Dissemination Of Evidence-based Guidelines Research Articles

Tamsulosin off-label use in kidney stones: Review and survey

This study investigates the effectiveness and healthcare perceptions of Tamsulosin, an off-label medication for kidney stone management. Despite the documented benefits, the quest for alternative treatments like Tamsulosin persists, driven by its advantages and patient satisfaction levels. This research includes a literature review and a survey of pharmacy students’ opinions on Tamsulosin, aiming to bridge the knowledge gap. This study, which involved 38 first-year professional pharmacy students, achieved a 92% response rate. The research used questionnaire that collected demographic information and assessed participants' knowledge and opinions using a Likert scale, which was integrated into a drug informatics course. We analyzed the responses using SPSS software, utilizing descriptive and chi-square statistical methods. The survey, completed by 38 participants, revealed discrepancies between current treatment practices and the students' understandings. Despite Tamsulosin's documented efficacy in facilitating stone passage, significant skepticism exists about its use without FDA approval. The research showed varied levels of understanding and skepticism towards off-label use among the students. Moreover, 70.3% of respondents recognized Tamsulosin's potential for managing kidney stones, despite its lack of FDA approval, indicating a cautious yet acknowledging attitude towards non-approved drug use for organ rejection. There's a noted need for improved education and the dissemination of evidence-based guidelines in clinical practice. The study uncovers varied knowledge and perceptions among healthcare professionals and pharmacy students regarding Tamsulosin's use in kidney stone management. The gap between clinical evidence and survey participants' awareness underscores the importance of further research and education to align clinical practices with evidence-based guidelines

Type 2 Diabetes in High-risk Youth: Improving Identification and Interventions in Community Health with a Decade of Quality Improvement Efforts.

This manuscript describes quality improvement interventions with aims (1) to increase identification and follow-up testing of youth with prediabetes and type 2 diabetes (T2D) and (2) to improve outcomes for youth with prediabetes and low-range T2D (HbA1c 6.5-6.9%). Interventions included (a) dissemination of evidence-based guidelines and (b) creation of in-house weight management (WM) programs and programs to increase prediabetes follow-up testing and T2D self-management. Data from the electronic health record are presented. Between 2009-2020, T2D screening for obese youth increased from 24% to 76%. Two WM programs served 2,726 unique youth for 11,110 billable visits. Youth with prediabetes seen in WM clinic had a lower risk of developing T2D if they attended three or more visits. Teaching self-monitoring blood glucose showed promise for improving HbA1c outcomes in youth with low-range T2D. Interventions have increased identification, access to preventive services, and treatment for youth with prediabetes and T2D.

A feasibility randomized controlled trial of an mHealth app vs booklets for patient-facing guidelines in adults with SCD

AbstractDespite the increased number of evidence-based guidelines for sickle cell disease (SCD), dissemination of evidence-based guidelines in lay language for individuals or families with SCD has not been evaluated. We conducted a feasibility randomized controlled trial to determine the acceptability of a mobile health (mHealth) app with patient-facing guidelines to improve the knowledge of individuals with SCD about SCD-specific knowledge and reduce hospitalizations. Primary outcome measures include recruitment, retention, and adherence rates. Adults with SCD were enrolled at 2 sickle cell centers between 2018 and 2022. Participants were randomized to receive either an mHealth app + booklet with patient-facing guidelines or a booklet with the guidelines alone. Participants completed surveys at baseline and a final 6-month visit. Approximately 67 of 74 (91%) agreed to participate and were randomized, with 50 of 67 (75%) completing all the study components. All participants who completed the study in the treatment arm used the app. Our results demonstrated high recruitment, retention, and adherence rate for the first randomized trial for an mHealth app with patient-facing guidelines in adults with SCD. This clinical trial was registered at https://www.clinicaltrials.gov/ as #NCT03629678.

Management of adrenal insufficiency during Ramadan fasting: a survey of physicians.

Introduction:Appropriate dose adjustments of glucocorticoids replacement therapy for adrenal insufficiency (AI) is vital.Objective:We sought to scope physicians’ perceptions, and practices regarding Ramadan fasting (RF) impact on the management of AI.Methods:A web-based survey of a convenience sample of endocrinologists.Results:Nearly two-thirds of 145 respondents (64.1%) were adult endocrinologists and almost half (49%) saw more than 10 hypoadrenal patients per year. Most respondents (78.6%) prescribed hydrocortisone, while the minority prescribed other preparations. The glucocorticoid doses were reportedly divided twice daily by 70.8% and thrice daily by 22.2% of respondents. Respondents recognized RF as having potential consequences in adrenal insufficiency patients included causing hypoglycaemia, undue tiredness, and fatigue, hypotension, feeling dizzy, and light-headedness. Symptoms of under-replacement were thought to happen in the late afternoon by 59.3% of respondents. Almost half (45.5%) of respondents thought that RF has some probable or definite impact on glucocorticoid therapy that certainly warrants specific concern and possible action. Three quarters (76.4%) of respondents confirmed providing specific management recommendations during RF. The most frequently reported recommendation was taking in the usual morning dose of hydrocortisone just before pre-dawn meal (Suhor) (57.8%). A third switch patients from hydrocortisone to prednisolone/prednisone. Half reported providing patients with specific recommendations regarding breaking their fast and/or seeking help if hypoadrenal symptoms occur.Conclusions:There is a remarkable variation in the physicians’ perceptions and practices regarding the management of AI during Ramadan. This warrants professional effort to increase the awareness and dissemination of evidence-based guidelines.

Water matrices as potential source of SARS-CoV-2 transmission – An overview from environmental perspective

Evidently, the emergence of novel coronavirus disease (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has rapidly blowout across the world. Since, the presence of coronaviruses, including SARS-CoV-2 in the fecal specimens and anal swabs of some infected patients, has raised emerging concern with the likelihood of fecal-based spread must be inspected and clarified. Therefore, herein, an effort has been made to spotlight the current scenarios and possible solutions to better understand the risks associated with the wastewater matrices as a potential source of SARS-CoV-2 transmission in the environment. The information reviewed here constitutes a paramount intellectual basis to sustenance ongoing research to tackle the SARS-CoV-2 issue. Thus, this overview indicates the most accessible frontiers related to the detection, quantification, and possible transmission of SARS-CoV-2 in the environment through water routes. The regulatory authorities and policymakers must assure the society via dissemination of evidence-based guidelines that the water matrices, including groundwater and drinking water resources are safe. Finally, we have identified and enlisted a number of pressing questions concerning the ongoing SARS-CoV-2 transmission or COVID-19 emergence issue that must be carefully answered to put further and deeper insight into SARS-CoV-2/COVID-19 in future studies.

Awareness of physicians and pharmacists of aldosterone antagonists in heart failure and myocardial infarction in Jordan.

Objective:to evaluate physicians and clinical pharmacists’ awareness and practices regarding use of aldosterone antagonists in heart failure (HF) and post-myocardial infarction (MI).Methods:First, we reviewed the prescription of aldosterone antagonists among 408 patients presenting to the cardiology clinic at a major hospital in Jordan. Second, physicians and pharmacists working in cardiovascular departments completed a questionnaire related to use of aldosterone antagonists in HF and post-MI.Results:Thirty patients (7.59%) were eligible for aldosterone antagonist; only 4 received them at discharge (13.3%). The survey was completed by 153 professionals (response rate 76.12%). About 72.1% of participants were aware of studies regarding use of aldosterone antagonists post-MI and in HF. Moreover, 10.45%/53.6% of participants strongly agreed/agreed that these agents are useful in normotensive post-MI and HF patients. Spironolactone was the most prescribed drug by 92.1% of participants. About 41.8% of participants reported use of spironolactone in post-MI and HF. With respect to guidelines, only 39.2% of participants agreed that adding spironolactone to standard therapy in HF is recommended, and 48.3% agreed on adding it directly post-MI. Clinical pharmacists and cardiologists were generally more aware of guidelines than pharmacists, cardiac surgeons and residents/fellows.Conclusions:there is an under-use of aldosterone antagonists in HF and post-MI patients, and a lack of detailed awareness of current guidelines among health care providers. Dissemination of evidence-based guidelines and usage protocols may improve management of post-MI and HF.

Hypertension Control Strategies in a Patient Centered Medical Home

Background: Partnership betweenMaryland’sMulti-payerPatient CenteredMedical Home programand Maryland Million Hearts programhasbeen thecatalyst for focused quality improvementstrategiesspecific to chronic disease managementandcontrol.Methods: This project was initiated in the 52 NCQA recognizedPCMH practices from theMMPP. A nested cohort of19 practices received technical assistance to includestaff training, new workflows implementation, dissemination ofevidence-based guidelines, optimizing HITuse, patientself-managementand linkage to communityand state resources. Observations weredocumented in 2011, 2012, 2013 and at the end of the PDSA in June2014. Annually reported quality metricsbypractices during this time period were analyzed byeach individual metric and theoverallaverage change was calculated and tested forstatistical significance. All tests were two-tailed.Results: NQF 18 and NQF 28A maintained theirachievement threshold from December 2013 toJune2014. NQF 28Ademonstratednon-significantdecrease from94.6% in December2013 to93.4% in June 2014 (p value=0.646),but maintained values greater than achievement threshold. NQF 28Bdemonstrated significant change from2011 at 23.5% followed bypractices trainingand resource linkages to 52.2% in June 2014 (p value<0.01 for totalchange from2011-2014). NQF 59 demonstratedan increase from17% in December2013 to 24.9% inJune2014, which wasnot statisticallysignificant (p value= 0.342). NQF 575 demonstrated a non-significant increase from62.8% December2013 to 71.1% inJune2014 (p value=0.217).Conclusions: Focusedquality improvementprograms have greatpropensity forsuccess inchronic disease management whensystematically implemented.

Influencing factors for high quality care on postpartum haemorrhage in the Netherlands: patient and professional perspectives.

BackgroundPostpartum haemorrhage (PPH) remains a major contributor to maternal morbidity even in high resource settings, despite the development and dissemination of evidence-based guidelines and Advance-Trauma-Life-Support (ATLS) based courses for optimal management of PPH. We aimed to assess current influencing factors (obstacles and facilitators) for the delivery of high quality PPH-care from both patient and professional perspective.MethodsWe qualitatively explored influencing factors for delivering high quality PPH-care, by having individual interviews with PPH-patients and focus group interviews with the different types of professionals working in the delivery room. For both perspectives, the theoretical frameworks of Grol and Cabana were used to classify the influencing factors for optimal PPH-care (factors of the guidelines, of professionals, of patients, of the social setting and of the organisation). In order to assess the importance of the influencing factors found among the professionals, we quantified these factors in a web-based questionnaire.ResultsA total of 12 patients and 41 professionals participated in the interviews, and 315 complete surveys were analyzed. The main obstacle for high quality PPH-care identified by patients was the lack of information given by the professionals to the patient and partner before, during and after the PPH event. An informative patient website, a patient leaflet and a follow-up consultation were mentioned as facilitators. The main obstacles according to the professionals were: lack of clarity of the guidelines, lack of knowledge and failing team-communication. Team training and checklists/ flowcharts were considered facilitators.ConclusionsDifferent obstacles to the delivery of high quality PPH-care were identified by both patients and professionals. These data can be used to develop a focused strategy to improve PPH-care.Trial registrationNCT 00928863

Introduction: guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine.

On behalf of the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) Joint Section on Disorders of the Spine and Peripheral Nerves, it is with distinct pleasure that I introduce the “Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine.” The initial version of these guidelines was originally published in the June 2005 issue of the Journal of Neurosurgery: Spine.1 The update presented in this issue of the Journal of Neurosurgery: Spine exemplifies the commitment that organized neurosurgery, in cooperation with our orthopedic colleagues, has made to ensure that this vital source of information continues to evolve and reflect the most current evidence on each of the topics covered. In a very real sense these guidelines are a credit to all clinicians involved in the care of disorders of the spine. That is the body of work on which the literature is based, which in turn is the foundation of these guidelines. This work is also a credit to the established infrastructure created by the Guidelines Committee of the AANS and CNS to facilitate the production and dissemination of evidence-based guidelines. In addition, the successful publication of this material would not have been possible without the assistance provided by the staff at the Journal of Neurosurgery Publishing Group. Their expertise in the peer-review process, editorial guidance, and transmission of information have enhanced the overall quality and impact of this effort. I personally want to thank Dr. James T. Rutka, M.D., Ph.D., Editor-in-Chief of the Journal of Neurosurgery: Spine, for his forbearance and attention to this project. As the literature has evolved, so too has the process of guidelines development. As there is no well-accepted standard protocol for updating guidelines, a significant amount of time and effort was expended to establish the methodology. Consensus among members of the expert panel was achieved in accord with a well-defined methodology to minimize bias, maximize integrity, and create a final product consistent with the highest ideals of evidence-based medicine. Among the most important missions of the AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves is the generation of highquality evidence that can assist both our membership and the spine community at large in providing the highestquality care for our patients. Just as this work builds on the foundation created by the original 2005 publication, it is anticipated that this document will in time be updated as well. For the moment, however, it reflects an unbiased synthesis of the literature and points toward the quality spine care that we, as clinicians, aspire to provide. It is an honor to present this Guideline Update on behalf of the AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves to the readership of the Journal of Neurosurgery: Spine. This update reflects the highest ideals of the section. It is offered to physicians of all levels who seek a greater understanding of the role lumbar fusion can play in the care of patients with degenerative disease of the lumbar spine. (http://thejns.org/doi/abs/10.3171/2014.4.SPINE14190)

An assessment of diabetes‐related knowledge among registered nurses working in hospitals in Jordan

Nurses play a vital role in caring for people with diabetes where knowledge constitutes the cornerstone of this care. This study assessed the level of Jordanian nurses' perceived and actual knowledge of diabetes and examined the relationship between nurses' actual knowledge of diabetes and their different characteristics. A cross-sectional descriptive design was used to report knowledge regarding diabetes. Registered nurses were asked to complete self-administered questionnaires. The Diabetes Self-Report Tool and the Modified Diabetes Basic Knowledge Test were used to assess nurses' perceived and actual knowledge of diabetes. A total of 277 out of the 450 eligible registered nurses accepted to participate and returned questionnaires from seven hospitals in Jordan. Nurses in this study mostly demonstrated a knowledge deficit in clinical and theoretical-based topics, such as initial treatment of hypoglycaemia, insulin storage and preparation; meal planning and duration of action with hypoglycaemic agents. Nurses' actual knowledge of diabetes was positively correlated with their perceived knowledge, perceived competence and level of education. Study participants were selected using convenience sampling. The length of time needed for nurses exceeded 50 min to complete study questionnaires. This study examined current knowledge among Jordanian registered nurses regarding diabetes. A knowledge deficit regarding diabetes was demonstrated by the nurses who participated in this study. The role of continuing education is essential to supporting nurses' knowledge of complex clinical conditions, such as diabetes. Adequate implementation and dissemination of evidence-based guidelines on caring for people with diabetes is a prerequisite to improve the nurses' knowledge. Promoting continuing education in diabetes for nurses requires continuous effort and creativity. Healthcare system administrators must acknowledge and prioritize the need for this education.

Implementing chronic disease prevention amongst cancer survivors

Implementing chronic disease prevention amongst cancer survivors

Delivering the Promise: Progress, Challenges, Opportunities

In science and in medicine, we live in extraordinary times. The lifespan of man has been nearly doubled over the past century, and the quality of life has also been vastly improved. Science promised a great deal, and it has delivered, at least in part. But why has it not delivered that promise in full and transformed all of our lives? Can we do better? I think we can. Let’s start where it all comes together—with a patient: Our patient, a 74-year-old white male living in the suburbs of a major US city, is fortunate. He has just been discharged from the hospital after a 2-day stay for an ST elevation myocardial infarction and a coronary artery stenting procedure. He benefited from multiple technologies developed through research over many years. His father died of an MI at age 54. Because of research and the development and dissemination of evidence-based guidelines, our patient’s physician knew that he should screen this man for risk factors.1 So, at age 45, he was diagnosed with hypertension and had it effectively treated. He stopped smoking, exercised, lost weight, and restricted sodium in his diet. At age 66, a statin was added to his regimen because of an elevated cholesterol level. On the day of his admission, the patient, who had been coached by his physician, knew to call 911 immediately when he experienced chest pain. And the emergency medical personnel, seeing the ST elevation on the portable EKG done on site, knew where to transport him.2 After his successful primary angioplasty, his hospital team provided high-quality care using the Get With The Guidelines program,3 a Web-based tool developed by the American Heart Association to help translate scientific knowledge into day-to-day practice, and he went home with effective secondary prevention. This patient’s experience …

Guidelines on the Use of Intravenous Immune Globulin for Hematologic Conditions

Canada's per capita use of intravenous immune globulin (IVIG) grew by approximately 115% between 1998 and 2006, making Canada one of the world's highest per capita users of IVIG. It is believed that most of this growth is attributable to off-label usage. To help ensure IVIG use is in keeping with an evidence-based approach to the practice of medicine, the National Advisory Committee on Blood and Blood Products of Canada (NAC) and Canadian Blood Services convened a panel of national experts to develop an evidence-based practice guideline on the use of IVIG for hematologic conditions. The mandate of the expert panel was to review evidence regarding use of IVIG for 18 hematologic conditions and formulate recommendations on IVIG use for each. A panel of 13 clinical experts and 1 expert in practice guideline development met to review the evidence and reach consensus on the recommendations for the use of IVIG. The primary sources used by the panel were 3 recent evidence-based reviews. Recommendations were based on interpretation of the available evidence and where evidence was lacking, consensus of expert clinical opinion. A draft of the practice guideline was circulated to hematologists in Canada for feedback. The results of this process were reviewed by the expert panel, and modifications to the draft guideline were made where appropriate. This practice guideline will provide the NAC with a basis for making recommendations to provincial and territorial health ministries regarding IVIG use management. Specific recommendations for routine use of IVIG were made for 7 conditions including acquired red cell aplasia; acquired hypogammaglobulinemia (secondary to malignancy); fetal-neonatal alloimmune thrombocytopenia; hemolytic disease of the newborn; HIV-associated thrombocytopenia; idiopathic thrombocytopenic purpura; and posttransfusion purpura. Intravenous immune globulin was not recommended for use, except under certain life-threatening circumstances, for 8 conditions including acquired hemophilia; acquired von Willebrand disease; autoimmune hemolytic anemia; autoimmune neutropenia; hemolytic transfusion reaction; hemolytic transfusion reaction associated with sickle cell disease; hemolytic uremic syndrome/thrombotic thrombocytopenic purpura; and viral-associated hemophagocytic syndrome. Intravenous immune globulin was not recommended for 2 conditions (aplastic anemia and hematopoietic stem cell transplantation) and was contraindicated for 1 condition (heparin-induced thrombocytopenia). For most hematologic conditions reviewed by the expert panel, routine use of IVIG was not recommended. Development and dissemination of evidence-based guidelines may help to facilitate appropriate use of IVIG.

Early detection and primary prevention of type 2 diabetes: what's happening in your locality?

Activities relating to the early detection and primary prevention of type 2 diabetes are likely to vary widely. This study used a telephone questionnaire to determine current practice in primary care in one locality in the United Kingdom. Validation of practice responses was performed by a separate analysis of biochemistry laboratory records. A 100% response rate was obtained. For 31 (86%) practices this information was obtained from the lead GP. Nine (25%) practices operated no system for identifying those at risk of developing type 2 diabetes, 15 (42%) did so opportunistically, three (8%) issued invitations to come in and be tested, and nine (25%) did both. A patient with a negative test would be followed up annually by 17/27 (63%) practices; the rest operated no formal arrangements for a repeat test. There was a significantly higher mean number of glucose tests requested in those practices using both opportunistic identification and invitations than those with no active identification (mean number of glucoses requested per 1000 population = 205 (±SEM 17) vs 149 (±SEM 16). Current primary care activities in the early identification and prevention of type 2 diabetes show considerable variation between practices and some deviation from current recommendations which are, in general, consensus, not evidence-based. The most active practices requested significantly higher numbers of glucose tests compared with the least active, providing some validation of the responses obtained. The development and effective dissemination of evidence-based guidelines, as well as making available service development monies, may go some way to addressing these issues. Copyright © 2006 John Wiley & Sons, Ltd.

Rave reviews?

Rave reviews?