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Voon KKR, Lim AAT, Wong HC, Sim YF, Foong KWC. Decision-making patterns among expert and novice orthodontists and oral maxillofacial surgeons in the management of adults with Class III malocclusions and moderate degree of skeletal discrepancies. J Orthod 2023; 50:410-422. [PMID: 37357426 DOI: 10.1177/14653125231181603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To explore the decision-making patterns among expert and novice orthodontists and oral maxillofacial surgeons in the management of adults with Class III malocclusions and moderate skeletal discrepancies. DESIGN Self-administered questionnaire survey. SETTING Faculty of Dentistry, National University of Singapore and the University Dental Cluster, National University Hospital, Singapore. PARTICIPANTS A total of 55 clinicians, comprising 13 expert orthodontists, 20 novice orthodontists, 10 expert oral maxillofacial surgeons and 12 novice oral maxillofacial surgeons. METHODS Clinicians assessed six adults with a Class III malocclusion and moderate skeletal discrepancy. They were asked to decide who could be managed exclusively by orthodontic camouflage, who would require combined orthodontic-orthognathic surgery as the only viable treatment, or who could be offered both treatment options. RESULTS The study found variable decision-making patterns among the clinicians in each case. Only 18.2%-40.0% of clinicians agreed that the cases selected were of moderate skeletal discrepancies and could be offered both treatment options whereas the rest were either more inclined to recommend orthodontic camouflage or orthognathic surgery. Intra-clinician agreement (n = 20) was only fair (Kappa value = 0.31). There was only slight inter-clinician agreement (n = 55) on their clinical decisions (Kappa value = 0.10). Clinical experience and dental specialty did not significantly influence clinicians' decisions. Oral and maxillofacial surgeons were 1.98 times more likely to indicate orthognathic surgery as the only viable treatment compared to the orthodontists (95% confidence interval = 1.15-3.42). CONCLUSION Variability in the patterns of decision-making for adults with a Class III malocclusion and moderate skeletal discrepancy was observed among the clinicians with low repeatability and agreement.
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Affiliation(s)
| | | | - Hung Chew Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yu Fan Sim
- Faculty of Dentistry, National University of Singapore, Singapore
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Wei D, Chang Y, Chen Q, Wang Q, Zhou H, Wu S, Xian X, Cui Z. Development and Application of a Reference Manual for Diagnosis and Rational Use of Antimicrobial Agents for Outpatient Primary Care (Digestive System Part): A Delphi Study. Infect Drug Resist 2023; 16:5433-5451. [PMID: 37638068 PMCID: PMC10460185 DOI: 10.2147/idr.s421133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/02/2023] [Indexed: 08/29/2023] Open
Abstract
Purpose To establish a concise and easy-to-understand reference manual for outpatient primary care providers, promoting correct diagnosis of digestive system diseases and rational antimicrobial use. Methods The establishment of the manual encompassed two processes: the development of a draft manual and the validation of the manual. The development process was based on a literature review and expert discussion. The manual comprises portions for disease diagnosis and rationality of antimicrobial use. The validation process employed a two-round Delphi technique, collecting consensus through paper-based or mail-based communications. The response of the Delphi group was assessed by the level of authority and commitment of the panelists and the degree of agreement among them. Furthermore, the manual was preliminarily applied among primary care physicians. Results A total of 29 panelists completed the Delphi working process. They were authoritative in their professional fields with authority coefficients of 0.813 and 0.818 for the two portions of the manual, respectively. The level of commitment of the panelists was measured by response rates, which were 100.00% and 96.67% for Round 1 and 2. After two rounds, a consensus was achieved with the consensus rates for the two portions of the manual being greater than 65% and 70%, respectively. Kendall W-tests had P-values < 0.001 in both rounds. This reference manual provides 200 diagnostic indicators for 29 common digestive diseases and recommendations for the rational use of antimicrobial agents for 13 categories of digestive diseases. The primary care physicians who used the reference manual reported high satisfaction and frequent usage. Conclusion Based on a collective consensus of professionals, a reference manual has been established, to provide a concise and easy-to-understand guide specifically for physicians and pharmacists in outpatient primary care. It could facilitate rapid learning to improve the accuracy of diagnosis and treatment for digestive disorders.
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Affiliation(s)
- Du Wei
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
| | - Yue Chang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
| | - Qi Chen
- Pharmacy Department, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, People’s Republic of China
| | - Qin Wang
- Department of Health Education, Tongren Centre for Disease Control and Prevention, Tongren, Guizhou, People’s Republic of China
| | - Hanni Zhou
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
| | - Shengyan Wu
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
| | - Xiaomin Xian
- School of Public Health, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
| | - Zhezhe Cui
- Guangxi Key Laboratory of Major Infectious Disease Prevention and Control and Biosafety Emergency Response, Guangxi Key Discipline platform of Tuberculosis Control, Guangxi Centre for Disease Control and Prevention, Nanning, Guangxi, People’s Republic of China
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3
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Elling CL, Goff SH, Hirsch SD, Tholen K, Kofonow JM, Curtis D, Robertson CE, Prager JD, Yoon PJ, Wine TM, Chan KH, Scholes MA, Friedman NR, Frank DN, Herrmann BW, Santos-Cortez RLP. Otitis Media in Children with Down Syndrome Is Associated with Shifts in the Nasopharyngeal and Middle Ear Microbiotas. Genet Test Mol Biomarkers 2023; 27:221-228. [PMID: 37522794 PMCID: PMC10494904 DOI: 10.1089/gtmb.2023.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Background: Otitis media (OM) is defined as middle ear (ME) inflammation that is usually due to infection. Globally, OM is a leading cause of hearing loss and is the most frequently diagnosed disease in young children. For OM, pediatric patients with Down syndrome (DS) demonstrate higher incidence rates, greater severity, and poorer outcomes. However, to date, no studies have investigated the bacterial profiles of children with DS and OM. Method: We aimed to determine if there are differences in composition of bacterial profiles or the relative abundance of individual taxa within the ME and nasopharyngeal (NP) microbiotas of pediatric OM patients with DS (n = 11) compared with those without DS (n = 84). We sequenced the 16S rRNA genes and analyzed the sequence data for diversity indices and relative abundance of individual taxa. Results: Individuals with DS demonstrated increased biodiversity in their ME and NP microbiotas. In children with OM, DS was associated with increased biodiversity and higher relative abundance of specific taxa in the ME. Conclusion: Our findings suggest that dysbioses in the NP of DS children contributes to their increased susceptibility to OM compared with controls. These findings suggest that DS influences regulation of the mucosal microbiota and contributes to OM pathology.
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Affiliation(s)
- Christina L. Elling
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Human Medical Genetics and Genomics Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Salina H. Goff
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Scott D. Hirsch
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kaitlyn Tholen
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jennifer M. Kofonow
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Danielle Curtis
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Charles E. Robertson
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jeremy D. Prager
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Patricia J. Yoon
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Todd M. Wine
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Kenny H. Chan
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Melissa A. Scholes
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Norman R. Friedman
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Daniel N. Frank
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Brian W. Herrmann
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Regie Lyn P. Santos-Cortez
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Center for Children's Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
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4
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Ninan K, Ali R, Morfaw F, McDonald SD. Prevention of pre-eclampsia with aspirin: A systematic review of guidelines and evaluation of the quality of recommendation evidence. Int J Gynaecol Obstet 2023; 161:26-39. [PMID: 36129381 DOI: 10.1002/ijgo.14471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Evidence has shown significant benefits of aspirin for preventing pre-eclampsia. OBJECTIVES The objective of this study was to systematically review recommendations from clinical practice guidelines and other recommendation documents on aspirin for the prevention of pre-eclampsia. SEARCH STRATEGY Ten databases were searched for statements from December 1, 2013, to January 1, 2022. SELECTION CRITERIA Without language restrictions, the most recent version of documents was considered. DATA COLLECTION AND ANALYSIS Two authors independently extracted recommendations. Guideline quality was assessed using a modified AGREE-II instrument and the AGREE-REX tool. MAIN RESULTS Out of 48 statements on the prevention of pre-eclampsia, 46 had recommendations on use of aspirin. Of them, 39 were supported by evidence from systematic reviews or randomized controlled trials. Three statements reported aspirin's significant reductions in preterm pre-eclampsia and one in perinatal death. Concerning quality, 41% of statements were rated as high quality in all domains of the AGREE-II tool, 15% were rated high quality in all domains of the AGREE-REX tool, and 11% were rated high quality in all domains on both tools. CONCLUSIONS While 96% of statements advocated for use of aspirin, only 9% reported a significant reduction in preterm pre-eclampsia or perinatal death. Based on the AGREE tools, future statements could use methodological improvement.
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Affiliation(s)
- Kiran Ninan
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rifaa Ali
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Frederick Morfaw
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Sarah D McDonald
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Division of Maternal-Fetal Medicine, McMaster University, Hamilton, Ontario, Canada
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5
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Sarkis LM, Jones AC, Ng A, Pantin C, Appleton SL, MacKay SG. Australasian Sleep Association position statement on consensus and evidence based treatment for primary snoring. Respirology 2023; 28:110-119. [PMID: 36617387 PMCID: PMC10108143 DOI: 10.1111/resp.14443] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/11/2022] [Indexed: 01/09/2023]
Abstract
Primary snoring impacts a significant portion of the adult population and has the potential to significantly impair quality of life. The purpose of these guidelines is to provide evidence-based recommendations to assist Australasian practitioners in the management of adult patients who present with primary snoring without significant obstructive sleep apnoea. The Timetable, Methodology and Standards by which this Position Statement has been established is outlined in the Appendix S1. The main recommendations are: Weight loss, and reduced alcohol consumption should be recommended, where appropriate If clinical judgement dictates, benzodiazepine and opioid reduction or avoidance may be advised Positional therapy should be considered in supine dominant snorers In dentate patients, Mandibular advancement devices (MAD) should be recommended as a first line treatment following assessment by both an appropriate Dentist and Sleep physician Continuous positive airway pressure (CPAP) devices may be recommended in patients with primary snoring in those already committed to their use or willing to try Surgical treatment of primary snoring by an appropriately credentialled surgeon may be advised and includes nasal (adjunctive), palatal and other interventions This position statement has been designed based on the best available current evidence and our combined expert clinical experience to facilitate the management of patients who present with primary snoring. It provides clinicians with a series of both non-surgical and surgical options with the aim of achieving optimal symptom control and patient outcomes. This is the first such set of recommendations to be established within Australasia and has also been reviewed and endorsed by the Australasian Sleep Association.
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Affiliation(s)
- Leba M Sarkis
- Otolaryngology Head and Neck Surgery Department, The Wollongong Hospital, Wollongong, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew C Jones
- Respiratory and Sleep Medicine Department, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Andrew Ng
- Centre for Sleep Disorders & Respiratory Failure St George Hospital, The Lucas Institute NSW, Australia
| | | | - Sarah L Appleton
- Flinders Health and Medical Research Institute- Sleep Health (Adelaide Institute for Sleep Health), College of Medicine of Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Stuart G MacKay
- Otolaryngology Head and Neck Surgery Department, The Wollongong Hospital, Wollongong, New South Wales, Australia.,School of Medicine, University of Wollongong, New South Wales, Australia
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6
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Urbančič J, Vozel D, Battelino S, Boršoš I, Bregant L, Glavan M, Iglič Č, Jenko K, Lanišnik B, Soklič Košak T. Management of Choanal Atresia: National Recommendations with a Comprehensive Literature Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010091. [PMID: 36670642 PMCID: PMC9856561 DOI: 10.3390/children10010091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023]
Abstract
Choanal atresia is the most common congenital anatomical abnormality of the nasal cavities, manifested with a clinical picture of neonatal respiratory distress. The treatment requires interdisciplinary management based mainly on tertiary referral centre experiences. However, there is a lack of high-quality evidence in the available literature. Recommendations were prepared based on a systematic review of the supporting literature: on a website survey addressed to the participating authors consisting of 28 questions and on five live meetings. The initial response to the recommendations was determined at their presentation at the sectional meeting of the section for otorhinolaryngology of the Slovenian Medical Association. Then, reactions from the professional public were accepted until the recommendations were presented at the Expert Council for Otorhinolaryngology of the Slovenian Medical Association. A systematic literature review identified eight systematic reviews or meta-analyses and four randomized controlled clinical trials. Thirty-four recommendations for diagnosis, treatment and postoperative management were consolidated. The paper presents the proposal and first Slovenian recommendations for treating patients with choanal atresia. They are based on foreign medical institutions' published literature and our clinical experience. They represent the basic requirements of diagnostics and may represent an essential guide in treatment.
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Affiliation(s)
- Jure Urbančič
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Otorhinolaryngology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Domen Vozel
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Otorhinolaryngology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
| | - Saba Battelino
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Otorhinolaryngology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Imre Boršoš
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Lev Bregant
- Division of Obstetrics and Gynecology, Department of Perinatology, Neonatal Intensive Care Unit, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia
| | - Matic Glavan
- Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Črtomir Iglič
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Klemen Jenko
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Otorhinolaryngology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Boštjan Lanišnik
- Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, University Medical Centre Maribor, 2000 Maribor, Slovenia
- Department of Otorhinolaryngology, Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
| | - Tanja Soklič Košak
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Otorhinolaryngology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Margaretha M, Azzopardi PS, Fisher J, Sawyer SM. School-based mental health promotion: A global policy review. Front Psychiatry 2023; 14:1126767. [PMID: 37139309 PMCID: PMC10149729 DOI: 10.3389/fpsyt.2023.1126767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/15/2023] [Indexed: 05/05/2023] Open
Abstract
Objectives Schools are increasingly recognized as important settings for mental health promotion, but it is unclear what actions schools should prioritize to promote student mental health and wellbeing. We undertook a policy review of global school-based mental health promotion policy documents from United Nations (UN) agencies to understand the frameworks they use and the actions they recommend for schools. Methods We searched for guidelines and manuals from UN agencies through the World Health Organization (WHO) library, the National Library of Australia and Google Scholar, from 2000 to 2021, using various combinations of search terms (e.g., mental health, wellbeing, psychosocial, health, school, framework, manual, and guidelines). Textual data synthesis was undertaken. Results Sixteen documents met inclusion criteria. UN policy documents commonly recommended a comprehensive school-health framework aimed at integrating actions to prevent, promote, and support mental health problems within the school community. The primary role of schools was framed around building enabling contexts for mental health and wellbeing. Terminology was relatively inconsistent across different guidelines and manuals, particularly around how comprehensive school health was conceptualized, which included aspects of scope, focus, and approach. Conclusion United Nations policy documents are oriented toward comprehensive school-health frameworks for student mental health and wellbeing that include mental health within wider health-promoting approaches. There are expectations that schools have the capabilities to deliver actions to prevent, promote and support mental health problems. Implication Effective implementation of school-based mental health promotion requires investments that facilitate specific actions from governments, schools, families, and communities.
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Affiliation(s)
- Margaretha Margaretha
- Department of Paediatrics, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
- Centre for Adolescent Health Royal Children’s Hospital, Melbourne, VIC, Australia
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia
- Faculty of Psychology, Universitas Airlangga, Surabaya, East Java, Indonesia
- *Correspondence: Margaretha Margaretha,
| | - Peter Sebastian Azzopardi
- Department of Paediatrics, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
- Centre for Adolescent Health Royal Children’s Hospital, Melbourne, VIC, Australia
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia
- Adolescent Health and Wellbeing, Telethon Kids Institute, Adelaide, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Susan Margaret Sawyer
- Department of Paediatrics, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
- Centre for Adolescent Health Royal Children’s Hospital, Melbourne, VIC, Australia
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia
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8
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Terman SA, Steinberg KE, Hinerman N. Flaws in advance directives that request withdrawing assisted feeding in late-stage dementia may cause premature or prolonged dying. BMC Med Ethics 2022; 23:100. [PMID: 36203173 PMCID: PMC9535899 DOI: 10.1186/s12910-022-00831-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 08/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background The terminal illness of late-stage (advanced) Alzheimer’s and related dementias is progressively cruel, burdensome, and can last years if caregivers assist oral feeding and hydrating. Options to avoid prolonged dying are limited since advanced dementia patients cannot qualify for Medical Aid in Dying. Physicians and judges can insist on clear and convincing evidence that the patient wants to die—which many advance directives cannot provide. Proxies/agents’ substituted judgment may not be concordant with patients’ requests. While advance directives can be patients’ last resort to attain a peaceful and timely dying consistent with their lifelong values, success depends on their being effective and acceptable. A single flaw can provide opponents justification to refuse the directive’s requests to cease assisted feeding. Aim This article considers 24 common advance directive flaws in four categories. Process flaws focus on how patients express their end-of-life wishes. Content flaws reflect drafters’ selection of conditions and interventions, and how they are described. Inherent flaws can make advance directives unacceptable to authorities concerned about premature dying. Strategies are needed to compel physicians to write needed orders and to prevent third parties from sabotaging these orders after they are implemented. The article includes excerpts from “dementia-specific” directives or supplements that exemplify each flaw—mostly from the US and Europe. No directive critiqued here included an effective strategy to resolve this long-debated bioethical conflict: the past directive requests “Cease assisted feeding” but the incapacitated patient apparently expresses the desire to “Continue assisted feeding.” Some opponents to the controversial request, cease assisted feeding, use this conflict as a conceptual wedge to practice hard paternalism. This article proposes a protocol to prevent this conflict from emerging. These strategies may prevent authorities from requiring patients to fulfill authorities’ additional clinical criteria as a prerequisite to honor the requests in patients directives. Conclusion This critique of flaws may serve as a guide to drafting and to selecting effective and acceptable advance directives for dementia. It also poses several bioethical and clinical questions to those in authority: Does your paternalistic refusal to honor patients’ wishes respect their self-determination? Protect vulnerable patients from harm? Force patients to endure prolonged suffering? Violate the principles of bioethics? Violate the very foundation of patient-centered care?
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Affiliation(s)
| | - Karl E Steinberg
- California State University Shiley Haynes Institute for Palliative Care, San Marcos, CA, USA
| | - Nathaniel Hinerman
- Department of Theology and Religious Studies and School of Nursing and Health Professions, University of San Francisco, San Francisco, USA
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9
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Adams A, Ferguson M, Greer AM, Burmeister C, Lock K, McDougall J, Scow M, Buxton JA. Guideline development in harm reduction: Considerations around the meaningful involvement of people who access services. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 4:100086. [PMID: 36846576 PMCID: PMC9948926 DOI: 10.1016/j.dadr.2022.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/13/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022]
Abstract
Background Harm reduction seeks to minimizes the negative effects of drug use while respecting the rights of people with lived and living experience of substance use (PWLLE). Guideline standards ("guidelines for guidelines") provide direction on developing healthcare guidelines. To identify essential considerations for guideline development within harm reduction, we examined whether guideline standards are consistent with a harm reduction approach in their recommendations on involving people who access services. Methods We searched the literature from 2011-2021 to identify guideline standards used in harm reduction and publications on involving PWLLE in developing harm reduction services. We used thematic analysis to compare their guidance on involving people who access services. Findings were validated with two organizations of PWLLE. Results Six guideline standards and 18 publications met inclusion criteria. We identified three themes related to involving people who access services: Reasons for Involvement, Methods of Involvement, and Factors in Success. Subthemes varied across the literature. We identified five essential considerations for guideline development in harm reduction: establishing a shared understanding of reasons for involving PWLLE; respecting their expertise; partnering with PWLLE to ensure appropriate engagement; incorporating perspectives of populations disproportionately affected by substance use; and securing resources. Conclusion Guideline standards and the harm reduction literature approach the involvement of people who access services from different perspectives. Thoughtful integration of the two paradigms can improve guidelines while empowering PWLLE. Our findings can support the development of high-quality guidelines that align with the fundamental principles of harm reduction in their involvement of PWLLE.
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Affiliation(s)
- Alison Adams
- British Columbia Center for Disease Control, 655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada,School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z8, Canada
| | - Max Ferguson
- British Columbia Center for Disease Control, 655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Alissa M. Greer
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Charlene Burmeister
- British Columbia Center for Disease Control, 655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Kurt Lock
- British Columbia Center for Disease Control, 655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Jenny McDougall
- British Columbia Center for Disease Control, 655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Marnie Scow
- British Columbia Center for Disease Control, 655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada,School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z8, Canada
| | - Jane A. Buxton
- British Columbia Center for Disease Control, 655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada,School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z8, Canada,Corresponding author at: BC Centre for Disease Control, 655 West 12th Ave., Vancouver, BC V5Z 4R4, Canada.
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10
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Serum Fibrinogen Level and Cytokine Production as Prognostic Biomarkers for Idiopathic Sudden Sensorineural Hearing Loss. Otol Neurotol 2022; 43:e712-e719. [PMID: 35802892 DOI: 10.1097/mao.0000000000003552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES No clinically useful prognostic factors have been identified for idiopathic sudden sensorineural hearing loss (ISSNHL). The current study therefore sought to identify useful prognostic factors for idiopathic sudden sensorineural hearing loss from blood biomarkers while attempting to classify the pathogenic mechanism and formulate treatment strategies based on these results. STUDY DESIGN Prospective cohort study. SETTING Tertiary referral center. METHODS A total of 47 patients with acute phase ISSNHL were treated with steroid at an initial dose of 1 mg/kg/day and hyperbaric oxygen therapy and followed up for 6 months. Serum fibrinogen levels, peripheral blood mononu- clear cells (PBMCs), and interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α production levels from PBMCs were measured, after which patient's pre- and post- treatment hearing was compared. RESULTS In the overall cohort, the mean improvement level, mean recovery rate, and mean fibrinogen level was 20.3 dB, 46.2%, 292.0 mg/mL, respectively. The mean levels of IL-1β, IL-6, and TNF-α produced by peripheral blood mononu- clear cells cultured under lipopolysaccharide stimulation were 318.4, 498.1, and 857.6 pg/mL, respectively. High fibrinogen levels were associated with poor hearing progno- sis. Lipopolysaccharide-stimulated cytokine production by PBMCs did not correlate with hearing changes; however, the prognosis was significantly better in patients with low fibrinogen levels and high IL-1β levels produced by PBMCs than in other patients. CONCLUSIONS Our results suggest that patients with simple inflammatory-type ISSNHL responded well to standard therapy. Therefore, serum fibrinogen levels and PBMCs cytokine production may help determine the management of ISSNHL based on its pathogenic mechanism.
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11
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Ferguson M, Medley A, Rittenbach K, Brothers TD, Strike C, Ng J, Leece P, Elton-Marshall T, Ali F, Lorenzetti DL, Buxton JA. Priority setting for Canadian Take-Home Naloxone best practice guideline development: an adapted online Delphi method. Harm Reduct J 2022; 19:71. [PMID: 35780136 PMCID: PMC9250272 DOI: 10.1186/s12954-022-00650-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Take-Home Naloxone (THN) is a core intervention aimed at addressing the toxic illicit opioid drug supply crisis. Although THN programs are available in all provinces and territories throughout Canada, there are currently no standardized guidelines for THN programs. The Delphi method is a tool for consensus building often used in policy development that allows for engagement of stakeholders. METHODS We used an adapted anonymous online Delphi method to elicit priorities for a Canadian guideline on THN as a means of facilitating meaningful stakeholder engagement. A guideline development group generated a series of key questions that were then brought to a 15-member voting panel. The voting panel was comprised of people with lived and living experience of substance use, academics specializing in harm reduction, and clinicians and public health professionals from across Canada. Two rounds of voting were undertaken to score questions on importance for inclusion in the guideline. RESULTS Nine questions that were identified as most important include what equipment should be in THN kits, whether there are important differences between intramuscular and intranasal naloxone administration, how stigma impacts access to distribution programs, how effective THN programs are at saving lives, what distribution models are most effective and equitable, storage considerations for naloxone in a community setting, the role of CPR and rescue breathing in overdose response, client preference of naloxone distribution program type, and what aftercare should be provided for people who respond to overdoses. CONCLUSIONS The Delphi method is an equitable consensus building process that generated priorities to guide guideline development.
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Affiliation(s)
- Max Ferguson
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Andrea Medley
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Katherine Rittenbach
- Alberta Health Services (AHS), Edmonton, AB, Canada.,University of Calgary, Calgary, AB, Canada.,University of Alberta, Edmonton, AB, Canada
| | - Thomas D Brothers
- Department of Medicine, Dalhousie University, Halifax, NS, Canada.,UCL Collaborative Centre for Inclusion Health, University College London, London, UK
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Justin Ng
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Pamela Leece
- Public Health Ontario (PHO), Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Tara Elton-Marshall
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Centre for Addiction and Mental Health, Institute of Mental Health Policy Research, Toronto, ON, Canada
| | - Farihah Ali
- Centre for Addiction and Mental Health, Institute of Mental Health Policy Research, Toronto, ON, Canada
| | | | - Jane A Buxton
- BC Centre for Disease Control, Vancouver, BC, Canada. .,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
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12
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Khabsa J, Petkovic J, Riddle A, Lytvyn L, Magwood O, Atwere P, Campbell P, Katikireddi SV, Merner B, Nasser M, Chang S, Jaramillo Garcia A, Limburg H, Guise J, Tugwell P, Akl EA. PROTOCOL: Conflict of interest issues when engaging stakeholders in health and healthcare guideline development: a systematic review. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1232. [PMID: 36911340 PMCID: PMC9013401 DOI: 10.1002/cl2.1232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This is the protocol for a Campbell systematic review. The overall objective of this study is to gather and summarize the existing literature on conflict of interest issues when engaging stakeholders in guideline development.
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Affiliation(s)
- Joanne Khabsa
- Clinical Research InstituteAmerican University of Beirut Medical CenterBeirutLebanon
| | | | - Alison Riddle
- School of Epidemiology and Public Health, Faculty of MedicineUniversity of OttawaOttawaCanada
| | - Lyubov Lytvyn
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
| | - Olivia Magwood
- C.T. Lamont Primary Health Care Research CentreBruyère Research InstituteOttawaCanada
| | - Pearl Atwere
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research UnitGlasgow Caledonian UniversityGlasgowUK
| | | | - Bronwen Merner
- School of Psychology and Public Health, Centre for Health Communication and ParticipationLa Trobe UniversityBundooraAustralia
| | - Mona Nasser
- Peninsula Dental SchoolPlymouth University Peninsula Schools of Medicine and DentistryPlymouthUK
| | - Stephanie Chang
- Annals of Internal MedicineAmerican College of PhysiciansWashington, DCUSA
| | - Alejandra Jaramillo Garcia
- Applied Research DivisionCentre for Surveillance and Applied Research Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada/Government of CanadaOttawaCanada
| | - Heather Limburg
- Global Health and Guidelines DivisionPublic Health Agency of CanadaOttawaCanada
| | - Jeanne‐Marie Guise
- Departments of Obstetrics and Gynecology, Medical Informatics and Clinical Epidemiology, Public Health & Preventive Medicine, and Emergency MedicineOregon Health and Science UniversityPortlandOregonUSA
| | - Peter Tugwell
- Department of Medicine, Faculty of MedicineUniversity of OttawaOttawaCanada
| | - Elie A. Akl
- Department of Internal MedicineAmerican University of BeirutBeirutLebanon
- Department of Health Research Methods, Evidence, and Impact (HEI)McMaster UniversityHamiltonOntarioCanada
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13
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Li HY, Wang HS, Wang YL, Wang J, Huo XC, Zhao Q. Management of Ventilator-Associated Pneumonia: Quality Assessment of Clinical Practice Guidelines and Variations in Recommendations on Drug Therapy for Prevention and Treatment. Front Pharmacol 2022; 13:903378. [PMID: 35668946 PMCID: PMC9163435 DOI: 10.3389/fphar.2022.903378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/29/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose: To assess the quality of clinical practice guidelines (CPGs) related to drug therapy for prevention and control of ventilator-associated pneumonia (VAP) and compare the differences and similarities between recommendations. Methods: Electronic databases (including PubMed, Cochrane library, Embase, Web of Science), guideline development organizations, and professional societies were searched to identify CPGs for VAP from 20 January 2012 to 20 January 2022. The Appraisal of Guidelines Research & Evaluation (AGREE) II instrument was used to evaluate the quality of the guidelines. The recommendations on drug therapy for prevention and treatment for each guideline were extracted, and then a descriptive synthesis was performed to analyze the scope/topic, and consistency of the recommendations. Results: Thirteen CPGs were included. The median score and interquartile range (IQR) in each domain are shown below: scope and purpose 72.22% (63.89%,83.33%); stakeholder involvement 44.44% (38.89%,52.78%); rigor of development 43.75% (31.25%,57.29%); clarity and presentation 94.44% (77.78%,94.44%); applicability 20.83 (8.34%,33.34%) and editorial independence 50% (33.33%,66.67%). We extracted 21 recommendations on drug therapy for prevention of VAP and 51 recommendations on drugs used for treatment. Some controversies remained among the included guidelines. Conclusion: There is considerable variability in the development processes and reporting of VAP guidelines. Despite many similarities, the recommendations still had some inconsistencies in the details. For the prevention and treatment of VAP, local microbial epidemiology and antibiotic sensitivity must be considered, and recommendations should be regularly revised as new evidence emerges.
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Affiliation(s)
- Hong-Yan Li
- Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Hai-Shan Wang
- Department of Intensive Care Unit, Yantai YEDA Hospital, Yantai, China
| | - Ying-Lin Wang
- Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Jing Wang
- Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Xue-Chen Huo
- Department of Hepatobiliary Surgery, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
- *Correspondence: Xue-Chen Huo, ; Quan Zhao,
| | - Quan Zhao
- Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
- *Correspondence: Xue-Chen Huo, ; Quan Zhao,
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14
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Dewidar O, Lotfi T, Langendam MW, Parmelli E, Saz Parkinson Z, Solo K, Chu DK, Mathew JL, Akl EA, Brignardello-Petersen R, Mustafa RA, Moja L, Iorio A, Chi Y, Canelo-Aybar C, Kredo T, Karpusheff J, Turgeon AF, Alonso-Coello P, Wiercioch W, Gerritsen A, Klugar M, Rojas MX, Tugwell P, Welch VA, Pottie K, Munn Z, Nieuwlaat R, Ford N, Stevens A, Khabsa J, Nasir Z, Leontiadis G, Meerpohl J, Piggott T, Qaseem A, Matthews M, Schünemann HJ. Good or best practice statements: proposal for the operationalisation and implementation of GRADE guidance. BMJ Evid Based Med 2022; 28:189-196. [PMID: 35428694 DOI: 10.1136/bmjebm-2022-111962] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 02/05/2023]
Abstract
An evidence-based approach is considered the gold standard for health decision-making. Sometimes, a guideline panel might judge the certainty that the desirable effects of an intervention clearly outweigh its undesirable effects as high, but the body of supportive evidence is indirect. In such cases, the application of the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach for grading the strength of recommendations is inappropriate. Instead, the GRADE Working Group has recommended developing ungraded best or good practice statement (GPS) and developed guidance under which circumsances they would be appropriate.Through an evaluation of COVID-1- related recommendations on the eCOVID Recommendation Map (COVID-19.recmap.org), we found that recommendations qualifying a GPS were widespread. However, guideline developers failed to label them as GPS or transparently report justifications for their development. We identified ways to improve and facilitate the operationalisation and implementation of the GRADE guidance for GPS.Herein, we propose a structured process for the development of GPSs that includes applying a sequential order for the GRADE guidance for developing GPS. This operationalisation considers relevant evidence-to-decision criteria when assessing the net consequences of implementing the statement, and reporting information supporting judgments for each criterion. We also propose a standardised table to facilitate the identification of GPS and reporting of their development. This operationalised guidance, if endorsed by guideline developers, may palliate some of the shortcomings identified. Our proposal may also inform future updates of the GRADE guidance for GPS.
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Affiliation(s)
- Omar Dewidar
- Methods Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Tamara Lotfi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada
| | - Miranda W Langendam
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Elena Parmelli
- Joint Research Centre, European Commission, Ispra, Lombardia, Italy
| | - Zuleika Saz Parkinson
- Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias, Madrid, Spain
| | - Karla Solo
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Derek K Chu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Joseph L Mathew
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Elie A Akl
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Reem A Mustafa
- Internal Medicine, Division of Nephrology and Hypertension, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Lorenzo Moja
- Department of Health Product Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yuan Chi
- Yealth Network, Beijing Yealth Technology Co., Ltd, Beijing, China
- Cochrane Campbell Global Ageing Partnership, London, UK
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau-CIBERESP, Barcelona, Spain
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Clinical Pharmacology, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | | | - Alexis F Turgeon
- Centre de Recherche du Centre Hospitalier Affilié Universitaire de Québec (CHA), CHA-Hôpital de l'Enfant-Jésus, Université Laval, Québec City, Québec, Canada
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau-CIBERESP, Barcelona, Spain
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada
| | - Annette Gerritsen
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - María Ximena Rojas
- Department of Clinical Epidemiology and Public Health, Institut d'Investigació Biomèdica Sant Pau IIB Sant Pau, Barcelona, Spain
| | - Peter Tugwell
- Department of Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Vivian Andrea Welch
- Methods Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin Pottie
- Deparatment of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Zachary Munn
- Joanna Briggs Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada
| | - Nathan Ford
- Department of HIV, Hepatitis and Sexually Transmitted Infections, World Health Organization, Geneva, Switzerland
| | - Adrienne Stevens
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Zil Nasir
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada
| | - Grigorios Leontiadis
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Joerg Meerpohl
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
- Medical Center - University of Freiburg, Institute for Evidence in Medicine, Freiburg, Germany
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada
| | - Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania, USA
| | - Micayla Matthews
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Biomedical Sciences Humanitas University, Humanitas University, Milan, Italy
- Cochrane Canada, Hamilton, Ontario, Canada
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15
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Bonet M, Ciabati L, De Oliveira LL, Souza R, Browne JL, Rijken M, Fawcus S, Hofmeyr GJ, Liabsuetrakul T, Gülümser Ç, Blennerhassett A, Lissauer D, Meher S, Althabe F, Oladapo O. Constructing evidence-based clinical intrapartum care algorithms for decision-support tools. BJOG 2022. [PMID: 35411684 DOI: 10.1111/1471-0528.16958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022]
Abstract
AIM To describe standardised iterative methods used by a multidisciplinary group to develop evidence-based clinical intrapartum care algorithms for the management of uneventful and complicated labours. POPULATION Singleton, term pregnancies considered to be at low risk of developing complications at admission to the birthing facility. SETTING Health facilities in low- and middle-income countries. SEARCH STRATEGY Literature reviews were conducted to identify standardised methods for algorithm development and examples from other fields, and evidence and guidelines for intrapartum care. Searches for different algorithm topics were last updated between January and October 2020 and included a combination of terms such as 'labour', 'intrapartum', 'algorithms' and specific topic terms, using Cochrane Library and MEDLINE/PubMED, CINAHL, National Guidelines Clearinghouse and Google. CASE SCENARIOS Nine algorithm topics were identified for monitoring and management of uncomplicated labour and childbirth, identification and management of abnormalities of fetal heart rate, liquor, uterine contractions, labour progress, maternal pulse and blood pressure, temperature, urine and complicated third stage of labour. Each topic included between two and four case scenarios covering most common deviations, severity of related complications or critical clinical outcomes. CONCLUSIONS Intrapartum care algorithms provide a framework for monitoring women, and identifying and managing complications during labour and childbirth. These algorithms will support implementation of WHO recommendations and facilitate the development by stakeholders of evidence-based, up to date, paper-based or digital reminders and decision-support tools. The algorithms need to be field tested and may need to be adapted to specific contexts. TWEETABLE ABSTRACT Evidence-based intrapartum care clinical algorithms for a safe and positive childbirth experience.
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Affiliation(s)
- M Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - L Ciabati
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - L L De Oliveira
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - R Souza
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - J L Browne
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - M Rijken
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - S Fawcus
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - G J Hofmeyr
- Effective Care Research Unit, Walter Sisulu University and Eastern Cape Department of Health, University of the Witwatersrand, East London, South Africa
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana
| | - T Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Ç Gülümser
- Department of Obstetrics and Gynecology, University of Health Science School of Medicine, Ankara, Turkey
| | - A Blennerhassett
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- World Health Organization Collaborating Centre for Global Women's Health Research, Birmingham, UK
| | - D Lissauer
- Malawi-Liverpool-Wellcome Trust Research Institute, Queen Elizabeth Central Hospital, College of Medicine, Blantyre, Malawi
- Institute of Life Course and Medical Sciences, William Henry Duncan Building, University of Liverpool, Liverpool, UK
| | - S Meher
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - F Althabe
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - O Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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16
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Park DY, Choi JH, Kim DK, Jung YG, Mun SJ, Min HJ, Park SK, Shin JM, Yang HC, Hong SN, Mo JH. Clinical Practice Guideline: Nasal Irrigation for Chronic Rhinosinusitis in Adults. Clin Exp Otorhinolaryngol 2022; 15:5-23. [PMID: 35158420 PMCID: PMC8901942 DOI: 10.21053/ceo.2021.00654] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022] Open
Abstract
The Korean Society of Otorhinolaryngology-Head and Neck Surgery and Korean Rhinologic Society appointed a guideline development group (GDG) to establish a clinical practice guideline, and the GDG developed a guideline for nasal irrigation for adult patients with chronic rhinosinusitis (CRS). The guideline focuses on knowledge gaps, practice variations, and clinical concerns associated with nasal irrigation. Nasal irrigation has been recommended as the first-line treatment for CRS in various guidelines, and its clinical effectiveness has been demonstrated through a number of studies with robust evidence. However, no guidelines have presented a consistent nasal irrigation method. Several databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers using a predefined search strategy. When insufficient evidence was found, the GDG sought expert opinions and attempted to fill the evidence gap. Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. The committee developed 11 evidence-based recommendations. This guideline focuses on the evidence-based quality improvement opportunities deemed the most important by the GDG. Moreover, the guideline addresses whether nasal lavage helps treat CRS, what type of rinsing solution should be used, and the effectiveness of using additional medications to increase the therapeutic effect.
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Affiliation(s)
- Do-Yang Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Ji Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Yong Gi Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sue Jean Mun
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun Jin Min
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Soo Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae-Min Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Seung-No Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Hun Mo
- Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
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17
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Tonsillar-related pathologies: An analysis of the evidence underpinning management recommendations. Int J Pediatr Otorhinolaryngol 2022; 152:110992. [PMID: 34883327 DOI: 10.1016/j.ijporl.2021.110992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 11/11/2021] [Accepted: 11/22/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Evidence-based decision making is crucial in reducing the health and economic burdens imposed by tonsillar-related pathologies. Clinical practice guidelines are used to guide these decisions; however, uptake of recommendations in these guidelines is low. Systematic reviews are the highest level of evidence used to influence guideline recommendations; therefore, improving the reporting and methodological quality of systematic reviews related to tonsillar-related pathologies may improve guideline uptake and patient care. METHODS We used PubMed to search for all clinical practice guidelines related to tonsillar-related pathologies from 2010 to 2020. Included guidelines were then searched for all systematic reviews and meta-analyses. Study characteristics were extracted from each cited systematic review/meta-analysis before being evaluated using the PRISMA (Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses) and AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews 2) instruments. We then compared systematic reviews conducted by a Cochrane systematic review group with non-Cochrane systematic reviews. RESULTS Seven clinical practice guidelines were included in our study and within these guidelines 98 SRs/MAs were cited, 80 of which were unique and included. Systematic reviews composed 9.1% (98/1082) of all guideline citations. Guideline PRISMA scores ranged from 0.47 to 0.83 with a mean score of 0.71 (n = 80) and guideline AMSTAR-2 scores ranged from 0.52 to 0.83 with a mean of 0.56 (7.29/13) and 0.75 (11.94/16) (n = 80). Cochrane systematic reviews displayed greater PRISMA (0.88 vs. 0.64: p < 0.001) and AMSTAR-2 (0.90 vs. 0.57; p < 0.001) scores compared to the non-Cochrane studies. We found PRISMA and AMSTAR-2 scores were positively correlated across guidelines (r = 0.93). CONCLUSION Wide variation exists in adherence to PRISMA and AMSTAR-2 guidelines among systematic reviews cited in clinical practice guidelines for tonsillar-related pathologies. Prior registration and adequate risk of bias assessment are two areas where improvements may be needed. Given the importance of guideline uptake, careful considerations to improve the methodological and reporting quality of evidence supporting tonsillar-related pathology recommendations are necessary.
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Johnson AL, Torgerson T, Adewumi MT, Kee M, Farahani C, Wehrmann DJ, Francis CL, Vassar M. Discontinuation and nonpublication of pediatric otolaryngology clinical trials. Int J Pediatr Otorhinolaryngol 2021; 151:110972. [PMID: 34773883 DOI: 10.1016/j.ijporl.2021.110972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/16/2021] [Accepted: 11/08/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Randomized controlled trial (RCT) discontinuation and nonpublication are potential mechanisms of waste in resources and lead to decreased advancement of medical science and compromised ethical issues in all specialties. However, the prevalence of discontinued or unpublished RCTs regarding common pediatric otolaryngology disorders and interventions remains unclear. STUDY DESIGN Cross-sectional analysis. METHODS Retrospective analysis of common pediatric otolaryngology RCTs registered in ClinicalTrials.gov up until November 2, 2018. Data were collected from the registry, and publication status was identified. If a reason for trial discontinuation or nonpublication was not identified through a systematic search, corresponding trialists were contacted through email. RESULTS After exclusion, 260 RCTs were included for analysis. Analysis found 198 (76%) RCTs were completed, and 62 (24%) trials were discontinued. The most commonly reported reasons for RCT discontinuation were program termination by sponsor or management (7/24; 29.2%), lack of participant enrollment, difficulty recruiting, or slow accrual (7/24; 29.2%). A total of 192 (192/260; 73.8%) published RCTs and 68 (68/260; 26.2%) unpublished RCTs were identified. Twenty-six (26/62; 42%) of the discontinued RCTs reached publication, while 36 (58%) remained unpublished. Regarding the completed RCTs, 166 of 198 (83.8%) completed trials reached publication, while 32 (32/198; 16.2%) remained unpublished after trial completion. CONCLUSIONS Approximately 1 in 4 of included RCTs were discontinued or did not reach publication. Findings suggest further guidance is needed for RCTs regarding common pediatric otolaryngology disorders and interventions. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Austin L Johnson
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.
| | - Trevor Torgerson
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | | | - Micah Kee
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Clay Farahani
- Oklahoma State University Medical Center, Department of Otolaryngology, Tulsa, OK, USA
| | - Daniel J Wehrmann
- University of Nebraska Medical Center, Department of Otolaryngology, Omaha, NE, USA
| | - Carrie L Francis
- University of Kansas Medical Center, Department of Otolaryngology, Kansas City, KS, USA
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Bastani P, Mohammadpour M, Bahmaei J, Ravangard R, Mehralian G. Hospital management by health services management graduates: the change paradigm in Iran. Heliyon 2021; 7:e08414. [PMID: 34869929 PMCID: PMC8626693 DOI: 10.1016/j.heliyon.2021.e08414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/02/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The hospital management and its functions can be very important in improving the quality of hospital care, and their managers need several competencies to perform these functions efficiently and effectively. Today, more attention should be paid to the use of professional hospital managers, especially those educated in the field of Health Services Management. The present study aimed to study the change paradigm of hospital management by graduates of Health Services Management in a hospital in Iran as a developing country. MATERIALS AND METHODS This study was a qualitative case study conducted in the Hazrate Ali Asghar Hospital in Shiraz, Iran in 2018 in order to determine the "why", "how" and "what" aspects of applying hospital managers educated in the field of Health Services Management instead of other traditional managers, as a change paradigm. The samples were selected purposefully and semi-structured in-depth interviews with 12 people were used to explain the experiences of management style by graduates of Health Services Management. Data were collected and analyzed simultaneously using the thematic analysis method and with the inductive approach. RESULTS Results of the interviews led to the identification of 6 main themes and 26 sub-themes. The main themes were structural reforms, process reforms, organizational culture reforms, performance reforms, resource reforms, and consequences and results. CONCLUSION According to the results, shifting from the use of traditional managers to the use of graduates of Health Services Management in the hospital proposed as a change paradigm in the hospital management is accompanied by some reforms in the hospital structures, processes, resources, culture, and performance. Such reforms may lead to some valuable final consequences and results such as increasing patient and staff satisfaction and effectiveness of actions and activities. This hypothesis is recommended to be tested in other similar settings.
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Affiliation(s)
- Peivand Bastani
- Health Human Resources Research Center, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadtaghi Mohammadpour
- Student Research Committee, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jamshid Bahmaei
- Student Research Committee, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Ravangard
- Health Human Resources Research Center, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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20
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Kiptanui Z, Ghosh S, Ali S, Desai K, Harris I. Transparency, health equity, and strategies in state-based protocols for remdesivir allocation and use. PLoS One 2021; 16:e0257648. [PMID: 34662359 PMCID: PMC8523064 DOI: 10.1371/journal.pone.0257648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background The Emergency Use Authorization (EUA) of remdesivir for coronavirus disease 2019 raised questions on transparency of applied strategy, and how to equitably allocate and prioritize eligible patients given limited supply of the medication. The absence of federal oversight highlighted the critical role by states in health policymaking during a pandemic. Objective To identify public state-based protocols for remdesivir allocation and clinical guidance for prioritizing remdesivir use and assess approaches and inclusion of language promoting equitable access or mitigating health disparities. Methods We identified remdesivir allocation strategies and clinical use guidelines for all 50 states in the U.S. and the District of Columbia accessible on state health department websites or via internet searches. Public protocols dated between May 1, 2020 and September 30, 2020 were included in the study. We reviewed strategies for allocation and clinical use, including whether protocols contained explicit language on equitable access to remdesivir or mitigating health disparities. Results A total of 38 states had a remdesivir allocation strategy, with 33 states (87%) making these public. States used diverse allocation strategies, and only 10 (30%) of the 33 states included language on equitable allocation. A total of 30 states had remdesivir clinical use guidelines, where all were publicly accessible. All guidelines referenced recommendations by federal agencies but varied in their presentation format. Of the 30 states, 12 (40%) had guidelines that included language on equitable use. Neither an allocation strategy or clinical use guideline were identified (public or non-public) for 10 states and the District of Columbia during the study period. Conclusions The experience with the remdesivir EUA presents an opportunity for federal and state governments to develop transparent protocols promoting fair and equal access to treatments for future pandemics.
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Affiliation(s)
- Zippora Kiptanui
- Index Analytics LLC, Catonsville, MD, United States of America
- * E-mail:
| | - Sanchari Ghosh
- IMPAQ International LLC, Columbia, Maryland, United States of America
| | - Sabeen Ali
- IMPAQ International LLC, Columbia, Maryland, United States of America
| | - Karishma Desai
- IMPAQ International LLC, Columbia, Maryland, United States of America
| | - Ilene Harris
- IMPAQ International LLC, Columbia, Maryland, United States of America
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21
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Crous EC, North N. Sleep promotion for hospitalised children: Developing an evidence-based guideline for nurses. Curationis 2021; 44:e1-e10. [PMID: 34636624 PMCID: PMC8603136 DOI: 10.4102/curationis.v44i1.2219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 07/16/2021] [Accepted: 08/15/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Adequate sleep in hospitalised children is important for a variety of physiological and psychological processes associated with growth, development, and recovery from illness and injury. Hospitalisation often prioritises clinical care activities at the expense of age-appropriate sleep. Nurses and the wider healthcare team contribute to this paradox. However, through conscious practice and partnering with mothers, nurses are able to enact change and promote sleep. OBJECTIVES To adopt, adapt or contextualise existing guidelines to develop an evidence-based practice guideline to promote sleep-friendly ward environments and routines facilitated by nurses, and in partnership with mothers. METHOD A six-step methodology for guideline adaptation was followed, as recommended by the South African Guidelines Excellence project: (1) existing guidelines and protocols were identified and (2) appraised using the AGREE II instrument; (3) an evidence base was developed; (4) recommendations were modified, (5) assigned levels of evidence and grades of recommendation; and (6) end user guidance was developed. Expert consultation was sought throughout. RESULTS Existing relevant guidance comprised 61 adult-centric recommendations. Modification of the evidence base led to six composited recommendations that facilitate sleep in hospitalised children: (1) prioritising patient safety; (2) collaborating with the mother or caregiver to promote sleep; (3) coordinating ward routine and (4) environment to improve sleep; (5) work with clinical and non-clinical staff; and (6) performing basic sleep assessments. Practice recommendations were aligned to the South African regulatory framework for nursing. CONCLUSION Hospitalisation is a time of physiological and psychological dysregulation for children, which is amplified by poor sleep in a hospital. Nurses have the opportunity to promote sleep during hospitalisation by implementing this African-centric guideline in partnership with mothers.
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Affiliation(s)
- Elijeshca C Crous
- The Harry Crossley Children's Nursing Development Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town.
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22
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Jeong SH, Kim Y, Lyu AR, Shin SA, Kim TH, Huh YH, Je AR, Gajibhiye A, Yu Y, Jin Y, Park MJ, Park YH. Junctional Modulation of Round Window Membrane Enhances Dexamethasone Uptake into the Inner Ear and Recovery after NIHL. Int J Mol Sci 2021; 22:ijms221810061. [PMID: 34576224 PMCID: PMC8464844 DOI: 10.3390/ijms221810061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022] Open
Abstract
Delivery of substances into the inner ear via local routes is increasingly being used in clinical treatment. Studies have focused on methods to increase permeability through the round window membrane (RWM) and enhance drug diffusion into the inner ear. However, the clinical applications of those methods have been unclear and few studies have investigated the efficacy of methods in an inner ear injury model. Here, we employed the medium chain fatty acid caprate, a biologically safe, clinically applicable substance, to modulate tight junctions of the RWM. Intratympanic treatment of sodium caprate (SC) induced transient, but wider, gaps in intercellular spaces of the RWM epithelial layer and enhanced the perilymph and cochlear concentrations/uptake of dexamethasone. Importantly, dexamethasone co-administered with SC led to significantly more rapid recovery from noise-induced hearing loss at 4 and 8 kHz, compared with the dexamethasone-only group. Taken together, our data indicate that junctional modulation of the RWM by SC enhances dexamethasone uptake into the inner ear, thereby hastening the recovery of hearing sensitivity after noise trauma.
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Affiliation(s)
- Seong-Hun Jeong
- Department of Medical Science, Chungnam National University, Daejeon 35015, Korea; (S.-H.J.); (A.-R.L.); (A.G.)
| | - Yoonjoong Kim
- Department of Otolaryngology—Head and Neck Surgery, Chungbuk National University Hospital, Cheongju 28644, Korea;
| | - Ah-Ra Lyu
- Department of Medical Science, Chungnam National University, Daejeon 35015, Korea; (S.-H.J.); (A.-R.L.); (A.G.)
- Department of Otolaryngology—Head and Neck Surgery, Chungnam National University, Daejeon 35015, Korea; (S.-A.S.); (Y.Y.)
| | - Sun-Ae Shin
- Department of Otolaryngology—Head and Neck Surgery, Chungnam National University, Daejeon 35015, Korea; (S.-A.S.); (Y.Y.)
- Brain Research Institute, College of Medicine, Chungnam National University, Daejeon 35015, Korea
| | - Tae Hwan Kim
- Biomedical Research Institute, Chungnam National University Hospital, Daejeon 35015, Korea;
| | - Yang Hoon Huh
- Electron Microscopy Research Center, Korea Basic Science Institute, Cheongju 28116, Korea; (Y.H.H.); (A.R.J.)
| | - A Reum Je
- Electron Microscopy Research Center, Korea Basic Science Institute, Cheongju 28116, Korea; (Y.H.H.); (A.R.J.)
| | - Akanksha Gajibhiye
- Department of Medical Science, Chungnam National University, Daejeon 35015, Korea; (S.-H.J.); (A.-R.L.); (A.G.)
| | - Yang Yu
- Department of Otolaryngology—Head and Neck Surgery, Chungnam National University, Daejeon 35015, Korea; (S.-A.S.); (Y.Y.)
| | - Yongde Jin
- Department of Otolaryngology—Head and Neck Surgery, Yanbian University Hospital, Yanji 133000, China;
| | - Min Jung Park
- Department of Otolaryngology—Head and Neck Surgery, Chungnam National University, Daejeon 35015, Korea; (S.-A.S.); (Y.Y.)
- Brain Research Institute, College of Medicine, Chungnam National University, Daejeon 35015, Korea
- Correspondence: (M.J.P.); (Y.-H.P.)
| | - Yong-Ho Park
- Department of Medical Science, Chungnam National University, Daejeon 35015, Korea; (S.-H.J.); (A.-R.L.); (A.G.)
- Department of Otolaryngology—Head and Neck Surgery, Chungnam National University, Daejeon 35015, Korea; (S.-A.S.); (Y.Y.)
- Brain Research Institute, College of Medicine, Chungnam National University, Daejeon 35015, Korea
- Biomedical Research Institute, Chungnam National University Hospital, Daejeon 35015, Korea;
- Correspondence: (M.J.P.); (Y.-H.P.)
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23
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Heerschap C, Butt B. Algorithmic approaches to ostomy management: An integrative review. Nurs Open 2021; 8:2912-2921. [PMID: 34467661 PMCID: PMC8510707 DOI: 10.1002/nop2.1044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/23/2021] [Accepted: 08/09/2021] [Indexed: 12/02/2022] Open
Abstract
Objective The aim of this review is to describe approaches to ostomy management utilizing algorithmic approaches found within the literature. Design An integrative review approach was used based on a modified Cooper's five‐stage research review framework. Data Sources Systematic searches occurred using the CINAHL and MEDLINE databases searching for peer‐reviewed, English publications. Review Methods There were 640 articles identified through the review process, 608 of which were excluded based on title and abstract review. The remaining 12 articles were assessed in full text after which two studies were removed as duplicates and six studies were excluded based on inclusion/exclusion criteria. Four studies were included in this synthesis. Studies were critically analysed using a critical appraisal tool developed for both qualitative and quantitative study assessments. Results Utilizing inductive content analysis, included literature was presented within two categories: validation of ostomy algorithms and implementation of ostomy algorithms in practice. Four themes emerged from these categories including the following: algorithm validation, identifying underlying causes, focus on accessories and large‐scale implementation. Conclusion No currently available validated algorithms published in full were found during this literature review. Current literature demonstrates the potential benefit for ostomy management algorithms to standardize and improve ostomy patient care. Impact This study sought to determine the availability and supporting research of ostomy management algorithms which may assist in standardizing and improving ostomy care. This review has demonstrated a lack of available ostomy management algorithms. Given the potential benefit of ostomy algorithms identified within the literature, further studies should be completed to develop, validate and test new ostomy management algorithms.
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Affiliation(s)
- Corey Heerschap
- Royal Victoria Regional Health Centre, Barrie, ON, Canada.,School of Nursing, Queens University, Kingston, ON, Canada
| | - Britney Butt
- North York General Hospital, Toronto, ON, Canada
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24
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The Quality of Six Clinical Practice Guidelines in Health and Social Sciences: Are We on the Right Track? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:821-829. [PMID: 33866456 DOI: 10.1007/s10488-021-01132-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
Interest in the development and promotion of clinical practice guidelines (CPGs) continues to grow in many professions. However, the potential benefits associated with CPGs are dependent upon their quality. A number of studies have shown that the quality of CPGs varies greatly. Furthermore, the quality of many of the CPGs used in health and social sciences has yet to be examined. In light of this, the aim of this study was to examine the quality of CPGs that focus on intervention and care management in mental health in Quebec. A search of Quebec regulatory bodies websites was conducted and six CPGs were included in this study. The CPGs were assessed by four trained raters using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Items scores and domains scores were considered to determine the quality of the six CPGs. Results show that many of the CPGs did not achieve minimum ratings for numerous quality checks. Notably, none of the CPGs were designed using a rigorous methodology, they lacked transparency throughout the development process and insufficient consideration was given to the applicability of the recommendations they included. Because these shortcomings may hinder the efficacy and utilization of CPGs, suggestions to improve the development of CPGs and to improve their quality are discussed.
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Ciquier G, Azzi M, Hébert C, Watkins-Martin K, Drapeau M. Assessing the quality of seven clinical practice guidelines from four professional regulatory bodies in Quebec: What's the verdict? J Eval Clin Pract 2021; 27:25-33. [PMID: 32083781 DOI: 10.1111/jep.13374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Clinical practice guidelines (CPGs) have become a common feature in the health and social care fields, as they promote evidence-based practice and aim to improve quality of care and patient outcome. However, the benefits of the recommendations reported in CPGs are only as good as the quality of the CPGs themselves. Indeed, rigorous development and strategies for reporting are significant precursors to successful implementation of the recommendations that are proposed. Unfortunately, research has demonstrated that there is much variability in their level of quality. Furthermore, the quality of many CPGs has yet to be examined. The aim of the present study was to assess the quality of seven CPGs from four Quebec professional regulatory bodies pertaining to clinical evaluations in the fields of medicine, psychoeducation, psychotherapy, and social work. METHODS The seven Quebec CPGs were assessed by four trained appraisers using the Appraisal of Guidelines for Research and Evaluation II guideline evaluation tool. RESULTS Results suggest that while some quality criteria were met, most were not, denoting that these CPGs are of sub-optimal quality. CONCLUSION Our findings highlight that there is still a lot to be done in order to improve the rigour and transparency with which scientific evidence is assessed and applied when developing CPGs. Impacts regarding the implementation of these CPGs are discussed in light of their use in clinical practice.
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Affiliation(s)
- Gabrielle Ciquier
- Department of Counselling Psychology, McGill University, Montreal, Canada
| | - Michelle Azzi
- Department of Counselling Psychology, McGill University, Montreal, Canada
| | - Catherine Hébert
- Department of Counselling Psychology, McGill University, Montreal, Canada
| | - Kia Watkins-Martin
- Department of Counselling Psychology, McGill University, Montreal, Canada
| | - Martin Drapeau
- Department of Counselling Psychology, McGill University, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
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Schmalbach CE, Brereton J, Bowman C, Denneny JC. American Academy of Otolaryngology-Head and Neck Surgery/Foundation Reg-ent Registry: Purpose, Properties, and Priorities. Otolaryngol Head Neck Surg 2021; 164:964-971. [PMID: 33433257 DOI: 10.1177/0194599820984135] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE (1) To describe the patient and membership cohort captured by the otolaryngology-based specialty-specific Reg-ent registry. (2) To outline the capabilities of the Reg-ent registry, including the process by which members can access evidence-based data to address knowledge gaps identified by the American Academy of Otolaryngology-Head and Neck Surgery/Foundation and ultimately define "quality" for our field of otolaryngology-head and neck surgery. METHODS Data analytics was performed on Reg-ent (2015-2020). RESULTS A total of 1629 participants from 239 practices were enrolled in Reg-ent, and 42 health care specialties were represented. Reg-ent encompassed 6,496,477 unique patients and 24,296,713 encounters/visits: the 45- to 64-year age group had the highest representation (n = 1,597,618, 28.1%); 3,867,835 (60.3%) patients identified as Caucasian; and "private" was the most common insurance (33%), followed by Blue Cross/Blue Shield (22%). Allergic rhinitis-unspecified and sensorineural hearing loss-bilateral were the top 2 diagnoses (9% each). Overall, 302 research gaps were identified from 17 clinical practice guidelines. DISCUSSION Reg-ent benefits are vast-from monitoring one's practice to defining otolaryngology-head and neck surgery quality, participating in advocacy, and conducting research. Reg-ent provides mechanisms for benchmarking, quality assessment, and performance measure development, with the objective of defining and guiding best practice in otolaryngology-head and neck surgery. To be successful, patient diversity must be achieved to include ethnicity and socioeconomic status. Increasing academic medical center membership will assist in achieving diversity so that the quality domain of equitable care is achieved. IMPLICATIONS FOR PRACTICE Reg-ent provides the first ever registry that is specific to otolaryngology-head and neck surgery and compliant with HIPAA (Health Insurance Portability and Accountability Act) to collect patient outcomes and define evidence-based quality care.
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Affiliation(s)
- Cecelia E Schmalbach
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Jean Brereton
- American Academy of Otolaryngology-Head and Neck Surgery/ Foundation, Alexandria, Virginia, USA
| | - Cathlin Bowman
- American Academy of Otolaryngology-Head and Neck Surgery/ Foundation, Alexandria, Virginia, USA
| | - James C Denneny
- American Academy of Otolaryngology-Head and Neck Surgery/ Foundation, Alexandria, Virginia, USA
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Silva MFD, Rocha PK, Echevarria-Guanilo ME, Bertoncello KCG, Souza SD, Schneider KLK. CONSTRUCTION OF THE INSTRUMENT FOR CARE TRANSITION IN PEDIATRIC UNITS. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2018-0206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to build and semantically validate a safe communication tool to systematize care transition in pediatric clinical and emergency units. Method: a methodological study, based on the Classic Theory of Psychometric Tests and on the Instrument Development Model, proposed by Pasquali, which included seven professionals, five nurses and two physicians, experts in pediatrics and/or patient safety, who followed specific criteria for inclusion. Data collection was carried out between November and December 2016 and took place with the application of a form made available to the experts via the Google Drive/Microsoft® tool in two validation rounds, conducted by the Delphi Technique, being organized into two domains with 19 items. Data analysis was performed by calculating the Content Validity Index. Results: in order to validate the content, it was necessary to reach a Content Validity Index ≥ 0.80; thus, in the first round, five items underwent changes and were adjusted according to the experts' recommendations. These were validated in the second round, maintaining two domains and nineteen items. Conclusion: the construction and content validation of the instrument can enhance and qualify the clinical practice and contribute to minimize failures in pediatric patient safety associated with effective communication.
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Benski C, Di Filippo D, Taraschi G, Reich MR. Guidelines for Pregnancy Management During the COVID-19 Pandemic: A Public Health Conundrum. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218277. [PMID: 33182412 PMCID: PMC7664946 DOI: 10.3390/ijerph17218277] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 12/16/2022]
Abstract
Pregnant women seem to be at risk for developing complications from COVID-19. Given the limited knowledge about the impact of COVID-19 on pregnancy, management guidelines are fundamental. Our aim was to examine the obstetrics guidelines released from December 2019 to April 2020 to compare their recommendations and to assess how useful they could be to maternal health workers. We reviewed 11 guidelines on obstetrics management, assessing four domains: (1) timeliness: the time between the declaration of pandemics by WHO and a guideline release and update; (2) accessibility: the readiness to access a guideline by searching it on a common browser; (3) completeness: the amount of foundational topics covered; and (4) consistency: the agreement among different guidelines. In terms of timeliness, the Royal College of Obstetricians and Gynaecologists (RCOG) was the first organization to release their recommendation. Only four guidelines were accessible with one click, while only 6/11 guidelines covered more than 80% of the 30 foundational topics we identified. For consistency, the study highlights the existence of 10 points of conflict among the recommendations. The present research revealed a lack of uniformity and consistency, resulting in potentially challenging decisions for healthcare providers.
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Affiliation(s)
- Caroline Benski
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Department of Obstetrics and Gynecology, Geneva University Hospital, 1205 Geneva, Switzerland;
- Correspondence: ; Tel.: +41-(7)-8739-7261
| | - Daria Di Filippo
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW 2031, Australia;
| | - Gianmarco Taraschi
- Department of Obstetrics and Gynecology, Geneva University Hospital, 1205 Geneva, Switzerland;
| | - Michael R. Reich
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
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Salem A, Elamir H, Alfoudri H, Shamsah M, Abdelraheem S, Abdo I, Galal M, Ali L. Improving management of hospitalised patients with COVID-19: algorithms and tools for implementation and measurement. BMJ Open Qual 2020; 9:e001130. [PMID: 33199287 PMCID: PMC7670554 DOI: 10.1136/bmjoq-2020-001130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/12/2020] [Accepted: 11/08/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic represents an unprecedented challenge to healthcare systems and nations across the world. Particularly challenging are the lack of agreed-upon management guidelines and variations in practice. Our hospital is a large, secondary-care government hospital in Kuwait, which has increased its capacity by approximately 28% to manage the care of patients with COVID-19. The surge in capacity has necessitated the redeployment of staff who are not well-trained to manage such conditions. There was a great need to develop a tool to help redeployed staff in decision-making for patients with COVID-19, a tool which could also be used for training. METHODS Based on the best available clinical knowledge and best practices, an eight member multidisciplinary group of clinical and quality experts undertook the development of a clinical algorithm-based toolkit to guide training and practice for the management of patients with COVID-19. The team followed Horabin and Lewis' seven-step approach in developing the algorithms and a five-step method in writing them. Moreover, we applied Rosenfeld et al's five points to each algorithm. RESULTS A set of seven clinical algorithms and one illustrative layout diagram were developed. The algorithms were augmented with documentation forms, data-collection online forms and spreadsheets and an indicators' reference sheet to guide implementation and performance measurement. The final version underwent several revisions and amendments prior to approval. CONCLUSIONS A large volume of published literature on the topic of COVID-19 pandemic was translated into a user-friendly, algorithm-based toolkit for the management of patients with COVID-19. This toolkit can be used for training and decision-making to improve the quality of care provided to patients with COVID-19.
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Affiliation(s)
- Ahmed Salem
- Anaesthesia and Intensive Care Department, Sabah Al Ahmad Urology Centre, Ministry of Health, Sabah, Kuwait
- Anaesthesia and Intensive Care Department, Faculty of Medicine, Banha University, Benha, Egypt
| | - Hossam Elamir
- Quality and Accreditation Directorate, Ministry of Health, Safat, Kuwait
| | - Huda Alfoudri
- Anaesthesia, Critical Care and Pain Management Department, Adan Hospital, Ministry of Health, Hadiya, Kuwait
| | - Mohammed Shamsah
- Anaesthesia, Critical Care and Pain Management Department, Adan Hospital, Ministry of Health, Hadiya, Kuwait
| | - Shams Abdelraheem
- Critical Care Department, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Ibtissam Abdo
- Quality and Accreditation Directorate, Ministry of Health, Safat, Kuwait
| | - Mohammad Galal
- Quality and Accreditation Directorate, Ministry of Health, Safat, Kuwait
| | - Lamiaa Ali
- Quality and Accreditation Directorate, Ministry of Health, Safat, Kuwait
- Public Health Department, Fayoum University Faculty of Medicine, Fayoum, Egypt
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Chakraborty S, Brijnath B, Dermentzis J, Mazza D. Defining key questions for clinical practice guidelines: a novel approach for developing clinically relevant questions. Health Res Policy Syst 2020; 18:113. [PMID: 32993665 PMCID: PMC7523054 DOI: 10.1186/s12961-020-00628-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/04/2020] [Indexed: 12/12/2022] Open
Abstract
Background There is no standardised protocol for developing clinically relevant guideline questions. We aimed to create such a protocol and to apply it to developing a new guideline. Methods We reviewed international guideline manuals and, through consensus, combined steps for developing clinical questions to produce a best-practice protocol that incorporated qualitative research. The protocol was applied to develop clinical questions for a guideline for general practitioners. Results A best-practice protocol incorporating qualitative research was created. Using the protocol, we developed 10 clinical questions that spanned diagnosis, management and follow-up. Conclusions Guideline developers can apply this protocol to develop clinically relevant guideline questions.
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Affiliation(s)
- Samantha Chakraborty
- Department of General Practice, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Victoria, 3150, Australia.
| | - Bianca Brijnath
- Department of General Practice, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Victoria, 3150, Australia.,National Ageing Research Institute Ltd, Parkville, Australia
| | - Jacinta Dermentzis
- Department of General Practice, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Victoria, 3150, Australia
| | - Danielle Mazza
- Department of General Practice, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Victoria, 3150, Australia
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Sethi N, Singh S, Kaur J, Raghukumar S, Ramchandani C, Dharmana S, Balani K, Jain H, Khoja M, Singhal S. Consensus Guidelines on Opening Up of Aesthetic Practices in India During the COVID-19 Era. Clin Cosmet Investig Dermatol 2020; 13:661-669. [PMID: 32982359 PMCID: PMC7490074 DOI: 10.2147/ccid.s267528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/12/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The COVID-19 is a pandemic which has affected most people directly or indirectly. It being a communicable disease, the best way to control the disease is to prevent its spread. Lockdown in India has resulted in aesthetic practices all over the country being shut down indefinitely. As things return to normal, most aesthetic practitioners are looking forward to opening practices. Hence, there was a definite need for a consensus on how to safely open up practices in India and at the same time reassure patients coming into these clinics that their safety is paramount. METHODS This consensus guidelines use the PICO model in its structure. Five critical areas for opening up clinical establishments were identified and approached independently. A questionnaire was prepared using the modified Likert scale, and all the stakeholders were asked to answer the same. Any differences were then resolved with discussion among the stakeholders. The entire study was divided into five subgroups which were then analyzed in detail. RESULTS Key recommendations and consensus guidelines were made after detailed analysis. Handy flow diagram reviews of these key areas have been provided. A thorough review of literature was also done on each of the critical areas and recommendations incorporated wherever feasible. CONCLUSION These recommendations have considered the difficulties and cultural issues faced by aesthetic practices in India. They are user friendly, easy to understand and implement. These guidelines would help in reassuring practices to open up safely and continue serving patients with utmost care. LEVEL OF EVIDENCE Level V, Consensus guidelines.
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Affiliation(s)
- Nitin Sethi
- Plastic & Cosmetic Surgery, Fortis Hospital, Ludhiana, Punjab141001, India
| | - Sukhbir Singh
- Resplendent the Cosmetic Studio, New Delhi110048, India
| | - Jasleen Kaur
- Department of Dermatology, SGRDIMS & R, Amritsar, India
| | | | | | | | | | - Hema Jain
- Health and Harmony Clinic, Pune, India
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Appropriate extent of surgery for aspirin-exacerbated respiratory disease. World J Otorhinolaryngol Head Neck Surg 2020; 6:235-240. [PMID: 33336179 PMCID: PMC7729211 DOI: 10.1016/j.wjorl.2020.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/19/2020] [Accepted: 07/24/2020] [Indexed: 11/20/2022] Open
Abstract
The current literature lacks strong guidelines regarding surgical management of patients with aspirin-exacerbated respiratory disease (AERD), who present with the clinical triad of chronic rhinosinusitis with nasal polyposis (CRSwNP), bronchial asthma, and aspirin/nonsteroidal anti-inflammatory drug intolerance. To further define the effectiveness of sinus surgery in treating AERD patients, this review article discusses current evidence regarding outcomes associated with more extensive surgery, the benefits of frontal sinus surgery on polyposis, and the role of Draf III intervention. Numerous studies suggest that Draf III frontal sinusotomy may be an efficacious early intervention due to increased neo-ostial patency and subsequent distribution of topical therapies. Future studies that further investigate the efficacy and safety of extensive surgery in AERD patients are warranted.
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Aran G, Hicks C, Demand A, Johnson AL, Beaman J, Bailey Y, Haught M, Lane A, Sinnett P, Vassar M. Treating schizophrenia: the quality of evidence behind treatment recommendations and how it can improve. BMJ Evid Based Med 2020; 25:138-142. [PMID: 31672699 DOI: 10.1136/bmjebm-2019-111233] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To assess the methodological and reporting quality of systematic reviews that comprise the American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Schizophrenia and to determine the extent to which results from Cochrane systematic reviews published after guideline development would alter or confirm current recommendations. PARTICIPANTS Systematic reviews that underpinned recommendations in the APA guidelines and Cochrane systematic reviews. MAIN OUTCOME Three independent reviewers scored all systematic reviews referenced in the guideline for quality and reporting using AMSTAR and PRISMA checklist, respectively. Items in both tools were individually graded and compared to identify consistently low-performing areas within the systematic reviews. Post hoc analysis of the Cochrane systematic reviews since the latest revision of APA's guidelines were performed to determine whether their findings were congruent with recent recommendations. RESULTS The mean score of the 57 reviews on the PRISMA checklist was 70%. The mean AMSTAR score was 6.8, correlating with a moderate quality score. Post hoc analysis revealed that 171 Cochrane reviews had been published since the APA guideline release. Only half of the reviews of pharmacological interventions confirmed current recommendations. CONCLUSIONS AND RELEVANCE The methodological quality of the systematic reviews included in the APA guideline was deficient in key areas. Our study brings to light the importance of using high-quality evidence in the development of clinical practice guidelines. An updated APA guideline (last updated in 2009) is necessary to provide the highest quality treatment recommendations for clinicians in the management of schizophrenia. TRIAL REGISTRATION NUMBER UMIN-CTR, UMIN000023099.
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Affiliation(s)
- Greg Aran
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
- Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Chandler Hicks
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
- Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Alexander Demand
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
- Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Austin L Johnson
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Jason Beaman
- Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
- Department of Psychiatry, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Yakiji Bailey
- Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Melissa Haught
- Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Aaron Lane
- Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Philip Sinnett
- Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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Turton L, Souza P, Thibodeau L, Hickson L, Gifford R, Bird J, Stropahl M, Gailey L, Fulton B, Scarinci N, Ekberg K, Timmer B. Guidelines for Best Practice in the Audiological Management of Adults with Severe and Profound Hearing Loss. Semin Hear 2020; 41:141-246. [PMID: 33364673 PMCID: PMC7744249 DOI: 10.1055/s-0040-1714744] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Individuals with severe to profound hearing loss are likely to present with complex listening needs that require evidence-based solutions. This document is intended to inform the practice of hearing care professionals who are involved in the audiological management of adults with a severe to profound degree of hearing loss and will highlight the special considerations and practices required to optimize outcomes for these individuals.
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Affiliation(s)
- Laura Turton
- Department of Audiology, South Warwickshire NHS Foundation Trust, Warwick, United Kingdom
| | - Pamela Souza
- Communication Sciences and Disorders and Knowles Hearing Center, Northwestern University, Evanston, Illinois
| | - Linda Thibodeau
- University of Texas at Dallas, Callier Center for Communication Disorders, Dallas, Texas
| | - Louise Hickson
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - René Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Judith Bird
- Cambridge University Hospital NHS Foundation Trust, United Kingdom
| | - Maren Stropahl
- Department of Science and Technology, Sonova AG, Stäfa, Switzerland
| | | | | | - Nerina Scarinci
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Katie Ekberg
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Barbra Timmer
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
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Hura N, Xie DX, Choby GW, Schlosser RJ, Orlov CP, Seal SM, Rowan NR. Treatment of post-viral olfactory dysfunction: an evidence-based review with recommendations. Int Forum Allergy Rhinol 2020; 10:1065-1086. [PMID: 32567798 PMCID: PMC7361320 DOI: 10.1002/alr.22624] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 12/29/2022]
Abstract
Background Post‐viral olfactory dysfunction (PVOD) is one of the most common causes of olfactory loss. Despite its prevalence, optimal treatment strategies remain unclear. This article provides a comprehensive review of PVOD treatment options and provides evidence‐based recommendations for their use. Methods A systematic review of the Medline, Embase, Cochrane, Web of Science, Scopus, and Google Scholar databases was completed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Studies with defined olfactory outcomes of patients treated for PVOD following medical, surgical, acupuncture, or olfactory training interventions were included. The Clinical Practice Guideline Development Manual and Conference on Guideline Standardization (COGS) instrument recommendations were followed in accordance with a previously described, rigorous, iterative process to create an evidence‐based review with recommendations. Results From 552 initial candidate articles, 36 studies with data for 2183 patients with PVOD were ultimately included. The most common method to assess olfactory outcomes was Sniffin’ Sticks. Broad treatment categories included: olfactory training, systemic steroids, topical therapies, a variety of heterogeneous non‐steroidal oral medications, and acupuncture. Conclusion Based on the available evidence, olfactory training is a recommendation for the treatment of PVOD. The use of short‐term systemic and/or topical steroids is an option in select patients after careful consideration of potential risks of oral steroids. Though some pharmacological investigations offer promising preliminary results for systemic and topical medications alike, a paucity of high‐quality studies limits the ability to make meaningful evidence‐based recommendations for the use of these therapies for the treatment of PVOD.
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Affiliation(s)
- Nanki Hura
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Deborah X Xie
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Garret W Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic College of Medicine, Rochester, MN
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Cinthia P Orlov
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stella M Seal
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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Westerlund A, Ivarsson A, Richter-Sundberg L. Evidence-based practice in child and adolescent mental health services - The challenge of implementing national guidelines for treatment of depression and anxiety. Scand J Caring Sci 2020; 35:476-484. [PMID: 32323362 DOI: 10.1111/scs.12859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 03/22/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mental health problems are one of the most pressing public health concerns of our time. Sweden has seen a sharp increase in mental disorders among children and youth during the last decade. The evidence base for treatment of psychiatric conditions has developed strongly. Clinical practice guidelines aim to compile such evidence and support healthcare professionals in evidence-based clinical decision-making. In Sweden, the national guidelines for the treatment of depression and anxiety disorders in children and adolescents were launched in 2010. The aim of this study was two folded, (i) to explore to what extent these guidelines were known and adhered to by health professionals in Child and Adolescent Mental Health Services and (ii) to investigate factors influencing implementation of the guidelines informed by the Consolidated Framework for Implementation Research. METHODS A qualitative approach was used, and data were collected through interviews with 18 health professionals in Child Mental Health Services in Sweden and a combination of conventional and directed content analyses was used. The Consolidated Framework for Implementation Research guided and structured data collection and analysis. RESULTS The guidelines were largely unknown by health professionals in Child Mental Health Services in all the clinics investigated. Adherence to guideline recommendations was reported as very low. Barriers to implementation were found in relation to the characteristics of the intervention, outer setting, inner setting and characteristics of the individuals involved. CONCLUSIONS The government initiative to develop and disseminate the guidelines seems to have made very little impact on health professionals' clinical practice. The guidelines were poorly aligned with the health professionals' knowledge and beliefs about effective mental health services for children and youth with depression and anxiety disorders. Suggestions for future efforts to improve the development and implementation of guidelines in Child Mental Health Services settings are given.
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Affiliation(s)
- Anna Westerlund
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Linda Richter-Sundberg
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Department of Clinical Science, Unit of Child and Adolescent Psychiatry, Umeå University, Umeå, Sweden
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Mansfield E, Noble N, Sanson-Fisher R, Mazza D, Bryant J. Primary Care Physicians' Perceived Barriers to Optimal Dementia Care: A Systematic Review. THE GERONTOLOGIST 2020; 59:e697-e708. [PMID: 29939234 DOI: 10.1093/geront/gny067] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Primary care physicians (PCPs) have a key role in providing care for people with dementia and their carers, however, a range of barriers prevent them from delivering optimal care. We reviewed studies on PCPs' perceptions of barriers to providing optimal dementia care, including their methodological quality, whether they focused on barriers related to diagnosis and/or management, and the patient-, provider-, and system-level barriers identified. RESEARCH DESIGN AND METHODS Studies were included if they were quantitative studies published since 2006 which reported on PCPs' perceptions of the barriers to providing dementia care. The methodological quality of identified studies was assessed using an adapted version of accepted rating criteria for quantitative studies. Data were extracted from studies which were rated as "moderate" or "strong" quality. RESULTS A total of 20 studies were identified, 16 of which were rated as "moderate" or "strong" methodological quality. Patient-related barriers included a reluctance to acknowledge cognitive decline and patient nonadherence to management plans. Provider-related barriers included a lack of training and confidence. System-related barriers included a lack of time during consultations and lack of support services. DISCUSSION AND IMPLICATIONS This review highlights a range of barriers to dementia diagnosis and management from studies rated as being methodologically adequate. Future studies should also utilize theory-driven approaches to exploring a comprehensive range of barriers to optimal dementia care across the care trajectory.
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Affiliation(s)
- Elise Mansfield
- Health Behaviour Research Collaborative, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Natasha Noble
- Health Behaviour Research Collaborative, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Danielle Mazza
- Department of General Practice, Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jamie Bryant
- Health Behaviour Research Collaborative, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
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Howard B, Chapman C, Meyer C, Walters C, Vassar M. Analysis of completeness of reporting utilizing the Reporting Items for practice Guidelines in Healthcare Statement in gastroenterology clinical practice guidelines. INT J EVID-BASED HEA 2020; 17:173-178. [PMID: 31246697 DOI: 10.1097/xeb.0000000000000174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM Assessing reporting quality is important as it allows distinctions to be made between poor methodology and poor reporting practices. The Reporting Items for practice Guidelines in Healthcare (RIGHT) Statement checklist was published in 2017 to improve the thoroughness and reporting quality of clinical practice guidelines (CPGs). CPGs are evidence-based recommendations developed to assist clinician decision-making in the diagnosis and management of patients. The aim of this study is to assess the completeness of reporting in CPGs listed by the American College of Gastroenterology (ACG) and their frequency of reporting items listed in the RIGHT Statement. METHODS Using the 22 criteria (35 items) of the RIGHT Statement checklist, two researchers independently documented the adherence to each item for all eligible guidelines listed by the ACG. This study was conducted from 01/10/18 to 05/12/18. Data were recorded onto a prespecified Google data abstraction form and extracted into MS Excel for statistical analysis. RESULTS Out of 38 eligible guidelines, nine of the 35 RIGHT (25.7%) checklist items were met with less than 50% adherence. The mean adherence was 26.8 (SD ± 9.5); median adherence was 30 (interquartile range 21.5-33.5). The publication dates ranged from 2007 to 2017 with seven of the guidelines (18.4%) published between 2007 and 2009, 11 (29%) published between 2010 and 2013, and 20 (52.6%) published between 2014 and 2017. CONCLUSION The completeness of reporting in CPGs listed by the ACG remains inadequate in several key areas. Poor adherence to items of the RIGHT Statement checklist demonstrates that there is area for improvement in reporting quality.
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Affiliation(s)
- Benjamin Howard
- Department of Institutional Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Chris Chapman
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Chase Meyer
- Department of Institutional Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Corbin Walters
- Department of Institutional Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Matt Vassar
- Department of Institutional Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
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El-Harakeh A, Lotfi T, Ahmad A, Morsi RZ, Fadlallah R, Bou-Karroum L, Akl EA. The implementation of prioritization exercises in the development and update of health practice guidelines: A scoping review. PLoS One 2020; 15:e0229249. [PMID: 32196520 PMCID: PMC7083273 DOI: 10.1371/journal.pone.0229249] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/02/2020] [Indexed: 02/07/2023] Open
Abstract
Background The development of trustworthy guidelines requires substantial investment of resources and time. This highlights the need to prioritize topics for guideline development and update. Objective To systematically identify and describe prioritization exercises that have been conducted for the purpose of the de novo development, update or adaptation of health practice guidelines. Methods We searched Medline and CINAHL electronic databases from inception to July 2019, supplemented by hand-searching Google Scholar and the reference lists of relevant studies. We included studies describing prioritization exercises that have been conducted during the de novo development, update or adaptation of guidelines addressing clinical, public health or health systems topics. Two reviewers worked independently and in duplicate to complete study selection and data extraction. We consolidated findings in a semi-quantitative and narrative way. Results Out of 33,339 identified citations, twelve studies met the eligibility criteria. All included studies focused on prioritizing topics; none on questions or outcomes. While three exercises focused on updating guidelines, nine were on de novo development. All included studies addressed clinical topics. We adopted a framework that categorizes prioritization into 11 steps clustered in three phases (pre-prioritization, prioritization and post-prioritization). Four studies covered more than half of the 11 prioritization steps across the three phases. The most frequently reported steps for generating initial list of topics were stakeholders’ input (n = 8) and literature review (n = 7). The application of criteria to determine research priorities was used in eight studies. We used and updated a common framework of 22 prioritization criteria, clustered in 6 domains. The most frequently reported criteria related to the health burden of disease (n = 9) and potential impact of the intervention on health outcomes (n = 5). All the studies involved health care providers in the prioritization exercises. Only one study involved patients. There was a variation in the number and type of the prioritization exercises’ outputs. Conclusions This review included 12 prioritization exercises that addressed different aspects of priority setting for guideline development and update that can guide the work of researchers, funders, and other stakeholders seeking to prioritize guideline topics.
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Affiliation(s)
- Amena El-Harakeh
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Clinical Research Institute (CRI), American University of Beirut Medical Center, Beirut, Lebanon
| | - Tamara Lotfi
- Global Evidence Synthesis Initiative (GESI) Secretariat, American University of Beirut, Beirut, Lebanon
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ali Ahmad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Rami Z. Morsi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Racha Fadlallah
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Lama Bou-Karroum
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Elie A. Akl
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Clinical Research Institute (CRI), American University of Beirut Medical Center, Beirut, Lebanon
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada
- * E-mail:
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Sonis J, Chen OM. Approval processes in evidence-based clinical practice guidelines sponsored by medical specialty societies. PLoS One 2020; 15:e0229004. [PMID: 32050261 PMCID: PMC7015697 DOI: 10.1371/journal.pone.0229004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 01/28/2020] [Indexed: 11/19/2022] Open
Abstract
Objective To determine the approval processes for evidence-based Clinical Practice Guidelines sponsored by medical specialty societies in the United States. Study design and setting Cross-sectional analysis of published Clinical Practice Guidelines and Guideline procedure manuals, sponsored by the 43 members of the Council of Medical Specialty Societies in the United States. Approval processes were measured by written evidence in the specialty society’s guideline procedure manual or published guidelines, through May 2017. Results Among the 36 (of 43) specialty societies that published evidence-based Clinical Practice Guidelines, 27 (75%) required approval by a committee representing the society as a whole. None specified the criteria used for approval decisions. Six specialty societies (17%) required approval but included procedures to maintain some editorial independence for the guideline development group, such as approval by a guideline committee not an executive committee or approval dependent on fidelity to established guideline methodology, not content. One society required Board review, but not approval. The approval process was not reported by 2 (6%) of the specialty societies. Conclusions Most medical specialty societies in the U.S. require approval of guidelines by a board that represents the society as whole. Since medical specialty societies have loyalties to the patients they serve and to their physician members, and because the interests of those two groups may differ, such an approval process introduces a potential conflict of interest into the guideline development process.
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Affiliation(s)
- Jeffrey Sonis
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Olivia M. Chen
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, United States of America
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Lunny C, Salzwedel DM, Liu T, Ramasubbu C, Gerrish S, Puil L, Mintzes B, Wright JM. Validation of five search filters for retrieval of clinical practice guidelines produced low precision. J Clin Epidemiol 2020; 117:109-116. [DOI: 10.1016/j.jclinepi.2019.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/31/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
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Torgerson T, Johnson AL, Jellison S, Tanghetti M, Langley J, Nguyen LHP, Vassar M. Reporting of Clinical Trial Interventions Published in Leading Otolaryngology–Head and Neck Surgery Journals. Laryngoscope 2019; 130:E507-E514. [DOI: 10.1002/lary.28404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/16/2019] [Accepted: 10/24/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Trevor Torgerson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa Oklahoma U.S.A
| | - Austin L. Johnson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa Oklahoma U.S.A
| | - Sam Jellison
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa Oklahoma U.S.A
| | - Margo Tanghetti
- Department of OtolaryngologyOklahoma State University Medical Center Tulsa Oklahoma U.S.A
| | - Jean‐Maria Langley
- Department of OtolaryngologyOklahoma State University Medical Center Tulsa Oklahoma U.S.A
| | - Lily H. P. Nguyen
- Department of Otolaryngology–Head and Neck SurgeryMcGill University Montreal Quebec Canada
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa Oklahoma U.S.A
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El-Harakeh A, Morsi RZ, Fadlallah R, Bou-Karroum L, Lotfi T, Akl EA. Prioritization approaches in the development of health practice guidelines: a systematic review. BMC Health Serv Res 2019; 19:692. [PMID: 31615509 PMCID: PMC6792189 DOI: 10.1186/s12913-019-4567-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/27/2019] [Indexed: 12/20/2022] Open
Abstract
Background Given the considerable efforts and resources required to develop practice guidelines, developers need to prioritize what topics and questions to address. This study aims to identify and describe prioritization approaches in the development of clinical, public health, or health systems guidelines. Methods We searched Medline and CINAHL electronic databases in addition to Google Scholar. We included papers describing prioritization approaches in sufficient detail allowing for reproducibility. We synthesized findings in a semi-quantitative way. We followed an iterative process to develop a common framework of prioritization criteria that captures all of the criteria reported by each included study. Results Our search captured 33,339 unique citations out of which we identified 10 papers reporting prioritization approaches for guideline development. All of the identified approaches focused on prioritizing guideline topics but none on prioritizing recommendation questions or outcomes. The two most frequently reported steps of the development process for these approaches were reviewing the grey literature (9 out of 10, 90%) and engaging various stakeholders (9 out of 10, 90%). We derived a common framework of 20 prioritization criteria that can be used when prioritizing guideline topics. The most frequently reported criteria were the health burden of disease which was included in all of the approaches, practice variation (8 out of 10, 80%), and impact on health outcomes (7 out of 10, 70%). Two of the identified approaches stood out as being comprehensive and detailed. Conclusions We described 10 prioritization approaches in the development of health practice guidelines. There is a need to assess the effectiveness, efficiency and transparency of the identified approaches and to develop standardized and validated priority setting tools.
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Affiliation(s)
- Amena El-Harakeh
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Clinical Research Institute (CRI), American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Z Morsi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Racha Fadlallah
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Lama Bou-Karroum
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Tamara Lotfi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Global Evidence Synthesis Initiative (GESI) Secretariat, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon. .,Clinical Research Institute (CRI), American University of Beirut Medical Center, Beirut, Lebanon. .,Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada. .,Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad-El-Solh Beirut 1107 2020, Beirut, Lebanon.
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Brenner MJ, Chang CWD, Boss EF, Goldman JL, Rosenfeld RM, Schmalbach CE. Patient Safety/Quality Improvement Primer, Part I: What PS/QI Means to Your Otolaryngology Practice. Otolaryngol Head Neck Surg 2019; 159:3-10. [PMID: 29968525 DOI: 10.1177/0194599818779547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patient safety/quality improvement (PS/QI) is the cornerstone of 21st-century health care. Otolaryngology-Head and Neck Surgery is excited to provide a dedicated PS/QI primer. The overarching goal for this PS/QI series is to provide a comprehensive and practical resource that assists readers, authors, and peer reviewers in understanding PS/QI research, its unique methodology, and the associated reporting standards for trustworthy performance measures. The target audience includes resident and fellows, faculty from the private sector and academia, and allied health professionals. This inaugural primer reviews PS/QI background as it relates to otolaryngology practice. It explores the history, goals, and development of performance measurement. In addition, it highlights opportunities for integrating PS/QI into otolaryngology practice. Payers will drive patients to quality care based on outcomes. Otolaryngologists have a responsibility to embrace a culture of PS/QI. In doing so, we will define optimal, quality otolaryngology care through objective data and metrics.
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Affiliation(s)
- Michael J Brenner
- 1 School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Emily F Boss
- 3 School of Medicine Johns Hopkins University, Baltimore, Maryland, USA
| | - Julie L Goldman
- 4 School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | | | - Cecelia E Schmalbach
- 6 Roudebush Veterans Medical Center, School of Medicine, Indiana University, Indianapolis, Indiana, USA
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Horn J, Checketts JX, Jawhar O, Vassar M. Evaluation of Industry Relationships Among Authors of Otolaryngology Clinical Practice Guidelines. JAMA Otolaryngol Head Neck Surg 2019; 144:194-201. [PMID: 29270633 DOI: 10.1001/jamaoto.2017.2741] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Financial relationships between physicians and industry have influence on patient care. Therefore, organizations producing clinical practice guidelines (CPGs) must have policies limiting financial conflicts during guideline development. Objectives To evaluate payments received by physician authors of otolaryngology CPGs, compare disclosure statements for accuracy, and investigate the extent to which the American Academy of Otolaryngology-Head and Neck Surgery complied with standards for guideline development from the Institute of Medicine (IOM). Design, Setting, and Participants This cross-sectional analysis retrieved CPGs from the American Academy of Otolaryngology-Head and Neck Surgery Foundation that were published or revised from January 1, 2013, through December 31, 2015, by 49 authors. Data were retrieved from December 1 through 31, 2016. Industry payments received by authors were extracted using the Centers for Medicare & Medicaid Services Open Payments database. The values and types of these payments were then evaluated and used to determine whether self-reported disclosure statements were accurate and whether guidelines adhered to applicable IOM standards. Main Outcomes and Measures The monetary amounts and types of payments received by physicians who author otolaryngology guidelines and the accuracy of disclosure statements. Results Of the 49 physicians in this sample, 39 (80%) received an industry payment. Twenty-one authors (43%) accepted more than $1000; 12 (24%), more than $10 000; 7 (14%), more than $50 000; and 2 (4%), more than $100 000. Mean (SD) financial payments amounted to $18 431 ($53 459) per physician. Total reimbursement for all authors was $995 282. Disclosure statements disagreed with the Open Payments database for 3 authors, amounting to approximately $20 000 among them. Of the 3 IOM standards assessed, only 1 was consistently enforced. Conclusions and Relevance Some CPG authors failed to fully disclose all financial conflicts of interest, and most guideline development panels and chairpersons had conflicts. In addition, adherence to IOM standards for guideline development was lacking. This study is relevant to CPG panels authoring recommendations, physicians implementing CPGs to guide patient care, and the organizations establishing policies for guideline development.
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Affiliation(s)
- Jarryd Horn
- Currently a medical student at Oklahoma State University Center for Health Sciences, Tulsa
| | - Jake Xavier Checketts
- Currently a medical student at Oklahoma State University Center for Health Sciences, Tulsa
| | - Omar Jawhar
- Currently a medical student at Midwestern University, Phoenix, Arizona
| | - Matt Vassar
- Department of Psychiatry, Oklahoma State University Center for Health Sciences, Tulsa
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Krouse HJ, Reavis CCW, Stachler RJ, Francis DO, O'Connor S. Plain Language Summary: Hoarseness (Dysphonia). Otolaryngol Head Neck Surg 2019; 158:427-431. [PMID: 29494315 DOI: 10.1177/0194599817751137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This plain language summary for patients serves as an overview in explaining hoarseness (dysphonia). The summary applies to patients in all age groups and is based on the 2018 "Clinical Practice Guideline: Hoarseness (Dysphonia) (Update)." The evidence-based guideline includes research to support more effective identification and management of patients with hoarseness (dysphonia). The primary purpose of the guideline is to improve the quality of care for patients with hoarseness (dysphonia) based on current best evidence.
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Affiliation(s)
- Helene J Krouse
- 1 University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | | | - Robert J Stachler
- 3 Stachler ENT, West Bloomfield, Michigan, USA.,4 Wayne State University, Allen Park, Michigan, USA
| | | | - Sarah O'Connor
- 6 American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
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Meyer C, Bowers A, Heavener TE, Checketts JX, Vassar M. From clinical practice guideline development to trial registration: A systematic investigation of research pipeline for inflammatory bowel disease. Indian J Gastroenterol 2019; 38:247-262. [PMID: 31270778 DOI: 10.1007/s12664-019-00965-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/21/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Clinical practice guidelines help practitioners manage patients in an effective and systematic way, and they assist in making evidence-based decisions related to diagnosis and treatment. Each recommendation is ranked based on evidence. The goal of this study is to determine gaps in research for inflammatory bowel diseases (IBD) by using the low-level evidence recommendations. METHODS We extracted low-level evidence recommendations set forth by the American College of Gastroenterology in IBD, ulcerative colitis (UC), and Crohn's disease. ClinicalTrials.gov , the World Health Organization's International Clinical Trials Registry Platform and PubMed were then used to locate studies relevant to the recommendations. RESULTS There were 30 low-level evidence recommendations, and 23 had recent or ongoing studies addressing them. We screened 2938 trials and 4321 published articles, 221 of which addressed low-quality recommendations. There were five recommendations that received the majority of research attention (143/221, 65%). CONCLUSION This study used clinical practice guidelines to help determine areas of needed research in IBD, UC, and Crohn's disease. By searching trial registries and articles indexed on PubMed, we identified the extent to which studies were being conducted to address research gaps. Of the gaps identified, five recommendations received most of the attention. While most of the significant gaps had some recent or ongoing research, our study found several areas where investigation is still needed. Clinical practice guidelines are an effective method to prioritize future research.
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Affiliation(s)
- Chase Meyer
- Center for Health Sciences, Oklahoma State University, 1111 W 17th Street, Tulsa, OK, 74107, USA
| | - Aaron Bowers
- Center for Health Sciences, Oklahoma State University, 1111 W 17th Street, Tulsa, OK, 74107, USA
| | - Trace E Heavener
- Department of Internal Medicine, Baylor Scott and White Medical Center-Temple, 2401 South 31st Street, Temple, TX, 76508, USA.
| | - Jake X Checketts
- Center for Health Sciences, Oklahoma State University, 1111 W 17th Street, Tulsa, OK, 74107, USA
| | - Matt Vassar
- Center for Health Sciences, Oklahoma State University, 1111 W 17th Street, Tulsa, OK, 74107, USA
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Afshari A, De Hert S. Pitfalls of clinical practice guidelines in the era of broken science: Let's raise the standards. Eur J Anaesthesiol 2019; 35:903-906. [PMID: 30376487 DOI: 10.1097/eja.0000000000000892] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Arash Afshari
- From the Department of Paediatric and Obstetric Anaesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (AA) and Department of Anaesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium (SDH)
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Tetreault L, Nater A, Garwood P, Badhiwala JH, Wilson JR, Fehlings MG. Development and Implementation of Clinical Practice Guidelines: An Update and Synthesis of the Literature With a Focus in Application to Spinal Conditions. Global Spine J 2019; 9:53S-64S. [PMID: 31157146 PMCID: PMC6512193 DOI: 10.1177/2192568219831689] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Review. OBJECTIVES The objectives of this review are to (a) summarize the role of clinical practice guidelines (CPGs), (b) outline the methodology involved in formulating CPGs, (c) provide an illustration of these principles using a CPG developed for degenerative cervical myelopathy, and (d) highlight the importance of knowledge translation. METHODS A review of the literature was conducted to summarize current standards in CPG development and implementation. RESULTS CPGs are systematically developed statements intended to affect decisions made by health care providers, policy makers, and patients. The main objectives of CPGs are to synthesize and translate evidence into recommendations, optimize patient outcomes, standardize care, and facilitate shared decision making among physicians, patients, and their caregivers. The main steps involved in the development of CPGs include defining the clinical problem, assembling a multidisciplinary guideline development group and systematic review team, conducting a systematic review of the literature, translating the evidence to recommendations, critically appraising the CPG and updating the document when new studies arise. The final step in developing a CPG is to implement it into clinical practice; this step requires an assessment of the barriers to implementation and the formulation of effective dissemination strategies. CONCLUSION CPGs are an important component in the teaching and practice of medicine and are available for a wide spectrum of diseases. CPGs, however, can only be used to influence clinical practice if the recommendations are informed by a systematic review of the literature and developed using rigorous methodology. The opportunity to transform clinical management of spinal conditions is an attractive outcome of the application of high-quality CPGs.
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Affiliation(s)
- Lindsay Tetreault
- Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- University College Cork, Cork, Ireland
| | - Anick Nater
- Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Jetan H. Badhiwala
- Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Michael G. Fehlings
- Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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Finestone SA, Giordano T, Mitchell RB, Walsh SA, O'Connor SS, Satterfield LM. Plain Language Summary for Patients: Tonsillectomy in Children. Otolaryngol Head Neck Surg 2019; 160:206-212. [PMID: 30921526 DOI: 10.1177/0194599818817758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This plain language summary for patients serves as an overview explaining tonsillectomy in children and to help patients, caregivers, and clinicians in their discussions about the reasons that a tonsillectomy may be needed, management options, and care related to the procedure. This summary applies to patients ages 1 through 18 years and is based on the 2019 "Clinical Practice Guideline: Tonsillectomy in Children (Update)." This evidence-based guideline mainly addresses the need for tonsillectomy based on breathing problems that take place during sleep and repeated sore throats or "tonsillitis." The guideline was developed to identify quality improvement opportunities in managing children under consideration for tonsillectomy and to create clear recommendations for clinicians to use in medical practice.
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Affiliation(s)
- Sandra A Finestone
- 1 Consumers United for Evidence-based Healthcare, Fredericton, New Brunswick, Canada
| | - Terri Giordano
- 2 The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Sandra A Walsh
- 1 Consumers United for Evidence-based Healthcare, Fredericton, New Brunswick, Canada
| | - Sarah S O'Connor
- 4 Department of Research and Quality, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Lisa M Satterfield
- 4 Department of Research and Quality, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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