scholarly journals Acupuncture for cancer pain: an evidence-based clinical practice guideline

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Long Ge ◽  
Qi Wang ◽  
Yihan He ◽  
Darong Wu ◽  
Qi Zhou ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cancer Pain ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Patient Preferences ◽  
Small Sample ◽  
Evidence Based ◽  
Breast Cancer Patients ◽  
Strong Recommendation ◽  
Opioid Dose

Abstract Background This study aims to develop an evidence-based clinical practice guideline of acupuncture in the treatment of patients with moderate and severe cancer pain. Methods The development of this guideline was triggered by a systematic review published in JAMA Oncology in 2020. We searched databases and websites for evidence on patient preferences and values, and other resources of using acupuncture for treatment of cancer pain. Recommendations were developed through a Delphi consensus of an international multidisciplinary panel including 13 western medicine oncologists, Chinese medicine/acupuncture clinical practitioners, and two patient representatives. The certainty of evidence, patient preferences and values, resources, and other factors were fully considered in formulating the recommendations. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was employed to rate the certainty of evidence and the strength of recommendations. Results The guideline proposed three recommendations: (1) a strong recommendation for the treatment of acupuncture rather than no treatment to relieve pain in patients with moderate to severe cancer pain; (2) a weak recommendation for the combination treatments with acupuncture/acupressure to reduce pain intensity, decrease the opioid dose, and alleviate opioid-related side effects in moderate to severe cancer pain patients who are using analgesics; and (3) a strong recommendation for acupuncture in breast cancer patients to relieve their aromatase inhibitor-induced arthralgia. Conclusion This proposed guideline provides recommendations for the management of patients with cancer pain. The small sample sizes of evidence limit the strength of the recommendations and highlights the need for additional research.

scholarly journals The development and evaluation of an online educational tool for the evidence-based management of neck pain by chiropractic teaching faculty

2020 ◽  
Author(s):  
Leslie Verville ◽  
Pierre Côté DC ◽  
Diane Grondin ◽  
Silvano Mior DC ◽  
Robin Kay
Keyword(s):  
Clinical Practice ◽  
Neck Pain ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Thinking Skills ◽  
Faculty Members ◽  
Evidence Based ◽  
Learning Design ◽  
Educational Tool ◽  
Learning Tool

Objective To develop an online, interactive educational tool to deliver an evidence-based clinical practice guideline to faculty members at a Canadian chiropractic college. Second, to evaluate the learning, design, and engagement constructs of the tool in a sample of chiropractic faculty members. Methods Using an integrated knowledge translation methodology and the Knowledge to Action Framework, we developed an evidence-based online learning tool. The context of the tool focused on a clinical practice guideline on the management of neck pain. We evaluated the learning, design, and engagement constructs in a sample of faculty members and residents using the Learning Object Evaluation Scale for Students. Participants were also asked to provide suggestions for improvement of the tool. Results Sixteen participants completed the evaluation. Most (68.8%) participants were chiropractors, 75% were male and 56% were between the ages of 25 and 44 years. At least 75% of participants agreed that the learning, design, and engagement constructs of the learning tool were adequate. The open-ended suggestions unveiled 3 pedagogical themes, relating to multimedia, thinking skills, and learner control, within the tool that could benefit from further development. These themes informed recommendations to improve the tool. Conclusion Our online, interactive, module-based learning tool has sound pedagogical properties. Further research is needed to determine if its use is associated with a change in knowledge.

Evidence-Based Clinical Practice Guideline: Reconstruction after Skin Cancer Resection

2021 ◽  
Vol 47 (7) ◽  
pp. 891-907
Author(s):  
Andrew Chen ◽  
John G. Albertini ◽  
Jeremy S. Bordeaux ◽  
Michael W. Chen ◽  
Jonathan L. Cook ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Skin Cancer ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Evidence Based ◽  
Cancer Resection

scholarly journals Clinical Practice Guideline for Systemic Antifungal Prophylaxis in Pediatric Patients With Cancer and Hematopoietic Stem-Cell Transplantation Recipients

2020 ◽  
Vol 38 (27) ◽  
pp. 3205-3216
Author(s):  
Thomas Lehrnbecher ◽  
Brian T. Fisher ◽  
Bob Phillips ◽  
Melissa Beauchemin ◽  
Fabianne Carlesse ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stem Cell ◽  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Pediatric Patients ◽  
Antifungal Prophylaxis ◽  
Hematopoietic Stem ◽  
Strong Recommendation ◽  
Patients With Cancer

PURPOSE To develop a clinical practice guideline for systemic antifungal prophylaxis in pediatric patients with cancer and hematopoietic stem-cell transplantation (HSCT) recipients. METHODS Recommendations were developed by an international multidisciplinary panel that included a patient advocate. We conducted a systematic review of systemic antifungal prophylaxis in children and adults with cancer and HSCT recipients. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to make strong or weak recommendations and to classify level of evidence as high, moderate, low, or very low. The panel considered directness of the data to pediatric patients. RESULTS There were 68 randomized trials included in the systematic review, of which 6 (9%) were conducted in a solely pediatric population. Strong recommendations were made to administer systemic antifungal prophylaxis to children and adolescents receiving treatment of acute myeloid leukemia, to those undergoing allogeneic HSCT pre-engraftment, and to those receiving systemic immunosuppression for graft-versus-host disease treatment. A strong recommendation was made to administer a mold-active agent with an echinocandin or a mold-active azole when systemic antifungal prophylaxis is warranted. For children younger than 13 years of age, an echinocandin, voriconazole, or itraconazole is suggested. Posaconazole may also be used in those age 13 years or older. A strong recommendation against routine administration of amphotericin as systemic antifungal prophylaxis was made. CONCLUSION We developed a clinical practice guideline for systemic antifungal prophylaxis administration in pediatric patients with cancer and HSCT recipients. Implementation and assessment of guideline-concordant rates and impacts are important future steps.

scholarly journals Clinical practice guideline on the prevention and management of neonatal extravasation injury: a before-and-after study design

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kam Ming Chan ◽  
Janita Pak Chun Chau ◽  
Kai Chow Choi ◽  
Genevieve Po Gee Fung ◽  
Wai Wa Lui ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Central Line ◽  
Evidence Based ◽  
Post Intervention ◽  
Before And After ◽  
Level Of Knowledge ◽  
Intravenous Catheters ◽  
Before And After Study

Abstract Background Extravasation injury resulting from intravenous therapies delivered via peripheral intravenous catheters or umbilical and peripherally inserted central venous catheters is a common iatrogenic complication occurring in neonatal intensive care units. This study aimed to evaluate the effectiveness of an evidence-based clinical practice guideline in the prevention and management of neonatal extravasation injury by nurses. Methods A controlled before-and-after study was conducted in a neonatal unit. The clinical practice guideline was developed, and a multifaceted educational program was delivered to nurses. Neonatal outcomes, including the rates of peripheral intravenous extravasation and extravasation from a central line, were collected at the pre- and post-intervention periods. Post-intervention data for nurses, including the nurses’ level of knowledge and adherence, were collected at six months after the program. Results 104 and 109 neonates were recruited in the pre-intervention period (control) and the post-intervention period (intervention), respectively. The extravasation rate before and after the intervention was 14.04 and 2.90 per 1,000 peripheral intravenous catheters days, respectively. The adjusted odds ratio of peripheral intravenous extravasation post-intervention compared with that of pre-intervention was 0.20 (95% confidence interval: 0.05–0.74; p = 0.02) after adjusting for peripheral intravenous catheter days. The extravasation from a central line rate of the control and intervention groups post-intervention was 4.94 and zero per 1,000 central venous catheter days, respectively. Fifty-nine registered nurses were recruited. At six months post-program, there were significant improvements in the nurses’ level of knowledge and adherence. Conclusions These findings suggest that the implementation of an evidence-based clinical practice guideline significantly reduced the rate of peripheral intravenous extravasation and extravasation from a central line in neonates. However, to maintain nurses’ knowledge and adherence to the evidence-based practice, the educational program will have to be conducted periodically and incorporated into the nurses’ induction program. Trial registration ClinicalTrials.gov, Identifiers: NCT04321447. Registered 20 March 2020 - Retrospectively registered.

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