Practice Guidelines Research Articles

Construction of Preoperative Assessment Program for Day Surgery in Geriatric Cataract Patients: An Evidence-Based Delphi Study

PurposeTo construct a scientific cataract day surgery preoperative assessment program to provide a scientific assessment tool for health care providers. DesignLiterature review, two-round e-Delphi study, and quantitative studies. MethodsWith the recommended opinions of clinical practice guidelines for cataract surgery as the guiding framework, an item pool was formed on the basis of literature review and guideline content analysis, and the dimensions and items of evaluation program were determined by two rounds of correspondence consultation using Delphi expert method. Then, 315 patients from an ophthalmic hospital were selected for investigation to analyze its reliability and validity. FindingsThe positive coefficients for the 2 rounds of correspondence with experts were 100.00% and 95.83%, and the authority coefficients were 0.90 and 0.89. Kendall's coordination coefficient W values of 0.29 and 0.24 for the first and second rounds and the differences were statistically different (P < .05). The coefficient of variation was 0.14 and 0.10, respectively. The formal assessment items included 3 first-level indicators, 12 secondary-level indicators, and 48 tertiary indicators, with an overall Cronbach's coefficient of 0.66 and cumulative variance contributions of 69.19%, 65.84%, and 57.15% for the 3 first-level indicators. ConclusionThe high reliability of the preoperative cataract day surgery program compiled by applying evidence-based analysis and the Delphi method can provide scientific guidance to clinical nurses for preoperative assessment, which in turn ensures patient safety and improves the quality of patient access services.

The Need to Develop Evidence-based Practice Guidelines for School Nurses in Iran.

The Need to Develop Evidence-based Practice Guidelines for School Nurses in Iran.

CME exam: Patient-Centered Practice Guidelines: GRADEing Evidence to Incorporate Certainty, Balance Between Benefits and Harms, Equity, Feasibility, and Cost-Effectiveness

CME exam: Patient-Centered Practice Guidelines: GRADEing Evidence to Incorporate Certainty, Balance Between Benefits and Harms, Equity, Feasibility, and Cost-Effectiveness

Evaluating Obesity: The "Why" Behind the American Academy of Pediatrics' Obesity Treatment Clinical Practice Guideline.

The 2023 American Academy of Pediatrics' "Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity (Obesity CPG)" is a comprehensive document that addresses the evaluation and treatment of pediatric obesity. Much attention has been focused on the use of medications and surgery to treat severe obesity, but the document also thoroughly reviews the evaluation of obesity and its comorbidities through key action statements and consensus recommendations. The majority of these evaluation guidelines are well within the scope of the general pediatrician and an understanding of and implementation of them can lead to improved obesity care in the primary care setting. The goal of this article is to guide the reader in the evaluation of obesity and its comorbidities in the primary care setting through a chronic disease model lens as a basis for all future care. [Pediatr Ann. 2024;53(10):e378-e385.].

‘How-To:’ Scoping Review?

Scoping reviews are a type of evidence synthesis that aims to identify and map the breadth of evidence available on a particular topic, field, concept, or issue, within or across a defined context or contexts. Scoping reviews can contribute to clinical practice guideline development, policy making, reduce research waste by eliminating duplication of research effort, and be a precursor to a systematic review. This paper aims to provide a brief introduction of how to conduct and report scoping reviews, their role and value of within the evidence synthesis ecosystem, the differences and similarities between these reviews and other types of evidence syntheses such as systematic reviews, mapping reviews, evidence and gap maps and overviews and how to overcome common challenges often associated in the conduct, reporting and dissemination of scoping reviews.

Critical Power and Maximal Lactate Steady State in Cycling: "Watts" the Difference?

From a physiological perspective, the delineation between steady-state and non-steady-state exercise, also referred to as the maximal metabolic steady state, holds paramount importance for evaluating athletic performance and designing and monitoring training programs. The critical power and the maximal lactate steady state are two widely used indices to estimate this threshold, yet previous studies consistently reported significant discrepancies between their associated power outputs. These findings have fueled the debate regarding the interchangeability of critical power and themaximal lactate steady state in practice. This paper reviews the methodological intricacies intrinsic to the determination of these thresholds, and elucidates how inappropriate determination methods and methodological inconsistencies between studies have contributed to the documented differences in the literature. Through a critical examination of relevant literature and by integration of our laboratory data, we demonstrate that differences between critical power and themaximal lactate steady state may be reconciled to only a few Watts when applying appropriate and strict determination criteria, so that both indices may be used to estimate the maximal metabolic steady-state threshold in practice. To this end, we have defined a set of good practice guidelines to assist scientists and coaches in obtaining the most valid critical power and maximal lactate steady state estimates.

Policy and practice review consensus statements and clinical guidelines on managing pediatric trauma and orthopedics during the COVID-19 pandemic: a systematic review on the global response for future pandemics and public health crises.

The COVID-19 pandemic has been recognized as an unprecedented global health crisis. Over 7 million mortalities have been documented with many paediatric fatalities. Trauma and orthopaedic care, much like other specialities, were marginalized due to resource allocation during the pandemic which affected paediatric care. This is the first systematic review to centralise and compile the recommended published guidelines from professional bodies in principally English speaking countries on managing paediatric trauma and orthopaedic care. These guidelines will be required to be implemented sooner and more effectively in case of future pandemics with similar impact. A search was conducted on PubMed/MedLine, Cochrane Library and Embase using terms including p(a)ediatric or child* and/or COVID* or coronavirus or SARS-CoV-2 and/or trauma and/or orthop(a)edic* with a simplified MeSH heading [mh] in order to make the search as comprehensive as possible. General terminology was utilized to make the search as exhaustive as possible for this systematic review. Another search was conducted on resources available in the public domain from professional bodies publishing on consensus statements and clinical practice guidelines in countries where English is the principal language managing pediatric trauma and orthopedics. The review adhered to PRISMA guidance. The search revealed a total of 62 results from both databases and professional bodies. Duplicates were removed. This was then reviewed to identify a total of 21 results which fit the inclusion criteria and included within the main analysis. The guidelines from professional bodies were outlined and categorized into aspects of clinical care. The impact of COVID-19 pandemic has compelled for changes in clinical practice and pediatric management. The systematic review highlights the relevant guidelines on service provision for pediatric patients including indications for urgent referrals, surgical prioritization, reasons for follow-up and trauma guidelines. The rationale for care during the unpredictable evolution of the COVID-19 pandemic may have the potential to be translated and replicated in future pandemics of similar significance.

Professional practice guidelines regarding the management of a call for suspected cardiac arrest in an emergency call center

Professional practice guidelines regarding the management of a call for suspected cardiac arrest in an emergency call center

Physical Therapy Management of Congenital Muscular Torticollis: A 2024 Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association Academy of Pediatric Physical Therapy.

Congenital muscular torticollis (CMT) is a postural condition evident shortly after birth. The 2013 CMT Clinical Practice Guideline (2013 CMT CPG) set standards for the identification, referral, and physical therapy management of infants with CMT, and its implementation resulted in improved clinical outcomes. It was updated in 2018 to reflect current evidence and 7 resources were developed to support implementation. Purpose: This 2024 CMT CPG is intended as a reference document to guide physical therapists, families, health care professionals, educators, and researchers to improve clinical outcomes and health services for children with CMT, as well as to inform the need for continued research. Results/Conclusions: The 2024 CMT CPG addresses: education for prevention, screening, examination and evaluation including recommended outcome measures, consultation with and referral to other health care providers, classification and prognosis, first-choice and evidence-informed supplemental interventions, discontinuation from direct intervention, reassessment and discharge, implementation and compliance recommendations, and research recommendations.

JS3-2 Evidence gaps in cardio-oncology clinical practice guidelines – a sea of opportunity

JS3-2 Evidence gaps in cardio-oncology clinical practice guidelines – a sea of opportunity

Family Involvement in Routine Services for Individuals With Severe Mental Illness: Scoping Review of Barriers and Strategies.

The authors investigated barriers to practices that promote family involvement in mental health services, focusing on individuals with severe mental illness, their families, and mental health providers. Additionally, the authors sought to identify strategies to facilitate family involvement in mental health provision to highlight the engagement process in routine practice and propose future directions for organizations to establish a family-friendly environment. Systematic searches for literature published from January 1990 to March 2023 were conducted in PsycInfo, PubMed, CINAHL, Sociological Abstracts, and Scopus databases. Gray literature searches and backward and forward snowballing strategies were also used. Forty-six articles were reviewed, revealing contextual backgrounds and engagement practices that hindered family involvement. Inconsistencies in family involvement stemmed from organizational culture, societal attitudes, and providers' negating of family expertise. Uncertainty regarding confidentiality policies and the absence of practice guidelines posed challenges for providers. Negative experiences of families within the mental health system along with variable commitment also hampered involvement. Some service users declined family involvement because of privacy concerns and differing expectations regarding the extent of involvement. Promoting a shared culture of family work, integrating practice standards, and engaging in professional development activities emerged as key strategies. A gap exists between implementing policies and practices for family involvement in mental health treatment. Without cultural and organizational shifts in support of working with families, the uptake of family involvement practices will remain inadequate. Each stakeholder has different perceptions of the barriers to family involvement, and family involvement will remain elusive without a shared agreement on its importance.

Quality Improvement Initiative: Identifying Barriers to Reducing Time to First Feed With Human Milk in Low Birth Weight Infants.

Early exposure to human milk and time to first trophic feed in low birth weight (LBW) infants (<2 kg) is associated with a decreased risk of mortality, sepsis, and length of hospital stay. This project, focused on infants born at less than 2 kg, aimed to identify the mean time to first feed after birth, identify barriers to initiation of the first feed, and meet the target of having 90% of infants receive their first feed within the first 6 hours of life. This quality improvement (QI) project occurred in a thirty-bed level III NICU over 29 months using two Plan-Do-Study-Act (PDSA) cycles. A first-feed audit tool and a multifaceted educational plan were at the forefront of this initiative. Interventions were multidisciplinary, targeted, and extended to all healthcare team members caring for LBW infants, including staff of Labor and Delivery, the NICU, and the Child Health Transport Team. At the end of the QI project, 91.3% of inborn infants and 27.5% of outborn infants were being fed by 6 hours of age, compared with 78.8% and 12.5%, respectively, prior to the project. The mean time to first feed for inborn infants after the PDSA cycles was reduced to 4.4 hours, having a decrease of 80 minutes. A multidisciplinary approach was a key factor in the success of this QI initiative. Increasing staff education and improving clinical practice guidelines regarding the importance of early exposure to human milk are associated with reducing first feed times after birth.

Standardized treatment of oral cancer under the guidance of clinical practice guidelines of National Comprehensive Cancer Network.

Oral cancer represents a serious public health problem affecting oral and system health with a high global incidence. Treatment strategies for oral cancer vary in different disciplines and are likely to be limited to certain doctor's personal experience. While clinical practice guidelines are considered to enable doctors to determine the most appropriate and consistent treatment strategy according to the patient's situation. National Comprehensive Cancer Network (NCCN) clinical practice guidelines have become the most prevalent in global clinical oncology practice. This article mainly focuses on cases to discuss the normalized treatment strategy for oral cancer in different stages based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Head and Neck Cancers, Version 3, 2024.

Clinical practice guidelines in adult diagnostic flexible bronchoscopy: systematic review of the literature and quality appraisal with AGREE II

Clinical practice guidelines in adult diagnostic flexible bronchoscopy: systematic review of the literature and quality appraisal with AGREE II

Predicting mucosal inflammation in IBD patients using patient-reported symptom scores and a faecal calprotectin home test: protocol for a multicentre prospective validation study

IntroductionCrohn’s disease and ulcerative colitis are chronic inflammatory bowel diseases (IBD) with a relapsing-remitting nature. With adequate non-invasive prediction of mucosal inflammation, endoscopies can be prevented and treatment optimised earlier...

Delphi consensus recommendations for the management of chronic insomnia in Canada

ObjectiveThe lack of current Canadian practice guidelines for the management of insomnia poses a challenge for healthcare providers (HCP) in selecting the appropriate treatment options. This study aimed to establish expert consensus recommendations for the management of chronic insomnia in Canada. Composition of the committeeSixteen multidisciplinary experts in sleep medicine and insomnia across Canada developed consensus recommendations based on their knowledge of the literature and their practical experience. MethodsThe consensus recommendations were developed through a Delphi method. Consensus was reached if at least 75% of the voting participants “agreed” or “strongly agreed” with the corresponding statements. The quality of supporting evidence was rated using a GRADE rating system. ReportAmong 37 recommendations that reached consensus for the management of chronic insomnia, the experts recommend and agree that: ConclusionThese consensus recommendations highlight the need to increase awareness, capacity for, and access to CBT-I; integrate newly approved pharmacotherapy; reduce both self-medication and medications with limited evidence or low risk/benefit ratio.

Variable practice patterns in the surgical management of renal hyperparathyroidism

BackgroundHyperparathyroidism is common among patients with chronic kidney disease, end-stage kidney disease, and kidney transplant. The American Association for Endocrine Surgery published clinical practice guidelines that address the surgical treatment of secondary and tertiary hyperparathyroidism. The purpose of this study is to determine practice patterns for the surgical management of secondary and tertiary hyperparathyroidism prior to guideline publication. MethodsWith the approval of the American Association for Endocrine Surgery, a Qualtrics email survey was sent to the Association’s membership in 2022 about current clinical decision making for surgical treatment of secondary and tertiary hyperparathyroidism. Respondents were divided into groups based on surgical subspecialty (endocrine surgery versus non-endocrine surgery), yearly parathyroidectomy volume, and yearly parathyroidectomy volume for surgical treatment of secondary and tertiary hyperparathyroidism. Descriptive statistics were performed; the role of volume was evaluated. ResultsThere were 142 responses from 795 solicited email addresses (18% response rate); 114 (84%) identified as endocrine surgeons. The majority (62%) perform >50 parathyroidectomies yearly, but most perform <10 parathyroidectomies for surgical treatment of secondary and tertiary hyperparathyroidism per year (<10/y, 53.7%; 10–30/y, 41.9%; >30/y, 4.4%). Subtotal parathyroidectomy is most commonly performed for surgical treatment of secondary (83%) and tertiary (52%) hyperparathyroidism, but transcervical thymectomy variably performed for both. There was no consensus regarding starting calcitriol preoperatively (always 43%, never 25%, depends on vitamin D levels 24%) or stopping cinacalcet (2 weeks prior 28%, day of surgery 29%, postoperatively 20%). Surgeons who perform >10 parathyroidectomies per year for surgical treatment of secondary and tertiary hyperparathyroidism were less likely to consider the patient's preoperative vitamin D levels to inform their decision to start calcitriol before surgery (<10 cases/year, 34%; ≥10 cases/year 15%; P = .023), were more likely to have a postoperative hypocalcemia protocol managed by the surgical team (<10 cases/year, 49%; ≥10 cases/year, 58%; P = .029), and were more likely to use intraoperative parathyroid hormone monitoring for tertiary hyperparathyroidism (<10 cases/year, 70%; ≥10 cases/year, 87%; P = .046). ConclusionThe majority of respondents perform <10 parathyroidectomies yearly for surgical treatment of secondary and tertiary hyperparathyroidism. Subtotal parathyroidectomy was most commonly performed, but there was little other consensus regarding preoperative management, intraoperative decision-making, and postoperative care. Opportunity exists through guideline dissemination to improve heterogeneity of care provided to surgical treatment of secondary and tertiary hyperparathyroidism patients.

Analysis of ChatGPT in the Triage of Common Spinal Complaints

ChatGPT is a natural language processing chatbot with a significant prevalence in modern media with a clear application in the medical triage workflow. ChatGPT has shown significant capacity for understanding clinical vignettes, radiology reports, and even passing the American Board of Neurological Surgery board examination. There has never been an evaluation of the chatbot in triage and diagnosing spinal vignettes common to primary and urgent care practice. Fifteen clinical scenarios were created to mimic spinal complaints common to primary and urgent care scenarios. GPT-4 was instructed to assess the situation as if it was in a primary care office and determine diagnosis, imaging recommendations, and if emergency room (ER) or operative referral was necessary. Answers were recorded and the results compared to those of attending and resident respondents. GPT-4 provided the most likely diagnosis in each scenario. Additionally, it recommended reasonable clinical management of each scenario which would fall within standard practice guidelines. ChatGPT tended toward over-referral to the ER; however, this was not significant. GPT-4 was noninferior in all categories when compared to respondents. ChatGPT is a powerful tool for primary triage of spinal issues. It can rapidly and accurately evaluate clinical scenarios and provide clear diagnostic reasoning. GPT-4 is not designed for medical use and will provide a disclaimer as such. It did tend toward over-referring patients to the ER. With specific training, it is likely that artificial intelligence and natural language processing chatbots will become widely used in primary triage of spinal issues.

Implementing mobile text messaging on glycemic control in patients with diabetes mellitus.

Uncontrolled blood glucose may lead to serious complications in patients with type two diabetes mellitus (T2DM). Patients may not have the support, motivation, or encouragement to adhere to the lifestyle changes necessary to control their T2DM. More than 75% of the primary care clinic's patients are diagnosed with T2DM, with most patients at the practice site having an average hemoglobin A1c (HbA1c) level of 8.5%. The primary care clinic did not use text messaging to disseminate diabetes self-management education and support (DSMES) as outlined in Standard 4 of the American Diabetic Association's (ADA) clinical practice guideline. This evidence-based quality improvement project was conducted in a rural outpatient primary care clinic to determine whether implementing the ADA's 2022 National Standards for DSMES using text messaging would affect HbA1C levels among adult patients with T2DM. Patients were sent weekly text messages over a 12-week period. Text messages contained information promoting self-care, tips about healthy diet, exercise reminders, instructions about proper blood glucose monitoring, and reminders about medication adherence. A total of 160 patients were included. A paired-sample t -test showed a reduction in HbA1c levels after the intervention from baseline (M = 7.53, SD = 1.72) to postimplementation (M = 6.91, SD = 0.89), t (159) = 11.88, p = .001. Based on the results, implementing the ADA's National Standards for DSMES Standard 4 may affect HbA1c levels in this population.

Stereotactic Radiosurgery for Intracranial Cavernous Malformations: International Stereotactic Radiosurgery Society, Systematic Review, Meta-Analysis, and Practice Guidelines

The International Stereotactic Radiosurgery Society (ISRS) aims to establish evidence-based guidelines for single-fraction stereotactic radiosurgery (SRS) in treating intracranial cavernous malformations. We conducted a systematic review following PRISMA and MOOSE guidelines, searching electronic databases up to January 2024 to assess SRS's impact on post-treatment hemorrhage rates. Pooled risk ratios (RR) and confidence intervals were utilized to quantify this effect, along with assessments of lesion volume changes, seizure outcomes, and SRS-related adverse effects. Our meta-analysis included 32 studies with 2672 patients. A significant decrease in annual hemorrhage rates was observed post-treatment (RR=0.17), with rates of RR=0.29 in the first 2 years and RR=0.11 thereafter. Hemorrhage rates significantly differed before and after 2 years post-SRS (RR=0.36). Among epileptic patients, 20.2% had epilepsy pre-treatment, and 49.9% were seizure-free post-SRS, while 30.6% experienced reduced seizure frequency. Lesion volume changes showed a reduction in 46.9%, stability in 47.1%, and an increase in 6.7%. Symptomatic radiation effects affected 8% of patients. Subgroup analysis revealed symptomatic change rates of 6% at doses ≤13Gy compared to 9% at doses >13Gy. Permanent clinical deficits were rare (2%). This meta-analysis suggests SRS is an effective intervention for intracranial cavernous malformations, significantly reducing hemorrhage rates and improving seizure outcomes. ISRS practice guidelines are provided.