Clinical management guideline for 21-hydroxylase deficiency(2026)

Glaucoma Clinical Guidelines

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surgical Management of Ulcerative Colitis.

Purpose. Type 2 diabetes mellitus (T2DM) is poorly managed in the Caribbean region; therefore, conducting an assessment on the content and quality of clinical guidelines could assist guideline developers in detecting and addressing information gaps. Hence, this study aimed to benchmark and compare the clinical guidelines for T2DM management from the Caribbean to guidelines developed internationally and by high-income countries. Methods. Seven T2DM management clinical guidelines were a priori selected from international and high-income country-specific clinical guidelines and then compared to the country-specific T2DM management clinical guidelines of the Caribbean region. Two reviewers independently assessed content (using a previously piloted data extraction form) and quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Results. The Caribbean clinical guideline was found to contain similar levels of T2DM management topics when compared to international and high-income country-specific clinical guidelines; however, one country-specific clinical guideline from New Zealand was found to have substantially lower levels of content. The clinical guideline from the Caribbean was found to be of low quality and could not be used in practice; however, only three comparator clinical guidelines were found to be of high quality and could be recommended for use in clinical practice. A further three comparator clinical guidelines could be used in practice with minor modifications. Conclusion. Although the T2DM management clinical guidelines from the Caribbean region contained high levels of content with regards to relevant topics, it was of insufficient quality to be used in clinical practice. Therefore, an alternative high-quality clinical guideline, as identified within this study, should be adopted and used within the Caribbean region to manage T2DM until a high-quality region-specific clinical guideline can be developed.

Background: Clinical management guidelines (CMGs) are decision support tools for patient care used by professionals, patients, and family caregivers. Since clinical experts develop numerous CMGs, their technical language hinders comprehension and access by nonmedical stakeholders. Additionally, the views of affected individuals and their families are often not incorporated into treatment guidelines. We developed an adequate methodology for addressing the needs and preferences of family and professional stakeholders regarding CMGs, a recently developed protocol for managing congenital disorders of glycosylation (CDG), a family of rare metabolic diseases. We used the CDG community and phosphomannomutase 2 (PMM2)-CDG CMGs as a pilot to test and implement our methodology. Results: We listened to 89 PMM2-CDG families and 35 professional stakeholders and quantified their CMG-related needs and preferences through an electronic questionnaire. Most families and professionals rated CMGs as relevant (86.5% and 94.3%, respectively), and valuable (84.3% and 94.3%, respectively) in CDG management. The most identified challenges were the lack of CMG awareness (50.6% of families) and the lack of plain language CMG (39.3% of professionals). Concordantly, among families, the most suggested solution was involving them in CMG development (55.1%), while professionals proposed adapting CMGs to include plain language (71.4%). Based on these results, a participatory framework built upon health literacy principles was created to improve CMG comprehension and accessibility. The outputs are six complementary CMG-related resources differentially adapted to the CDG community’s needs and preferences, with a plain language PMM2-CDG CMG as the primary outcome. Additionally, the participants established a distribution plan to ensure wider access to all resources. Conclusions: This empowering, people-centric methodology accelerates CMG development and accessibility to all stakeholders, ultimately improving the quality of life of individuals living with a specific condition and raising the possibility of application to other clinical guidelines.

Introduction: Inadequate management of acute traumatic pain in the prehospital stage is a fact, which has many physical and mental adverse effects. No clinical guideline for the pain management of prehospital trauma patients in Iran has been published yet. Aims: This study aimed at development and domestication of a clinical guideline for pharmacological management of pain in prehospital trauma patients. Materials and Methods: A multistage evolutionary study method was used. First, a systematic review of articles, books, and guidelines for prehospital acute pain management with a comprehensive approach was carried out, then clinical guidelines with the most relevance to the topic were selected, and their quality was evaluated with AGREE tools. Finally, the initial guideline was developed based on the recommendations of the most comprehensive ones. The Delphi method and experts panel were used to summarize the information and finalize the clinical guidelines recommendations. Results: A total of 38 clinical guidelines and 150 related articles were found, of which five more comprehensive clinical guidelines and the most relevant topics were identified and reviewed. The recommendations that were agreed on by the Delphi stage were considered as the final recommendations, and others were reviewed again in the panel of experts by making the necessary changes. Finally, the domestic clinical guideline with 52 recommendations in three areas (general, assessment, and drug recommendations) was developed. Conclusions: Iran prehospital emergency organizations can use the recommendations of this clinical guideline to improve the quality of care, satisfaction, and protect patients' right.

Chronic pain is highly prevalent and more common in people with chronic obstructive pulmonary disease (COPD) than people of similar age/sex in the general population. This systematic review aimed to describe how frequently and in which contexts pain is considered in the clinical practice guidelines (CPGs) for the broad management of COPD. Databases (Medline, Scopus, CiNAHL, EMbase, and clinical guideline) and websites were searched to identify current versions of COPD CPGs published in any language since 2006. Data on the frequency, context, and specific recommendations or strategies for the assessment or management of pain were extracted, collated, and reported descriptively. Of the 41 CPGs (English n = 20) reviewed, 16 (39%) did not mention pain. Within the remaining 25 CPGs, pain was mentioned 67 times (ranging from 1 to 10 mentions in a single CPG). The most frequent contexts for mentioning pain were as a potential side effect of specific pharmacotherapies (22 mentions in 13 CPGs), as part of differential diagnosis (14 mentions in 10 CPGs), and end of life or palliative care management (7 mentions in 6 CPGs). In people with COPD, chronic pain is common; adversely impacts quality of life, mood, breathlessness, and participation in activities of daily living; and warrants consideration within CPGs for COPD.

Introduction: Tai Chi is a moderate mindful physical activity with long historical practice. There are new and novel types and forms of Tai Chi with promising results. The aim of this narrative review was to assess the quantity of the presence of Tai Chi in clinical guidelines that recommended or mentioned Tai Chi globally. Materials and Methods: Three medical databases were searched from inception to November 1, 2021, the retrieved search results were screened by two authors according to inclusion and exclusion criteria. Literature in English language, which is a clinical guideline, and Tai Chi was mentioned or recommended in the text of the guideline were included. Results: A total of 1539 articles were retrieved after searching medical databases. Retrieved articles were screened by two authors for possible inclusion in this review. Finally, 50 clinical guidelines that mentioned Tai Chi were included. Tai Chi was recommended 38 times of the 50 included clinical guidelines that mentioned Tai Chi (76%). Tai Chi was mentioned mostly in clinical guidelines for pain management (n = 5), osteoarthritis (n = 5), and cancer (n = 5). Furthermore, Tai Chi was recommended in all included clinical guidelines for (pain management, low back pain, stroke, and Parkinson's disease). Conclusions: Tai Chi was recommended mostly in the management of pain and musculoskeletal diseases. Updating health promotion and chronic diseases management programs to include the new forms and types of mindful exercises according to the best scientific evidence is suggested. This review recommended performing future research and critical analysis assessing the quality of evidence of included clinical guidelines.

IntroductionThyroid nodules are common and fine-needle aspiration (FNA) biopsy is the standard of care for work-up to exclude thyroid cancer. In this study, we examined the discrepancy between daily practice and recommended diagnostic approach for management of thyroid nodules, based on history taking, laboratory, and imaging studies.MethodsThis was a retrospective chart review of 199 patients who had ultrasound-guided fine needle aspiration (UGFNA) performed at a Midwest academic medical center from January 2010 to December 2011. The quality measures were selected based on recommended clinical practice guidelines, including family history, history of neck radiation, neck symptoms, TSH test, and thyroid ultrasound.ResultsThe majority of patients were Caucasian females. Family history of thyroid cancer and childhood neck radiation exposure were documented in 79 subjects (40%) and 76 subjects (38%), respectively. Neck symptoms were documented in most subjects, including dysphonia (56.8%), dysphagia (69.9%), and dyspnea (41.2%). Most subjects had a TSH measured and an ultrasound performed prior to biopsy (75% and 86%, respectively).ConclusionsIt appears there is a gap between current patient care and clinical practice guidelines for management of thyroid nodules. Clinical history and ultrasound features for risk stratification of UGFNA were lacking, which could reflect physicians’ unfamiliarity with the guidelines. As thyroid nodules are common, enhancing knowledge of the current guidelines could improve appropriate work-up. Further studies are needed to identify factors associated with the poor compliance with clinical guidelines in management of thyroid nodules.

The coronavirus disease 2019 (COVID-19) pandemic affected cancer service delivery and the feasibility of following the standard treatment guidelines. The present paper describes the use of clinical care guidelines for cancer management in routine practice and the approach adopted towards cancer care during the COVID-19 pandemic in India. A web-based survey was done in 107 hospitals (including public and private health facilities) that hosted Hospital-Based Cancer Registries under the National Cancer Registry Programme. The participants comprised Principal Investigators of these registries, who were also medical, surgical, and radiation oncology clinicians. The survey was done between May 1, 2021, and July 31, 2021. Participants were provided with a web link for the survey questionnaire, confidential login, and password. The study found high utilization of Clinical Practice Guidelines (CPGs) during practice, with eight out of ten physicians constantly to referring them. The study reported lack of knowledge, skills, and training to administer the treatment based on the guidelines followed by organizational infrastructure and affordability of treatment by the patients as the factors hampering utilization. International clinical guidelines were preferred when compared to national guidelines. The COVID-19 pandemic decreased the use of CPGs, wherein six out of ten clinicians reported their use. Stakeholders who formulate clinical guidelines must consider the practical aspects and feasibility of implementing such guidelines during a pandemic and similar situations. This should be coupled with adequate changes in care practice to ensure optimal care delivery and a continuum of cancer care in routine and pandemic-imposed situations.

Children really are not little adults: What we can take away from the 2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices

Iterating Toward Convergence: Guideline Development and the Quality of Clinical Care

Objective: to analyze the global scientific literature regarding Protocols and Clinical Guidelines for tuberculosis management aimed at the Population Deprived of Liberty. Method: this is an integrative review conducted in electronic databases, repositories of protocols and clinical guidelines, government organization websites and gray literature. The search, selection and analysis were performed in pairs. A critical evaluation was performed using the Appraisal of Guidelines Research & Evaluation checklist and matrices of the extracted recommendations were constructed. Results: a total of 10 studies were included in the final analysis of the qualitative synthesis. Heterogeneity in developing the documents and the different recommended actions for TB in the context of liberty deprivation were identified. The protocols included actions for health promotion, disease prevention, screening, diagnosis and treatment of tuberculosis in the prison context. A general assessment of the guidelines’ adequacy ranged from 3 to 6, with a recommendation for use with modifications for all guidelines. Conclusions: clinical protocols and guidelines for tuberculosis management in prison settings were recommended with modifications for use, especially in the “rigor of development” and “editorial independence” areas. Therefore, the need to develop documents with scientific rigor and that safely transmit content is emphasized.

Focus

Developing Clinical Practice Guidelines.- Evaluation of Clinical Practice Guidelines.- Fundamentals and Role of Clinical Pathway in Clinical Guidelines: Application of a Clinical Pathway for Transurethral Resection of the Prostate.- Technical Evaluation and Its Ethics for New Interventional Treatment.- Issues in Clinical Studies for Development of Medical Devices in Japan.- Clinical Practice Guideline for Benign Prostate Hyperplasia in Japan.- Standard Treatment Modality for Ureteral Calculi.- Review of the Clinical Guidelines for Staghorn Calculi.- Standard Treatment Modality for Ureteropelvic Junction Obstruction.- Standard Treatment Modality for Female Stress Incontinence.

Prostate cancer (PCa) is the second most common cancer worldwide and the sixth leading cause of cancer deaths in men. In South Africa (SA), PCa accounts for ~13% of male deaths. The direct medical costs associated with PCa diagnosis and treatment according to the national clinical guidelines for prostate cancer control and management are not documented. To estimate the direct medical costs for localised PCa diagnosis and treatment according to the national clinical guidelines for prostate cancer control and management in SA. The direct medical costs for diagnosis and treatment of prostate cancer were estimated from the payer's perspective using a micro- costing approach, with a time horizon of 12 months. Cost items were identified from the national PCa clinical guidelines and quantified according to the treatment options for low- (LRPCa), intermediate- (IRPCa) and high-risk (HRPCa) categories. Cost data were obtained from different government databases. The unit costs and PCa incidence data from 2022 were then used to estimate total costs for treating all new PCa cases. Total costs were calculated for each treatment method listed in the clinical guidelines according to PCa risk categories. The total cost for treating 10 944 new PCa cases in 2022 was estimated at ZAR2.1 billion. Per patient costs ranged from ZAR7 265 to ZAR143 156 for LRPCa, ZAR8 926 to ZAR144 817 for IRPCa and ZAR14 874 to ZAR151 872 for HRPCa. The total cost for managing all patients with LRPCa, IRPCa and HRPCa were estimated at ZAR401.3 million, ZAR371.1 million and ZAR1.4 billion, respectively. This study estimated the cost for diagnosis and treatment of localised PCa according to national clinical guidelines for PCa control and management. The costs increased with each risk category of the cancer. The study highlights the need for policy-makers to increase early detection and management, to reduce the need for high-cost interventions.