Summary Of Guidelines Research Articles

Rapid recommendations: Updates from 2021 guidelines: part 2.

This is the final article in a 2-part series summarizing updates from clinical practice guidelines published in 2021 that are relevant to primary care in Canada.[1][1] Having an easily accessible summary of key updated guidelines can help physicians adopt relevant changes in standards of care. This

Guidelines of guidelines: focal therapy for prostate cancer, is it time for consensus?

To provide a summary and discussion of international guidelines, position statements and consensus statements in relation to focal therapy (FT) for prostate cancer (PCa). The European Association of Urology-European Association of Nuclear Medicine-European Society for Radiotherapy and Oncology-European Society of Urogential Radiology-International Society of Urological Pathology-International Society of Geriatric Oncology and American Urological Association-American Society for Radiation Oncology-Society of Urologic Oncology guidelines were interrogated for recommendations for FT. PubMed and Ovid Medline were searched for consensus statements. Only studies in English since 2015 were included. Reference lists of the included articles were also interrogated and a manual search for studies was also performed. Our results showed a lack of long-term randomised data for FT. International Urological guidelines emphasised the need for more high-quality clinical trials with robust oncological and toxicity outcomes. Consensus and positions statements were heterogenous. A globally accepted guideline for FT planning, technique and follow-up are still yet to be determined. Well-designed studies with long-term follow-up and robust clinical and toxicity endpoints are needed to improve our understanding of FT and create uniform guidelines to streamline management and follow-up.

Malignant trophoblastic disease: a rare tumor requiring personalized treatment. Stateof-the-art

Gestational trophoblastic disease (GTD) is a rare tumor characterized by spectrum of trophoblastic proliferative disorders associated with pregnancy. These neoplasms occur in less than 1% of female genital malignancies. There is a high curability of the disease even in the presence of disseminated process with the ability to preserve reproductive function. However, this is possible if timely diagnosis and adequate treatment tactics were applied. The article presents a review of the literature and the summary of guidelines of treatment of this malignancy.

Summary of the clinical practice guideline for the treatment of depression across three age cohorts.

The American Psychological Association (APA) developed this clinical practice guideline to provide recommendations for the treatment of depressive disorders, including major depression, subsyndromal depression, and persistent depressive disorder. It addresses three developmental cohorts: adolescents, general adults, and older adults (ages 60 and over). Ten systematic reviews and meta-analyses, along with other literature and observations from practitioners and patients, served as the basis for the guideline. The guideline development panel consisted of health professionals from psychology, psychiatry, and family medicine as well as community members who self-identified as having had depression. The panel examined the efficacy of psychological treatments and of complementary and alternative medicine treatments. It also examined comparative effectiveness among psychological treatments, by themselves and in combination with pharmacotherapy, and comparative effectiveness of psychological treatments in relation to pharmacotherapy and to complementary and alternative treatments. The panel made recommendations for treatment of depression in adolescents, adults, and older adults but did not make treatment recommendations specific to children. These recommendations, presented in detail in the guideline, are summarized here. The target audience for the guideline includes clinicians, researchers, patients, family members, and policymakers. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Increasing statin prescription rates to prevent cardiovascular disease among high-risk populations: a quality improvement intervention centred on a novel interactive tool

Statins are indicated for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD). Our previous study of 1042 consecutive patient encounters at our large urban academic institution found that one...

Post–COVID-19 Condition Summary of Guidelines


 The purpose of this report is to provide an overview for the existing guidelines about post–COVID-19 condition available on the online COVID-19 Recommendations Map.
 As of May 2022, 16 clinical practice guidelines that addressed post–COVID-19 condition were available to be summarized, spanning 7 different intents (topic areas): diagnosis, health services and systems, infection control, planning and monitoring, screening, treatment and rehabilitation, and vaccination.
 
 Eleven guidelines included recommendations related to diagnosis.
 Five guidelines included recommendations related to health services and systems.
 Six guidelines included recommendations related to infection control.
 Six guidelines included recommendations related to planning and monitoring.
 Four guidelines included recommendations related to screening.
 Eleven guidelines included recommendations related to treatment and rehabilitation.
 Six guidelines included recommendations related to vaccination.
 
 

Summary of key guidelines for locoregional treatment of HCC in Asia, Europe, South and North America.

Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide accounting for over 800,000 new cases in 2018, with the highest incidence in Asia and Africa where hepatitis B is the most common risk factor. In Europe, Japan, and the United States, hepatitis C chronic alcohol abuse and non-alcoholic fatty liver disease are more common risk factors. Five-year survival is low, less than 20% worldwide. HCC is a particularly challenging disease to treat because therapeutic options and prognosis must also consider hepatitis or cirrhosis independent of the malignancy. Locoregional therapies (LRT) including ablation, arterially directed therapy and external beam radiation are the preferred treatments for patients with good performance status, unresectable disease limited to the liver and preserved liver function. In practice, patients with portal vein tumor thrombus and limited extrahepatic disease may also be considered candidates for LRT. There are several guidelines developed by expert panels provide recommendations on treating this challenging disease including the Barcelona Clinic Liver Cancer, European Association for the Study of the Liver, European Society for Medical Oncology, American Association for the Study of the Liver Diseases, and the National Comprehensive Cancer Network. The purpose of this paper is to review the guidelines as they are applied clinically in regions with high incidence of HCC.

Equipping Small Businesses to Navigate Health Orders and Occupational Safety During the COVID-19 Pandemic.

From July 2020 to June 2021, the UC San Diego COVID-19 Small Business Outreach Project conducted COVID-19-related educational outreach to small businesses in high-risk communities of San Diego County and distributed over 1,200 toolkits containing COVID-19-related safety tips, best practices, and a summary of pertinent guidelines and COVID-19 vaccine information.

Dietary Factors Associated with Asthma Development: A Narrative Review and Summary of Current Guidelines and Recommendations.

Asthma is a complex disease, caused by a combination of genetic and environmental factors. The prevalence of asthma is increasing too rapidly to be attributable to genetic factors alone. Thus, environmental factors are becoming increasingly recognized as the cause of asthma. Modifying these environmental factors may be a simple approach for asthma prevention. To date, dietary intervention is an interesting modifiable factor because it can be implemented at the population level. The modification of systemic inflammation, oxidation, and microbial composition might be a mechanistic basis for prevention. This review summarizes the mechanistic basis and evidence from clinical studies on the association between dietary factors and asthma development. We also summarize the recommendations from many organizations and regional guidelines to assist the practicing physician to improve patient care.

Exercise, Diet, and Weight Management During Cancer Treatment: ASCO Guideline Summary and Q&A.

Exercise, Diet, and Weight Management During Cancer Treatment: ASCO Guideline Summary and Q&A.

The Swedish national guidelines on prostate cancer, part 2: recurrent, metastatic and castration resistant disease

Objective There is now an unprecedented amount of evidence to consider when revising prostate cancer guidelines. We believe that there is a value in publishing summaries of national clinical guidelines in English for others to read and comment on. Methods This is part 2 of a summary of the Swedish prostate cancer guidelines that were published in June 2022. This part covers recurrence after local treatment and management of metastatic and castration resistant disease. Part 1 covers early detection, diagnostics, staging, patient support and management of non-metastatic disease. Results The 2022 Swedish guidelines include several new recommendations. Among these is a recommendation of a period of observation with repeated PSA tests for patients with approximately 10 years’ life expectancy who experience a BCR more than 2–5 years after radical prostatectomy, to allow for estimating the PSA doubling time before deciding whether to give salvage radiotherapy or not. Recent results from the PEACE-1 trial led to the recommendation of triple-treatment with a GnRH agonist, abiraterone plus prednisolone and 6 cycles of docetaxel for patients with high-volume metastatic disease who are fit for chemotherapy. The Swedish guidelines differ from the European ones by having more restrictive recommendations about genetic testing of and high-dose zoledronic acid or denosumab treatment for men with metastatic prostate cancer, and by recommending considering bicalutamide monotherapy for selected patients with low-volume metastatic disease. Conclusions The 2022 Swedish prostate cancer guidelines include several new recommendations and some that differ from the European guidelines.

AAOS Clinical Practice Guideline Summary: Management of Hip Fractures in Older Adults.

Fragility hip fractures are a major public health problem with a notable effect on quality of life for patients and their families. Management of Hip Fractures in Older Adults: Evidence-Based Clinical Practice Guideline serves as current evidence-based practice guidelines for orthopaedic surgeons in the management of this common fracture and is based on a systematic review of published studies examining the surgical treatment of hip fractures in adults aged 55 years and older (older adults). The lower age limit for the patient population was set at 55 years but was also required to have a median age of 65 years. All aspects of care for older patients at risk of hip fracture or who have sustained a hip fracture could not be addressed within the scope of this guideline, including important topics of prevention of primary or secondary hip fractures or posthospital rehabilitation. This guideline contains 16 recommendations and three options to assist orthopaedic surgeons and all qualified physicians managing patients older than 55 years with hip fractures based on the best current available evidence. It is also intended to serve as an information resource for professional healthcare practitioners and developers of practice guidelines and recommendations. In addition to providing pragmatic practice recommendations, this guideline also highlights gaps in the literature and informs areas for future research and quality measure development.

A Decade of Success in Melanoma Immunotherapy and Targeted Therapy: What Every Radiologist Should Know.

Treatment strategies for malignant melanoma have rapidly evolved over the past decade. Because of its propensity to develop advanced stage and metastatic disease, melanoma has contributed to the majority of mortalities among patients with skin cancer. The development of novel therapeutics such as immunotherapy and targeted molecular therapies has revolutionized the treatment of patients with advanced stage and metastatic malignant melanoma. Immune checkpoint inhibitors, BRAF/MEK inhibitors, and other revolutionary therapies have demonstrated remarkable success in the treatment of this common malignancy. Along with these advancements in systemic therapies, imaging has continued to play a critical role in the diagnosis and follow-up of patients with malignant melanoma. As the use of these novel therapies continues to expand, knowledge of the evolving therapeutic landscape of melanoma is becoming critical for radiologists. In this review, we provide a primer for radiologists outlining the evolution of immunotherapy and targeted therapy in the treatment of melanoma. We discuss the critical role of imaging in evaluation of treatment response, including a summary of current imaging response guidelines. Last, we summarize the essential role of imaging in the evaluation of potential adverse events seen in patients with malignant melanoma undergoing treatment with immune checkpoint inhibitors.

Summary and Key Points of Clinical Guidelines for Low Back Pain 2019

Summary and Key Points of Clinical Guidelines for Low Back Pain 2019

Summary of the Clinical Practice Guidelines for Penile Cancer 2021 by the Japanese Urological Association.

Penile cancer is a rare cancer for which no medical guidelines have been established before in Japan. These guidelines aim to standardize, as much as possible, the therapeutic modality for penile cancer, for which empirical evidence is limited on a global scale, thereby bolstering therapeutic outcomes for patients with penile cancer. The new guidelines conform to the Minds Guide for Developing Clinical Practice Guidelines (2017) as much as possible. However, virtually no randomized comparative studies and meta-analyses based on such randomized studies have been conducted. Therefore, only the findings available at present were listed after conducting an exhaustive literature review of items with extremely low evidence levels and for which bodies of evidence and grades of recommendation were not evaluated. Clinical questions were set for items with a relatively large number of studies, including retrospective studies. However, since it is virtually impracticable to summarize bodies of evidence by systematic reviews, recommendation grades and evidence levels were discussed and determined by the consensus panel of the Preparatory Committee. The following were outlined: epidemiological, pathological, diagnostic, therapeutic, follow-up, and quality of life-related findings. Additionally, seven clinical questions were established to determine recommendation grades and evidence levels. We hope that these guidelines will prove to be useful to medical professionals engaged in clinical practice related to penile cancer in Japan and anticipate that critical reviews of the guidelines will lead to further refinement of the next edition.

Anesthetic consideations for endovascular treatment of acute ischemic stroke.

The purpose of this Continuing Professional Development module is to provide information pertaining to anesthetic considerations and management of endovascular thrombectomy (EVT) for patients with acute ischemic stroke. Acute ischemic stroke is a devastating neurologic disorder and timely intervention is key to a good neurologic outcome. This article provides an overview of three important concepts: pathophysiology and disease characteristics of acute ischemic stroke, and the procedural and anesthetic aspects of EVT. Key considerations include recognition of stroke symptoms, timing and urgency of intervention, procedural considerations for anesthesiologists, risks and benefits of different anesthetic techniques, and a summary of recent guidelines. In particular, current recommendations for blood pressure management in this setting are reviewed. Timely intervention for patients with acute ischemic stroke is of utmost importance. Endovascular thrombectomy is a minimally invasive procedure that has evolved over recent decades and improves outcomes for selected patients with ischemic stroke. Anesthesiologists should have a good understanding of potential complications and anesthetic options. Recent randomized trials have shown that both general anesthesia and sedation are associated with good outcomes; the anesthetic approach should be individualized and may vary by institution. Careful monitoring and maintenance of hemodynamic goals are critical, as is effective communication with the multidisciplinary team.

Wellness Review 2021, Part 2

Introduction: This article presents Part 2 of the biannual JWellness Review of literature from 2021 (July – December). We emphasize new science and resilience initiatives published outside of JWellness that seek understanding of burnout and thriving among healthcare professionals (HCPs). Methods: For the interval of July 1 to December 30, 2021, PubMed was queried for empirical and observational research studies, review articles, guideline summaries, letters, and editorials. Of 93 results, we reviewed methods and salient points to arrive at a final list of 48 articles for inclusion. Literature in Review: Common themes that emerged included teamwork, EMR optimization, group decompression, applications to support wellness interventions, and digital means of assessing burnout outcomes. COVID-19 exposed incident physician suicidal ideation and completion; however, some resilience measures are increasing despite continued waves of the pandemic. A few landmark publications described precedent control-measured wellness outcomes, each with positive results. Conclusion: Results of early randomized controlled investigations are inspiring, especially those involving small groups, positive psychology, coaching, mindfulness, religion, and wellness curricula. We note a resounding commonality among investigated causes for provider burnout: poor institutional culture. Conversely, quality teams and collegiality represent protective factors. Individuals cannot succeed in large groups without systems interventions and support. Training programs must assess stress, motivation, engagement, financial health, and clinical supervision—all variables meaningfully associated with resilience.

Barriers, Strategies, and Best Practices for BIM Adoption in Quebec Prefabrication Small and Medium-Sized Enterprises (SMEs)

Prefabricated construction has long faced problems due to the industry’s fragmentation. Building Information Modeling (BIM) has thus appeared as an efficient solution to provide a favorable environment for efficient completion of projects. Despite its benefits, implementing BIM successfully in small and medium-sized enterprises (SMEs), which represent the vast majority of manufacturers in Quebec, requires deep risk analysis and rigorous strategies. Hence, this work aims to study BIM implementation barriers, strategies, and best practices in wood prefabrication for SMEs through a literature review, semi-structured interviews, and an online survey. After qualitative content analysis, 30 critical barriers, 7 strategic milestones, and 31 best practices to maximize BIM benefits were revealed. One of the critical barriers concerns the effort required to develop BIM software libraries and programs to translate information from the BIM model to production equipment. Among the best strategies, it is essential to start by analyzing the current business model of the SMEs and to appoint a small BIM committee whose main responsibilities are management, coordination, and modeling. The prevalent best practices were to support the implementation team and encourage communication and collaboration. Previous studies show that BIM is not fully exploited in prefabrication for various reasons. This study highlights the critical barriers, strategies, and best practices for BIM adoption and proposes a framework for BIM implementation in prefabrication SMEs in Quebec, Canada. It also provides a summary of current knowledge and guidelines to promote BIM adoption in this sector.

An Evidence-based and Inclusive Breast Cancer Screening Strategy: Summary of Current Guidelines from the American College of Radiology and Society of Breast Imaging.

HomeRadiology: Imaging CancerVol. 4, No. 2 PreviousNext Research HighlightsFree AccessAn Evidence-based and Inclusive Breast Cancer Screening Strategy: Summary of Current Guidelines from the American College of Radiology and Society of Breast ImagingDevan Diwanji, Bonnie JoeDevan Diwanji, Bonnie JoeDevan DiwanjiBonnie JoePublished Online:Mar 18 2022https://doi.org/10.1148/rycan.229003MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Take-Away Points■ Major Focus: For persons at average risk, initiating annual screening mammography at age 40 years confers the greatest reduction in breast cancer mortality with diagnosis at earlier stages and better options for surgery and chemotherapy.■ Key Result: Screening should continue past age 74 years without upper age limit unless significant comorbidities limit life expectancy.■ Impact: Breast cancer risk assessment should be performed by age 30 years, especially in Black, Asian, and Hispanic women, to appropriately define risk category for each person.Breast cancer is the most common nonskin cancer and the second leading cause of cancer death in women. Although advances in treatments have significantly improved survival, they alone cannot overcome the disadvantage of a late-stage cancer diagnosis. Regular breast cancer screening with mammography reduces mortality by approximately 40% for women age 40 years and older. Experts from the American College of Radiology (ACR) and Society of Breast Imaging (SBI) reviewed data from numerous trials and imaging studies to offer evidence-based recommendations for screening mammography. Recommendations focused on reducing morbidity and mortality while addressing screening disparities and risks of screening versus not screening.The ACR and SBI recommend annual screening mammography starting at age 40 years for individuals at average risk. Starting at age 40 years versus 45 or 50 years helps detect cancer at earlier stages in which smaller tumor burdens and less metastatic potential broaden effective therapeutic options. Annual screening helps identify cancers with potential to grow and metastasize during longer screening interval periods. More than one-third of breast cancer deaths and nearly half for women age 40–49 years manifested in the 2nd year after mammography with negative findings. Because one in five breast cancers occur in women age 75 years and older, the ACR and SBI recommend screening past 75 years of age with consideration for comorbidities that limit life expectancy. More frequent screening increases benign-outcome recalls and biopsies but should be balanced against benefits of gained life-years and fewer deaths from breast cancer. Overdiagnosis from mammography screening occurs in less than 1% of women younger than 60 years of age, independent of screening interval or age to begin screening. A single mammography examination provides minimal radiation, equivalent to 6 weeks of natural background radiation. The ratio of lives saved by mammography compared with the theoretical possibility of lives lost from increased radiation exposure is 50–75 to one. Both benefits and risks should be considered to help individuals make informed choices regarding screening.The ACR and SBI recommendations address racial disparities associated with less frequent or delayed screening. Racial and ethnic minority women younger than 50 years old are 72% more likely to be diagnosed with invasive breast cancer than non-Hispanic White women. One-third of breast cancers in Black, Asian, and Hispanic women are diagnosed before 50 years of age. Biological factors, including higher incidences of mutations in BRCA1 and BRCA2 and aggressive triple-negative disease in racial and ethnic minority women, as well as systemic inequities in access to screening mammography may contribute to these discrepancies. Earlier or more frequent screening may detect cancers earlier in racial and ethnic minority women and mitigate some differences.Highlighted ArticleMonticciolo DL, Malak SF, Friedewald SM, et al. Breast cancer screening recommendations inclusive of all women at average risk: update from the ACR and Society of Breast Imaging. J Am Coll Radiol 2021; 18(9):1280–1288. doi: https://doi.org/10.1016/j.jacr.2021.04.021Highlighted ArticleMonticciolo DL, Malak SF, Friedewald SM, et al. Breast cancer screening recommendations inclusive of all women at average risk: update from the ACR and Society of Breast Imaging. J Am Coll Radiol 2021;18(9):1280–1288. doi:https://doi.org/10.1016/j.jacr.2021.04.021 Crossref, Medline, Google ScholarArticle HistoryPublished online: Mar 18 2022 FiguresReferencesRelatedDetailsRecommended Articles Age-based versus Risk-based Mammography Screening in Women 40–49 Years Old: A Cross-sectional StudyRadiology2019Volume: 292Issue: 2pp. 321-328Sustainable Benefits of Digital Breast Tomosynthesis ScreeningRadiology2020Volume: 298Issue: 1pp. 58-59Non-BRCA Early-Onset Breast Cancer in Young WomenRadioGraphics2022Volume: 42Issue: 1pp. 5-22Digital Mammography and Breast Tomosynthesis Performance in Women with a Personal History of Breast Cancer, 2007–2016Radiology2021Volume: 300Issue: 2pp. 290-300Invited Commentary: The Challenges of Early-Onset Breast CancerRadioGraphics2022Volume: 42Issue: 1pp. E16-E17See More RSNA Education Exhibits How to Identify Women Who Are Above Average Risk for Developing Breast Cancer: Retrospective Review of our Institution's First Year Experience After Implementing a Breast Cancer Risk Assessment Program in Breast ImagingDigital Posters2018High Risk Breast Cancer Screening  Digital Posters2020Non-Contrast-Enhanced Breast MR Screening for Women with Dense BreastsDigital Posters2019 RSNA Case Collection Multifocal breast cancerRSNA Case Collection2020Male invasive Ductal Carcinoma RSNA Case Collection2022Invasive ductal carcinoma of the breastRSNA Case Collection2020 Vol. 4, No. 2 Metrics Altmetric Score PDF download

Occupational radiation and pregnancy: reality or disinformation? A review of the literature and summary of current clinical guidelines

Exposure to ionizing radiation is a decisive factor in women's choice of entering the field of interventional radiology. This issue explains the low percentage of women in interventional radiology and the high number of women who take leave from work when they are pregnant even though they have no problems with their pregnancy.The current guidelines and legal framework regarding pregnancy and ionizing radiation from different national institutions are not in line with the scientific evidence. They establish recommendations based on disinformation and a need to protect the fetus that has not been scientifically validated. Lack of knowledge and lack of evidence-based information could contribute to gender-based inequality at work.This article reviews the evidence from the articles and clinical guidelines in PubMed, paying special attention to publications from the last five years (2015-2020). Additionally, it reports the results of an online survey of healthcare professionals exposed to radiation in their work.