Implementation Of International Guidelines Research Articles

American Society of Hematology, ABHH, ACHO, Grupo CAHT, Grupo CLAHT, SAH, SBHH, SHU, SOCHIHEM, SOMETH, Sociedad Panamena de Hematología, Sociedad Peruana de Hematología, and SVH 2023 guidelines for diagnosis of venous thromboembolism and for its management in special populations in Latin America.

Implementation of international guidelines in Latin American settings requires additional considerations (ie, values and preferences, resources, accessibility, feasibility, and impact on health equity). The purpose of this guideline is to provide evidence-based recommendations about the diagnosis of venous thromboembolism (VTE) and its management in children and during pregnancy. We used the GRADE ADOLOPMENT method to adapt recommendations from 3 American Society of Hematology (ASH) VTE guidelines (diagnosis of VTE, VTE in pregnancy, and VTE in the pediatric population). ASH and 12 local hematology societies formed a guideline panel comprising medical professionals from 10 countries in Latin America. Panelists prioritized 10 questions about the diagnosis of VTE and 18 questions about its management in special populations that were relevant for the Latin American context. A knowledge synthesis team updated evidence reviews of health effects conducted for the original ASH guidelines and summarized information about factors specific to the Latin American context. In comparison with the original guideline, there were significant changes in 2 of 10 diagnostic recommendations (changes in the diagnostic algorithms) and in 9 of 18 management recommendations (4 changed direction and 5 changed strength). This guideline ADOLOPMENT project highlighted the importance of contextualizing recommendations in other settings based on differences in values, resources, feasibility, and health equity impact.

Recommendations for the prevention, screening, diagnosis, staging, and management of cervical cancer in areas with limited resources: Report from the International Gynecological Cancer Society consensus meeting.

Nearly 85% of cervical cancer new cases are diagnosed in limited resources countries. Although several strategies have been proposed to reduce the disease burden, challenges remain to provide the best possible care. We report recommendations from an expert consensus meeting convened to address from prevention to management of cervical cancer in limited resources countries. The expert panel, composed by invited specialists from 38 developing countries in Africa, Asia, Eastern Europe, Latin America, and the Middle East, convened in Rio de Janeiro in September 2019, during the Global Meeting of the International Gynecological Cancer Society (IGCS). Panel members considered the published scientific evidence and their practical experience on the topics, as well as the perceived cost-effectiveness of, and access to, the available interventions. The focus of the recommendations was on geographic regions rather than entire countries because medical practice varies considerably in the countries represented. Resource limitation was qualified as limited access to qualified surgeons, contemporary imaging or radiation-oncology techniques, antineoplastic drugs, or overall funding for provision of state-of-the-art care. Consensus was defined as at least 75% of the voting members selecting a particular answer of the multiple-choice questionnaire, whereas the majority vote was considered as 50% to 74.9%. Consensus was reached for 25 of the 121 (20.7%) questions, whereas for 54 (44.6%) questions there was one option garnering between 50% to 74.9% of votes (majority votes). For the remaining questions, considerable heterogeneity in responses was observed. The implementation of international guidelines is challenging in countries with resource limitations or unique health-care landscapes. The development of guidelines by the health care providers in those regions is more reflective of the reality on the ground and may improve medical practice and patient care. However, challenges remain toward achieving that goal at political, economic, social, and medical levels.

Knowledge and implementation of the guidelines of the holistic educational approach in the Republic of Slovenia

Introduction: The UNESCO Education Sector and the European Commission for decades emphasise the importance and necessity of introducing a holistic approach to education. The school policies emphasise only a cognitive or rationalist approach and the educational process is operating in a reductionist and deterministic manner. From a sustainable point of view, such consequences are various and multifaceted – on a personal and a social level. Methods: The aim of the research was to establish the level of knowledge of Delors Report, Incheon Declaration and holistic approach among educational professionals (N=525) in Slovenia. A causal non-experimental method of research was used to search the causes for use of international guidelines and knowledge of holistic approaches. The connections between knowledge of documents and demographics were determined with chi-square test, the importance of pillars by statements, compliance with international guidelines by self- assessment. Results: The results show low familiarity with Delors Report (27%), Incheon Declaration (10.8%) and holistic approach (58.6%). The reasons given for a better knowledge of the Delors Report are older age, longer years of service, and the position of principal. Familiarity with that report influences the with holistic approach, but not on importance of certain pillar, or implementation of international guidelines. There is an inversely proportional correlation between familiarity with Incheon Declaration and holistic approach. Conclusion: The awareness of documents and holistic educational approaches is perceived only on a formalistic, declarative level. A solution is in the introduction of logopedagogy/holistic approaches based on anthropological attitude (logotherapy/existential analysis) towards understanding man as a physical, mental and spiritual being.

Prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolemia, and associated risk factors in the Czech Republic, Russia, Poland and Lithuania: a cross-sectional study

BackgroundEmpirical evidence on the epidemiology of hypertension, diabetes and hypercholesterolemia is limited in many countries in Central and Eastern Europe. We aimed to estimate the prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolemia in the Czech Republic, Russia, Poland and Lithuania, and to identify the risk factors for the three chronic conditions.MethodsWe analysed cross-sectional data from the HAPIEE study, including adults aged 45–69 years in the Czech Republic, Russia, Poland and Lithuania, collected between 2002 and 2008 (total sample N = 30,882). Among prevalent cases, we estimated awareness, treatment, and control of hypertension, diabetes and hypercholesterolemia by gender and country. Multivariate logistic regression was applied to identify associated risk factors.ResultsIn each country among both men and women, we found high prevalence but low control of hypertension, diabetes, and hypercholesterolemia. Awareness rates of hypertension were the lowest in both men (61.40%) and women (69.21%) in the Czech Republic, while awareness rates of hypercholesterolemia were the highest in both men (46.51%) and women (51.20%) in Poland. Polish participants also had the highest rates of awareness (77.37% in men and 79.53% in women), treatment (71.99% in men and 74.87% in women) and control (30.98% in men and 38.08% in women) of diabetes. The common risk factors for the three chronic conditions were age, gender, education, obesity and alcohol consumption.ConclusionsPatterns of awareness, treatment and control rates of hypertension, diabetes and hypercholesterolemia differed by country. Efforts should be made in all four countries to control these conditions, including implementation of international guidelines in everyday practice to improve detection and effective management of these conditions.

TheMidwifery Student’s Observations about the Implementation of International Guidelines and Protocols in Greek Maternity Hospitals

Background: Childbirth is a unique experience ina woman’s life and always remains indelibly engraved in her memory. For this reason, it is necessary to ensure appropriate conditions to have a positive birth experience. Thus, guidelines and protocols have been developed by major international organizations that aim to promote normal labor and better care for the mother and fetus without unnecessary interventions. The aim of this study is to investigate whether the international guidelines and protocols are observed in Greek maternity hospitals. Methods: The study involved 124 male and female students from the three departments of Midwifery: University of West Attica, International Hellenic University and University Western Macedonia, which completed an equal number of self-report questionnaires with their socio-demographic data and were then asked to answer questions posed by instructions for normal childbirth. Results: It was observed that many of the guidelines are not followed, such as grooming and enema, prohibition of feeding and fluid intake, application of pressure on the bottom of the uterus, frequent vaginal examination, prohibition in the presence of sessions, continuous cardiotocographic follow-up in low-risk pregnancies, termination of delivery only in a supine gynecological position, routine perineotomy and immediate ligation of the umbilical cord. Conclusions: The purpose of the guidelines is to maintain the natural course of childbirth by avoiding a series of unnecessary acts that alter the naturalness and undermine the rights of women in childbirth.

Iron Deficiency Anemia in Inflammatory Bowel Diseases-A Narrative Review.

Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, is characterized by chronic inflammation of the gastrointestinal tract. IBD has been associated with numerous symptoms and complications, with the most common being iron deficiency anemia (IDA). Iron deficiency in IBD is caused by inadequate intake, malabsorption (including duodenal involvement and surgical removal), and chronic blood loss by mucosal ulcerations. Therefore, an appropriate diet should be enforced. Iron deficiency and iron supplementation have been associated with alterations to gut microbiota. IBD-associated anemia, in particular iron deficiency anemia, is associated with a significant decrease in quality of life and with clinical symptoms such as chronic fatigue, headaches and dizziness, reduced exercise tolerance, pale skin, nails, conjunctiva, and fainting. However, despite these numerous adverse symptoms, IDA remains undertreated. The European Crohn’s and Colitis Organisation (ECCO) guidelines state that patients should be monitored for anemia. Adequate treatment, whether oral or intravenous, should be implemented while taking into consideration C-reactive protein values (CRP), hemoglobin levels, and therapeutic response. It should be stressed that every case of anemia in IBD patients should be treated. Intravenous iron formulations, which are more superior compared to the oral form, should be used. There is a need to increase awareness and implementation of international guidelines on iron supplementation in patients with IBD.

Challenges of delivering reproductive health services to forced displaced populations

BackgroundOf the 80 million forced displaced persons worldwide, women and children bear greater morbidity and mortality, especially in conflict-affected regions. This is due to disruption in health service provision, breakdown of social institutions and increase in sexual and gender-based violence. Reproductive health (RH) service delivery as part of humanitarian health cluster services is outlined in the Minimum Initial Service Package (MISP). This study explores the challenges of delivering RH services to forced-displaced populations, focussing on field level stakeholders in humanitarian settings.MethodsQualitative semi-structured interviews were conducted with stakeholders from non-governmental and United Nations agencies involved in delivering RH services to conflict-affected populations. Additionally, a scoping review, using the Arksey and O'Malley framework, of the literature was also conducted reviewing challenges of delivering RH programmes to women in forced displaced populations. An inductive and deductive thematic approach was used in data analysis.ResultsEleven key informants (KIs) were interviewed from six conflict-affected countries including Syria, Afghanistan and Libya. Main emerging themes were: 1. Poor awareness of international guidelines (including the MISP) 2. Service provision barriers including lack of human resources 3. Attitudes towards SRH and women's rights 4. Disruption of health services due to COVID-19.ConclusionsThis study has highlighted the main challenges that the humanitarian actors delivering RH programmes in conflict-affected settings face. Implementation of international guidelines remains a key barrier. Key policy recommendations would be to standardise training for all RH providers, prioritise training in the MISP and address cultural attitudes towards RH. Further research exploring the use of WHO's essential medicines for RH and the long-term impact of COVID-19 on forced displaced females needs to be conducted.Key messages Providing basic essential reproductive health services to conflict affected populations remains a challenge, including implementation of standardised international guidance through the MISP.One key policy recommendation would be to prioritise training in MISP for conflict-affected humanitarian settings to ensure it is offered as part of the essential package.

A National Survey Identifying the Factors Associated With Cardiovascular Care Nurses' Perceived Knowledge of International Practice Guidelines: The First Step in the Development of an Implementation Strategy.

The implementation of international guidelines within everyday practice remains problematic, which can have a detrimental impact on quality of care delivered. This study aimed to ascertain the factors associated with clinical nurses' perceived knowledge of international guidelines. In this cross-sectional survey, nurses from 45 hospitals across Ireland were recruited. A previously validated anonymous questionnaire that assessed guideline knowledge, use, and barriers to implementation was used. Data were analyzed using SPSS 23 and logistic regression. Of the 542 responses, 54% had used international guidelines relevant to their practice and 50% had consulted within the last year. Most nurses perceived that poor patient follow-up, lack of time and resources, poor clinical leadership, workload, long guidelines, and not understanding guideline detail were barriers to guideline use and implementation. Forty-five percent rated their perceived knowledge of guidelines as "low." Logistic regression identified that "high" knowledge levels were significantly associated with having read guidelines in the last year and their use with practice. In contrast, low knowledge of the guidelines was associated with perceptions that they were lengthy and not easy to use, lack of confidence to challenge colleagues when guidelines are not implemented, or not being able to influence current practice. This study identified the specific knowledge needs in this cohort of mainly basic grade registered nurses, with low perceived guideline knowledge. A whole unit or team approach led by nurse champions is needed to develop and establish practice and educational strategies that would increase the availability, application, and knowledge of guidelines within everyday practice.

Abstract 16: Presentation and Management of Egyptian Female Breast Cancer In Alexandria, Egypt: An Implementation Study

Abstract Purpose: Exploration of the population profile and management of female breast cancer in a representative sample from Alexandria, Egypt, to identify system inefficiencies and barriers preventing full implementation of international guidelines, negatively impacting the outcome. Methods: The study surveyed 7125 records from three major public oncology services at Main University Hospital, Gamal Abd-elnasser Hospital and Ayadi Almostakbel Oncology Center, between 2007 and 2016. Results: 73.4% (5236 records) of the records contained usable information. The median age was 54 years, with positive family history in 31.5%. The median duration of complaint before diagnosis was 3.1 months (IQR 1.6-7.5). 55.2% were early stage, 37.6% were locally advanced and 7.2% were stage IV. Breast surgery was performed for 4976 cases. Axillary surgery was done for 4945 cases. Most cases were hormone receptor positive. 15.3% were HER2 positive. The median duration to start chemotherapy was 1.03 months (IQR 0.7-1.6). Adjuvant chemotherapy was given to 3667 and neoadjuvant chemotherapy was given to 333. Anthracycline-based combination chemotherapy, with or without Taxanes was the commonest. 86% received hormonal treatment. 180/317 trastuzumab-eligible patients received trastuzumab. 69.5% started radiotherapy > 6 months from presentation. Conventionally and hypofractionated regimens were used in 46.6% and 53.5%, respectively. 1109 developed relapse (local in 155, distant in 130 and 794 had both). In non-metastatic cases, median overall and disease free survivals were 149.1 and 77.1 months respectively. In metastatic cases, the median progression free survival was 19.6 months. Conclusion: The study revealed defects in the record system, delayed diagnosis and treatment, and inadherence to targeted therapy protocols in a significant part of eligible patients. Suggested implementation strategies include promotion of national or hospital based registries, information, education and communication with target populations and health carers, establishing a patient navigation system and monitoring outcomes of the interventions. Citation Format: Yousri Rostom, Salah Abdelmonem, Marwa Shaker, Nayera Mahmoud, Nevine Labib, Abdelsalam A. Ismail, Maher Soliman. Presentation and Management of Egyptian Female Breast Cancer In Alexandria, Egypt: An Implementation Study [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 16.

Evidence-Based Recommendations on the Pharmacological Management of Osteoarthritis and Chronic Low Back Pain: An Asian Consensus

The overall burden of chronic musculoskeletal pain in Asian countries will continue to increase as the population ages, as will the demand for safe and effective pain management. Currently available Asian guidelines are mostly outdated and targeted only to primary care. Implementation of international guidelines may be unsuitable for Asian patients due to cultural, local economic and regulatory factors. With the aim of developing Asian-specifi c consensus recommendations for the pharmacological management of osteoarthritis (OA) pain and chronic low back pain (cLBP), we convened to review and discuss recent available evidence for pharmacotherapy, clinical experiences, and current practice challenges they face in the region, including challenges in opioid use. Taking these into consideration, we provided general recommendations for the overall assessment and management of OA pain and cLBP. The strength of the recommendations regarding the use of pharmacological agents was assessed using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system. Where evidence is confl icting or limited, we made no recommendation pending the availability of further evidence. We recommend topical non-steroidal anti-infl ammatory drugs (NSAIDs) as a fi rst-line pharmacological treatment of OA pain, while oral NSAIDs should be considered as a fi rst-line pharmacological treatment of cLBP. Acetaminophen has been commonly used as the fi rst-line treatment for OA pain and cLBP, but its long-term use is not recommended based on recent evidence. These consensus recommendations are not prescriptive, and serve as a guide for decision-making in clinical practice. The optimal management of OA pain and cLBP should ultimately be individualized to each patient.

Global But Not Regional? The Role of African Regional Migration Regimes in the International Governance Architecture

Regional organisations and migration regimes are increasingly being acknowledged in global migration policies. The global compacts for migration and on refugees adopted in December 2018 recognise the migration-related expertise and important function of regional organisations in the implementation of international guidelines and policies. But the compacts’ wording is vague on the division of labour between global and regional migration regimes, and important questions remain unanswered regarding the added value and ideal role of regional migration regimes in the international system. This is particularly true for regions of the global South, whose institutional arrangements, substantive focus and performance in migration-related norm setting and implementation remain understudied. The authors contribute to filling this knowledge gap by considering two migration policy processes in the context of their overall (regional) migration governance systems and regimes – the ECOWAS Protocol for the Free Movement of Persons and the IGAD Regional Framework for Durable Solutions for Somali Refugees. Based on a qualitative research design, they find that regional migration regimes possess some comparative advantages compared with global ones, which enhance their agency. However, depending on institutional path dependencies, the degree of legalisation and the interests of powerful internal and external actors, levels of agency with regards to different migration types might show significant variation.

Andexanet alfa for the reversal of factor Xa inhibitors

ABSTRACTIntroduction: Andexanet alfa is a recombinant modified factor Xa protein that has been developed to reverse factor Xa inhibitors. Since May 2018, the FDA has approved its utilization in patients treated with apixaban and rivaroxaban in case of life-threatening or uncontrolled bleeding. On 28 of February 2019, the Committee for Medicinal Products for Human Use adopted a positive opinion, recommending the granting of a conditional marketing authorization for andexanet alfa in Europe.Area covered: The authors provide an overview of andexanet alfa development and its pharmacokinetic and pharmacodynamic properties. The results of the clinical phase III trial ANNEXA as well as current limitations related to andexanet alfa are also discussed.Expert opinion: Although phase I and II studies have proven that andexanet alfa can be effective in reversing the effect of factor Xa inhibitors, its efficacy in major bleeding patients has only been shown for apixaban and rivaroxaban, without any comparator group. Well-designed studies comparing the efficacy and safety of andexanet alfa to other reversal strategies are required to confirm preliminary data. The benefit of andexanet alfa in specific settings needs to be investigated and its use in clinical practice needs to be facilitated by the implementation of international guidelines.

Prevalence and predictors of gestational diabetes mellitus: a nationwide multicentre prospective study.

Prevalence rates of gestational diabetes mellitus (GDM) show considerable variation among different countries and regions of the world. The primary aim of this study was to determine the nationwide prevalence and predictors of GDM in Turkey. We conducted prospective nationwide screening among pregnant women. Between August 2016 and November 2017, a total of 2643 pregnant women from 51 centres in 12 different regions were enrolled. A two-step screening method and Carpenter and Coustan criteria were used in the diagnosis of GDM. Clinical and biochemical data were obtained using electronic database software. The national prevalence of GDM was found to be 16.2% [95% confidence intervals (CI) 15.0% to 17.4%] without a significant difference between urban and rural regions. Women with GDM were older (mean age: 32±5 vs. 28±5years, P<0.001) and heavier (mean BMI: 27.2±5.1 vs. 24.7±4.7kg/m2 , P<0.001) than their counterparts without GDM. The prevalence of GDM tended to increase with age (<25years, 6.9%; 26-35years, 15.6%; and 36-45years, 32.7%; P<0.001). Maternal age, maternal BMI, history of previous GDM and family history of diabetes mellitus were independent predictors of developing GDM (P<0.05 for all). Low-risk women (age <25years, BMI <25kg/m2 , no family history of diabetes) comprised 10.7% of the total population and the prevalence of GDM in these women was 4.5% (95% CI 2.4% to 7.8%). The results of this nationwide study indicate that GDM is very common, affecting one in seven pregnancies in Turkey. Implementation of international guidelines on screening and management of this public health problem is required.

Hematopoietic Cell Transplantation for Mucopolysaccharidosis Patients Is Safe and Effective: Results after Implementation of International Guidelines

Allogeneic hematopoietic cell transplantation (HCT) is the only treatment able to prevent progressive neurodegenerative disease in a selected group of mucopolysaccharidosis (MPS) disorders. However, its use was historically limited by the high risk of graft failure and transplantation-related morbidity and mortality. Therefore, since 2005 new international HCT guidelines for MPS disorders were proposed. The survival and graft outcomes of MPS patients receiving HCT according to these guidelines in 2 European centers of expertise were evaluated. Two consecutive conditioning regimens were used, busulfan/cyclophosphamide or fludarabine/busulfan-based, both with exposure-targeted i.v. busulfan. A noncarrier matched sibling donor (MSD), matched unrelated cord blood (UCB), or matched unrelated donor (MUD) were considered to be preferred donors. If not available, a mismatched UCB donor was used. Participants were 62 MPS patients (56 MPS type I–Hurler, 2 MPS type II, 2 MPS type III, and 2 MPS type VI) receiving HCT at median age 13.5 months (range, 3 to 44). Forty-one patients received a UCB donor, 17 MSD, and 4 MUD. High overall survival (95.2%) and event-free survival (90.3%) were achieved with only low toxicity: 13.3% acute graft-versus-host disease aGVHD) grades II to IV and 14.8% chronic GVHD (1.9% extensive). A mismatched donor predicted for lower event-free survival (P = .04). A higher age at HCT was a predictor for both aGVHD (P = .001) and chronic GVHD (P = .01). The use of a mismatched donor was a predictor for aGVHD (P = .01). Higher rates of full-donor chimerism were achieved in successfully transplanted UCB recipients compared with MSD/MUD (P = .002). If complying with the international HCT guidelines, HCT in MPS patients results in high safety and efficacy. This allows extension of HCT to more attenuated MPS types. Because a younger age at HCT is associated with reduction of HCT-related toxicity, newborn screening may further increase safety.

Hematopoietic Cell Transplantation for MPS Patients Is Safe and Effective: Results after Implementation of International Guidelines

Hematopoietic Cell Transplantation for MPS Patients Is Safe and Effective: Results after Implementation of International Guidelines

Anaemia management in patients with inflammatory bowel disease

Anaemia and iron deficiency (ID) are common complications in inflammatory bowel disease (IBD). In patients undergoing iron therapy, intravenous iron supplementation is recommended in preference to oral therapy. This study evaluated routine practice in the management of IBD-associated anaemia and ID to verify implementation of international treatment guidelines. Gastroenterologists from nine European countries (n=344) were surveyed about their last five IBD patients treated for anaemia (n=1404). Collected information included tests performed at anaemia diagnosis, haemoglobin (Hb) levels and iron status parameters, the anaemia treatment given and, if applicable, the iron administration route. Selection of diagnostic tests and treatment for IBD-associated anaemia varied considerably across Europe. Anaemia and iron status were mainly assessed by Hb (88%) and serum ferritin (75%). Transferrin saturation was only tested in 25% of patients. At diagnosis of anaemia, 56% presented with at least moderate anaemia (Hb<10 g/dl) and 15% with severe anaemia (Hb<8 g/dl). ID (ferritin<30 ng/ml) was detected in 76%. Almost all patients (92%) received iron supplementation; however, only 28% received intravenous iron and 67% oral iron. Management practice was similar in 2009 and 2011. In clinical practice, most IBD patients received oral iron even though this administration route may aggravate the disease, and despite international guidelines recommending intravenous administration as the preferred route. The high frequency of ID suggests insufficient monitoring of iron status in IBD patients. There is a need to increase awareness and implementation of international guidelines on iron supplementation in patients with IBD.

Management of allergic rhinitis in general practitioners

For patients suffering from allergic rhinitis (AR), general practitioners (GPs) are often their first source of medical advice. It is one of the top-ten reasons for a visit to the primary care clinics and AR was estimated to be 10-40% of the total patient visits in about 50% of the primary care clinics. The standard of management for AR among GPs is thus a key outcome assessment of AR management and implementation of international guidelines in general healthcare practice.

Developing Recommendations for Vascular Access for Hemodialysis: Vascular Access Working Group of the Italian Society of Nephrology

This paper presents an overview of the project carried out by the Vascular Access (VA) Working Group of the Italian Society of Nephrology with the aim of developing 4 position papers at the national level on how to choose, use, and implant the different, possible types of vascular access. The topics of the project are: 1) recommendations on the use of prosthetic arteriovenous fistulas for vascular access in hemodialysis, 2) recommendations on the use of venous catheters for hemodialysis, 3) infections induced by a venous catheter for hemodialysis, and 4) how to create and maintain a vascular access for hemodialysis. This paper also gives an explanation of the difficulties existing in Italy in the implementation of international guidelines, mostly due to significant differences in the procedures for the creation of VA, compared with the countries where most of the literature on the subject has been published. Individual position papers were drafted for each of the different topics. A list of recommendations was produced based on existing guidelines. Then these recommendations were critically reviewed by experts working in Italy, who expressed their opinion on their inclusion in position papers. The working method used to gather the opinions of the various experts is described. The final target is to provide clinicians interested in VA with updated documents on selected topics. Such documents will be updated periodically, and they will present a thorough overview of expert opinions.

Thromboembolierisiko und -prophylaxe internistischer und chirurgischer Patienten im Krankenhaus

Venous thromboembolism (VTE) leads to an increased morbidity in hospitalized patients. This multinational cross-sectional survey was designed to assess the prevalence of VTE risk factors and to determine the proportion of at-risk patients who receive effective VTE-prophylaxis. The results of the 16 participating German hospitals of the study are presented and compared with the international results. All hospital inpatients aged >or= 40 years admitted to a medical ward and all surgical inpatients aged >or= 18 years were enrolled. The American College of Chest Physicians (ACCP) guidelines (2004) were applied to assess VTE risk and to determine whether patients were receiving recommended VTE prophylaxis. Overall, 2,370 patients were enrolled: 1,210 (51 %) were categorised as surgical and 1,160 (49 %) as acute medically ill. 838 (69 %) of surgical and 479 (41 %) of medical patients were judged to be at risk for VTE. Of the surgical patients at risk, 772 (92 %) received ACCP-recommended VTE prophylaxis, compared with 337 (70 %) medical patients at risk of VTE. Low-molecular weight heparins were most frequently used. In total, in comparison to other countries, Germany has a leading position in the implementation of international guidelines with regard to VTE prophylaxis. Whereas in a surgical ward effective VTE prophylaxis is consistently standard care, in the medical indications there is still room for improvement in terms of stratification of VTE risk and corresponding VTE-prophylaxis.

2119 Delay in implementation of international guidelines forcomputed tomographies with iodinated contrast media

2119 Delay in implementation of international guidelines forcomputed tomographies with iodinated contrast media