Updated Clinical Practice Research Articles

Burden of pulmonary arterial hypertension in Germany

This study aimed to describe health care provision, resource consumption and related costs, as well as treatment patterns and quality of life in adult patients with pulmonary arterial hypertension (PAH) in Germany. Data for this retrospective and prospective cost-of-illness-study were derived from hospitals, general practitioners and patients. Costs were evaluated from the perspective of third party payer and patient. Quality of life data were collected by using three validated instruments. A total of 167 patients were enrolled at 10 hospitals. Time period from first occurrence of symptoms to confirmed diagnosis of PAH was 2.3 years on average. Mean number of GP visits was 1.5 per patient per month, and within 15 months, inpatient stays were reported for 50% of patients. The ratio of combination therapy to single-drug therapy for endothelin receptor antagonists, phosphodiesterase-5-inhibitor and prostacyclin analogues increased significantly during 15 months. Treatment costs were, on average, euro47,400 per patient per year, arising mainly from drugs. Compared to the general population, quality of life of PAH patients was considerably impaired. This is the first study which evaluated aspects of the medical and economic consequences of PAH based on a large cohort of PAH patients in Germany.

Periodic Health Examination and Prevention Guidelines for Koreans

Periodic Health Examination and Prevention Guidelines for Koreans were first proposed since 1988. Based on that guideline, clinical preventive services has been applied to clinic population in a few University Hospitals since 1991. In 1995, LHMP development committee in Korean Academy of Family Physician Society first published evidence based clinical practice guidelines and updated the guidelines in 2003. Lifetime Health Maintenance Program (LHMP) commitee represents efforts to take a more updated evidence-based approach to the development of the third updated clinical practice guideline in 2009. We focused on approaches that can reliably assess the extent of updating required, a model of limited literature searches with modest expert involvement to reduce the cost and time.

Medical Therapy for Pulmonary Arterial Hypertension: Updated ACCP Evidence-Based Clinical Practice Guidelines

A consensus panel convened by the American College of Chest Physicians developed guidelines for the treatment of pulmonary arterial hypertension (PAH) that were published in 2004. Subsequently, several important clinical trials have been published, and new treatments have received regulatory approval. In addition, add-on and combination therapy are being explored, which promise to open new therapeutic avenues. This article, taking into consideration studies published prior to September 1, 2006, provides an update to the previously published guidelines. The original guidelines have been summarized, a discussion of new studies has been added, and the treatment algorithm has been revised to take into account recent developments in therapy. This update provides evidence-based treatment recommendations for physicians involved in the care of patients with PAH. Due to the complexity of the diagnostic evaluation required and the treatment options available, referral of patients with PAH to a specialized center continues to be strongly recommended.

Updated clinical practice guidelines for the prevention and treatment of mucositis

Considerable progress in research and clinical application has been made since the original guidelines for managing mucositis in cancer patients were published in 2004, and the first active drug for the prevention and treatment of this condition has been approved by the United States Food and Drug Administration and other regulatory agencies in Europe and Australia. These changes necessitate an updated review of the literature and guidelines. Panel members reviewed the biomedical literature on mucositis published in English between January 2002 and May 2005 and reached a consensus based on the criteria of the American Society of Clinical Oncology. Changes in the guidelines included recommendations for the use of palifermin for oral mucositis associated with stem cell transplantation, amifostine for radiation proctitis, and cryotherapy for mucositis associated with high-dose melphalan. Recommendations against specific practices were introduced: Systemic glutamine was not recommended for the prevention of gastrointestinal mucositis, and sucralfate and antimicrobial lozenges were not recommended for radiation-induced oral mucositis. Furthermore, new guidelines suggested that granulocyte-macrophage-colony stimulating factor mouthwashes not be used for oral mucositis prevention in the transplantation population. Advances in mucositis treatment and research have been complemented by an increased rate of publication on mucosal injury in cancer. However, additional and sustained efforts will be required to gain a fuller understanding of the pathobiology, impact on overall patient status, optimal therapeutic strategies, and improved educational programs for health professionals, patients, and caregivers. These efforts are likely to have significant clinical and economic impact on the treatment of cancer patients. Cancer 2007;109:820-31. (c) 2007 American Cancer Society.

Ethical aspects of evidence based medicine (EBM)

The American Academy of Orthopedic Surgeons has released an updated Clinical Practice Guideline (CPG) on the evaluation and treatment of carpal tunnel syndrome (CTS). In 2007, the initial CPG on CTS evaluated diagnosis and in 2008 and 2011, the CPG on CTS assessed treatment. The most recent CPG assesses both diagnosis and treatment in a generally non-controversial way. We assess the potential impact of this CPG on the care of workers compensation patients.

Standardization of syndrome differentiation based on stages for breast cancer: a significant and updating topic on mastology of traditional Chinese medicine

The incidence of breast cancer increased rapidly in recent years. Breast cancer has become the most frequent malignant tumor of female especially in the developed regions. Traditional Chinese medicine (TCM) is effective in treating breast cancer, but its theories appear hysteretic, restricting the progress in clinical practice, teaching and research of TCM in the treatment of breast cancer. This article described the significance and urgency to work out the standardization of syndrome differentiation based on stages for breast cancer and put it into practice. It also analyzed the foundations, ideas and approaches of the research of standardization of syndrome differentiation based on stages for breast cancer in light of the changes of spectrum of diseases, the weaknesses of modern medicine in treating breast cancer, and the existed problems in the update clinical practice.

The National Comprehensive Cancer Network (NCCN) has included new treatment options in its updated Multiple Myeloma Clinical Practice Guidelines.

The National Comprehensive Cancer Network (NCCN) has included new treatment options in its updated Multiple Myeloma Clinical Practice Guidelines.

2003 update of Standards, Options and Recommandations for radiotherapy for patients with salivary gland malignant tumors (excluding lymphona, sarcoma and melanoma)

The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers. and specialists from French public universities,general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. To update clinical practice guidelines for the management of patients with salivary gland malignant tumors previously validated in 1997. These recommendations cover diagnosis, treatment and follow-up of patients with these tumors. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guidelines have been defined, the document is submitted for review by independent reviewers. This article presents the updated clinical practice guidelines concerning irradiation of patient with salivary gland tumors. The main recommendations are: 3 dimensional conformal radiotherapy (with or without intensity modulation) or 2D irradiation can be used; for surgical complete resected patients, postoperative photon radiotherapy should not be used in case of low grade stage I and 11 tumors(standard, level of evidence B2) but should be used for high grade stage II, II and IV tumors and for low grade stage III and IV tumors(standard, level of evidence B2). Neutron therapy should not be used in all of these cases (standard, level of evidence D); for patients presenting an incomplete macroscopic or microscopic surgical residual disease, postoperative irradiation must be delivered(standard). Neutron or photon therapy can be either delivered (options); for non operable patients neutron or photon therapy can be either delivered (options, level of evidence B2); for unresectable tumors or in case of recurrent neoplasms, exclusive neutron therapy or surgical tumor reduction combined with postoperative photon beam irradiation can be proposed (options, level of evidence C).

Professional Roles - The Nurse Educator: A Personal View

Introduction. Many people with compromised tissue viability are still not benefiting from the implementation of evidence based practice despite the growing number of appointments of nurse specialists within the field of tissue viability. However, the evolution of tissue viability services means that nurses are required to adapt quickly to new practice developments. These factors have increased the need for tissue viability courses that are designed to update clinical practice, facilitate clinical decision-making and increase awareness of legal and ethical implications resulting from role expansion • Purchasers and providers of health care now recognise that mismanagement of patients with wounds is both costly and unnecessary and, as a result, the demand for this type of course continues to rise• Therefore, as the speciality of tissue viability continues to develop, so does the need for specialist nurse lecturers who are able to deliver high quality education to practitioners across a variety of care settings.