Download A. UK Guidelines - NHS Greater Glasgow and Clyde

NHS Greater Glasgow and Clyde
- Clinical Librarian -
NHSGGC Guidelines Newsletter
May 2007
Welcome to the NHS GG&C 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
General Primary Health Care ……………………………………………………………………………….
Cardiovascular Health
……………………………………………………………………………….
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. 3
p. 3
p. 3
p. 3
B. International Guidelines ………………………………………………………………………………………….
p. 4
1.
2.
3.
4.
5.
6.
7.
1.
2.
3.
4.
5.
6.
7.
General Primary Health Care ……………………………………………………………………………….
Cardiovascular Health
……………………………………………………………………………….
Cancer Care/Palliative Care
…………………………………………………………………….
Mental Health and Learning Disabilities …………………………………………………………………….
Dentistry
………………………………………………………………………………………….
Sexual Health, BBV and related Topics …………………………………………………………………….
Child Health
………………………………………………………………………………………….
C. Guidelines Implementation ……………………………………………………………………………………….
p. 4
p. 10
p. 10
p. 14
p. 16
p. 16
p. 18
p. 19
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 a document request form and send it to your local NHS library.
1
Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
A. UK Guidelines
General Primary Health Care
Baglin TP, Cousins D, Keeling DM, Perry DJ, Watson HG. Recommendations from the British
Committee for Standards in Haematology and National Patient Safety Agency. British Journal of
Haematology 136(1) 2007: 26-9.
National Institute for Cinical and Healthcare Excellence (NICE). Workplace smoking. London: NICE,
2007. URL: http://guidance.nice.org.uk/PHI5 [last accessed: 02 May 2007].
National Library for Health. Clinical Knowledge Summaries. Angio-oedema and Anaphylaxis. NLH,
2007. URL: http://www.cks.library.nhs.uk/angio_oedema_and_anaphylaxis [last accessed: 02 May
2007].
National Library for Health. Clinical Knowledge Summaries. Head lice. NLH, 2007. URL:
http://www.cks.library.nhs.uk/head_lice [last accessed: 02 May 2007].
National Library for Health. Clinical Knowledge Summaries. Insect Bites and Stings. NLH, 2007.
URL: http://www.cks.library.nhs.uk/insect_bites_and_stings [last accessed: 02 May 2007].
National Library for Health. Clinical Knowledge Summaries. Urticaria. NLH, 2007. URL:
http://www.cks.library.nhs.uk/urticaria [last accessed: 02 May 2007].
Back to the Contents page
Cardiovascular Health
Sargazi M, Neithercut D. Criteria for considering people at risk for cardiovascular disease
prevention; guidelines of the Joint British Societies of cardiovascular disease in clinical
practice [1]. Annals of Clinical Biochemistry 44(2) 2007.
Back to the Contents page
Cancer Care/Palliative Care
National Library for Health. Clinical Knowledge Summaries. Palliative cancer care - oral problems.
NLH, 2007. URL: http://www.cks.library.nhs.uk/palliative_cancer_care_oral [last accessed: 02 May
2007].
Back to the Contents page
2
Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
Mental Health and Learning Disabilities
National Institute for Cinical and Healthcare Excellence (NICE). Anxiety: management of anxiety
(panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in
primary, secondary and community care. Update. London: NICE, 2007. URL:
http://guidance.nice.org.uk/CG22 [last accessed: 02 May 2007].
National Institute for Cinical and Healthcare Excellence (NICE). Depression: management of
depression in primary and secondary care - NICE guidance. Update. London: NICE, 2007. URL:
http://guidance.nice.org.uk/CG23 [last accessed: 02 May 2007].
Back to the Contents page
Dentistry
No relevant new guidance was published this month.
Back to the Contents page
Sexual Health, BBV and related Topics
No relevant new guidance was published this month.
Back to the Contents page
Child Health
No relevant new guidance was published this month.
Back to the Contents page
3
Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
B. International Guidelines
General Primary Health Care
Ades L, Group CCGW. Guidelines for the diagnosis and management of Marfan syndrome.
Heart, Lung & Circulation 16(1) 2007: 28-30.
AGA Institute. AGA Institute medical position statement on the diagnosis and management of
celiac disease. Gastroenterology 131(6) 2006: 1977-80.
Balague F, Mannion AF, Pellise F, Cedraschi C. Clinical update: low back pain. Lancet 369(9563)
2007: 726-728.
Belmin J, Vellas B, Gillette S, Nourhashemi F, Berrut G, Ferry M, et al. Practical guidelines for the
diagnosis and management of weight loss in Alzheimer's disease: A consensus from
appropriateness ratings of a large expert panel. Journal of Nutrition, Health & Aging 11(1) 2007:
33-37.
Background: Weight loss is a frequent condition in Alzheimer's disease patients and is responsible for
complications and impaired quality of life. Practical guidelines for the diagnosis and management of
weight loss in Alzheimer's disease are lacking. Aim: To elaborate practical guidelines for the diagnosis
and management of weight loss in Alzheimer's disease. Methods: Following a literature review, a set of
statements about weight loss in Alzheimer's disease were proposed to a 23-member nationwide expert
panel drawn from French geriatricians selected by the organisation committee. Statements were
discussed and modified with the experts during a meeting and modified according to their remarks. By
the means of a postal questionnaire each expert was then asked to rate each statement on a 9-point
appropriateness scale, 1 being highly inappropriate and 9 highly appropriate. Analysis was based on the
median and the range of the ratings. To avoid the influence of extreme or atypical opinions, the two
ratings the furthest from the median were excluded from analysis for each statement.
Agreement/disagreement about the statements was determined using the RAND/UCLA methodology.
Results: Of the 23 statements selected by the expert panel and submitted for rating, 17 obtained the
agreement of the expert panel. Practical guidelines were produced from these 17 statements.
Conclusion: These expert panel ratings, based on the best evidence currently available, provide
comprehensive guidelines to appropriately diagnose, manage and prevent weight loss in Alzheimer's
disease.
Billiard M, Bassetti C, Dauvilliers Y, Dolenc-Groselj L, Lammers GJ, Mayer G, et al. EFNS guidelines
on management of narcolepsy. European Journal of Neurology 13(10) 2006: 1035-1048.
Management of narcolepsy with or without cataplexy relies on several classes of drugs, namely
stimulants for excessive daytime sleepiness and irresistible episodes of sleep, antidepressants for
cataplexy and hypnosedative drugs for disturbed nocturnal sleep. In addition, behavioral measures can
be of notable value. Guidelines on the management of narcolepsy have already been published.
However contemporary guidelines are necessary given the growing use of modafinil to treat excessive
daytime sleepiness in Europe within the last 5-10 years, and the decreasing need for amphetamines and
amphetamine-like stimulants; the extensive use of new antidepressants in the treatment of cataplexy,
apart from consistent randomized placebo-controlled clinical trials; and the present reemergence of
gamma-hydroxybutyrate under the name sodium oxybate, as a treatment of all major symptoms of
narcolepsy. A task force composed of the leading specialists of narcolepsy in Europe has been
appointed. This task force conducted an extensive review of pharmacological and behavioral trials
available in the literature. All trials were analyzed according to their class evidence. Recommendations
concerning the treatment of each single symptom of narcolepsy as well as general recommendations
were made. Modafinil is the first-line pharmacological treatment of excessive daytime sleepiness and
irresistible episodes of sleep in association with behavioral measures. However, based on several large
randomized controlled trials showing the activity of sodium oxybate, not only on cataplexy but also on
excessive daytime sleepiness and irresistible episodes of sleep, there is a growing practice in the USA to
use it for the later indications. Given the availability of modafinil and methylphenidate, and the forseen
4
Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
registration of sodium oxybate for narcolepsy (including excessive daytime sleepiness, cataplexy,
disturbed nocturnal sleep) in Europe, the place of other compounds will become fairly limited. Since its
recent registration cataplexy sodium oxybate has now become the first-line treatment of cataplexy.
Second-line treatments are antidepressants, either tricyclics or newer antidepressants, the later being
increasingly used these past years despite few or no randomized placebo-controlled clinical trials. As for
disturbed nocturnal sleep the best option is still hypnotics until sodium oxybate is registered for
narcolepsy. The treatments used for narcolepsy, either pharmacological or behavioral, are diverse.
However the quality of the published clinical evidences supporting them varies widely and studies
comparing the efficacy of different substances are lacking. Several treatments are used on an empirical
basis, specially antidepressants for cataplexy, due to the fact that these medications are already used
widely in depressed patients, leaving little motivation from the manufacturers to investigate efficacy in
relatively rare indications. Others, in particular the more recently developed substances, such as
modafinil or sodium oxybate, are evaluated in large randomized placebo-controlled trials. Our objective
was to reinforce the use of those drugs evaluated in randomized placebo-controlled trials and to reach a
consensus, as much as possible, on the use of other available medications.
Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, et al. Interventional techniques:
evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician
10(1) 2007: 7-111.
BACKGROUND: The evidence-based practice guidelines for the management of chronic spinal pain with
interventional techniques were developed to provide recommendations to clinicians in the United States.
OBJECTIVE: To develop evidence-based clinical practice guidelines for interventional techniques in the
diagnosis and treatment of chronic spinal pain, utilizing all types of evidence and to apply an evidencebased approach, with broad representation by specialists from academic and clinical practices. DESIGN:
Study design consisted of formulation of essentials of guidelines and a series of potential evidence
linkages representing conclusions and statements about relationships between clinical interventions and
outcomes. METHODS: The elements of the guideline preparation process included literature searches,
literature synthesis, systematic review, consensus evaluation, open forum presentation, and blinded peer
review. Methodologic quality evaluation criteria utilized included the Agency for Healthcare Research
and Quality (AHRQ) criteria, Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria, and
Cochrane review criteria. The designation of levels of evidence was from Level I (conclusive), Level II
(strong), Level III (moderate), Level IV (limited), to Level V (indeterminate). RESULTS: Among the
diagnostic interventions, the accuracy of facet joint nerve blocks is strong in the diagnosis of lumbar and
cervical facet joint pain, whereas, it is moderate in the diagnosis of thoracic facet joint pain. The
evidence is strong for lumbar discography, whereas, the evidence is limited for cervical and thoracic
discography. The evidence for transforaminal epidural injections or selective nerve root blocks in the
preoperative evaluation of patients with negative or inconclusive imaging studies is moderate. The
evidence for diagnostic sacroiliac joint injections is moderate. The evidence for therapeutic lumbar
intraarticular facet injections is moderate for short-term and long-term improvement, whereas, it is limited
for cervical facet joint injections. The evidence for lumbar and cervical medial branch blocks is moderate.
The evidence for medial branch neurotomy is moderate. The evidence for caudal epidural steroid
injections is strong for short-term relief and moderate for long-term relief in managing chronic low back
and radicular pain, and limited in managing pain of postlumbar laminectomy syndrome. The evidence for
interlaminar epidural steroid injections is strong for short-term relief and limited for long-term relief in
managing lumbar radiculopathy, whereas, for cervical radiculopathy the evidence is moderate. The
evidence for transforaminal epidural steroid injections is strong for short-term and moderate for long-term
improvement in managing lumbar nerve root pain, whereas, it is moderate for cervical nerve root pain
and limited in managing pain secondary to lumbar post laminectomy syndrome and spinal stenosis. The
evidence for percutaneous epidural adhesiolysis is strong. For spinal endoscopic adhesiolysis, the
evidence is strong for short-term relief and moderate for long-term relief. For sacroiliac intraarticular
injections, the evidence is moderate for short-term relief and limited for long-term relief. The evidence for
radiofrequency neurotomy for sacroiliac joint pain is limited.The evidence for intradiscal electrothermal
therapy is moderate in managing chronic discogenic low back pain, whereas for annuloplasty the
evidence is limited. Among the various techniques utilized for percutaneous disc decompression, the
evidence is moderate for short-term and limited for long-term relief for automated percutaneous lumbar
discectomy, and percutaneous laser discectomy, whereas it is limited for nucleoplasty and for
DeKompressor technology. For vertebral augmentation procedures, the evidence is moderate for both
vertebroplasty and kyphoplasty. The evidence for spinal cord stimulation in failed back surgery syndrome
and complex regional pain syndrome is strong for short-term relief and moderate for long-term relief. The
evidence for implantable intrathecal infusion systems is strong for short-term relief and moderate for
long-term relief. CONCLUSION: These guidelines include the evaluation of evidence for diagnostic and
therapeutic procedures in managing chronic spinal pain and recommendations for managing spinal pain.
However, these guidelines do not constitute inflexible treatment recommendations. These guidelines
also do not represent a "standard of care."
5
Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
Cano SJ, Thompson AJ, Bhatia K, Fitzpatrick R, Warner TT, Hobart JC. Evidence-based guidelines
for using the short form 36 in cervical dystonia. Movement Disorders 22(1) 2007: 122-126.
We aimed to provide evidence-based guidelines for using the Short Form 36 (SF-36) as an outcome
measure in cervical dystonia (CD). To do this, we tested the hypothesized relationships between items,
scales, and summary measures of the SF-36 using psychometric analyses in data from a postal survey
of 235 people with CD. Although the majority of subscales performed adequately, the Role Physical and
Role Emotional subscales had substantial floor and/or ceiling effects. Evidence did not support
computing SF-36 Physical and Mental Component Summary scores. We propose guidelines that include
the recommendation that these subscale and summary scores should be reported with caution.
Chyka PA, Erdman AR, Christianson G, Wax PM, Booze LL, Manoguerra AS, et al. Salicylate
poisoning: an evidence-based consensus guideline for out-of-hospital management. Clinical
Toxicology: The Official Journal of the American Academy of Clinical Toxicology & European
Association of Poisons Centres & Clinical Toxicologists 45(2) 2007: 95-131.
A review of U.S. poison center data for 2004 showed over 40,000 exposures to salicylate-containing
products. A guideline that determines the conditions for emergency department referral and pre-hospital
care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce
health care costs, and reduce life disruption for patients and caregivers. An evidence-based expert
consensus process was used to create the guideline. Relevant articles were abstracted by a trained
physician researcher. The first draft of the guideline was created by the lead author. The entire panel
discussed and refined the guideline before distribution to secondary reviewers for comment. The panel
then made changes based on the secondary review comments. The objective of this guideline is to
assist poison center personnel in the appropriate out-of-hospital triage and initial out-of-hospital
management of patients with a suspected exposure to salicylates by 1) describing the process by which
a specialist in poison information should evaluate an exposure to salicylates, 2) identifying the key
decision elements in managing cases of salicylate exposure, 3) providing clear and practical
recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This
guideline is based on an assessment of current scientific and clinical information. The expert consensus
panel recognizes that specific patient care decisions may be at variance with this guideline and are the
prerogative of the patient and the health professionals providing care, considering all of the
circumstances involved. This guideline does not substitute for clinical judgment. Recommendations are
in chronological order of likely clinical use. The grade of recommendation is in parentheses: 1) Patients
with stated or suspected self-harm or who are the victims of a potentially malicious administration of a
salicylate, should be referred to an emergency department immediately. This referral should be guided
by local poison center procedures. In general, this should occur regardless of the dose reported (Grade
D). 2) The presence of typical symptoms of salicylate toxicity such as hematemesis, tachypnea,
hyperpnea, dyspnea, tinnitus, deafness, lethargy, seizures, unexplained lethargy, or confusion warrants
referral to an emergency department for evaluation (Grade C). 3) Patients who exhibit typical symptoms
of salicylate toxicity or nonspecific symptoms such as unexplained lethargy, confusion, or dyspnea,
which could indicate the development of chronic salicylate toxicity, should be referred to an emergency
department (Grade C). 4) Patients without evidence of self-harm should have further evaluation,
including determination of the dose, time of ingestion, presence of symptoms, history of other medical
conditions, and the presence of co-ingestants. The acute ingestion of more than 150 mg/kg or 6.5 g of
aspirin equivalent, whichever is less, warrants referral to an emergency department. Ingestion of greater
than a lick or taste of oil of wintergreen (98% methyl salicylate) by children under 6 years of age and
more than 4 mL of oil of wintergreen by patients 6 years of age and older could cause systemic salicylate
toxicity and warrants referral to an emergency department (Grade C). 5) Do not induce emesis for
ingestions of salicylates (Grade D). 6) Consider the out-of-hospital administration of activated charcoal
for acute ingestions of a toxic dose if it is immediately available, no contraindications are present, the
patient is not vomiting, and local guidelines for its out-of-hospital use are observed. However, do not
delay transportation in order to administer activated charcoal (Grade D). 7) Women in the last trimester
of pregnancy who ingest below the dose for emergency department referral and do not have other
referral conditions should be directed to their primary care physician, obstetrician, or a non-emergent
health care facility for evaluation of maternal and fetal risk. Routine referral to an emergency department
for immediate care is not required (Grade C). 8) For asymptomatic patients with dermal exposures to
methyl salicylate or salicylic acid, the skin should be thoroughly washed with soap and water and the
patient can be observed at home for development of symptoms (Grade C). 9) For patients with an ocular
exposure of methyl salicylate or salicylic acid, the eye(s) should be irrigated with room-temperature tap
water for 15 minutes. If after irrigation the patient is having pain, decreased visual acuity, or persistent
irritation, referral for an ophthalmological examination is indicated (Grade D). 10) Poison centers should
6
Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
monitor the onset of symptoms whenever possible by conducting follow-up calls at periodic intervals for
approximately 12 hours after ingestion of non-enteric-coated salicylate products, and for approximately
24 hours after the ingestion of enteric-coated aspirin (Grade C).
Delpero W, Beiko G, Casey R, Ells A, Kertes P, Molgat Y, et al. Canadian ophthalmological society
evidence-based clinical practice guidelines for the periodic eye examination in adults in
Canada. Canadian Journal of Ophthalmology 42(1) 2007.
Diener HC, Allenberg JR, Bode C, Busse O, Forsting M, Grau AJ, et al. Recommendations of the
German Neurological Society and the German Stroke Society for Primary and Secondary
Stroke Prevention: Update 2007. Aktuelle Neurologie 34(1) 2007: 8-12.
In 2005 the German Neurological Society and the German Stroke Society published recommendations
for the primary and secondary prevention of stroke. In the meantime the results from many randomised
trials became available. This leads to the necessity to update the recommendations.
Fitch MT, van de Beek D. Emergency diagnosis and treatment of adult meningitis. The Lancet
Infectious Diseases 7(3) 2007: 191-200.
Despite the existence of antibiotic therapies against acute bacterial meningitis, patients with the disease
continue to suffer significant morbidity and mortality in both high and low-income countries. Dilemmas
exist for emergency medicine and primary-care providers who need to accurately diagnose patients with
bacterial meningitis and then rapidly administer antibiotics and adjunctive therapies for this lifethreatening disease. Physical examination may not perform well enough to accurately identify patients
with meningitis, and traditionally described lumbar puncture results for viral and bacterial disease cannot
always predict bacterial meningitis. Results from recent studies have implications for current treatment
guidelines for adults with suspected bacterial meningitis, and it is important that physicians who
prescribe the initial doses of antibiotics in an emergency setting are aware of guidelines for antibiotics
and adjunctive steroids. We present an overview and discussion of key diagnostic and therapeutic
decisions in the emergency evaluation and treatment of adults with suspected bacterial meningitis.
Holohan V, Deenadayalan Y, Grimmer K. Evidence-based physiotherapy for acute low back pain:
a composite clinical algorithm synthesized from seven recent clinical guidelines... including
commentary by Spadoni G. Physiotherapy Canada. 58(4) 2006: 280-90. (33 ref).
PURPOSE:To produce a composite evidence-based treatment algorithm for physiotherapy management
of acute low back pain (LBP) using current, high-quality, English-language clinical
guidelines.METHODS:A systematic literature review of library databases and Internet search engines
was performed to identify full-text, English-language clinical guidelines on the physiotherapy treatment of
acute LBP. Quality assessment of the guidelines was undertaken by two independent reviewers using
the AGREE instrument. Guideline recommendations were synthesized into interventions that were
supported by strong, moderate or weak evidence. A composite clinical algorithm for physiotherapy
management of acute LBP was developed.RESULTS:Seven guidelines were included. Keeping active,
written patient education, manipulation and referral to a spine specialist had strong supporting evidence
for the management of acute non-radiating LBP. There were a large number of treatment options with
moderate or inconclusive evidence. Bed rest and massage, as stand-alone treatments, had strong
evidence of harm for patients with acute non-radiating LBP.CONCLUSIONS:Based on current evidence,
a composite algorithm was constructed to assist physiotherapists when making treatment decisions for
acute LBP. A synthesis of current clinical guideline recommendations provides physiotherapists with
readily interpretable guidance for the management of acute LBP and encourages the uptake of bestevidence treatment options.
Institute for Clinical Systems Improvement (ICSI). Chronic obstructive pulmonary disease.
Bloomington:
ICSI,
2007.
URL:
http://www.icsi.org/guidelines_and_more/guidelines__order_sets___protocols/respiratory/chronic_obst
ructive_pulmonary_disease/chronic_obstructive_pulmonary_disease__guideline_.html [last accessed:
02 May 2007].
Institute for Clinical Systems Improvement (ICSI). Palliative Care. Bloomington: ICSI, 2007. URL:
http://www.icsi.org/guidelines_and_more/guidelines__order_sets___protocols/other_health_care_con
7
Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
ditions/palliative_care/palliative_care_11875.html [last accessed: 02 May 2007].
Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of respiratory illness in
children
and
adults.
Bloomington:
ICSI,
2007.
URL:
http://www.icsi.org/guidelines_and_more/guidelines__order_sets___protocols/respiratory/respiratory_il
lness_in_children_and_adults__guideline_/respiratory_illness_in_children_and_adults__guideline__1
3110.html [last accessed: 02 May 2007].
Lund JN, Nystrom PO, Coremans G, Herold A, Karaitianos I, Spyrou M, et al. An evidence-based
treatment algorithm for anal fissure. Coloproctology 29(1) 2007: 1-5.
Guidelines for the treatment of anal fissure have been published in the USA and UK but differ. Many
centers follow guidelines based on local experience. In December 2005, we met with the aim of
developing an evidence-based treatment algorithm for anal fissure, applicable to both primary and
secondary care. This algorithm may rationalize the treatment of anal fissure in primary and secondary
care settings.
May A, Leone M, Afra J, Linde M, Sandor PS, Evers S, et al. EFNS guidelines on the treatment of
cluster headache and other trigeminal-autonomic cephalalgias. European Journal of Neurology
13(10) 2006: 1066-1077.
Cluster headache and the other trigeminal-autonomic cephalalgias [paroxysmal hemicrania, short-lasting
unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome] are
rare but very disabling conditions with a major impact on the patient's quality of life. The objective of this
study was to give evidence-based recommendations for the treatment of these headache disorders
based on a literature search and consensus amongst a panel of experts. All available medical reference
systems were screened for any kind of studies on cluster headache, paroxysmal hemicrania and SUNCT
syndrome. The findings in these studies were evaluated according to the recommendations of the
European Federation of Neurological Societies resulting in level A, B or C recommendations and good
practice points. For the acute treatment of cluster headache attacks, oxygen (100%) with a flow of at
least 7 1/min over 15 min and 6 mg subcutaneous sumatriptan are drugs of first choice. Prophylaxis of
cluster headache should be performed with verapamil at a daily dose of at least 240 mg (maximum dose
depends on efficacy or tolerability). Although no class I or II trials are available, steroids are clearly
effective in cluster headache. Therefore, the use of at least 100 mg methylprednisone (or equivalent
corticosteroid) given orally or at up to 500 mg i.v. per day over 5 days (then tapering down) is
recommended. Methysergide, lithium and topiramate are recommended as alternative treatments.
Surgical procedures, although in part promising, require further scientific evaluation. For paroxysmal
hemicranias, indomethacin at a daily dose of up to 225 mg is the drug of choice. For treatment of
SUNCT syndrome, large series suggest that lamotrigine is the most effective preventive agent, with
topiramate and gabapentin also being useful. Intravenous lidocaine may also be helpful as an acute
therapy when patients are extremely distressed and disabled by frequent attacks.
Nichols JH, Christenson RH, Clarke W, Gronowski A, Hammett-Stabler CA, Jacobs E, et al.
Executive summary. The National Academy of Clinical Biochemistry Laboratory Medicine
Practice Guideline: Evidence-based practice for point-of-care testing. Clinica Chimica Acta
379(1-2) 2007: 14-28.
Background: Point-of-care testing (POCT) is clinical laboratory testing conducted close to the site of
patient care. POCT has the potential to provide faster test results and therapeutic intervention with
improved patient outcomes. However, when over-utilized or used inappropriately POCT results can be
misleading and increase healthcare costs. Methods: The National Academy of Clinical Biochemistry
developed evidence-based Laboratory Medicine Practice Guidelines for POCT. Results: These
Laboratory Medicine Practice Guidelines systematically review the scientific literature relating POCT to
clinical outcomes and offer recommendations to improve the clinical utility of POCT. Conclusions: These
guidelines will be useful to clinicians considering the addition of POCT, to those that question current
practices in POCT, and to clinicians seeking evidence-based support for POCT in clinical management.
These guidelines represent the most comprehensive systematic review of the POCT literature to date
and will help define future research that is needed to add to our current POCT knowledge base.
Piche T, Dapoigny M, Bouteloup C, Chassagne P, Coffin B, Desfourneaux V, et al.
Recommendations for clinical practice in the management and treatment of chronic
8
Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
constipation of adults. Gastroenterologie Clinique et Biologique 31(2) 2007: 125-135.
Raterink G. Diabetes update: injectable therapies for type 2 diabetes: practical applications for
older adults with pancreatic failure. Nursing Clinics of North America. 42(1) 2007: 43-57.
The goal of therapy for older adults who have type 2 diabetes and pancreatic failure is to provide the
best management program that meets his/her individual needs and lifestyle. The goals are to maintain
blood sugar control, but more importantly, to prevent complications and to provide the patient with a
better quality of life through a more natural metabolic state. Decisions about when to add insulin to the
regimen, the goals of therapy, what types of insulin to use, and how to monitor response are based on
the pathophysiologic mechanisms, which ensures overall treatment success. The information that
patients gather and record will assist in decisions about therapy that maximize the benefits and eliminate
the problems that patients often experience when therapies are modified without a careful plan.
Rayala HJ, Wagner AA. Pulmonary embolism: new algorithms for diagnosis and treatment.
Contemporary Urology. 19(3) 2007: 30-5. (29 ref).
Pulmonary embolism is a troubling postoperative complication associated with urologic surgery. Recently
refined algorithms can aid in the timely diagnosis and treatment of this potentially life-threatening
condition.
Robert M, Ross S. Conservative Management of Urinary Incontinence. J Obstet Gynaecol Can
28(12) 2006: 1113–1118.
Sennekamp J, Muller-Wening D, Amthor M, Baur X, Bergmann KC, Costabel U, et al. Guidelines for
diagnosing extrinsic allergic alveolitis (hypersensitivity pneumonitis) (German Extrinsic
Allergic Alveolitis Study Group). Pneumologie 61(1) 2007: 52-56.
Strauss JS, Krowchuk DP, Leyden JJ, Lucky AW, Shalita AR, Siegfried EC, et al. Guidelines of care
for acne vulgaris management. Journal of the American Academy of Dermatology 56(4) 2007: 651663.
Disclaimer: Adherence to these guidelines will not ensure successful treatment in every situation.
Furthermore, these guidelines should not be deemed inclusive of all proper methods of care or exclusive
of other methods of care reasonably directed to obtaining the same results. The ultimate judgment
regarding the propriety of any specific therapy must be made by the physician and the patient in light of
all the circumstances presented by the individual patient.
Vignatelli L, Billiard M, Clarenbach P, Garcia-Borreguero D, Kaynak D, Liesiene V, et al. EFNS
guidelines on management of restless legs syndrome and periodic limb movement disorder in
sleep. European Journal of Neurology 13(10) 2006: 1049-1065.
In 2003, the EFNS Task Force was set up for putting forth guidelines for the management of the
Restless Legs Syndrome (RLS) and the Periodic Limb Movement Disorder (PLMD). After determining
the objectives for management and the search strategy for primary and secondary RLS and for PLMD, a
review of the scientific literature up to 2004 was performed for the drug classes and interventions
employed
in
treatment
(drugs
acting
on
the
adrenoreceptor,
antiepileptic
drugs,
benzodiazepines/hypnotics, dopaminergic agents, opioids, other treatments). Previous guidelines were
consulted. All trials were analysed according to class of evidence, and recommendations formed
according to the 2004 EFNS criteria for rating. Dopaminergic agents came out as having the best
evidence for efficacy in primary RLS. Reported adverse events were usually mild and reversible;
augmentation was a feature with dopaminergic agents. No controlled trials were available for RLS in
children and for RLS during pregnancy. The following level A recommendations can be offered: for
primary RLS, cabergoline, gabapentin, pergolide, ropinirole, levodopa and rotigotine by transdermal
delivery (the latter two for short-term use) are effective in relieving the symptoms. Transdermal oestradiol
is ineffective for PLMD.
Back to the Contents page
9
Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
Cardiovascular Health
Arnold JMO, Howlett JG, Dorian P, Ducharme A, Giannetti N, Haddad H, et al. Canadian
Cardiovascular Society Consensus Conference recommendations on heart failure update 2007:
Prevention, management during intercurrent illness or acute decompensation, and use of
biomarkers. Canadian Journal of Cardiology 23(1) 2007: 21-45.
Heart failure is common, yet it is difficult to treat. It presents in many different guises and circumstances
in which therapy needs to be individualized. The Canadian Cardiovascular Society published a
comprehensive set of recommendations in January 2006 on the diagnosis and management of heart
failure, and the present update builds on those core recommendations. Based on feedback obtained
through a national program of heart failure workshops during 2006, several topics were identified as
priorities because of the challenges they pose to health care professionals. New evidence-based
recommendations were developed using the structured approach for the review and assessment of
evidence adopted and previously described by the Society. Specific recommendations and practical tips
were written for the prevention of heart failure, the management of heart failure during intercurrent
illness, the treatment of acute heart failure, and the current and future roles of biomarkers in heart failure
care. Specific clinical questions that are addressed include: which patients should be identified as being
at high risk of developing heart failure and which interventions should be used? What complications can
occur in heart failure patients during an intercurrent illness, how should these patients be monitored and
which medications may require a dose adjustment or discontinuation? What are the best therapeutic,
both drug and nondrug, strategies for patients with acute heart failure? How can new biomarkers help in
the treatment of heart failure, and when and how should BNP be measured in heart failure patients? The
goals of the present update are to translate best evidence into practice, to apply clinical wisdom where
evidence for specific strategies is weaker, and to aid physicians and other health care providers to
optimally treat heart failure patients to result in a measurable impact on patient health and clinical
outcomes in Canada.
Fatkin D, Group CCGW. Guidelines for the diagnosis and management of familial dilated
cardiomyopathy. Heart, Lung & Circulation 16(1) 2007: 19-21.
Ryden L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, de Boer MJ, et al. Guidelines on
diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The Task Force on
Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the
European Association for the Study of Diabetes (EASD). European Heart Journal 28(1) 2007: 88136.
Skinner JR, Group CCGW. Guidelines for the diagnosis and management of familial long QT
syndrome. Heart, Lung & Circulation 16(1) 2007: 22-4
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Cancer Care/Palliative Care
Anderson KC, Alsina M, Bensinger W, Biermann JS, Chanan-Khan A, Comenzo RL, et al. Multiple
myeloma: Clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer
Network 5(2) 2007: 118-147.
Although multiple myeloma is sensitive to both chemotherapy and radiation therapy, it remains incurable.
However, treatment algorithms (based on published data and clinical experience) can be developed to
optimize therapy, which include not only therapy for the underlying disease but also supportive therapy
10
Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
to enhance quality of life. These guidelines prominently identify the clinical settings appropriate for
treatment of patients on clinical research protocols.
Anonymous. Clinical guidelines. Routine aspirin or nonsteroidal anti-inflammatory drugs for the
primary prevention of colorectal cancer: U.S. Preventive Services Task Force recommendation
statement. Annals of Internal Medicine. 146(5) 2007: 361-4, I35. (33 ref).
This statement summarizes the U.S. Preventive Services Task Force (USPSTF) recommendation and
supporting scientific evidence on routine use of aspirin or nonsteroidal anti-inflammatory drugs for the
primary prevention of colorectal cancer. The complete information on which this statement is based,
including evidence tables and references, is available in the accompanying articles in this issue and on
the USPSTF Web site (http://www.preventiveservices.ahrq.gov). The USPSTF is redesigning its
recommendation statement in response to feedback from primary care clinicians. The USPSTF plans to
release, later in 2007, a new, updated recommendation statement that is easier to read and incorporates
advances in USPSTF methodology. The recommendation statement below is an interim version that
combines existing language and elements with a new format. Although the definitions of grades remain
the same, other elements have been revised.
Body JJ, Coleman R, Clezardin P, Ripamonti C, Rizzoli R, Aapro M. International society of
geriatric oncology (SIOG) clinical practice recommendations for the use of bisphosphonates in
elderly patients. European Journal of Cancer 43(5) 2007: 852-858.
A society of geriatric oncology (SIOG) task force reviewed information from the literature (in PubMed) on
bisphosphonates in elderly patients with bone metastases until December 2005. Additional pertinent
data were obtained from the manufacturers. Bisphosphonates are recommended in the elderly with bone
metastases to prevent skeletal-related events. Intravenous formulations are preferred for the treatment
of hypercalcaemia. It has been recognised that zoledronic acid, ibandronate and pamidronate can
effectively contribute in relieving metastatic bone pain. Creatinine clearance should be monitored in
every patient, and a less renally toxic agent should be used where evidence of similar efficacy is
available. The assessment and optimisation of hydration status is recommended. Due to the risk from
osteonecrosis of the jaw, routine oral examination and treatment of dental problems by a dental team is
recommended before bisphosphonates. Physicians should choose the most appropriate
bisphosphonate. Safety precautions are particularly important in elderly patients. Further research is
needed in this population.
Braathen LR, Szeimies RM, Basset-Seguin N, Bissonnette R, Foley P, Pariser D, et al. Guidelines on
the use of photodynamic therapy for nonmelanoma skin cancer: an international consensus.
International Society for Photodynamic Therapy in Dermatology, 2005. Journal of the American
Academy of Dermatology 56(1) 2007: 125-43.
Topical photodynamic therapy (PDT) is used to treat nonmelanoma skin cancers, such as actinic
keratoses, Bowen's disease, and basal cell carcinoma (superficial and nodular). This article presents upto-date, practical, evidence-based recommendations on the use of topical PDT using 5-aminolevulinic
acid or methyl aminolevulinate for the treatment (and prevention) of nonmelanoma skin cancers. A
systematic literature review was conducted (using MEDLINE), and recommendations were made on the
basis of the quality of evidence for efficacy, safety/tolerability, cosmetic outcome, and patient
satisfaction/preference. Topical PDT is highly effective in the treatment of actinic keratoses, Bowen's
disease, superficial and thin nodular basal cell carcinomas, with cosmesis typically superior to that
achieved with existing standard therapies. PDT may also be a means of preventing certain
nonmelanoma skin cancers in immunosuppressed patients.
Butler CT. Pediatric skin care: guidelines for assessment, prevention, and treatment. Pediatric
Nursing. 32(5) 2006: 443-50, 452-4.
The review of literature suggests the pediatric population is at risk for skin breakdown and therefore
pressure ulcer development. The literature reveals limited information on pediatric skin care issues in
comparison to the adult population. The prevention and treatment of pressure ulcers and maintenance of
skin integrity in the pediatric population often is not a high priority especially in the critically ill child.
Research has demonstrated that children differ from adults in the anatomical sites of skin breakdown;
however, treatment remains the same. It is important to have an understanding of the underlying
physiology of ulcer formation, the factors responsible for ulcer development, and the factors that put
11
Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
infants and children at risk for developing pressure ulcers. Accurate assessment, documentation,
prevention, and treatment are all key factors.
Carlson RW, Anderson BO, Burstein HJ, Carter WB, Edge SB, Farrar WB, et al. The NCCN. Invasive
breast cancer: Clinical practice guidelines in oncology. Journal of the National Comprehensive
Cancer Network 5(3) 2007: 246-312.
The therapeutic options for patients with noninvasive or invasive breast cancer are complex and varied.
In many situations, the patient and physician are responsible for jointly exploring and selecting the most
appropriate option from among the available alternatives. With rare exceptions, the evaluation,
treatment, and follow-up recommendations in these guidelines are based on the results of past and
present clinical trials. However, not a single clinical situation exists in which the treatment of breast
cancer has been optimized with respect to either maximizing cure or minimizing toxicity and
disfigurement. Therefore, patient and physician participation in prospective clinical trials allows patients
to not only receive state-of-the-art cancer treatment but also contribute to improving the treatment of
future patients.
Crawford J, Althaus B, Armitage J, Balducci L, Bennett C, Blayney DW, et al. Myeloid growth
factors: Clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer
Network 5(2) 2007: 188-202.
Chemotherapy-induced neutropenia can cause complications that result in dose reductions or treatment
delays that can, in turn, compromise clinical outcomes. Although the prophylactic use of colonystimulating factors (CSFs) can reduce the risk, severity, and duration of severe and febrile neutropenia,
they are not routinely administered to all patients undergoing myelosuppressive chemotherapy because
of the costs. Selective use may, however, enhance their cost-effectiveness. These guidelines discuss
the preventative or prophylactic use of recombinant human granulocyte-CSF to reduce the incidence,
length, and severity of chemotherapy-related neutropenia and and prevent life-threatening complications.
Henry DH. Guidelines and recommendations for the management of anaemia in patients with
lymphoid malignancies. Drugs 67(2) 2007: 175-194.
Patients with lymphoid malignancies frequently require repetitive and intensive anticancer treatments to
induce and maintain disease remission. Anaemia (haemoglobin [Hb] <12 g/dL) is a common and
debilitating problem associated with both the malignancy itself and its treatment burden. Anaemia
negatively impacts on all aspects of patient quality of life (QOL) and treatment outcomes and survival,
particularly in this disease setting. Widely acknowledged goals of anaemia treatment include Hb
correction to ~12 g/dL, reduction in transfusion requirements and optimisation of patient QOL. Since the
introduction of recombinant human erythropoietic therapy, transfusion (once the only anaemia treatment
option available) is now primarily reserved for non-responders or those with severe or life-threatening
anaemia. Data from randomised, double-blind, placebo-controlled studies, and large, non-randomised,
open-label, community-based studies, along with almost 15 years of practical experience, support the
assertion that epoetin alfa administered at a dosage of 150-300 U/kg three times weekly or 40 000-60
000U once weekly, both of which are US FDA-approved dose administration schedules, can effectively
and safely achieve anaemia treatment goals for the majority of patients with lymphoid malignancies.
Data and practical experience collected over the last 5 years on another erythropoietic agent with a
slightly longer half-life but lower binding affinity, darbepoetin alfa, show that this agent when
administered according to the FDA-approved dose administration schedules (2.25-4.5 mug/kg once
weekly or 500mug once every 3 weeks) or according to a commonly-administered dose in clinical
practice (3.0-5.0 mug/kg once every 2 weeks) can also effectively and safely correct anaemia, reduce
transfusion requirements and improve QOL in many patients with lymphoid malignancies. One
comparative head-to-head trial suggested that epoetin alfa might be superior to darbepoetin alfa in
anaemic cancer patients receiving chemotherapy with respect to timing and magnitude of Hb correction,
although further study is necessary, especially concerning optimal dose administration. Alternative dose
administration schedules, such as epoetin alfa 80 000U every 2 weeks from initiation or 80 000U every 3
weeks following initiation with once weekly administration and darbepoetin alfa 4.5 mug/kg every 3
weeks following initiation with once weekly administration, are being actively investigated with the goal of
increased flexibility for patients and healthcare providers. The treatment of anaemia in patients with
lymphoid malignancies is an important part of overall disease management, as evidenced by continuous
investigation of existing erythropoietic agents and new agents. Although treatment guidelines issued by
organisations such as the National Comprehensive Cancer Network (NCCN) and American Society of
Hematology (ASH)/American Society of Clinical Oncology (ASCO) suggest intervention with
12
Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
erythropoietic therapy when Hb falls below 10-11 g/dL or based on clinical symptoms, data suggest that
anaemia is vastly under-recognised and under-treated. Clearly, an update on the definition, identification
and optimal management of anaemia in patients with lymphoid malignancies is warranted.
Keefe DM, Schubert MM, Elting LS, Sonis ST, Epstein JB, Raber-Durlacher JE, et al. Updated
clinical practice guidelines for the prevention and treatment of mucositis. Cancer 109(5) 2007:
820-831.
Considerable progress in research and clinical application has been made since the original guidelines
for managing mucositis in cancer patients were published in 2004, and the first active drug for the
prevention and treatment of this condition has been approved by the United States Food and Drug
Administration and other regulatory agencies in Europe and Australia. These changes necessitate an
updated review of the literature and guidelines. Panel members reviewed the biomedical literature on
mucositis published in English between January 2002 and May 2005 and reached a consensus based
on the criteria of the American Society of Clinical Oncology. Changes in the guidelines included
recommendations for the use of palifermin for oral mucositis associated with stem cell transplantation,
amifostine for radiation proctitis, and cryotherapy for mucositis associated with high-dose melphalan.
Recommendations against specific practices were introduced: Systemic glutamine was not
recommended for the prevention of gastro-intestinal mucositis, and sucralfate and antimicrobial lozenges
were not recommended for radiation-induced oral mucositis. Furthermore, new guidelines suggested that
granulocyte-macrophage-colony stimulating factor mouthwashes not be used for oral mucositis
prevention in the transplantation population. Advances in mucositis treatment and research have been
complemented by an increased rate of publication on mucosal injury in cancer. However, additional and
sustained efforts will be required to gain a fuller understanding of the pathobiology, impact on overall
patient status, optimal therapeutic strategies, and improved educational programs for health
professionals, patients, and caregivers. These efforts are likely to have significant clinical and economic
impact on the treatment of cancer patients.
Macbeth FR, Abratt RP, Cho KH, Stephens RJ, Jeremic B. Lung cancer management in limited
resource settings: Guidelines for appropriate good care. Radiotherapy & Oncology 82(2) 2007:
123-131.
Lung cancer is a major cause of cancer death worldwide and is becoming an increasing problem in
developing countries. It is important that, in countries where health care resources are limited, these
resources are used most effectively and cost-effectively. The authors, with the support of the
International Atomic Energy Agency, drew on existing evidence-based clinical guidelines, published
systematic reviews and meta-analyses, as well as recent research publications, to summarise the
current evidence and to make broad recommendations on the non-surgical treatment of patients with
lung cancer. Tables were constructed which summarise the different treatment options for specific
groups of patients, the increase in resource use for and the likely additional clinical benefit from each
option. These tables can be used to assess the cost-effectiveness and appropriateness of different
interventions in a particular health care system and to develop local clinical guidelines.
McNaught J, Reid RL. Progesterone-Only and Non-Hormonal Contraception in the Breast
Cancer Survivor: Joint Review and Committee Opinion of the Society of Obstetricians and
Gynaecologists of Canada and the Society of Gynecologic Oncologists of Canada. J Obstet
Gynaecol Can 28(616–626) 2006.
Rindi G, De Herder WW, O'Toole D, Wiedenmann B. Consensus guidelines for the management of
patients with digestive neuroendocrine tumors: Why such guidelines and how we went about
it. Neuroendocrinology 84(3) 2006: 155-157.
Rosolowich V. Breast Self-Examination. J Obstet Gynaecol Can 28(8) 2006: 728–730.
Back to the Contents page
13
Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
Mental Health and Learning Disabilities
Adler LA, Barkley RA, Newcorn JH, Spencer TJ, Weiss MD. Managing ADHD in children,
adolescents, and adults with comorbid anxiety. Journal of Clinical Psychiatry 68(3) 2007: 451-462.
Connolly SD, Bernstein GA, Work Group on Quality Issues. Practice parameter for the assessment
and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc
Psychiatry 46(2) 2007: 267-83.
Feldman G. Cognitive and Behavioral Therapies for Depression: Overview, New Directions, and
Practical Recommendations for Dissemination. Psychiatric Clinics of North America 30(1) 2007:
39-50.
Cognitive-behavioral therapy (CBT) is a nonpharmacologic strategy for depression treatment that has
received considerable empirical support. This article provides an overview of the history and core
techniques of CBT and discusses recently developed techniques and augmentations to CBT for
depression. It reviews empirical studies comparing the relative efficacy of CBT and antidepressant
medication as well as their combination. Studies highlighting the relapse-prevention properties of CBT
are reviewed also. The article concludes with a discussion of practical recommendations for integrating
CBT into a depression treatment plan.
Fick D, Mion L, Boltz M. Try this: best practices in nursing care for hospitalized older adults.
Assessing and managing delirium in persons with dementia. SCI Nursing. 23(4) 2006: 2p.
Fiske J, Frenkel H, Griffiths J, Jones V, British Society of G, British Society for D, et al. Guidelines for
the development of local standards of oral health care for people with dementia. Gerodontology
1 2006: 5-32.
McClellan J, Kowatch R, Findling RL, Work Group on Quality Issues. Practice parameter for the
assessment and treatment of children and adolescents with bipolar disorder. J Am Acad Child
Adolesc Psychiatry 46(1) 2007: 107-25.
Nuttin B, Gabriels L, Cosyns P. Guidelines for electrical brain stimulation in psychiatric
disorders. Neuromodulation 10(2) 2007: 183-184.
Parker G, Fletcher K. Treating depression with the evidence-based psychotherapies: A critique
of the evidence. Acta Psychiatrica Scandinavica 115(5) 2007: 352-359.
Objective: While Cognitive Behaviour Therapy (CBT) and Interpersonal Therapy (IPT) have been
positioned as first-line evidence-based treatments for depression, we suggest that limitations to the
'evidence' deserve wider appreciation. Method: A systematic literature search was undertaken, and
limitations to the evidence base discussed. Results: The review suggests that the specificity of CBT and
IPT treatments for depression has yet to be demonstrated and details likely reasons. Conclusion: The
superiority of CBT and IPT may well be able to be demonstrated across defined rather than universal
circumstances. To achieve this aim, outcome research should move away from testing treatments as if
they have universal application for heterogeneous disorder categories. Findings have distinct
implications for the clinical management of depressive disorders, and particularly in relation to the utility
of psychotherapy.
Steiner H, Remsing L, Work Group on Quality Issues. Practice parameter for the assessment and
treatment of children and adolescents with oppositional defiant disorder. J Am Acad Child
Adolesc Psychiatry 46(2) 2007: 126-41.
Trivedi MH, Daly EJ. Measurement-based care for refractory depression: A clinical decision
support model for clinical research and practice. Drug & Alcohol Dependence 88(SUPPL. 2) 2007:
S61-S71.
14
Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
Despite years of antidepressant drug development and patient and provider education, suboptimal
medication dosing and duration of exposure resulting in incomplete remission of symptoms remains the
norm in the treatment of depression. Additionally, since no one treatment is effective for all patients,
optimal implementation focusing on the measurement of symptoms, side effects, and function is
essential to determine effective sequential treatment approaches. There is a need for a paradigm shift in
how clinical decision making is incorporated into clinical practice and for a move away from the trial-anderror approach that currently determines the 'next best' treatment. This paper describes how our
experience with the Texas Medication Algorithm Project (TMAP) and the Sequenced Treatment
Alternatives to Relieve Depression (STAR*D) trial has confirmed the need for easy-to-use clinical
support systems to ensure fidelity to guidelines. To further enhance guideline fidelity, we have developed
an electronic decision support system that provides critical feedback and guidance at the point of patient
care. We believe that a measurement-based care (MBC) approach is essential to any decision support
system, allowing physicians to individualize and adapt decisions about patient care based on symptom
progress, tolerability of medication, and dose optimization. We also believe that successful integration of
sequential algorithms with MBC into real-world clinics will facilitate change that will endure and improve
patient outcomes. Although we use major depression to illustrate our approach, the issues addressed
are applicable to other chronic psychiatric conditions including comorbid depression and substance use
disorder as well as other medical illnesses.
Visser-Vandewalle V. On the edge between movement disorder surgery and psychosurgery:
Guidelines for deep brain stimulation in Tourette syndrome. Neuromodulation 10(2) 2007: 182183.
Winters NC, Pumariga A, Work Group on Community Child and Adolescent Psychiatry, Work Group
on Quality Issues. Practice parameter on child and adolescent mental health care in community
systems of care. J Am Acad Child Adolesc Psychiatry 46(2) 2007: 284-99.
Woolf AD, Erdman AR, Nelson LS, Caravati EM, Cobaugh DJ, Booze LL, et al. Tricyclic
antidepressant poisoning: An evidence-based consensus guideline for out-of-hospital
management. Clinical Toxicology: The Official Journal of the American Academy of Clinical
Toxicology & European Association of Poisons Centres & Clinical Toxicologists 45(3) 2007: 203-233.
A review of U.S. poison center data for 2004 showed over 12,000 exposures to tricyclic antidepressants
(TCAs). A guideline that determines the conditions for emergency department referral and prehospital
care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce
healthcare costs, and reduce life disruption for patients and caregivers. An evidence-based expert
consensus process was used to create the guideline. Relevant articles were abstracted by a trained
physician researcher. The first draft of the guideline was created by the lead author. The entire panel
discussed and refined the guideline before distribution to secondary reviewers for comment. The panel
then made changes based on the secondary review comments. The objective of this guideline is to
assist poison center personnel in the appropriate prehospital triage and management of patients with
suspected ingestions of TCAs by 1) describing the manner in which an ingestion of a TCA might be
managed, 2) identifying the key decision elements in managing cases of TCA ingestion, 3) providing
clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs
for research. This guideline applies to ingestion of TCAs alone. Co-ingestion of additional substances
could require different referral and management recommendations depending on their combined
toxicities. This guideline is based on the assessment of current scientific and clinical information. The
panel recognizes that specific patient care decisions may be at variance with this guideline and are the
prerogative of the patient and the health professionals providing care, considering all the circumstances
involved. This guideline does not substitute for clinical judgment. Recommendations are in chronological
order of likely clinical use. The grade of recommendation is in parentheses. 1) Patients with suspected
self-harm or who are the victims of malicious administration of a TCA should be referred to an
emergency department immediately (Grade D). 2) Patients with acute TCA ingestions who are less than
6 years of age and other patients without evidence of self-harm should have further evaluation including
standard history taking and determination of the presence of co-ingestants (especially other
psychopharmaceutical agents) and underlying exacerbating conditions, such as convulsions or cardiac
arrhythmias. Ingestion of a TCA in combination with other drugs might warrant referral to an emergency
department. The ingestion of a TCA by a patient with significant underlying cardiovascular or
neurological disease should cause referral to an emergency department at a lower dose than for other
individuals. Because of the potential severity of TCA poisoning, transportation by EMS, with close
monitoring of clinical status and vital signs en route, should be considered (Grade D). 3) Patients who
15
Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
are symptomatic (e.g., weak, drowsy, dizzy, tremulous, palpitations) after a TCA ingestion should be
referred to an emergency department (Grade B). 4) Ingestion of either of the following amounts
(whichever is lower) would warrant consideration of referral to an emergency department: an amount
that exceeds the usual maximum single therapeutic dose or an amount equal to or greater than the
lowest reported toxic dose. For all TCAs except desipramine, nortriptyline, trimipramine, and
protriptyline, this dose is >5 mg/kg. For despiramine it is >2.5 mg/kg; for nortriptyline it is >2.5 mg/kg; for
trimipramine it is >2.5 mg/kg; and for protriptyline it is >1 mg/kg. This recommendation applies to both
patients who are naive to the specific TCA and to patients currently taking cyclic antidepressants who
take extra doses, in which case the extra doses should be added to the daily dose taken and then
compared to the threshold dose for referral to an emergency department (Grades B/C). 5) Do not induce
emesis (Grade D). 6) The risk-to-benefit ratio of prehospital activated charcoal for gastrointestinal
decontamination in TCA poisoning is unknown. Prehospital activated charcoal administration, if
available, should only be carried out by health professionals and only if no contraindications are present.
Do not delay transportation in order to administer activated charcoal (Grades B/D). 7) For unintentional
poisonings, asymptomatic patients are unlikely to develop symptoms if the interval between the ingestion
and the initial call to a poison center is greater than 6 hours. These patients do not need referral to an
emergency department facility (Grade C). 8) Follow-up calls to determine the outcome for a TCA
ingestions ideally should be made within 4 hours of the initial call to a poison center and then at
appropriate intervals thereafter based on the clinical judgment of the poison center staff (Grade D). 9) An
ECG or rhythm strip, if available, should be checked during the prehospital assessment of a TCA
overdose patient. A wide-complex arrhythmia with a QRS duration longer than 100 msec is an indicator
that the patient should be immediately stabilized, given sodium bicarbonate if there is a protocol for its
use, and transported to an emergency department (Grade B). 10) Symptomatic patients with TCA
poisoning might require prehospital interventions, such as intravenous fluids, cardiovascular agents, and
respiratory support, in accordance with standard ACLS guidelines (Grade D). 11) Administration of
sodium bicarbonate might be beneficial for patients with severe or life-threatening TCA toxicity if there is
a prehospital protocol for its use (Grades B/D). 12) For TCA-associated convulsions, benzodiazepines
are recommended (Grade D). 13) Flumazenil is not recommended for patients with TCA poisoning
(Grade D).
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Dentistry
No relevant new guidance was published this month.
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Sexual Health, BBV and related Topics
Herring A, Ballard R, Mabey D, Peeling RW, Initiative WTSTDD. Evaluation of rapid diagnostic
tests: syphilis. Nature Reviews. Microbiology. 4(12 Suppl) 2006.
Herring A, Ballard R, Mabey D, Peeling RW, Initiative WTSTDD. Evaluation of rapid diagnostic
tests: chlamydia and gonorrhoea. Nature Reviews. Microbiology. 4(12 Suppl) 2006.
Keena-Lindsay L, Yudin MH. HIV Screening in Pregnancy. J Obstet Gynaecol Can 28(12) 2006:
1103–1107.
McNaught J, Reid RL. Progesterone-Only and Non-Hormonal Contraception in the Breast
Cancer Survivor: Joint Review and Committee Opinion of the Society of Obstetricians and
Gynaecologists of Canada and the Society of Gynecologic Oncologists of Canada. J Obstet
Gynaecol Can 28(616–626) 2006.
New York State Department of Health. Suicidality and violence in patients with HIV/AIDS. New
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Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
York:
New
York
State
Department
of
Health,
2007.
URL:
http://www.hivguidelines.org/GuideLine.aspx?pageID=261&guideLineID=84&vType=txt [last accessed:
02 May 2007].
Practice Committee of the American Society for Reproductive Medicine. Vaccination guidelines for
female infertility patients. Fertility & Sterility 86(5 Suppl) 2006.
Encounters for infertility care are opportunities to assess and update immunization status. Women of
reproductive age are often unaware of their need for immunization, their own immunization status, and
the potentially serious consequences of preventable disease on pregnancy outcome. The purpose of this
ASRM Practice Committee document is to summarize current recommendations regarding vaccinations
for women of reproductive age.
Practice Committee of the American Society for Reproductive Medicine. Vasectomy reversal. Fertility
& Sterility 86(5 Suppl) 2006.
Practice Committee of the American Society for Reproductive Medicine. Optimal evaluation of the
infertile female. Fertility & Sterility 86(5 Suppl) 2006.
Practice Committee of the American Society for Reproductive Medicine. Hepatitis and reproduction.
Fertility & Sterility 86(5 Suppl) 2006.
This bulletin will review the various viral etiologies of hepatitis, their mode of transmission, and
implications for infertile couples, pregnant women, and health care workers. [References: 38]
Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain
associated with endometriosis. Fertility & Sterility 86(5 Suppl) 2006.
Pain associated with endometriosis requires careful evaluation to exclude other potential causes and
may involve a number of different mechanisms. Both medical and surgical treatments for pain related to
endometriosis are effective and choice of treatment must be individualized. [References: 86]
Practice Committee of the American Society for Reproductive Medicine. Ovarian hyperstimulation
syndrome. Fertility & Sterility 86(5 Suppl) 2006.
Practice Committee of the American Society for Reproductive Medicine. Smoking and infertility.
Fertility & Sterility 86(5 Suppl) 2006.
Approximately 30% of reproductive age women and 35% of reproductive age men in the United States
smoke cigarettes. Substantial harmful effects of cigarette smoke on fecundity and reproduction have
become apparent but are not generally appreciated. [References: 54]
Practice Committee of the American Society for Reproductive Medicine. Endometriosis and
infertility. Fertility & Sterility 86(5 Suppl) 2006.
Women with endometriosis typically present with pelvic pain, infertility or an adnexal mass. Surgery for
persistent adnexal masses may be indicated to remove an endometrioma or other pelvic pathology.
Surgical or medical therapy is efficacious for pelvic pain due to endometriosis, but treatment of
endometriosis in the female partner of an infertile couple raises a number of complex clinical questions
that do not have simple answers. [References: 36]
Practice Committee of the American Society for Reproductive Medicine. Report on varicocele and
infertility. Fertility & Sterility 86(5 Suppl) 2006.
Practice Committee of the American Society for Reproductive Medicine. Multiple pregnancy
associated with infertility therapy. Fertility & Sterility 86(5 Suppl) 2006.
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Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
Practice Committee of the American Society for Reproductive Medicine. Effectiveness and
treatment for unexplained infertility. Fertility & Sterility 86(5 Suppl) 2006.
Practice Committee of the American Society for Reproductive Medicine. Position statement on
nurses performing focused ultrasound examinations in a gynecology/infertility setting. Fertility
& Sterility 86(5 Suppl) 2006.
Practice Committee of the Society for Assisted Reproductive Technology, Practice Committee of the
American Society for Reproductive Medicine. American Society for Reproductive Medicine/Society
for Assisted Reproductive Technology position statement on West Nile virus. Fertility & Sterility
86(5 Suppl) 2006.
Although there is currently no definitive evidence linking West Nile virus (WNV) transmission with
reproductive cells, it is recommended that practitioners defer gamete donors who have confirmed or
suspected WNV infections.
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Child Health
Banasiak NC. Practice guidelines. Childhood asthma part one: initial assessment, diagnosis,
and education. Journal of Pediatric Health Care. 21(1) 2007: 44-8.
Comeau AM, Accurso FJ, White TB, Campbell PW, 3rd, Hoffman G, Parad RB, et al. Guidelines for
implementation of cystic fibrosis newborn screening programs: Cystic Fibrosis Foundation
workshop report. Pediatrics 119(2) 2007.
Newborn screening for cystic fibrosis offers the opportunity for early intervention and improved
outcomes. This summary, resulting from a workshop sponsored by the Cystic Fibrosis Foundation to
facilitate implementation of widespread high quality cystic fibrosis newborn screening, outlines the steps
necessary for success based on the experience of existing programs. Planning should begin with a
workgroup composed of those who will be responsible for the success of the local program, typically
including the state newborn screening program director and cystic fibrosis care center directors. The
workgroup must develop a screening algorithm based on program resources and goals including
mechanisms available for sample collection, regional demographics, the spectrum of cystic fibrosis
disease to be detected, and acceptable failure rates of the screen. The workgroup must also ensure that
all necessary guidelines and resources for screening, diagnosis, and care be in place prior to cystic
fibrosis newborn screening implementation. These include educational materials for parents and primary
care providers; systems for screening and for providing diagnostic testing and counseling for screenpositive infants and their families; and protocols for care of this unique population. This summary
explores the benefits and risks of various screening algorithms, including complex situations that can
occur involving unclear diagnostic results, and provides guidelines and sample materials for state
newborn screening programs to develop and implement high quality screening for cystic fibrosis.
Summers AM, Langlois S, Wyatt P, Wilson RD. Prenatal Screening for Fetal Aneuploidy. J Obstet
Gynaecol Can 29(2) 2007: 146–161.
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18
Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
C. Guidelines Implementation
Ayres CG, Griffith HM. Perceived barriers to and facilitators of the implementation of priority
clinical preventive services guidelines. American Journal of Managed Care 13(3) 2007: 150-5.
OBJECTIVE: To obtain feedback from contracted health plan (HP) clinicians responsible for
implementing preventive services regarding an established set of priority guidelines identified by a
coalition of medical directors and to identify barriers to and facilitators of the implementation of these
priority guidelines in clinician practice. STUDY DESIGN: Qualitative design using a focus group
approach. PARTICIPANTS AND METHODS: Three focus group meetings among contracted HP
clinicians were conducted in New Jersey in 3 geographic regions (northern, central, and southern New
Jersey). Clinicians directly involved in delivering preventive services to pediatric, adult, and geriatric
patients participated. RESULTS: Barriers to guideline implementation were identified by the clinicians
regarding payment and cost, time, legal issues, inconsistency among HP tools, tracking, a lack of
internalization, and the patient-clinician relationship. In addition, facilitators of guideline implementation,
including HP support, patient materials, clinician awareness, and tool consistency, were identified.
CONCLUSIONS: Clinicians' perceived barriers to guideline implementation are in themselves a barrier to
the delivery of preventive care services. If clinicians perceive barriers to implementing priority
recommendations, they may be unlikely to make the conscious effort to deliver preventive care. There
needs to be better dialogue between HPs and contracted clinicians to minimize the perceptions of
barriers and to increase clinician awareness of and sensitivity to preventive care for priority
implementation. To improve the delivery of preventive services in clinician practice, competing HPs must
communicate in a single voice with contracted clinicians in the area of preventive care.
Berlowitz DR, Frantz RA. Implementing Best Practices in Pressure Ulcer Care: The Role of
Continuous Quality Improvement. Journal of the American Medical Directors Association 8(3
SUPPL) 2007: S37-S41.
Fretheim A, Schunemann HJ, Oxman AD. Improving the use of research evidence in guideline
development: 15. Disseminating and implementing guidelines. Health Research Policy & Systems
4 2006: 27.
Background: The World Health Organization (WHO), like many other organisations around the world,
has recognised the need to use more rigorous processes to ensure that health care recommendations
are informed by the best available research evidence. This is the 15th of a series of 16 reviews that have
been prepared as background for advice from the WHO Advisory Committee on Health Research to
WHO on how to achieve this. Objectives: In this review we address strategies for the implementation of
recommendations in health care. Methods: We examined overviews of systematic reviews of
interventions to improve health care delivery and health care systems prepared by the Cochrane
Effective Practice and Organisation of Care (EPOC) group. We also conducted searches using PubMed
and three databases of methodological studies for existing systematic reviews and relevant
methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based
on the available evidence, consideration of what WHO and other organisations are doing and logical
arguments. Key questions and answers: What should WHO do to disseminate and facilitate the uptake
of recommendations? * WHO should choose strategies to implement their guidelines from among those
which have been evaluated positively in the published literature on implementation research * Because
the evidence base is weak and modest to moderate effects, at best, can be anticipated, WHO should
promote rigorous evaluations of implementation strategies. What should be done at headquarters, by
regional offices and in countries? * Adaptation and implementation of WHO guidelines should be done
locally, at the national or sub-national level. bull; WHO headquarters and regional offices should support
the development and evaluation of implementation strategies by local authorities.
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19
Carsten Mandt, Clinical Librarian, NHS GG&C, West House, CGSU Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].