Nhsggc partnerships Guidelines Newsletter



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NHS Greater Glasgow and Clyde
- Clinical Librarian -





NHSGGC Partnerships Guidelines Newsletter

August 2006

Welcome to the Partnerships Guidelines Newsletter. The newsletter is intended as an information tool to help you keep up to date with developments in your area of clinical expertise and interest. It is not in any way an expression of organisational policy. The inclusion of a guideline in this newsletter does not imply that it is used, or should be implemented, within NHS Greater Glasgow and Clyde.  Any views expressed in guidelines quoted in the newsletter will have to be subjected to the scrutiny of your own clinical judgement.  You are, however, welcome to use the guideline newsletter to inform your practice or service development.


This newsletter covers national and international guidelines that have either been published or added to specialist databases (such as Medline or CINAHL) in the previous month. It is divided into three sections: one for clinical guidelines from the UK, one for clinical guidelines from international bodies and one for publications on guideline implementation. Within the two clinical sections, there are sub-categories to make it easier for you to find the guidelines that might be relevant to your practice.
Where available, the newsletter includes abstracts and links to online full-text versions or executive summaries of the guidelines.

Contents


A. UK Guidelines ……………………………………………………………………………………………………. p.2




  1. Primary Care …………………………………………………………………………………………. p. 2

  2. Cancer Care/Palliative Care ………………………………………………………………………………. p. 2

  3. Mental Health and Learning Disabilities ……………………………………………………………………. p. 2

  4. Dentistry …………………………………………………………………………………………. p. 2

  5. Sexual Health, BBV and related Topics ……………………………………………………………………. p. 3

  6. Child Health …………………………………………………………………………………………. p. 3

B. International Guidelines …………………………………………………………………………………………. p. 4




  1. Primary Care …………………………………………………………………………………………. p. 4

  2. Cancer Care/Palliative Care ……………………………………………………………………. p. 7

  3. Mental Health and Learning Disabilities ……………………………………………………………………. p. 9

  4. Dentistry …………………………………………………………………………………………. p. 10

  5. Sexual Health, BBV and related Topics ……………………………………………………………………. p. 10

  6. Child Health …………………………………………………………………………………………. p. 10

C. Guidelines Implementation ………………………………………………………………………………………. p. 12


If you would like to obtain full text versions of any of the guidelines listed in the newsletter, please refer to the NHSScotland e-Library where you will find most of the guidelines in full text. The e-Library is accessible to all NHSScotland staff at http://www.elib.scot.nhs.uk. Full text access requires an ATHENS password, which can be obtained online from the e-Library website. For those guidelines that are not available online, please fill in and sign the document request form that is included with the newsletter and send it to the Maria Henderson Library, Gartnavel Royal Hospital. Phone: 0141-211 3913.


A. UK Guidelines




Primary Care

National Institute for Cinical and Healthcare Excellence (NICE). Etanercept and efalizumab for the treatment of adults with psoriasis. London: NICE, 2006. URL: http://www.nice.org.uk/page.aspx?o=TA103 [last accessed: 02 August 2006].


National Institute for Cinical and Healthcare Excellence (NICE). Etanercept and infliximab for the treatment of psoriatic arthritis. London: NICE, 2006. URL: http://www.nice.org.uk/page.aspx?o=TA104 [last accessed: 02 August 2006].
Vanholder R. Chronic kidney disease in adults - UK guidelines for identification, management and referral. Nephrology Dialysis Transplantation 21(7) 2006: 1776-1777.
If you have any comments on the above Guidelines, or would like a copy of any SIGN Guidelines, please contact Grace Watson at Clinical Audit on 0141 211 3916 or email grace.watson@glacomen.scot.nhs.uk.

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Cancer Care/Palliative Care



No relevant new guidance was published this month.

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Mental Health and Learning Disabilities

National Institute for Cinical and Healthcare Excellence (NICE). The Management of bipolar disorder in adults, children and adolescents, in primary and secondary care. London: NICE, 2006. URL: http://www.nice.org.uk/page.aspx?o=CG38 [last accessed: 02 August 2006].


If you have any comments on the above Guidelines, or would like a copy of any SIGN Guidelines, please contact Grace Watson at Clinical Audit on 0141 211 3916 or email grace.watson@glacomen.scot.nhs.uk.

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Dentistry



No relevant new guidance was published this month.

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Sexual Health, BBV and related Topics

National Institute for Cinical and Healthcare Excellence (NICE). Postnatal care. London: NICE, 2006. URL: http://www.nice.org.uk/page.aspx?o=cg037 [last accessed: 02 August 2006].


If you have any comments on the above Guidelines, or would like a copy of any SIGN Guidelines, please contact Grace Watson at Clinical Audit on 0141 211 3916 or email grace.watson@glacomen.scot.nhs.uk.

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Child Health

National Institute for Cinical and Healthcare Excellence (NICE). Postnatal care. London: NICE, 2006. URL: http://www.nice.org.uk/page.aspx?o=cg037 [last accessed: 02 August 2006].


If you have any comments on the above Guidelines, or would like a copy of any SIGN Guidelines, please contact Grace Watson at Clinical Audit on 0141 211 3916 or email grace.watson@glacomen.scot.nhs.uk.

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B. International Guidelines




Primary Care

AACE Hypertension Task Force. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the diagnosis and treatment of hypertension. Endocrine Practice 12(2) 2006: 193-222.


Anonymous. Management of osteoporosis in postmenopausal women: 2006 Position statement of The North American Menopause Society. Menopause 13(3) 2006: 340-367.
OBJECTIVE: To update the evidence-based position statement published by The North American Menopause Society (NAMS) in 2002 regarding the management of osteoporosis in postmenopausal women. DESIGN: NAMS followed the general principles established for evidence-based guidelines to create this updated document. A panel of clinicians and researchers expert in the field of metabolic bone diseases and/or women's health were enlisted to review the 2002 NAMS position statement, compile supporting statements, and reach consensus on recommendations. The panel's recommendations were reviewed and approved by the NAMS Board of Trustees. RESULTS: Osteoporosis, whose prevalence is especially high among elderly postmenopausal women, increases the risk of fractures. Hip and spine fractures are associated with particularly high morbidity and mortality in this population. Given the health implications of osteoporotic fractures, the primary goal of osteoporosis therapy is to prevent fractures, which is accomplished by slowing or stopping bone loss, maintaining bone strength, and minimizing or eliminating factors that may contribute to fractures. The evaluation of postmenopausal women for osteoporosis risk requires a medical history, physical examination, and diagnostic tests. Major risk factors for postmenopausal osteoporosis (as defined by bone mineral density) include advanced age, genetics, lifestyle factors (such as low calcium and vitamin D intake, smoking), thinness, and menopause status. The most common risk factors for osteoporotic fracture are advanced age, low bone mineral density, and previous fracture as an adult. Management focuses first on nonpharmacologic measures, such as a balanced diet, adequate calcium and vitamin D intake, adequate exercise, smoking cessation, avoidance of excessive alcohol intake, and fall prevention. If pharmacologic therapy is indicated, government-approved options are bisphosphonates, a selective estrogen-receptor modulator, parathyroid hormone, estrogens, and calcitonin. CONCLUSIONS: Management strategies for postmenopausal women involve identifying those at risk of low bone density and fracture, followed by instituting measures that focus on reducing modifiable risk factors through lifestyle changes and, if indicated, pharmacologic therapy. copyright 2006 by The North American Menopause Society.
Anonymous. MOH nursing clinical practice guidelines 1/2005. Prevention of falls in hospitals and long term care institutions. Singapore Nursing Journal. 33(2) 2006: 52-4. (3 ref).
Anonymous. U.S. Preventive Services Task Force. Screening for peripheral arterial disease: recommendation statement. American Family Physician. 73(3) 2006: 497-500. (17 ref).
Anonymous. Guidelines for diagnosis and treatment of Paget's disease of bone. Osteologie 15(2) 2006: 141-148.
Anonymous. Antibiotic therapy by common general practice approach to upper respiratory infections of adults and children: Recommendations (October 2005). Medecine Therapeutique 12(2) 2006: 126-139.
Bathgate A. Recommendations for alcohol-related liver disease. Lancet 367(9528) 2006: 2045-2046.
Beckham JD, Tyler KL. Initial management of acute bacterial meningitis in adults: Summary of IDSA guidelines. Reviews in Neurological Diseases 3(2) 2006: 57-60.
The management of acute, community-acquired bacterial meningitis is a neurologic and infectious disease emergency. Early recognition and prompt diagnostic evaluation and treatment are essential to the successful treatment of patients with this condition. Recommendations from the Infectious Disease Society of America practice guidelines for the diagnosis and treatment of bacterial meningitis are presented and discussed. The importance of a thorough understanding of the appropriate initial management is explained.
Blondin MM. Prevention of deep vein thrombosis. Iowa City: University of Iowa Gerontological Nursing Research Center, Research Dissemination Core, 2006.URL: http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=9266 [last checked: 02 August 2006].
Britnell SJ, Cole JV, Isherwood L, al. e. Postural Health in Women: The Role of Physiotherapy. J Obstet Gynaecol Can 27(5) 2005: 493–500. URL: http://www.sogc.org/guidelines/public/159E-JPS-May2005.pdf [last accessed: 02 August 2006].
Goldstein LB, Adams R, Alberts MJ, Appel LJ, Brass LM, Bushnell CD, et al. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 113(24) 2006: 20.
BACKGROUND AND PURPOSE: This guideline provides an overview of the evidence on various established and potential stroke risk factors and provides recommendations for the reduction of stroke risk. METHODS: Writing group members were nominated by the committee chair on the basis of each writer's previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statement Oversight Committee. The writers used systematic literature reviews (covering the time period since the last review published in 2001 up to January 2005), reference to previously published guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate recommendations based on standard American Heart Association criteria. All members of the writing group had numerous opportunities to comment in writing on the recommendations and approved the final version of this document. The guideline underwent extensive peer review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS: Schemes for assessing a person's risk of a first stroke were evaluated. Risk factors or risk markers for a first stroke were classified according to their potential for modification (nonmodifiable, modifiable, or potentially modifiable) and strength of evidence (well documented or less well documented). Nonmodifiable risk factors include age, sex, low birth weight, race/ethnicity, and genetic factors. Well-documented and modifiable risk factors include hypertension, exposure to cigarette smoke, diabetes, atrial fibrillation and certain other cardiac conditions, dyslipidemia, carotid artery stenosis, sickle cell disease, postmenopausal hormone therapy, poor diet, physical inactivity, and obesity and body fat distribution. Less well-documented or potentially modifiable risk factors include the metabolic syndrome, alcohol abuse, drug abuse, oral contraceptive use, sleep-disordered breathing, migraine headache, hyperhomocysteinemia, elevated lipoprotein(a), elevated lipoprotein-associated phospholipase, hypercoagulability, inflammation, and infection. Data on the use of aspirin for primary stroke prevention are reviewed. CONCLUSIONS: Extensive evidence is available identifying a variety of specific factors that increase the risk of a first stroke and providing strategies for reducing that risk.
Hodsman A, Papaioannou A, Cranney A. Clinical practice guidelines for the use of parathyroid hormone in the treatment of osteoporosis. CMAJ 175(1) 2006: 48-51. URL: http://www.cmaj.ca/cgi/content/full/175/1/48 [last accessed: 02 August 2006].
Hollander-Rodriguez JC, Calvert JF, Jr. Hyperkalemia. American Family Physician. 73(2) 2006: 283-90, 207-9, 346 passim.
Hyperkalemia is a potentially life-threatening metabolic problem caused by inability of the kidneys to excrete potassium, impairment of the mechanisms that move potassium from the circulation into the cells, or a combination of these factors. Acute episodes of hyperkalemia commonly are triggered by the introduction of a medication affecting potassium homeostasis; illness or dehydration also can be triggers. In patients with diabetic nephropathy, hyperkalemia may be caused by the syndrome of hyporeninemic hypoaldosteronism. The presence of typical electrocardiographic changes or a rapid rise in serum potassium indicates that hyperkalemia is potentially life threatening. Urine potassium, creatinine, and osmolarity should be obtained as a first step in determining the cause of hyperkalemia, which directs long-term treatment. Intravenous calcium is effective in reversing electrocardiographic changes and reducing the risk of arrhythmias but does not lower serum potassium. Serum potassium levels can be lowered acutely by using intravenous insulin and glucose, nebulized beta2 agonists, or both. Sodium polystyrene therapy, sometimes with intravenous furosemide and saline, is then initiated to lower total body potassium levels.
Institute for Clinical Systems Improvement (ICSI). Stable coronary artery disease. Bloomington: ICSI, 2006. URL: http://www.icsi.org/knowledge/detail.asp?catID=29&itemID=192 [last accessed: 02 August 2006].
Institute for Clinical Systems Improvement (ICSI). Management of Acne. Bloomington: ICSI, 2006. URL: http://www.icsi.org/knowledge/detail.asp?catID=29&itemID=832 [last accessed: 02 August 2006].
Institute for Clinical Systems Improvement (ICSI). Immunizations. Bloomington: ICSI, 2006.URL: http://www.icsi.org/knowledge/detail.asp?catID=29&itemID=174 [last accessed: 02 August 2006].
Institute for Clinical Systems Improvement (ICSI). Community-acquired pneumonia in adults. Bloomington: ICSI, 2006. URL: http://www.icsi.org/knowledge/detail.asp?catID=29&itemID=160 [last accessed: 02 August 2006].
Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D, et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep 29(3) 2006: 375-80.
Legout V, Moyse D. Chronic pain: Clinical guidelines and measurement methods. Douleurs 7(2 C-1) 2006: 63-67.
The measurement of chronic pain has been the topic of many investigations due to difficulties in achieving correct assessment. Chronic pain has to be measured with suitable tools so the physician can assess the effects of applied treatments. Parallel display of pain intensity and its numerical equivalent is a specific property a visual analogic scales. A clinically meaningful improvement represents a reduction of 2 points on an 11-point numerical rating scale. Recall pain does not reflect corresponding current pain precisely. But the magnitude and the direction of the difference varies according to authors. While being based on clinical and legal recommendations, this review of the key literature proposes to put forward the main points concerning the evaluation of the chronic pain patient.
Nowicka P, Bryngelsson S. Sugars or sweeteners: Towards guidelines for their use in practice - Report from an expert consultation. Scandinavian Journal of Food & Nutrition 50(2) 2006: 89-96.
With the aim of suggesting recommendations regarding the practical implementation of sweeteners from a nutritional point of view for different groups of consumers, based on present scientific knowledge, the Swedish Nutrition Foundation (SNF) arranged a workshop focusing on the use of sugars and sweeteners in relation to obesity, diabetes, dental health, appetite, reward and addiction. The discussions and conclusions are summarized in this article. It was concluded that restrictions to keep the intake of refined sugars within the recommendations (10 E %) should be achieved by limited intake of foods high in sugars, e.g. sweet drinks and candies, rather than other foods that provide less significant amounts of sugars. From a practical point of view it may be useful to restrict the intake of foods high in sugars, especially drinks, to a small amount and to a limited number of occasions, e.g. once or twice a week. Regarding sweeteners, the present intake is considered to be safe from a toxicological point of view. Non-caloric intense sweeteners may be useful for lowering the energy content of liquid and semi-solid foods. Sweeteners may also provide tooth-friendly alternatives within certain food categories, but do not reduce the erosive potential of acidic foods. copyright 2006 Taylor & Francis.
Schnitzer TJ. Update on guidelines for the treatment of chronic musculoskeletal pain. Clinical Rheumatology 25(SUPPL. 7) 2006: S22-S29.
Chronic musculoskeletal pain is a major - and growing - burden on today's ageing populations. Professional organisations including the American College of Rheumatology (ACR), American Pain Society (APS) and European League Against Rheumatism (EULAR) have published treatment guidelines within the past 5 years to assist clinicians achieve effective pain management. Safety is a core concern in all these guidelines, especially for chronic conditions such as osteoarthritis that require long-term treatment. Hence, there is a consensus among recommendations that paracetamol should be the first-line analgesic agent due to its favourable side effect and safety profile, despite being somewhat less effective in pain relief than anti-inflammatory drugs. Cyclooxygenase-2 (COX-2)-selective anti-inflammatory drugs were developed with the goal of delivering effective pain relief without the serious gastrointestinal (GI) side effects linked with traditional non-selective non-steroidal anti-inflammatory drugs (NSAIDs). Clinical trial evidence supported these benefits, and COX-2 inhibitors were widely adopted, both in clinical practice and in official guidelines. Recently, accumulating data have linked COX-2 inhibitors with serious cardiovascular and/or cardiorenal effects and/or serious cutaneous adverse reactions (SCARs), particularly at anti-inflammatory doses or when used long term. Regulatory authorities in both Europe and the USA have responded to these data with the withdrawal of rofecoxib and valdecoxib, and the strengthening of prescribing advice on all anti-inflammatory drugs. COX-2 inhibitors and non-selective NSAIDs should now be used with increased caution in patients at increased cardiovascular and/or cardiorenal risk, e.g., patients with congestive heart failure, hypertension, etc. Regulatory advice and good clinical practice are to use anti-inflammatory drugs at the lowest effective dose and for the shortest possible time. There are as yet no updated official guidelines that incorporate these new data and regulatory advice. An international multidisciplinary panel, the Working Group on Pain Management, has generated new recommendations for the treatment of moderate-to-severe musculoskeletal pain. These guidelines, formulated in response to recent developments concerning COX-2 inhibitors and other NSAIDs, focus on paracetamol as the baseline drug for chronic pain management; when greater analgesia is desired, the addition of weak opioids is recommended based on a preferable GI and cardiovascular profile, compared with non-steroidal anti-inflammatory drugs.
Trescot AM, Boswell MV, Atluri SL, Hansen HC, Deer TR, Abdi S, et al. Opioid guidelines in the management of chronic non-cancer pain. Pain Physician 9(1) 2006: 1-39.
BACKGROUND: Opioid abuse has increased at an alarming rate. However, available evidence suggests a wide variance in the use of opioids, as documented by different medical specialties, medical boards, advocacy groups, and the Drug Enforcement Administration (DEA). OBJECTIVES: The objective of these opioid guidelines by the American Society of Interventional Pain Physicians (ASIPP) is to provide guidance for the use of opioids for the treatment of chronic non-cancer pain, to bring consistency in opioid philosophy among the many diverse groups involved, to improve the treatment of chronic non-cancer pain, and to reduce the incidence of drug diversion. DESIGN: A policy committee evaluated a systematic review of the available literature regarding opioid use in managing chronic non-cancer pain. This resulted in the formulation of the essentials of guidelines, a series of potential evidence linkages representing conclusions, followed by statements regarding relationships between clinical interventions and outcomes. METHODS: Consistent with the Agency for Healthcare Research and Quality (AHRQ) hierarchical and comprehensive standards, the elements of the guideline preparation process included literature searches, literature synthesis, systematic review, consensus evaluation, open forum presentations, formal endorsement by the Board of Directors of the American Society of Interventional Pain Physicians (ASIPP), and blinded peer review. Evidence was designated based on scientific merit as Level I (conclusive), Level II (strong), Level III (moderate), Level IV (limited), or Level V (indeterminate). RESULTS: After an extensive review and analysis of the literature, the authors utilized two systematic reviews, two narrative reviews, 32 studies included in prior systematic reviews, and 10 additional studies in the synthesis of evidence. The evidence was limited. CONCLUSION: These guidelines evaluated the evidence for the use of opioids in the management of chronic non-cancer pain and recommendations for management. These guidelines are based on the best available scientific evidence and do not constitute inflexible treatment recommendations. Because of the changing body of evidence, this document is not intended to be a "standard of care."

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Cancer Care/Palliative Care

American Society of Clinical Oncology, Kris MG, Hesketh PJ, Somerfield MR, Feyer P, Clark-Snow R, et al. American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. Journal of Clinical Oncology 24(18) 2006: 2932-47.


PURPOSE: To update the 1999 American Society of Clinical Oncology guideline for antiemetics in oncology. UPDATE METHODOLOGY: The Update Committee completed a review and analysis of data published from 1998 thru February 2006. The literature review focused on published randomized controlled trials, and systematic reviews and meta-analyses of published phase II and phase III randomized controlled trials. RECOMMENDATIONS: The three-drug combination of a 5-hydroxytryptamine-3 (5-HT(3)) serotonin receptor antagonist, dexamethasone, and aprepitant is recommended before chemotherapy of high emetic risk. For persons receiving chemotherapy of high emetic risk, there is no group of patients for whom agents of lower therapeutic index are appropriate first-choice antiemetics. These agents should be reserved for patients intolerant of or refractory to 5-HT3 serotonin receptor antagonists, neurokinin-1 receptor antagonists, and dexamethasone. The three-drug combination of a 5-HT3 receptor serotonin antagonist, dexamethasone, and aprepitant is recommended for patients receiving an anthracycline and cyclophosphamide. For patients receiving other chemotherapy of moderate emetic risk, the Update Committee continues to recommend the two-drug combination of a 5-HT3 receptor serotonin antagonist and dexamethasone. In all patients receiving cisplatin and all other agents of high emetic risk, the two-drug combination of dexamethasone and aprepitant is recommended for the prevention of delayed emesis. The Update Committee no longer recommends the combination of a 5-HT3 serotonin receptor antagonist and dexamethasone for the prevention of delayed emesis after chemotherapeutic agents of high emetic risk. CONCLUSION The Update Committee recommends that clinicians administer antiemetics while considering patients' emetic risk categories and other characteristics.
American Society of Clinical Oncology, Lee SJ, Schover LR, Partridge AH, Patrizio P, Wallace WH, et al. American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. Journal of Clinical Oncology 24(18) 2006: 2917-31.
PURPOSE: To develop guidance to practicing oncologists about available fertility preservation methods and related issues in people treated for cancer. METHODS: An expert panel and a writing committee were formed. The questions to be addressed by the guideline were determined, and a systematic review of the literature from 1987 to 2005 was performed, and included a search of online databases and consultation with content experts. RESULTS: The literature review found many cohort studies, case series, and case reports, but relatively few randomized or definitive trials examining the success and impact of fertility preservation methods in people with cancer. Fertility preservation methods are used infrequently in people with cancer. RECOMMENDATIONS: As part of education and informed consent before cancer therapy, oncologists should address the possibility of infertility with patients treated during their reproductive years and be prepared to discuss possible fertility preservation options or refer appropriate and interested patients to reproductive specialists. Clinician judgment should be employed in the timing of raising this issue, but discussion at the earliest possible opportunity is encouraged. Sperm and embryo cryopreservation are considered standard practice and are widely available; other available fertility preservation methods should be considered investigational and be performed in centers with the necessary expertise. CONCLUSION: Fertility preservation is often possible in people undergoing treatment for cancer. To preserve the full range of options, fertility preservation approaches should be considered as early as possible during treatment planning. [References: 167]

From L, Marrett L, Johnston M, Mai V, Fong J, Rosen C, et al. Screening for skin cancer: a clinical practice guideline. Toronto: Cancer Care Ontario, 2006. URL: http://www.cancercare.on.ca/pdf/pebc15-1f.pdf [last accessed: 02 August 2006].


Institute for Clinical Systems Improvement (ICSI). Colorectal cancer screening. Bloomington: ICSI, 2006. URL: http://www.icsi.org/knowledge/detail.asp?catID=29&itemID=159 [last accessed: 02 August 2006].
Noble J, Ellis P, Mackay JA, Evans WK, Lung Cancer Disease Site Group. Second-line or subsequent systemic therapy for recurrent or progressive non-small cell lung cancer: a clinical practice guideline. Toronto: Cancer Care Ontario, 2006. URL: http://www.cancercare.on.ca/pdf/pebc7-19f.pdf [last accessed: 02 August 2006].
Robien K, Levin R, Pritchett E, Otto M, American Dietetic Association. American Dietetic Association: standards of practice and standards of professional performance for registered dietitians (generalist, specialty, and advanced) in oncology nutrition care. Journal of the American Dietetic Association 106(6) 2006: 946-51.
The Standards of Practice and Standards of Professional Performance in Oncology Nutrition Care serve as a professional resource for self-evaluation and professional development for RDs specializing in oncology nutrition practice. Application of these documents in clinical practice presents the opportunity for quality improvement in oncology nutrition services provided by the RD. Just as the professional self-evaluation and continuing education process is an ongoing cycle, these standards are also a work in progress, and will be reviewed and updated on a regular basis. The Standards of Practice and Standards of Professional Performance are a quality initiative of the ADA and ON DPG that reflect a commitment to improving the quality of nutrition services provided by RDs in oncology settings.

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Mental Health and Learning Disabilities

Karande S. Autism: A review for family physicians. Indian Journal of Medical Sciences 60(5) 2006: 205-215.


Autism is a complex neurodevelopmental disorder characterized by qualitative impairments in social interaction and communication, with restricted, repetitive, stereotyped patterns of behavior, interests and activities. These behaviors manifest along a wide spectrum and commence before 36 months of age. Diagnosis of autism is made by ascertaining whether the child's specific behaviors meet the Diagnostic and Statistical Manual of Mental Disorders-IV-Revised criteria. Its etiology is still unclear but recent studies suggest that genetics plays a major role in conferring susceptibility. Recent neuroimaging research studies indicate that autism may be caused by atypical functioning in the central nervous system, particularly in the limbic system: amygdala and hippocampus. In a third of autistic children, loss of language and/or social skills occurs during the second year of life, usually between 15 and 21 months of age. Comorbidity with mental retardation, epilepsy, disruptive behaviors and learning difficulty is not uncommon. Although there is currently no known cure for autism there is evidence to suggest that early intervention therapy can improve functioning of autistic children. Judicious use of psychotropic drugs is necessary to manage associated aggression, hyperactivity, self-mutilation, temper tantrums; but drugs are not a substitute for behavioral and educational interventions. The family physician can play an important role in detecting autism early, coordinating its assessment and treatment, counseling the parents and classroom teacher, and monitoring the child's progress on a long term basis.
Leamon MH. When to refer patients for substance abuse assessment and treatment. Primary Psychiatry 13(6) 2006: 46-51.
Despite the prevalence of substance use problems in psychiatric and primary care settings, many physicians feel unprepared to engage, assess, or treat patients with such problems. Substance abuse and low-risk drinking have distinct diagnostic criteria, and therefore require different methods of assessment. For patients with substance-related problems, the 'Stages of Change' model of behavior change can be useful for formulating referral strategies tailored to a patient's readiness for, or stage of, change. Referral resources must be developed for a range of interventions, treatment intensities, and availabilities. Nevertheless, problems with substance use are as treatable as many chronic illnesses, either in the office or by referral to specialized assessment and treatment resources.
Wambaugh JL, Duffy JR, McNeil MR, Robin DA, Rogers MA. Treatment guidelines for acquired apraxia of speech: A synthesis and evaluation of the evidence. Journal of Medical Speech Language Pathology 14(2) 2006.
This report provides a summary and critical appraisal of the evidence utilized in the development of treatment guidelines for acquired apraxia of speech (AOS). This systematic review of the AOS treatment literature is a result of the efforts of the Academy of Neurologic Communication Disorders and Sciences (ANCDS) Writing Committee of Treatment Guidelines for AOS. Fifty-nine publications that met inclusion criteria were reviewed in terms of 33 variables pertaining to issues such as subject, treatment, and outcome descriptions, and scientific adequacy. Although the review revealed many weaknesses in the evidence base, findings indicated that patients with AOS can benefit from treatment.

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Dentistry



No relevant new guidance was published this month.
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Sexual Health, BBV and related Topics

ACOG Committee on Practice Bulletins-Gynecology. ACOG practice bulletin. No. 73: Use of hormonal contraception in women with coexisting medical conditions. Obstetrics & Gynecology 107(6) 2006: 1453-72.


Bachmann GA, Rosen R, Finn VW, Utian WH, Ayers C, Basson R, et al. Vulvodynia: A state-of-the-art consensus on definitions, diagnosis and management. Journal of Reproductive Medicine for the Obstetrician & Gynecologist 51(6) 2006: 447-456.
Vulvodynia is a chronic pain syndrome affecting up to 18% of the. female population. Despite its high prevalence and associated distress, the etiology, diagnosis and clinical management of the disorder have not been clearly delineated. This 'white paper' describes the findings and recommendations of a consensus conference panel based on a comprehensive review of the published literature on vulvodynia in addition to expert presentations on research findings and clinical management approaches. The consensus panel also identified key topics and issues for further research, including the role of inflammatory mechanisms and genetic factors and psychosexual contributors.
FIGO Committee for the Ethical Aspects of Human Reproduction and Women's Health. Ethical guidelines on conscientious objection. Reproductive Health Matters 14(27) 2006: 148-9.
The International Federation of Obstetricians and Gynecologists (FIGO) Committee for the Ethical Aspects of Human Reproduction and Women's Health considers the ethical aspects of issues that impact the discipline of obstetrics, gynecology and women's health. The following document represents the result of that carefully researched and considered discussion. This material is not intended to reflect an official position of FIGO, but to provide material for consideration and debate about these ethical aspects of our discipline for member organizations and their constituent membership.
New York State Department of Health. Personality disorders in patients with HIV/AIDS. In: Mental health care for people with HIV infection: HIV clinical guidelines for the primary care practitioner. New York: New York State Department of Health, 2006. URL: http://www.hivguidelines.org/public_html/center/clinical-guidelines/mental_health_guidelines/mental_health/supp_html_files/mental_health_page3.htm [last accessed: 02 August 2006].
Rosolowich V, al. e. Mastalgia. J Obstet Gynaecol Can 28(1) 2006: 49-60. URL: http://www.sogc.org/guidelines/public/170E-CPG-January2006.pdf [last accessed: 02 August 2006].

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Child Health

American Dietetic Association. Position of the American Dietetic Association: individual-, family-, school-, and community-based interventions for pediatric overweight. Journal of the American Dietetic Association 106(6) 2006: 925-45.


The American Dietetic Association (ADA), recognizing that overweight is a significant problem for children and adolescents in the United States, takes the position that pediatric overweight intervention requires a combination of family-based and school-based multi-component programs that include the promotion of physical activity, parent training/modeling, behavioral counseling, and nutrition education. Furthermore, although not yet evidence-based, community-based and environmental interventions are recommended as among the most feasible ways to support healthful lifestyles for the greatest numbers of children and their families. ADA supports the commitment of resources for programs, policy development, and research for the efficacious promotion of healthful eating habits and increased physical activity in all children and adolescents, regardless of weight status. This is the first position paper of ADA to be based on a rigorous systematic evidence-based analysis of the pediatric overweight literature on intervention programs. The research showed positive effects of two specific kinds of overweight interventions: a) multicomponent, family-based programs for children between the ages of 5 and 12 years, and b) multicomponent, school-based programs for adolescents. Multicomponent programs include behavioral counseling, promotion of physical activity, parent training/modeling, dietary counseling, and nutrition education. Analysis of the literature to date points to the need for further investigation of promising strategies not yet adequately evaluated. Furthermore, this review highlights the need for research to develop effective and innovative overweight prevention programs for various sectors of the population, including those of varying ethnicities, young children, and adolescents. To support and enhance the efficacy of family- and school-based weight interventions, community-wide interventions should be undertaken; few such interventions have been conducted and even fewer evaluated.
Roth J, Bechtold S, Borte G, Dressler F, Girschick HJ, Borte M. Osteoporosis in juvenile idiopathic arthritis. Recommendations for diagnosis, prevention and therapy - Consensus statement of the German Society for Pediatric Rheumatology. Monatsschrift fur Kinderheilkunde 154(5) 2006: 456-464.
In a high percentage of patients with juvenile idiopathic arthritis (JIA) a pathologic loss of bone or the failure of bone mass to increase has been described, even with new therapeutic approaches. The decrease in bone mass correlates with the duration of active disease, and to some degree with the number of joints affected. In several studies, muscle mass has been found to be the strongest predictor of bone mass. A standardized diagnostic approach to the musculoskeletal system plus prophylactic measures and therapy are therefore mandatory in all children with JIA who do not achieve rapid remission. This review describes the options for diagnosis and treatment, and they are summarized in an algorithm.

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C. Guidelines Implementation

Athavale D, McCullough S, Mactier H. Implementing the new BCG vaccination guidelines - A maternity hospital-based clinic approach. Journal of Public Health 28(2) 2006: 133-136.


Background: With the recent changes to the UK BCG vaccination programme, the emphasis on childhood immunisation changes to identification and immunisation of at risk neonates. We report our experience of improving the system for provision of early BCG immunisation to high-risk infants born in the east of Glasgow. Methods: A maternity hospital-based BCG clinic was established, together with a programme designed to increase awareness among midwifery and junior medical staff. Results: Neonatal identification of at risk infants increased by 300% and was associated with high rates of clinic attendance and a 93% uptake of BCG immunisation in early infancy. Almost all infants were immunised within the first three months of life. Conclusion: Targeting parents prior to discharge from the maternity unit is an effective means of implementing BCG immunisation guidelines. The clinic model described is a successful and easily implemented example of co-operation between acute and community services.
Cairns J. Providing guidance to the NHS: The Scottish Medicines Consortium and the National Institute for Clinical Excellence compared. Health Policy 76(2) 2006: 134-143.
There is wide acceptance that cost-effectiveness is a relevant consideration when deciding which treatments to make available in publicly funded health services. An unresolved issue concerns the timing and the extent of such evaluations. The United Kingdom provides examples of two distinct approaches. The Scottish Medicines Consortium (SMC) provides guidance to the NHS in Scotland based on a rapid early review of the evidence. The National Institute for Health and Clinical Excellence (NICE) provides guidance to the NHS in England and Wales based on a later, more extensive review of the evidence. This paper explores how the difference in approach affects the role of the pharmaceutical industry, clinical experts and other stakeholders. It compares the guidance produced when both bodies have evaluated the same medicines. It addresses the general question of when to assess the cost-effectiveness of medicines. It concludes that there are important differences between the approaches of SMC and NICE, relating primarily to the timing of the review of evidence on clinical and cost-effectiveness. The difference in timing means that the activities of the two bodies are to a large extent complementary.
Clark M. True cost of guideline implementation. Journal of Wound Care 15(5) 2006.
Heinonen S. Critical evaluation of evidence: A lesson to learn from a recent meta-analysis. Acta Obstetricia et Gynecologica Scandinavica 85(3) 2006: 260-262.
Jacobs DG, Brewer ML. Application of the APA practice guidelines on suicide to clinical practice. Cns Spectrums 11(6) 2006: 447-454.
This article presents charts from The American Psychiatric Association Practice Guideline for the Assessment and Treatment of Patients with Suicidal Behaviors, part of the Practice Guidelines for the Treatment of Psychiatric Disorders Compendium, and a summary of the assessment information in a format that can be used in routine clinical practice. Four steps in the assessment process are presented: the use of a thorough psychiatric examination to obtain information about the patient's current presentation, history, diagnosis, and to recognize suicide risk factors therein; the necessity of asking very specific questions about suicidal ideation, intent, plans, and attempts; the process of making an estimation of the patient's level of suicide risk is explained; and the use of modifiable risk and protective factors as the basis for treatment planning is demonstrated. Case reports are used to clarify use of each step in this process.

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Carsten Mandt, Clinical Librarian, NHSGGC, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: carsten.mandt@gartnavel.glacomen.scot.nhs.uk.






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