THERAPEUTIC GUIDELINES FOR MEDIASTINAL CYSTS

Abstract Background Since patients receiving surgery may experience surgical site infections, therapeutic guidelines for reducing hospitalization time and cost include appropriate antibiotic use. However, the association between adherence to therapeutic guidelines and healthcare utilization is currently unclear. Objectives This study aimed to confirm the positive association between the adherence to guidelines of antibiotic therapy and a reduction in the length of stay and cost of hospitalization, especially considering the high infection rates in abdominal surgery. Methods This cross-sectional study used administrative data (diagnosis procedure combination data) collected using the case-mix system implemented in acute-care hospitals in Japan. We assessed the length of hospital stay and cost of hospitalization for patients who received prophylactic antibiotic for abdominal surgeries consistent with therapeutic guidelines. The data of patients aged 15 years or older who received appendectomy, laparoscopic cholecystectomy or inguinal hernia repair were extracted. The appropriateness of antibiotic prophylaxis was evaluated in terms of the Japanese guidelines for antibiotic selection and treatment duration. To assess the mean difference in antibiotic costs and length of stay, we performed the propensity score matching by confounding factors. Furthermore, we assessed the progress in healthcare utilization of this therapy over a decade. Results Of the 302 233 patients who received single general surgery from April 2014 to March 2016, 198 885 were eligible for analysis after applying the exclusion criteria (143 975 in the adherence and 54 910 in the non-adherence group). Each group comprised 48 439 patients after propensity score matching. Inappropriate antibiotic selection and duration were observed in 9294 (9.8%) and 687 (0.7%) of inguinal hernia repairs, 6431 (25.3%) and 311 (1.2%) of appendectomies and 38 134 (48.5%) and 391 (0.5%) of laparoscopic cholecystectomy cases, respectively. After propensity score matching by operation type, average hospitalization length (6.5 [SD 3.8] and 7.3 [SD 4.8] days) and costs (536 000 [SD 167 000] JPY and 573 000 [SD 213 000] JPY) differed significantly between adherence and non-adherence groups. Conclusion The results revealed that unnecessary healthcare utilization was associated with failure to adhere to therapeutic guidelines for prophylactic antibiotic therapy in elective general surgeries. We concluded that the progress of reduction in length of hospitalization over the decade was successful. Notably, adherence to treatment duration was better than that was 10 years ago. In this decade, administrators in hospitals have attempted to reduce the duration of hospitalization by developing various clinical pathways for surgical procedures and quality indicators. However, 15 877 patients (8.7%) were prescribed oral antibiotics the day after surgery. These observations should be evaluated further.

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Do Guidelines for the Diagnosis and Monitoring of Diabetes Mellitus Fulfill the Criteria of Evidence-Based Guideline Development?

Clinical Chemistry ◽

10.1373/clinchem.2008.109082 ◽

2008 ◽

Vol 54 (11) ◽

pp. 1872-1882 ◽

Cited By ~ 17

Author(s):

Eva Nagy ◽

Joseph Watine ◽

Peter S Bunting ◽

Rita Onody ◽

Wytze P Oosterhuis ◽

...

Keyword(s):

Diabetes Mellitus ◽

Methodological Quality ◽

Guideline Development ◽

Evidence Based ◽

Test Results ◽

Time Period ◽

Therapeutic Guidelines ◽

Therapeutic Recommendations ◽

Evidence Based Guideline

Abstract Background: Although the methodological quality of therapeutic guidelines (GLs) has been criticized, little is known regarding the quality of GLs that make diagnostic recommendations. Therefore, we assessed the methodological quality of GLs providing diagnostic recommendations for managing diabetes mellitus (DM) and explored several reasons for differences in quality across these GLs. Methods: After systematic searches of published and electronic resources dated between 1999 and 2007, 26 DM GLs, published in English, were selected and scored for methodological quality using the AGREE Instrument. Subgroup analyses were performed based on the source, scope, length, origin, and date and type of publication of GLs. Using a checklist, we collected laboratory-specific items within GLs thought to be important for interpretation of test results. Results: The 26 diagnostic GLs had significant shortcomings in methodological quality according to the AGREE criteria. GLs from agencies that had clear procedures for GL development, were longer than 50 pages, or were published in electronic databases were of higher quality. Diagnostic GLs contained more preanalytical or analytical information than combined (i.e., diagnostic and therapeutic) recommendations, but the overall quality was not significantly different. The quality of GLs did not show much improvement over the time period investigated. Conclusions: The methodological shortcomings of diagnostic GLs in DM raise questions regarding the validity of recommendations in these documents that may affect their implementation in practice. Our results suggest the need for standardization of GL terminology and for higher-quality, systematically developed recommendations based on explicit guideline development and reporting standards in laboratory medicine.

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Commentary

PEDIATRICS ◽

10.1542/peds.38.4.545 ◽

1966 ◽

Vol 38 (4) ◽

pp. 545-546

Author(s):

JEROLD F. LUCEY

Keyword(s):

Serum Albumin ◽

Experimental Evidence ◽

Additional Treatment ◽

Therapeutic Guidelines ◽

Neurotoxic Effects

The foregoing article and comments create a dilemma for pediatricians. The experimental evidence cited is quite convincing that increased amounts of serum albumin decrease the neurotoxic effects of bilirubin. If physicians are convinced of its usefulness, they will want to use this additional treatment for hyperbilirubinemia when it is indicated. Unfortunately, well established therapeutic guidelines do not exist. Serum albumin does not need to be administered to all infants requiring exchange transfusions. Some tentative answers to the questions of which infants should be treated and the amount of serum albumin to be used have been suggested by Dr. Odell in his comments.

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Editorial: Head and neck cancers: recent pathological approaches and new therapeutic guidelines for sino-nasal, thyroid and squamous cell carcinomas

Current Opinion in Oncology ◽

10.1097/cco.0000000000000724 ◽

2021 ◽

Vol 33 (3) ◽

pp. 159

Author(s):

Joël Guigay

Keyword(s):

Head And Neck ◽

Squamous Cell ◽

Squamous Cell Carcinomas ◽

Head And Neck Cancers ◽

Therapeutic Guidelines

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Diabetic Foot Care Plan

Canadian Journal of Infectious Diseases ◽

10.1155/2000/684697 ◽

2000 ◽

Vol 11 (suppl d) ◽

pp. 15D-21D

Author(s):

Gordon Dow ◽

The Diabetic Foot Care Plan Working Group

Keyword(s):

Diabetes Mellitus ◽

Antibiotic Therapy ◽

Diabetic Foot ◽

Economic Loss ◽

Care Plan ◽

Foot Care ◽

Foot Ulceration ◽

General Management ◽

Clinical Scenarios ◽

Therapeutic Guidelines

Diabetes mellitus is the number one cause of limb loss in North America, and is associated with growing, unacceptable rates of morbidity, mortality and economic loss. Approximately 80% of these amputations are preceded by the development of foot ulceration. Various disciplines have studied the prevention and management of foot ulceration in those with diabetes. The present care plan was constructed to incorporate the important contributions from these disciplines into practical therapeutic guidelines. The care plan has been divided into three basic sections: assessment, general management and antibiotic therapy. Each of these sections is described in detail and borrows heavily from previous Canadian position papers. Application of the care plan is illustrated by multiple diabetic foot clinical scenarios, which have been categorized according to the Wagner classification.

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Single Institutional Experience with Primary Mediastinal Cysts: Clinicopathological Study of 108 Resected Cases

Annals of Thoracic and Cardiovascular Surgery ◽

10.5761/atcs.oa.13-00151 ◽

2014 ◽

Vol 20 (5) ◽

pp. 365-369 ◽

Cited By ~ 9

Author(s):

Yoshiki Kozu ◽

Kenji Suzuki ◽

Shiaki Oh ◽

Takeshi Matsunaga ◽

Yukio Tsushima ◽

...

Keyword(s):

Clinicopathological Study ◽

Institutional Experience ◽

Mediastinal Cysts

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Changes in antimicrobial prescribing behavior after the introduction of the antimicrobial stewardship program: A pre- and post-intervention survey

Infectious Disease Reports ◽

10.4081/idr.2017.7268 ◽

2017 ◽

Vol 9 (3) ◽

Cited By ~ 1

Author(s):

Ruchir Chavada ◽

Harry N. Walker ◽

Deborah Tong ◽

Amy Murray

Keyword(s):

Antimicrobial Stewardship ◽

Evidence Based ◽

Post Intervention ◽

Electronic Decision Support ◽

Prescribing Behavior ◽

Antimicrobial Prescribing ◽

Stewardship Program ◽

Wilcoxon Rank Sum Test ◽

Therapeutic Guidelines ◽

Evidence Based Guidelines

The introduction of an antimicrobial stewardship (AMS) program is associated with a change in antimicrobial prescribing behavior. A proposed mechanism for this change is by impacting the <em>prescribing</em> <em>etiquette</em> described in qualitative studies. This study sought to detect a change in prescribing attitudes 12 months after the introduction of AMS and gauge utility of various AMS interventions. Surveys were distributed to doctors in two regional Australian hospitals on a convenience basis 6 months before, and 12 months after, the introduction of AMS. Agreement with 20 statements describing attitudes (cultural, behavioral and knowledge) towards antimicrobial prescribing was assessed on a 4-point Likert scale. Mean response scores were compared using the Wilcoxon Rank sum test. 155 responses were collected before the introduction of AMS, and 144 afterwards. After the introduction of AMS, an increase was observed in knowledge about available resources such as electronic decision support systems (EDSS) and therapeutic guidelines, with raised awareness about the support available through AMS rounds and the process to be followed when prescribing restricted antimicrobials. Additionally, doctors were less likely to rely on pharmacy to ascertain when an antimicrobial was restricted, depend on infectious diseases consultant advice and use past experience to guide antimicrobial prescribing. Responses to this survey indicate that positive changes to the antimicrobial prescribing etiquette may be achieved with the introduction of an AMS program. Use of EDSS and other resources such as evidence-based guidelines are perceived to be important to drive rational antimicrobial prescribing within AMS programs.

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Single Hole High Flow Arteriovenous Fistula

Interventional Neuroradiology ◽

10.1177/159101990200800110 ◽

2002 ◽

Vol 8 (1) ◽

pp. 55-60 ◽

Cited By ~ 7

Author(s):

C. Campos ◽

R. Piske ◽

J. Nunes ◽

S.B. Soares ◽

J.A. Castro ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Fatal Outcome ◽

High Flow ◽

Total Occlusion ◽

Single Hole ◽

Therapeutic Guidelines ◽

Venous Ectasia ◽

Pial Arteriovenous Fistula ◽

Glue Injection ◽

The Right

A high flow pial arteriovenous fistula in a twenty-years-old girl is described. The arteriovenous communication corresponds to a single hole fistula on the right rolandic area, with a giant venous ectasia. The patient presented seizures and left hemiparesis as symptoms. The fistula was embolized with glue obtaining total occlusion of the shunt. Hypotension was induced and valsalva manoeuver was done during the glue injection to reduce the flow into the fistula, however 26 hours after the procedure the patient bled resulting in a fatal outcome. The purpose of this paper is discuss the presentation of Rendu-Osler-Weber (ROW) in children and the therapeutic guidelines.

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