GuideLine

Objective This guideline revises the 2008 Royal Dutch Society for Physical Therapy guideline for physical therapy for patients with rheumatoid arthritis (RA). Method This revised guideline was developed according to the Appraisal of Guidelines for Research and Evaluation tool and the Guidelines International Network standards. A multidisciplinary guideline panel formulated clinical questions based on perceived barriers in current care. For every clinical question, a narrative or systematic literature review was undertaken, where appropriate. The guideline panel formulated recommendations based on the results of the literature reviews, the values and preferences of patients and clinicians, and the acceptability, feasibility, and costs, as described in the Grading of Recommendations Assessment, Development and Evaluation evidence-to-decision framework. Results The eventual guideline describes a comprehensive assessment based on the International Classification of Functioning, Disabili...

Rivers and water are valuable natural resources for human life, environment and national development. Recognition of water resources as national heritage will contribute towards more long term sustainable property development. Waterfront development is already a well-established phenomenon internationally. In Malaysia, as the economy began to change in 1980s, so did the land uses along many of the river and waterfront locations. The pressures of new technology coupled with an urban population growth and urbanization began to force a transition from water dependent industry to a variety of non-water dependent developments such as apartments, offices, and retail shopping areas. Residential waterfront development has taken advantage of available land and water amenities and incorporated as a feature or “selling point ” of the development. It has been found that wide views of water add an average of 59 % to the value of waterfront property, as well as providing attractive landscaping an...

Enhanced recovery of patients after surgery (''ERAS'') has become an important focus of perioperative management. From a metabolic and nutritional point of view, the key aspects of perioperative care include: avoidance of long periods of pre-operative fasting; re-establishment of oral feeding as early as possible after surgery; integration of nutrition into the overall management of the patient; metabolic control, e.g. of blood glucose; reduction of factors which exacerbate stress-related catabolism or impair gastrointestinal function; early mobilisation Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and if necessary tube feeding (TF) offers the possibility of increasing or ensuring nutrient Abbreviations: EN, enteral nutrition (oral nutritional supplements and tube feeding); ONS, oral nutritional supplements; TF, tube feeding; Normal food/normal nutrition: normal diet as offered by the catering system of a hospital including special diets $ For further information on methodology see Schütz et al. 231 For further information on definition of terms see Lochs et al. 232

Enhanced recovery of patients after surgery (''ERAS'') has become an important focus of perioperative management. From a metabolic and nutritional point of view, the key aspects of perioperative care include: avoidance of long periods of pre-operative fasting; re-establishment of oral feeding as early as possible after surgery; integration of nutrition into the overall management of the patient; metabolic control, e.g. of blood glucose; reduction of factors which exacerbate stress-related catabolism or impair gastrointestinal function; early mobilisation Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and if necessary tube feeding (TF) offers the possibility of increasing or ensuring nutrient Abbreviations: EN, enteral nutrition (oral nutritional supplements and tube feeding); ONS, oral nutritional supplements; TF, tube feeding; Normal food/normal nutrition: normal diet as offered by the catering system of a hospital including special diets $ For further information on methodology see Schütz et al. 231 For further information on definition of terms see Lochs et al. 232

PURPOSE To provide guidance on the clinical management of dyspnea in adult patients with advanced cancer. METHODS ASCO convened an Expert Panel to review the evidence and formulate recommendations. An Agency for Healthcare Research and Quality (AHRQ) systematic review provided the evidence base for nonpharmacologic and pharmacologic interventions to alleviate dyspnea. The review included randomized controlled trials (RCTs) and observational studies with a concurrent comparison group published through early May 2020. The ASCO Expert Panel also wished to address dyspnea assessment, management of underlying conditions, and palliative care referrals, and for these questions, an additional systematic review identified RCTs, systematic reviews, and guidelines published through July 2020. RESULTS The AHRQ systematic review included 48 RCTs and two retrospective cohort studies. Lung cancer and mesothelioma were the most commonly addressed types of cancer. Nonpharmacologic interventions such...

Enhanced recovery of patients after surgery (''ERAS'') has become an important focus of perioperative management. From a metabolic and nutritional point of view, the key aspects of perioperative care include: avoidance of long periods of pre-operative fasting; re-establishment of oral feeding as early as possible after surgery; integration of nutrition into the overall management of the patient; metabolic control, e.g. of blood glucose; reduction of factors which exacerbate stress-related catabolism or impair gastrointestinal function; early mobilisation Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and if necessary tube feeding (TF) offers the possibility of increasing or ensuring nutrient Abbreviations: EN, enteral nutrition (oral nutritional supplements and tube feeding); ONS, oral nutritional supplements; TF, tube feeding; Normal food/normal nutrition: normal diet as offered by the catering system of a hospital including special diets $ For further information on methodology see Schütz et al. 231 For further information on definition of terms see Lochs et al. 232

These guidelines are directed toward the typical male patient over 50 years of age, presenting with LUTS and benign prostatic enlargement (BPE) and/or benign prostatic obstruction (BPO). It is recognized that men with LUTS associated with causes other than BPO may require more extensive diagnostic workup and different treatment considerations. We acknowledge that not all patients identify as male. These guidelines should also be applicable to non-binary people, transwomen, and any patients who may have anatomical features of a cis-male genitourinary tract such as a prostate. It is our intent to make these guidelines inclusive to all persons experiencing lower urinary tract symptoms or an enlarged prostate. In this document, we will address both diagnostic and treatment issues. Diagnostic guidelines are described in the following terms as: mandatory, recommended, optional, or not recommended. The recommendations for diagnostic guidelines and principles of treatment were developed on the basis of clinical principle (widely agreed upon by Canadian urologists) and/or expert opinion (consensus of committee and reviewers). The grade of recommendation will not be offered for diagnostic recommendations. Guidelines for treatment are described using the GRADE approach 4 for summarizing the evidence and making recommendations CUAJ-CUA Guideline Elterman et al CUA guideline: BPH/LUTS

An estimated 58,240 Americans were diagnosed with renal cancer and 13,040 died of the disease in the United States in 2010. 1 Renal cell carcinoma (RCC) constitutes 2% to 3% of all malignancies, with a median age at diagnosis of 65 years. The rate of RCC has increased by 2% per year for the past 65 years. The reason for this increase is unknown. Approximately 90% of renal tumors are RCC, and 85% of these are clear cell tumors. 2 Other less common cell types include papillary, chromophobe, and Bellini duct (collecting duct) tumors. Collecting duct carcinoma constitutes fewer than 1% of kidney cancer cases. Medullary renal carcinoma is a variant of collecting duct renal carcinoma and was described initially as occurring in patients who are sickle cell trait-positive.

Abbreviations & Acronyms AS = active surveillance BMA = bone-modifying agent CA = clinical answer CAB = combined androgen blockade CQ = clinical question CRPC = castration-resistant prostate cancer CT = computed tomography EBRT = external-beam irradiation HDR = high-dose-rate brachytherapy HIFU = high-intensity focal ultrasound IDC-P = intraductal carcinoma of the prostate LDR = low-dose-rate brachytherapy LH-RH = luteinizing hormonereleasing hormone LRP = laparoscopic radical prostatectomy MRI = magnetic resonance imaging NCCN = National Comprehensive Cancer Network PDE5 = phosphodiesterase type 5 PRIAS = Prostate Cancer Research International Active Surveillance PSA = prostate-specific antigen PSA-V = prostate-specific antigen velocity PSAD = prostate-specific antigen density PSA-DT = prostate-specific antigen doubling time QALY = quality-adjusted life years QOL = quality of life RANKL = receptor activator of nuclear factor-jB ligand RARP = robot-assisted radical prostatectomy RG = grade of recommendation RP = radical prostatectomy RRP = retropubic radical prostatectomy SRT = salvage radiotherapy TURP = transurethral resection of the prostate UICC = Union for International Cancer Control

Multiple sclerosis (MS) is a complex disease with new drugs becoming available in the past years. There is a need for a reference tool compiling current data to aid professionals in treatment decisions. To develop an evidence-based clinical practice guideline for the pharmacological treatment of people with MS. This guideline has been developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology and following the updated EAN recommendations. Clinical questions were formulated in Patients-Intervention-Comparator-Outcome (PICO) format and outcomes were prioritized. The quality of evidence was rated into four categories according to the risk of bias. The recommendations with assigned strength (strong and weak) were formulated based on the quality of evidence and the risk-benefit balance. Consensus between the panelists was reached by use of the modified nominal group technique. A total of 10 questions were agreed, encompassing treatment effic...

In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the "Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care". Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM) in conjunction with Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidenc...

Updated guideline for the management of upper respiratory tract infections in South Africa: 2008 adds to the burden of antibiotic resistance. Antibiotic resistance is increasing in Streptococcus pneumoniae, the microorganism responsible for most cases of acute otitis media (AOM) and acute bacterial sinusitis (ABS). Method: The Infectious Diseases Society of Southern Africa held a multidisciplinary meeting to draw up a national guideline for the management of URTIs in 2003. Background information reviewed included randomised controlled trials, existing URTI guidelines and local antibiotic susceptibility patterns. The initial document was drafted at the meeting. Subsequent drafts were circulated to members of the working group for modification. The guideline was published in the South African Medical Journal in 2004 and was a consensus document based upon the opinions of the working group. In 2008 it was decided to update and republish the guideline. This was done electronically using the same working group members, including overseas experts. Output: Penicillin remains the drug of choice for tonsillopharyngitis. Single-dose parenteral administration of benzathine penicillin is effective, but many favour oral administration twice daily for 10 days. Amoxycillin remains the drug of choice for both AOM and ABS. A dose of 90 mg/kg/day is recommended in general, which should be effective for pneumococci with high-level penicillin resistance (this is particularly likely in children ≤2 years of age, in day-care attendees, in cases with prior AOM within the past six months, and in children who have received antibiotics within the last three months). Alternative antibiotic choices are given in the guideline with recommendations for their specific indications. These antibiotics include amoxycillin-clavulanate, some cephalosporins, the macrolide/azalide and ketolide groups of agents and the respiratory fluoroquinolones. Conclusion: The guideline should assist rational antibiotic prescribing for URTIs. However, it should be continuously updated when new information becomes available from randomised controlled trials and surveillance studies of local antibiotic susceptibility patterns.

B lood pressure (BP) is an important common modifiable risk factor for cardiovascular disease. In 2014e15, 6 million adult Australians were hypertensive (BP 140/90 mmHg) or were taking BP-lowering medication. 1 Hypertension is more common in those with lower household incomes and in regional areas of Australia (http:/ /heartfoundation.org.au/aboutus/what-we-do/heart-disease-in-australia/high-blood-pressurestatistics). Many Australians have untreated hypertension, including a significant proportion of Aboriginal and Torres Strait Islander people. 1 Cardiovascular diseases are associated with a high level of health care expenditure. 2 Controlled BP is associated with lower risks of stroke, coronary heart disease, chronic kidney disease, heart failure and death. Small reductions in BP (1e2 mmHg) are known to markedly reduce population cardiovascular morbidity and mortality. 3,4 Method The National Blood Pressure and Vascular Disease Advisory Committee, an expert committee of the National Heart Foundation of Australia, has updated the Guide to management of hypertension 2008: assessing and managing raised blood pressure in adults (last updated in 2010) 5 to equip health professionals across the Australian health care system, especially those within primary care and community services, with the latest evidence to prevent, detect and manage hypertension.

This practice guideline follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation, bringing together groups and individuals throughout the world, with the goal of improving the use of antenatal corticosteroids (ACS) for fetal maturation. In fact, this document provides further guidance for healthcare practitioners on the appropriate use of ACS with the aim to increase the timely administration and avoid unnecessary or excessive use. Therefore, it is not intended to establish a legal standard of care. This document is based on consensus among perinatal experts throughout the world and serves as a guideline for use in clinical practice.

Introduction Most studies have reported barriers to guideline usage mainly from doctors' perspective; few have reported the perspective of other stakeholders. This study aimed to determine the views and barriers to adherence of a national clinical practice guideline (CPG) on management of hypertension from the perspectives of policymakers, doctors and allied healthcare professionals. Methods This study used a qualitative approach with purposive sampling. Seven in depth interviews and six focus group discussions were conducted with 35 healthcare professionals (policy makers, doctors, pharmacists and nurses) at a teaching hospital in Kuala Lumpur, Malaysia, between February and June 2013. All interviews were audio-recorded, transcribed verbatim and checked. Thematic approach was used to analyse the data. Results Two main themes and three sub-themes emerged from this study. The main themes were (1) variation in the use of CPG and (2) barriers to adherence to CPG. The three sub-themes for barriers were issues inherent to the CPG, systems and policy that is not supportive of CPG use, and attitudes and behaviour of stakeholders. The main users of the CPG were the primary care doctors. Pharmacists only partially use the guidelines, while nurses and policy makers were not using the CPG at all. Participants had suggested few strategies to improve usage and adherence to CPG. First, update the CPG regularly and keep its content simple with specific sections for allied health workers. Second, use technology to facilitate CPG accessibility and provide protected time for implementation of CPG recommendations.

The success of clinical decision-support systems requires that they are seamlessly integrated into clinical workflow. In the SAGE project, which aims to create the technological infra-structure for implementing computable clinical practice guide-lines in enterprise settings, we created a deployment-driven methodology for developing guideline knowledge bases. It in-volves (1) identification of usage scenarios of guideline-based care in clinical workflow, (2) distillation and disambiguation of guideline knowledge relevant to these usage scenarios, (3) formalization of data elements and vocabulary used in the guideline, and (4) encoding of usage scenarios and guideline knowledge using an executable guideline model. This method-ology makes explicit the points in the care process where guideline-based decision aids are appropriate and the roles of clinicians for whom the guideline-based assistance is intended. We have evaluated the methodology by simulating the deploy-ment of an immuniza...

Aim of the study: Clinical practice guidelines (CPG) are an appropriate method to optimise routine clinical care. Numerous CPGs for the diagnosis and treatment of breast cancer have been developed by national health institutions or medical societies. While a comparison of methodological criteria has been undertaken before, it is unknown whether these CPGs differ in their actual treatment recommendations. Methods: We included national breast cancer CPGs from the USA, Canada, Australia, the UK, and Germany that satisfy internationally recognised methodological criteria and are in widespread use in daily clinical care. Treatment recommendations for adjuvant invasive breast cancer including surgery, radiation, endocrine therapy, chemotherapy and anti-HER2-therapy were compared. Results: Recommendations for endocrine therapy show discordances regarding optimal usage of ovarian function suppression for premenopausal patients and aromatase inhibitors for postmenopausal patients. However, most other treatment recommendations exhibit a large degree of congruency. This reflects the fact that they rest on the same evidence base, and that many national guidelines are adopted from other guidelines so that well accepted guidelines are cited within other guidelines. Concluding statement: Considering that the development of guidelines is a very expensive and resource-intensive task the question arises whether the development of national guidelines in numerous countries is worth the effort since the recommendations differ only marginally.

The success of clinical decision-support systems requires that they are seamlessly integrated into clinical workflow. In the SAGE project, which aims to create the technological infra-structure for implementing computable clinical practice guide-lines in enterprise settings, we created a deployment-driven methodology for developing guideline knowledge bases. It involves (1) identification of usage scenarios of guideline-based care in clinical workflow, (2) distillation and disambiguation of guideline knowledge relevant to these usage scenarios, (3) formalization of data elements and vocabulary used in the guideline, and (4) encoding of usage scenarios and guideline knowledge using an executable guideline model. This methodology makes explicit the points in the care process where guideline-based decision aids are appropriate and the roles of clinicians for whom the guideline-based assistance is intended. We have evaluated the methodology by simulating the deployment of an immunizatio...

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External ventricular drains (EVDs) are commonly used to facilitate removal of cerebrospinal fluid in patients with neurologic dysfunction. Despite a high risk for infection (upward of 45%), many hospitals lack strict protocols for EVD placement and maintenance. In addition, EVD infections are typically not tracked with the same diligence as central-line catheter infections, because there are no widely accepted standards for routine management of EVDs. The purpose of this review is to provide a guide for the development of a standardized, best practice EVD protocol for catheter insertion, care, and maintenance to reduce ventriculostomy-related infections. A secondary goal of this review is to provide support for the future development of guidelines for the consistent tracking of EVD insertion and maintenance practices.At an academic medical center, an interdisciplinary team of nurses, advanced practice nurses, and neurointensivists reviewed recent medical and nursing literature as we...

Healthcare costs for low back pain (LBP) are increasing rapidly. Hence, it is important to provide treatments that are effective and cost-effective. The purpose of this systematic review was to investigate the cost-effectiveness of guideline-endorsed treatments for LBP. We searched nine clinical and economic electronic databases and the reference list of relevant systematic reviews and included studies for eligible studies. Economic evaluations conducted alongside randomised controlled trials investigating treatments for LBP endorsed by the guideline of the American College of Physicians and the American Pain Society were included. Two independent reviewers screened search results and extracted data. Data extracted included the type and perspective of the economic evaluation, the treatment comparators, and the relative cost-effectiveness of the treatment comparators. Twenty-six studies were included. Most studies found that interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation or cognitive-behavioural therapy were costeffective in people with sub-acute or chronic LBP. Massage alone was unlikely to be cost-effective. There were inconsistent results on the cost-effectiveness of advice, insufficient evidence on spinal manipulation for people with acute LBP, and no evidence on the cost-effectiveness of medications, yoga or relaxation. This review found evidence supporting the cost-effectiveness of the guidelineendorsed treatments of interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation and cognitivebehavioural therapy for sub-acute or chronic LBP. There is little or inconsistent evidence for other treatments endorsed in the guideline. Keywords Low back pain Á Cost-effectiveness analysis Á Systematic review Recently, the American College of Physicians and the American Pain Society published a joint clinical guideline which recommended the following treatments for nonspecific LBP [3]:

Rivers and water are valuable natural resources for human life, environment and national development. Recognition of water resources as national heritage will contribute towards more long term sustainable property development. Waterfront development is already a well-...

Acute bronchiolitis is defined as viral-induced inflammation of bronchioles. The clinical manifestations occur as a consequence of airway inflammation and air trapping. Bronchiolitis most commonly occurs as an acute illness in children younger than 2 years of age. The most frequent cause is rhinovirus or respiratory syncytial virus (RSV) infection, other respiratory viruses being less common (Table I). The illness is generally self-limiting. Patients often feed poorly and have mild upper respiratory tract infection (URTI) signs, low-grade fever, hyperinflation of the chest and wheezing. Symptoms of severe illness include tachypnoea and lower chest wall retractions. 1 Bronchiolitis must be differentiated from aspiration of a foreign body, in which URTI signs are lacking. The most reliable clinical feature of bronchiolitis is hyperinflation of the chest, evident by loss of cardiac dullness on percussion, an upper border of the liver pushed down to below the 6th intercostal space, and the presence of a 'Hoover sign' (subcostal recession, which occurs when a flattened diaphragm pulls laterally against the lower chest wall). Diffuse expiratory wheezing is common.

Difficult to control atopic dermatitis (AD) presents a therapeutic challenge and often requires combinations of topical and systemic treatment. Anti-inflammatory treatment of severe AD most commonly includes topical glucocorticosteroids and topical calcineurin antagonists used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, the topical calcineurin inhibitors tacrolimus and pimecrolimus are preferred in certain locations. Systemic anti-inflammatory treatment is an option for severe refractory cases. Microbial colonization and superinfection contribute to disease exacerbation and thus justify additional antimicrobial / antiseptic treatment. Systemic antihistamines (H1) may relieve pruritus but do not have sufficient effect on eczema. Adjuvant therapy includes UV irradiation preferably of UVA1 wavelength. "Eczema school" educational programs have been proven to be helpful.

From 27–29 March 2019, a technical workshop was held at the Australian Institute of Marine Science (AIMS) in Townsville, Queensland, Australia to discuss key issues associated with the derivation of water quality guideline values (GVs). This report summarises the discussion around many of the identified key issues and makes recommendations on the necessary steps to improve the GV derivation methods.

Maintenance intravenous fluids (IVFs) are used to provide critical supportive care for children who are acutely ill. IVFs are required if sufficient fluids cannot be provided by using enteral administration for reasons such as gastrointestinal illness, respiratory compromise, neurologic impairment, a perioperative state, or being moribund from an acute or chronic illness. Despite the common use of maintenance IVFs, there is high variability in fluid prescribing practices and a lack of guidelines for fluid composition administration and electrolyte monitoring. The administration of hypotonic IVFs has been the standard in pediatrics. Concerns have been raised that this approach results in a high incidence of hyponatremia and that isotonic IVFs could prevent the development of hyponatremia. Our goal in this guideline is to provide an evidence-based approach for choosing the tonicity of maintenance IVFs in most patients from 28 days to 18 years of age who require maintenance IVFs. This ...

The primary objective of this study was to provide an insight into sustainable production indicators used by the petrochemical industry in Malaysia to measure the sustainability of the industry's operations. In achieving the research objective, the case study method was employed. The petrochemical industry was selected because of its major contribution to the Malaysian economy (market share and total investment), its significant impacts to the environment and, high societal and occupational risks. The sector is also highly dependent on non-renewable fossil fuels such as natural gas, LPG and diesel; and is energy intensive. Utilising the five-tier framework developed by the Lowell Centre for Sustainable Production (LCSP) and indicators identified by the Global Reporting Initiative (GRI) Guidelines 3.1, an analysis of indicators used by the petrochemical sector was carried Out. The LCSP framework was selected as it is an established framework and has been successfully used in sim...

The primary objective of this study was to provide an insight into sustainable production indicators used by the petrochemical industry in Malaysia to measure the sustainability of the industry's operations. In achieving the research objective, the case study method was employed. The petrochemical industry was selected because of its major contribution to the Malaysian economy (market share and total investment), its significant impacts to the environment and, high societal and occupational risks. The sector is also highly dependent on non-renewable fossil fuels such as natural gas, LPG and diesel; and is energy intensive. Utilising the five-tier framework developed by the Lowell Centre for Sustainable Production (LCSP) and indicators identified by the Global Reporting Initiative (GRI) Guidelines 3.1, an analysis of indicators used by the petrochemical sector was carried out. The LCSP framework was selected as it is an established framework and has been successfully used in similar case studies in other parts of the world. Furthermore, at present there is no common framework in Malaysia to assess sustainable production at the industrial level. Under the GRI guidelines, performance indicators have been grouped into six categories. The six categories include Environment (EN1-EN30), Economic (EC1-EC9), Society (SO1-SO8), Human Rights (HR1-HR9), Labour Practices and Decent Work (LA1-LA14) and Product Responsibility (PR1-PR9). The study was carried out using the questionnaire survey method and supplemented with semi-structured in-depth interviews. To ensure their suitability and applicability in the Malaysian context, the indicators selected for the study were based on feedback obtained from the participating companies. An analysis of the information obtained from the participating companies indicates the satisfactory performance of the petrochemical industry in employing most of the indicators identified within the GRI framework to advance towards sustainability. Results indicate that the majority of the indicators monitored are related to compliance (Level 1), performance (Level 2) and environmental impacts (Level 3). The single Level 4 indicator which relates to products and services was weakly monitored (38.5%). None of the indicators monitored fell within Level 5 category which addresses sustainability issues in terms of the ecological carrying capacity. The Level 5 indicators which assess sustainability in a community or regional context can only be effectively implemented once the necessary policies and regulations are in place; and with greater awareness and cooperation between the regulators and stakeholders. © 2012 Elsevier Ltd. All rights reserved.

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Background Many studies conducted in the past focused on patients’ sociodemographic factors and medical profiles to identify the determinants of suboptimal blood pressure control. However, prescribing patterns and clinicians’ adherence to guidelines are also important factors affecting the rate of blood pressure control. Therefore, this study aimed to determine clinicians’ prescribing patterns, patients’ medication adherence, and its determinants among hypertensive patients at Jimma University Medical Center. Methods A general prospective cohort study was conducted among hypertensive patients who had regular follow-up at Jimma university ambulatory cardiac clinic from March 20, 2018, to June 20, 2018. Patients’ specific data was collected with a face-to-face interview and from their medical charts. Clinicians’ related data were collected through a self-administered questionnaire. Data were analyzed using SPSS version 21.0. Bivariate and multivariable logistic regression analyses wer...

PNH Education and Study Group (PESG) have been established in December 2013 as a non-profit, independent, medical organization www.pesg.org. Paroxysmal Nocturnal Hemoglobinuria (PNH) is a multi-systemic disease that should be treated with a multidisciplinary approach. Patients may apply to the clinics other than the hematology due to variability and diversity of clinical findings which lower the rate of diagnosis due to low awareness about PNH. PNH might be overlooked and diagnosis might be delayed. Regarding these, PESG was established with the collaboration of Immunology, Cardiology, Thorax Diseases (Pulmonology), Neurology, Gastroenterology, General Surgery and Urology specialists in addition to hematologists dealing with PNH. The PESG study group aims to increase the awareness about PNH, including training activities about PNH, strengthening the relations between clinics and planning of clinical studies as a goal. It is the first professional organization focusing on PNH, in Tur...

Poor reporting quality may contribute to irreproducibility of results and failed 'bench-to-bedside' translation. Consequently, guidelines have been developed to improve the complete and transparent reporting of in vivo preclinical studies. To examine the impact of such guidelines on core methodological and analytical reporting items in the preclinical anesthesiology literature, we sampled a cohort of studies.

Background. Retinopathy of prematurity (ROP), one of the most common causes of preventable blindness in preterm neonates, is emerging as a 'third epidemic' in middle-income countries including South Africa. This is due to the increasing survival of preterm neonates, insufficient monitoring of oxygen saturation (SaO 2) in most centres, and lack of an ROP screening guideline in most neonatal units. Objective. To guide the standard of care for SaO 2 and ROP screening in preterm neonates weighing <1 500 g. Validation. This guideline, endorsed by the United South African Neonatal Association (USANA), the Ophthalmological Society of South Africa (OSSA), and the South African Vitreoretinal Society, was developed by the ROP Working Group of South Africa, comprised of neonatologists, ophthalmologists and paediatricians. Recommendations. All healthcare professionals involved in the care of preterm neonates should be aware of SaO 2 and ROP screening guidelines. Mothers should be counselled about the possible complications of prematurity.

Background: There are an increasing number of studies reporting the efficacy of educational strategies to facilitate the development of knowledge and skills underpinning evidence based practice (EBP). To date there is no standardised guideline for describing the teaching, evaluation, context or content of EBP educational strategies. The heterogeneity in the reporting of EBP educational interventions makes comparisons between studies difficult. The aim of this program of research is to develop the Guideline for Reporting EBP Educational interventions and Teaching (GREET) statement and an accompanying explanation and elaboration (E&E) paper. Methods/design: Three stages are planned for the development process. Stage one will comprise a systematic review to identify features commonly reported in descriptions of EBP educational interventions. In stage two, corresponding authors of articles included in the systematic review and the editors of the journals in which these studies were published will be invited to participate in a Delphi process to reach consensus on items to be considered when reporting EBP educational interventions. The final stage of the project will include the development and pilot testing of the GREET statement and E&E paper. Outcome: The final outcome will be the creation of a Guideline for Reporting EBP Educational interventions and Teaching (GREET) statement and E&E paper. Discussion: The reporting of health research including EBP educational research interventions, have been criticised for a lack of transparency and completeness. The development of the GREET statement will enable the standardised reporting of EBP educational research. This will provide a guide for researchers, reviewers and publishers for reporting EBP educational interventions.

Background: The 2007 World Health Organization (WHO) guideline to diagnose smear-negative tuberculosis (TB) in HIV-prevalent settings was mainly based on expert advice and therefore requires evaluation in real life situations. Methods: In 2009, this guideline was introduced at the ALERT hospital in Ethiopia. From October 2009 to January 2011, the accuracy of the guideline was evaluated using Mycobacterium tuberculosis culture positivity as reference standard in HIV positive TB suspects. Results: A total of 459 TB suspects were enrolled during the study period; 336 (73.2%) were HIV positive. Acid fast bacilli sputum smear microscopy was done for 74.7% (251/336) HIV positive TB suspects; 94.4% (237/251) were smear negative. A chest X-ray was performed in 92.8% (220/237) and a Mycobacterium tuberculosis culture in 63.7% (151/237). The median TB diagnostic delay for smear negative cases was 3 days (interquartile range 3-4 days). Of the 75 patients diagnosed with smear negative pulmonary TB, 89. 4% (67/75) were diagnosed by chest X-ray, 9.4% (7/75) by culture and 1.3% (1/75) by clinical suspicion only. In 147 smear negative TB suspects Mycobacterium tuberculosis culture and chest X-ray results were available. Among these 147 patients, the sensitivity of the chest X-ray to diagnose smear negative TB in HIV-positive TB suspects was 53.3% (95% CI: 26.7-78.7); the specificity 67.4% (95% CI: 58.7-75.3). Conclusion: The 2007 WHO diagnostic algorithm for the diagnosis of smear negative TB is likely to reduce the diagnostic delay and therefore decrease morbidity and mortality of TB in a HIV prevalent settings like Ethiopia.

Background and aims: Early elevation in blood pressure (BP) known as acute hypertensive response is common in patients with spontaneous intracerebral hemorrhage (ICH), and a known predictor of a poor outcome. We aimed to identify the independent predictors. Methods: We pooled INTERACT1 (n ¼ 404) and INTERACT2 (n ¼ 2839) of acute ICH patients (<6 hrs of onset) with elevated systolic BP (SBP, 150-220 mmHg) who were randomized to intensive (target SBP < 140 mmHg) or guideline-recommended (target SBP < 180 mmHg) management. BP at randomisation was measured at least twice and at least two minutes apart using the non-paretic arm (or right arm in situations of coma or tetraparesis) with the patient supine. Multivariable linear regression was used to determine associations. Results: Among 3233 patients, the mean age was 63.4 (12.8) years, mean SBP 179.3 (17.1) mmHg and 36.8% were female. History of hypertension (estimate 2.295, SE 0.691), admission glycemia > 6.5 mmol/lt (3.132, 0.618), elevated heart rate (1.238, 0.222 per 10-bmp increase), and higher NIHSS (0.154, 0.047 per 1-point increase) were significantly associated with hypertensive response at baseline. The use of antithrombotics (À3.742, 0.954) and time from onset to randomization (À0.992, 0.255 per 1-hour increase) were inversely associated with hypertensive response. Conclusions: For patients with acute ICH, if they are with history of hypertension, elevated blood glucose and heart rate, severe neurological deficit, not on antithrombotics, and presented earlier, more frequent BP measurement is required and more intensive BP treatment may be needed.

Patient and public involvement in clinical practice guideline development is recommended to increase guideline trustworthiness and relevance. To engage multiple sclerosis (MS) patients and caregivers in definition of the key questions to be answered in the EAN Guideline on Palliative Care of People with Severe MS. A mixed methods approach was used: International online survey launched by the national MS societies of eight countries, after pilot testing/debriefing on 20 MS patients and 18 caregivers; focus group meetings (FGMs) of Italian and German MS patients and caregivers. Of 1199 participants, 951 (79%) completed the whole online survey, and 934 from seven countries were analyzed: 751 (80%) were MS patients (74% women, mean age 46.1) and 183 (20%) caregivers (36% spouses/partners, 72% women, mean age 47.4). Participants agreed/strongly agreed on inclusion of the nine pre-specified topics (from 89% for &#39;advance care planning&#39; to 98% for &#39;multidisciplinary rehabilitati...

Ventilator-associated pneumonia (VAP) has been poorly studied in South Africa, but is likely to be a significant problem, with resulting increased morbidity and mortality in the paediatric intensive care unit population. This guideline is intended to review the evidence and recommendations for prevention and management of VAP in children and to provide, where possible, clear advice to aid the care of these children, to limit costly and unnecessary therapies and--importantly--limit inappropriate use of antimicrobial agents, The Working Group was constituted. Literature on the aetiology, prevention and management of paediatric VAP is reviewed. Evidence-based clinical practice guidelines are provided for VAP diagnosis and prevention in South Africa. In addition, the current status of antimicrobial use has been reviewed and clear recommendations are set out.

American College of Cardiology (ACC), American Heart Association (AHA) and Society for Cardiovascular Angiography and Interventions (SCAI) recently released the Clinical Practice Guidelines for myocardial revascularization [1]. The guidelines were the felt need of the fraternity and this single all-encompassing document, relegating the previous six guidelines on the subject to archives, is indeed welcome. However, the downgrading of coronary artery bypass surgery for stable multivessel coronary artery disease and its bracketing with percutaneous coronary interventions has caused a lot of anguish in the surgical fraternity. This document presents the official viewpoint of the Indian Association of Cardiovascular and Thoracic Surgeons on the matter.