Search

Guideline writers have a responsibility to generate recommendations that are both evidence-based and free of bias. How best to quantify and report potential conflicts has been unclear. This extension of the Reporting Items for practice Guidelines in HealThcare (RIGHT) checklist provides a checklist-based approach to reviewing, assessing, and reporting conflicts of interest for guideline-writing bodies. Background: Conflicts of interest (COIs) of contributors to a guideline project and the funding of that project can influence the development of the guideline. Comprehensive reporting of information on COIs and funding is essential for the transparency and credibility of guidelines. Objective: To develop an extension of the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement for the reporting of COIs and funding in policy documents of guideline organizations and in guidelines: the RIGHT-COI&F checklist. Design: The recommendations of the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network were followed. The process consisted of registration of the project and setting up working groups, generation of the initial list of items, achieving consensus on the items, and formulating and testing the final checklist. Setting: International collaboration. Participants: 44 experts. Measurements: Consensus on checklist items. Results: The checklist contains 27 items: 18 about the COIs of contributors and 9 about the funding of the guideline project. Of the 27 items, 16 are labeled as policy related because they address the reporting of COI and funding policies that apply across an organization's guideline projects. These items should be described ideally in the organization's policy documents, otherwise in the specific guideline. The remaining 11 items are labeled as implementation related and they address the reporting of COIs and funding of the specific guideline. Limitation: The RIGHT-COI&F checklist requires testing in real-life use. Conclusion: The RIGHT-COI&F checklist can be used to guide the reporting of COIs and funding in guideline development and to assess the completeness of reporting in published guidelines and policy documents. Primary Funding Source: The Fundamental Research Funds for the Central Universities of China. [ABSTRACT FROM AUTHOR]

Background: A rapid review, guided by a protocol, was conducted to inform development of the World Health Organization’s guideline on personal protective equipment in the context of the ongoing (2013–present) Western African filovirus disease outbreak, with a focus on health care workers directly caring for patients with Ebola or Marburg virus diseases. Methods: Electronic databases and grey literature sources were searched. Eligibility criteria initially included comparative studies on Ebola and Marburg virus diseases reported in English or French, but criteria were expanded to studies on other viral hemorrhagic fevers and non-comparative designs due to the paucity of studies. After title and abstract screening (two people to exclude), full-text reports of potentially relevant articles were assessed in duplicate. Fifty-seven percent of extraction information was verified. The Grading of Recommendations Assessment, Development and Evaluation framework was used to inform the quality of evidence assessments. Results: Thirty non-comparative studies (8 related to Ebola virus disease) were located, and 27 provided data on viral transmission. Reporting of personal protective equipment components and infection prevention and control protocols was generally poor. Conclusions: Insufficient evidence exists to draw conclusions regarding the comparative effectiveness of various types of personal protective equipment. Additional research is urgently needed to determine optimal PPE for health care workers caring for patients with filovirus. [ABSTRACT FROM AUTHOR]

In response to the substantial and increasing healthcare requirements of older adults with multiple chronic conditions and acknowledgment of major gaps in knowledge and funding, two expert meetings were convened to identify a research agenda addressing the needs of this population. Research priorities are to develop and evaluate more-effective models of health care, develop and evaluate management practices and organizational structures that lead to improved long-term care, develop and implement relevant and effective preventive health strategies, determine the most effective interventions in patients who have concurrent cognitive or emotional impairments, and determine how interventions during and after hospitalization affect the outcomes of hospitalized patients. [ABSTRACT FROM AUTHOR]

Randomized, controlled trials (RCTs) are firmly established as the standard for determining which medical treatments are effective. In some areas of health care, however, among them surgery, public health, and the organization of health care delivery, most evidence addressing the effectiveness of clinical or policy interventions rests on nonrandomized studies. We examine the use of study designs other than RCTs in Evidence-based Practice Center reports addressing questions of the effectiveness of treatment interventions. These reports offer the opportunity to examine the approaches used and the challenges faced by reviewers when nonrandomized studies are included and their quality assessed. We then offer recommendations for using these studies in systematic reviews of treatment interventions. [ABSTRACT FROM AUTHOR]

Presents a chronic care model for the implementation of evidence-based diabetes care in geriatric patients. Prevalence of diabetes mellitus in older adults; Practice and organization of care for chronic illnesses; Evidence-based, clinical interventions implemented in the physician's practice.

Translation research transforms currently available knowledge into useful measures for everyday clinical and public health practice. We review the progress in diabetes translation research and identify future challenges and opportunities in this field. Several promising interventions to optimize implementation of efficacious diabetes treatments are available. Many of these interventions, singly or in combination, need to be more formally tested in larger randomized or quasi-experimental practical trials using outcomes of special interest to patients (for example, patient satisfaction and quality of life) and policymakers (for example, cost and costeffectiveness). The long-term outcomes (such as morbidity, mortality, quality of life, and costs) of strategies aimed at improving diabetes care must be assessed. Translation research also needs to incorporate ways of studying complex systems of care. The challenges and opportunities offered by translation research are tremendous. [ABSTRACT FROM AUTHOR]

Facing limited resources and increases in demand from competing programs, policymakers and health care providers seek guidance from economic studies on how to use health care resources wisely. Previous economic studies mainly focused on estimating the cost of diabetes and cost-effectiveness of different interventions. These studies found that diabetes is costly and that its cost will continue to increase; thus, more resources should be devoted to research aimed at finding effective means to prevent the disease and its complications. In addition, the cost-effectiveness of interventions varies greatly in terms of quality-adjusted life-years gained; therefore, efficient uses of resources should be an important consideration when interventions are prioritized. The need for economic studies will continue to grow because of increasing demand for limited resources from the growing number of interventions available. Future studies should be of better quality and broadened in areas of research. [ABSTRACT FROM AUTHOR]

The burden of chronic diseases is tremendous, and traditional methods of healthcare delivery are unsuitable for addressing these needs. Chronic disease management has emerged as a new strategy for chronic disease care, but a consistent definition has not been utilized. Our objective is to present an operational definition of chronic disease management. Based on prior systematic reviews of chronic disease management programs, we propose a definition encompassing the main constructs noted in our reviews. We define chronic disease management in the clinical setting as an organized, proactive, multi-component, patient-centered approach to healthcare delivery that involves all members of a defined population who have a specific disease entity (or a subpopulation with specific risk factors). Care is focused on, and integrated across the entire spectrum of the disease and its complications, the prevention of comorbid conditions, and relevant aspects of the delivery system. Essential components include identification of the population, implementation of clinical practice guidelines or other decision-making tools, implementation of additional patient-, provider-, or healthcare system-focused interventions, the use of clinical information systems, and the measurement and management of outcomes. Consistent use of this definition and adequate documentation of the component interventions of chronic disease management will enable comparisons among programs and outcomes in evaluation research and clinical practice. Most importantly, it will assist in determining which specific interventions or combinations thereof, implemented as part of chronic disease management, are most effective. [ABSTRACT FROM AUTHOR]

The author discusses her efforts to provide quality medical care for her mother. According to the author, she had to let the treating physician know that she is also a physician in order to get the timely care that she thought her mother needed. She mentions that while taking care of her mother, she learned more about nursing than she had previously learned in her many years as a physician.

Abstract: This article is the first of a series providing guidance for use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of rating quality of evidence and grading strength of recommendations in systematic reviews, health technology assessments (HTAs), and clinical practice guidelines addressing alternative management options. The GRADE process begins with asking an explicit question, including specification of all important outcomes. After the evidence is collected and summarized, GRADE provides explicit criteria for rating the quality of evidence that include study design, risk of bias, imprecision, inconsistency, indirectness, and magnitude of effect. Recommendations are characterized as strong or weak (alternative terms conditional or discretionary) according to the quality of the supporting evidence and the balance between desirable and undesirable consequences of the alternative management options. GRADE suggests summarizing evidence in succinct, transparent, and informative summary of findings tables that show the quality of evidence and the magnitude of relative and absolute effects for each important outcome and/or as evidence profiles that provide, in addition, detailed information about the reason for the quality of evidence rating. Subsequent articles in this series will address GRADE’s approach to formulating questions, assessing quality of evidence, and developing recommendations. [Copyright &y& Elsevier]