Evidence-based Clinical Practice Guidelines Research Articles

Expert consensus on the clinical application of narrow-band intense pulsed light (2024 edition)

The continuous innovation of medical cosmetology technology promotes the rapid development of aesthetic medicine. Narrow-band intense pulsed light (NB-IPL), which is developed based on conventional intense pulsed light, is a more accurate, efficient, and safer technique on clinical application. In order to promote more professionalization and standardization of the clinical application of NB-IPL, a panel of clinical experts in plastic surgery, dermatology and other fields developed the consensus based on the evidence-based medicine, clinical practice, and authoritative guidelines of other disciplines. The consensus panel discussed the indications, treatment parameters, contraindications, and precautions for the clinical application of NB-IPL and would serve as a reference for clinicians, nurses, teaching and research personnels engaged in plastic and cosmetics related work.

Executive Summary: Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU.

Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care facilities have implemented systems aimed at detecting and responding to such patients. To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients. The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinician-methodologists with expertise in developing evidence-based clinical practice guidelines. We generated actionable questions using the Population, Intervention, Control, and Outcomes format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs). The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among "unselected" patients due to the absence of data regarding the benefit and the potential harms of false positive alarms, the risk of alarm fatigue, and cost. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners' concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients' goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system (GPS). The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU.

2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia.

New evidence is available examining the use of corticosteroids in sepsis, acute respiratory distress syndrome (ARDS) and community-acquired pneumonia (CAP), warranting a focused update of the 2017 guideline on critical illness-related corticosteroid insufficiency. To develop evidence-based recommendations for use of corticosteroids in hospitalized adults and children with sepsis, ARDS, and CAP. The 22-member panel included diverse representation from medicine, including adult and pediatric intensivists, pulmonologists, endocrinologists, nurses, pharmacists, and clinician-methodologists with expertise in developing evidence-based Clinical Practice Guidelines. We followed Society of Critical Care Medicine conflict of interest policies in all phases of the guideline development, including task force selection and voting. After development of five focused Population, Intervention, Control, and Outcomes (PICO) questions, we conducted systematic reviews to identify the best available evidence addressing each question. We evaluated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach and formulated recommendations using the evidence-to-decision framework. In response to the five PICOs, the panel issued four recommendations addressing the use of corticosteroids in patients with sepsis, ARDS, and CAP. These included a conditional recommendation to administer corticosteroids for patients with septic shock and critically ill patients with ARDS and a strong recommendation for use in hospitalized patients with severe CAP. The panel also recommended against high dose/short duration administration of corticosteroids for septic shock. In response to the final PICO regarding type of corticosteroid molecule in ARDS, the panel was unable to provide specific recommendations addressing corticosteroid molecule, dose, and duration of therapy, based on currently available evidence. The panel provided updated recommendations based on current evidence to inform clinicians, patients, and other stakeholders on the use of corticosteroids for sepsis, ARDS, and CAP.

Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU: 2023.

Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care hospitals have implemented systems aimed at detecting and responding to such patients. To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients. The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinician-methodologists with expertise in developing evidence-based Clinical Practice Guidelines. We generated actionable questions using the Population, Intervention, Control, and Outcomes (PICO) format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation Approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs). The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among unselected patients. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners' concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients' goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system. The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU.

Chat Generative Pretrained Transformer (ChatGPT) and Bard: Artificial Intelligence Does not yet Provide Clinically Supported Answers for Hip and Knee Osteoarthritis

BackgroundAdvancements in artificial intelligence (AI) have led to the creation of large language models (LLMs), such as Chat Generative Pretrained Transformer (ChatGPT) and Bard, that analyze online resources to synthesize responses to user queries. Despite their popularity, the accuracy of LLM responses to medical questions remains unknown. This study aimed to compare the responses of ChatGPT and Bard regarding treatments for hip and knee osteoarthritis with the American Academy of Orthopaedic Surgeons (AAOS) Evidence-Based Clinical Practice Guidelines (CPGs) recommendations. MethodsBoth ChatGPT (Open AI) and Bard (Google) were queried regarding 20 treatments (10 for hip and 10 for knee osteoarthritis) from the AAOS CPGs. Responses were classified by 2 reviewers as being in “Concordance,” “Discordance,” or “No Concordance” with AAOS CPGs. A Cohen’s Kappa coefficient was used to assess inter-rater reliability, and Chi-squared analyses were used to compare responses between LLMs. ResultsOverall, ChatGPT and Bard provided responses that were concordant with the AAOS CPGs for 16 (80%) and 12 (60%) treatments, respectively. Notably, ChatGPT and Bard encouraged the use of non-recommended treatments in 30% and 60% of queries, respectively. There were no differences in performance when evaluating by joint or by recommended versus non-recommended treatments. Studies were referenced in 6 (30%) of the Bard responses and none (0%) of the ChatGPT responses. Of the 6 Bard responses, studies could only be identified for 1 (16.7%). Of the remaining, 2 (33.3%) responses cited studies in journals that did not exist, 2 (33.3%) cited studies that could not be found with the information given, and 1 (16.7%) provided links to unrelated studies. ConclusionsBoth ChatGPT and Bard do not consistently provide responses that align with the AAOS CPGs. Consequently, physicians and patients should temper expectations on the guidance AI platforms can currently provide.

Guidelines and epilepsy practice: Antiseizure medication initiation following an unprovoked first seizure in adults

ObjectivesAdherence rate to evidence-based clinical practice guidelines is relatively low and the impact of guidelines on clinical practice in epilepsy is variable. The 2015 practice guideline on the management of an unprovoked first seizure in adults specifies clinical variables associated with increased risk of seizure recurrence and the impact of immediate antiseizure medication (ASM) treatment on seizure outcome.We aimed to evaluate the impact of the evidence-based guideline for the management of an unprovoked first seizure in adults on clinical practice in our adult neurology department. MethodsWe retrospectively reviewed the computerized database of 169 adult patients admitted to the adult neurology department at Shamir-Assaf Harofeh Medical Center following a first unprovoked seizure between October 2011 and October 2018. ResultsASMs were initiated in 86% of patients with a first unprovoked seizure pre- and in all patients admitted post- guideline publication. Monotherapy and use of old generation ASMs were more common in both groups and a combination of old- and new generation ASMs - among the pre-guideline group. The pre-guideline decision to initiate ASM treatment was significantly influenced only by epileptiform discharges in the electroencephalogram (EEG). DiscussionThis is the first study to evaluate the impact of the 2015 practice guideline on the initiation of ASM treatment after a first unprovoked seizure in adults. Further studies are needed to assess the global contribution of the guideline to clinical practice and its impact on patient outcomes.

Normology: Is it Time to Rethink Point-of-Care Ultrasound Training?

Point-of-care ultrasound (PoCUS) is increasingly being adopted by clinicians to augment their clinical examination and aid procedures. Evidence-based clinical practice guidelines now support many aspects of PoCUS practice. As a result, more and more medical schools are integrating PoCUS into their curricula, creating a significant demand for training resources. All training must ensure that trainees have the appropriate knowledge, skills and behaviour to enable the clinical integration of PoCUS. The transition from supervised to unsupervised practice is an important step in PoCUS, but should not be confused with expertise. At the start of clinical practice, confirming that something is not normal is probably enough, and trainees can subsequently improve their PoCUS diagnostic accuracy at the bedside during clinical rotations. Our hypothesis is that competency can be achieved without the need to scan patients suspected or suffering from the target pathology. This would enable most of the training to be carried out outside the clinical environment, using volunteers in planned sessions. These planned sessions will be able to accommodate a larger number of trainees and may facilitate collaboration between specialties. When patients are scanned in the clinical environment, trainees should have acquired a good level of competence beforehand. In summary, normology principles could help PoCUS trainees, at the start of their training, to acquire the knowledge, skills and behaviour necessary to achieve a level of competency allowing them to proceed to unsupervised practice. Initially confirming whether something is normal or not is enough. Nevertheless, further research should be conducted to support this concept, and its impact on PoCUS teaching in clinical practice.

Evidence-based clinical practice guideline type 2 diabetes. Screening, diagnosis, screening of secondary complications and concomitant diseases

Evidence-based clinical practice guideline type 2 diabetes. Screening, diagnosis, screening of secondary complications and concomitant diseases

Navigating the Complex Landscape of Ebola Infection Treatment: A Review of Emerging Pharmacological Approaches.

In 1976 Ebola revealed itself to the world, marking the beginning of a series of localized outbreaks. However, it was the Ebola outbreak that began in 2013 that incited fear and anxiety around the globe. Since then, our comprehension of the virus has been steadily expanding. Ebola virus (EBOV), belonging to the Orthoebolavirus genus of the Filoviridae family, possesses a non-segmented, negative single-stranded RNA genome comprising seven genes that encode multiple proteins. These proteins collectively orchestrate the intricate process of infecting host cells. It is not possible to view each protein as monofunctional. Instead, they synergistically contribute to the pathogenicity of the virus. Understanding this multifaceted replication cycle is crucial for the development of effective antiviral strategies. Currently, two antibody-based therapeutics have received approval for treating Ebola virus disease (EVD). In 2022, the first evidence-based clinical practice guideline dedicated to specific therapies for EVD was published. Although notable progress has been made in recent years, deaths still occur. Consequently, there is an urgent need to enhance the therapeutic options available to improve the outcomes of the disease. Emerging therapeutics can target viral proteins as direct-acting antivirals or host factors as host-directed antivirals. They both have advantages and disadvantages. One way to bypass some disadvantages is to repurpose already approved drugs for non-EVD indications to treat EVD. This review offers detailed insight into the role of each viral protein in the replication cycle of the virus, as understanding how the virus interacts with host cells is critical to understanding how emerging therapeutics exert their activity. Using this knowledge, this review delves into the intricate mechanisms of action of current and emerging therapeutics.

Contemporary issues in neuro rehabilitation

Stroke is prevailing as the third most common neurological condition on a global scale and an estimated 25.7 million people are those who have survived it. Stroke is one of the overburdening conditions in about 33% of all individuals affected by permanent disability. Because of the high incidence of risk factors especially in Asia (including Pakistan) with an approximation of 250 cases per one lac persons. Occurrence is mostly seen in the older population and is often found with certain other co-morbidities such as dementia. To enhance the post-stroke quality of life in the geriatric population, especially the ones with existing co-morbidities. Physical rehabilitation of stroke plays a vital role[1]. Studies have demonstrated that the rehabilitation of patients with stroke is a lifelong process during which the survivors sequentially develop new physical habits, and transform their activities of daily living[2]. Stroke rehabilitation treatment protocol lasts quite a long. Therefore, it is sometimes tiresome for the patients and their families because of frequent visits to healthcare settings. Additionally, due to a shortage of skilled and specialized rehabilitation professionals, there is a scarcity of quality treatment protocols and as a result, the objectives of most of the rehab programs are not practical and achievable. Thus, preventing the patients from making a significant recovery[3]. The evidence does not support guidelines that are being followed in the healthcare systems of our country regarding stroke management. While working with individuals recovering from stroke and other neurological disorders, rehabilitation generally focuses on strength training[4]. Despite the fact, that the urban population in developing nations like Pakistan has now access to medical facilities such as stroke rehabilitation, the country's rising population is resulting in an overburdening of the healthcare system leading to sloppiness of all the medical services including rehabilitation[3]. Although most rehabilitation professionals and physical therapists know the fact that the traditional techniques used in neuro rehab are not always effective, still they use them on their patients, this lack of evidence-based practice may be due to inaccessibility to authentic clinical practice guidelines and other physiotherapy databases[4]. For instance, relying on outdated techniques such as range of motion exercises and stretching exercises for treating stroke patients is not as effective as using proprioceptive neuromuscular facilitation exercises to improve the coordination and functional ability of patients, thereby improving motor function along with balance and gait[5]. Conventional approaches in rehabilitation management particularly in the domain of neurology are becoming ineffective due to the huge demand that chronic neurological illnesses are placing on our healthcare system. New creative techniques, including integrated care pathways, are needed to obtain better outcomes[6]. The process of governing skillful clinical and administrative pathways is needed to overcome situations associated with a rise in the number of admissions and long stays in hospitals or healthcare resources. Implementing more innovative approaches by management can achieve better outcomes with a reduction in admissions and shortened hospital stays. It will cohesively lead to effective treatment guidelines, greater patient satisfaction, and improved quality of life. Most of European countries are regulated by integrated rehabilitation services to help patients navigate healthcare services more effectively for an impressive, person-centered approach to rehabilitation care[6]. Unified rehabilitation at the current regional and national level with updated approaches and action plans along with evidence-based clinical practice guidelines is required to safeguard the delivery of person-centred rehabilitation care. Thus, we can conclude that there is a dire need to promote the development and implementation of standardized care in neuro-rehabilitation centers for enhancement in the quality of rehabilitation services. In addition to the use of digital media platforms for spreading awareness among the general masses, regulation and periodic reviews of rehabilitation services are also required.

Methodological quality of evidence-based clinical practice guidelines in cariology.

The present study aimed to appraise the methodological quality of evidence-based Clinical Practice Guidelines (CPGs) in the cariology field. A systematic search on electronic databases (MEDLINE/Pubmed, EMBASE, DAREandEpistemonikos), websites, and guideline organizations were undertaken. Evidence-based CPGs including at least one recommendation for clinical prevention and/or management of dental caries, developed for any clinical setting, were included. The quality of each guideline was evaluated using the AGREE II tool. Descriptive analysis was performed and the average overall score for each domain was calculated. Thirty-two guidelines were included. Most of the CPGs achieved higher scores for the domains of clarity of presentation (66.7%, 95% IC 37.3-52.2) and scope and purpose (59.6%, 95% IC 53.7-65.5) domains; and lower scores for editorial independence (46.1%, 95% IC 37.8-55.7) and applicability domain (44.7%, 95% IC 37-55.3). The reviewers assessed 12 CPGs (37.5%) as recommended for use, 15 (46.9%) recommended with modifications, and 5 (15.6%) as not recommended. The overall methodological quality of evidence-based CPGs in the cariology field is moderate, and there is a need for improvements in reporting related to most domains. The poorest reporting was found in the description of the domains' applicability of its recommendations and editorial independence. Clinical Practice Guidelines provide guidance to patients, healthcare professionals, and stakeholders. The quality of these documents is essential for establishing trust in their recommendations.

Recommendations for psoriasis treatment in Pediatrics

in one third of patients with psoriasis, symptoms start during childhood and adolescence, with a strong emotional and psychosocial impact. to develop a guideline for the systemic treatment of psoriasis in pediatric patients by means of recommendations based on the best available evidence. Sources: articles indexed in PubMed, Epistemonikos, Google Scholar, Cochrane Library and Scielo, published between January 2010 and May 2022, in English, Spanish and Portuguese. Study selection: evidence-based clinical practice guidelines, systematic reviews, meta-analyses, randomized controlled studies, observational studies (case-control, cohort studies, real-life registries) and evaluations of biosimilar drugs in patients up to and including 17 years of age were considered. The keywords "psoriasis" and "treatment" were used in all three languages. Data extraction: the literature was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE) recommendations. Data synthesis: evidence tables were developed and analyzed by the expert committee. The questions for the development of recommendations were based on the PICO system (population, intervention, comparison, outcome). A total of 8 recommendations and 7 points of good practice were developed. The direction and strength of the recommendations were expressed according to the GRADE system. the final decision on a specific therapy should be based on the best opinion of the treating physician, the individual characteristics, and the values and preferences of the patients and their caregivers.

Clinical practice guidelines in prehospital pain management for paramedics: a systematic review protocol.

The purpose of this review is to examine prehospital pain management clinical practice guidelines (CPGs) to identify recommendations that can be adopted or adapted into paramedic clinical practice. An additional aim is to consider the methodological quality of these CPGs and the recommendations within them. Quality, evidence-based CPGs support clinicians and optimize patient care. However, not all CPGs meet rigorous evidence-based standards, and some may be misleading. As pain is a common reason for patients to access ambulance services, the evaluation of pain management CPGs, their quality, and whether their recommendations can be adopted or adapted into practice is required to increase understanding in this area. We will include CPGs for pain management intended for prehospital services in civilian communities. CPGs in English published from 2017, and containing clear recommendations addressing pain of any cause will be considered for inclusion. This review will combine methodologies, including the PICAR framework (population, intervention, comparison, attributes of eligible CPGs, recommendation characteristics) by Johnston et al. , and the JBI umbrella and scoping review methodologies. The search strategy will cover 12 databases, including PubMed, Embase, and specific CPG databases (eg, GIN Library). Additionally, Google Scholar and Google will be searched, and prehospital organizations without regular publications will be contacted. The AGREE II and AGREE-REX tools will be used to assess the methodological rigor and clinical credibility of the CPGs. The characteristics of both CPGs and the recommendations will be extracted and discussed in the review. PROSPERO CRD42022352951.

Effects of evidence-based clinical practice guidelines for COVID-19 in health care quality improvements. A third systematic review.

Background Historically, Evidence-Based Clinical Practice Guidelines were thought to primarily enhance healthcare consistency and quality. However, this claim requires conclusive confirmation. We employed the Donabedian model encompassing three dimensions, patient outcomes, process, and structure, to evaluate the use of EB-CPGs and their potential healthcare improvements. This represents our third systematic review within a series exploring significant pathologies. The overarching goal is to assess the effectiveness of EB-CPGs to enhance care quality. Methods Following the methodology of the Manual of Cochrane, a descriptive analysis was performed due to considerable heterogeneity in the included studies. Searches were carried out from 2019 to May 2023 across databases including EMBASE, PubMed, OVID, Cochrane Central RCT, and grey literature. No limitations were imposed on language. We selected only randomised controlled trials (RCTs). Results Across the fifteen evaluated RCTs, 220 interventions were examined. Of these, 6 (3%) were associated with structure, while 136 (62%) focused on the healthcare delivery process, and 78 (35%) targeted patient health outcomes. No significant differences were identified between the compared groups in 155 interventions (71%) regarding the implementation of EB-CPGs. In 27 interventions (12%), the outcome benefited the control group, while the intervention group demonstrated favourable outcomes in 38 (17%). Conclusions Our research revealed slight quality improvement in healthcare through EB-CPGs in patient outcomes and healthcare processes. Neutral results suggest no clear advantage among groups. In future studies, it would be necessary to enhance both the design and methodological rigour of RCTs and to consider in their analysis the strength of the recommendations included in the EB-CPGs along with their respective levels of evidence certainty. This would enable more precise hypotheses to be established regarding the reasons behind these findings. PROSPERO registration CRD42022354708.

Diagnosis, treatment, and prevention of community-acquired pneumonia in children: an evidence-based clinical practice guideline adapted for the use in Egypt using ‘Adapted ADAPTE’

BackgroundWe recently adapted a guideline for Community-Acquired Pneumonia (CAP) in children to the Egyptian health system. Adaptation of evidence-based clinical practice guidelines to the local healthcare context is a valid alternative to de novo development that can upgrade their application without enforcing a major burden on resources. The objective of this manuscript is to elucidate diagnosis, treatment, and prevention of CAP as well as methods used for the adaptation process to produce the 1st National Guideline for Community-Acquired Pneumonia in children in Egypt using Adapted ADAPTE method. The full process was described extensively with all three phases of set up, adaptation, and finalization. An adaptation group and an external review including clinical content experts and methodologists conducted the process.ResultsThe authors adapted 10 principal categories of recommendations from three source Clinical Practice Guidelines. Recommendations incorporate; common clinical manifestations, indications for hospitalization and intensive care unit admission, indications for laboratory investigations and radiology in diagnosis, choice of empiric antibiotic therapy in the outpatient and hospitalized children with non-complicated CAP and the duration of therapy, the role of influenza antiviral therapy, follow-up anticipated response to therapy, management of non-responding pneumonia, criteria of safe discharge, and prevention of CAP. Many tools were gathered and established to improve implement ability containing two clinical algorithms for management of non-complicated CAP and for non-responding pneumonia in children, pathway for assessment of severity of CAP in primary care facilities, medication tables, simplified Arabic patient information, PowerPoint slide presentation lecture for management of CAP, and online resources.ConclusionThe final clinical guideline supports pediatricians and related healthcare workers with evidence-based applicable guidance for managing community-acquired pneumonia in Egypt. This work demonstrated the efficiency of Adapted ADAPTE and highlighted the importance of a cooperative clinical and methodological professional group for adaptation of national guidelines.

Korean clinical practice guidelines for diagnostic and procedural sedation.

Safe and effective sedation depends on various factors, such as the choice of sedatives, sedation techniques used, experience of the sedation provider, degree of sedation-related education and training, equipment and healthcare worker availability, the patient's underlying diseases, and the procedure being performed. The purpose of these evidence-based multidisciplinary clinical practice guidelines is to ensure the safety and efficacy of sedation, thereby contributing to patient safety and ultimately improving public health. These clinical practice guidelines comprise 15 key questions covering various topics related to the following: the sedation providers; medications and equipment available; appropriate patient selection; anesthesiologist referrals for high-risk patients; pre-sedation fasting; comparison of representative drugs used in adult and pediatric patients; respiratory system, cardiovascular system, and sedation depth monitoring during sedation; management of respiratory complications during pediatric sedation; and discharge criteria. The recommendations in these clinical practice guidelines were systematically developed to assist providers and patients in sedation-related decision making for diagnostic and therapeutic examinations or procedures. Depending on the characteristics of primary, secondary, and tertiary care institutions as well as the clinical needs and limitations, sedation providers at each medical institution may choose to apply the recommendations as they are, modify them appropriately, or reject them completely.

Analysis of the Perception and Treatment of Osteoarthritis of the Knee Through Social Media: An Observational Study of the Top 100 Viral TikTok Videos.

TikTokis apopularplatformthat can be used formedical insights. However, spreading inaccurate information about diagnosing or treating medical conditions canundermine the quality of patient care. Our assessment focused on the discourse surrounding knee osteoarthritis onTikTok, with two primary objectives: 1) identifying the creators behind osteoarthritis-related content, and 2) examining whether a connection exists between the reach of video content and the strength of recommendations provided. The top 100TikTokvideos were chosen based on likes on March 29, 2023. Posts were identified using the hashtag ("#Osteoarthritis"). Videos were classified by the following: number of likes, comments, shares, date of upload, uploader (medical professional, non-medical professional, or business), and video content (medical treatment, home remedy, personal story). Treatmentswere rated according to theAmerican Academy of Orthopaedic Surgeons (AAOS) Evidence-Based Clinical Practice Guideline for Osteoarthritis using the strength of evidence criteria (1-4 stars). Descriptive and univariate analyses were performed. Among the top videos, 67.7% were uploaded by medical professionals.Private companies, despite having the highest average likes (29,681.2) and shares (1,367.5) per video, had a limited average evidence strength of 2.13.Physician-created videos had the second-highest average number of likes (25,440.1) and shares (1,224.5) per video with a strength of evidence of 3.03. Non-medical professional videos had the lowest evidence support (0.89). Medical treatments, the most liked and shared content, had the lowest evidence strength (1). There was nostatistically significant correlation between the number of likes (p=0.808), comments (p=0.647), or shares (p=0.439) to the strength of evidence regarding the intervention. TikTokcan be unreliable forkneeosteoarthritistreatment information. It is common to find non-physicians sharing medical advice on the platform, with medical treatments demonstrating the weakest level of supporting evidence.Orthopaedic surgeons should advise their patients thatTikToktreatment recommendations may not align with established guidelines.

Evidence-based Egyptian clinical practice guidelines: for the prevention and management of iron deficiency and iron deficiency anemia in infants, children and adolescents

BackgroundIron deficiency (ID) is the most common nutritional disorder affecting all age groups. Infants and young children are vulnerable to anemia especially iron deficiency anemia (IDA), which represents a public health problem with defined impacts on the health of communities. IDA, however, is a preventable and treatable condition; therefore, early diagnosis represents the cornerstone in protection from its adverse consequences and combating its contributing factors. Several international guidelines for the management of ID/IDA are available, however national guidelines that can be implemented and suits our local needs are lacking.ObjectiveTo adapt the pre-existing high-quality practice guidelines for the screening, prevention and management of ID/IDA in different pediatric age groups, to be available for the national use by general practitioners, pediatricians, and other health care professionals.ResultsThe adaptation group for this guideline included key leaders from different Egyptian institutions. The panel used the ADAPTE methodology for adaptation of guidelines. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to the target context of use. The guideline covered all important aspects of detection, identification of infants, children, and adolescents at high risk of developing ID/IDA, proper management, and prevention. The final version of the adapted clinical practice guideline has been made after thorough review of an external review panel and was guided by their official recommendations and modifications. Implementation tools included algorithms, tables, and flow charts to aid decision making in practice, as well as patient-directed information in the Arabic language.ConclusionsThis adapted guideline serves as a tool for the screening, prevention and management of ID/IDA in different pediatric age groups.

General practitioners' attitudes and knowledge about attention-deficit hyperactivity disorder (ADHD): Insights from a survey.

The Review of health services for children, young people and families within the NSW Health system identified that novel models of care were needed to improve access to clinical management for people with ADHD. The present study aimed to evaluate GPs' knowledge of and attitudes towards ADHD and the challenges and opportunities for a more substantial role for GPs in ADHD management. An online survey of Australian GPs was conducted, with recruitment via email invitation. Out of 230 respondents, 213 surveys could be analysed. Of these, 97% believed ADHD was a genuine condition, with 90% identifying inattention as a primary symptom. Most (92%) had seen and diagnosed ADHD within the past year. Prevalent concerns included inadequate access to specialist assessment and treatment; 77% felt that GPs should have a more substantial role in ADHD management. Barriers included lack of time, knowledge and experience. There was willingness amongst respondents take on a greater role in managing individuals with ADHD. However, a need for further training and education was highlighted. The Australian Evidence-Based Clinical Practice Guideline for ADHD may resolve an identified need for clinical guidance.

Context matters: using an Evidence to Decision (EtD) framework to develop and encourage uptake of opioid deprescribing guideline recommendations at the point-of-care

ObjectivesTo describe the development and use of an Evidence to Decision (EtD) framework when formulating recommendations for the Evidence-Based Clinical Practice Guideline for Deprescribing Opioid Analgesics. Study Design and SettingEvidence was derived from an overview of systematic reviews and qualitative studies conducted with healthcare professionals and people who take opioids for pain. A multidisciplinary guideline development group conducted extensive EtD framework review and iterative refinement to ensure that guideline recommendations captured contextual factors relevant to the guideline target setting and audience. ResultsThe guideline development group considered and accounted for the complexities of opioid deprescribing at the individual and health system level, shaping recommendations and practice points to facilitate point-of-care use. Stakeholders exhibited diverse preferences, beliefs, and values. This variability, low certainty of evidence, and system-level policies and funding models impacted the strength of the generated recommendations, resulting in the formulation of four ‘conditional’ recommendations. ConclusionThe context within which evidence-based recommendations are considered, as well as the political and health system environment, can contribute to the success of recommendation implementation. Use of an EtD framework allowed for the development of implementable recommendations relevant at the point-of-care through consideration of limitations of the evidence and relevant contextual factors.