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Qvist I, Lane DA, Risom SS, Hendriks JM, Højen AA, Johnsen SP, Frost L. Implementation of patient education for patients with atrial fibrillation: nationwide cross-sectional survey and one-year follow-up. Eur J Cardiovasc Nurs 2024; 23:251-257. [PMID: 37490762 DOI: 10.1093/eurjcn/zvad066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 06/14/2023] [Accepted: 07/13/2023] [Indexed: 07/27/2023]
Abstract
AIMS Clinical practice guidelines recommend patient education for patients with atrial fibrillation (AF) as a part of holistic care, however, clinical guidelines lack detailed specification on the content, structure, and delivery of AF education programmes. To examine the implementation of education for patients with AF in Denmark in relation to coverage, organization, and content. METHODS AND RESULTS A cross-sectional survey was conducted from February to May 2021. The survey contained questions on the organization, delivery, and content of education for patients with AF from all 29 AF outpatient hospital sites in Denmark. The survey was conducted by email and telephone. One-year follow-up was done in May 2022 by email. Patient education was provided by healthcare professionals in 16 (55%) hospitals. Nurse workforce issues, management, non-prioritization, and lack of guidance for implementation were reasons for the absence of patient education in 13 (45%) hospitals. The structure of patient education differed in relation to group or individual teaching methods and six different education models were used. Content of the AF disease education was generally similar. At 1-year follow-up, another four hospitals reported offering patient education (69% in total). CONCLUSION Initially, almost half of the hospitals did not provide patient education, but at 1-year follow-up, 69% of hospitals delivered patient education. Patient education was heterogeneous in relation to delivery, frequency, and duration. Future research should address individualized patient education that may demonstrate superiority in relation to quality of life, less hospital admissions, and increased longevity.
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Affiliation(s)
- Ina Qvist
- Department of Medicine, Diagnostic Centre Silkeborg, University Research Clinic for Innovative Patient Pathways, Regional Hospital Central Jutland, Falkevej 1-3, 8600 Silkeborg, Denmark
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, 6 W Derby Street, L7 8TX Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Niels Jernes vej 10, 9220 Aalborg Ø, Denmark
| | - Signe Stelling Risom
- Department of Heart Diseases, Herlev and Gentofte Hospital, Niels Andersensvej 65, 2900 Hellerup, Denmark
- Department of Nursing and Nutrition, Department of Clinical Medicine, University College Copenhagen, University of Copenhagen, Blegdamsvej 3B, 2000 København N, Denmark
| | - Jeroen M Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park (N203), GPO Box 2100, 5001 Adelaide, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, North Terrace, 5005 Adelaide, Australia
| | - Anette Arbjerg Højen
- Aalborg Thrombosis Research Unit, Department of Cardiology, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg S, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Niels Jernes vej 10, 9220 Aalborg Ø, Denmark
| | - Lars Frost
- Department of Medicine, Diagnostic Centre Silkeborg, University Research Clinic for Innovative Patient Pathways, Regional Hospital Central Jutland, Falkevej 1-3, 8600 Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Vennelyst Boulevard 4, 8000 Aarhus C, Denmark
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Man JP, Klopotowska J, Asselbergs FW, Handoko ML, Chamuleau SAJ, Schuuring MJ. Digital Solutions to Optimize Guideline-Directed Medical Therapy Prescriptions in Heart Failure Patients: Current Applications and Future Directions. Curr Heart Fail Rep 2024; 21:147-161. [PMID: 38363516 PMCID: PMC10924030 DOI: 10.1007/s11897-024-00649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
PURPOSEOF REVIEW Guideline-directed medical therapy (GDMT) underuse is common in heart failure (HF) patients. Digital solutions have the potential to support medical professionals to optimize GDMT prescriptions in a growing HF population. We aimed to review current literature on the effectiveness of digital solutions on optimization of GDMT prescriptions in patients with HF. RECENT FINDINGS We report on the efficacy, characteristics of the study, and population of published digital solutions for GDMT optimization. The following digital solutions are discussed: teleconsultation, telemonitoring, cardiac implantable electronic devices, clinical decision support embedded within electronic health records, and multifaceted interventions. Effect of digital solutions is reported in dedicated studies, retrospective studies, or larger studies with another focus that also commented on GDMT use. Overall, we see more studies on digital solutions that report a significant increase in GDMT use. However, there is a large heterogeneity in study design, outcomes used, and populations studied, which hampers comparison of the different digital solutions. Barriers, facilitators, study designs, and future directions are discussed. There remains a need for well-designed evaluation studies to determine safety and effectiveness of digital solutions for GDMT optimization in patients with HF. Based on this review, measuring and controlling vital signs in telemedicine studies should be encouraged, professionals should be actively alerted about suboptimal GDMT, the researchers should consider employing multifaceted digital solutions to optimize effectiveness, and use study designs that fit the unique sociotechnical aspects of digital solutions. Future directions are expected to include artificial intelligence solutions to handle larger datasets and relieve medical professional's workload.
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Affiliation(s)
- Jelle P Man
- Department of Cardiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Joanna Klopotowska
- Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Folkert W Asselbergs
- Institute of Health Informatics, University College London, London, UK
- The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, UK
- Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Mark J Schuuring
- Department of Cardiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Netherlands Heart Institute, Utrecht, The Netherlands.
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Siemens W, Mahler S, Schaefer C, Nothacker M, Piechotta V, Prien P, Schüler S, Schwarz S, Blödt S, Thielemann I, Harder T, Kapp P, Labonté V, Meerpohl JJ, Braun C. [Development of criteria for the prospective assessment of the need for updating guideline recommendations: The AGIL criteria]. Z Evid Fortbild Qual Gesundhwes 2024; 184:7-17. [PMID: 38238131 DOI: 10.1016/j.zefq.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 03/18/2024]
Abstract
BACKGROUND Evidence-based guideline and vaccination recommendations should continuously be updated to appropriately support health care decisions. However, resources for updating guidelines are often limited. The aim of this project was to develop a list of criteria for the prospective assessment of the need for updating individual guideline or vaccination recommendations, which can be applied from the time a guideline or guideline update is finalised. METHODS In this article we describe the development of the AGIL criteria (Assessment of Guidelines for Updating Recommendations). The AGIL criteria were developed by experienced scientists and experts in the field of guideline development in a multi-step process. The five steps included: 1) development of an initial list of criteria by the project team; 2) online survey of guideline experts on the initial version of the criteria list; 3) revision of the criteria list based on the results of the online survey; 4) workshop on the criteria list at the EbM Congress 2023; 5) creation of version 1.0 of the AGIL criteria based on the workshop results. RESULTS The initial list included the following three criteria: 1) relevance of the question 2) availability of new relevant evidence, and 3) impact of potentially new evidence. The response rate of the online survey for fully completed questionnaires was 31.0% (N=195; 630 guideline experts were contacted by email). For 90.3% (n=176) of the respondents, the criteria list included all essential aspects for assessing the need for updating guideline recommendations. More than three quarters of respondents rated the importance of the three criteria as "very important" or "important" (criteria 1-3: 75.3%, 86.1%, 85.2%) and - with the exception of criterion 1 - comprehensibility as "very comprehensible" or "comprehensible" (criteria 1-3: 58.4%, 75.9%, 78.5%). The results of the online survey and the workshop generally confirmed the three criteria with their two sub-questions. The incorporation of all feedback resulted in the AGIL criteria (version 1.0), recapping: 1) relevance of the question regarding a) PICO components and b) other factors, e.g. epidemiological aspects; 2) availability of new evidence a) on health-related benefits and harms and b) on other decision factors, e.g. feasibility, acceptability; 3) impact of new evidence a) on the certainty of evidence on which the recommendation is based and b) on the present recommendation, e.g. STRENGTH OF RECOMMENDATION DISCUSSION The moderate response rate of the online survey may have limited its representativeness. Nevertheless, we consider the response rate to be satisfactory in this research context. The inclusion of many experts in the online survey and the EbM Congress workshop is a strength of the project and supports the quality of the results. CONCLUSIONS The AGIL criteria provide a structured guidance for the prospective assessment of the need for updating individual guideline recommendations and other evidence-based recommendations. The implementation and evaluation of the AGIL criteria 1.0 in a field test is planned.
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Affiliation(s)
- Waldemar Siemens
- Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland; Cochrane Deutschland, Cochrane Deutschland Stiftung, Freiburg, Deutschland.
| | - Sonja Mahler
- Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Corinna Schaefer
- Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin, Deutschland
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Institut für Medizinisches Wissensmanagement (AWMF-IMWi), Marburg, Deutschland
| | | | - Peggy Prien
- Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin, Deutschland
| | - Sabine Schüler
- Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin, Deutschland
| | - Sabine Schwarz
- Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin, Deutschland
| | - Susanne Blödt
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Institut für Medizinisches Wissensmanagement (AWMF-IMWi), Marburg, Deutschland
| | | | | | - Philipp Kapp
- Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Valérie Labonté
- Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland; Cochrane Deutschland, Cochrane Deutschland Stiftung, Freiburg, Deutschland
| | - Joerg J Meerpohl
- Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland; Cochrane Deutschland, Cochrane Deutschland Stiftung, Freiburg, Deutschland
| | - Cordula Braun
- Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland; Cochrane Deutschland, Cochrane Deutschland Stiftung, Freiburg, Deutschland
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Kiel S, Weckmann G, Chenot JF, Stracke S, Spallek J, Angelow A. Referral criteria for chronic kidney disease: implications for disease management and healthcare expenditure-analysis of a population-based sample. BMC Nephrol 2022; 23:225. [PMID: 35751012 PMCID: PMC9229756 DOI: 10.1186/s12882-022-02845-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Clinical practice guidelines recommend specialist referral according to different criteria. The aim was to assess recommended and observed referral rate and health care expenditure according to recommendations from: • Kidney Disease Improving Global Outcomes (KDIGO,2012) • National Institute for Health and Care Excellence (NICE,2014) • German Society of Nephrology/German Society of Internal Medicine (DGfN/DGIM,2015) • German College of General Practitioners and Family Physicians (DEGAM,2019) • Kidney failure risk equation (NICE,2021) Methods Data of the population-based cohort Study of Health in Pomerania were matched with claims data. Proportion of subjects meeting referral criteria and corresponding health care expenditures were calculated and projected to the population of Mecklenburg-Vorpommern. Results Data from 1927 subjects were analysed. Overall proportion of subjects meeting referral criteria ranged from 4.9% (DEGAM) to 8.3% (DGfN/DGIM). The majority of patients eligible for referral were ≥ 60 years. In subjects older than 60 years, differences were even more pronounced, and rates ranged from 9.7% (DEGAM) to 16.5% (DGfN/DGIM). Estimated population level costs varied between €1,432,440 (DEGAM) and €2,386,186 (DGfN/DGIM). From 190 patients with eGFR < 60 ml/min, 15 had a risk of end stage renal disease > 5% within the next 5 years. Conclusions Applying different referral criteria results in different referral rates and costs. Referral rates exceed actually observed consultation rates. Criteria need to be evaluated in terms of available workforce, resources and regarding over- and underutilization of nephrology services. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02845-0.
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Affiliation(s)
- Simone Kiel
- Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Fleischmannstrasse 6, Greifswald, 17475, Germany.
| | - Gesine Weckmann
- Faculty of Applied Health Sciences, European University of Applied Sciences, Rostock, Germany
| | - Jean-François Chenot
- Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Fleischmannstrasse 6, Greifswald, 17475, Germany
| | - Sylvia Stracke
- Department of Internal Medicine A, Nephrology, University Medicine Greifswald, Greifswald, Germany.,KfH Kidney Center Greifswald, Greifswald, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus- Senftenberg, Senftenberg, Germany
| | - Aniela Angelow
- Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Fleischmannstrasse 6, Greifswald, 17475, Germany
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Ley S, Biederer J, Ley-Zaporozhan J, Wielpütz MO, Vogel-Claussen J, Das M, Hamer O. [Chest X-ray: implementation and indication : Recommendations of the thoracic imaging working group of the German Radiological Society]. Radiologe 2022; 62:149-157. [PMID: 35006315 DOI: 10.1007/s00117-021-00952-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Even after more than 100 years, the chest X‑ray is still an important technique to detect important pathological changes of lungs, heart and vessels in a fast and low-dose manner. For the German-speaking regions, there are only recommendations available published by the "Ständigen Strahlenschutzkommission (SSK)" regarding the indication. These recommendations are not updated on a regular basis and more recent developments are only integrated with delayed. METHODS The chest division of the German Radiological Society has summarized their expertise for the usage and indication of the chest X‑ray. Especially within the field of oncology the usage of chest X‑ray is evaluated differently to the aforementioned recommendations; here chest computed tomography (CT) is much more sensitive for evaluation of metastasis and local invasion of tumors. Also, within the area of infectious diseases in non-immunocompetent patients, CT is the method of choice. Based on the structure of the current recommendations, many current guidelines and indications are summarized and presented within the context of the usage of chest X‑ray.
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Affiliation(s)
- Sebastian Ley
- Diagnostische und Interventionelle Radiologie, Artemed Klinikum München Süd, Am Isarkanal 30, 81379, München, Deutschland. .,Radiologie, Internistisches Klinikum München Süd, Am Isarkanal 36, München, Deutschland.
| | - Jürgen Biederer
- Diagnostische und interventionelle Radiologie, Universitätsklinikum Heidelberg, 69120, Heidelberg, Deutschland.,Translational Lung Research Centre Heidelberg (TLRC), Mitglied des Deutschen Zentrums für Lungenforschung (DZL), 69120, Heidelberg, Deutschland.,Faculty of Medicine, University of Latvia, Raina bulvaris 19, 1586, Riga, Lettland.,Medizinische Fakultät, Christian-Albrechts-Universität zu Kiel, 24098, Kiel, Deutschland
| | - Julia Ley-Zaporozhan
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, München, Deutschland.,Comprehensive Pneumology Center Munich (CPC-M), Deutsches Zentrum für Lungenforschung (DZL), München, Deutschland
| | - Mark O Wielpütz
- Translational Lung Research Centre Heidelberg (TLRC), Mitglied des Deutschen Zentrums für Lungenforschung (DZL), 69120, Heidelberg, Deutschland.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.,Klinik für Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik, Universitätsklinikum Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland
| | - Jens Vogel-Claussen
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Hannover, Deutschland.,2 BREATH (Biomedical Research in End-stage and Obstructive Lung Disease Hannover), Deutsches Zentrum für Lungenforschung (DZL), Hannover, Deutschland
| | - Marco Das
- Klinik für diagnostische und interventionelle Radiologie, Helios Klinikum Duisburg, Duisburg, Deutschland
| | - Okka Hamer
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Deutschland.,Abteilung für Radiologie, Klinik Donaustauf, Donaustauf, Deutschland
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Weber MA, Baur-Melnyk A. [Radiological diagnosis of multiple myeloma : Role of imaging and the current S3 guideline]. Radiologe 2021. [PMID: 34919153 DOI: 10.1007/s00117-021-00943-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
CLINICAL ISSUE Multiple myeloma is a clonal B‑lymphocyte neoplasm of terminally differentiated plasma cells and accounts for approximately 10% of all hematologic malignancies. Reduction of bone mass, seen on computed tomography (CT) as focal osteolysis, or general osteopenia is mainly caused by tumor-induced resorption of bone. STANDARD RADIOLOGICAL METHODS Imaging methods are used in multiple myeloma to record the extent of various dimensions of the disease manifestations (damage to bone substance, bone marrow infiltration, extramedullary involvement) and the disease course. The aim of this review article is to summarize and outline the recommendations of the S3 guideline "Diagnostics, therapy and follow-up care for patients with monoclonal gammopathy of unclear significance (MGUS) or multiple myeloma" in terms of radiographic imaging. APPRAISAL AND PRACTICAL RECOMMENDATIONS The use of the conventional X‑ray skeletal status (Paris scheme) is obsolete. When a patient with symptomatic multiple myeloma is initially diagnosed, a whole-body CT should be performed to determine the extent of skeletal damage. The S3 guideline also regards CT as the first imaging modality in relapse and progression.
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Jacobson M, Coakley N, Bernardini M, Branco KA, Elit L, Ferguson S, Kim R. Risk reduction strategies for BRCA1/2 hereditary ovarian cancer syndromes: a clinical practice guideline. Hered Cancer Clin Pract 2021; 19:39. [PMID: 34565426 PMCID: PMC8474940 DOI: 10.1186/s13053-021-00196-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/10/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The purpose of this guideline is to make recommendations regarding the care of women who harbour a pathogenic or likely pathogenic variant in BRCA1 and BRCA2. METHODS Draft recommendations were formulated based on evidence obtained through a systematic review of RCTs, comparative retrospective studies and guideline endorsement. The draft recommendations underwent an internal review by clinical and methodology experts, and an external review by clinical practitioners. RESULTS The literature search yielded 1 guideline, 5 systematic reviews, and 15 studies that met the eligibility criteria. CONCLUSIONS In women who harbour a pathogenic or likely pathogenic variant in BRCA1 and BRCA2 screening for ovarian cancer is not recommended. Risk-reducing surgery is recommended to reduce the risk of ovarian cancer. In the absence of contraindications, premenopausal women undergoing RRSO should be offered hormone therapy until menopause. Systemic hormone replacement therapy, is not recommended for women who have had a personal history of breast cancer. RRSO should be considered for breast cancer risk reduction in women younger than 50 years. After a breast cancer diagnosis, RRSO for breast cancer mortality reduction can be considered within two years to women who harbour a pathogenic or likely pathogenic variant in BRCA1 if younger than the recommended age range for ovarian cancer risk reduction. RRSO before the age of 40 and specifically for breast cancer treatment in BRCA2 should be considered only if recommended by their breast cancer oncologist. Following RRSO, it is not recommended to do surveillance for peritoneal cancer.
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Affiliation(s)
- Michelle Jacobson
- Women’s College Hospital, Toronto, ON Canada
- University of Toronto, Toronto, ON Canada
| | - Nadia Coakley
- Department of Oncology, McMaster University, Hamilton, ON Canada
- Ontario Health’s Cancer Care Ontario’s Program in Evidence-based care, McMaster University, Juravinski Site, G Wing, 2nd Floor room 227, 711 Concession Street, Hamilton, ON L8V 1C3 Canada
| | - Marcus Bernardini
- University of Toronto, Toronto, ON Canada
- Princess Margaret Cancer Center, University Health Network (UHN) Toronto, Mount Sinai, Toronto, ON Canada
| | | | - Laurie Elit
- Department of Oncology, McMaster University, Hamilton, ON Canada
- Hamilton Health Sciences Centre-Juravinski Cancer Centre, Hamilton, ON Canada
| | - Sarah Ferguson
- University of Toronto, Toronto, ON Canada
- Ontario Health, Cancer Care Ontario, Toronto, ON Canada
- University Health Network (UHN), Toronto, ON Canada
| | - Raymond Kim
- University of Toronto, Toronto, ON Canada
- Princess Margaret Cancer Centre, Toronto, ON Canada
- Sick Kids Hospital, Toronto, ON Canada
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Di Marco F, D'Amato M, Lombardo FP, Micheletto C, Heiman F, Pegoraro V, Boarino S, Manna G, Mastromauro F, Spennato S, Papi A. The Burden of Short-Acting β 2-Agonist Use in Asthma: Is There an Italian Case? An Update from SABINA Program. Adv Ther 2021; 38:3816-30. [PMID: 34043208 DOI: 10.1007/s12325-021-01772-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/01/2021] [Indexed: 12/26/2022]
Abstract
Introduction Preliminary results from the SABINA (SABA use INAsthma) program showed lower overuse of short-acting β2-agonist (SABA) in Italy compared to other European countries. The aim of the present study was to ascertain whether SABINA’s results might have been affected by the Italian National Health System and pharmaceutical market dynamics, by examining patients’ characteristics in relation to SABA prescription/purchase habits. Methods Multiple approaches were used: (1) a retrospective study using the General Practitioners’ (GPs) Italian IQVIA Longitudinal Patient Database (LPD) to assess SABA overuse (more than two canisters/year) and its association with exacerbation risk; (2) a survey conducted across 200 Italian pharmacies to calculate the proportions of SABA purchases without a prescription; (3) a cross-sectional study on the specialists’ IQVIA Patient Analyzer database to understand the SABA prescription habits of specialists. Results Among SABA users identified through IQVIA LPD, the proportion of patients having more than two SABA canisters/year was 32%. Overall, patients prescribed more than two SABA canisters/year by GPs had 30% higher risk of exacerbations than patients with a maximum of two SABA canisters/year. The joint evaluation of IQVIA LPD and survey’s findings revealed that IQVIA LPD tracks three out of four SABA canisters dispensed. The survey showed that, on average, SABA users purchased four canisters/year. Patients prescribed SABA by specialists were more frequently men, younger, thinner, and had higher spirometry values. Conclusion SABA overuse is common in Italy, with a share of consumption not regulated by medical prescriptions. Because SABA overuse increases exacerbation risk, changes to national guidelines should be encouraged to ensure implementation of global recommendations. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01772-0.
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Heimro LS, Hermann M, Davies TT, Haugstvedt A, Haltbakk J, Graue M. Documented diabetes care among older people receiving home care services: a cross-sectional study. BMC Endocr Disord 2021; 21:46. [PMID: 33691687 PMCID: PMC7945364 DOI: 10.1186/s12902-021-00713-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 03/03/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Home care services plays an important role in diabetes management, and to enable older adults remain home-dwellers. Adequate follow-up and systematic nursing documentation are necessary elements in high quality diabetes care. Therefore, the purpose of this study was to examine the diabetes treatment and management for older persons with diabetes receiving home care services. METHODS A cross-sectional study was used to assess the diabetes treatment and management in a Norwegian municipality. Demographic (age, sex, living situation) and clinical data (diabetes diagnose, type of glucose lowering treatment, diabetes-related comorbidities, functional status) were collected from electronic home care records. Also, information on diabetes management; i.e. follow-up routines on glycated haemoglobin (HbA1c), self-monitoring of blood glucose, insulin administration and risk factors (blood pressure, body mass index and nutritional status) were registered. HbA1c was measured upon inclusion. Descriptive and inferential statistics were applied in the data analysis. RESULTS A total of 92 home care records from older home-dwelling persons with diabetes, aged 66-99 years were assessed. Only 52 (57 %) of the individuals had the diabetes diagnosis documented in the home care record. A routine for self-monitoring of blood glucose was documented for 27 (29 %) of the individuals. Only 2 (2 %) had individual target for HbA1c documented and only 3 (3 %) had a documented routine for measuring HbA1c as recommended in international guidelines. Among 30 insulin treated older individuals, a description of the insulin regimen lacked in 4 (13 %) of the home care records. Also, documentation on who performed self-monitoring of blood glucose was unclear or lacking for 5 (17 %) individuals. CONCLUSIONS The study demonstrates lack of documentation in home care records with respect to diagnosis, treatment goals and routines for monitoring of blood glucose, as well as insufficient documentation on responsibilities of diabetes management among older home-dwelling adults living with diabetes. This indicates that home care services may be suboptimal and a potential threat to patient safety.
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Affiliation(s)
- Lovise S Heimro
- Dept. of Health and Caring Sciences, Western Norway University of Applied Sciences, Stord, Norway.
| | - Monica Hermann
- Dept. of Health and Caring Sciences, Western Norway University of Applied Sciences, Stord, Norway
| | - Therese Thuen Davies
- Dept. of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Anne Haugstvedt
- Dept. of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Johannes Haltbakk
- Dept. of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Marit Graue
- Dept. of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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10
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Setkowski K, van Balkom AJLM, Dongelmans DA, Gilissen R. Prioritizing suicide prevention guideline recommendations in specialist mental healthcare: a Delphi study. BMC Psychiatry 2020; 20:55. [PMID: 32033603 PMCID: PMC7007653 DOI: 10.1186/s12888-020-2465-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 01/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Delphi technique is a proven and reliable method to create common definitions and to achieve convergence of opinion. This study aimed to prioritize suicide prevention guideline recommendations and to develop a set of quality indicators (QIs) for suicide prevention in specialist mental healthcare. METHODS This study selected 12 key recommendations from the guideline to modify them into QIs. After feedback from two face-to-face workgroup sessions, 11 recommendations were rephrased and selected to serve as QIs. Next, a Delphi study with the 11 QIs was performed to achieve convergence of opinion among a panel of 90 participants (23 suicide experts, 23 members of patients' advisory boards or experts with experiences in suicidal behavior and 44 mental healthcare professionals). The participants scored the 11 QIs on two selection criteria: relevance (it affects the number of suicides in the institution) and action orientation (institutions or professionals themselves can influence it) using a 5-point Likert scale. Also, data analysts working in mental healthcare institutions (MHIs) rated each QI on feasibility (is it feasible to monitor and extract from existing systems). Consensus was defined as 70% agreement with priority scores of four or five. RESULTS Out of the 11 recommendations, participants prioritized five recommendations as relevant and action-oriented in optimizing the quality of care for suicide prevention: 1) screening for suicidal thoughts and behavior, 2) safety plan, 3) early follow-up on discharge, 4) continuity of care and 5) involving family or significant others. Only one of the 11 recommendations early follow-up on discharge reached consensus on all three selection criteria (relevance, action orientation, and feasibility). CONCLUSIONS The prioritization of relevant and action-oriented suicide prevention guideline recommendations is an important step towards the improvement of quality of care in specialist mental healthcare.
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Affiliation(s)
| | - Anton J. L. M. van Balkom
- grid.420193.d0000 0004 0546 0540Department of Psychiatry, Amsterdam UMC, location VUmc, Amsterdam Public Health research institute and GGZ inGeest, Amsterdam, The Netherlands
| | - Dave A. Dongelmans
- Department of Intensive Care Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands ,National Intensive Care Evaluation (NICE) foundation, Amsterdam, The Netherlands
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11
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Pilatz A, Hossain H, Kaiser R, Mankertz A, Schüttler CG, Domann E, Schuppe HC, Chakraborty T, Weidner W, Wagenlehner F. Acute epididymitis revisited: impact of molecular diagnostics on etiology and contemporary guideline recommendations. Eur Urol 2014; 68:428-35. [PMID: 25542628 DOI: 10.1016/j.eururo.2014.12.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 12/03/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Acute epididymitis is a common infectious disease of unknown etiology in about 30% of cases with guidelines based on studies published >15 yr ago. OBJECTIVE To investigate the etiology of acute epididymitis using state-of-the-art methods and to provide rational data for antimicrobial therapy and clinical management. DESIGN, SETTING, AND PARTICIPANTS Between 2007 and 2013, 237 patients (150 antimicrobially naive and 87 antibiotically pretreated) with acute epididymitis underwent comprehensive investigation comprising microbiologic cultures, polymerase chain reaction (PCR) for sexually transmitted infections (STIs), 16S ribosomal DNA (rDNA) analysis, and PCR detection of 23 viruses. Clinical management followed international guidelines. OUTCOME MEASURES AND STATISTICAL ANALYSIS Etiology, clinical management, and outcome after 3 mo were assessed. RESULTS AND LIMITATIONS A causative pathogen, predominantly Escherichia coli (56%), was identified in 132 antibiotic-naive patients (88%) and 44 pretreated patients (51%); 16S rDNA analysis increased the detection rate by 10%. STIs were present in 34 cases (14%) (25 patients with Chlamydia trachomatis) and were not restricted to a specific age group. Enteroviruses were found in only two patients (1%). In naive patients, cultured bacteria were susceptible to fluoroquinolones and group 3 cephalosporins in >85% of cases (preateted patients: 42% and 67%, respectively). Primary empirical therapy was continued in 88% of naive patients for 11 d and in 77% of pretreated patients for 13 d with indwelling urinary catheters, rendering patients as high risk for switching. Only six patients (2.5%) underwent semicastration. Prostate-specific antigen levels halved within 3 mo, except in patients who were antibiotic naive and without detected pathogens. Study limitations included a lack of susceptibility testing in cases of STIs. CONCLUSIONS Even in antimicrobially pretreated patients, acute epididymitis is mainly of bacterial origin. STIs are not limited to patients aged <35 yr. Viral epididymitis seems a rare condition. Current guideline recommendations on empirical antimicrobial therapy are adequate. PATIENT SUMMARY Patients with acute epididymitis should receive appropriate diagnostics and antimicrobial therapy for safe conservative management.
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Affiliation(s)
- Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany.
| | - Hamid Hossain
- Institute for Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Rolf Kaiser
- Institute of Virology, University of Cologne, Cologne, Germany
| | - Annette Mankertz
- National Reference Center Measles, Mumps, Rubella, Robert Koch Institute, Berlin, Germany
| | | | - Eugen Domann
- Institute for Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Hans-Christian Schuppe
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Trinad Chakraborty
- Institute for Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Wolfgang Weidner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Florian Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
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12
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Scheuing N, Berger G, Bergis D, Gohlke B, Konrad K, Laubner K, Lilienthal E, Moser C, Schütz-Fuhrmann I, Thon A, Holl RW. Adherence to clinical care guidelines for cystic fibrosis-related diabetes in 659 German/Austrian patients. J Cyst Fibros 2014; 13:730-6. [PMID: 24917115 DOI: 10.1016/j.jcf.2014.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 04/10/2014] [Accepted: 05/09/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Germany/Austria, data on medical care for cystic fibrosis-related diabetes (CFRD) is limited. METHODS Anonymized data from 659 CFRD patients were analyzed and compared to the latest ADA/CFF guidelines. RESULTS Specialized diabetes clinics were attended less frequently than recommended (3.1 vs. 4.0 times yearly). 7.9% of patients had a complete profile of examinations: diabetes education (44.9%), HbA1c (88.8%), blood pressure (79.5%), BMI (86.5%), lipid status (37.5%), retinopathy (29.9%), microalbuminuria (33.2%), and self-monitoring of blood glucose (71.6%). HbA1c and blood pressure were measured less frequently than recommended (2.3 and 2.0 vs. 4.0 times yearly). Overall, guidelines were followed more frequently in children than adults. Contrary to recommendations, not all patients were treated with insulin (77.2 vs. 100.0%). Insulin therapy was initiated earlier in children than adults, but there was still a substantial delay (0.9 vs. 2.7years after diagnosis, p<0.001). CONCLUSION In CFRD patients studied, adherence to care guidelines was suboptimal.
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Affiliation(s)
- Nicole Scheuing
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, D-89081 Ulm, Germany.
| | - Gabriele Berger
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Dominik Bergis
- Department of Internal Medicine I, Division of Endocrinology & Metabolism, Goethe University Hospital, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany
| | - Bettina Gohlke
- Pediatric Endocrinology Division, Children's Hospital, University of Bonn, Adenauerallee 119, D-53113 Bonn, Germany
| | - Katja Konrad
- Department of Pediatrics II, University Children's Hospital Essen, Hufelandstraße 55, D-45147 Essen, Germany
| | - Katharina Laubner
- Department of Internal Medicine II, Division of Endocrinology and Diabetology, University Hospital of Freiburg, Hugstetter Straße 49, D-79106 Freiburg, Germany
| | - Eggert Lilienthal
- Department of Pediatrics, University of Bochum, Alexandrinenstraße 5, D-44791 Bochum, Germany
| | - Christine Moser
- Department of Pediatrics I, Medical University of Innsbruck, Christoph Probst Platz 1, A-6020 Innsbruck, Austria
| | - Ingrid Schütz-Fuhrmann
- 3rd Medical Department, Hospital Hietzing, Wolkersbergenstraße 1, A-1130 Vienna, Austria
| | - Angelika Thon
- Department of Pediatrics, Hannover Medical School, Carl-Neuberg-Straße 1, D-30625 Hannover, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, D-89081 Ulm, Germany
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