Evidence-based Recommendations For Diagnosis Research Articles

Egyptian pediatric clinical practice guidelines for urinary tract infections in infants and children (evidence based)

BackgroundNational evidence-based recommendations for diagnosis, treatment, imaging, and follow-up in urinary tract infection are crucial being a major health problem in pediatrics. Every region should follow international recommendations with respect to the disease local profile and available facilities for that area.MethodsBased on AGREE II (the assessment tool of practice guidelines), Egyptian CGLs used *American Academy Pediatrics, *European Association Urology, European Society Pediatric Urology, and *Asian Association Urinary tract infections as its evidence-based references. Health questions were listed for evidence base answers adopted from selected CGLs after their permission. Key statements were approved by all members and further approved by the Egyptian Pediatric Guidelines Committee after local and international external peer reviewing.Results(1) Diagnosis recommendations: Urine culture with diagnostic colony counts is essential for diagnosis. Catheter samples are important for critical cases and non-toilet-trained cases especially when they show significant bacteriuria and pyuria. (2) Treatment plan included areas of debate as choice of antibiotic, oral versus intravenous, duration, antibiotic prophylaxis considering age, disease severity, recurrence, + risk factors, and imaging reports. (3) Imaging recommendations were tailored to suit our community. Renal bladder ultrasound is important for children with febrile UTI, due to the high prevalence of congenital anomalies of the kidney and urinary tract, paucity of prenatal ultrasound, and lack of medical documentation to reflect previously diagnosed UTI or US reports. We recommend renal isotopic scan and voiding cystography for serious presentation, high-risk factors, recurrence, and abnormal US. (4) Urological consultation is recommended: in urosepsis or obstruction, male infants < 6 months. Acute basal DMSA is recommended in congenital renal hypodysplasia. Six months post-infection, US and DMSA are recommended in severe pyelonephritis and vesico-ureteric reflux, where those with abnormal US or DMSA or both should have voiding cystography. (5) Follow-up recommendations include family orientation with hazards of noncompliance and monitoring at pregnancy.ConclusionDiagnosis and treatment show strong recommendations. Imaging depends on patient assessment. Referral to a pediatric nephrologist and urologist in complicated cases is crucial. Follow-up after the age of 16 years in adult clinics is important.

Leitliniengerechte Diagnostik der Pankreatitis

There is currently no S3guideline that contains statements on the diagnosis and treatment of acute, chronic and autoimmune pancreatitis in asingle guideline. This article presents the most relevant recommendations relating to radiological imaging from the new "S3guideline for pancreatitis". The guideline was developed by the DGVS (German Society for Digestive and Metabolic Diseases). After an online-based Delphi survey, the statements were discussed by an interdisciplinary expert team at a3-day consensus conference and then agreed upon. The level of evidence scheme (version2) of the Oxford Centre for Evidence-based Medicine was used. The new German "S3guideline pancreatitis" comprises for the first time all entities of pancreatitis, acute, chronic and autoimmune pancreatitis and contains alarge number of innovations with regard to diagnostic imaging and therapy. In addition to the evidence-based recommendations for diagnosis and therapy, aGerman-language glossary of the revised Atlanta classification on acute pancreatitis was adopted by consensus of the interdisciplinary guideline expert team. Furthermore, protocol recommendations for the performance of computed tomography (CT) are provided for the first time. In this article we introduce the key recommendations and innovations in the field of diagnostic radiologic imaging for acute, chronic and autoimmune pancreatitis. In the future, every radiologist should have deep knowledge of the recommended time intervals for radiological imaging in acute pancreatitis and know the German terms for the description of acute pancreatitis; furthermore they should be able to classify the morphologies to the appropriate stages.

Hypoglycemic symptoms in the absence of diabetes: Pilot evidence of clinical hypoglycemia in young women

AimsClinical visits of non-diabetic patients reporting hypoglycemic symptoms are common in endocrinology practices, but remain understudied and lack clinical definition and evidence-based recommendations for diagnosis or treatment. Our goal was to pilot test the concordance of hypoglycemic symptoms with low glucose values in young non-diabetic individuals. MethodsWe recruited eight individuals who reported regularly experiencing symptoms consistent with hypoglycemia to wear a blinded Dexcom continuous glucose monitor and report symptoms for seven days. We excluded individuals with diabetes or other known causes of hypoglycemia or similar symptoms. ResultsParticipants were all women with an average age of 29 years. 25% were African American and 25% had obesity. All participants experienced glucose values ≤ 70 mg/dL and half (4/8) experienced glucose ≤ 54 mg/dL for at least 15 min or 3 consecutive readings. Average time between last meal and reported symptoms was 4.4 h. Lower glucose values were significantly associated with higher odds of experiencing hypoglycemic symptoms 1.15 (CI: 1.07–1.24) for every −5mg/dL, (p < 0.001) from mixed effects models for repeated measures adjusted for age, race, and body mass index. All participants also reported engaging in potentially obesogenic behaviors in order to avoid symptoms. ConclusionsIndividuals with hypoglycemic symptoms in the absence of diabetes experience clinical hypoglycemia, indicating the need to understand the etiology, behavioral responses, and other health risks that might be associated with this understudied condition.

2454-PUB: Hypoglycemic Symptoms in the Absence of Diabetes: Pilot Evidence of Clinical Hypoglycemia in Young Healthy Women

Background: Hypoglycemic symptoms in the absence of diabetes remains a common complaint in endocrinology practices, but remains understudied and lacks clinical definition and evidence-based recommendations for diagnosis or treatment. Our goal was to pilot test the concordance of hypoglycemic symptoms with low glucose values in young healthy individuals. Methods: We recruited 8 individuals who reported regularly experiencing symptoms consistent with hypoglycemia to wear a blinded Dexcom continuous glucose monitor and report symptoms for seven days. We excluded individuals with diabetes or other known causes of hypoglycemia. Results: All participants experienced glucose values &amp;lt;70mg/dL and half (4/8) experienced glucose &amp;lt;50mg/dL for at least 15 minutes or 3 consecutive readings. Lower glucose values were significantly associated with higher odds of experiencing hypoglycemic symptoms (OR=1.15 (1.06-1.24) for every 5mg/dL, p&amp;lt;0.001) from mixed effects models for repeated measures (Figure). All participants also reported reduced quality of life and engaging in potentially obesogenic behaviors in order to avoid symptoms. Conclusions: Individuals with hypoglycemic symptoms in the absence of diabetes experience clinical hypoglycemia, indicating the need to understand the etiology, behavioral responses, and other health risks that might be associated with this condition. Disclosure M. Mongraw-Chaffin: None. D. McClain: None. D.P. Beavers: None. Funding National Center for Advancing Translational Sciences (UL1TR001420)

Core Elements of Outpatient Antibiotic Stewardship.

The Core Elements of Outpatient Antibiotic Stewardship provides a framework for antibiotic stewardship for outpatient clinicians and facilities that routinely provide antibiotic treatment. This report augments existing guidance for other clinical settings. In 2014 and 2015, respectively, CDC released the Core Elements of Hospital Antibiotic Stewardship Programs and the Core Elements of Antibiotic Stewardship for Nursing Homes. Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing involves implementing effective strategies to modify prescribing practices to align them with evidence-based recommendations for diagnosis and management. The four core elements of outpatient antibiotic stewardship are commitment, action for policy and practice, tracking and reporting, and education and expertise. Outpatient clinicians and facility leaders can commit to improving antibiotic prescribing and take action by implementing at least one policy or practice aimed at improving antibiotic prescribing practices. Clinicians and leaders of outpatient clinics and health care systems can track antibiotic prescribing practices and regularly report these data back to clinicians. Clinicians can provide educational resources to patients and families on appropriate antibiotic use. Finally, leaders of outpatient clinics and health systems can provide clinicians with education aimed at improving antibiotic prescribing and with access to persons with expertise in antibiotic stewardship. Establishing effective antibiotic stewardship interventions can protect patients and improve clinical outcomes in outpatient health care settings.

Neonatal central venous catheter thrombosis: diagnosis, management, and outcome.

Thrombotic occlusion of central venous catheters (CVCs) is a common problem in newborns. No guideline systematically addresses the diagnosis, management, and prevention of this complication. The objective of this review is to establish evidence-based guidance for the management of CVC thrombosis. A comprehensive literature search was conducted from 1948 to 2012. Twenty-six articles fulfilling four criteria - humans, neonates aged less than 28 days, CVC insertion, and English language - were included for analysis. The incidence of thrombosis was 9.2% (308/3332). Singly inserted umbilical venous catheters (UVCs) and peripherally inserted central catheters accounted for more than 80% of all CVCs. Frequently reported thrombotic sites were the hepatic vein, right atrium, and inferior vena cava. Symptoms included distal swelling of affected areas and thrombocytopenia. Increased length of catheter stay, infusion of blood products, and malpositioned UVCs were identified risk factors. The commonest diagnostic investigations confirming thrombosis were echocardiography and ultrasonography. Spontaneous resolution may occur in UVC-related thrombosis but warrants close monitoring. Thrombolysis with urokinase alone or combined with low molecular weight heparin might be effective and well tolerated. Prophylactic heparin increases the duration of catheter usability (P < 0.005, 95% confidence interval 0.35-0.81), decreases catheter occlusion, but may not uniformly prevent thrombosis. CVC-related thrombosis is an underreported complication because events in the majority occur silently. Currently, solid evidence-based recommendations for diagnosis and treatment are not possible. Well designed prospective studies are urgently required to establish a concrete investigational approach to CVC thrombosis and to institute well tolerated therapeutic modalities.

I70 Development of Evidence-Based Recommendations for Diagnosis, Assessment and Treatment of Lupus

I70 Development of Evidence-Based Recommendations for Diagnosis, Assessment and Treatment of Lupus

Year in review 2014: asthma.

Asthma continues to be recognized as a well-known respiratory disease requiring complex management. Asthma is assessed and treated by clinicians across the continuum. The interest in evidence-based recommendations for diagnosis, treatment, and long-term management is ongoing and essential for aligning clinical practice with its changes. The purpose of this review is to provide updates from recent literature on asthma for clinicians.

SHARE – workpackage 5: evidence-based recommendations for diagnosis and treatment of kawasaki disease and henoch schönlein purpura

Kawasaki Disease (KD) and Henoch Schonlein Purpura (HSP) are paediatric vasculitides that can lead to significant morbidity. Evidence-based guidelines are sparse and management is mostly based on physician experience. Consequently, treatment regimens differ throughout Europe. In 2012, a European initiative called SHARE (Single Hub and Access point for paediatric Rheumatology in Europe) was launched to optimize and disseminate guidelines for diagnosis and management for children and young adults with paediatric rheumatic diseases (PRD) such as KD and HSP within Europe.

SHARE – workpackage 5: evidence-based recommendations for diagnosis and treatment of rare paediatric vasculitides

Polyarteritis Nodosa (PAN), Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA), Eosinophilic Granulomatosis with Polyangiitis (EGPA) and Takayasu Arteritis (TA) are rare paediatric vasculitides that can lead to significant morbidity. Evidence-based guidelines are sparse and management is mostly based on physician experience. Consequently, treatment regimens differ throughout Europe. In 2012, a European initiative called SHARE (Single Hub and Access point for paediatric Rheumatology in Europe) was launched to optimize and disseminate guidelines for diagnosis and management for children and young adults with paediatric rheumatic diseases (PRD) such as vasculitis within Europe.

A Review of the 2008 Singapore Ministry of Health Clinical Practice Guidelines on Osteoporosis and an Update

Osteoporosis is a major public health problem worldwide and it is of particular significance in a rapidly aging society such as Singapore. In order to prevent the devastating sequelae of osteoporosis, it is important, to diagnose the condition early, to identify its associated risk factors and to initiate pharmacotherapy promptly when required. In addition, it is important to increase awareness of this condition amongst both health care professionals and the public. The Singapore Ministry of Health (MOH) Clinical Practice Guidelines published in 2008 was an update of a previously published version in 2002. It aimed at providing the best evidence-based recommendations for diagnosis, classification, evaluation and multidisciplinary management of osteoporosis and osteoporotic fractures in Singapore. This article summarizes the guidelines, discusses their applicability and utilization in Singapore and briefly outlines updates in management since the publication of the CPG.

Recommendations for Obesity Management from Singapore

Obesity, defined as a condition of excessive body fat with adverse effects on health, is an increasing global problem which contributes to chronic disease burden and health care costs. The Singapore Ministry of Health (MOH) released Clinical Practice Guidelines (CPG) in 2004, aimed at providing best evidence-based recommendations for diagnosis, classification, evaluation and multidisciplinary management (diet, physical activity, medication and surgery) of overweight and obesity in adults and the pediatric population. This article summarizes the guidelines, discusses their utility in Singapore and strategies for increasing their use, and briefly outlines updates in management since the CPG’s publication. A revised CPG is urgently needed in view of the increasing prevalence of overweight and obesity in Singapore and the numerous advances in the management of overweight and obesity.

Optic Pathway Gliomas in Neurofibromatosis 1 (NF-1)

Advances in the pathophysiology and clinical behavior of NF-1 associated optic pathway gliomas (OPG) made over the past 10 years are examined, and evidence-based recommendations for diagnosis and management are proposed by researchers from Children's Memorial Hospital, Chicago; St Thomas's Hospital, London; Children's Hospital of Philadelphia; University of Pennsylvania School of Medicine, Philadelphia; and Washington University School of Medicine, St Louis, MO, The initial diagnostic and management guidelines proposed by a task force in 1997 are extended, and unanswered questions are addressed.

Chemotherapy for Bladder Cancer: Treatment Guidelines for Neoadjuvant Chemotherapy, Bladder Preservation, Adjuvant Chemotherapy, and Metastatic Cancer

To determine the optimal use of chemotherapy in the neoadjuvant, adjuvant, and metastatic setting in patients with advanced urothelial cell carcinoma, a consensus conference was convened by the World Health Organization (WHO) and the Société Internationale d'Urologie (SIU) to critically review the published literature on chemotherapy for patients with locally advanced bladder cancer. This article reports the development of international guidelines for the treatment of patients with locally advanced bladder cancer with neoadjuvant and adjuvant chemotherapy. Bladder preservation is also discussed, as is chemotherapy for patients with metastatic urothelial cancer. The conference panel consisted of 10 medical oncologists and urologists from 3 continents who are experts in this field and who reviewed the English-language literature through October 2004. Relevant English-language literature was identified with the use of Medline; additional cited works not detected on the initial search regarding neoadjuvant chemotherapy, bladder preservation, adjuvant chemotherapy, and chemotherapy for patients with metastatic urothelial cancer were reviewed. Evidence-based recommendations for diagnosis and management of the disease were made with reference to a 4-point scale. Results of the authors' deliberations are presented as a consensus document. Meta-analysis of randomized trials on cisplatin-containing combination neoadjuvant chemotherapy revealed a 5% difference in favor of neoadjuvant chemotherapy. No randomized trials have yet compared survival with transurethral resection of bladder tumor alone versus cystectomy for the management of patients with muscle-invasive disease. Collaborative international adjuvant chemotherapy trials are needed to assist researchers in assessing the true value of adjuvant chemotherapy. Systemic cisplatin-based combination chemotherapy is the only current modality that has been shown in phase 3 trials to improve survival in responsive patients with advanced urothelial cancer. A panel of international experts has formulated grade A through D recommendations for the management of patients with locally advanced and metastatic urothelial cancer on the basis of level 1 to 3 evidence and the findings of phase 2 trials, prospective randomized clinical trials, and meta-analyses.

Low-grade T a (noninvasive) urothelial carcinoma of the bladder

This article discusses the development of international guidelines for the diagnosis, treatment, follow-up, and prevention of low-grade Ta urothelial carcinoma of the bladder. The authors, who are experts in this field from 3 continents and 7 countries, reviewed the English language literature through September 2004. The results of the authors’ deliberations are presented here as a consensus document. The objective of this study was to determine the optimal diagnostic workup, treatment, follow-up, and prevention of low-grade, Ta urothelial carcinoma of the bladder. A consensus conference convened by the World Health Organization (WHO) and the Société Internationale d’Urologie (SIU) met to critically review the literature on the diagnosis and treatment of low-grade Ta urothelial carcinoma of the bladder. Research was conducted using Medline; this search engine also was used to identify additional works not detected at the initial search. Evidence-based recommendations for diagnosis and management of the disease were made with reference to a 4-point scale. Low-grade Ta urothelial carcinoma of the bladder is a well-studied subject with many level 1 and 2 evidence references that support clinical practice. Findings from 135 reviewed citations are summarized. Many grade A and B recommendations on the diagnostic workup and management of this disease can be given with level 1 and 2 evidence based on prospective randomized clinical trials of sufficient statistical power. This should improve the quality of the treatment of this disease.