.2%, and 80% had HbA(1c) levels less than or equal to 8.0%. CONCLUSIONS,Although endocrinologists must manage patients with multifaceted problems, complex treatment regimens yield glycemic control levels comparable with the Diabetes Control and Complications Trial and allow ADA guidelines to be met in a routine practice setting. [source] Guideline Implementation Research: Exploring the Gap between Evidence and Practice in the CRUSADE Quality Improvement InitiativeACADEMIC EMERGENCY MEDICINE, Issue 11 2007Andra L. Blomkalns MD Translating research results into routine clinical practice remains difficult. Guidelines, such as the 2002 American College of Cardiology/American Heart Association Guidelines for the Management of Patients with Unstable Angina and non-ST-segment elevation myocardial infarction, have been developed to provide a streamlined, evidence-based approach to patient care that is of high quality and is reproducible. The Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation (CRUSADE) Quality Improvement Initiative was developed as a registry for non,ST-segment elevation acute coronary syndromes to track the use of guideline-based acute and discharge treatments for hospitalized patients, as well as outcomes associated with the use of these treatments. Care for more than 200,000 patients at more than 400 high-volume acute care hospitals in the United States was tracked in CRUSADE, with feedback provided to participating physicians and hospitals regarding their performance over time and compared with similar institutions. Such access to data has proved important in stimulating improvements in non,ST-segment elevation acute coronary syndromes care at participating hospitals for delivery of acute and discharge guideline-based therapy, as well as improving outcomes for patients. Providing quality improvement methods such as protocol order sets, continuing education programs, and a CRUSADE Quality Improvement Initiative toolbox serve to actively stimulate physician providers and institutions to improve care. The CRUSADE Initiative has also proven to be a fertile source of research in translation of treatment guidelines into routine care, resulting in more than 52 published articles and 86 abstracts presented at major emergency medicine and cardiology meetings. The cycle for research of guideline implementation demonstrated by CRUSADE includes four major steps,observation, intervention, investigation, and publication,that serve as the basis for evaluating the impact of any evidence-based guideline on patient care. Due to the success of CRUSADE, the American College of Cardiology combined the CRUSADE Initiative with the National Registry for Myocardial Infarction ST-segment elevation myocardial infarction program to form the National Cardiovascular Data Registry,Acute Coronary Treatment & Intervention Outcomes Network Registry beginning in January 2007. [source] Cumulative Dose of Hypertension Predicts Outcome in Intracranial Hemorrhage Better Than American Heart Association GuidelinesACADEMIC EMERGENCY MEDICINE, Issue 8 2007Christopher W. Barton MD BackgroundHypertension is common after intracranial hemorrhage (ICH) and may be associated with higher mortality and adverse neurologic outcome. The American Heart Association recommends that blood pressure be maintained at a mean arterial pressure (MAP) less than 130 mm Hg to prevent secondary brain injury. ObjectivesTo prospectively evaluate whether a new method of assessing hypertension in ICH more accurately identifies patients at risk for adverse outcomes. MethodsThe authors prospectively studied all patients presenting to two University of California, San Francisco hospitals with acute ICH from June 1, 2001, to May 31, 2004. Factors related to acute hospitalization were recorded in a database, including all charted vital signs for the first 15 days. Patients were followed up for one year, with their modified Rankin Scale (mRS) score at 12 months as primary outcome. Hypertension dose was determined as the area under the curve between patient MAP and a cut point of 110 mm Hg while in the emergency department (ED). The dose was adjusted for time spent in the ED (dose/timeed [d/ted]). Hypertension dose was divided into four categories (none, and progressive tertiles). Multivariate logistic regression was used to calculate the odds ratio for adverse mRS by tertiles of d/ted. ResultsA total of 237 subjects with an ED average (±SD) length of stay of 3.42 (±3.7) hours were enrolled. In a multivariate logistic regression model controlling for the effects of age, volume of hemorrhage, presence of intraventricular hemorrhage, race, and preexisting hypertension, there was a 4.7- and 6.1-fold greater likelihood of an adverse neurologic outcome (by mRS) at one and 12 months, respectively, in the highest d/ted tertile relative to the referent group without hypertension. ConclusionsHypertension after acute ICH is associated with adverse neurologic outcome. The dose of hypertension may more accurately identify patients at risk for adverse outcomes than the American Heart Association guidelines and may lead to better outcomes if treated when identified in this manner. [source] Profiles in Patient Safety: Antibiotic Timing in Pneumonia and Pay-for-performanceACADEMIC EMERGENCY MEDICINE, Issue 7 2006Jesse M. Pines MD The delivery of antibiotics within four hours of hospital arrival for patients who are admitted with pneumonia, as mandated by the Joint Commission for the Accreditation of Healthcare Organizations and the Centers for Medicare and Medicaid Services, has gained considerable attention recently because of the plan to implement pay-for-performance for adherence to this standard. Although early antibiotic administration has been associated with improved survival for patients with pneumonia in two large retrospective studies, the effect on actual patient care and outcomes for patients with pneumonia and other emergency department patients of providing financial incentives and disincentives to hospitals for performance on this measure currently is unknown. This article provides an in-depth case-based description of the evidence behind antibiotic timing in pneumonia, discusses potential program effects, and analyzes how the practical implementation of pay-for-performance for pneumonia conforms to American Medical Association guidelines on pay-for-performance. [source] The Impact of Race on the Acute Management of Chest PainACADEMIC EMERGENCY MEDICINE, Issue 11 2003Arvind Venkat MD Abstract Objectives: African Americans with acute coronary syndromes receive cardiac catheterization less frequently than whites. The objective was to determine if such disparities extend to acute evaluation and noninterventional treatment. Methods: Data on adults with chest pain (N= 7,935) presenting to eight emergency departments (EDs) were evaluated from the Internet Tracking Registry of Acute Coronary Syndromes. Groups were selected from final ED diagnosis: 1) acute myocardial infarction (AMI), n= 400; 2) unstable angina/non,ST-elevation myocardial infarction (UA/NSTEMI), n= 1,153; and 3) nonacute coronary syndrome chest pain (non-ACS CP), n= 6,382. American College of Cardiology/American Heart Association guidelines for AMI and UA/NSTEMI were used to evaluate racial disparities with logistic regression models. Odds ratios (ORs) were adjusted for age, gender, guideline publication, and insurance status. Non-ACS CP patients were assessed by comparing electrocardiographic (ECG)/laboratory evaluation, medical treatment, admission rates, and invasive and noninvasive testing for coronary artery disease (CAD). Results: African Americans with UA/NSTEMI received glycoprotein IIb/IIIa receptor inhibitors less often than whites (OR, 0.41; 95% CI = 0.19 to 0.91). African Americans with non-ACS CP underwent ECG/laboratory evaluation, medical treatment, and invasive and noninvasive testing for CAD less often than whites (p < 0.05). Other nonwhites with non-ACS CP were admitted and received invasive testing for CAD less often than whites (p < 0.01). African Americans and other nonwhites with AMI underwent catheterization less frequently than whites (OR, 0.45; 95% CI = 0.29 to 0.71 and OR, 0.40; 95% CI = 0.17 to 0.92, respectively). A similar disparity in catheterization was noted in UA/NSTEMI therapy (OR, 0.53; 95% CI = 0.40 to 0.68 and OR, 0.68; 95% CI = 0.47 to 0.99). Conclusions: Racial disparities in acute chest pain management extend beyond cardiac catheterization. Poor compliance with recommended treatments for ACS may be an explanation. [source] British HIV Association guidelines for the management of coinfection with HIV-1 and hepatitis B or C virus 2010HIV MEDICINE, Issue 1 2010G Brook First page of article [source] British HIV Association guidelines for immunization of HIV-infected adults 2008HIV MEDICINE, Issue 10 2008AM Geretti First page of article [source] British HIV Association guidelines for the treatment of HIV-1-infected adults with antiretroviral therapy 2008HIV MEDICINE, Issue 8 2008BG Gazzard First page of article [source] Genotypic antiretroviral drug resistance testing at low viral loads in the UKHIV MEDICINE, Issue 8 2008PA Cane Background Antiretroviral drug resistance testing is recommended in HIV-1 infected patients failing therapy in order to inform treatment selection. Although guidelines and test manufacturers recommend a viral load of at least 500,1000 HIV-1 RNA copies/mL for genotypic resistance testing to be performed, prompt management of virological failure could benefit from testing at lower viral load levels. Methods Laboratories undertaking genotypic resistance testing were asked to provide figures for the number of resistance tests undertaken at viral loads <2000 copies/mL, the success rates of such tests and the extent of resistance detected, all stratified for viral load levels. Results Of the replies received, most laboratories were attempting resistance testing at viral loads below the recommended guidelines, with variable success and outcomes. Conclusions This audit of current practice in the UK for undertaking genotypic resistance tests at viral loads <1000 copies/mL highlights the widespread use of such testing outside the British HIV Association guidelines. [source] Clinical Utility of Office-Based Cognitive Predictors of Fitness to Drive in Persons with Dementia: A Systematic ReviewJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2006Frank J. Molnar MDCM OBJECTIVES: To perform a systematic review of evidence available regarding in-office cognitive tests that differentiate safe from unsafe drivers with dementia. DESIGN: A comprehensive literature search of multiple databases including Medline, CINAHL, PsychInfo, AARP Ageline, and Sociofile from 1984 to 2005 was performed. This was supplemented by a search of Current Contents and a review of the bibliographies of all relevant articles. SETTING: English prospective cohort, retrospective cohort, and case-control studies that used accepted diagnostic criteria for dementia or Alzheimer's disease and that employed one of the primary outcomes of crash, simulator assessment, or on-road assessment were included. PARTICIPANTS: Two reviewers. MEASUREMENTS: The reviewers independently assessed study design, main outcome of interest, cognitive tests, and population details and assigned a Newcastle-Ottawa quality assessment rating. RESULTS: Sixteen articles met the inclusion criteria. Tests recommended by guidelines (e.g., the American Medical Association (AMA) and Canadian Medical Association guidelines) for the assessment of fitness to drive did not demonstrate robustly positive findings (e.g., Mini-Mental State Examination, Trails B) or were not evaluated in any of the included studies (e.g., Clock Drawing). Fifteen studies did not report any cutoff scores. CONCLUSION: Without validated cutoff scores, it is impossible to employ tests in a standardized fashion in front-line clinical settings. This study identified a research gap that will prevent the development of evidence-based guidelines. Recommendations to address this gap are that driving researchers routinely perform cutoff score analyses and that stakeholder organizations (e.g., AMA, American Geriatrics Society) sponsor consensus fora to review driving research methodologies. [source] Failure to distinguish systemic-onset juvenile idiopathic arthritis from incomplete Kawasaki disease in an infantJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 10 2007Haruki Komatsu Abstract: In an infant, an initial diagnosis of incomplete Kawasaki disease was made according to the American Heart Association guidelines. However, the diagnosis of systemic-onset juvenile idiopathic arthritis was established later. Physicians need to recognize that systemic-onset juvenile idiopathic arthritis can be mistaken for incomplete Kawasaki disease, even when the guidelines are used. [source] Homocysteine and cardiovascular disease: A review of current recommendations for screening and treatmentJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 3 2005KarenL. Purpose To review the literature for, and provide advanced practice nurses (APNs) with, current recommendations for screening and treatment of hyperhomocysteinemia. Data sources Medscape literature search of selected research studies and related journal articles. Conclusions While data from most epidemiologic studies support the argument that hyperhomocysteinemia is an independent risk factor for cardiovascular disease, the debate continues as to when screening and treating patients is appropriate. The consensus is that more randomized controlled trials are needed to further study the benefits of routine screening and the efficacy of treating hyperhomocysteinemia. Implications for practice Until the results of ongoing clinical trials are available, APNs should follow the American Heart Association guidelines for screening for elevated levels of homocysteine and continue to promote a well-balanced diet that includes foods rich in folic acid as part of health promotion through primary prevention. [source] The use of vasopressin for treating vasodilatory shock and cardiopulmonary arrestJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2009DACVIM, Richard D. Scroggin Jr. Abstract Objective , To discuss 3 potential mechanisms for loss of peripheral vasomotor tone during vasodilatory shock; review vasopressin physiology; review the available animal experimental and human clinical studies of vasopressin in vasodilatory shock and cardiopulmonary arrest; and make recommendations based on review of the data for the use of vasopressin in vasodilatory shock and cardiopulmonary arrest. Data Sources , Human clinical studies, veterinary experimental studies, forum proceedings, book chapters, and American Heart Association guidelines. Human and Veterinary Data Synthesis , Septic shock is the most common form of vasodilatory shock. The exogenous administration of vasopressin in animal models of fluid-resuscitated septic and hemorrhagic shock significantly increases mean arterial pressure and improves survival. The effect of vasopressin on return to spontaneous circulation, initial cardiac rhythm, and survival compared with epinephrine is mixed. Improved survival in human patients with ventricular fibrillation, pulseless ventricular tachycardia, and nonspecific cardiopulmonary arrest has been observed in 4 small studies of vasopressin versus epinephrine. Three large studies, though, did not find a significant difference between vasopressin and epinephrine in patients with cardiopulmonary arrest regardless of initial cardiac rhythm. No veterinary clinical trials have been performed using vasopressin in cardiopulmonary arrest. Conclusion , Vasopressin (0.01,0.04 U/min, IV) should be considered in small animal veterinary patients with vasodilatory shock that is unresponsive to fluid resuscitation and catecholamine (dobutamine, dopamine, and norepinephrine) administration. Vasopressin (0.2,0.8 U/kg, IV once) administration during cardiopulmonary resuscitation in small animal veterinary patients with pulseless electrical activity or ventricular asystole may be beneficial for myocardial and cerebral blood flow. [source] Cumulative Dose of Hypertension Predicts Outcome in Intracranial Hemorrhage Better Than American Heart Association GuidelinesACADEMIC EMERGENCY MEDICINE, Issue 8 2007Christopher W. Barton MD BackgroundHypertension is common after intracranial hemorrhage (ICH) and may be associated with higher mortality and adverse neurologic outcome. The American Heart Association recommends that blood pressure be maintained at a mean arterial pressure (MAP) less than 130 mm Hg to prevent secondary brain injury. ObjectivesTo prospectively evaluate whether a new method of assessing hypertension in ICH more accurately identifies patients at risk for adverse outcomes. MethodsThe authors prospectively studied all patients presenting to two University of California, San Francisco hospitals with acute ICH from June 1, 2001, to May 31, 2004. Factors related to acute hospitalization were recorded in a database, including all charted vital signs for the first 15 days. Patients were followed up for one year, with their modified Rankin Scale (mRS) score at 12 months as primary outcome. Hypertension dose was determined as the area under the curve between patient MAP and a cut point of 110 mm Hg while in the emergency department (ED). The dose was adjusted for time spent in the ED (dose/timeed [d/ted]). Hypertension dose was divided into four categories (none, and progressive tertiles). Multivariate logistic regression was used to calculate the odds ratio for adverse mRS by tertiles of d/ted. ResultsA total of 237 subjects with an ED average (±SD) length of stay of 3.42 (±3.7) hours were enrolled. In a multivariate logistic regression model controlling for the effects of age, volume of hemorrhage, presence of intraventricular hemorrhage, race, and preexisting hypertension, there was a 4.7- and 6.1-fold greater likelihood of an adverse neurologic outcome (by mRS) at one and 12 months, respectively, in the highest d/ted tertile relative to the referent group without hypertension. ConclusionsHypertension after acute ICH is associated with adverse neurologic outcome. The dose of hypertension may more accurately identify patients at risk for adverse outcomes than the American Heart Association guidelines and may lead to better outcomes if treated when identified in this manner. 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