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Background Trustworthy clinical practice guidelines (CPGs) require identification and careful management of conflicts of interest (COIs) among all participants in the guideline development. Furthermore, COIs are more common than anticipated. However, there are no universally accepted methods to identify and manage COIs. Objective To describe and summarize the current COI disclosure forms and management policies in selected critical care professional societies that develop high-impact CPGs. In addition, we aim to provide suggestions to guideline developers on how to identify and manage different types of COIs. Methods We searched PubMed and MEDLINE for CPGs published between 2013 and 2018 in English language and addressed general critical care topics. We then ranked the CPGs according to the numbers of citations and selected the first five critical care professional societies that sponsored the guidelines. We obtained the most recent COI declaration forms and management policies. Two reviewers abstracted data on different types of COI in each of the disclosure forms and management policies. Results All selected professional critical care societies require that members declare direct financial COIs; four societies inquire specifically about intellectual COIs (involvement in primary research). Three out of five societies require members to disclose indirect institutional financial COIs; however, none inquire about other forms of institutional COI. We developed, by consensus, a streamlined framework to classify and manage different types of COIs. Conclusion The current COI disclosure forms of selected professional societies provide more attention to financial disclosures and COIs and less attention to detecting and managing intellectual COIs, while rarely addressing institutional COIs. We provide some suggestions for guideline developers on the classification and management of different COIs in the context of CPGs., Author(s): Waleed Alhazzani [sup.1] [sup.2], Kimberley Lewis [sup.1], Roman Jaeschke [sup.1] [sup.2], Bram Rochwerg [sup.1] [sup.2], Morten Hylander Møller [sup.3], Laura Evans [sup.4], Kevin C. Wilson [sup.5], Sheena Patel [sup.6], [...]

Context.--Laboratories must demonstrate analytic validity before any test can be used clinically, but studies have shown inconsistent practices in immunohistochemical assay validation. Objective.--To assess changes in immunohistochemistry analytic validation practices after publication of an evidence-based laboratory practice guideline. Design.--A survey on current immunohistochemistry assay validation practices and on the awareness and adoption of a recently published guideline was sent to subscribers enrolled in one of 3 relevant College of American Pathologists proficiency testing programs and to additional nonsubscribing laboratories that perform immunohistochemical testing. The results were compared with an earlier survey of validation practices. Results.--Analysis was based on responses from 1085 laboratories that perform immunohistochemical staining. Of 1057 responses, 65.4% (691) were aware of the guideline recommendations before this survey was sent and 79.9% (550 of 688) of those have already adopted some or all of the recommendations. Compared with the 2010 survey, a significant number of laboratories now have written validation procedures for both predictive and nonpredictive marker assays and specifications for the minimum numbers of cases needed for validation. There was also significant improvement in compliance with validation requirements, with 99% (100 of 102) having validated their most recently introduced predictive marker assay, compared with 74.9% (326 of 435) in 2010. The difficulty in finding validation cases for rare antigens and resource limitations were cited as the biggest challenges in implementing the guideline. Conclusions.--Dissemination of the 2014 evidencebased guideline validation practices had a positive impact on laboratory performance; some or all of the recommendations have been adopted by nearly 80% of respondents. (Arch Pathol Lab Med. 2017;141:1247-1254; doi: 10.5858/arpa.2016-0558-CP), The College of American Pathologists (CAP) Pathology and Laboratory Quality Center (the CAP Center) develops and maintains evidence-based laboratory practice guidelines (LPGs) that follow the US Institute of Medicine's Clinical [...]

Latino children in the US are systematically underdiagnosed with Autism Spectrum Disorder (ASD); therefore, it is important that recent changes to the diagnostic process do not exacerbate this pattern of under-identification. Previous research has found that the Autism Diagnostic Interview-Revised (ADI-R) algorithm, based on the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition, Text Revision (DSM-IV-TR), has limitations with Latino children of Spanish speaking parents. We evaluated whether an ADI-R algorithm based on the new DSM-5 classification for ASD would be more sensitive in identifying Latino children of Spanish speaking parents who have a clinical diagnosis of ASD. Findings suggest that the DSM-5 algorithm shows better sensitivity than the DSM-IV-TR algorithm for Latino children., Author(s): Sandy Magaña [sup.1] , Sandra B. Vanegas [sup.2] Author Affiliations: (1) grid.185648.6Department of Disability and Human Development, University of Illinois at Chicago, 1640 W Roosevelt Road 2080 SSB, 60608, [...]

Objective Postpartum hemorrhage (PPH) has a continuously rising incidence worldwide, suggesting suboptimal care. An important step in optimizing care is the translation of evidence-based guidelines into comprehensive hospital protocols. However, knowledge about the quality of these protocols is lacking. The objective of this study was to evaluate the quality of PPH-protocols on structure and content in the Netherlands. Methods We performed an observational multicenter study. Eighteen PPH-protocols from 3 University Hospitals (UH), 8 Teaching Hospitals (TH) and 7 Non-Teaching hospitals (NTH) throughout the Netherlands were acquired. The structure of the PPH-protocols was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) Instrument. The content was appraised using previously developed quality indicators, based on international guidelines and Advance-Trauma-Life-Support (ATLS)-based course instructions. Results The quality of the protocols for postpartum hemorrhage for both structure and content varied widely between different hospitals, but all of them showed room for improvement. The protocols scored mainly below average on the different items of the AGREE-II instrument (8 of the 10 items scored, Author(s): Mallory D. Woiski[sup.1] , Helena C. van Vugt[sup.1] , Anneke Dijkman[sup.2] , Richard P. Grol[sup.3] , Abraham Marcus[sup.4] , Johanna M. Middeldorp[sup.5] , Ben W. Mol[sup.6] , Femke Mols[sup.1] [...]

Author(s): Michael P. Casaer [sup.1] , Jean Reignier [sup.2] , Gordon Doig [sup.3] Author Affiliations: (1) 0000 0001 0668 7884, grid.5596.f, Clinical Department and Laboratory of Intensive Care Medicine, University [...]

CLINICAL SCENARIO You are a young general surgeon in a community practice. A new consultation is scheduled in your clinic: a 60-year-old woman presenting with chronic venous ulcers on both [...]

Introduction The purpose of a scientific paper is to communicate results and within the paper this applies especially to the presentation of data. It is the universal practice in medical journals to present statistical results using tables. Good tables are an integral part of the manuscript. To help researchers communicate their results, we present practical guidance for reporting statistical results using tables. Results Five key points are presented for reporting statistical results using tables: (1) early reflection and choice about the results to present, (2) presentation of tables and definition of rows and columns, (3) filling the cells, (4) title, caption, footnotes, and quality, (5) final checklist. Conclusion This guidance is a practical tool to improve the reporting of statistical results using tables when presenting ICU data in future research., Author(s): Corinne Alberti [sup.1] [sup.2] [sup.3] , Rym Boulkedid [sup.1] [sup.2] Author Affiliations: (1) grid.413235.2, 0000000419370589, AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, , 48 Bd Sérurier, 75019, Paris, France [...]

Introduction: Diabetes care in Canada is usually provided in family practice offices, which may not have nurses to provide planned, proactive care as recommended by guidelines. The use of medical office assistants (MOAs) to do key tasks in diabetes care may improve the effectiveness of care and reduce costs. We sought to determine whether an expanded MOA role in a rural practice was beneficial to patients and the practice. Methods: We systematically evaluated the provision of diabetes care as measured by key indicators, patient and provider satisfaction, and use of health care services. Results: Involvement by MOAs improved adherence to selected aspects of guideline-based care, and patient and provider satisfaction was high. The actual outcomes of the surrogate markers measured in care and downstream use of acute care services appeared to be unchanged during this study. Conclusion: Use of MOAs to help provide team-based diabetes care in family practice resulted in improved performance of key indicators for diabetes care. Introduction : Les soins aux personnes atteintes de diabete au Canada sont habituellement fournis par des pratiques de medecine familiale qui ne disposent pas necessairement d'infirmieres pour dispenser les soins proactifs planifies recommandes par les lignes directrices. Le recours aux adjointes de bureau medical (ABM) pour effectuer des taches cles en soin du diabete peut ameliorer l'efficacite des soins et reduire les couts. Nous avons cherche a determiner si un role elargi pour les ABM dans une pratique rurale etait benefique pour les patients et la pratique. Methodes : Nous avons evalue systematiquement la prestation de soins aux personnes atteintes de diabete telle que mesuree par des indicateurs cles, par la satisfaction des patients et des fournisseurs et par l'utilisation des services de sante. Resultats : L'intervention des ABM a ameliore l'observation de certains aspects des soins bases sur les lignes directrices, et la satisfaction des patients et des fournisseurs etait elevee. Les resultats concrets au niveau des marqueurs substituts mesures pour les soins et l'utilisation en aval des services de soins actifs n'ont pas semble changer au cours de l'etude. Conclusion : Le recours aux ABM pour aider a fournir les soins du diabete en equipe dans une pratique de medecine familiale a ameliore le rendement d'indicateurs cles en soin du diabete., INTRODUCTION Given the major burden of diabetes in Canada, it is vital to improve health outcomes through improved care. (1-7) Diabetes care in Canada is largely provided by family doctors. [...]