Clinical Practice Guidelines Research Articles

Differential impact of clinic BP target on the prevalence and predictors of the masked uncontrolled hypertension and white-coat uncontrolled hypertension

Abstract Background Although intensive blood pressure (BP) control have been advocated, major clinical practices guidelines still recommend clinic BP (cBP) < 149/90 mmHg as the target for antihypertensive therapy. But, cBP targets could influence the prevalence and predictors of any hypertension phenotype. We investigated how different cBP targets impacted on the prevalence and predictors of masked uncontrolled hypertension (MUCH) and white-coat uncontrolled hypertension (WUCH) using the Korean Ambulatory Blood Pressure (KorABP) registry. Methods A multicenter prospective longitudinal cohort study was performed in outpatients with hypertension. Among 5,965 patients enrolled in the KorABP registry, 1,601 patients on antihypertensive medications with a valid ambulatory BP monitoring record were included in this study. Two different cBP targets, <130/80mmHg (intensive) and <140/90 mmHg (conventional) were investigated. Results Controlled ambulatory BP (aBP; <130/80 mmHg) was observed in 472 patients (29.5%). Controlled cBP was shown in 348 patients (21.7%) with the intensive cBP target and in 697 patients (43.5%) with the conventional cBP target. Controlled hypertension, WUCH, MUCH and uncontrolled hypertension were found in 294, 174, 54, and 1,075 patients with the intensive target and in 378, 94, 319 and 810 patients with the conventional target, respectively. Among the patients with controlled cBP, the prevalence of MUCH markedly decreased with the intensive target (15.5%), compared to the conventional target (45.8%). In contrast, among the patients with uncontrolled cBP, the prevalence of WUCH had only 3.8% increase with the intensive target (10.4%), compared to the conventional target (14.2%) (Figure 1). With the conventional target, 75.9% of patients with MUCH had cBP between 130/80 mmHg and 139/89 mmHg. The concordance between the controlled aBP and controlled cBP was higher with the intensive target than with the conventional target (Cohen’s κ 0.62 [0.58-0.67] vs. 0.46 [0.41-0.50]). The logistic models for MUCH included the left ventricular mass index and underuse of antihypertensive drugs (<2 types of drugs) as the common predictors of the both targets. With the conventional target, clinic systolic BP and diastolic BP were the strongest predictors of MUCH, but the cBP was not a predictor of MUCH with the intensive target. The logistic models for WUCH included beta-blocker use, increased heart rate and lower waist circumference and clinic systolic BP as the common predictors of WUCH with the both target. The logistic model for MUCH performed better with the conventional target, whereas the logistic model for WUCH performed better with the intensive target (Figure 2). Conclusion The use of the intensive cBP target (<130/80 mmHg) could reduce the prevalence of MUCH with minimal increase in the prevalence of WUCH and would provide the better assessment for the BP control status than the use of the conventional cBP target (<140/90 mmHg).Figure 1Figure 2

Prevalence and Correlates of Cannabis Use among Cancer Survivors

Abstract Background Delaware has legalized marijuana use for both medical and recreational use. This study identified factors associated with cannabis use among adults with chronic relative to individuals without a history of cancer in the First State. Methods Combined data (2020, 2021 and 2022) from the Behavioral Risk Factor Surveillance System (BRFSS) were analyzed for Delaware. Multivariable logistic regression examined individual-level demographic, socio-economic, clinical, and behavioral predictors associated with marijuana use stratified by history of cancer. Results Cannabis use was lower among cancer survivors compared to individuals with no history of cancer (6.76% vs. 13.43%). However, a higher proportion of cancer survivors reported use for medical purposes (75.13% vs. 64.28%). Marijuana use prevalence decreased with age among cancer survivors. After adjusting for sex, age, educational attainment, self-reported race/ethnicity, mental health status and physical health status, current smoking (odds ratio [OR], 4.24 vs. 2.74) and binge drinking (OR, 2.45 vs. 1.75) were associated with cannabis use in both groups. Conclusions Adults with cancer were more likely to use marijuana. Marijuana use prevalence decreased with age. Public perceptions of marijuana is becoming more acceptable. Risk of medical conditions such as cancer increase with age. As such, older adults might also become consumers of marijuana. Clinicians should screen for marijuana use among patients and initiate open discussions with patients about the benefits and risks associated with marijuana. Key messages • Need for ongoing cannabis research to better understand and inform its use for medical purposes. • Development of high-quality standardized education materials and clinical practice guidelines for marijuana use.

Continuing Professional Development (CPD) and Vocational Education and Training (VET) in Periodontology and Implant Dentistry.

To (i) evaluate structured postgraduate part-time programs in periodontology, including those addressing peri-implant diseases, among members of the European Federation of Periodontology (EFP), (ii) the impact of the 2018 classification scheme and EFP clinical practice guidelines and (iii) propose a framework for periodontal vocational education and training. A summary of relevant European guidelines for vocational education and training was compiled. In a survey and in a systematic review, current part-time programs in continuing professional education in periodontology as well as in prevention and management of peri-implant diseases were examined. The implementation and dissemination of the 2018 classification scheme and the EFP clinical practice guidelines were assessed by literature analysis. Based on these findings, a framework for periodontal vocational education and training was generated. Part-time programs for professional development in periodontology are established in nine EFP member countries. The systematic review identified lack of knowledge in prevention and management of peri-implant diseases among dental practitioners and hygienists. Continuing professional development was found to be important for education in prevention, classification and management of periodontal as well as peri-implant diseases. The proposed European framework consists of an escalator model with three levels (certificate, diploma and master). Considering the identified variation in the national programs, there is a need to improve education in periodontal and peri-implant diseases. The proposed frameworkmay will help harmonize the national structures. The proposed framework for part-time professional development is expected to enhance professional qualification.

Measuring guideline adherence in physiotherapy: A scoping review of methodological approaches.

Clinical practice guidelines summarise the existing evidence on specific health conditions and aim to optimise quality of care by providing evidence-based recommendations. Studies have reported a gap between research findings and clinical practice in physiotherapy. Guideline adherence is often used as a measure of agreement between therapeutic care and guideline recommendations. However, there is currently no standardised methodological approach for measuring guideline adherence. The objective of this scoping review was to summarise the methods and results of studies that assessed guideline adherence in physiotherapy. MEDLINE, EMBASE, PEDro and CENTRAL databases were searched for relevant literature up to December 2022. Published reports of observational studies and controlled clinical trials that provided information on the assessment of guideline adherence in physiotherapists were included. The selection process was performed independently by two reviewers. The methodological quality of the identified reports was not assessed. Results were summarised narratively. From a total of 2560 potentially relevant records, 53 reports were included in the analysis. Physiotherapists' adherence to guidelines was primarily assessed in the context of musculoskeletal conditions, such as low back pain (n = 25, 47.2%) and osteoarthritis (n = 8, 15.1%). A wide range of measurement approaches were used with the majority of reports using web-based surveys (n = 21, 39.6%), followed by chart reviews (n = 17, 32.1%). Most reports (n = 21, 39.6%) provided information on the level of adherence in terms of frequency dichotomising (self-reported) clinical practice as adherent or non-adherent. Adherence rates varied widely between included reports. Although the large number of included reports indicates a high level of interest in the topic of guideline adherence, there is considerable heterogeneity between studies regarding the methodological approaches used to assess guideline adherence in physiotherapists. This reduces the comparability of the study results. INPLASY (registration no. 202250081). Registered on 12th May 2022.

Thyroid function status in patients with hypothyroidism on thyroxine replacement and associated factors: a retrospective cohort study in primary care

BackgroundLong-term management of patients with hypothyroidism on thyroxine replacement requires thyroid function test (TFT) monitoring once every six–12 months as recommended by clinical practice guidelines. This study determined their thyroid function status during two-year follow-up visits in primary care, and the factors influencing their thyroid status, and assessed the optimal interval for TFTs.MethodsA retrospective cohort study was conducted on adults with a clinical diagnosis code for hypothyroidism in their electronic health records taken from a group of polyclinics in Singapore between July 2017 and June 2020. The follow-up thyroid status was categorized as under-replacement (TSH ≥ 3.70mIU/L), over-replacement (TSH ≤ 0.65mIU/L) or euthyroid (TSH 0.65–3.70mIU/L). The patients’ demographic, clinical and TFT data were analyzed using appropriate statistical tests during the two-year follow-up. Stepwise logistic regression analysis identified the factors associated with suboptimal thyroid control. Kaplan–Meier analysis was used to compare their thyroid function status in association with the interval between TFT monitoring.ResultsData from 5,749 eligible subjects (mean age 62.1 ± 13.29 years; 79% female; 79.7% Chinese) were analyzed. After a two-year follow-up, 61.9% (n = 3558) of all subjects were euthyroid, with 29.5% (n = 1694) being under-replaced and 8.6% (n = 497) over-replaced. However, thyroid status did not differ significantly with the various dose regimen (daily, segmented, or alternate days) (p = 0.193). Stepwise logistic regression showed that thyroxine under-replacement was significantly associated with the male gender (AOR = 1.25,95%CI = 1.03–1.51,p = 0.02) and obesity (AOR = 1.34,95%CI = 1.08–1.66,p = 0.008). Every unit (μg/kg body weight) increase in the mean daily thyroxine dose was associated with 2.72 times greater odds of over-replacement. When comparing thyroid function monitoring at intervals of 13-24 months, monitoring at shorter intervals (≤ 12 months) was less likely to detect thyroxine under-replacement (AOR = 0.57,95%CI = 0.44–0.74,p < 0.001) and over-replacement (AOR = 0.62,95%CI = 0.41–0.97,p = 0.033). Among the 3,312 adults who were euthyroid at baseline, 22.2%, 41.7% and 59.6% had suboptimal thyroid control at 6, 12 and 24 months respectively (Kaplan–Meier analysis).ConclusionAround six in ten patients were euthyroid with thyroxine replacement for hypothyroidism in primary care over two years. Thyroxine under-replacement was associated with male gender and obesity. The proportion of euthyroid patients developing abnormal thyroid function doubled with TFTs at six, 12 and 24-month intervals.

Applicability of heart failure clinical practice guidelines in low- and middle-income countries.

Clinical practice guidelines are commonly written by professional societies in high-income countries (HIC) with limited anticipation of implementation obstacles in other environments. We used heart failure (HF) guidelines as a paradigm to examine this concern, by conducting a survey to understand clinicians' ability to implement HF guidelines and their perceptions of the current HF guideline applicability in low- and middle-income countries (LMIC). An online survey of physicians in the database of the Translational Medicine Academy who treat HF patients was offered by email from 5 October to 27 November 2023, inquiring of participants' demographic information, experience, and views of HF guidelines as related to their practice. Of 2622 participating clinicians, 1592 partially completed, and an additional 1030 fully completed the survey. Participants were from 138 countries; 668 practiced in HIC, and 1954 in LMIC. Those from LMIC regarded HF guidelines to be less applicable in their country than did those from HIC (p = 0.0002). Of all those responding, 75.3% indicated that it was somewhat or mostly true that the HF guidelines were mostly applicable to HIC. Those from LMIC, but not HIC indicated that the greatest implementation obstacle was that the guidelines were for HIC (51.3% vs. 43.1%; p = 0.0387). A significantly higher proportion of respondents from LMIC indicated that resources for caring for their patients were somewhat or mostly limiting in most cases, than did those in HIC (41.6% vs. 32.5%, p = 0.0068). This survey examined the widely-held thought that HF guidelines are broadly applicable to all regions of the world, concluding that such a perception is incorrect. Clinicians from LMIC view the absence of consideration of local resource limitations as the greatest obstacle for guideline implementation. The results regarding HF guidelines likely also have implications for other guidelines and resultant patient outcomes.

Optimización de la triple terapia en el tratamiento del cáncer de próstata hormonosensible metastásico

Triple therapy with docetaxel, androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs) has demonstrated survival benefits in patients with metastatic hormone-sensitive prostate cancer (mHSPC), especially in those with high-risk disease. However, once the use of ADT and docetaxel is established, guidelines do not clearly specify which ARPI is most appropriate. In this work, a literature review to identify phase III clinical trials, systematic reviews, meta-analyses, and clinical practice guidelines on triple therapy in mHSPC was carried out. Evidence and recommendations were qualitatively reviewed to provide guidelines on the most suitable ARPI based on patient risk, disease volume, and nature of metastases (synchronous or metachronous). This review aims to update the previously published consensus on the optimal pharmacological treatment for mHSPC and to expose the opinions of hospital pharmacy, urology and medical and radiation oncology experts.

Low-value interventions to deimplement: A secondary analysis of a systematic review of low back pain clinical practice guidelines.

To perform a secondary review of low back pain (LBP) clinical practice guidelines (CPG) identified in a recently conducted systematic review and to synthesize and summarize low-value recommendations as practices that may be candidates for deimplementation. LBP (subacute or chronic) CPGs in English (symptom based, created by a governmental or professional society, published between January 1990 and May 2020) were previously identified using MEDLINE, EMBASE, CINAHL, Ortho Guidelines, CPG Infobase, Emergency Care Research Institute, Guidelines International Network, National Institute of Health and Care Excellence, and Scottish Intercollegiate Guideline Network. Twenty-one CPGs were reviewed from a systematic review (previously published). Full-text review of all 21 CPGs was conducted, and three recommendation categories indicative of low value (recommend strongly against, recommend weakly against, inconclusive/insufficient evidence) were identified using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) language and approach. One hundred thirty-five low-value recommendations were identified and classified under eight intervention categories: orthotics/support, traction, physical modalities, pharmacological interventions, injections, surgery, bed rest, and miscellaneous. Traction, transcutaneous electrical nerve stimulation (TENS), therapeutic ultrasound (TUS), and selective serotonin reuptake inhibitors (SSRI) had the most CPGs recommend strongly against their usage. Opioids were recommended strongly against by four CPGs. No significant difference (p > .05) was found between CPG quality and a specific deimplementation recommendation or between CPG quality and the number of strongly against, weakly against, and inconclusive/insufficient evidence recommendations. Clinicians managing patients with chronic LBP should consider deimplementing these low-value interventions (traction, TENS, TUS, and SSRI).

Summary for Clinicians: Clinical Practice Guideline for the Detection of Bronchiolitis Obliterans Syndrome Following Pediatric Hematopoietic Stem Cell Transplant.

Summary for Clinicians: Clinical Practice Guideline for the Detection of Bronchiolitis Obliterans Syndrome Following Pediatric Hematopoietic Stem Cell Transplant.

Collaborative and integrated working between general practice and community pharmacies: A realist review of what works, for whom, and in which contexts.

Collaborative and integrated (C + I) working between general practice and community pharmacies has the potential to increase accessibility to services, improve service efficiency and quality of care, and reduce health care expenditures. Many existing studies report challenges and complexities inherent in establishing effective C + I ways of working. The aim of our review is to understand how, when and why working arrangements between General Practitioners (GP) and Community Pharmacists (CP) can provide the conditions necessary for effective communication, decision-making, and C + I working. We conducted a realist review to explore the key contextual factors and mechanisms through which GP-CP C + I working may be achieved. MEDLINE, Embase, CINAHL, PsycINFO, HMIC, Web of Science, IBSS, ASSIA, Sociological Abstracts, Sociology Database and the King's Fund Library Database were searched for articles and grey literature published between January 2000 and April 2022. A total of 136 documents were included in the final synthesis. Our findings highlight the importance of mutually beneficial remuneration models to support effective integration of services; supportive organisational cultures and values; flexible and agile IT systems/technologies; adequate physical infrastructure and space design to support multidisciplinary teamworking; the importance of establishing patient's trust in collaborative processes between GP-CP; and the need to acknowledge, support and utilise effective triadic relationships. Our research generates new insights regarding how, why and in which contexts C + I working can be achieved between GPs and CPs. The findings of our review can be used to inform future policy, research and clinical practice guidelines for designing and delivering C + I care.

Effect of high-flow nasal cannula oxygen versus standard oxygen on mortality in patients with acute hypoxaemic respiratory failure: protocol for a multicentre, randomised controlled trial (SOHO)

IntroductionFirst-line oxygenation strategy in patients with acute hypoxaemic respiratory failure consists in standard oxygen or high-flow nasal oxygen therapy. Clinical practice guidelines suggest the use of high-flow nasal oxygen rather...

04 Care for adolescents with substance use: A national survey of paediatric hospitals

Abstract Background Substance use is a recognized Paediatric health care issue. More than 9 in 10 individuals receiving treatment for substance use disorders report that their first use of substances occurred by young adulthood. The Canadian Institute for Health Information reported that 5% of hospital stays among Canadian youth in 2017-2018 were related to harmful substance use. In a study of youth with a first-time emergency department visit for a mental health problem between 2010 and 2014, most visits were due to substance related disorders. Despite this, little is known about practices relating to substance use in children's hospitals. Objectives 1. To describe how adolescents who present to Paediatric hospitals with substance use disorders or substance-related health issues are identified, assessed, and treated. 2. To identify best-practices that can inform national standards of care. Design/Methods An online questionnaire was utilized to obtain information on: 1. Clinical practices in the emergency department, inpatient services and ICU; 2. Hospital policies and practice guidelines; and 3. Hospital and community programs and resources. Recruitment emails were sent to hospital leaders (CEO or equivalent) at all 13 Paediatric hospitals. Leaders were asked to identify one individual to complete the survey on behalf of their hospital with input from relevant stakeholders in the various clinical areas. The survey was developed iteratively by a national group of 9 adolescent medicine clinicians and 2 Paediatric trainees. The survey was piloted at a single Paediatric hospital and refined. The survey was administered via RedCap technology. Results Survey response rate was 70% (9/13 hospitals). The mean number of contributors to each survey was 9 (range of 1-35). Overall, few hospitals utilized best practices consistently. There was inconsistency in the use of validated screening tools, use of clinical practice guidelines for monitoring and ongoing care and prescribing of nicotine replacement therapy and opioid agonist therapy. These inconsistencies were noted within each clinical setting (emergency department, inpatient services, and ICU), across services in each hospital, and between hospitals. With respect to hospital services, 5/9 had some type of consult team related to substance use (e.g., adolescent medicine), 4/9 had specialized substance use outpatient services, and 2/9 offered partial hospitalization/day treatment for patients with substance use issues. Local community-based substance use resources were identified as insufficient to address needs by 8/9 hospitals. Conclusion Inconsistencies in the care of adolescents with substance use disorders or substance-related health issues highlights the need for national guidelines for Paediatric hospital-based assessment and care, and enhanced coordination between services and systems of care for this patient population.

HBV biomarkers and their role in guiding treatment decisions.

Over 300 million individuals worldwide are chronically infected with Hepatitis B Virus and at risk for progressive liver disease. Due to the lack of a therapy that reliably achieves viral elimination and the variability of liver disease progression, treatment decisions are guided by the degree of liver disease and viral biomarkers as the viral life-cycle is well characterised and largely conserved between individuals. In contrast, the immunological landscape is much more heterogenous and diverse and the measurement of its components is less well standardized. Due to the lack of a universal and easily measurable set of biomarkers, clinical practice guidelines remain controversial, aiming for a balance between simplifying treatment decisions by reducing biomarker requirements and using all available biomarkers to avoid overtreatment of patients with low risk for disease progression. While approved therapies such as nucleos(t)ide analogues improve patient outcomes, the inability to achieve complete cure highlights the need for novel therapies. Since no treatment candidate has demonstrated universal efficacy, biomarkers will remain important for treatment stratification. Here, we summarize the current knowledge on virological and immunological biomarkers with a specific focus on how they might be beneficial in guiding treatment decisions in chronic Hepatitis B.

Antimalarials in Lupus Nephritis: How Strong is the Evidence?

Systemic lupus erythematosus is a chronic multisystem autoimmune disease that affects the kidneys in approximately 50% of patients, with prevalence rising to as high as 70% in certain populations, such as African Americans and Asians. Antimalarials -and particularly hydroxychloroquine- are currently considered a mainstay of therapy, together with immunosuppressants. Over the last decades, several studies have extensively investigated the mechanisms of action of antimalarial agents, and their potential beneficial properties in patients with SLE in general. However, the evidence for the therapeutic benefit of hydroxychloroquine in patients with lupus nephritis (LN) derives mainly from observational studies, conducted in an era prior to the refinement of induction and maintenance protocols for immunosuppressive therapy. Despite the paucity of high-quality evidence on its efficacy in LN, the nephrology community widely supports the universal use of hydroxychloroquine in LN patients, and recommendations for its use are firmly entrenched in various clinical practice guidelines. Nonetheless, the use of antimalarials may also carry inherent risks, underscoring the importance of personalized approaches in these patients. Herein, we comprehensively review the available literature on antimalarials in LN aiming to update the current evidence, limitations, and future perspectives for the use of antimalarials in adults.

Perceptions of the 2D short animated videos for literacy against chronic diseases among adults with diabetes and/or hypertension: a qualitative study in primary care clinics.

Animation has promise for teaching complex health content through smartphone applications. However, smartphones have had limited use in Thailand for health literacy improvement among adults with chronic diseases. This study aims to explore the perceptions of adults with diabetes and/or hypertension resulting from 2D short animated videos for literacy against chronic disease that are available via smartphones. Four animated videos were initially developed based on clinical practice guidelines and nursing experience. Physicians, an expert in health education, and an animation team developed and revised scripts and storyboards of the animated videos. Lastly, videos were validated by physicians and health educators for content breadth and depth and by media experts for motion graphics and illustration. Each video presents a different situation in diabetes, hypertension, missing appointments, and obesity, ranging from 2.18 to 4.14min in duration. The inclusion criteria were adults 35-70 years old with diabetes or hypertension who received care from primary care units. Thematic analysis was performed on the extracted data. Twenty participants with a mean age of 58.4 years (SD 6.7; ranged 41-68) were focus-group interviewed. Three animation elements were assessed, including presentation, impacts, and suggestions. Participants had positive responses regarding the presentation (suitability of images and smooth motion graphics, short length of videos, simple language, understandable content, and clear sound) and impacts (recalling information, enhancing engagement, and motivating health awareness and behavior change). Suggested improvements were for a bigger font size for subtitles and considering the use of spoken text instead of on-screen text for recommendations at the end of the animations. Animated videos are acceptable for delivering health information. Pilot testing animated videos for promoting literacy against chronic diseases in adults with diabetes and hypertension is needed for optimal utility.

Clinical practice guidelines for the management of bronchiolitis in children (2024 version)

Clinical practice guidelines for the management of bronchiolitis in children (2024 version)

Constructing a picture of fatigue in the context of cancer: assessment of construct overlap in common fatigue scales.

Individuals diagnosed with cancer experience multiple inter-related short- and long-term side effects. Chief among such symptomology is cancer-related fatigue (CRF), which, if left unmanaged, can become chronic and result in increased disability and healthcare utilization. A growing number of self-report scales have been developed to measure CRF symptoms based on various theoretical conceptualizations with the aim of promoting targeted assessment and intervention efforts. It may be, however, unwise to assume that the various measures are conceptually similar (i.e., that they assess for the same constructs). Accordingly, we aimed to characterize item content among nine self-report scales, using a Jaccard index to quantify content overlap among scales. We characterized construct assessment among nine self-report scales recommended to assess CRF by a recent clinical practice guideline, and used a Jaccard index to quantify content overlap among scales. Analysis of 208 items across nine rating scales resulted in 20 distinct symptoms of CRF assessed. The most common symptoms were energy level (captured in all nine scales), cognitive function, impaired task performance (in eight scales), sleepiness, and physical function (in seven scales). Mean overlap among all scales was low (Jaccard index = 0.455). Only one construct (duration of fatigue; 5.0%) was captured by a single scale, and one symptom (energy level; 5.0%) was common across all scales. The PFS, MFSI, and BFI each captured at least one symptom from each of the NCCN domains of CRF. CRF scales are heterogeneousin the content they measure, critically impairing integration of knowledge across studies using disparate scales. Future work is urgently needed to build more integrated theoretical and/or computational models of CRF based on relevant mechanisms.

Treatment and Management of Anaplastic Thyroid Carcinoma: Appraisal of Clinical Practice Guidelines.

Treatment and Management of Anaplastic Thyroid Carcinoma: Appraisal of Clinical Practice Guidelines.

Neuromuscular monitoring: A tutorial for pharmacists.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. To describe neuromuscular monitoring modalities and highlight the importance of neuromuscular monitoring to clinical pharmacy practice. A growing body of literature and clinical practice guidelines have highlighted the importance of neuromuscular monitoring practices to ensure patient safety during surgery and in the intensive care unit. Understanding neuromuscular monitoring modalities can allow pharmacists to enhance participation in institutional discussions and optimization of neuromuscular blocker administration and reversal practices. We have described the various modalities of neuromuscular monitoring and considerations for using different modalities. Neuromuscular monitoring should be performed whenever neuromuscular blocking agents are administered. This practice represents an evidence-based approach to minimizing the occurrence of residual neuromuscular blockade and its associated complications.

Interpretation of Guidelines for Diagnosis, Management, and Prevention of Pertussis in China (2024 Edition)

Abstract The resurgence of pertussis in China has recently attracted much attention. The incidence and burden of pertussis are largely underestimated in China owing to the lack of active pertussis surveillance and insufficient laboratory diagnosis. The high prevalence of macrolide-resistant Bordetella pertussis imposes a major challenge for the management of pertussis cases. To address a series of practice issues regarding pertussis diagnosis, treatment, and prevention, especially immunization practices, a multidisciplinary guideline development group (GDG) consisting of experts in the fields of infectious diseases, pediatric critical care medicine, clinical microbiology, epidemiology, and immunization planning jointly developed the first clinical practice guidelines for pertussis in China. Utilizing the Grading of Recommendations Assessment, Development and Evaluation Evidence-to-Decision framework recommended by the World Health Organization, the GDG formulated corresponding recommendations and suggestions. Good Practice Statements were created for issues not suitable for conventional evidence rating through the presentation of evidence and expert experience. The implementation suggestions for the 12 priority clinical questions given in this paper fully considered Chinese and international experiences as well as the national situation and policy. The primary target audience of these guidelines includes clinicians, microbiology laboratory staff, public health professionals, and policymakers.