scholarly journals Trends in Female Representation on NCCN Guideline Panels

2020 ◽  
Vol 18 (8) ◽  
pp. 1084-1086 ◽  
Author(s):  
Pranammya Dey ◽  
Angela K. Green ◽  
Michael Haddadin ◽  
Peter B. Bach ◽  
Aaron P. Mitchell
Keyword(s):  
Clinical Practice ◽  
Practice Guidelines ◽  
Time Trends ◽  
Female Physician ◽  
Standard Of Care ◽  
Female Representation ◽  
Nccn Guidelines ◽  
Representation Of Women ◽  
Physician Scientists ◽  
Disease Specific

Background: NCCN produces highly influential disease-specific oncology clinical practice guidelines. Because the number of women in academic oncology has increased, we assessed whether the composition of NCCN Guidelines Panels reflected this trend. Methods: Using historical guidelines requested from NCCN, we investigated time trends for female representation on 21 NCCN Guidelines Panels and analyzed the trends for female-predominant cancers (breast, ovarian, uterine, and cervical) compared with all cancers. Results: From 2013 to 2019, there was an increase from 123 women of 541 total panelists (22.7%) to 175 women of 542 panelists (32.3%). Within the 4 female-predominant cancers, the increase was more rapid: from 30 of 101 total panelists (29.7%) to 66 of 118 panelists (56.4%). Excluding female-predominant cancers, increases were minimal. Conclusions: There could be multiple explanations for these differing trends, including the possibility of more rapid increases in the underlying pool of female physician-scientists in female-predominant specialties or more efforts to increase the representation of women in decisions about the standard of care in cancers predominantly affecting women.

scholarly journals Text Classification in Clinical Practice Guidelines Using Machine-Learning Assisted Pattern-Based Approach

2021 ◽  
Vol 11 (8) ◽  
pp. 3296
Author(s):  
Musarrat Hussain ◽  
Jamil Hussain ◽  
Taqdir Ali ◽  
Syed Imran Ali ◽  
Hafiz Syed Muhammad Bilal ◽  
...  
Keyword(s):  
Machine Learning ◽  
Decision Making ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Machine Learning Algorithms ◽  
Nominal Group ◽  
Specific Information ◽  
Matching Techniques ◽  
Disease Specific

Clinical Practice Guidelines (CPGs) aim to optimize patient care by assisting physicians during the decision-making process. However, guideline adherence is highly affected by its unstructured format and aggregation of background information with disease-specific information. The objective of our study is to extract disease-specific information from CPG for enhancing its adherence ratio. In this research, we propose a semi-automatic mechanism for extracting disease-specific information from CPGs using pattern-matching techniques. We apply supervised and unsupervised machine-learning algorithms on CPG to extract a list of salient terms contributing to distinguishing recommendation sentences (RS) from non-recommendation sentences (NRS). Simultaneously, a group of experts also analyzes the same CPG and extract the initial patterns “Heuristic Patterns” using a group decision-making method, nominal group technique (NGT). We provide the list of salient terms to the experts and ask them to refine their extracted patterns. The experts refine patterns considering the provided salient terms. The extracted heuristic patterns depend on specific terms and suffer from the specialization problem due to synonymy and polysemy. Therefore, we generalize the heuristic patterns to part-of-speech (POS) patterns and unified medical language system (UMLS) patterns, which make the proposed method generalize for all types of CPGs. We evaluated the initial extracted patterns on asthma, rhinosinusitis, and hypertension guidelines with the accuracy of 76.92%, 84.63%, and 89.16%, respectively. The accuracy increased to 78.89%, 85.32%, and 92.07% with refined machine-learning assistive patterns, respectively. Our system assists physicians by locating disease-specific information in the CPGs, which enhances the physicians’ performance and reduces CPG processing time. Additionally, it is beneficial in CPGs content annotation.

Frailty Status and Cognitive Function Should Guide Prescribing in Long-term Care Facilities

2021 ◽  
Vol 36 (10) ◽  
pp. 469-473
Author(s):  
Shin J. Liau ◽  
J. Simon Bell
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Long Term Care ◽  
Adverse Drug Events ◽  
Cognitive Status ◽  
Term Care ◽  
Care Facilities ◽  
Disease Specific

Frailty, dementia and complex multimorbidity are highly prevalent among residents of long-term care facilities (LTCFs). Prescribing for residents of LTCFs is often informed by disease-specific clinical practice guidelines based on research conducted among younger and more robust adults. However, frailty and cognitive impairment may modify medication benefits and risks. Residents with frailty and advanced dementia may be at increased susceptibility to adverse drug events (ADEs) and often have a lower likelihood of achieving long-term therapeutic benefit from chronic preventative medications. For this reason, there is a strong rationale for deprescribing, particularlyamong residents with high medication burdens, swallowing difficulties or limited dexterity. Conversely, frailty and dementia have also been associated with under-prescribing of clinically indicated medications. Unnecessarily withholding treatment based on assumed risk may deprive vulnerable population groups from receiving evidence-based care. There is a need for specific evidence regarding medication benefits and risks in LTCF residents with frailty and dementia. Observational studies conducted using routinely collected health data may complement evidence from randomized controlled trials that often exclude people living with dementia, frailty and in LTCFs. Balancing over- and under-prescribing requires consideration of each resident’s frailty and cognitive status, therapeutic goals, time-to-benefit, potential ADEs, and individual values or preferences. Incorporating frailty screening into medication review may also provide better alignment of medication regimens to changing goals of care. Timely identification of frail residents as part of treatment decision-making may assist with targeting interventions to minimize and monitor for ADEs. Shifting away from rigid application of conventional disease-specific clinical practice guidelines may provide an individualized and more holistic assessment of medication benefits and risks in the LTCF setting.

Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology

2021 ◽  
Vol 19 (3) ◽  
pp. 329-359
Author(s):  
Al B. Benson ◽  
Alan P. Venook ◽  
Mahmoud M. Al-Hawary ◽  
Mustafa A. Arain ◽  
Yi-Jen Chen ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Systemic Therapy ◽  
Checkpoint Inhibitors ◽  
Therapy Options ◽  
Nccn Guidelines ◽  
Positive Treatment ◽  
Biomarker Testing

This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Colon Cancer focuses on systemic therapy options for the treatment of metastatic colorectal cancer (mCRC), because important updates have recently been made to this section. These updates include recommendations for first-line use of checkpoint inhibitors for mCRC, that is deficient mismatch repair/microsatellite instability-high, recommendations related to the use of biosimilars, and expanded recommendations for biomarker testing. The systemic therapy recommendations now include targeted therapy options for patients with mCRC that is HER2-amplified, or BRAF V600E mutation–positive. Treatment and management of nonmetastatic or resectable/ablatable metastatic disease are discussed in the complete version of the NCCN Guidelines for Colon Cancer available at NCCN.org. Additional topics covered in the complete version include risk assessment, staging, pathology, posttreatment surveillance, and survivorship.

Level of Scientific Evidence Underlying Recommendations from the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Hematologic Malignancies: Are We Moving Forward?

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 32-32
Author(s):  
Aakash Desai ◽  
Harry E Fuentes ◽  
Sri Harsha Tella ◽  
Caleb J Scheckel ◽  
Thejaswi Poonacha ◽  
...  
Keyword(s):  
Clinical Practice ◽  
National Comprehensive Cancer Network ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Scientific Evidence ◽  
Hematologic Malignancies ◽  
Level Of Evidence ◽  
Nccn Guidelines ◽  
Therapeutic Recommendations ◽  
Cancer Network

Background: National Comprehensive Cancer Network (NCCN) guidelines are the most comprehensive and widely used standard for clinical care in malignant hematology by clinicians and payers in the US. The level of scientific evidence in NCCN guidelines for malignant hematological conditions has not been recently investigated. We describe the distribution of categories of evidence and consensus (EC) among the 10 most common hematologic malignancies with regard to recommendations for staging, initial and salvage therapy, and surveillance. Methods: NCCN uses a system of guideline development distinct from other major professional organizations. The NCCN definitions for EC are: category I, high level of evidence such as randomized controlled trials with uniform consensus; category IIA, lower level of evidence with uniform consensus; category IIB, lower level of evidence without a uniform consensus but with no major disagreement; and category III, any level of evidence but with major disagreement. We compared our results with previously published results from 2011 guidelines. Results: Total recommendations increased by 16.6% from 1160 (2011) to 1353 (2020). Of the 1353 recommendations, Category 1, 2A, 2B and 3 EC were 5%, 91%, 4%, 1% while in 2011 they were 3%, 93%, 4% and 0% respectively. Recommendations with category 1 EC were found in all guidelines, except for Burkitt's Lymphoma. 6.3% of therapeutic recommendations were category 1 EC with the majority (56.4%) pertaining to initial therapy. Guidelines with highest proportions of therapeutic recommendations with category 1 EC were Multiple Myeloma (12.4%), CLL/SLL (6.9%) and AML (5.6%). Between 2011 and 2020, the proportion of category I recommendations increased significantly only in Follicular lymphoma and CLL/SLL. No category 1 EC recommendations existed in staging or surveillance. Conclusion: Recommendations issued in the 2020 NCCN guidelines are largely developed from lower levels of evidence but with uniform expert opinion. Despite the major advances in hematology in the past decade, this is largely unchanged. Our study underscores the urgent need and available opportunities to expand the current evidence base in malignant hematological disorders which forms the platform for clinical practice guidelines. Figure Disclosures No relevant conflicts of interest to declare.

scholarly journals Cutaneous Melanoma, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

2019 ◽  
Vol 17 (4) ◽  
pp. 367-402 ◽  
Author(s):  
Daniel G. Coit ◽  
John A. Thompson ◽  
Mark R. Albertini ◽  
Christopher Barker ◽  
William E. Carson ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Targeted Therapy ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Cutaneous Melanoma ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Distant Metastatic Disease ◽  
Nccn Guidelines ◽  
The Past

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Cutaneous melanoma have been significantly revised over the past few years in response to emerging data on immune checkpoint inhibitor therapies and BRAF-targeted therapy. This article summarizes the data and rationale supporting extensive changes to the recommendations for systemic therapy as adjuvant treatment of resected disease and as treatment of unresectable or distant metastatic disease.

scholarly journals Clinical Practice Guidelines: An Opinion of the Legal Implication to Veterinary Medicine

Animals ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. 577 ◽  
Author(s):  
Michela Pugliese ◽  
Eva Voslarova ◽  
Vito Biondi ◽  
Annamaria Passantino
Keyword(s):  
Veterinary Medicine ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Small Animal ◽  
Standard Of Care ◽  
Evidence Based ◽  
Veterinary Profession ◽  
Legal Implications ◽  
Legal Implication

The strengthening of the bond between humans and animals has changed the landscape of the veterinary profession. This has, in turn, led the legal system to assess damages in veterinary malpractice and liability cases more carefully, paying attention to the possibility of using clinical practice guidelines (CPGs) to prove whether the defendant veterinarian contravened or not the standard of care. In this era of evidence-based veterinary medicine, CPGs are becoming an integral part of many aspects of veterinary practice, even if CPGs do not have the force of law and are situated halfway between ethical rules and legal requirements. Although guidelines have been used for several years, there seems to be a general lack of recognition of the medical and legal ramifications of CPGs for veterinarians. This creates ambiguity and inconsistency in the care that veterinary practitioners provide, compromises the care animals receive, and prevents the courts from assessing veterinarian competence in a systematic and rational way. On the basis of these considerations, this article discusses the legal implications of CPGs in veterinary medicine for dogs and cats and explores how the law may treat CPGs in the future. Redefining the CPGs should be a priority for veterinary profession. NOTE: The authors chose to use the terms “companion animal,” “pet,” and “small animal” interchangeably throughout this article, as all three are commonly in use and refer to the same animals (dogs and cats).

Abstract 12: Gender Trends in Authorship of Cardiology Academic Literature - A 40-Year Perspective

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
David Ouyang ◽  
David Sing ◽  
Sonia Shah ◽  
Robert Harrington ◽  
Fatima Rodriguez
Keyword(s):  
Academic Medicine ◽  
Medical Training ◽  
European Heart Journal ◽  
Female Physician ◽  
Research Articles ◽  
Original Research ◽  
Female Representation ◽  
Representation Of Women ◽  
Female Authors ◽  
Prolific Authors

Background: Despite advances in the representation of women in medical training, women continue to be underrepresented in cardiology, academic medicine, and senior positions within academic medicine. This study seeks to determine the representation of female physician-investigators in cardiology through review of published literature in three prominent cardiology journals over time. Understanding disparities in research productivity can highlight barriers to female representation in academic cardiology. Methods: Authors of original research articles between 1980 and 2017 from three high impact cardiology journals (Journal of the American College of Cardiology, Circulation, and European Heart Journal) were extracted from PubMed. Author sex were determined and the proportion of female first and senior authors were calculated for consecutive time cohorts. Results: We identified 78,558 unique authors of 55,085 primary research articles. Female authors accounted for 33.1% of all authors, however they represented only 26.7% of first authors and 19.7% of senior authors (p < 0.001 for both). Looking at the most prolific authors, female authors are also underrepresented, accounting for only 5% of the top 100 authors. Conclusions: Using a large database of published manuscripts, we found that female representation in cardiology research has increased over the last four decades. However there is still disproportionate underrepresentation in first authorship, senior authorship and in authors with the most publications. In addition to recruiting more women into cardiology, further efforts should be made to identify and address barriers in advancement for female physician-scientists.

NCCN Guidelines for Survivorship Expanded to Address Two Common Conditions

2014 ◽  
Vol 12 (5S) ◽  
pp. 825-827 ◽  
Author(s):  
Elizabeth Kvale ◽  
Susan G. Urba
Keyword(s):  
Clinical Trials ◽  
Cognitive Impairment ◽  
Clinical Practice ◽  
Peripheral Neuropathy ◽  
Cancer Pain ◽  
Practice Guidelines ◽  
Strong Evidence ◽  
Evidence Based ◽  
Nccn Guidelines

The NCCN Clinical Practice Guidelines in Oncology for Survivorship include a new section on cancer-associated cognitive impairment and an expanded section on adult cancer pain that more completely addresses chemotherapy-induced peripheral neuropathy. These additions to the guidelines are the result of increasing awareness that long-term cancer survivors struggle with many late effects. Both the assessment and the management of cognitive impairment still lack a strong evidence-based foundation. The management of peripheral neuropathy, including the use of anti-depressants and opioids, often in combination, is backed by data primarily derived from clinical trials performed for various types of peripheral neuropathy.

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