As mucus is highly hydrated, special care has to be taken to preserve this in histological preparations during immunostaining. Here, we describe how to fix tissues in such a way that the mucus is preserved in paraffin-embedded tissue. We also describe how the major macromolecular components in the mucus, the ...

OBJECTIVES:: This is a prospective study in an urgent-care ophthalmic setting to investigate contact lens (CL) complications and their association with extended wear (EW). METHODS:: Data on CL designs, care system(s), and ocular complications were collected over a 6-month period. RESULTS:: One thousand three hundred and sixty-nine patients presented to ...

The purpose of this article is to describe a dynamic approach for 3-dimensional analyses of facial soft-tissue movements. The method and analysis have numerous applications but, most specifically, are used to assess diagnostic and treatment outcomes of soft-tissue surgery in patients with repaired cleft lip and palate.

BackgroundThere is recent evidence that the modified early warning scoring systems (MEWS) in the emergency department (ED) can identify patients at risk of deterioration. However, concerns remain that they are not sensitive enough to use as a risk assessment tool.ObjectiveTo assess use of MEWS in UK EDs.MethodsA postal survey was ...

: Variability exists in the documentation of death by neurologic criteria in children. We hypothesized that the use of a note template/checklist, which included directive (educational) prompts based on institutional neurologic determination of death criteria, improved thoroughness of documentation within our institutional guidelines for the neurologic determination of death. : ...

Diabetic chronic wounds with joint sepsis and osteomyelitis of the hindfoot can be difficult pathologic entities to treat. Limb salvage approaches are based on careful preoperative evaluation, surgical technique, and postoperative care. This article reviews the overall management of subtalar joint osteomyelitis with a case report showing primary arthrodesis with ...

Purpose. To evaluate compliance with diagnostic and therapeutic recommendations of the European Glaucoma Society (EGS) for the management of glaucoma in Spain, as determined using the Achievable Benchmarks of Care approach. Methods. A panel of 3 experts extracted quality and process-of-care indicators from the EGS guidelines. Investigators from all over ...

The World Health Organization (WHO) Tool for Situational Analysis to Assess Emergency and Essential Surgical Care (hereafter called the WHO Tool) has been used in more than 25 countries and is the largest effort to assess surgical care in the world. However, it has not yet been independently validated. Test-retest ...

Although there is a wealth of guidance concerning the management of patients with ventilator-associated pneumonia (VAP), compliance with recommendations concerning optimal treatment practices is highly variable. This document presents a comprehensive care bundle package addressing all aspects of VAP diagnosis and treatment in an attempt to promote guideline-compliant practices. Uniquely, ...

Venous thromboembolism is a major cause of morbidity and mortality worldwide and most often affects hospitalized postoperative surgical and medical patients. Venous thromboembolism prophylaxis undoubtedly improves the care of these patients, as demonstrated by the current literature and guidelines. Failure to prescribe prophylaxis when indicated, however, remains a vital health ...

What's known on the subject? and What does the study add? The suprapubic catheter (SPC) is a useful and widely used tool in urological practice. However, complications can arise from its insertion or ongoing care. Currently there are no guidelines relating to SPC usage. This study has reviewed the available ...

Optimizing the links in the Chain of Survival improves outcomes and saves lives. The use of evidence-based education and implementation strategies will allow organizations and communities to strengthen these links in the most effective and efficient manner.

We assessed whether existing guidelines for the primary care of lesbian, gay, and bisexual (LGB) people meet appropriate standards of developmental rigor, and whether they provide consistent recommendations useful for primary care clinicians. We performed a systematic review of such guidelines using the Cochrane Collaboration method. The countries searched were ...

Clinical practice guidelines (CPGs) have been hailed as a useful method of translating evidence into practice. Several CPGs have been published that provide recommendations for feeding patients in the intensive care unit (ICU). Despite a rigorous development process and active dissemination of these guidelines, their impact on nutrition practice has ...

Several clinical practice guidelines focusing on nutrition therapy in mechanically ventilated, critically ill patients are available to assist busy critical care practitioners in making decisions regarding feeding their patients. However, large gaps have been observed between guideline recommendations and actual practice. To be effective in optimizing nutrition practice, guideline development ...

The context in which critical care providers work has been shown to be associated with adherence to recommendations of clinical practice guidelines (CPGs). Consideration of contextual factors such as organizational culture may therefore be important when implementing guidelines. Organizational culture has been defined simply as "how things are around here" ...

Clinical trials are the foundation underlying clinical decision-making. However, stringent inclusion and exclusion criteria may reduce the generalizability of their results, especially for patients seen in the emergency department (ED). Guideline recommendations, based on clinical trials and pertinent registries, apply to broad populations, but not all patients cared for at ...

Rationale, aims and objectives  Little is documented about contemporary management of speech and swallowing disorders associated with paediatric acquired brain injury (ABI). It is therefore challenging for clinicians in this field to benchmark their clinical management against current evidence or practices undertaken in other centres. To address this issue, we ...

OBJECTIVE: To increase clinician adherence to prescribing guidelines for pulmonary medications in children with cystic fibrosis (CF). DESIGN: Quality improvement project with multiple time series design. SETTING: The CF center at a tertiary care pediatric hospital in the United States. PATIENTS: Children with CF who were eligible to receive oral ...

Rationale, aims and objectives  A collaborative, multidisciplinary guideline adaptation process was developed to construct a single overarching, evidence-based clinical practice guideline (CPG) for all primary care practitioners responsible for the management of low back pain (LBP) to curb the use of ineffective treatments and improve patient outcomes. Methods  The adaptation ...

The purpose of this guideline is to promote a high-quality specialty care for patients with structural irregularities of the internal and/or external nose associated with functional and/or relevant aesthetic impairment. The guideline was designed for use in the outpatient and inpatient specialist medical care and is therefore specifically targeted to ...

There has been an exponential increase in the number of nephrological meta-analyses published, but their relative contribution to the nephrology literature is unclear and their influence on physician behavior and evidence-based patient care is poorly understood. We studied the nephrology literature, point-of-care resources, guidelines, and a questionnaire survey of the ...

Clinical practice guidelines (CPGs) have become an essential, useful, and integral part of the practice of medicine in general and for the care of patients with chronic kidney disease (CKD) in particular. The reasons why CPGs have proven useful are related to the need of physicians, patients, and providers. Physician ...

This review aims to describe available standards for delivery of palliative and supportive care for cancer patients and discuss to what extent these guidelines have been evaluated and disseminated into standard care. Ovid searches were conducted to identify relevant guidelines, randomized studies comparing guideline-based care to usual care, and articles ...

This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this text. In preparing this guideline, we performed a search of the medical literature by using PubMed. Additional ...

To develop an occupational asthma learning module, which could be used both as an educational tool and to evaluate awareness and usage of clinical guidelines in primary care. Healthcare professionals were invited to undertake an interactive BMJ Learning module, developed from existing national occupational asthma guidelines. Participants were invited to ...

Epidermolysis bullosa (EB) has become recognized as a multisystem disorder that poses a number of pre-, intra-, and postoperative challenges. While anesthesiologists have long appreciated the potential difficult intubation in patients with EB, other systems can be affected by this disorder. Hematologic, cardiac, skeletal, gastrointestinal, nutritional, and metabolic deficiencies are ...

Patient care based on best available evidence is increasingly viewed as the hallmark of good quality medical diagnosis and treatment, yet its uptake is often slow and uneven and the reasons underlying the slow diffusion of evidence-based guidelines remain elusive. The authors report a qualitative study conducted at a major ...

The aim of this study was to examine the adherence of occupational physicians (OP) to the Dutch guideline on the management of common mental health problems and its effect on return to work as part of the process evaluation of a trial comparing adherence to the guideline to care as ...

Chronic spine-related conditions are very problematic in terms of treatment and indemnity costs, diagnostic complexity, and appropriate case management. Currently no chiropractic-directed guideline exists related to chiropractic management of the chronic spine pain patient. The purpose of this project was to develop a broad-based multidisciplinary consensus of medical and chiropractic ...

Summary.  In 2009, a questionnaire was circulated to 19 national haemophilia patient organizations in Europe affiliated to the European Haemophilia Consortium (EHC) and the World Federation of Hemophilia (WFH) to seek information about the organization of haemophilia care and treatment available at a national level. The responses received highlighted differences ...

To determine the effect of the implementation of a shared care guideline for the lumbosacral radicular syndrome (LRS) on unnecessary early referrals and the duration of the total diagnostic procedure. Introduction of shared care guideline in November 2005. Pre-test in 2005 (April to October), a first post-test in 2006 (April ...

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve ...

The Clinical Practice Guideline (CPG) on hoarseness (dysphonia) has several shortcomings that undermine its initial intent to improve the care of patients with dysphonia. The purpose of this document is to identify and comment on those shortcomings. The guideline authors made curious and unsupported policy recommendations in some areas, such ...

Osteoarthritis (OA) is not an easy condition to manage. It is very heterogeneous, has an unpredictable natural history, and has variable effects on health status. A wide range of management options is available to OA patients and their health care advisors. Guidelines help the clinician through this complexity. There are ...

RATIONALE: Cystic fibrosis (CF) is a recessive genetic disease characterized by dehydration of the airway surface liquid and impaired mucociliary clearance. As a result, individuals with the disease have difficulty clearing pathogens from the lung and experience chronic pulmonary infections and inflammation. There may be intermittent pulmonary exacerbations or acute ...

BACKGROUND: Measures for pay-for-performance and public reporting programs may be based on clinical practice guidelines. The impact of guideline changes over time-and whether evolving clinical evidence can render measures based on prior guidelines misleading-is not known. OBJECTIVE: To assess the impact of using different percutaneous coronary intervention (PCI) guidelines when ...

Evidence-based guidelines have the potential to improve the quality of health care by promoting interventions of proven benefit and discouraging unnecessary, ineffective, or harmful interventions. Recent years have seen the development of several evidence-based guidelines developed for osteoarthritis (OA) management. There is some consistency in the numerous guidelines that are ...

The aim of this study is to review current oral care practices in children being treated for cancer against audit criteria derived from national guidelines, and to compare findings with data from a baseline survey carried out in 2002 prior to implementation of the national guidelines. A telephone survey was ...

The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of acute spontaneous intracerebral hemorrhage. A formal literature search of MEDLINE was performed. Data were synthesized with the use of evidence tables. Writing committee members met by teleconference to discuss data-derived recommendations. The ...

clinical guidelines can improve quality of care summarising available knowledge and proposing recommendations for health care decisions. Being up to date is one of their quality requisites. Little experience is available on when and how guidelines should be updated. We report on the update process of evidence-based clinical recommendations on ...

The aim of this review was to address: (1) How is spinal stability assessed? (2) What is the role of bracing/should braces be used? (3) When is it safe to mobilise the patient? (4) What position should the patient be nursed in? Controversy surrounds the care for patients with metastatic ...

Patients undergoing noncardiac surgery are at risk of adverse perioperative and long-term outcome. When considering a patient for noncardiac surgery, a careful preoperative clinical risk evaluation and subsequent risk-reduction strategies are essential to reduce postoperative complications. To assist physicians with decision making, clinical guidelines are developed. The aim of clinical ...

As the chiropractic profession delineates its role in the emerging health care marketplace, it will become increasingly important that the scope of appropriate chiropractic care is clearly defined relative to overall patient case management. Therefore, the Council on Chiropractic Guidelines and Practice Parameters engaged in a multidisciplinary consensus process addressing ...

In 2005, the American Heart Association (AHA) released guidelines to improve survival rates from out-of-hospital cardiac arrest (OHCA). To determine if, and when, emergency medical services (EMS) agencies participating in the Resuscitation Outcomes Consortium (ROC) implemented these guidelines. We contacted 178 EMS agencies and completed structured telephone interviews with 176 ...

This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this text. In preparing this guideline, a search of the medical literature was performed by using PubMed. Additional ...

Guidelines are produced in oncology to facilitate clinical decision making and improve clinical practice. However, existing guidelines are mainly developed for countries with a certain availability of means and cultural aspects are rarely taken into account. Around the Mediterranean Area, countries share common cultural backgrounds but also great disparities with ...

Anaphylaxis is often managed inadequately. We used findings from a systematic review of gaps in anaphylaxis management to develop evidence-based recommendations for gaps rated as clinically important by a panel of Canadian allergy experts. The nominal group technique (NGT) consensus methodology was used to develop evidence-based recommendations for the management ...

BACKGROUND: There are many complications involved in the immobilization of unconscious patients with potential cervical spine injuries. In February 2005, the Intensive Care Society (ICS), United Kingdom, produced consensus guidelines to evaluate spinal injuries in unconscious victims of blunt multiple injuries to address this important clinical problem. METHODS: A postal ...

This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this text. In preparing this guideline, a search of the medical literature was performed by using PubMed. Additional ...