Putting guidelines into practice: has the era of perioperative chemotherapy arrived?
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ABSTRACT:
SUBMITTER: Georgiou CL
PROVIDER: S-EPMC5989122 | biostudies-literature | 2018 May
REPOSITORIES: biostudies-literature
Publications
Putting guidelines into practice: has the era of perioperative chemotherapy arrived?
Georgiou Chloe L CL Pezaro Carmel C Sengupta Shomik S
Translational andrology and urology 20180501 Suppl 2
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Project description:BackgroundThe COVID-19 pandemic has prompted many countries to formulate guidelines on how to deal with a worst-case scenario in which the number of patients needing intensive care unit (ICU) care exceeds the number of available beds. This study aims to explore the experiences of triage teams when triaging fictitious patients with the Dutch triage guidelines. It provides an overview of the factors that influence decision-making when performing ICU triage with triage guidelines.MethodsEight triage teams from four hospitals were given files of fictitious patients needing intensive care and instructed to triage these patients. Sessions were observed and audio-recorded. Four focus group interviews with triage team members were held to reflect on the sessions and the Dutch guidelines. The results were analyzed by inductive content analysis.ResultsThe Dutch triage guidelines were the main basis for making triage decisions. However, some teams also allowed their own considerations (outside of the guidelines) to play a role when making triage decisions, for example to help avoid using non-medical criteria such as prioritization based on age group. Group processes also played a role in decision-making: triage choices can be influenced by the triagists' opinion on the guidelines and the carefulness with which they are applied. Intensivists, being most experienced in prognostication of critical illness, often had the most decisive role during triage sessions.ConclusionsUsing the Dutch triage guidelines is feasible, but there were some inconsistencies in prioritization between teams that may be undesirable. ICU triage guideline writers should consider which aspects of their criteria might, when applied in practice, lead to inconsistencies or ethically questionable prioritization of patients. Practical training of triage team members in applying the guidelines, including explanation of the rationale underlying the triage criteria, might improve the willingness and ability of triage teams to follow the guidelines closely.
| S-EPMC10449194 | biostudies-literature
Project description:BackgroundSurgical-related incidents are a common cause of in-hospital adverse events. Surgical patient safety would benefit from evidence-based practices, but a comprehensive collection of patient safety recommendations is still lacking. This study aimed to compile and assess the perioperative patient safety recommendations for adults.MethodA systematic review of clinical practice guidelines was conducted using Medline, Embase, Cochrane, Virtual Health Library Regional Portal, and Trip Database from 2012 to 2022. Eligibility criteria followed a PICAR strategy for patient safety recommendations in the perioperative care continuum. Guidelines were appraised for quality, particularly focusing on the 'rigour of development' domain of the AGREE-II tool for those containing strong recommendations. Descriptive analyses were conducted, emphasizing guideline quality, recommendation strength, and the supporting level of evidence.ResultsFrom the 267 guidelines, 4666 perioperative patient safety recommendations were extracted, of which 44.9% (2095) were strongly recommended. Of these, 322 had the highest level of evidence, but only 18 guidelines met high standards in the AGREE-II 'rigour of development' domain. A subset of 78 recommendations ranked the highest in the strength of recommendation, level of evidence, and rigour of development of their guidelines. A gap was found within pre-admission and post-discharge care recommendations.DiscussionThis review highlights the noteworthy variability in the methodological quality of the guidelines, and a discordance between strength of recommendation and evidence level of the available perioperative patient safety recommendations. These findings provide valuable information for advising policy decisions and promoting best practices to enhance global surgical safety.RegistrationPROSPERO (CRD42022347449).
| S-EPMC11632830 | biostudies-literature
Project description: Not available
| S-EPMC1463949 | biostudies-literature
Project description:Conservation gardening (CG) represents a socio-ecological approach to address the decline of native plant species and transform the gardening industry into an innovative conservation tool. However, essential information regarding amenable plants, their ecological requirements for gardening, and commercial availability remains limited and not readily available. In this study, we present a workflow using Germany as a case study to bridge this knowledge gap. We synthesized the Red Lists of all 16 federal states in Germany, and text-mined a comprehensive platform for garden plants, as well as multiple German producers of native plants. To provide accessible information, we developed a user-friendly app ( https://conservation-gardening.shinyapps.io/app-en/ ) that offers region-specific lists of CG plants, along with practical guidance for planting and purchasing. Our findings reveal that a median of 845 plant species are red-listed across federal states (ranging from 515 to 1123), with 41% of these species amenable to gardening (ranging from 29 to 53%), resulting in a total of 988 CG species. Notably, 66% of these species (650) are already available for purchase. Additionally, we observed that many CG plants exhibit drought tolerance and require less fertilizer on average, with implications for long-term urban planning and climate adaptation. Collaborating with gardening experts, we present a selection of purchasable CG balcony plants for each federal state, highlighting the feasibility of CG even for individuals without gardens. With a multitude of declining plants amenable to gardening and the vital role of gardens as refuges and green corridors, CG holds substantial potential to catalyze transformative change in bending the curve of biodiversity loss.
| S-EPMC10471578 | biostudies-literature
Project description:Peritoneal surface malignancy (PSM) is a common manifestation of digestive and gynecologic malignancies alike. At present, patients with isolated PSM are treated with a combination therapy of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The combination of CRS and intraperitoneal (IP) chemotherapy should now be considered standard of care for PSM from appendiceal epithelial cancers, colorectal cancer and peritoneal mesothelioma. Although there is a near universal standardization regarding the CRS, we are still lacking a much-needed standardization among the various IP chemotherapy treatment modalities used today in clinical practice. Pharmacologic evidence should be generated to answer important questions raised by the myriad of variables associated with IP chemotherapy.
| S-EPMC6405035 | biostudies-literature
Project description:BackgroundClinical Practice Guidelines suggest that frailty be measured during kidney transplant eligibility assessments. Yet it is not known how frailty is best assessed in this setting or whether its assessment is acceptable to patients. We aimed to examine the construct validity and feasibility of Frailty Index (FI) assessment among patients attending a kidney transplant assessment clinic and to explore patients' perspectives on frailty and the acceptability of its routine assessment.MethodsA 58-item FI was calculated for 147 clinic patients. Semistructured interviews were conducted with a subgroup of 29 patients. The FI was validated against normative FI characteristics (mean, distribution, limit), age, and the Estimated Post-Transplant Survival Score. Feasibility was assessed using descriptive statistics. Qualitative data were analyzed using reflexive thematic analysis.ResultsThe mean FI was 0.23 (±0.10, normal distribution, limit 0.53). FI increased with age and Estimated Post-Transplant Survival score. The FI was completed for 62.8% of eligible patients (147/234). The median completion time was 10 min, and completion rate (with no missing data) was 100%. Four themes were identified: perceptions of frailty, acceptability, perceived benefits, and risks of frailty measurement. Patients linked frailty with age and adverse outcomes, and most did not consider themselves frail. Patients reported that the FI was quick, simple, and efficient. They felt that frailty assessment is relevant to transplant eligibility and should be used to address potentially reversible factors.ConclusionsThe FI demonstrated construct validity and was feasible and acceptable in this clinic setting. The challenge is ensuring that routine assessments lead to better care.
| S-EPMC10581598 | biostudies-literature
Project description:IntroductionPerioperative care is a broad field covering an array of elective and emergency procedures. Clinical practice guidelines (CPGs) for perioperative care exist with various degrees of methodological quality. We intend to critically appraise them using AGREE II instrument and investigate the use of Grading of Recommendations, Assessment, Development and Evaluations (GRADE).Methods and analysisWe searched MEDLINE (Ovid), Epistemonikos, Cochrane Database of Systematic Reviews and PROSPERO and did not identify any similar systematic review in this area. We will search databases, repositories and websites of guideline developers and medical societies, including MEDLINE (Ovid), Embase (Ovid), DynaMed, the GIN international guideline library and registry of guidelines in development, BIGG international database of GRADE guidelines, ECRI Guideline Trust or National Institute for Clinical Evidence to identify all CPGs for perioperative care in an adult population in a general clinical setting. We will include CPGs, expert guidance, position papers, guidance documents and consensus statements published in the last 5 years by experts or international organisations that provide guidance or recommendations in the available full text with no geographical or language limitation. Excluded will be those containing only good practice statements. Two independent reviewers will perform critical appraisal using the AGREE II tool. The data presented in a narrative and tabular form will include the results of the critical appraisal for all identified CPGs for all AGREE II domains and an assessment of the use of the GRADE approach.Ethics and disseminationEthics approval is not required. We will disseminate the findings through professional networks and conference presentations and will publish the results.
| S-EPMC8671973 | biostudies-literature
Project description:Hyperglycemia is the major risk factor for microvascular complications in patients with type 2 diabetes (T2D). However, cardiovascular disease (CVD) is the principal cause of death, and lowering HbA1c has only a modest effect on reducing CVD risk and mortality. The recently published LEADER and SUSTAIN-6 trials demonstrate that, in T2D patients with high CVD risk, the glucagon-like peptide 1 receptor agonists liraglutide and semaglutide reduce the primary major adverse cardiac events (MACE) end point (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke) by 13% and 24%, respectively. The EMPA-REG OUTCOME, IRIS (subjects without diabetes), and PROactive (second principal end point) studies also demonstrated a significant reduction in cardiovascular events in T2D patients treated with empagliflozin and pioglitazone. However, the benefit of these four antidiabetes agents (liraglutide, semaglutide, empagliflozin, and pioglitazone) on the three individual MACE end points differed, suggesting that different underlying mechanisms were responsible for the reduction in cardiovascular events. Since liraglutide, semaglutide, pioglitazone, and empagliflozin similarly lower the plasma glucose concentration but appear to reduce CVD risk by different mechanisms, there emerges the intriguing possibility that, if used in combination, the effects of these antidiabetes agents may be additive or even multiplicative with regard to cardiovascular benefit.
| S-EPMC5481984 | biostudies-literature
Project description: Not available
| S-EPMC9806012 | biostudies-literature
Project description:BackgroundOne of the main elements of patient-centered care is an enhancement of patient preparedness. Thus, pre-visit planning assessment tools was emerged to prepare and involve patients in their treatment process.ObjectiveThe main objective of this article was to review the applied tools and techniques for consideration of putting pre-visit planning into practice.MethodsWeb of Science, Scopus, IEEE, and PubMed databases were searched using keywords from January 2001 to November 2020. The review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Then, qualitative analysis was done to suggest an appropriate framework by mapping the main concepts.ResultsOut of 385 citations were retrieved in initial database searches, 49 studies from ten countries were included. Applied pre-visit techniques can be classified into eight categories. Our results showed that almost 81% of studies were related to procedures that were done between each visit, while 42% of articles were related to before visits. Accordingly, the main approach of included articles was patient preparedness. While 38 studies reported this approach is effective, three studies reported the effectiveness of such tools as moderate, only two articles believed it had a low effect on improving patient-centered care.ConclusionThis survey summarized the characteristics of published studies on pre-visit planning in the proposed framework. This approach could enhance the quality of patient care alongside enhancement patient-provider communication. However, such an approach can also be helpful to control pandemic diseases by reducing unnecessary referrals.
| S-EPMC8116646 | biostudies-literature