Pancreatic cancer.Evidence based management guidelines of the Hungarian Pancreatic Study Group

Pancreatic cancer is a disease with a poor prognosis usually diagnosed at a late stage. Therefore, screening, diagnosis, treatment and palliation of pancreatic cancer patients require up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available scientific evidence and international guidelines. The preparatory and consultation board appointed by the Hungarian Pancreatic Study Group translated and complemented/modified the recent international guidelines. 37 clinical statements in 10 major topics were defined (Risk factors and genetics, Screening, Diagnosis, Staging, Surgical care, Pathology, Systemic treatment, Radiation therapy, Palliation and supportive care, Follow-up and recurrence). Evidence was graded according to the National Comprehensive Cancer Network (NCCN) grading system. The draft of the guideline was presented and discussed at the consensus meeting in September 12, 2014. Statements were accepted with either total (more than 95% of votes, n = 15) or strong agreement (more than 70% of votes, n = 22). The present guideline is the first evidence based pancreatic cancer guideline in Hungary that provides a solid ground for teaching purposes, offers quick reference in everyday patient care and guides patient financing options. The authors strongly believe that these guidelines will become a standard reference for pancreatic cancer treatment in Hungary. Orv. Hetil., 2015, 156(8), 326–339.

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Pediatric pancreatitis.Evidence based management guidelines of the Hungarian Pancreatic Study Group

Orvosi Hetilap ◽

10.1556/oh.2015.30062 ◽

2015 ◽

Vol 156 (8) ◽

pp. 308-325 ◽

Cited By ~ 7

Author(s):

Andrea Párniczky ◽

László Czakó ◽

Zsolt Dubravcsik ◽

Gyula Farkas ◽

Péter Hegyi ◽

...

Keyword(s):

Task Force ◽

Consensus Meeting ◽

Study Group ◽

Evidence Based ◽

Management Guidelines ◽

International Guidelines ◽

The Past ◽

Basic Reference ◽

Clinical Questions ◽

Evidence Based Guideline

Pediatric pancreatitis is a rare disease with variable etiology. In the past 10–15 years the incidence of pediatric pancreatitis has been increased. The management of pediatric pancreatitis requires up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidences. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. In 8 topics (diagnosis; etiology; prognosis; imaging; therapy; biliary tract management; complications; chronic pancreatitis) 50 relevant clinical questions were defined. (Evidence was classified according to the UpToDate®grading system. The draft of the guidelines was presented and discussed at the consensus meeting on September 12, 2014. All clinical questions were accepted with total (more than 95%) agreement. The present Hungarian Pancreatic Study Group guideline is the first evidence based pediatric pancreatitis guideline in Hungary. This guideline provides very important and helpful data for tuition of pediatric pancreatitis in everyday practice and establishing proper finance and, therefore, the authors believe that these guidelines will widely serve as a basic reference in Hungary. Orv. Hetil., 2015, 156(8), 308–325.

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Autoimmune pancreatitis.Evidence based management guidelines of the Hungarian Pancreatic Study Group

Orvosi Hetilap ◽

10.1556/oh.2015.30061 ◽

2015 ◽

Vol 156 (8) ◽

pp. 292-307 ◽

Cited By ~ 4

Author(s):

Zsolt Dubravcsik ◽

Gyula Farkas ◽

Péter Hegyi ◽

István Hritz ◽

Dezső Kelemen ◽

...

Keyword(s):

Autoimmune Pancreatitis ◽

Task Force ◽

Correct Diagnosis ◽

Differential Diagnostics ◽

Study Group ◽

Evidence Based ◽

Management Guidelines ◽

International Guidelines ◽

Basic Reference ◽

Evidence Based Guideline

Autoimmune pancreatitis is a rare disease which can even mimic pancreatic tumor, however, unlike the latter, it requires not surgical but conservative management. Correct diagnosis and differential diagnosis of autoimmune pancreatitis and treatment of these patients requires up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidences. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. 29 relevant clinical questions in 4 topics were defined (Basics; Diagnosis; Differential diagnostics; Therapy). Evidence was classified according to the UpToDate®grading system. The draft of the guidelines was presented and discussed at the consensus meeting on September 12, 2014. All clinial questions were accepted with almost total (more than 95%) agreement. The present guideline is the first evidence based autoimmune pancreatitis guideline in Hungary. The guideline may provide very important and helpful data for tuition of autoimmune pancreatitis, for everyday practice and for establishing proper finance. Therefore, the authors believe that these guidelines will widely become a basic reference in Hungary. Orv. Hetil., 2015, 156(8), 292–307.

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Chronic pancreatitis.Evidence based management guidelines of the Hungarian Pancreatic Study Group

Orvosi Hetilap ◽

10.1556/oh.2015.30060 ◽

2015 ◽

Vol 156 (7) ◽

pp. 262-288 ◽

Cited By ~ 12

Author(s):

Tamás Takács ◽

László Czakó ◽

Zsolt Dubravcsik ◽

Gyula Farkas ◽

Péter Hegyi ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Treatment Guidelines ◽

Task Force ◽

Correct Diagnosis ◽

Study Group ◽

Evidence Based ◽

International Guidelines ◽

Basic Reference ◽

Evidence Based Guideline

Chronic pancreatitis is an inflammatory disease associated with structural and functional damage of the pancreas. In most cases pain, maldigestion and weight loss are the leading sympthoms, which significantly worsen the quality of life. Correct diagnosis and differential diagnosis of chronic pancreatitis and treatment of these patients requires up-to-date and evidence based treatment guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidence. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. 123 relevant clinical questions in 11 topics were defined. Evidence was classified according to the UpToDate®grading system. The draft of the guidelines were presented and discussed at the consensus meeting in September 12, 2014. All clinial questions were accepted with total or strong agreement. The present guideline is the first evidence based chronic pancreatitis guideline in Hungary. This guideline provides very important and helpful data for tuition, everyday practice and proper financing of chronic pancreatitis. Therefore, the authors believe that these guidelines will widely become a basic reference in Hungary. Orv. Hetil., 2015, 156(7), 262–288.

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Acute pancreatitis.Evidence based management guidelines of the Hungarian Pancreatic Study Group

Orvosi Hetilap ◽

10.1556/oh.2015.30059 ◽

2015 ◽

Vol 156 (7) ◽

pp. 244-261 ◽

Cited By ~ 16

Author(s):

István Hritz ◽

László Czakó ◽

Zsolt Dubravcsik ◽

Gyula Farkas ◽

Dezső Kelemen ◽

...

Keyword(s):

Acute Pancreatitis ◽

Treatment Guidelines ◽

Task Force ◽

Necrotizing Pancreatitis ◽

Infectious Complications ◽

Study Group ◽

Evidence Based ◽

International Guidelines ◽

Clinical Questions ◽

Evidence Based Guideline

Acute pancreatitis is one of the most common diseases of the gastrointestinal tract associated with significant morbidity and mortality that requires up-to-date and evidence based treatment guidelines. The Hungarian Pancreatic Study Group proposed to prepare evidence based guideline for the medical and surgical management of acute pancreatitis based on the available international guidelines and evidence. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and, if it was necessary, complemented and/or modified the international guidelines. All together 42 relevant clinical questions were defined in 11 topics (Diagnosis and etiology, Prognosis, Imaging, Fluid therapy, Intensive care management, Prevention of infectious complications, Nutrition, Biliary interventions, Post-endoscopic retrograde cholangio-pancreatography pancreatitis, Indication, timing and strategy for intervention in necrotizing pancreatitis, Timing of cholecystectomy [or endoscopic sphincterotomy]). Evidence was classified according to the UpToDate®grading system. The draft of the guideline was presented and discussed at the consensus meeting on September 12, 2014. 25 clinical questions with almost total (more than 95%) and 17 clinical questions with strong (more than 70%) agreement were accepted. The present guideline is the first evidence based acute pancreatitis guideline in Hungary. The guideline may provide important help for tuition, everyday practice and for establishment of proper finance of acute pancreatitis. Therefore, the authors believe that these guidelines will widely become as basic reference in Hungary. Orv. Hetil., 2015, 156(7), 244–261.

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Evidence-Based Surgery

DeckerMed Surgery ◽

10.2310/surg.2008 ◽

2017 ◽

Author(s):

Karl Y. Bilimoria ◽

Benjamin S Brooke

Keyword(s):

Scientific Evidence ◽

Surgical Techniques ◽

Internal Validity ◽

Surgical Care ◽

Evidence Based ◽

Services Research ◽

Surgical Decision ◽

Evidence Based Surgery ◽

Quality Of Research

The practice of surgery has undergone a dramatic evolution over the last century with the availability of new scientific evidence supporting different surgical techniques and management. Evidence-based surgery is defined as the judicious and systematic application of scientific evidence to surgical decision making and the establishment of standards of surgical care. This includes efforts to appraise the strength of scientific evidence and evaluate the quality of research studies or evidence, as well as efforts to interpret and apply evidence to clinical practice. In this review, we discuss important methodology and approaches in surgical health services research to accomplish these goals and improve the quality of care in surgery. By providing this overview, we hope readers will be able to navigate the surgical literature and apply evidence-based science to their own surgical practice. This review contains 1 figure, 3 tables, and 43 references. Key words: bias, comparative effectiveness, confounding, evidence, external validity, implementation science, internal validity, pragmatic trials, quality, risk adjustment, surgery

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Evidence-Based Surgery

10.2310/vasc.2008 ◽

2017 ◽

Author(s):

Karl Y. Bilimoria ◽

Benjamin S Brooke

Keyword(s):

Scientific Evidence ◽

Surgical Techniques ◽

Internal Validity ◽

Surgical Care ◽

Evidence Based ◽

Services Research ◽

Surgical Decision ◽

Evidence Based Surgery ◽

Quality Of Research

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Thoracic Surgery in the COVID-19 Pandemic: A Novel Approach to Reach Guideline Consensus

Journal of Clinical Medicine ◽

10.3390/jcm10132769 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2769

Author(s):

Tomasz Dziodzio ◽

Sebastian Knitter ◽

Helen Hairun Wu ◽

Paul Viktor Ritschl ◽

Karl-Herbert Hillebrandt ◽

...

Keyword(s):

Thoracic Surgery ◽

Scientific Evidence ◽

Healthcare Systems ◽

Evidence Based ◽

Prospective Data ◽

National Healthcare ◽

Novel Approach ◽

High Degree ◽

Key Questions

The COVID-19 pandemic challenges international and national healthcare systems. In the field of thoracic surgery, procedures may be deferred due to mandatory constraints of the access to diagnostics, staff and follow-up facilities. There is a lack of prospective data on the management of benign and malignant thoracic conditions in the pandemic. Therefore, we derived recommendations from 14 thoracic societies to address key questions on the topic of COVID-19 in the field of thoracic surgery. Respective recommendations were extracted and the degree of consensus among different organizations was calculated. A high degree of consensus was found to temporarily suspend non-critical elective procedures or procedures for benign conditions and to prioritize patients with symptomatic or advanced cancer. Prior to hospitalization, patients should be screened for respiratory symptoms indicating possible COVID-19 infection and most societies recommended to screen all patients for COVID-19 prior to admission. There was a weak consensus on the usage of serology tests and CT scans for COVID-19 diagnostics. Nearly all societies suggested to postpone elective procedures in patients with suspected or confirmed COVID-19 and recommended constant reevaluation of these patients. Additionally, we summarized recommendations focusing on precautions in the theater and the management of chest drains. This study provides a novel approach to informed guidance for thoracic surgeons during the COVID-19 pandemic in the absence of scientific evidence-based data.

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Benefit and costs of surveillance on cancer risk patients: the example of pancreatic cystic tumors

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.879 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

P A Cortesi ◽

D Tamburino ◽

R Facchetti ◽

M Micale ◽

L G Mantovani ◽

...

Keyword(s):

Pancreatic Cancer ◽

Clinical Practice ◽

Pancreatic Surgery ◽

Cancer Surveillance ◽

Pancreatic Cysts ◽

Significant Heterogeneity ◽

International Guidelines ◽

Cystic Tumors ◽

Mean Cost

Abstract Background Increasing number of expert recommendations and guidelines of cancer surveillance have become available in the last decade. This complex scenario have increased the uncertainty on the most valuable approach to adopt. This study aim to evaluate the case of premalignant pancreatic primarily cystic tumors surveillance, assessing the differences of programmes proposed and applied. Methods A review of American, European and International guidelines for surveillance of asymptomatic neoplastic pancreatic cysts was performed to assess the difference of programmes proposed. An amibispective observational study, form 1995 to 2019, was conducted on patients with premalignant pancreatic primarily cystic tumors monitored in 10 centers from 4 European countries. We estimated incidence of pancreatic cancer and surgery intervention for high grade dysplasia (HGD)/Pancreatic cancer. We also assessed the follow-up visits and exams frequency during the surveillance period and the relative mean cost per patient-year. Results The guidelines reported significant differences in patient’s stratification, surveillance intensity (frequency of visits-exams), and surveillance duration. In the study conducted, 961 patients were enrolled with a median (IQR) follow-up of 4.47(2.8-7.0) years. HGD or Pancreatic carcinoma was reported by 43(4.4%) patients and 67(7.0%) undergone pancreatic surgery. Within the pancreatic surgery performed, 60.6% was rated as over-treated (None/low-moderate grade dysplsya). A big variability was reported in the surveillance with a median (IQR) visit per patient-year of 0.77(0.49-1.03) and with a mean cost per-patient year of €163.3. Conclusions Significant heterogeneity between surveillance approaches was reported in guidelines and clinical practice. Reliable and specific data on efficacy and costs associated to surveillances programmes proposed are needed in order to perform robust assessment and help decision makers in implementing the most valuable one. Key messages Significant variability of surveillance programmes proposed and applied for pancreatic cystic are reported in the guidelines and clinical practice. We need more robust efficacy and costs data in order to identify the most valuable surveillances approach to implement in clinical practice and recommend in the national and international guidelines.

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Implementation of evidence-based practices in the perineal pain management in the postpartum period

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2021-0084 ◽

2022 ◽

Vol 75 (2) ◽

Author(s):

Raquel Gomes de Oliveira Tomaz ◽

Ana Paula Almeida Brito ◽

Maria Luiza Gonzalez Riesco

Keyword(s):

Pain Management ◽

Professional Training ◽

Scientific Evidence ◽

Maternity Hospital ◽

Perineal Pain ◽

Evidence Based ◽

Evidence Based Practices ◽

Care Protocol ◽

Nursing Professionals

ABSTRACT Objectives: To implement strategies for managing perineal pain in puerperal women admitted to a public maternity hospital in São Paulo state and to evaluate their compliance with evidence-based practices. Methods: Implementation study using the JBI model conducted with nursing professionals and puerperal women between September and December 2019. Interviews with puerperal women and medical record data were used to audit seven evidence-based criteria. The interventions adopted included a care protocol, professional training, and folder elaboration for puerperal women. Results: Prior to the intervention, deficits in audited practices and obstacles to pain management were identified, which were overcome by the strategies employed. The follow-up audit demonstrated improvements in compliance with best care practices. Conclusion: There was an increase in the criteria compliance evaluated after the implemented strategies, contributing to improving the nursing care results in the perineal pain management based on the best scientific evidence.

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Pain and pain management in hospitalized patients before and after an intervention

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2016.11.006 ◽

2017 ◽

Vol 15 (1) ◽

pp. 22-29 ◽

Cited By ~ 6

Author(s):

Viveka Andersson ◽

Stefan Bergman ◽

Ingela Henoch ◽

Kerstin Wickström Ene ◽

Eva Otterström-Rydberg ◽

...

Keyword(s):

Pain Management ◽

Severe Pain ◽

Hospitalized Patients ◽

Baseline Survey ◽

Evidence Based ◽

Pain Rating ◽

Management Guidelines ◽

Disturbed Sleep ◽

Evidence Based Guidelines

AbstractBackground and aimStudies have shown that pain is common among hospitalized patients and that there is a lack of compliance with pain management guidelines. Improving pain management does not only involve developing new drugs or technology; even more important is an effective organisation that utilises existing expertise. The aim of this study was to investigate whether pain in hospitalized patients can be reduced by implementing evidence-based pain management guidelines, providing education for staff and an organisation that includes pain responsibility nurses.MethodsA cross-sectional study was carried out between 2009 and 2010 at two hospitals in southwest Sweden, comprising a baseline survey followed by an intervention. The study involved 306 patients, who answered questions about pain intensity at rest and while moving, disturbed sleep due to pain and whether they had used a pain rating scale while in hospital. Medical records were scrutinised for analgesic prescriptions. An intervention then took place, involving implementation of evidence-based guidelines, staff education and the introduction of pain responsibility nurses. A follow-up survey was carried out in 2012, in which 293 patients answered the same questions and their medical records were also reviewed. The baseline results were then compared with those of the follow-up survey.ResultsWhen compared with the baseline survey, the follow-up survey revealed significant differences in the use of validated pain rating instruments as well as the prescription of more appropriate analgesics. Prescription of paracetamol increased significantly in the follow-up survey; 56% of the patients were prescribed paracetamol on a regular basis, compared with 42% at baseline. There was also a significant increase in the use of strong opioids, from 38% at baseline to 55% at follow-up. Prescriptions of weak opioids decreased from 16% at baseline to 4% at follow-up. No significant differences were observed in patient pain levels in the follow-up survey. At baseline, 29% of the patients reported moderate to severe pain at rest (NRS 4–10) and at follow-up that figure was 24% (NRS 4–10). In both surveys, 41% reported moderate to severe pain (NRS 5–10) during movement. Thirty-nine percent reported disturbed sleep at night at both baseline and follow-up.ConclusionsThis study demonstrates that evidence-based guidelines made accessible to all staff as a pocket size booklet and on the intranet, in combination with staff education, pain responsibility nurses who informed other staff on their own wards, improved the prescription of analgesics in the hospitals studied. In order to achieve a noticeable effect for patients, i.e., reduced pain levels, an intervention containing more components than those employed in the present study is required.ImplicationsNurses and physicians need greater knowledge about the importance of pain rating. A vital part of pain management at hospitals is continuous evaluation of treatment outcomes to prevent severe pain and disturbed sleep. The complexity of pain and pain management requires commitment, time and knowledge on the part of healthcare staff. Multi-professional pain teams that support ward staff in pain management are necessary in order to reduce suffering and unnecessary pain in hospitalized patients.

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