Introduction Of Guidelines Research Articles

Adenoma and Sessile Serrated Lesion Detection Rates at Screening Colonoscopy for Ages 45–49 Years vs Older Ages Since the Introduction of New Colorectal Cancer Screening Guidelines

All major U.S. guidelines now endorse average-risk colorectal cancer (CRC) screening at 45-49 years of age. Concerns exist that endoscopic capacity may be strained, that low-risk persons may self-select for screening, and that calculations of the adenoma detection rate may be diluted. We analyzed age-specific screening colonoscopy volumes and lesion detection rates before vs after the endorsement of CRC screening at 45-49 years of age. We compared colonoscopy volumes and lesion detection rates in our healthcare system during period 1 (October 2017 to December 2018), before the first change in guidelines, vs period 2 (January 2019 to August 2021), the era of new guidelines. The proportion of first-time screening colonoscopies performed in 45- to 49-year-olds increased from 3.5% to 11.6% (relative risk, 3.36; 95% CI, 2.45-4.61). The period 2 detection rates for adenoma, advanced adenoma, sessile serrated lesion, advanced sessile serrated lesion, adenomas per colonoscopy, and lesions per colonoscopy were very similar for 45- to 49-year-olds (34.3%, 6.3%, 8.6%, 2.9%, 0.58, and 0.69, respectively) and 50- to 54-year-olds (38.2%, 5.8%, 9.4%, 3.0%, 0.63, and 0.76, respectively) at first-time screening, and for 60- to 64-year-olds at rescreening (33.4%, 6.1%, 7.2%, 2.3%, 0.61, and 0.70, respectively). All detection rates, adenomas per colonoscopy, and lesions per colonoscopy increased from period 1 to period 2 (eg, overall adenoma detection rate 35.1% vs 42.6%; P < .0001), without any decreases among 45- to 49-year-olds. In our healthcare system, a lower CRC screening initiation age has modestly affected colonoscopy volume by age without compromising screening yield. Lesion detection rates, including for advanced adenomas, in average-risk 45- to 49-year-olds approximate those in 50- to 54-year-olds at first-time screening and 60- to 64-year-olds at rescreening. National monitoring is needed to assess fully the impact of lowering the CRC screening initiation age.

Children's rights in Austrian hospitals: implementation factors for children's participation

HintergrundFür Kinder und Jugendliche (sowie deren Eltern) ist es wichtig, in Entscheidungen bezüglich ihrer Behandlung eingebunden zu werden und mitzusprechen. Dennoch sind Partizipationsprozesse nicht überall in die Behandlungsabläufe in Krankenhäusern eingebaut. Über die Umsetzung von Kinderrechten bzw. Partizipation in österreichischen Krankenhäusern gab es bisher keine Daten.FragestellungDie Studie untersucht, inwiefern Kinderrechte (insbesondere das Recht auf Partizipation) und die EACH-Charta in österreichischen Krankenhäusern bekannt sind, wie sie umgesetzt werden und was förderliche und hinderliche Faktoren dabei sind.MethodenEs wurden eine Fragebogenerhebung unter ärztlichen und pflegerischen Leitungspersonen auf Kinder- und Jugendstationen (n = 133) sowie qualitative Interviews mit Fachexpert:innen, medizinischem Fachpersonal sowie betroffenen Eltern und einer Jugendlichen (n = 15) durchgeführt.ErgebnisseIn Krankenhäusern wird bereits Einiges getan, um die Rechte von Kindern zu wahren. Es herrscht vielerorts Bewusstsein für eine kindzentrierte Behandlung und für die Notwendigkeit, Kinder und Jugendliche während ihres Krankenhausaufenthalts partizipieren zu lassen. Dennoch zeigen die Interviews mit Eltern, dass es große Unterschiede zwischen Krankenhäusern gibt.DiskussionEs wurden 3 Bereiche für Handlungsempfehlungen identifiziert: 1. Verankerung der Kinderrechte – gesetzlich und in der Ausbildung des medizinischen Fachpersonals, 2. Stärkung der Team- und Feedbackkultur, z. B. durch mehr Personalressourcen für Teamarbeit, und 3. gute Gesundheitsinformation und gute Gesprächsqualität durch qualitätsgesicherte, verständliche, evidenzbasierte Informationen für Kinder und Jugendliche sowie durch patientenzentrierte Gesprächsführung der medizinischen Fachkräfte.

Nutrition and diabetes self-management in aged care: Exploring community-dwelling older adults' expectations.

To explore the diabetes self-management expectations of older adults with diabetes, not yet accessing residential aged care services. Admission to residential aged care (RAC) can create many interruptions to usual food choices and diabetes self-management, and we know little about the concerns of the emerging ageing population. This is a qualitative study employing focus groups and inductive thematic analysis involving 18 older adults with diabetes between the ages of 60 and 88, living in their own homes within an Australian city. Focus groups were recruited on a sequential basis and progressively analysed using an inductive process until data saturation was reached. Focus groups were digitally recorded and transcribed verbatim for thematic analysis. Three key themes were generated: autonomy, individualised dietary management and the food service system. Older adults speculated that they would want a collaborative approach to maintain their health in ageing and to self-manage their diabetes while feasible. Participants wanted autonomy over food choices, flexible meal timings and quality meals. There was a significant anxiety that aged care staff and existing food service systems in RAC could not support these preferences. Community-dwelling older adults with diabetes would highly value aged care services that facilitated autonomy, individualised nutrition support and flexibility, but feared this will not be feasible. The introduction of new diabetes and RAC guidelines may require an implementation plan to include the full food service system, from staff education to meal preparation, ordering and service.

Current and future federal and state sampling guidance for per- and polyfluoroalkyl substances in environmental matrices

Per- and polyfluoroalkyl substances (PFAS) are a class of emerging contaminants composed of an estimated 5000 to 10,000 human-made, fluorinated, organic chemicals. Due to the complexity of PFAS, the need for multiple environmental matrix considerations and the absence of a promulgated federal standard for environmental sampling and analysis, U.S. states have begun developing health-based regulatory and/or guidance values for a limited number of PFAS in environmental matrices. As there is a growing body of science to inform PFAS sampling guidance standard development, it is important to understand which U.S. states are implementing sampling guidelines and how they plan to handle emerging PFAS. This critical review discusses the current and impending federal and state sampling guidelines for PFAS in environmental matrices, the data gaps surrounding PFAS sampling guidance in U.S. states, and the future impacts of impending guidance documents and regulations. Ten federal guidance documents are available for PFAS sampling guidance and analysis. The maximum number of PFAS covered in these guidance documents is 25 analytes spanning across 8 unique media. While the EPA has developed several different sampling and analytical guidelines for PFAS, there is no formal regulation of PFAS or requirements of states to enforce these guidelines. As a result, only 31 states have informally adopted sampling guidelines, while the other 19 states have no guidance documentation in place for PFAS. The introduction of new PFAS sampling guidelines by the EPA, as well as updated analytical guidelines that target more PFAS or total organofluoride, is expected to continuously shift the landscape of federal and state guidance for PFAS sampling moving forward.

Platform antitrust in China

ABSTRACT This article reviews the recent developments in digital platform antitrust in China. I first introduce the key players in China’s platform industry, particularly those that have been frequently affected by recent antitrust events. I then provide a brief overview of economic theories that are often cited in think tank reports and official documents, including network externalities, hub-and-spoke collusion, and contestable markets. Finally, recent platform antitrust events in China are reviewed, including the introduction of platform antitrust guidelines and major antitrust cases.

Sztuczna inteligencja w problematyce modeli oceny ryzyka w instytucjach finansowych z perspektywy prawno-regulacyjnej

Purpose of the article / hypothesis: This article aims to verify the need to introduce additional legal and regulatory requirements in relation to the models used in banks, including, in particular, risk assessment models. At the same time, the article analyzes the need for possible introduction of sector-specific guidelines, or the need to include the above-mentioned models in the classification of high-risk artificial intelligence systems, referred to in the draft EU regulation on artificial intelligence. Methodology: The article is based on an analysis of the available literature on the subject, legal acts as well as regulations and standards developed both at the local and international level. Research results / results: The issue of the application of models in the financial sector, mainly banking, is of significant importance from the perspective of the regulator and supervisor. Quality, compliance with the regulations, but also efficiency and effective supervision may constitute the (instability) of a given financial institution, the instability of which may be a component – at least potentially – of systemic risk. Banks commonly use internal models that generally allow the calculation of capital requirements to cover specific risks in a bank’s business, such as credit risk or market risk. Internal models have been evolving for years and are undoubtedly becoming more and more accurate (they predict with a greater probability the occurrence of certain events), although they are still only certain assumptions that reality can verify, as evidenced by financial crises that have already occurred in the past as well as failures of banks considered to be stable. At the same time, the development of new technologies, in particular the so-called artificial intelligence makes institutions more and more willing to use various models, e.g. machine learning, to support these models and obtain theoretically better results. The European Union, but also other jurisdictions are considering or already introducing specific legal and regulatory solutions that are to introduce clear rules related to the use of certain artificial intelligence systems, including those used by financial institutions. As a result, institutions – already burdened with significant regulatory requirements, may soon be obliged to go through another "health path" of a legal and regulatory compliance nature.

Effects of the Current Japanese Guideline for Dedicated, Intensive Lipid-lowering Therapy on Lipid Profile and Coronary Events in Patients After Acute Coronary Syndrome

Background: Patients with acute coronary syndrome (ACS) still have high rates of recurrent adverse cardiovascular events. The purpose of this study was to evaluate the effects of changes in the Japan Atherosclerosis Society Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases for intensive lipid-lowering therapy on the prescription status, lipid profile and clinical outcomes among Japanese patients with ACS. Methods: Data were retrospectively analysed for 283 consecutive patients with de novo ACS who underwent primary percutaneous coronary intervention and received follow-up coronary angiography between January 2012 and September 2019. Patients were divided into two groups according to the to onset of ACS relative to the guideline update – before (Group 1; n=182) and after (Group 2; n=101). Changes in prescription status, lipid profile and clinical outcomes (composite of cardiac death and non-fatal MI, coronary events from culprit and non-culprit lesions) were evaluated. Results: Post-treatment LDL concentrations were significantly lower in Group 2, but target LDL concentrations of &lt;1.81 mmol/l were only achieved in 58.4% of patients. In Group 2, 85% of patients who received combination high-intensity statin/ezetimibe therapy achieved the target LDL. After propensity score matching, the incidence of coronary events from non-culprit lesions was significantly lower in Group 2 than Group 1 (3.0% versus 19.4%, respectively; p&lt;0.01). Cox model analysis showed that the guideline update resulted in a lower rate of events from non-culprit lesions (HR 0.50; 95% CI [0.33–0.75]). Conclusion: The introduction of new guidelines improved the prescription status and lipid profile in ACS patients. Guideline-recommended more intensive lipid-lowering therapy may decrease events from non-culprit lesions in ACS patients.

Peripheral Neuropathy Phenotyping in Rat Models of Type 2 Diabetes Mellitus: Evaluating Uptake of the Neurodiab Guidelines and Identifying Future Directions.

Diabetic peripheral neuropathy (DPN) affects over half of type 2 diabetes mellitus (T2DM) patients, with an urgent need for effective pharmacotherapies. While many rat and mouse models of T2DM exist, the phenotyping of DPN has been challenging with inconsistencies across laboratories. To better characterize DPN in rodents, a consensus guideline was published in 2014 to accelerate the translation of preclinical findings. Here we review DPN phenotyping in rat models of T2DM against the ‘Neurodiab’ criteria to identify uptake of the guidelines and discuss how DPN phenotypes differ between models and according to diabetes duration and sex. A search of PubMed, Scopus and Web of Science databases identified 125 studies, categorised as either diet and/or chemically induced models or transgenic/spontaneous models of T2DM. The use of diet and chemically induced T2DM models has exceeded that of transgenic models in recent years, and the introduction of the Neurodiab guidelines has not appreciably increased the number of studies assessing all key DPN endpoints. Combined high-fat diet and low dose streptozotocin rat models are the most frequently used and well characterised. Overall, we recommend adherence to Neurodiab guidelines for creating better animal models of DPN to accelerate translation and drug development.

Antibiotikumhasználat korai szepszis gyanúja esetén újszülöttkorban

Early-onset neonatal sepsis is a rare, but life-threatening condition. In 2017, the Hungarian Neonatal Society issued a national guideline to rationalize the use of antibiotic use in neonatal sepsis. To retrospectively determine the frequency of prescribed antibiotics before and after the introduction of national guidance. Data of neonates (>34. gestational weeks) delivered in our hospital between 1st January 2014 and 31st December 2018 were analysed with focusing on signs of sepsis, number of neonates treated with antibiotics, incidence of early-onset neonatal sepsis, sepsis-related mortality. Statistical analysis was performed with RStudio software (significance: p<0.05). During the analysed time period, 12 347 neonates were born, 1502 (12.16%) neonates were given antibiotics, showing a significant decrease after 2017: 517 (21.10%) in 2014, 401 (16.63%) in 2015, 459 (17.96%) in 2016, 61 (2.39%) in 2017, 64 (2.69%) in 2018, respectively. Out of the group of neonates treated with antibiotics (n = 1502), only 239 (15.91%) neonates showed the clinical signs of sepsis. No significant change was observed in the number of symptomatic newborns during the study period: 52 (2.12%) in 2014, 42 (1.74%) in 2015, 42 (1.64%) in 2016, 46 (1.80%) in 2017, 57 (2.40%) in 2018, p = 0.285. Blood culture confirmed neonatal sepsis was observed in 4 babies, incidence of early-onset neonatal sepsis was 0.324/1000, sepsis-related mortality was zero. Before the introduction of the national guideline, most of the neonates were prescribed antibiotics based on risk factors. Since 2017, antibiotics have been mainly preserved for newborns with clinical signs of sepsis. Despite cessation of antiobiotic treatment indicated by risk factors, the number of symptomatic babies and sepsis-related mortality have not increased. The use of antibiotics for neonates >34th gestational week can be safely reduced, entailing a decrease in short- and long-term complications of early antibiotic use. Orv Hetil. 2022; 163(11): 431-437.

Detection of NTRK Fusions and TRK Expression and Performance of pan-TRK Immunohistochemistry in Routine Diagnostics: Results from a Nationwide Community-Based Cohort.

Gene fusions involving NTRK1, NTRK2, and NTRK3 are rare drivers of cancer that can be targeted with histology-agnostic inhibitors. This study aimed to determine the nationwide landscape of NTRK/TRK testing in the Netherlands and the usage of pan-TRK immunohistochemistry (IHC) as a preselection tool to detect NTRK fusions. All pathology reports in 2017–2020 containing the search term ‘TRK’ were retrieved from the Dutch Pathology Registry (PALGA). Patient characteristics, tumor histology, NTRK/TRK testing methods, and reported results were extracted. NTRK/TRK testing was reported for 7457 tumors. Absolute testing rates increased from 815 (2017) to 3380 (2020). Tumors were tested with DNA/RNA-based molecular assay(s) (48%), IHC (47%), or in combination (5%). A total of 69 fusions involving NTRK1 (n = 22), NTRK2 (n = 6) and NTRK3 (n = 41) were identified in tumors from adult (n = 51) and pediatric (n = 18) patients. In patients tested with both IHC and a molecular assay (n = 327, of which 29 NTRK fusion-positive), pan-TRK IHC had a sensitivity of 77% (95% confidence interval (CI), 56–91) and a specificity of 84% (95% CI, 78–88%). These results showed that pan-TRK IHC has a low sensitivity in current routine practice and warrants the introduction of quality guidelines regarding the implementation and interpretation of pan-TRK IHC.

382 Compliance With Current Excision Margin Guidelines for Non-Melanoma Skin Cancer: Do We Make the Cut?

Abstract Aim Non-melanoma skin cancers (NMSC) are the most common malignancies worldwide, with basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) constituting an ever-growing clinical burden within Plastic &amp; Reconstructive Surgery. In this 3-cycle Quality Improvement (QI) initiative we sought to evaluate and improve our unit’s compliance with British Association of Dermatology (BAD) guidance on excision margins for NMSCs. Method Following results from two Plan-Do-Study-Act (PDSA) cycles, a third retrospective review of clinic letters, operative notes and histopathology reports was undertaken to identify NMSCs that were excised during May 2021 and assess compliance with recommended excision margins according to risk stratification. Results The dissemination of cycle 1 findings at departmental meetings, as well as the implementation of guideline posters and operative note templates conferred a significant improvement in both clinical documentation (12% to 100%) and local compliance with excision margin guidelines for BCCs (53% to 71%) and SCCs (50% to 79%). Following the adoption of new BAD guidelines on SSC margins in early 2021, a third cycle comprising 42 lesions demonstrated a sustained improvement in clinical documentation (100%) after a 7-month period and similar guideline compliance rates for both BCC (67%) and SCC (78%). Conclusions Adequate excision margins in cutaneous malignant pathology are vital to ensure complete removal, thus minimising the risk of recurrence. Although improvement across the PDSA cycles has been sustained despite the introduction of new SCC margin guidelines, we aim to introduce further interventions such as a knowledge and practice survey to continue improving excision margin compliance.

The impact of COVID-19 on the well-being, education and clinical practice of general practice trainees and trainers: a national cross-sectional study

BackgroundCOVID-19 has changed General Practice (GP) education as well as GP clinical activities. These changes have had an impact on the well-being of medical trainees and the role of GP plays in the society. We have therefore aimed to investigate the impact that COVID-19 has had on GP trainees and trainers in four domains: education, workload, practice organization and the role of GP in society.Design: a cross-sectional study design was used.MethodsThe Interuniversity Centre for the Education of General Practitioners sent an online survey with close-ended and open-ended questions to all GP trainees and trainers in Flanders, active in the period March – September 2020. Descriptive statistics were performed to analyze the quantitative data and thematic analysis for the qualitative data.Results216 (response 25%) GP trainees and 311 (response 26%) trainers participated. GP trainees (63%, N = 136) and trainers (76%, N = 236) reported new learning opportunities since the COVID-19 pandemic. The introduction of telehealth consulting and changing guidelines required new communication and organizational skills. Most of the GP trainees (75%, n = 162) and trainers (71%, n = 221) experienced more stress at work and an overload of administrative work. The unfamiliarity with a new infectious disease and the fact that COVID-19 care compromised general GP clinical activities, created insecurity among GP trainers and trainees. Moreover, GP trainees felt that general GP activities were insufficiently covered during the COVID-19 pandemic for their training in GP. GP trainers and trainees experienced mutual support, and secondary support came from other direct colleagues. Measures such as reducing the writing of medical certificates and financial support for administrative and (para) medical support can help to reprioritize the core of GP care.COVID-19 has enhanced the use of digital learning over peer-to-peer learning and lectures. However, GP trainees and trainers preferred blended learning educational activities.ConclusionsCOVID-19 has created learning opportunities such as telehealth consulting and a flexible organization structure. To ensure quality GP education during the pandemic and beyond, regular GP care should remain the core activity of GP trainees and trainers and a balance between all different learning methods should be found.

Process analytical technology – A review of game changer regulatory framework by US FDA

The concept of process analytical technology is introduced with the purpose of providing important information after the analysis of critical quality parameters which can have direct or indirect impact on the product quality. This type of information is helpful in maintaining the product quality while keeping the manufacturing cost low. The implementation of PAT will potentially improve the operational control and compliance as per regulatory guidelines for continuous real time quality assurance during manufacturing. The concept is relatively new for both academia and industry hence Considerable amount of study has been carried out to explore the various aspects of PAT guidelines and their successful implementation. This review mainly contains introduction and background of PAT guidelines as the first step in QBD implementation. Detailed understanding of analysis and selection of suitable analytical technique is the most important aspect of PAT guidelines. These analytical techniques will even play crucial role at the time of scale up and detailed evaluation of drug and dosage forms. The main purpose of this review is to understand the right perspective of PAT guidelines towards the goal of achieving products with highest quality.

Looking through the windows: a study about the dependency of phase-coupling estimates on the data length.

Being able to characterize functional connectivity (FC) state dynamics in a real-time setting, such as in brain-computer interface, neurofeedback or closed-loop neurostimulation frameworks, requires the rapid detection of the statistical dependencies that quantify FC in short windows of data. The aim of this study is to characterize, through extensive realistic simulations, the reliability of FC estimation as a function of the data length. In particular, we focused on FC as measured by phase-coupling (PC) of neuronal oscillations, one of the most functionally relevant neural coupling modes. We generated synthetic data corresponding to different scenarios by varying the data length, the signal-to-noise ratio, the phase difference value, the spectral analysis approach (Hilbert or Fourier) and the fractional bandwidth. We compared seven PC metrics, i.e. imaginary part of phase locking value (PLV), PLV of orthogonalized signals, phase lag index (PLI), debiased weighted PLI, imaginary part of coherency, coherence of orthogonalized signals and lagged coherence. Our findings show that, for a signal-to-noise-ratio of at least 10 dB, a data window that contains 5 to 8 cycles of the oscillation of interest (e.g. a 500-800ms window at 10Hz) is generally required to achieve reliable PC estimates. In general, Hilbert-based approaches were associated with higher performance than Fourier-based approaches. Furthermore, the results suggest that, when the analysis is performed in a narrow frequency range, a larger window is required. The achieved results pave the way to the introduction of best-practice guidelines to be followed when a real-time frequency-specific PC assessment is at target.

Looking through the windows: a study about the dependency of phase-coupling estimates on the data length

Objective. Being able to characterize functional connectivity (FC) state dynamics in a real-time setting, such as in brain–computer interface, neurofeedback or closed-loop neurostimulation frameworks, requires the rapid detection of the statistical dependencies that quantify FC in short windows of data. The aim of this study is to characterize, through extensive realistic simulations, the reliability of FC estimation as a function of the data length. In particular, we focused on FC as measured by phase-coupling (PC) of neuronal oscillations, one of the most functionally relevant neural coupling modes. Approach. We generated synthetic data corresponding to different scenarios by varying the data length, the signal-to-noise ratio (SNR), the phase difference value, the spectral analysis approach (Hilbert or Fourier) and the fractional bandwidth. We compared seven PC metrics, i.e. imaginary part of phase locking value (iPLV), PLV of orthogonalized signals, phase lag index (PLI), debiased weighted PLI, imaginary part of coherency, coherence of orthogonalized signals and lagged coherence. Main results. Our findings show that, for a SNR of at least 10 dB, a data window that contains 5–8 cycles of the oscillation of interest (e.g. a 500–800 ms window at 10 Hz) is generally required to achieve reliable PC estimates. In general, Hilbert-based approaches were associated with higher performance than Fourier-based approaches. Furthermore, the results suggest that, when the analysis is performed in a narrow frequency range, a larger window is required. Significance. The achieved results pave the way to the introduction of best-practice guidelines to be followed when a real-time frequency-specific PC assessment is at target.

Introducing NICE guidelines for intravenous fluid therapy into a district general hospital

BackgroundNational Institute for Health and Care Excellence (NICE) guidelines on intravenous fluid prescribing for adults in hospital, issued in 2013, advised less use of 0.9% sodium chloride than current practice,...

Assessing the effectiveness and efficiency of the provincial MuniMEC forum inter-government relations structures in the Eastern Cape Province, South Africa

Background: This research examines the effectiveness and efficiency of the Provincial MuniMEC in facilitating the Inter-Government Relations (IGR) arrangements for improvement provincial service provision mandate in the Eastern Cape Province. Post-1994 local government reforms led to the establishment of wall-to-wall municipalities to accelerate municipal services provision and the introduction of systemic municipal service provision guidelines as part of socio-economic transformation. Objective: The effectiveness and efficiency of this plan remains unclear. This research intends to address this issue with the view to contribute on strategies that can be adopted to improve service provision through the integration of IGR structures. Method: The study adopted a qualitative approach by administering structured questionnaires to purposely selected participants and carefully reviewed various documents and policies in IGR and Local Government. The questionnaire analysis included theoretical propositions that incorporated the efficiency of the provincial MuniMEC IGR structures, the legal IGR framework, and the participatory approach in MuniMEC IGR structures by stakeholders. Result: One core finding is that the MuniMEC IGR structure has contributed to the coordination and integration of government service delivery interventions at municipalities, yet little empirical evidence explains this improvement. Research shows that government’s IGR obligation to coordinate the integration of government service delivery interventions to municipalities could have more impact on service delivery improvement than the utilisation of a single-oriented approach. This study provides lessons on the view that any regulation without a structured implementation plan leads to poor service delivery. A key recommendation is that both the national and provincial government need to promote shared service delivery through the enhancement of the IGR framework.

Changes in Australian food anaphylaxis admission rates following introduction of updated allergy prevention guidelines

Food anaphylaxis admission rates have increased steadily in recent decades. Global food allergy prevention guidelines recommending early introduction of allergenic foods were introduced in 2015-2016. Australian guidelines to not delay the introduction of allergenic foods were introduced in 2007-2008. Our aim was to examine whether introduction of Australian guidelines (2007-2008) and global allergy prevention guidelines (2015-2016) were associated with reductions in food anaphylaxis admission rates. We compared food anaphylaxis admission rates across 3 periods: 1998-1999 to 2006-2007, 2007-2008 to 2014-2015, and 2015-2016 to 2018-2019. Annual food anaphylaxis admission rates increased 9-fold between 1998-1999 and 2018-2019, from 2.0 per 105 population to 18.2 per 105 population; the highest absolute rates were in those younger than 1 year. When year-on-year rates of change were examined across the 3 time periods, the annual rate of increase slowed after 2007-2008 in those aged 1 to 4 years (17.6%, 6.2%, and 3.9% per year, respectively) and those aged 5 to 9 years (22%, 13.9%, and -2.4%, respectively), and after 2015-2016, in those aged 10 to 14 years (17.5%, 18.0%, and 10.8%, respectively). By contrast, the year-on-year rate of increase accelerated in those younger than 1 year (5.2%, 8.0%, and 18.0%, respectively) and in all age groups older than 15 years. Although food anaphylaxis continues to increase overall, there is preliminary evidence indicating a slowing in the year-on-year rate of increase among those aged 1 to 4, 5 to 9, and 10 to 14 years, coinciding with introduction of updated infant feeding and allergy prevention guidelines in 2007-2008 and 2015-2016. Changes to the guidelines may have contributed to an attenuated rate of increase in food anaphylaxis in these age groups, as well as to increased rates in those younger than 1 year.

Dyslipidaemia management in the cardiac rehabilitation clinic of a tertiary referral centre: analysis of the impact of new ESC guidance on LDL-C target achievement.

BackgroundOptimisation of low-density lipoprotein cholesterol (LDL-C) targets is one component of cardiac rehabilitation (CR). The 2019 European Society of Cardiology (ESC) guidelines recommend lower LDL-C targets than those released in 2016.AimsTo determine the proportion of patients who met 2019 LDL-C targets and compare these to international standards; examine the effect of the introduction of the recent ESC guidelines on target achievement. Examine the choice of lipid lowering therapy (LLT) used in our cohort.MethodsRetrospective chart review of 163 patients who attended CR in 2019. Baseline LDL-C levels were calculated where applicable. Targets achieved were compared with the contemporary ESC guidance. Required LLT was estimated for those who were unable to meet their LDL-C target.ResultsOverall, 96/163 (59%) patients met their absolute LDL-C targets, which was favourable when compared to international standards. Fewer patients treated using the 2019 ESC guidelines met their absolute, (63% (70/112) vs. 51% (26/51)), or relative LDL-C 43% (22/51) targets. A high intensity statin was prescribed in 63% (89/163) of patients and only 9% (5/163) patients were prescribed ezetimibe therapy; increased use of these agents may have led to a further 20% (33/162) of patients meeting their LDL-C targets. 13% (22/163) of patients likely require PCSK9i therapy.ConclusionsPatients may be more likely to meet LDL-C targets while enrolled in CR compared to standard care. Following the introduction of lower absolute LDL-C targets and additional > 50% LDL-C reduction from baseline requirement, fewer patients are meeting the LDL-C targets set out in the 2019 ESC dyslipidaemia guidelines. Additionally, many patients are not on maximum statin therapy, ezetimibe is under-prescribed, and a guideline-reimbursement gap exists for those who require PCSK9i therapy.Supplementary informationThe online version contains supplementary material available at 10.1007/s11845-021-02885-9.

Surgeons have hesitated early cholecystectomy because of cardiovascular comorbidities during adoption of guidelines

The introduction of the guidelines has resulted in an increase of laparoscopic surgeries performed, but the rate of early surgery was still low. Here, the initial effect of the introduction of the guideline was confirmed in single center, and factors disturbing early cholecystectomy were analyzed. This study included 141 patients who were treated for acute cholecystitis from January 2010 to October 2014 at Kanazawa Medical Center. Each patient was assigned into a group according to when they received treatment. Patients in Group A were treated before the Tokyo Guidelines were introduced (n = 48 cases), those in Group B were treated after the introduction of the guidelines (93 cases). After the introduction of the guidelines, early laparoscopic cholecystectomy was significantly increased (P < 0.001), however, the rate of early operations was still 38.7% only. There are many cases with cardiovascular disease in delayed group, the prevalence had reached 50% as compared with early group of 24% (P < 0.01). Approximately 25% of patients continued antiplatelet or anticoagulant therapy. In the early days of guidelines introduction, the factor which most disturbed early surgery was the coexistence of cardiovascular disease. These contents could be described in the next revision of the guidelines.