Which strategies support the effective use of clinical practice guidelines and clinical quality registry data to inform health service delivery? A systematic review

BACKGROUND

Empirical evidence suggests data and insights from the clinical practice guidelines and clinical quality registries are not being fully utilised, leaving health service managers, clinicians and providers without clear guidance on how best to improve healthcare delivery. This lack of uptake of existing research knowledge represents low value to the healthcare system and needs to change.

METHODS

Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane Central and Cochrane Database of Systematic Reviews) were systematically searched. Included studies were published between 2000 and 2020 reporting on the attributes, evidence usage and impact of clinical practice guidelines and clinical quality registries on health service delivery.

RESULTS

Twenty-six articles including one randomised controlled trial, eight before-and-after studies, eight case studies/reviews, five surveys and four interview studies, covering a wide range of medical conditions and conducted in the USA, Australia and Europe, were identified. Five complementary strategies were derived to maximise the likelihood of best practice health service delivery: (1) feedback and transparency, (2) intervention sustainability, (3) clinical practice guideline adherence, (4) productive partnerships and (5) whole-of-team approach.

CONCLUSION

These five strategies, used in context-relevant combinations, are most likely to support the application of existing high-quality data, adding value to health service delivery. The review highlighted the limitations of study design in opportunistic registry studies that do not produce clear, usable evidence to guide changes to health service implementation practices. Recommendations include exploration of innovative methodologies, improved coordination of national registries and the use of incentives to encourage guideline adherence and wider dissemination of strategies used by successful registries.

Frequency of respiratory pathogens and SARS-CoV-2 in canine and feline samples submitted for respiratory testing in early 2020

Objectives

The emergence of the 2019 novel coronavirus (SARS‐CoV‐2) has necessitated evaluation of the potential for SARS‐CoV‐2 infection in dogs and cats. Using a large data set, we evaluated the frequency of SARS‐CoV‐2 and other respiratory pathogens in samples submitted for respiratory testing from mid‐February to mid‐April 2020.

Materials and Methods

A SARS‐CoV‐2 real‐time PCR was developed and validated. A subset of canine and feline samples submitted for respiratory pathogen panel testing to reference laboratories in Asia, Europe, and North America were also tested for SARS‐CoV‐2. The frequency of respiratory pathogens was compared for the February–April period of 2020 and 2019.

Results

Samples from 4616 patients were included in the study and 44% of canine and 69% of feline samples were PCR positive with Mycoplasma cynos and Bordetella bronchiseptica and Mycoplasma felis and feline calicivirus, respectively. No SARS‐CoV‐2 infections were identified. Positive results for respiratory samples were similar between years.

Clinical Significance

The data in this study suggest that during the emergence of the SARS‐CoV‐2 pandemic in early 2020, respiratory diseases in tested pet cats and dogs were caused by common veterinary pathogens and that SARS‐CoV‐2 infections in dogs and cats are rare.

The effects on cow performance and calf birth and weaning weight of replacing grass silage with brewers grains in a barley straw diet offered to pregnant beef cows of two different breeds

The effects on cow and calf performance of replacing grass silage with brewers grains in diets based on barley straw and fed to pregnant beef cows are reported. Using a 2 × 2 factorial arrangement of breed and diet, cows pregnant by artificial insemination (n = 34) of two breeds (cross-bred Limousin, n = 19 and pure-bred Luing, n = 15) were fed diets ad libitum which consisted of either (g/kg dry matter) barley straw (664) and grass silage (325; GS) or barley straw (783) and brewers grains (206, BG) and offered as total mixed rations. From gestation day (GD) 168 until 266, individual daily feed intakes were recorded and cow body weight (BW) and body condition score (BCS) measured weekly. Calving date, calf sex, birth and weaning BW, and calf age at weaning were also recorded. Between GD 168 and 266, cross-bred Limousin cows gained more weight than Luing cows (p < 0.05) and cows offered BG gained more weight than cows offered GS (p < 0.001). Luing cows lost more BCS than cross-bred Limousin cows (p < 0.05), but diet did not affect BCS. There were no differences in dry matter intake as a result of breed or diet. Calf birth BW, however, was greater for cows fed BG than GS (44 vs. 38 kg, SEM 1.0, p < 0.001) with no difference between breeds. At weaning, calves born to BG-fed cows were heavier than those born to GS-fed cows (330 vs. 286 kg, SEM 9.3, p < 0.01). In conclusion, replacement of grass silage with brewers grains improved the performance of beef cows and increased calf birth and weaning BW. Further analysis indicated that the superior performance of cows offered the BG diet was most likely due to increases in protein supply which may have improved both energy and protein supply to the foetus.

The pharmacokinetics and pharmacokinetic/pharmacodynamic relationships of evacetrapib administered as monotherapy or in combination with statins

Evacetrapib is a novel cholesteryl ester transfer protein (CETP) inhibitor currently being evaluated in a late-stage cardiovascular outcome trial. Using population-based models, we analyzed evacetrapib concentration data along with high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) data from a 12-week study in dyslipidemic patients treated with evacetrapib alone or in combination with atorvastatin, simvastatin, or rosuvastatin. Evacetrapib pharmacokinetics were characterized using a two-compartment model with first-order absorption. Evacetrapib exposure increased in a less than dose-proportional manner, similar to other CETP inhibitors. No patient factors had a clinically relevant impact on evacetrapib pharmacokinetics. The relationships between evacetrapib exposure and HDL-C and LDL-C were characterized using E_max models. The theoretical maximal mean HDL-C increase and LDL-C decrease relative to baseline were 177 and 44.1%, respectively. HDL-C change from baseline was found to be negatively correlated with baseline HDL-C. A pharmacologically independent LDL-C reduction was found when evacetrapib was coadministered with statins.