The Primary Care Management of Headache: Synopsis of the 2020 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline

ABSTRACT Introduction In June of 2020, the U.S. DVA and DoD approved a new joint clinical practice guideline for assessing and managing patients with headache. This guideline provides a framework to evaluate, treat, and longitudinally manage the individual needs and preferences of patients with headache. Methods In October of 2018, the DVA/DoD Evidence-Based Practice Work Group convened a guideline development panel that included clinical stakeholders and conformed to the National Academy of Medicine’s tenets for trustworthy clinical practice guidelines. Results The guideline panel developed key questions, systematically searched and evaluated the literature, created a 1-page algorithm, and advanced 42 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation system. Conclusion This synopsis summarizes the key features of the guideline in three areas: prevention, assessing and treating medication overuse headache, and nonpharmacologic and pharmacologic management of headache.

Bronchiolitis diagnosis, treatment, and prevention in children: an evidence-based clinical practice guideline adapted for the use in Egypt based on the ‘Adapted ADAPTE’ Methodology

Background The presented evidence-based clinical practice guideline (CPG) is proposed as a National CPG using an evidence-based and formal CPG adaptation methodology. The purpose of this study was to adapt the international CPGs’ recommendations for children with bronchiolitis to suit the healthcare system in the Egyptian context. This CPG, ‘diagnosis, treatment, and prevention of Bronchiolitis’, applies to children from 1 through 23 months of age. Other exclusions are noted. The quality of evidence, benefit-harm relationship, and strength of recommendations are indicated. This study is part of a larger collaborative initiative with the faculty staff of pediatric departments of 15 Egyptian universities and a national research center to formulate a national Committee (EPG) that aims to define the topics of, assign authors to, and assist in the adaptation of pediatric evidence-based CPGs according to a national strategic plan. The committee is guided by a formal CPG adaptation methodology: the ‘Adapted ADAPTE’. Results The Bronchiolitis Guideline Adaptation Group (BGAG) reviewed the results of the AGREE II assessment and decided to adapt mainly the Australasian (PREDICT) CPG and for the questions not answered in PREDICT we adapted the relevant recommendations from the American Academy of Pediatrics (AAP) CPG. Seven implementation tools were included: a care pathway for assessment of severity, a clinical algorithm for treatment of acute bronchiolitis in the emergency room, a separate flowchart for assessing babies with bronchiolitis, a power point slide presentation lecture for treatment of acute bronchiolitis, patient information in Arabic, a clinical score (Modified Tal Score) for prediction of bronchiolitis severity, and the criteria for admission and discharge in the hospital. A comprehensive set of multifaceted CPG implementation strategies was provided for the clinicians, patients, nurses, and other relevant stakeholders contextualized to the national settings Conclusion Our experience with this adaptation methodology provides useful insight into its utilization on a national level in Egypt. The BGAG recommended the next review of this adapted CPG to be after 3 years from its publication (i.e., 2022) after checking for updates in the original CPG.

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

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.

Qualitative Theme Analysis on Perception of Practice Scope among Emergency Medical Service Providers: Focused on Registered Nurses

This study aims to explore how emergency medical service (EMS) providers with registered nurses perceive their practice scope in Korea. This qualitative study analyzed the interview data of nine EMS providers with registered nurses using Braun and Clarke’s thematic analysis. Three themes and 10 subthemes were revealed. Theme 1 was “not clearly knowing the scope.” They perceived their scope as similar to that of a first-grade emergency medical technicians (EMTs), as wider than that of EMTs' scope, as focused on the controversial scope, it is determined according to the medical director. Theme 2 was “anxiety and distrust.” They were concerned whether they can be protected legally by the practice guideline, showed no confidence in the legal protection of the practice guideline, and were confused about their professional identity. Theme 3 was “different strengths in practices.” They reported that EMTs are more experienced and skillful in the prehospital field, as nurses lack education on prehospital emergency. However, they have different strengths from the beginning such as patient’s care. For ensuring stability of and consistency in the provided service, the practice scope of EMS providers with registered nurses needs to be clearly stipulated.