Evidence-based Outcomes Research Research Articles

United States expert panel consensus on uniform nomenclature and diagnosis for neuropathic pruritus

Importance: Neuropathic pruritus is a debilitating condition lacking a uniform approach to nomenclature and diagnosis. Objective: A panel of dermatologist experts in pruritus was convened to develop definitions, diagnostic recommendations, and treatment guidelines for neuropathic pruritus. Evidence review: A roundtable discussion of 10 experts was conducted on November 3, 2021, via the Zoom platform. This study follows the Standards for Reporting Qualitative Research reporting guidelines for qualitative studies. A systematic review of prior literature on the definition, scope, diagnostic, and treatment was performed, looking at sources of treatment from 1991 to 2021. Consensus was defined as >70% agreement for acceptance of a definition or recommendation. A draft of evidence was subjected to revision by all participants and was endorsed by all participants. Findings: The roundtable identified definitions for neuropathic pruritus, which included different forms of the condition based on cause and presentation such as brachioradial pruritus, notalgia paresthetica, and scalp pruritus. Diagnostic and treatment guidelines were also established. Limitations of this process included lack of randomized controlled studies. These recommendations are also based on expert consensus and must be further supported by evidence-based outcomes research. Conclusions: Neuropathic pruritus contains numerous subtypes, causes, diagnostic methods, and treatment modalities. The recommendations developed by this panel are meant to serve as shared nomenclature for future clinical studies.

An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures

Opioidoverprescribing is a major contributor to the opioid crisis. The lack of procedure-specific guidelines contributes to the vast differences in prescribing practices. To create opioid-prescribing consensus guidelines for common dermatologic procedures. We used a 4-step modified Delphi method to conduct a systematic discussion among a panel of dermatologists in the fields of general dermatology, dermatologic surgery, and cosmetics/phlebology to develop opioid prescribing guidelines for some of the most common dermatologic procedural scenarios. Guidelines were developed for opioid-naive patients undergoing routine procedures. Opioid tablets were defined as oxycodone 5-mg oral equivalents. Postoperative pain after most uncomplicated procedures (76%) can be adequately managed with acetaminophen and/or ibuprofen. Group consensus identified no specific dermatologic scenario that routinely requires more than 15 oxycodone 5-mg oral equivalents to manage postoperative pain. Group consensus found that 23% of the procedural scenarios routinely require 1 to 10 opioid tablets, and only 1 routinely requires 1 to 15 opioid tablets. These recommendations are based on expert consensus in lieu of quality evidence-based outcomes research. These recommendations must be individualized to accommodate patients' comorbidities. Procedure-specific opioid prescribing guidelines may serve as a foundation to produce effective and responsible postoperative pain management strategies after dermatologic interventions.

Preoperative and postoperative medical therapies for chronic rhinosinusitis: National surveys among Chinese otolaryngologists.

ObjectiveThe aim of this study was to evaluate clinical practice patterns of preoperative and postoperative medical therapies immediately surrounding sinus surgery for chronic rhinosinusitis (CRS) by Chinese otolaryngologists.MethodsTwo anonymous web-based surveys of preoperative and postoperative medical therapies were performed. These surveys assessed the frequency of prescription of oral corticosteroids, intranasal corticosteroid sprays, oral antibiotics, nasal saline irrigation, oral antihistamines, nasal antihistamines, anti-leukotriene agents, topical decongestants and oral mucolytics.ResultsA total of 304 (17.5%) preoperative and 143 (23.5%) postoperative questionnaires were completed and returned. Seventy-eight percent, 63% and 56% of respondents used preoperative intranasal corticosteroid sprays, oral antibiotics and oral mucolytics “always or often”, respectively. Ninety-four percent, 93%, 72% and 69% of respondents used postoperative intranasal corticosteroid sprays, nasal saline irrigation, oral antibiotics and oral mucolytics “always or often”, respectively. Oral antihistamines, nasal antihistamines, anti-leukotrienes and topical decongestants were not commonly used preoperatively or postoperatively.ConclusionsOur study demonstrated that current practice patterns of preoperative medical therapies among otolaryngologists are not uniformly based on evidence-based outcomes research. Postoperative oral antibiotics, intranasal corticosteroid sprays, nasal saline irrigation and oral mucolytics are commonly used by a majority of Chinese otolaryngologist for CRS. Practice patterns of postoperative medical therapy reflect recent guidelines.

Getting Started in Clinical Pharmacy Research

As a profound increase of health care expenditure and demand of chronic diseases management in the United States, the purpose of this review is to provide clinicians fundamental theory of how to conduct a scientific research in the health settings. Given different patients with a variety of disease status in the real world, randomized control trial (RCT) may not satisfy all the research questions. Therefore, evidence based outcomes research has been widely used for treatment guidance, reimbursement purposes and marketing strategy. An increasing use of evidence-based outcomes research raises awareness of the potential for choosing an appropriate research method in their clinical settings. This article summarizes the existing research methods and identifies the implications for practice in real world settings. After learning the pros and cons of each study design and the method of data collection in evidence based research, the clinicians are able to choose an appropriate method for their outcome measurement purposes. This article leads the clinicians step by step from propose a research question to conduct an observational study, and finally to disseminate the findings and publications. Therefore, effectively translate a normal question into a measurable research question may lead them to successfully conduct a scientific research. After learning the pros and cons of each study design and the method of data collection, the clinicians are able to choose an appropriate method for their outcome measurement purposes.

Perioperative care in functional endoscopic sinus surgery: a survey study

Functional endoscopic sinus surgery (FESS) is largely viewed as the standard of care in the treatment of chronic rhinosinusitis (CRS) refractory to medical treatment. While there is an understanding regarding the importance of some form of routine postoperative FESS care, no consensus currently exists regarding what the specific management routine should include. The authors of this survey study did not intend to examine the efficacy of such treatment protocols, but rather to determine and report on the current practice patterns of perioperative FESS care among otolaryngologists. This survey study was designed in accordance with and approved by our institutional review board. The online-based survey was designed using the online product SurveyMonkey®. A total of 859 otolaryngologists were identified and email addresses were obtained from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) website directory. Responses were collected anonymously. Our survey response rate was 32%. Multiple parameters of the otolaryngologists' perioperative care were collected. Among the data, some consistent patterns emerged: 93.2% of respondents use nasal saline irrigations postoperatively; 86.8% of otolaryngologists surveyed prescribe antibiotics in the immediate postoperative period; and office-based endoscopic sinus debridements are performed by a majority (87.9%) of those surveyed. This survey study demonstrates that current practices in perioperative FESS care can vary widely among otolaryngologists, and are not uniformly based on evidence-based outcomes research. Despite the lack of absolutes regarding the specific perioperative care in FESS, practice patterns emerge from the data regarding typical perioperative management among current otolaryngologists.

Views of Surgery Program Directors on the Current ACGME and Proposed IOM Duty-Hour Standards

The purpose of this study was to survey the experiences of surgery program directors with the current Accreditation Council for Graduate Medical Education (ACGME) duty-hour standards and views of the Institute of Medicine (IOM) proposed duty-hour recommendations. A total of 118 program directors (47.6% of all surgery programs in the US) responded to the survey. Results showed that the current duty-hour standards have hindered clinical education opportunities by reducing or eliminating rotations on many services, didactic teaching conferences, and clinical bedside teaching opportunities. Additionally, patient safety has been compromised by frequent hand offs of care. Most IOM recommendations were perceived as extremely difficult or impossible to implement, with the exception of the moonlighting recommendation. The results indicated that adopting the IOM recommendations is not feasible given current workforce limitations, and most program directors supported maintaining the current duty-hour standards until such time as there is evidence-based outcomes research to direct change. The conclusion was that the current ACGME duty-hour standards have reduced teaching opportunities and narrowed the scope of training.

The Psychological Safety of Breast Implant Surgery

One positive consequence of the challenge to silicone breast implants has been renewed interest in the psychological dimensions of plastic surgery. When asked questions about the psychological outcomes of women with breast implants, plastic surgery responded with work that is changing the very framework on which concepts such as body image and quality of life are founded. In the course of exploring the psychological impact of breast augmentation, traditional ways of thinking about patient characteristics and motivations have been called into question. There is a new focus on evidence-based outcomes research and an active search for methods that are valid, reliable, and sensitive enough to recognize and measure the emotional impact of changing physical appearance. With more information about psychiatric comorbidities and the identification of variables that influence patients' attitudes, augmentation mammaplasty with implants is better understood. Meanwhile, a new generation of investigators has been stimulated to study and reinterpret the psychodynamics of the aesthetic surgery experience.

How effective is medical nutrition therapy in diabetes care?

Historically, there has been a lack of evidence-based outcomes research to document clinical effectiveness. Today, evidence is available for the effectiveness of medical nutrition therapy (MNT) in diabetes management. Evidence exists from randomized controlled trials, observational studies, and meta-analyses that MNT improves metabolic outcomes such as blood glucose and hemoglobin A1C (A1C) in people with diabetes (Table 1)(1).

The evidence for the effectiveness of medical nutrition therapy in diabetes management.

Numerous advances in diabetes management and medical nutrition therapy (MNT) for individuals with diabetes make this an exciting time. Historically, a challenge to proving the benefit of MNT has been the lack of clinical and behavioral research. In recent years, however, evidence-based outcomes research that documents the clinical effectiveness of MNT in diabetes has been reported. The term “medical nutrition therapy” was introduced in 1994 by the American Dietetic Association to better articulate the nutrition therapy process. It is defined as the use of specific nutrition services to treat an illness, injury, or condition and involves two phases: 1 ) assessment of the nutritional status of the client and 2 ) treatment, which includes nutrition therapy, counseling, and the use of specialized nutrition supplements (1). MNT for diabetes incorporates a process that, when implemented correctly, includes: 1 ) an assessment of the patient’s nutrition and diabetes self-management knowledge and skills; 2 ) identification and negotiation of individually designed nutrition goals ; 3 ) nutrition intervention involving a careful match of both a meal-planning approach and educational materials to the patient’s needs, with flexibility in mind to have the plan be implemented by the patient; and 4) evaluation of outcomes and ongoing monitoring. These four steps are necessary to assist patients in acquiring and maintaining the knowledge, skills, attitudes, behaviors, and commitment to successfully meet the challenges of daily diabetes self-management (2). The primary purpose of this article is to review the evidence for the effectiveness of MNT in diabetes, both as an independent variable and in combination with other components of diabetes self-management training (DSMT). In addition, the recent studies that have demonstrated the effectiveness of lifestyle intervention, which included MNT, in preventing type 2 diabetes will be highlighted. Evidence from several studies that supports the cost-effectiveness of MNT in diabetes will also be …