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Gantner D, Cooper DJ, Finfer S, Bragge P. Determinants of Adherence to Best Practice in Severe Traumatic Brain Injury: A Qualitative Study. Neurocrit Care 2022; 37:744-753. [PMID: 35948737 PMCID: PMC9672018 DOI: 10.1007/s12028-022-01551-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 06/04/2022] [Indexed: 11/25/2022]
Abstract
Background Management of patients with severe traumatic brain injury (sTBI) is highly variable and inconsistently aligned with evidence derived from high-quality trials, including those examining intravenous fluid resuscitation and use of decompressive craniectomy surgery. This study explored the barriers and facilitators of general and specific evidence-based practices in sTBI from the perspectives of stakeholder clinicians. Methods This was a qualitative study of semistructured interviews conducted with specialist clinicians responsible for acute care of patients with sTBI. Interview analysis was guided by the Theoretical domains framework (TDF), and key themes were mapped to relevant TDF behavioral domains. Results Ten neurosurgeons, 12 intensive care specialists, and three trauma physicians from six high-income countries participated between May 2020 and May 2021. Key TDF domains were environmental context and resources, social influences, and beliefs about consequences. Evidence-aligned management of patients with sTBI is perceived to be facilitated by admission to academic research-oriented hospitals, development of local practice protocols, and interdisciplinary collaboration. Determinants of specific practices varied and included health policy change for fluid resuscitation and development of patient-centered goals for surgical decision-making. Conclusions In choosing interventions for patients with sTBI, clinicians integrate local environmental, social, professional, and emotional influences with evidence and associated clinical practice guideline recommendations. This study highlights determinants of evidence-based practice that may inform implementation efforts and thereby improve outcomes for patients with sTBI. Supplementary Information The online version contains supplementary material available at 10.1007/s12028-022-01551-x.
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Affiliation(s)
- Dashiell Gantner
- Australian and New Zealand Intensive Care Research Centre, Monash University, Level 3, 553 St Kilda Road, Melbourne, VIC, 3004, Australia. .,Department of Intensive Care, Alfred Health, Melbourne, Australia.
| | - D Jamie Cooper
- Australian and New Zealand Intensive Care Research Centre, Monash University, Level 3, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.,Department of Intensive Care, Alfred Health, Melbourne, Australia
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street, Newtown, Sydney, NSW, 2042, Australia.,School of Public Health, Imperial College London, London, UK
| | - Peter Bragge
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton Campus, Melbourne, VIC, 3800, Australia
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Colbeck M, Lockwood C, Peters M, Fulbrook P, McCabe D. The effect of evidence-based, treatment-oriented, clinical practice guidelines on improving patient care outcomes: a systematic review protocol. ACTA ACUST UNITED AC 2018; 14:42-51. [PMID: 27532648 DOI: 10.11124/jbisrir-2016-002515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION The question that this systematic review aims to address is: does the use of evidence-based, treatment-oriented, clinical practice guidelines by healthcare professionals result in improvements in patient outcomes?
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Affiliation(s)
- Marc Colbeck
- 1The Joanna Briggs Institute, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia 2Australian Catholic University, Banyo, Queensland, Australia
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Shaughnessy AF, Vaswani A, Andrews BK, Erlich DR, D'Amico F, Lexchin J, Cosgrove L. Developing a Clinician Friendly Tool to Identify Useful Clinical Practice Guidelines: G-TRUST. Ann Fam Med 2017; 15:413-418. [PMID: 28893810 PMCID: PMC5593723 DOI: 10.1370/afm.2119] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/06/2017] [Accepted: 03/16/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Clinicians are faced with a plethora of guidelines. To rate guidelines, they can select from a number of evaluation tools, most of which are long and difficult to apply. The goal of this project was to develop a simple, easy-to-use checklist for clinicians to use to identify trustworthy, relevant, and useful practice guidelines, the Guideline Trustworthiness, Relevance, and Utility Scoring Tool (G-TRUST). METHODS A modified Delphi process was used to obtain consensus of experts and guideline developers regarding a checklist of items and their relative impact on guideline quality. We conducted 4 rounds of sampling to refine wording, add and subtract items, and develop a scoring system. Multiple attribute utility analysis was used to develop a weighted utility score for each item to determine scoring. RESULTS Twenty-two experts in evidence-based medicine, 17 developers of high-quality guidelines, and 1 consumer representative participated. In rounds 1 and 2, items were rewritten or dropped, and 2 items were added. In round 3, weighted scores were calculated from rankings and relative weights assigned by the expert panel. In the last round, more than 75% of experts indicated 3 of the 8 checklist items to be major indicators of guideline usefulness and, using the AGREE tool as a reference standard, a scoring system was developed to identify guidelines as useful, may not be useful, and not useful. CONCLUSION The 8-item G-TRUST is potentially helpful as a tool for clinicians to identify useful guidelines. Further research will focus on its reliability when used by clinicians.
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Affiliation(s)
| | - Akansha Vaswani
- Department of Counseling and School Psychology, University of Massachusetts, Boston, Massachusetts
| | - Bonnie K Andrews
- Department of Counseling and School Psychology, University of Massachusetts, Boston, Massachusetts
| | | | - Frank D'Amico
- McAnulty College and Graduate School of Liberal Arts, Duquesne University, Pittsburgh, Pennsylvania
| | - Joel Lexchin
- School of Health Policy and Management, York University, Toronto, Canada
| | - Lisa Cosgrove
- Department of Counseling and School Psychology, University of Massachusetts, Boston, Massachusetts
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Shen J, Sun M, Zhou B, Yan J. Nonconformity in the clinical practice guidelines for subclinical Cushing's syndrome: which guidelines are trustworthy? Eur J Endocrinol 2014; 171:421-31. [PMID: 24986532 DOI: 10.1530/eje-14-0345] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE This study aimed to systematically evaluate the quality of clinical practice guidelines (CPGs) and to compare their recommendations for managing subclinical Cushing's syndrome (SCS) to assist practitioners in making rapid clinical decisions. DESIGN AND METHODS SCS management guidelines were retrieved from electronic databases. The Appraisal of Guidelines Research and Evaluation II (AGREE-II) tool and the Institute of Medicine (IOM) criteria were used to evaluate the quality of the selected guidelines. In addition, we further compared recommendations, cited references and levels of evidence between the SCS management guidelines. RESULTS We included five guidelines that were obtained through the literature selection process. On the basis of the AGREE-II and IOM criteria, none of the selected guidelines were satisfactory in all aspects. However, the Italian Association of Clinical Endocrinologists (IACE) guidelines demonstrated slightly higher scores than did the other guidelines, so this guideline was recommended (with certain modifications for several domains). Regarding the content of the CPGs, we found considerable differences in the recommendations for managing SCS. These differences were derived from citation selection bias, evidence interpretation bias, differences in the composition of the guidelines' workgroups and the omission of guidelines for updating and externally reviewing the recommendations. CONCLUSIONS There is generally poor guideline quality among different organisations, and remarkable differences exist in the recommendations for the same clinical subject. Therefore, future guideline development should be performed in strict accordance with the AGREE-II and IOM criteria.
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Affiliation(s)
- Jing Shen
- Department of EndocrinologyThe First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Mingfang Sun
- Department of EndocrinologyThe First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Bo Zhou
- Department of EndocrinologyThe First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Juping Yan
- Department of EndocrinologyThe First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
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Huang TW, Lai JH, Wu MY, Chen SL, Wu CH, Tam KW. Systematic review of clinical practice guidelines in the diagnosis and management of thyroid nodules and cancer. BMC Med 2013; 11:191. [PMID: 23987922 PMCID: PMC3765955 DOI: 10.1186/1741-7015-11-191] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/31/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Given the uncertainties regarding thyroid nodule assessment and management, physicians require systematically and transparently developed recommendations. This systematic review assesses the quality and consistency of the recommendations of international clinical practice guidelines (CPGs) for the diagnosis and management of thyroid nodules and cancer to assist physicians in making appropriate recommendations. METHODS The CPGs on the management of thyroid nodules and cancer published before June 2013 were retrieved. All the reviewed guidelines were in English. Four reviewers independently assessed the rigor of guideline development by using the Appraisal of Guidelines Research and Evaluation II (AGREE-II) instrument, and their reported evidence was evaluated. RESULTS Ten eligible guidelines were included: nine had been developed by professional organizations, and the remaining guideline was endorsed by an independent regional body. Three guidelines achieved a score of greater than 50% in all six AGREE-II domains. Guidelines scored highest on the measurement of 'scope and purpose' (≥61.1% for eight CPGs) and lowest on the measurement of 'applicability' (≤38.5% for five CPGs). The overall quality ranged from 3.0 to 6.25 on a seven-point scale on the AGREE-II tool. Most CPG recommendations on the management of thyroid cancer were relatively consistent. Guidelines varied regarding the indication of fine-needle aspiration for thyroid nodules, as well as in their suggestions for postoperative radioiodine ablation. CONCLUSIONS Our analysis showed that the current CPGs varied in methodological quality. More effort is needed to improve the quality of recommendations on the diagnosis and management of thyroid nodules and cancer.
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Affiliation(s)
- Tsai-Wei Huang
- Department of Nursing, College of Medicine and Nursing, Hung Kuang University, Taichung, Taiwan
| | - Jun-Hung Lai
- Department of Nursing, College of Medicine and Nursing, Hung Kuang University, Taichung, Taiwan
- Department of Internal Medicine, Erlin Branch of Changhua Christian Hospital, Taichung, Taiwan
| | - Mei-Yi Wu
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University - Shuang Ho Hospital, Taipei, Taiwan
- Center for Evidence-based Health Care, Taipei Medical University - Shuang Ho Hospital, Taipei, Taiwan
| | - Shiah-Lian Chen
- Department of Nursing, College of Medicine and Nursing, Hung Kuang University, Taichung, Taiwan
| | - Chih-Hsiung Wu
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of General Surgery, Department of Surgery, Taipei Medical University - Shuang Ho Hospital, Taipei, Taiwan
| | - Ka-Wai Tam
- Center for Evidence-based Health Care, Taipei Medical University - Shuang Ho Hospital, Taipei, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of General Surgery, Department of Surgery, Taipei Medical University - Shuang Ho Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Center for Evidence-based Medicine, Taipei Medical University, Taipei, Taiwan
- Evidence-based Medicine Center, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei 11031, Taiwan
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Alarcon JD, Rubiano AM, Chirinos MS, Valderrama A, Gich I, Bonfill X, Alonso-Coello P. Clinical practice guidelines for the care of patients with severe traumatic brain injury. J Trauma Acute Care Surg 2013; 75:311-9. [DOI: 10.1097/ta.0b013e3182924bf8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Cosgrove L, Bursztajn HJ, Erlich DR, Wheeler EE, Shaughnessy AF. Conflicts of interest and the quality of recommendations in clinical guidelines. J Eval Clin Pract 2013; 19:674-81. [PMID: 23731207 DOI: 10.1111/jep.12016] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is increasing concern that conflicts of interest affect the development process of clinical practice guidelines. We evaluated The American Psychiatric Association's Practice Guideline for the Treatment of Patients with Major Depressive Disorder to determine the existence of financial and intellectual conflicts of interest and examine their possible effects. We selected this guideline because of its influence on clinical practice and because this guideline recommends pharmacotherapy for all levels of depression, despite controversies over the evidence base. METHODS AND FINDINGS We determined the number and type of financial conflicts of interest for members of the guideline development group as well as for the independent panel charged with mitigating any effect of these conflicts. We also quantified the potential for intellectual conflicts of interest. We examined the quality of references used to support recommendations, as well as the degree of congruence between the research results and the recommendations. Fewer than half (44.4%) of the studies supporting the recommendations met criteria for high quality. Over one-third (34.2%) of the cited research did not study outpatients with major depressive disorder, and 17.2% did not measure clinically relevant results. One-fifth (19.7%) of the references were not congruent with the recommendations. Financial ties to industry were disclosed by all members (100%) of the guideline development committee with members reporting a mean 20.5 relationships (range 9-33). The majority of the committee participated on pharmaceutical companies' speakers' bureaus. Members of the independent panel that reviewed the guidelines for bias had undeclared financial relationships. As a marker of intellectual conflict of interest, 9.1% of all cited research and 13% of references supporting the recommendations were co-authored by the six guideline developers. CONCLUSIONS The prevalence of conflicts of interest among panel members was high. The quality of the evidence cited raises questions about the validity of the recommendations. Attention to the quality of cited studies and to the risk of bias resulting from conflicts of interest should be a priority for guideline development groups.
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Affiliation(s)
- Lisa Cosgrove
- The Edmond J. Safra Center for Ethics, Harvard University, Cambridge, MA, USA.
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Simone B, De Feo E, Nicolotti N, Ricciardi W, Boccia S. Methodological quality of English-language genetic guidelines on hereditary breast-cancer screening and management: an evaluation using the AGREE instrument. BMC Med 2012; 10:143. [PMID: 23171648 PMCID: PMC3520768 DOI: 10.1186/1741-7015-10-143] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 11/21/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We examined the methodological quality of guidelines on syndromes conferring genetic susceptibility to breast cancer. METHODS PubMed, EMBASE, and Google were searched for guidelines published up to October 2010. All guidelines in English were included. The Appraisal of Guidelines, Research and Evaluation (AGREE) instrument was used to assess the quality of the guidelines, and their reported evidence base was evaluated. RESULTS Thirteen guidelines were deemed eligible: seven had been developed by independent associations, and the other six had national/state endorsements. Four guidelines performed satisfactorily, achieving a score of greater than 50% in all six AGREE domains. Mean ± SD standardized scores for the six AGREE domains were: 90 ± 9% for 'scope and purpose', 51 ± 18% for 'stakeholder involvement', 55 ± 27% for 'rigour of development', 80 ± 11% for 'clarity and presentation', 37 ± 32% for 'applicability', and 47 ± 38% for 'editorial independence'. Ten of the thirteen guidelines were found to be based on research evidence. CONCLUSIONS Given the ethical implications and the high costs of genetic testing for hereditary breast cancer, guidelines on this topic should provide clear and evidence-based recommendations. Our analysis shows that there is scope for improving many aspects of the methodological quality of current guidelines. The AGREE instrument is a useful tool, and could be used profitably by guidelines developers to improve the quality of recommendations.
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Affiliation(s)
- Benedetto Simone
- Institute of Hygiene, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Emma De Feo
- Institute of Hygiene, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Nicola Nicolotti
- Institute of Hygiene, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Walter Ricciardi
- Institute of Hygiene, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Stefania Boccia
- Institute of Hygiene, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
- IRCCS San Raffaele Pisana, Rome, Italy
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FLAATTEN H. When will we ever learn? Acta Anaesthesiol Scand 2012; 56:1-2. [PMID: 22150408 DOI: 10.1111/j.1399-6576.2011.02594.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H. FLAATTEN
- Department of Anaesthesia and Intensive Care; General ICU; Haukeland University Hospital; Bergen; Norway
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Joffe AR, Carcillo J, Anton N, deCaen A, Han YY, Bell MJ, Maffei FA, Sullivan J, Thomas J, Garcia-Guerra G. Donation after cardiocirculatory death: a call for a moratorium pending full public disclosure and fully informed consent. Philos Ethics Humanit Med 2011; 6:17. [PMID: 22206616 PMCID: PMC3313846 DOI: 10.1186/1747-5341-6-17] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 12/29/2011] [Indexed: 05/20/2023] Open
Abstract
Many believe that the ethical problems of donation after cardiocirculatory death (DCD) have been "worked out" and that it is unclear why DCD should be resisted. In this paper we will argue that DCD donors may not yet be dead, and therefore that organ donation during DCD may violate the dead donor rule. We first present a description of the process of DCD and the standard ethical rationale for the practice. We then present our concerns with DCD, including the following: irreversibility of absent circulation has not occurred and the many attempts to claim it has have all failed; conflicts of interest at all steps in the DCD process, including the decision to withdraw life support before DCD, are simply unavoidable; potentially harmful premortem interventions to preserve organ utility are not justifiable, even with the help of the principle of double effect; claims that DCD conforms with the intent of the law and current accepted medical standards are misleading and inaccurate; and consensus statements by respected medical groups do not change these arguments due to their low quality including being plagued by conflict of interest. Moreover, some arguments in favor of DCD, while likely true, are "straw-man arguments," such as the great benefit of organ donation. The truth is that honesty and trustworthiness require that we face these problems instead of avoiding them. We believe that DCD is not ethically allowable because it abandons the dead donor rule, has unavoidable conflicts of interests, and implements premortem interventions which can hasten death. These important points have not been, but need to be fully disclosed to the public and incorporated into fully informed consent. These are tall orders, and require open public debate. Until this debate occurs, we call for a moratorium on the practice of DCD.
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Affiliation(s)
- Ari R Joffe
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital; Edmonton Clinic Health Academy 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
- John Dossetor Health Ethics Center, University of Alberta, Edmonton, Alberta, Canada
| | - Joe Carcillo
- Department of Pediatrics and Critical Care Medicine, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, 400 45th Street, Pittsburgh, PA, 15201, USA
| | - Natalie Anton
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital; Edmonton Clinic Health Academy 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Allan deCaen
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital; Edmonton Clinic Health Academy 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Yong Y Han
- Department of Pediatrics & Communicable Diseases, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Michael J Bell
- Department of Pediatrics and Critical Care Medicine, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, 400 45th Street, Pittsburgh, PA, 15201, USA
| | - Frank A Maffei
- Department of Pediatrics, Pediatric Critical Care Medicine, Janet Weis Children's Hospital, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - John Sullivan
- Department of Pediatrics, Pediatric Critical Care Medicine, Janet Weis Children's Hospital, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA, 17822, USA
- Golisano Children's Hospital at Strong, University of Rochester School of Medicine, 601 Elmwood Avenue, Rochester, NY 15642, USA
| | - James Thomas
- Department of Pediatrics, University of Texas, Southwestern Medical Center; 5323 Harry Hines Blvd, Dallas, Texas, 75390-9063, USA
| | - Gonzalo Garcia-Guerra
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital; Edmonton Clinic Health Academy 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
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Simone B, De Feo E, Nicolotti N, Ricciardi W, Boccia S. Quality evaluation of guidelines on genetic screening, surveillance and management of hereditary colorectal cancer. Eur J Public Health 2011; 22:914-20. [PMID: 22140249 DOI: 10.1093/eurpub/ckr166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We examined the methodological quality of guidelines on colorectal cancer genetic susceptibility syndromes. METHODS PubMed, EMBASE, and Google were searched up to July 2010. Adjourned guidelines in English were included. The Appraisal of Guidelines, Research and Evaluation (AGREE) instrument was used to assess their quality, and the reported evidence base of the guidelines was evaluated. RESULTS The search yielded 17 eligible guidelines: 11 were developed by independent associations, while 6 had national\state endorsement. Only three guidelines performed satisfactorily, achieving a score >50% in all 6 AGREE domains. Mean standardized scores for the 6 AGREE domains were: 'scope and purpose', 83.9 ± 22.5%; 'stakeholder involvement', 35.6 ± 24.9%; 'rigour of development', 48.6 ± 25.3%; 'clarity and presentation', 71.6 ± 19.3%; 'applicability', 33.8 ± 30.1%; 'editorial independence', 42.2 ± 39.7%. Guidelines with national endorsement performed better in all the domains, with a statistically significant difference in three domains. Fifteen guidelines out of 17 were found to be based on research evidence. CONCLUSIONS There is scope, in many areas, for improving the guidelines analysed, among which are the involvement of various professional figures and patients' representatives, and policies for their application. The AGREE instrument is a useful tool and could also be used profitably by guideline developers to improve the quality of recommendations.
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Chang SY, Sevransky J, Martin GS. Protocols in the management of critical illness. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 16:306. [PMID: 22424130 PMCID: PMC3584719 DOI: 10.1186/cc10578] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 12/01/2011] [Indexed: 01/04/2023]
Abstract
Care of the critically ill patient is becoming increasingly complex. Protocols, which standardize care of patients with similar diseases, represent a potential solution to managing multiple simultaneous problems in critically ill patients. In this article, we examine the advantages and disadvantages to care protocolization, and posit that careful and thoughtful implementation of protocols is likely to benefit patients. We also discuss the potential for unintended consequences, and even harm, with protocolization in critically ill patients using the Critical Illness Outcomes Study as a model to examine the effects of protocolization in large populations of intensive care patients.
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Affiliation(s)
- Steven Y Chang
- Division of Pulmonary and Critical Care Medicine, University of Medicine and Dentistry of New Jersey - New Jersey Medical School, 150 Bergen St, UH-I354, Newark, NJ 07103, USA.
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Clinical practice guidelines to inform evidence-based clinical practice. World J Urol 2011; 29:303-9. [DOI: 10.1007/s00345-011-0656-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Accepted: 02/01/2011] [Indexed: 01/17/2023] Open
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Eichacker PQ, Natanson C. Evaluating guidelines for critical care: a need for detail. Intensive Care Med 2010; 36:1631-1632. [PMID: 20734188 DOI: 10.1007/s00134-010-1978-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 07/07/2010] [Indexed: 12/01/2022]
Affiliation(s)
- Peter Q Eichacker
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Building 10, Room 2C145, Bethesda, MD, 20892-1662, USA.
| | - Charles Natanson
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Building 10, Room 2C145, Bethesda, MD, 20892-1662, USA
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Loveday BPT, Srinivasa S, Vather R, Mittal A, Petrov MS, Phillips ARJ, Windsor JA. High quantity and variable quality of guidelines for acute pancreatitis: a systematic review. Am J Gastroenterol 2010; 105:1466-76. [PMID: 20606652 DOI: 10.1038/ajg.2010.137] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Several clinical guidelines exist for acute pancreatitis, with varying recommendations. The aim of this study was to determine the quality of guidelines for acute pancreatitis. METHODS A literature search identified relevant guidelines, which were then reviewed to determine their document format and scope and the presence of endorsement by a professional body. The quality of guidelines was determined using the validated Grilli, Shaneyfelt, and AGREE instruments. RESULTS Twenty-one of the 30 guidelines analyzed were endorsed by professional bodies. Median quality scores were as follows: Grilli, 2; Shaneyfelt, 13; and AGREE, 50. Guideline quality did not improve over time. Guidelines endorsed by a professional body had higher scores than those without official endorsement. Guidelines with tables, a recommendations summary, evidence grading, and audit goals had significantly higher scores than guidelines lacking those features. CONCLUSIONS The many clinical guidelines for acute pancreatitis range widely in quality. Guidelines developed by professional bodies, and those with tables, a recommendations summary, evidence grading, and audit goals, are of higher quality. Further research is required to determine whether guideline quality alters clinical outcomes.
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Affiliation(s)
- Benjamin P T Loveday
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
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16
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Improving safety and documentation in intrahospital transport: Development of an intrahospital transport tool for critically ill patients. Intensive Crit Care Nurs 2010; 26:101-7. [DOI: 10.1016/j.iccn.2009.12.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 12/13/2009] [Accepted: 12/17/2009] [Indexed: 11/24/2022]
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17
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Gorman SK, Chung MH, Slavik RS, Zed PJ, Wilbur K, Dhingra VK. A critical appraisal of the quality of critical care pharmacotherapy clinical practice guidelines and their strength of recommendations. Intensive Care Med 2010; 36:1636-1643. [PMID: 20217048 DOI: 10.1007/s00134-010-1786-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Accepted: 02/04/2010] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Clinical practice guideline (CPG) quality assessment is important before applying their recommendations. Determining whether recommendation strength is consistent with supporting quality of evidence is also essential. We aimed to determine quality of critical care pharmacotherapy CPGs and to assess whether high quality evidence supports strong pharmacotherapy recommendations. METHODS MEDLINE (1966-February 2008), EMBASE (1980-February 2008), National Guideline Clearinghouse (February 2008) and personal files were searched to identify CPGs. Four appraisers evaluated each guideline using the appraisal of guidelines, research and evaluation (AGREE) instrument. AGREE assesses 23 items in six domains that include scope/purpose, stakeholder involvement, rigor of development, clarity, applicability and editorial independence. Standardized domain scores (0-100%) were determined to decide whether to recommend a guideline for use. One appraiser extracted strong pharmacotherapy recommendations and supporting evidence quality. RESULTS Twenty-four CPGs were included. Standardized domain scores were clarity [69% (95% confidence interval (CI) 62-76%)], scope/purpose [62% (95% CI 55-68%)], rigor of development [51% (95% CI 42-60%)], editorial independence [39% (95% CI 26-52%)], stakeholder involvement [32% (95% CI 26-37%)] and applicability [19% (95% CI 12-26%)]. The proportion of guidelines that could be strongly recommended, recommended with alterations and not recommended was 25, 37.5 and 37.5%, respectively. High quality evidence supported 36% of strong pharmacotherapy recommendations. CONCLUSION Variation in AGREE domain scores explain why one-third of critical care pharmacotherapy CPGs cannot be recommended. Only one-third of strong pharmacotherapy recommendations were supported by high quality evidence. We recommend appraisal of guideline quality and the caliber of supporting evidence prior to applying recommendations.
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Affiliation(s)
- Sean K Gorman
- Department of Pharmacy, Capital District Health Authority, College of Pharmacy, Dalhousie University, c/o Rm 2043 Victoria Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
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Powers RJ, Wirtschafter DW. Decreasing central line associated bloodstream infection in neonatal intensive care. Clin Perinatol 2010; 37:247-72. [PMID: 20363458 DOI: 10.1016/j.clp.2010.01.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Central Line Associated Bloodstream Infections (CLABSIs) have come to be recognized as preventable adverse events that result from lapses in technique at multiple levels of care. CLABSIs are associated with increased mortality and adverse outcomes that may have lifelong consequences. This review provides a summary of evidence-based strategies to reduce CLABSI in the newborn intensive care unit that have been described in the literature over the past decades. Implementation of these strategies in "bundles" is also discussed, citing examples of successful quality improvement collaboratives. The methods of implementation require an understanding of the scientific data and technical developments, as well as knowledge of how to influence change within the unique and complicated milieu of the newborn intensive care unit.
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Affiliation(s)
- Richard J Powers
- Good Samaritan Hospital, Newborn Intensive Care Unit, Pediatrix Neonatology Medical Group of San Jose, 3880 South Bascom Avenue, Suite 208, San Jose, CA 95124, USA.
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Forging a critical alliance: Addressing the research needs of the United States critical illness and injury community. Crit Care Med 2009; 37:3158-60. [PMID: 19661806 DOI: 10.1097/ccm.0b013e3181b03434] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Discuss the research needs of the critical illness and injury communities in the United States. DATA SOURCES Workshop session held during the 5 National Institutes of Health Symposium on the Functional Genomics of Critical Illness and Injury (November 15, 2007). STUDY SELECTION The current clinical research infrastructure misses opportunities for synergy and does not address many important needs. In addition, it remains challenging to rapidly and properly implement system-wide changes based upon reproducible evidence from clinical research. DATA EXTRACTION Author presentations, panel discussion, attendee feedback. DATA SYNTHESIS The critical illness and injury research communities seek better communication and interaction, both of which will improve the breadth and quality of acute care research. Success in meeting these needs should come from cooperative and strategic actions that favor collaboration, standardization of protocols, and strong leadership. An alliance framed on common goals will foster collaboration among experts to better promote clinical trials within the critically ill or injured patient population. CONCLUSIONS The U.S. Critical Illness and Injury Trials Group was funded to create a clinical research framework that can reduce the barriers to investigation using an investigator-initiated, evidence-driven, inclusive approach that has proven successful elsewhere. This alliance will provide an annual venue for systematic review and strategic planning that will include framing the research agenda, raising awareness for the value of acute care research, gathering and promoting best practices, and bolstering the critical care workforce.
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Scott NA, Moga C, Harstall C. Making the AGREE tool more user-friendly: the feasibility of a user guide based on Boolean operators. J Eval Clin Pract 2009; 15:1061-73. [PMID: 20367706 DOI: 10.1111/j.1365-2753.2009.01265.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Rationale, aims and objectives The Appraisal of Guidelines Research and Evaluation (AGREE) instrument is a generic tool for assessing guideline quality. This feasibility study aimed to reduce the ambiguity and subjectivity associated with AGREE item scoring, and to augment the tool's capacity to differentiate between good- and poor-quality guidelines. Methods A literature review was conducted to ascertain what AGREE instrument adjustments had been reported to date. The AGREE User Guide was then modified by: 1 constructing a detailed set of instructions, or dictionary, using Boolean operators, and 2 overlaying seven criteria to categorize guideline quality. The feasibility of the Boolean-based dictionary was tested by three appraisers using three randomly selected guidelines on low back pain management. The dictionary was then revised and re-tested. Results Of the 52 published studies identified, 14% had modified the instrument by adding or deleting items and 35% had adopted strategies, such as using a consensus approach, to overcome inconsistencies and ensure identical item scoring among appraisers. For the feasibility test, Pearson correlation coefficients ranged from 0.27 to 0.81. Revision and re-testing of the dictionary increased the level of agreement (range 0.41 to 0.94). Application of the revised dictionary not only decreased the variability of the domain scores, but also reduced the tool's reliability among inexperienced appraisers. Conclusion Appraisers found the Boolean-based AGREE User Guide easier to use than the original, which improved their confidence in the tool. Good reliability was achieved in the feasibility test, but the reliability and validity of some of the changes will require further evaluation.
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Affiliation(s)
- N Ann Scott
- Health Technology Assessment Unit, Institute of Health Economics, Edmonton, AB, Canada
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Arabi YM, Haddad S, Tamim HM, Al-Dawood A, Al-Qahtani S, Ferayan A, Al-Abdulmughni I, Al-Oweis J, Rugaan A. Mortality reduction after implementing a clinical practice guidelines-based management protocol for severe traumatic brain injury. J Crit Care 2009; 25:190-5. [PMID: 19592201 DOI: 10.1016/j.jcrc.2009.05.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 03/23/2009] [Accepted: 05/05/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The objective of this study was to examine the effect of implementing a clinical practice guidelines-based management protocol on the outcome of patients with severe traumatic brain injury (TBI). METHODS We carried out a pre-post guideline implementation study using previously collected data in the Intensive Care Unit (ICU). All patients older than 12 years with severe TBI, defined as a Glasgow Coma Scale score of 8 or less, from March 1999 to January 2001 (control group) and from February 2001 to December 2006 (protocol group) were identified and included in this study. Patients in the protocol group were managed using a clinical practice guidelines-based management protocol, derived from the guidelines published by the Brain Trauma Foundation. Primary outcome was hospital mortality, whereas the secondary outcome was ICU mortality. To assess whether the ICU protocol might have led to an increase in the number of surviving patients with severe disability, we examined the association of the protocol use and the need for tracheostomies, mechanical ventilation duration, and ICU and hospital length of stay (LOS) among survivors. RESULTS During the study period, a total of 434 patients met the inclusion criteria. After adjustment for several prognostic factors, the use of protocol was independently associated with a significant reduction in hospital and ICU mortality (odds ratio, 0.45; 95% confidence interval, 0.24-0.86; and odds ratio, 0.47; 95% confidence interval, 0.23-0.96, respectively). The use of the protocol was not associated with an increase in the need for tracheostomies, mechanical ventilation duration, ICU LOS, and hospital LOS. CONCLUSION The protocol implementation was associated with a reduction in hospital and ICU mortality. This improvement was not associated with an increase in the frequency of tracheostomies and in ICU or hospital LOS, suggesting that the improved survival was not associated with the increased number of surviving patients with severe disability and that the functional status might have also improved.
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Affiliation(s)
- Yaseen M Arabi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia 11426.
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Fowler RA, Adhikari NKJ, Scales DC, Lee WL, Rubenfeld GD. Update in critical care 2008. Am J Respir Crit Care Med 2009; 179:743-58. [PMID: 19383928 DOI: 10.1164/rccm.200902-0207up] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Robert A Fowler
- University of Toronto, Department of Medicine, Sunnybrook Health Sciences Centre, Chief, Program in Trauma, Emergency, and Critical Care, Toronto, ON, M4V 1E5 Canada
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Abstract
PURPOSE OF REVIEW Intensive care medicine consumes a high share of healthcare costs, and there is growing pressure to use the scarce resources efficiently. Accordingly, organizational issues and quality management have become an important focus of interest in recent years. Here, we will review current concepts of how outcome data can be used to identify areas requiring action. RECENT FINDINGS Using recently established models of outcome assessment, wide variability between individual ICUs is found, both with respect to outcome and resource use. Such variability implies that there are large differences in patient care processes not only within the ICU but also in pre-ICU and post-ICU care. Indeed, measures to improve the patient process in the ICU (including care of the critically ill, patient safety, and management of the ICU) have been presented in a number of recently published papers. SUMMARY Outcome assessment models provide an important framework for benchmarking. They may help the individual ICU to spot appropriate fields of action, plan and initiate quality improvement projects, and monitor the consequences of such activity.
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John K, Kazwala R, Mfinanga GS. Knowledge of causes, clinical features and diagnosis of common zoonoses among medical practitioners in Tanzania. BMC Infect Dis 2008; 8:162. [PMID: 19046464 PMCID: PMC2611996 DOI: 10.1186/1471-2334-8-162] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 12/02/2008] [Indexed: 11/26/2022] Open
Abstract
Background Many factors have been mentioned as contributing to under-diagnosis and under-reporting of zoonotic diseases particularly in the sub-Sahara African region. These include poor disease surveillance coverage, poor diagnostic capacity, the geographical distribution of those most affected and lack of clear strategies to address the plight of zoonotic diseases. The current study investigates the knowledge of medical practitioners of zoonotic diseases as a potential contributing factor to their under-diagnosis and hence under-reporting. Methods The study was designed as a cross-sectional survey. Semi-structured open-ended questionnaire was administered to medical practitioners to establish the knowledge of anthrax, rabies, brucellosis, trypanosomiasis, echinococcosis and bovine tuberculosis in selected health facilities within urban and rural settings in Tanzania between April and May 2005. Frequency data were analyzed using likelihood ratio chi-square in Minitab version 14 to compare practitioners' knowledge of transmission, clinical features and diagnosis of the zoonoses in the two settings. For each analysis, likelihood ratio chi-square p-value of less than 0.05 was considered to be significant. Fisher's exact test was used where expected results were less than five. Results Medical practitioners in rural health facilities had poor knowledge of transmission of sleeping sickness and clinical features of anthrax and rabies in humans compared to their urban counterparts. In both areas the practitioners had poor knowledge of how echinococcosis is transmitted to humans, clinical features of echinococcosis in humans, and diagnosis of bovine tuberculosis in humans. Conclusion Knowledge of medical practitioners of zoonotic diseases could be a contributing factor to their under-diagnosis and under-reporting in Tanzania. Refresher courses on zoonotic diseases should be conducted particularly to practitioners in rural areas. More emphasis should be put on zoonotic diseases in teaching curricula of medical practitioners' training institutions in Tanzania to improve the diagnosis, reporting and control of zoonotic diseases. Veterinary and medical collaboration should be strengthened to enable more effective control of zoonotic diseases in Tanzania.
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Affiliation(s)
- Kunda John
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania.
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Abstract
The intensive care unit (ICU) continues to be a major focus of decentralized pharmacy activities in health systems that care for critically ill patients. This is not surprising, given the need for rapid decision-making involving unstable patients, the large number of powerful medications typically used per patient, the high cost of many drugs used in the ICU and, most importantly, the evidence demonstrating the benefits of having a pharmacist as part of an interdisciplinary team. The purpose of this paper is to highlight important issues to consider when introducing or developing critical care pharmacy services beginning with the establishment of basic services and continuing through practitioner development, guideline/protocol development and implementation, patient safety, residency training, and research.
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Affiliation(s)
- Brian L Erstad
- College of Pharmacy, The University of Arizona, 1295 N. Martin - Pulido, PO Box 210207, Tucson, AZ 85721, USA.
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Leroy O, Mira JP, Montravers P, Gangneux JP, Gouin F, Sollet JP, Carlet J, Reynes J, Rosenheim M, Régnier B, Lortholary O. [Invasive candidiasis in ICU: analysis of antifungal treatments in the French study AmarCand]. ACTA ACUST UNITED AC 2008; 27:999-1007. [PMID: 19010637 DOI: 10.1016/j.annfar.2008.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2008] [Accepted: 10/02/2008] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Comparison of treatments initiated during invasive candidiasis in intensive care units with current French guidelines. STUDY DESIGN Prospective, observational, French multicenter study (October 2005-May 2006). PATIENTS AND METHODS Selection of patients with Candida species identification and in vitro antifungal susceptibility determination. The empiric treatments instituted before the microbiologic documentation of infection and the curative treatments instituted after identification of the causative Candida and determination of its susceptibility were collected and compared with treatments proposed by the French clinical practice guidelines (2004) for the management of patients with invasive candidiasis. RESULTS One hundred and eighty-six patients were studied. Invasive candidiasis was due to fluconazole-resistant or susceptible-dose dependent Candida in 18.3% of patients, without any significant influence of a previous treatment with azoles. Empiric and curative treatments were both in accordance with recommendations for 47% of patients. Recommendations were mainly not respected when proposed therapy was amphotericin B that disappeared from therapeutics used in ICU. Finally, 16.9% of episodes of invasive candidiasis, for which fluconazole was the recommended treatment, were due to fluconazole-resistant or susceptible-dose dependent Candida. CONCLUSION The support of French ICU physicians to current French guidelines was observed in 47% of cases. The infrequent use of amphotericin B must be emphasized. The nonnegligible incidence of fluconazole-resistant or susceptible-dose dependent Candida sp., particularly in patients without any prior exposition to azole agents, and the inability to predict this resistance should lead to propose a revision of 2004 guidelines.
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Affiliation(s)
- O Leroy
- Service de réanimation médicale et des maladies infectieuses, hôpital G.-Chatliez, centre hospitalier Gustave-Dron, 155, rue du Président-Coty, BP 619, 59208 Tourcoing cedex, France.
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Sepsis (mis) management: the hazards of a faith-based approach. Crit Care Med 2008; 36:2929-30. [PMID: 18812793 DOI: 10.1097/ccm.0b013e318187c6c1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rolls KD, Elliott D. Using consensus methods to develop clinical practice guidelines for intensive care: the intensive care collaborative project. Aust Crit Care 2008; 21:200-15. [PMID: 18922699 DOI: 10.1016/j.aucc.2008.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 08/07/2008] [Accepted: 08/26/2008] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Clinical practices or procedures based on the best available evidence are an essential resource within an intensive care unit (ICU). Maintaining the currency of a local clinical practice manual is challenging however, particularly in relation to the time required, other workload pressures and the availability of staff with relevant skills to interrogate the literature. The aim of the Intensive Care Collaborative (ICC) project was to use the synergism of group processes to develop state-based clinical guidelines for six common intensive care practices - eye care, oral care, endotracheal tube management, suctioning, arterial line management, and central venous catheter (CVC) management. METHODS Participants were 55 senior nurse clinicians from all nine area health services in NSW, seven academic facilitators, and staff from the Intensive Care Coordination and Monitoring Unit (ICCMU). A range of approaches were used to develop the six clinical practice guidelines (CPG) and related systematic literature reviews, including a preparatory educational seminar for participants, formation of working groups of clinicians, with subsequent teleconferences, e-mail and online forums to identify the scope of each guideline and review the literature. A consensus development conference (CDC) was conducted to finalise the reviews with a nominal group technique (NGT) used to develop recommendations for practice. External Validation Panels (EVP) verified the recommendations in each clinical practice guideline. Group voting was undertaken using a Likert scale (1-3 disagree, 4-6 neutral, 7-9 agree) with consensus agreement set as a median of at least seven. RESULTS Eighty-three recommendations for practice were developed for the six Clinical Practice Guidelines; 50% were based on research literature evidence (23% with high levels of evidence). The balance were based on consensus opinion of the panel members. Only five recommendations were not validated by external validation. CONCLUSION This project has demonstrated a method for guideline development that is robust, incorporating evidence from research and clinical expertise utilising an objective egalitarian framework.
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Affiliation(s)
- Kaye Denise Rolls
- Intensive Care Coordination and Monitoring Unit, NSW Health, Honorary Associate, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, Australia.
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Clinical practice guidelines: culture eats strategy for breakfast, lunch, and dinner. Crit Care Med 2008; 36:1360-1. [PMID: 18379267 DOI: 10.1097/ccm.0b013e31816a1260] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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