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NHS Greater Glasgow and Clyde
- Clinical Librarian -
NHSGGC Partnerships Guidelines Newsletter
October 2006
Welcome to the Partnerships Guidelines Newsletter. The newsletter is intended as an information tool to help you
keep up to date with developments in your area of clinical expertise and interest. It is not in any way an
expression of organisational policy. The inclusion of a guideline in this newsletter does not imply that it is used, or
should be implemented, within NHS Greater Glasgow and Clyde. Any views expressed in guidelines quoted in
the newsletter will have to be subjected to the scrutiny of your own clinical judgement. You are, however,
welcome to use the guideline newsletter to inform your practice or service development.
This newsletter covers national and international guidelines that have either been published or added to specialist
databases (such as Medline or CINAHL) in the previous month. It is divided into three sections: one for clinical
guidelines from the UK, one for clinical guidelines from international bodies and one for publications on guideline
implementation. Within the two clinical sections, there are sub-categories to make it easier for you to find the
guidelines that might be relevant to your practice.
Where available, the newsletter includes abstracts and links to online full-text versions or executive summaries of
the guidelines.
Contents
A. UK Guidelines …………………………………………………………………………………………………….
p.2
Primary Care
………………………………………………………………………………………….
Cancer Care/Palliative Care
……………………………………………………………………………….
Mental Health and Learning Disabilities …………………………………………………………………….
Dentistry
………………………………………………………………………………………….
Sexual Health, BBV and related Topics …………………………………………………………………….
Child Health
………………………………………………………………………………………….
p. 2
p. 2
p. 2
p. 2
p. 3
p. 3
B. International Guidelines ………………………………………………………………………………………….
p. 4
1.
2.
3.
4.
5.
6.
1.
2.
3.
4.
5.
6.
Primary Care
………………………………………………………………………………………….
Cancer Care/Palliative Care
…………………………………………………………………….
Mental Health and Learning Disabilities …………………………………………………………………….
Dentistry
………………………………………………………………………………………….
Sexual Health, BBV and related Topics …………………………………………………………………….
Child Health
………………………………………………………………………………………….
C. Guidelines Implementation ……………………………………………………………………………………….
p. 4
p. 7
p. 7
p. 9
p. 9
p. 10
p. 13
If you would like to obtain full text versions of any of the guidelines listed in the newsletter, please refer to the
NHSScotland e-Library where you will find most of the guidelines in full text. The e-Library is accessible to all
NHSScotland staff at http://www.elib.scot.nhs.uk. Full text access requires an ATHENS password, which can be
obtained online from the e-Library website. For those guidelines that are not available online, please fill in and
sign the document request form that is included with the newsletter and send it to the Maria Henderson Library,
Gartnavel Royal Hospital. Phone: 0141-211 3913.
1
Carsten Mandt, Clinical Librarian, NHSGGC, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
A. UK Guidelines
Primary Care
National Institute for Cinical and Healthcare Excellence (NICE). Anaemia management in people
with
chronic
kidney
disease
(CKD).
London:
NICE,
2006.
URL:
http://www.nice.org.uk/page.aspx?o=CG39 [last accessed: 05 October 2006].
Weston V, Coakley G. Guideline for the management of the hot swollen joint in adults with a
particular focus on septic arthritis. Journal of Antimicrobial Chemotherapy 58(3) 2006: 492-493.
The British Society for Rheumatology (BSR) Standards, Guidelines and Audit Working Group, in
conjunction with the British Society for Antimicrobial Chemotherapy, British Orthopaedic Association,
Royal College of General Practitioners and British Health Professionals in Rheumatology, has produced
an evidence-based guideline for the management of the hot swollen joint with particular focus on the
septic joint. The aim of the guideline is to help accurate diagnosis and appropriate treatment when a joint
is hot because of sepsis, while also ensuring that other causes such as crystal arthritis are recognized
and not over-treated.
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Cancer Care/Palliative Care
No relevant new guidance was published this month.
Back to the Contents page
Mental Health and Learning Disabilities
No relevant new guidance was published this month.
Back to the Contents page
Dentistry
No relevant new guidance was published this month.
Back to the Contents page
2
Carsten Mandt, Clinical Librarian, NHSGGC, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
Sexual Health, BBV and related Topics
Faculty of Family Planning and Reproductive Health Care (FFPRHC). The UK Medical Eligibility
Criteria
for
Contraceptive
Use
(2005/2006).
London:
FFPRHC,
2006.
URL:
http://www.ffprhc.org.uk/admin/uploads/LatestUpdatesCEU.html [last accessed: 05 October 2006].
Lyons F, Mulcahy F, Coulter-Smith S, Butler K. National guidelines for the management of HIV-1 in
pregnancy. Irish Medical Journal 99(5) 2006. URL:
Management of HIV-1 in pregnancy has reduced the mother-to-child- transmission (MTCT) rate from 2530% to <2% in the developed world, including Ireland. In Ireland most HIV positive pregnant women are
diagnosed through antenatal screening many of whom arrive here late in pregnancy. Geographic
dispersal and subsequent involvement of obstetric units throughout the country has resulted in a need
for clear, accessible management guidelines. The Irish Infection Society first published guidelines for the
management of HIV-1 in pregnancy in 2001 1. The updated guidelines became operational in January
2002 with some amendments in March 2003 and July 2004. These guidelines offer a broad management
outline for HIV positive pregnant women. Ultimately, each woman is assessed individually by a
multidisciplinary team and a careful plan is determined.
Nandwani R, Fisher M. Clinical standards for the screening and management of acquired
syphilis in HIV-positive adults. International Journal of STD & AIDS 17(9) 2006: 588-593.
These clinical standards for the screening and management of acquired syphilis in HIV-positive patients
in the UK were first made available on the MSSVD website in February 2002. They have been updated
by the 2006 UK National Guideline on the Sexual Health of People with HIV which is also published in
this issue of the Journal [pp. 594-606]. Many of the recommendations remain in force and therefore the
original document is published in full here.
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Child Health
No relevant new guidance was published this month.
Back to the Contents page
3
Carsten Mandt, Clinical Librarian, NHSGGC, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
B. International Guidelines
Primary Care
AACE Menopause Guidelines Revision Task Force. American Association of Clinical
Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of
menopause.
Endocr
Pract
12(3)
2006:
315-37.
URL:
http://www.aace.com/pub/pdf/guidelines/menopause.pdf [last accessed: 05 October 2006].
Anonymous. Global guideline for Type 2 diabetes: recommendations
comprehensive, and minimal care. Diabetic Medicine 23(6) 2006: 579-93.
for
standard,
Bergman-Evans B. Evidence-based guideline: improving medication management for older
adult clients. Journal of Gerontological Nursing. 32(7) 2006: 6-13.
Bonow RO, Carabello BA, Chatterjee K, De Leon Jr AC, Faxon DP, Freed MD, et al. ACC/AHA 2006
guidelines for the management of patients with valvular heart disease: A report of the
American College of Cardiology/American Heart Association Task Force on Practice
Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients
with Valvular Heart Disease) - Developed in collaboration with the Society of Cardiovascular
Anesthesiologists. Circulation 114(5) 2006: e84-e231.
Brink A, Feldman C, Duse A, Gopalan D, Grolman D, Mer M, et al. Guideline for the management of
nosocomial infections in South Africa. South African Medical Journal. Suid Afrikaanse Tydskrif Vir
Geneeskunde 96(7 Pt 2) 2006: 642-52.
OBJECTIVE: To write a guideline for the management and prevention of nosocomial infections in South
Africa in view of the following: Nosocomial infections are a common and increasing problem globally,
including South Africa. Widely varying standards of prevention and management of these important
infections. Increasing and emerging antimicrobial resistance among commonly isolated pathogens. The
significant economic burden of these infections on the health care system as well as their impact on
patient morbidity and mortality. The main aims of the guideline are to provide recommendations for the
initial choice of antimicrobial agents and the appropriate management of these infections encompassing
the following conditions: (i) nosocomial pneumonia, health care-associated pneumonia and ventilatorassociated pneumonia; (ii) nosocomial bloodstream infections; (iii) nosocomial intravascular infections;
(iv) nosocomial urinary tract infections; (v) nosocomial intra-abdominal infections; and (vi) nosocomial
surgical skin and soft-tissue infections. EVIDENCE: Working group of clinicians from relevant disciplines,
following detailed literature review. RECOMMENDATIONS: These include details of the likely
pathogens, an appropriate diagnostic approach, antibiotic treatment options and appropriate preventive
strategies.
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Dyslipidemia in
Adults With Diabetes. Canadian Journal of Diabetes 30(3) 2006: 230-40. URL:
http://www.diabetes.ca/cpg2003/downloads/Dyslipidemia2006.pdf [last accessed: 05 October 2006].
European Heart Rhythm Association, Heart Rhythm Society, Fuster V, Ryden LE, Cannom DS, Crijns
HJ, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: a report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines and the European Society of Cardiology
Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the
Management of Patients With Atrial Fibrillation). Journal of the American College of Cardiology
48(4) 2006: 854-906.
European Heart Rhythm Association, Heart Rhythm Society, Zipes DP, Camm AJ, Borggrefe M,
Buxton AE, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular
4
Carsten Mandt, Clinical Librarian, NHSGGC, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
arrhythmias and the prevention of sudden cardiac death: a report of the American College of
Cardiology/American Heart Association Task Force and the European Society of Cardiology
Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management
of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). Journal
of the American College of Cardiology 48(5) 2006: 5.
Franch HA. Erratum: Diet and lifestyle recommendations revision 2006: A scientific statement
from the American heart association nutrition committee (Circulation (2006) 114, (82-96) DOI:
10.1161/CIRCULATIONAHA.106.176158). Circulation 114(1) 2006.
Health Care Association of New Jersey (HCANJ). Medication management guideline. Hamilton, NJ:
HCANJ, 2006. URL: http://www.hcanj.org/docs/hcanjbp_medmgmt.pdf [last accessed: 05 October
2006].
Heart Failure Society of America. Nonpharmacologic management and health care maintenance
in patients with chronic heart failure. J Card Fail 12(1) 2006: e29-37.
Heart Failure Society of America. Managing patients with hypertension and heart failure. J Card
Fail 12(1) 2006: e112-4.
Heart Failure Society of America. Management of heart failure in special populations. J Card Fail
12(1) 2006: e115-9.
Institute for Clinical Systems Improvement (ICSI). Venous thromboembolism prophylaxis.
Bloomington: ICSI, 2006. URL: http://www.icsi.org/knowledge/detail.asp?catID=29&itemID=1140 [last
accessed: 05 October 2006].
Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of osteoporosis.
Bloomington: ICSI, 2006. URL: http://www.icsi.org/knowledge/detail.asp?catID=29&itemID=547 [last
accessed: 05 October 2006].
Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, et al. Diet and lifestyle
recommendations revision 2006: A scientific statement from the American heart association
nutrition committee. Circulation 114(1) 2006: 82-96.
Improving diet and lifestyle is a critical component of the American Heart Association's strategy for
cardiovascular disease risk reduction in the general population. This document presents
recommendations designed to meet this objective. Specific goals are to consume an overall healthy diet;
aim for a healthy body weight; aim for recommended levels of low-density lipoprotein cholesterol, highdensity lipoprotein cholesterol, and triglycerides; aim for normal blood pressure; aim for a normal blood
glucose level; be physically active; and avoid use of and exposure to tobacco products. The
recommendations are to balance caloric intake and physical activity to achieve and maintain a healthy
body weight; consume a diet rich in vegetables and fruits; choose whole-grain, high-fiber foods;
consume fish, especially oily fish, at least twice a week; limit intake of saturated fat to <7% of energy,
trans fat to <1% of energy, and cholesterol to <300 mg/day by choosing lean meats and vegetable
alternatives, fat-free (skim) or low-fat (1% fat) dairy products and minimize intake of partially
hydrogenated fats; minimize intake of beverages and foods with added sugars; choose and prepare
foods with little or no salt; if you consume alcohol, do so in moderation; and when you eat food prepared
outside of the home, follow these Diet and Lifestyle Recommendations. By adhering to these diet and
lifestyle recommendations, Americans can substantially reduce their risk of developing cardiovascular
disease, which remains the leading cause of morbidity and mortality in the United States.
Mackey T. The best therapies for bacterial rhinosinusitis. Clinical Advisor. 9(7) 2006: 59-60, 63-4.
Knowing when to prescribe antibiotics and what kind to give is crucial. Here are some guidelines for
patients with mild-to-moderate infections.
5
Carsten Mandt, Clinical Librarian, NHSGGC, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
Smith NM, Bresee JS, Shay DK, Uyeki TM, Cox NJ, Strikas RA. Prevention and control of
influenza: recommendations of the Advisory Committee on Immunization Practices
(ACIP). MMWR: Morbidity and Mortality Weekly Report. 55(RR-10) 2006: 1-41.
This report updates the 2005 recommendations by the Advisory Committee on Immunization Practices
(ACIP) regarding the use of influenza vaccine and antiviral agents (CDC. Prevention and control of
influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR
2005;54[No. RR-8]:1--44). The 2006 recommendations include new and updated information. Principal
changes include 1) recommending vaccination of children aged 24--59 months and their household
contacts and out-of-home caregivers against influenza; 2) highlighting the importance of administering 2
doses of influenza vaccine for children aged 6 months--<9 years who were previously unvaccinated; 3)
advising health-care providers, those planning organized campaigns, and state and local public health
agencies to a) develop plans for expanding outreach and infrastructure to vaccinate more persons than
the previous year and b) develop contingency plans for the timing and prioritization of administering
influenza vaccine, if the supply of vaccine is delayed and/or reduced; 4) reminding providers that they
should routinely offer influenza vaccine to patients throughout the influenza season; 5) recommending
that neither amantadine nor rimantadine be used for the treatment or chemoprophylaxis of influenza A in
the United States until evidence of susceptibility to these antiviral medications has been re-established
among circulating influenza A viruses; and 6) using the 2006--07 trivalent influenza vaccine virus strains:
A/New Caledonia/20/1999 (H1N1)-like, A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia/2506/2004like antigens. For the A/Wisconsin/67/2005 (H3N2)-like antigen, manufacturers may use the antigenically
equivalent A/Hiroshima/52/2005 virus; for the B/Malaysia/2506/2004-like antigen, manufacturers may
use the antigenically equivalent B/Ohio/1/2005 virus. A link to this report and other information can be
accessed at http://www.cdc.gov/flu.
Takata S, Hashimoto J, Nakatsuka K, Yoshimura N, Yoh K, Ohno I, et al. Guidelines for diagnosis
and management of Paget's disease of bone in Japan. Journal of Bone & Mineral Metabolism
24(5) 2006: 359-367.
We here propose guidelines for the diagnosis and management of Paget's disease of bone (PDB) in
Japan. These guidelines provide basic information on the epidemiology, pathophysiology, clinical signs
and symptoms, diagnosis, indications for treatment, and available therapy, including orthopedic surgery.
PDB is a chronic disorder characterized by focal abnormalities of bone turnover. The characteristic
feature of PDB is excessive osteoclastic bone resorption coupled to increased and disorganized bone
formation. The most common symptom of PDB is pain in involved bones. The most serious complication
of PDB is malignant bone or soft-tissue tumor. PDB is uncommon in Japan; our survey in 2003 found
169 patients with PDB. The prevalence of PDB in Japan is 0.15/100 000; in patients aged 55 years or
more, the proportion reaches 0.41/100 000. A careful medical history and physical examination are
essential for the diagnosis. The diagnosis of PDB is based on finding the typical features on radiographs.
Bone scintigraphy and measurement of serum alkaline phosphatase are sensitive means of screening
for PDB. Since PDB is a rare disease in Japan, bone biopsy is quite often used to exclude bone
metastases. The only evidence-based indication for treatment of PDB is pain in involved bones. In
Japan, etidronate and calcitonin are approved by the Ministry of Health, Labour and Welfare for treating
PDB, but currently risedronate is also under development for treating PDB in Japan. Indications for
surgical intervention in PDB include unstable fractures, osteoarthritis, malignant soft-tissue tumor,
osteosarcoma, and bone deformity.
The Endocrine Society. Evaluation and treatment of adult growth hormone deficiency: an
Endocrine Society clinical practice guideline. Chevy Chase: Endocrine Society, 2006. URL:
http://www.endo-society.org/quickcontent/clinicalpractice/clinical-guidelines/GH_clinicalguideline.cfm
[last accessed: 05 October 2006].
Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, et al. Infectious
Diseases Society of America practice guidelines for clinical assessment, treatment and
prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis. Alexandria:
Infectious
Diseases
Society
of
America,
2006.
URL:
http://www.journals.uchicago.edu/CID/journal/issues/v43n9/40897/40897.html [last accessed: 05
October 2006].
Back to the Contents page
6
Carsten Mandt, Clinical Librarian, NHSGGC, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
Cancer Care/Palliative Care
Houghton AN, Coit DG, Daud A, Dilawari RA, DiMaio D, Gollob JA, et al. Melanoma: Clinical
practice guidelines in oncology. Journal of the National Comprehensive Cancer Network 4(7) 2006:
666-684.
These guidelines represent an effort to distill and simplify an enormous body of knowledge and
experience into fairly simple management algorithms. In general, treatment recommendations for
primary tumors are based on better data than those for recurrent disease. Few, if any, firm
recommendations can be made for patients with melanoma regarding more controversial issues, such as
the extent of workup or intensity of follow-up. These guidelines are intended as a point of departure,
recognizing that all clinical decisions about individual patient management must be tempered by the
clinician's judgment and other factors, such as local resources and expertise, and the patient's needs,
wishes, and expectations. Furthermore, these guidelines are revised annually and continually as new
data become available.
Penack O, Beinert T, Buchheidt D, Einsele H, Hebart H, Kiehl MG, et al. Management of sepsis in
neutropenia: Guidelines of the infectious diseases working party (AGIHO) of the German
Society of Hematology and Oncology (DGHO). Annals of Hematology 85(7) 2006: 424-433.
These guidelines from the infectious diseases working party (AGIHO) of the German Society of
Hematology and Oncology (DGHO) give recommendations for the management of adults with
neutropenia and the diagnosis of sepsis. The guidelines are written for clinicians and focus on
pathophysiology, diagnosis, and treatment of sepsis. The manuscript contains evidence-based
recommendations for the assessment of the quality and strength of the data.
Zernikow B, Schiessl C, Wamsler C, Janen G, Grieinger N, Fengler R, et al. Practical pain control in
pediatric oncology. Recommendations of the German Society of Pediatric Oncology and
Hematology, the German Association for the Study of Pain, the German Society of Palliative
Care, and the Vodafone Institute of Children's Pain Therapy and Palliative Care. Monatsschrift
fur Kinderheilkunde 154(8) 2006: 773-787.
In pediatric oncology, optimal pain control is still a challenge. A structured pain history and the regular
scoring of pain intensity using age-adapted measuring tools are hallmarks of optimal pain control.
Psychological measures are as important as drug therapy in the prophylax is or control of pain,
especially when performing invasive procedures. Pain control is oriented toward the WHO multistep
therapeutic schedule. On no account should the pediatric patient have to climb up the 'analgesic ladder' strong pain requires the primary use of strong opioids. Give opioids preferably by the oral route and by
the clock - short-acting opioids should be used to treat breakthrough pain. Alternatives are i.v. infusion,
patient-controlled analgesia, and transdermal applications. Constipation is the adverse effect most often
seen with (oral) opioid therapy. Adverse effects should be anticipated, and prophylactic treatment should
be given consistently. The assistance of pediatric nurses is of the utmost importance in pediatric pain
control. Nurses deliver the basis for rational and effective pain control by scoring pain intensity and
documenting drug administration as well as adverse effects. The nurses' task is also to prepare the
patient for and monitor the patient during painful procedures. It is the responsibility of both nurse and
doctor to guarantee emergency intervention during sedation whenever needed. In our guideline we
comment on drug selection and dosage, pain measurement tools, and documentation tools for the
purpose of pain control. Those tools may be easily integrated into daily routine.
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Mental Health and Learning Disabilities
Canadian Psychiatric Association. Clinical practice guidelines. Management of anxiety disorders.
Canadian Journal of Psychiatry Revue Canadienne de Psychiatrie 51(8 Suppl 2) 2006 .
Hilty DM, Leamon MH, Lim RF, Kelly RH, Hales RE. Diagnosis and Treatment of Bipolar Disorder
7
Carsten Mandt, Clinical Librarian, NHSGGC, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
in the Primary Care Setting: A Concise Review. Primary Psychiatry 13(7) 2006: 77-85.
Bipolar disorder is a less common biologic disorder in primary care than are depressive and anxiety
disorders, but there is a high risk for poor outcomes for patients. Primary care physicians (PCPs) are
assuming increasing responsibility for the care of these patients in today's managed care environment,
working independently or in collaboration with a psychiatrist. The POP needs to carefully assess patients
presenting with depression, since many are bipolar. The PCP must then skillfully manage these patients
because of the significant morbidity and mortality associated with the disorder. This article outlines a
diagnostic approach for patients in primary care practice who present with mood symptoms. The article
also presents a management strategy for those who are diagnosed with bipolar disorder, including
patients who are considering pregnancy or who are pregnant.
Lyketsos CG, Colenda CC, Beck C, Blank K, Doraiswamy MP, Kalunian DA, et al. Position
statement of the American Association for Geriatric Psychiatry regarding principles of care for
patients with dementia resulting from Alzheimer disease. American Journal of Geriatric Psychiatry
14(7) 2006: 561-72.
Mahendra N, Hopper T, Bayles KA, Azuma T, Cleary S, Kim E, et al. Evidence-Based Practice
Recommendations for Working with Individuals with Dementia: Montessori-Based
Interventions. Journal of Medical Speech-Language Pathology 14(1) 2006: xv-xxv.
The Academy of Neurologic Communication Disorders and Sciences (ANCDS), the American SpeechLanguage-Hearing Association (ASHA), its Special Interest Division 2 (SID-2: Neurophysiology and
Neurogenic Speech and Language Disorders), and the Veterans Administration (VA) collaborated to
establish evidence-based practice guidelines to be used by speech-language pathologists who work with
individuals with dementia of the Alzheimer type (DAT). A writing committee was formed that generated a
technical report with evidence tables based on a systematic review and classification of the literature
related to use of direct and indirect interventions with individuals who have DAT. In this clinical report,
the level of scientific evidence related to Montessori-based interventions for persons with AD and related
dementias is examined, with findings and recommendations summarized. The five studies reviewed
were judged to provide Class II and Class III evidence to support the use of Montessori-based
interventions for persons with dementia. This article contains information about the characteristics of
study participants, types of Montessori-based interventions implemented, outcomes of the interventions,
methodological limitations, recommendations for clinical practice, and ideas for future research
directions.
Walsh BW. Treating self-injury: A practical guide. New York: Guilford Press; 2006.
Responding effectively to self-injury is one of the most pressing challenges for today's mental health
clinicians, especially those working with adolescents and young adults. This timely guide presents a
detailed road map for understanding and treating this alarming, increasingly prevalent problem. Uniquely
practical and comprehensive, the volume is solidly grounded in the author's extensive research and
clinical experience. It provides a variety of proven therapeutic techniques that immediately can be
applied in day-to-day practice with clients. Elucidating the nature and causes of self-injury, the book
gives particular attention to distinguishing it from suicide and from popular body modification practices.
Specific procedures are outlined for assessing persons at risk, ranging from those who do not have
psychiatric diagnoses to those with eating or mood disorders, posttraumatic stress disorder, personality
disorders, or psychoses. The practitioner is then taken step by step through selecting and implementing
interventions that match the problems and strengths of the individual client. Chapters offer clear, how-todo-it guidelines for contingency management, replacement skills training, cognitive therapy, body image
work, and exposure treatment of trauma. Psychopharmacological and family-based approaches are also
reviewed in depth. Throughout, vivid case examples illuminate the thoughts and feelings of self-injurers
and show what the treatment strategies look like in action. Special topics encompass treating major selfinjury, also known as self-mutilation; managing self-injury in school settings; engaging clients; and
dealing with the emotional impact of this kind of work on the therapist. A number of reproducible clinical
materials are included in the text and in the appendices, which also feature other helpful resources.
Written in a readable, accessible style, this pragmatic book fills a key need for clinical psychologists,
social workers, psychiatrists, family therapists, nurses, and school psychologists and counselors.
Students and trainees in these areas will find it a highly informative supplemental text.
Work Group on Substance Use Disorders, Kleber HD, Weiss RD, Anton RF, Rounsaville BJ, George
8
Carsten Mandt, Clinical Librarian, NHSGGC, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
TP, et al. Treatment of patients with substance use disorders, second edition. American Journal
of Psychiatry 163(8 Suppl) 2006: 5-82.
Back to the Contents page
Dentistry
Pickett FA, American Academy of Oral Medicine. Bisphosphonate-associated osteonecrosis of the
jaw: a literature review and clinical practice guidelines. Journal of Dental Hygiene 80(3) 2006.
BACKGROUND: Osteonecrosis of the jaw has recently been reported as a possible adverse drug effect
from bisphosphonate therapy. Reports are coming from all over the world. Norvartis, a pharmaceutical
manufacturer of two implicated drug products, has notified dentists in the United States and made
recommendations for dental management of cases. MECHANISM OF ACTION: The exact mechanism of
bisphosphonate effects leading to osteonecrosis of the jaw is unknown. The condition can affect both the
maxilla and the mandible. Most cases developed following oral infection or dental treatment.
PREVENTION AND MANAGEMENT: Clinical guidelines for prevention and management have recently
been published. Dental hygienists have a major role in patient education related to awareness of the
potential drug effect and to preventive oral health education.
Back to the Contents page
Sexual Health, BBV and related Topics
American College of Obstetricians and Gynecologists, Committee on Health Care for Undeserved
Women. ACOG Committee Opinion No. 343: psychosocial risk factors: perinatal screening and
intervention. Obstetrics & Gynecology 108(2) 2006: 469-77.
The American College of Obstetricians and Gynecologists advocates assessing for psychosocial risk
factors and helping women man-age psychosocial stressors as part of comprehensive care for women.
Psychosocial screening of all women seeking pregnancy evaluation or pre-natal care should be
performed regardless of social status, educational level, or race and ethnicity. Because problems may
arise during the pregnancy that were not present at the initial visit, it is best to perform psychosocial
screening at least once each trimester to increase the likelihood of identifying important issues and
reducing poor birth outcomes. When screening is completed, every effort should be made to identify
areas of concern, validate major issues with the patient, provide information, and, if indicated, make
suggestions for possible changes. When necessary, the health care provider should refer the patient for
further evaluation or intervention. Psychosocial risk factors also should be considered in discharge
planning after delivery. Many of the psychosocial issues that increase the risk for poor pregnancy
outcome also can affect the health and welfare of the newborn. Screening should include assessment of
barriers to care, unstable housing, unintended pregnancy, communication barriers, nutrition, tobacco
use, substance use, depression, safety, intimate partner violence, and stress.
Haagen EC, Hermens R, Nelen W, Braat DDM, Grol R, Kremer JAM. Subfertility guidelines in
Europe: The quantity and quality of intrauterine insemination guidelines. Human Reproduction
21(8) 2006: 2103-2109.
Background: International collaboration could facilitate systematic development of guidelines to regulate
and improve clinical practice. To promote European collaboration in guideline development in
reproductive medicine, insight into existing subfertility guidelines in Europe is essential. The study aim
was to explore the number and quality of clinical practice guidelines on homologous intrauterine
insemination (IUI) in Europe. Methods: To identify IUI guidelines in Europe, electronic databases and
Internet were systematically searched and key experts on assisted reproduction in 25 European
countries were questioned. The quality of IUI guidelines was systematically assessed with the
internationally validated Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument.
Qualitative methods were used to appraise IUI guideline recommendations and references. Results:
9
Carsten Mandt, Clinical Librarian, NHSGGC, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
National guidelines on IUI are available in four of 25 European countries. The quality of IUI guidelines in
Europe is moderate to high, but the recommendations and references differ considerably. Conclusions:
The number of IUI guidelines in Europe is surprisingly small, and differences in their recommendations
and references are considerable. To overcome these deficiencies in clinical guidance on IUI care in
Europe, a central body with expertise in up-to-date guideline development methodology and sufficient
resources could be established in Europe for central selection and international exchange of evidence to
support guideline recommendations.
Sharlip ID. Guidelines for the diagnosis and management of premature ejaculation. Journal of
Sexual Medicine 3(SUPPL. 4) 2006: 309-317.
Introduction. Until recently, premature ejaculation (PE) was believed to have a psychologic etiology
requiring psychosexual therapy. Recognition of a neurobiologic component to the etiology of PE has
since highlighted the need for diagnostic and management guidelines for this common sexual problem.
One major medical organization-the American Urological Association (AUA)-has established such
guidelines. In addition, the Second International Consultation on Sexual Dysfunctions (ICSD) in 2003
developed a set of recommendations for PE, as well as for other sexual dysfunctions. Aim. To review the
current guidelines for the diagnosis and treatment of PE. Methods. The Sexual Medicine Society of North
America hosted a State of the Art Conference on Premature Ejaculation on June 24-26, 2005 in
collaboration with the University of South Florida. The purpose was to have an open exchange of
contemporary research and clinical information on PE. There were 16 invited presenters and
discussants; the group focused on several educational objectives. Main outcome measure. Data from
the AUA Guideline on the Pharmacologic Management of Premature Ejaculation and the Second ICSD.
Results. Both documents emphasize the importance of a sexual history in diagnosing PE, and each of
these two documents recognizes that diagnosis involves a shortened intravaginal latency time as well as
patient reports of poor control over ejaculation and patient distress over the condition. Conclusions.
Condensed guidelines for the diagnosis and treatment of PE are presented. Once diagnosis is
suspected, optimal treatment regimens should be established utilizing randomized placebo-controlled
trials.
Wespes E, Amar E, Hatzichristou D, Hatzimouratidis K, Montorsi F, Pryor J, et al. EAU Guidelines on
erectile dysfunction: an update. European Urology 49(5) 2006: 806-15.
The introduction of new oral therapies has completely changed the diagnostic and therapeutic approach
to erectile dysfunction. A panel of experts in this field has developed guidelines for the clinical evaluation
and treatment based on the review of available scientific information.
Back to the Contents page
Child Health
American Academy of Pediatrics, Hymel KP, Committee on Child Abuse and Neglect, National
Association of Medical Examiners. Distinguishing sudden infant death syndrome from child
abuse
fatalities.
Pediatrics
118(1)
2006:
421-7.
URL:
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;118/1/421 [last accessed: 05 October
2006].
Anonymous. Evaluation and treatment of constipation in children: Summary of updated
recommendations of the North American Society for Pediatric Gastroenterology, Hepatology
and Nutrition. Journal of Pediatric Gastroenterology & Nutrition 43(3) 2006: 405-407.
Constipation is a common pediatric problem. To assist health care professionals who care for children
with constipation, the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition
(NASPGHAN) previously published a clinical guideline based on an integration of medical evidence with
expert opinion. To evaluate studies published since then, the NASPGHAN Constipation Guideline
Committee performed a comprehensive and systematic review of the medical literature since 1997, to
identify, review and rate the quality of new evidence. Based on this review, the recommendations of the
original clinical guideline were reaffirmed with several modified according to the new evidence. Below is
10
Carsten Mandt, Clinical Librarian, NHSGGC, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
a summary of the evidence reviewed for this update. The complete revised guideline is available online
in its entirety.
Anonymous. Evaluation and treatment of constipation in infants and children:
Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology
and Nutrition. Journal of Pediatric Gastroenterology & Nutrition 43(3) 2006: e1-e13.
Constipation, defined as a delay or difficulty in defecation, present for 2 or more weeks, is a common
pediatric problem encountered by both primary and specialty medical providers. The Constipation
Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and
Nutrition (NASPGHAN) has formulated a clinical practice guideline for the management of pediatric
constipation. The Constipation Guideline Committee, consisting of two primary care pediatricians, a
clinical epidemiologist, and pediatric gastroenterologists, based its recommendations on an integration of
a comprehensive and systematic review of the medical literature combined with expert opinion.
Consensus was achieved through Nominal Group Technique, a structured quantitative method. The
Committee developed two algorithms to assist with medical management, one for older infants and
children and the second for infants less than 1 year of age. The guideline provides recommendations for
management by the primary care provider, including evaluation, initial treatment, follow-up management,
and indications for consultation by a specialist. The Constipation Guideline Committee also provided
recommendations for management by the pediatric gastroenterologist.
Berns M. Hyperbilirubinemia in term newborns. Guidelines. Monatsschrift fur Kinderheilkunde
154(8) 2006: 835-843.
Neonatal jaundice is a frequent problem for all pediatricians. Over 60% of all term newborns show
clinical signs of jaundice in the first week of life, but only a small number need phototherapy or exchange
transfusion. Safe value limits for intervention can reduce bilirubin-induced neurotoxicity such as acute
bilirubinencephalopathy and irreversible kernicterus. Recurrence of kernicterus has been described;
besides unknown nonimmunological risk factors, early hospital discharge and inappropriate follow-up
seem to be responsible. Therefore, early identification of newborns at risk for developing severe
hyperbilirubinemia, along with parent education, has become the pediatrician's aim.
Brewster DR. Critical appraisal of the management of severe malnutrition: 1. Epidemiology and
treatment guidelines. Journal of Paediatrics & Child Health 42(10) 2006: 568-574.
Hospital case-fatality rates for severe malnutrition in the developing world remain high, particularly in
Africa where they have not changed much over recent decades. In an effort to improve case
management, WHO has developed treatment guidelines. The aim of this review is to critically appraise
the evidence for the guidelines and review important recent advances in the management of severe
malnutrition. We conclude that not only is the evidence base deficient, but also the external
generalisability of even good-quality studies is seriously compromised by the great variability in clinical
practice between regions and types of health facilities in the developing world, which is much greater
than between developed countries. The diagnosis of severe wasting is complicated by the dramatic
change in reference standards (from CDC/WHO 1978 to CDC 2000 in EpiNut) and also by difficulties in
accurate measurement of length. Although following treatment guidelines has resulted in improved
outcomes, there is evidence against the statement that case-fatality rates (particularly in African
hospitals) can be reduced below 5% and that higher rates are proof of poor practice, because there is
wide variation in severity of illness factors. The practice of prolonged hospital treatment of severe
malnutrition until wasting and/or oedema has resolved is being replaced by shorter hospital stays
combined with outpatient or community follow-up because of advances in dietary management outside
of hospital.
Cincinnati Children's Hospital Medical Center. Evidence based care guideline for community
acquired pneumonia in children 60 days through 17 years of age. Cincinnati: Cincinnati Children's
Hospital Medical Center, 2006. URL: http://www.cincinnatichildrens.org/svc/alpha/h/health-policy/evbased/pneumonia.htm [last accessed: 05 October 2006].
Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures
Steering Committee, Medical Home Initiatives for Children With Special Needs Project Advisory.
Identifying infants and young children with developmental disorders in the medical home: an
algorithm for developmental surveillance and screening. Pediatrics 118(1) 2006: 405-20. URL:
11
Carsten Mandt, Clinical Librarian, NHSGGC, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;118/1/405 [last accessed: 05 October
2006].
Moeschler JB, Shevell M, American Academy of Pediatrics Committee on Genetics. Clinical genetic
evaluation of the child with mental retardation or developmental delays. Pediatrics 117(6) 2006:
2304-16.
URL:
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;117/6/2304
[last
accessed: 05 October 2006].
Munns C, Zacharin MR, Rodda CP, Batch JA, Morley R, Cranswick NE, et al. Prevention and
treatment of infant and childhood vitamin D deficiency in Australia and New Zealand: a
consensus statement. Medical Journal of Australia 185(5) 2006: 268-72.
Vitamin D deficiency has re-emerged as a significant paediatric health issue, with complications
including hypocalcaemic seizures, rickets, limb pain and fracture. A major risk factor for infants is
maternal vitamin D deficiency. For older infants and children, risk factors include dark skin colour,
cultural practices, prolonged breastfeeding, restricted sun exposure and certain medical conditions. To
prevent vitamin D deficiency in infants, pregnant women, especially those who are dark-skinned or
veiled, should be screened and treated for vitamin D deficiency, and breastfed infants of dark-skinned or
veiled women should be supplemented with vitamin D for the first 12 months of life. Regular sunlight
exposure can prevent vitamin D deficiency, but the safe exposure time for children is unknown. To
prevent vitamin D deficiency, at-risk children should receive 400 IU vitamin D daily; if compliance is poor,
an annual dose of 150,000 IU may be considered. Treatment of vitamin D deficiency involves giving
ergocalciferol or cholecalciferol for 3 months (1000 IU/day if < 1 month of age; 3000 IU/day if 1-12
months of age; 5000 IU/day if > 12 months of age). High-dose bolus therapy (300,000-500,000 IU)
should be considered for children over 12 months of age if compliance or absorption issues are
suspected.
Parashar UD, Alexander JP, Glass RI, Advisory Committee on Immunization Practices (ACIP),
Centers for Disease Control and Prevention. Prevention of rotavirus gastroenteritis among infants
and children. Recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR
Recomm
Rep
55(RR-12)
2006:
1-13.
URL:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5512a1.htm [last accessed: 05 October 2006].
Back to the Contents page
12
Carsten Mandt, Clinical Librarian, NHSGGC, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
C. Guidelines Implementation
Hill SL, Small N. Differentiating between research, audit and quality improvements: governance
implications. Clinical Governance: An International Journal. 11(2) 2006: 98-107.
Purpose-In the context of changes in the priority given to ensuring that health care is evidence-based,
and that service quality should be maximised, there is a new emphasis on quality improvement
programmes in the UK National Health Service (NHS). It is not clear how far these programmes can be
categorised using the paradigms of research and audit. Making a distinction between what constitutes
audit, quality improvement and research is important in the context of enhanced clinical and research
governance requirements and in an environment of both sensitivity in relation to the ethics of research
and concern about the efficacy of ethics committees. This study aims to address this issue.,
Design/methodology/approach-This article reviews the literature on how quality improvement differs from
audit and research. It considers different ways of considering ethics in research and questions how far
one can rely on professional judgement as an alternative to formal ethics committee procedures. The
factors that characterise different sorts of activity are reworked to enable a template to be devised. The
template, presented in the form of a flow-chart, enables health care workers to better categorise a variety
of activities and highlights the necessary procedural requirements that follow., Findings-Key factors are
identified in the existing literature that help differentiate between quality improvement, audit and
research. These factors range from intent in undertaking the activity, through sample/site selection,
choice of methodology, analysis, patterns and speed of dissemination., Originality/value-If quality
improvement is to continue to be a central theme in the NHS agenda, it is important that both the Central
Office for Ethical Review and NHS organisations review the categorisation system to include quality
improvement in their clinical effectiveness structures.
Hill IR. State of the art of guidelines. Forensic Science International 159(SUPPL. 1) 2006: S1-S5.
Guidelines have existed in medicine for many centuries. Galen's doctrine of laudable pus sent many to
an early grave, but variance in treatment put the practitioner in a difficult position, especially if all did not
go well. Currently, guidelines proliferate, allegedly based upon careful evaluation of evidence culled from
a variety of sources. However, obedience to guidelines is variable internationally and nationally, thus
raising questions about their enforceability. They are, of course, not legally enforceable, but courts may
be influenced by them, and variation must be evidence-based. Guidelines cannot logically be regarded
as being set in stone; if that were the case, then there could be no innovation and medicine would not
advance.
Maddock A, Kralik D, Smith J. Clinical Governance improvement initiatives in community
nursing. Clinical Governance: an International Journal 11(3) 2006: 198-212. URL:
Purpose - The purpose of this paper is to describe a clinical governance framework applied in a
community nursing setting. Significant opportunities for improving quality and safety of clinical practice
through
clinical
governance
within a
community-nursing
organisation
are identified.
Design/methodology/approach - The intention in this paper is to achieve quality client outcomes by
translating a clinical governance framework into the day-to-day practice and processes of all staff, and
by developing a system of leadership that supports improvement as a fundamental part of organisational
processes. Findings - The paper finds that a comprehensive project plan was developed which involved
six interrelated steps or stages that would serve as indicators of project progress. Research
limitations/implications - In the paper, the organisation continues down the journey of implementing a
comprehensive clinical governance framework over a five-year implementation plan. Originality/value The paper shows that the improvement plan offers many exciting challenges for the organisation over
the coming years.
McClure JS. What it means to follow a guideline. Journal of the National Comprehensive Cancer
Network 4(7) 2006: 641-643.
Pilling S, Price K. Developing and implementing clinical guidelines: lessons from the NICE
schizophrenia guideline. Epidemiologia e Psichiatria Sociale 15(2) 2006: 109-16.
This paper describes the development of the clinical practice guideline on schizophrenia from the
13
Carsten Mandt, Clinical Librarian, NHSGGC, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
National Institute for Clinical Excellence (NICE) and outlines its main recommendations. It reviews the
evidence on effective implementation of guidelines generally and examines issues specific to the
schizophrenia guideline. It describes NICE's approach to supporting implementation alongside that
developed by the National Collaborating Centre for Mental Health (NCCMH) and looks at local
implementation examples for schizophrenia. The paper highlights key considerations for the forthcoming
revision of the NICE schizophrenia guideline. It makes recommendations concerning the scope of the
guideline and the quality and type of data available to the guideline developers: the lack of data on
outcomes such as quality of life and social functioning, the challenges presented by unpublished papers
and areas where evidence is limited. Since publication of the schizophrenia guideline, the NICE
development process has undergone significant methodological improvements. The grading of evidence
has been refined and more recently NICE proposed that grading of recommendations be dropped.
Consensus methods are increasingly and more effectively used to deal with areas where the evidencebase is limited. NICE and the NCCMH have developed a more implementation-ready range of guideline
products. The initial NICE guideline on schizophrenia was positively received nationally and
internationally. This paper highlights challenges that will be involved in updating the guideline and ways
to refine the methodology of development. Ultimately the impact of the guideline will be measured not in
its methodological rigor but in how its successful implementation improves patient care.
Roberts WD. Clinical practice guideline-related knowledge representation models and
comprehension-generated inferences of nurse practitioners and physicians at varying levels of
expertise. Dissertation Abstracts International: Section B: The Sciences and Engineering 66(12-B)
2006: 6531.
Clinical practice guidelines (CPGs) are intended to provide evidence-based knowledge for decision
making for patient care. However, these guidelines have been poorly adopted by healthcare providers.
One reason for this may be the static paper-based formats, isolated from the point of care. Biomedical
informatics has provided a solution to this limitation through Computer Interpretable Guidelines (CIGs).
An essential component of this process is CPG translation to a computer-interpretable model;
comprehension of the CPG is a prerequisite to this process. Although physicians and Advanced Practice
Nurses (APNs) are both CPG users, in the guideline modeling literature, the CPG translators are
typically physicians, suggesting that the models reflect physician comprehension of CPGs. It is not
known if APNs and physicians comprehend CPGs similarly and whether CPG comprehension varies by
level of expertise. Therefore, this descriptive study utilized novice and expert APN and physician
participants (n=12) using a CPG for screening for and treating tobacco use and dependence for a
simulated patient task to determine if the comprehended CPG-related knowledge content and structure
differed by discipline or by level of expertise (novice and expert). Methods. After gathering demographic
data from each participant, Think Aloud technique was employed to obtain verbal protocols as data. This
data set was derived as the participant was thinking aloud while using the study CPG to plan care for a
simulated patient. After planning the simulated patient's care, each participant drew a representative
model of the study CPG from recall. Methods of analysis for the verbal protocol data set included
protocol, discourse, and content analyses. Structural and content analyses were employed for the
examination of the recalled drawings. Results. The results of this study are derived from the examination
of comprehension activity types, comprehension-generated inferences of knowledge content and
structure made during the study task, and recall of the study CPG knowledge content and structure after
completing the study task. The results indicate similarities and differences in the comprehension of the
study CPG between the participants, grouped by discipline and level of expertise. The disciplines
similarly employed types of comprehension activities during the study task. The disciplines differed in
their comprehension-generated inferences of knowledge content; the physicians inferred more content
during the study task.
Watson J, Hockley J, Dewar J. Barriers to implementing an integrated care pathway for the last
days of life in nursing homes. International Journal of Palliative Nursing. 12(5) 2006: 234-40.
Back to the Contents page
14
Carsten Mandt, Clinical Librarian, NHSGGC, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].