Clinical Guidelines For Prevention Research Articles

The Dual Value of the Web: Risks and Benefits of the Use of the Internet in Disorders with A Self-Destructive Component in Adolescents and Young Adults

Eating disorders (ED) and non-suicidal self-injury (NSSI) present common aspects and factors which contribute to their onset and development. The last decade has seen an increasing circulation of online materials and interactions connected to ED and NSSI. There is a general agreement among mental health clinicians and researchers that this kind of online content involves serious risks, such as normalization and reinforcement of unhealthy behaviors, alongside with some benefits, like receiving peer support and validation. The aim of this paper is to offer an overview of major research contributions on this topic. After describing common aspects between these disorders, we analyze data concerning the usage of harm-advocating websites on internet and the characteristics of users. Furthermore, we define and explore the contents of both pro-ED and NSSI websites, and we extensively inspect risks and benefits of the exposure to these online content. Finally, we present clinical guidelines for assessment, intervention and prevention, particularly focusing on family interventions. Due to the rapidity of changes when technology is involved, the research on this topic is far from being concluded; more in-depth studies are needed, not only to explore long term effects of the use of the websites described, but also to investigate new alarming tendencies such as the diffusion of websites challenging self-destructive behaviors.

Validation and recalibration of the Framingham cardiovascular disease risk models in an Australian Indigenous cohort.

BackgroundIn Australia, clinical guidelines for primary prevention of cardiovascular disease recommend the use of the Framingham model to help identify those at high risk of developing the disease. However, this model has not been validated for the Indigenous population.DesignCohort study.MethodsFramingham models were applied to the Well Person’s Health Check (WPHC) cohort (followed 1998–2014), which included 1448 Aboriginal and Torres Strait Islanders from remote Indigenous communities in Far North Queensland. Cardiovascular disease risk predicted by the original and recalibrated Framingham models were compared with the observed risk in the WPHC cohort.ResultsThe observed five- and 10-year cardiovascular disease probability of the WPHC cohort was 10.0% (95% confidence interval (CI): 8.5–11.7) and 18.7% (95% CI: 16.7–21.0), respectively. The Framingham models significantly underestimated the cardiovascular disease risk for this cohort by around one-third, with a five-year cardiovascular disease risk estimate of 6.8% (95% CI: 6.4–7.2) and 10-year risk estimates of 12.0% (95% CI: 11.4–12.6) and 14.2% (95% CI: 13.5–14.8). The original Framingham models showed good discrimination ability (C-statistic of 0.67) but a significant lack of calibration (χ2 between 82.56 and 134.67). After recalibration the 2008 Framingham model corrected the underestimation and improved the calibration for five-year risk prediction (χ2 of 18.48).ConclusionsThe original Framingham models significantly underestimate the absolute cardiovascular disease risk for this Australian Indigenous population. The recalibrated 2008 Framingham model shows good performance on predicting five-year cardiovascular disease risk in this population and was used to calculate the first risk chart based on empirical validation using long-term follow-up data from a remote Australian Indigenous population.

Mediterranean diet as the diet of choice for patients with chronic kidney disease.

Traditional dietary management of chronic kidney disease (CKD) focuses on the quantity within the diet of energy and protein, and the restriction of single micronutrients, with little mention of dietary quality. Dietary patterns that are more plant-based, lower in meat (including processed meat), sodium and refined sugar, and have a higher content of grains and fibres are now included in multiple clinical guidelines for chronic disease prevention. The Mediterranean diet (MD) has been associated with reduced cardiovascular disease incidence in both observational and interventional studies. A wealth of evidence links MD with other beneficial effects on chronic diseases such as diabetes, obesity or cognitive health. This review examines each constituent of the classical MD and evaluates their suitability for the management of patients with CKD. We also evaluate the potential hyperkalaemia risk of increasing fruit and vegetable intake. Overall, a decrease in net endogenous acid production and increase in fibre may lead to a better control of metabolic acidosis. This, together with other putative favourable effects of MD on endothelial function, inflammation, lipid profile and blood pressure, provide mechanistic pathways to explain the observed reduced renal function decline and improved survival in CKD patients adhering to an MD.

The Accuracy of Hospital ICD-9-CM Codes for Determining Sickle Cell Disease Genotype

Sickle cell disease affects more than 100,000 individuals in the United States, among whom disease severity varies considerably. One factor that influences disease severity is the sickle cell disease genotype. For this reason, clinical prevention and treatment guidelines tend to differentiate between genotypes. However, previous research suggests caution when using a claimsbased determination of sickle cell disease genotype in healthcare quality studies. The objective of this study was to describe the extent of miscoding for the major sickle cell disease genotypes in hospital discharge data. Individuals with sickle cell disease were identified through newborn screening results or hemoglobinopathy specialty care centers, along with their sickle cell disease genotypes. These genotypes were compared to the diagnosis codes listed in hospital discharge data to assess the accuracy of the hospital codes in determining sickle cell disease genotype. Eighty-three percent (sickle cell anemia), 23% (Hemoglobin SC), and 31% (Hemoglobin Sβ+ thalassemia) of hospitalizations contained a diagnosis code that correctly reflected the individual's true sickle cell disease genotype. The accuracy of the sickle cell disease genotype coding was indeterminate in 11% (sickle cell anemia), 12% (Hemoglobin SC), and 7% (Hemoglobin Sβ+ thalassemia) and incorrect in 3% (sickle cell anemia), 61% (Hemoglobin SC), and 52% (Hemoglobin Sβ+ thalassemia) of the hospitalizations. The use of ICD-9-CM codes from hospital discharge data for determining specific sickle cell disease genotypes is problematic. Research based solely on these or other types of administrative data could lead to incorrect understanding of the disease.

Direct and indirect effects of attention and visual function on gait impairment in Parkinson's disease: influence of task and turning (Commentary on Stuart et al. (2017)).

Direct and indirect effects of attention and visual function on gait impairment in Parkinson's disease: influence of task and turning (Commentary on Stuart et al. (2017)).

Reaching beyond the review of research evidence: a qualitative study of decision making during the development of clinical practice guidelines for disease prevention in healthcare

BackgroundThe judgment and decision making process during guideline development is central for producing high-quality clinical practice guidelines, but the topic is relatively underexplored in the guideline research literature. We have studied the development process of national guidelines with a disease-prevention scope produced by the National board of Health and Welfare (NBHW) in Sweden. The NBHW formal guideline development model states that guideline recommendations should be based on five decision-criteria: research evidence; curative/preventive effect size, severity of the condition; cost-effectiveness; and ethical considerations. A group of health profession representatives (i.e. a prioritization group) was assigned the task of ranking condition-intervention pairs for guideline recommendations, taking into consideration the multiple decision criteria. The aim of this study was to investigate the decision making process during the two-year development of national guidelines for methods of preventing disease.MethodsA qualitative inductive longitudinal case study approach was used to investigate the decision making process. Questionnaires, non-participant observations of nine two-day group meetings, and documents provided data for the analysis. Conventional and summative qualitative content analysis was used to analyse data.ResultsThe guideline development model was modified ad-hoc as the group encountered three main types of dilemmas: high quality evidence vs. low adoptability of recommendation; insufficient evidence vs. high urgency to act; and incoherence in assessment and prioritization within and between four different lifestyle areas. The formal guideline development model guided the decision-criteria used, but three new or revised criteria were added by the group: ‘clinical knowledge and experience’, ‘potential guideline consequences’ and ‘needs of vulnerable groups’. The frequency of the use of various criteria in discussions varied over time. Gender, professional status, and interpersonal skills were perceived to affect individuals’ relative influence on group discussions.ConclusionsThe study shows that guideline development groups make compromises between rigour and pragmatism. The formal guideline development model incorporated multiple aspects, but offered few details on how the different criteria should be handled. The guideline development model devoted little attention to the role of the decision-model and group-related factors. Guideline development models could benefit from clarifying the role of the group-related factors and non-research evidence, such as clinical experience and ethical considerations, in decision-processes during guideline development.

Venous Thromboembolism in Children with Cancer and Blood Disorders.

Venous thromboembolism (VTE) in children is multifactorial and most often related to a combination of inherited and acquired thrombophilias. Children with cancer and blood disorders are often at risk for VTE due to disease-related factors such as inflammation and abnormal blood flow and treatment-related factors such as central venous catheters and surgery. We will review risk factors for VTE in children with leukemia, lymphoma, and solid tumors. We will also review risk factors for VTE in children with blood disorders with specific focus on sickle cell anemia and hemophilia. We will present the available evidence and clinical guidelines for prevention and treatment of VTE in these populations.

Clinical Practice Guidelines for Prevention, Diagnosis and Management of Early and Delayed-onset Ocular Injuries Due to Mustard Gas Exposure.

Purpose:To develop clinical practice guidelines (CPGs) for prevention, diagnosis, treatment and follow-up of ocular injuries caused by exposure to mustard gas.Methods:The clinical questions were designed by the guideline team. Websites and databases including National Guidelines Clearinghouse, National Institute for Clinical Excellence, Cochrane, and PubMed were searched to find related CPGs and explore possible answers to the clinical questions. Since there were no relevant CPGs in the literature, related articles in Persian and English languages were extracted. Each article along with its level of evidence was summarized. Additionally, hand search was performed by looking the reference list of each article. Consequently, recommendations were developed considering the clinical benefits and side effects of each therapeutic modality. The recommendations were re-evaluated in terms of customization criteria. All recommendations along with the related evidence were scored from 1 to 9 by experts from all medical universities of Iran. The level of agreement among the experts was evaluated by analyzing the given scores.Results:The agreement was achieved for all recommendations. The experts suggested a number of minor modifications which were applied to the recommendations. Finally, CPGs were developed with 98 recommendations under three major domains including prevention of injury, diagnosis and management of the acute and delayed-onset mustard gas ocular injuries.Conclusion:Considering the lack of CPGs for the prevention, diagnosis, and management of mustard gas-induced keratitis, these recommendations would be useful to prevent the serious ocular complications of mustard gas and standardize eye care services to the affected individuals.

Psychiatrists' experiences of suicide assessment.

BackgroundClinical guidelines for suicide prevention often stress the identification of risk and protective factors as well as the evaluation of suicidal intent. However, we know very little about what psychiatrists actually do when they make these assessments. The aim was to investigate psychiatrists’ own accounts of suicide assessment consultations, with a focus on their behaviors, attitudes and emotions.MethodSemi-structured in depth interviews were carried out with a purposive selection of 15 psychiatrists.ResultsThematic analysis revealed three main themes: understanding the patient in a precarious situation, understanding one’s own reactions, and understanding how the doctor-patient relationship impacted on risk assessment and management decisions. Emotional contact and credibility issues were common subthemes that arose when the respondents talked about trying to understand the patient. The psychiatrists stressed the semi-intuitive nature of their assessments. Problems related to the use of risk factor assessments and rating scales were apparent. Assessment consultations could evoke physical and emotional symptoms of anxiety, and concerns about responsibility could lead to repressive management decisions. In situations of mutual trust, however, the assessment consultation could kick-start a therapeutic process.ConclusionThis study highlights psychiatrists’ experiences in clinical suicide assessment situations. Findings have implications for professional development as well as for service delivery.

Poor adherence to guidelines for preventing central line-associated bloodstream infections (CLABSI): results of a worldwide survey.

BackgroundCentral line-associated bloodstream infections (CLABSI) are a cause of increased morbidity and mortality, and are largely preventable. We documented attitudes and practices in intensive care units (ICUs) in 2015 in order to assess compliance with CLABSI prevention guidelines.MethodsBetween June and October 2015, an online questionnaire was made available to medical doctors and nurses working in ICUs worldwide. We investigated practices related to central line (CL) insertion, maintenance and measurement of CLABSI-related data following the SHEA guidelines as a standard. We computed weighted estimates for high, middle and low-income countries using country population as a weight. Only countries providing at least 10 complete responses were included in these estimates.ResultsNinety five countries provided 3407 individual responses; no low income, 14 middle income (MIC) and 27 high income (HIC) countries provided 10 or more responses. Of the total respondents, 80% (MIC, SE = 1.5) and 81% (HIC, SE = 1.0) reported availability of written clinical guidelines for CLABSI prevention in their ICU; 23% (MIC,SE = 1.7) and 62% (HIC,SE = 1.4) reported compliance to the following (combined) recommendations for CL insertion: hand hygiene, full barrier precaution, chlorhexidine >0.5%, no topic or systemic antimicrobial prophylaxis; 60% (MIC,SE = 2.0) and 73% (HIC,SE = 1.2) reported daily assessment for the need of a central line. Most considered CLABSI measurement key to quality improvement, however few were able to report their CLABSI rate. Heterogeneity between countries was high and country specific results are made available.ConclusionsThis study has identified areas for improvement in CLABSI prevention practices linked to CL insertion and maintenance. Priorities for intervention differ between countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s13756-016-0139-y) contains supplementary material, which is available to authorized users.

Unstable carotid artery plaque: new insights and controversies in diagnostics and treatment.

Cardiovascular disease is estimated to be the leading cause of death, globally causing 14 million deaths each year. Stroke remains a massive public health problem and there is an increasing need for better strategies for the prevention and treatment of this disease. At least 20% of ischemic strokes are thromboembolic in nature, caused by a thromboembolism from an atherosclerotic plaque at the carotid bifurcation or the internal carotid artery. Current clinical guidelines for both primary and secondary prevention of stroke in patients with carotid stenosis caused by atherosclerotic plaques remain reliant on general patient characteristics (traditional risk factors for stroke) and static measures of the degree of artery stenosis. Patients with similar traditional risk factors, however, have been found to have different risk of stroke, and it has in recent years become increasingly clear that the degree of artery stenosis alone is not the best estimation of stroke risk. There is a need for new methods for the assessment of stroke risk to improve risk prediction for the individual patient. This review aims to give an overview of new methods available for the identification of carotid plaque instability and the assessment of stroke risk.

Should we reconsider the role of age in treatment allocation for primary prevention of cardiovascular disease?

Clinical practice guidelines for primary prevention of cardiovascular disease (CVD) are centred on a high-risk approach. The current role of cardiovascular risk assessment in clinical practice is two-fold. First, it serves as a starting point for risk communication between physicians and patients. Secondly, it is used as the primary mode to select candidates for lipid-lowering treatment (see Supplementary material online, Figures S1–S3 ).1–3 Based on an individual's age and risk factor profile, CVD risk calculators provide clinicians with an estimate of the individual's probability for developing CVD in the coming 10 years.4–6 Since CVD is highly age related, age is the strongest predictor for CVD in such calculators. In the most recent revisions of American and British prevention guidelines, risk thresholds for initiation of pharmacological treatment to reduce low-density lipoprotein (LDL) cholesterol have been substantially lowered. This decision has been driven by the accumulating data on the efficacy7,8 and safety profile9,10 of statins in primary prevention, as well as the low costs of generic statins. However, by lowering the thresholds, otherwise healthy older adults with minimal or no risk factors are now considered candidates for statin treatment solely by virtue of their age. Doctors are recommended to discuss statin initiation with men who have optimal risk factor levels at an age between 63 and 66 in the USA or UK ( Table 1 ). For women this is the case around the age of 70. As a consequence, the vast majority of individuals aged 55–65 and almost everyone aged ≥65 in the general population is currently considered a candidate for statin treatment in both the …

Developing clinical practice guidelines for caries prevention and management for pre-school children through the ADAPTE process and Delphi consensus.

BackgroundThis study aims to develop consensus evidence-based clinical guidelines for caries prevention and management by caries risk assessment for pre-school children in Hong Kong.MethodsEmploying the ADAPTE process, guidelines for caries prevention and management by caries risk assessment for pre-school children with a preliminary list of 91 recommendations was complied. External review of the guidelines was conducted by a panel of 41 reviewers from the Hong Kong Society of Paediatric Dentistry using a two-round web-based Delphi process. The reviewers were invited to contribute any comments on the draft-adapted guidelines and rated their agreement with each recommendation using a 9-point Likert scale. During the second round, 36 participants received anonymous feedback from the first round and assessed a narrowed list of 28 recommendations. Recommendations were retained and classified according to the median score and rating percentages by the reviewers.ResultsA total of 70 out of 91 recommendations were retained (five reached high consensus, 65 reached consensus), and 21 recommendations were discarded. Recommendations and guidelines were outlined.ConclusionsCaries prevention and management guidelines for pre-school children were developed for use in Hong Kong using the ADAPTE process and Delphi consensus to develop evidence-based recommendations. This can facilitate the translation of guidelines into dental practice.

Mechanism of anthracycline cardiotoxicity and analysis of mechanisms of cardioprotective effect of drugs and compounds of various chemical groups

Aim. Research of the main directions of the search of cytoprotectors under anthracycline antibiotics intoxication conditions for the further development and study of new potential cardioprotectors. Methods. The authors used synthesis and analysis method as the general scientific. Structural and functional, logical and semantic methods were used, as well as system and content analysis method. Results. Certain mechanisms of cardiotoxicity development, including oxidative stress development, activation of lipid peroxidation, antioxidants reduction, inhibition of nucleic acids and proteins synthesis, biogenesis disorder and mitochondrial fragmentation, etc., simultaneously causing the death of cardiomyocytes by necrosis and apoptosis activation, were studied. Among the offered potential cardioprotectors, known remedies of different chemical groups (Cardioxan, Carvedilol, Metformin, Telmisartan, Spironolactone, Trimetazidine, Phenytoin, Indole-3-Carbinol, etc.), biologically active substances of animal and plant origin were examined, and mechanisms of their action under anthracycline intoxication were offered. Nevertheless, despite numerous studies of potential cardioprotectors, at present time there is no specific clinical guideline for cardiomyopathy prevention after anthracycline antibiotics application, and cardiovascular diseases take first place among population mortality and disability causes in developed countries. Conclusion. Development and study of substances with optimal pharmacodynamic effects and pharmacokinetic parameters for myocardium structural and functional disorders correction are relevant and promising areas of research

The Japanese Breast Cancer Society clinical practice guidelines for epidemiology and prevention of breast cancer, 2015 edition.

The Japanese Breast Cancer Society clinical practice guidelines for epidemiology and prevention of breast cancer, 2015 edition.

Prediction of coronary artery disease risk based on multiple longitudinal biomarkers.

In the last decade, few topics in the area of cardiovascular disease (CVD) research have received as much attention as risk prediction. One of the well-documented risk factors for CVD is high blood pressure (BP). Traditional CVD risk prediction models consider BP levels measured at a single time and such models form the basis for current clinical guidelines for CVD prevention. However, in clinical practice, BP levels are often observed and recorded in a longitudinal fashion. Information on BP trajectories can be powerful predictors for CVD events. We consider joint modeling of time to coronary artery disease and individual longitudinal measures of systolic and diastolic BPs in a primary care cohort with up to 20 years of follow-up. We applied novel prediction metrics to assess the predictive performance of joint models. Predictive performances of proposed joint models and other models were assessed via simulations and illustrated using the primary care cohort.

사상체질병증 임상진료지침: 예방 및 위험인자

Clinical Practice Guideline for Sasang Constitutional Medicine: Prevention and Risk Fators of Sasangin Disease Na-Young Bae, Eui-ju Lee Dept. of Clinical Medicine, School of Korean Medicine, Pusan National University, Pusan, Korea Dept. of Sasang Constitutional Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea Objectives This research was proposed to present Clinical Practice Guideline (CPG) for Prevention of Sasangin disease pattern of Sasang Constitutional Medicine (SCM) and diseases closely related with Sasang constitution. Each CPG was developed by the national-wide experts committee consisting of SCM professors. Methods At first, we searched the literatures related to SCM such as 󰡔Dongeuisusebowon󰡕, Textbook of SCM and Clinical Guidebook of SCM. Also we searched the articles related to the studies about risk factors for Sasangin disease pattern of both at home and abroad. Finally, we selected leading risk factors of Sasangin disease pattern and developed CPG for prevention of Sasangin disease pattern of SCM. And then, we searched the literatures related SCM such as 󰡔Dongeuisusebowon󰡕 and the articles on the correlation between disease and Sasang constitution using case-control studies, observational studies or cross sectional studies of both at home and abroad. Next, we selected diseases closely related with Sasang constitution on the basis of articles including prevalence rate and odds ratio between disease and Sasang constitution and finally developed CPG for these diseases. Results and Conclusions We categorized risk factors of Sasang disease pattern into 2 types: non-modifiable and potentially modifiable. 3 items (age, sex and genetic factors) were classified as non-modifiable risk factors of Sasang disease pattern. 6 items (original symptom, stress, diet and nutrition, physical activity, alcohol and drug misuse) were classified as less well-documented or potentially modifiable risk factors of Sasangin disease pattern. We found out Sasang constitution is more likely to develop some diseases. It was proven that Sasang constitution increase the risk of hypertension, diabetes mellitus, metabolic syndrome, stroke, nonalcoholic fatty liver and obstructive sleep apnea. And there is high probability of Sasang constitution being potential risk factor for obesity, hyperlipidemia, allergy and cancer. Also, we found out Taeeumin is independent risk factor for hypertension, diabetes mellitus, metabolic syndrome, stroke, nonalcoholic fatty liver and obstructive sleep apnea. Therefore we recommend that Taeeumin need to prevent these disease by regular checkups and aggressive management.

Translation of clinical practice guidelines for childhood obesity prevention in primary care mobilizes a rural Midwest community.

The purpose of this project was to implement clinic system changes that support evidence-based guidelines for childhood obesity prevention. Adherence rates for prevention and screening of children in a rural Midwest primary care setting were used to measure the success of the program. Retrospective chart reviews reflected gaps in current practice and documentation. An evidence-based toolkit for childhood obesity prevention was used to implement clinic system changes for the identified gaps. The quality improvement approach proved to be effective in translating knowledge of obesity prevention guidelines into rural clinic practices with significant improvements in documentation of prevention measures that may positively impact the childhood obesity epidemic. Primary care providers, including nurse practitioners (NPs), are at the forefront of diagnosing, educating, and counseling children and families on obesity prevention and need appropriate resources and tools to deliver premier care. The program successfully demonstrated how barriers to practice, even with the unique challenges in a rural setting, can be overcome. NPs fulfill a pivotal primary care role and can provide leadership that may positively impact obesity prevention in their communities.

Child obesity service provision: a cross-sectional survey of physiotherapy practice trends and professional needs.

This study explored current physiotherapy practice trends for management of children who are overweight or obese. The professional needs of physiotherapists working with this population were also assessed, including the perceived need for physiotherapy clinical guidelines for prevention and management of children with obesity. A cross-sectional survey design was used, with questionnaires purposefully distributed through 13 key physiotherapy services throughout Australia. Snowball sampling resulted in completed questionnaires from 64 physiotherapists who provided services to children. Half (n=33, 52%) of respondents provided services specifically to overweight or obese children. Of those providing services, one-quarter had prior training specific to working with this population. Most used multi-disciplinary models (n=16, 76%) and provided under 5h of obesity-related services each week (n=29, 88%). Half (n=16, 49%) used body mass index as an outcome measure but more (n=25, 76%) used bodyweight. Only 14 (42%) assessed motor skills. The majority of respondents (n=57, 89%) indicated a need for physiotherapy guidelines to best manage overweight and obese children. Professional development priorities included: 'Educating children and families', 'Assessment methods' and 'Exercise prescription' for overweight and obese children. This data provides workforce intelligence to guide future professional training and inform development of clinical guidelines for physiotherapists in prevention and management of children with obesity and related chronic disease.

The international clinical practice guideline for prevention and treatment of pressure ulcers/injuries

The international clinical practice guideline for prevention and treatment of pressure ulcers/injuries