Cystic Fibrosis Foundation and European Cystic Fibrosis Society Survey of cystic fibrosis mental health care delivery

Background: Psychological morbidity in individuals with cystic fibrosis (CF) and their caregivers is common. The Cystic Fibrosis Foundation (CFF) and European Cystic Fibrosis Society (ECFS) Guidelines Committee on Mental Health sought the views of CF health care professionals concerning mental health care delivery. Methods: An online survey which focused on the current provision and barriers to mental health care was distributed to CF health care professionals. Results: Of the 1454 respondents, many did not have a colleague trained in mental health issues and 20% had no one on their team whose primary role was focused on assessing or treating these issues. Insufficient resources and a lack of competency were reported in relation to mental health referrals. Seventy-three percent of respondents had no experience with mental health screening. Of those who did, they utilized 48 different, validated scales. Conclusions: These data have informed the decision-making, dissemination and implementation strategies of the Mental Health Guidelines Committee sponsored by the CFF and ECFS

Achieving change in primary care—causes of the evidence to practice gap : systematic reviews of reviews

Acknowledgements The Evidence to Practice Project (SPCR FR4 project number: 122) is funded by the National Institute of Health Research (NIHR) School for Primary Care Research (SPCR). KD is part-funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Research and Care West Midlands and by a Knowledge Mobilisation Research Fellowship (KMRF-2014-03-002) from the NIHR. This paper presents independent research funded by the National Institute of Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Funding This study is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR).Peer reviewedPublisher PD

Compilation and evaluation of clinical practice guidelines for comprehensive approaches to patients with acute chest pain in the emergency room at Al-Zahra Hospital in Isfahan

Introduction & Aim: This study aimed to develop a standardof clinical guidelines for dealing with patients withacute chest pain in the emergency department at Al-ZahraHospital in Isfahan.Methods: In the first phase, a comprehensive approachand guidelines for patients with unstable angina referredto the emergency department, according to experts fromthe heart and emergency medicine and using valid sourceswas developed. In the second phase, the guidelines ereevaluated in a clinical trial. In this trial, 100 patients wererandomly assigned into intervention and control groups.The waiting time for the first visit, paraclinical measures,appropriate treatment; the physician’s satisfaction withtreatment, the patient’s admission to the emergencyroom, number of visits and treatment outcome; the patient’ssatisfaction from emergency services and treatmentoutcome were compared between two groups.Results: The mean of patients waiting time to receive thefirst visit, paraclinical measures, and appropriate treatmentin the intervention group were significantly lowerthan the control group (P-value<0.05). The mean of physician’ssatisfaction score from the treatment process, patient’sadmission to the emergency room, number of visitsand outcome of treatment in the intervention group wassignificantly higher than the control group (P-value<0.05).The mean patient satisfaction score from the emergencyservices in the intervention group was significantly higherthan the control group (P-value=0.0001).Conclusions: The developed guidelines for dealing withpatients with acute chest pain in the emergency roomsignificantly reduce the patient’s waiting time in receivingcare and improve the satisfaction of the physicians andthe patients

The GUIDES checklist: development of a tool to improve the successful use of guideline-based computerised clinical decision support

Background: Computerised decision support (CDS) based on trustworthy clinical guidelines is a key component of a learning healthcare system. Research shows that the effectiveness of CDS is mixed. Multifaceted context, system, recommendation and implementation factors may potentially affect the success of CDS interventions. This paper describes the development of a checklist that is intended to support professionals to implement CDS successfully. Methods: We developed the checklist through an iterative process that involved a systematic review of evidence and frameworks, a synthesis of the success factors identified in the review, feedback from an international expert panel that evaluated the checklist in relation to a list of desirable framework attributes, consultations with patients and healthcare consumers and pilot testing of the checklist. Results: We screened 5347 papers and selected 71 papers with relevant information on success factors for guideline-based CDS. From the selected papers, we developed a 16-factor checklist that is divided in four domains, i.e. the CDS context, content, system and implementation domains. The panel of experts evaluated the checklist positively as an instrument that could support people implementing guideline-based CDS across a wide range of settings globally. Patients and healthcare consumers identified guideline-based CDS as an important quality improvement intervention and perceived the GUIDES checklist as a suitable and useful strategy. Conclusions: The GUIDES checklist can support professionals in considering the factors that affect the success of CDS interventions. It may facilitate a deeper and more accurate understanding of the factors shaping CDS effectiveness. Relying on a structured approach may prevent that important factors are missed

Comparative Effectiveness Review Within the U.K.'s National Institute for Health and Clinical Excellence

Examines lessons from the National Institute for Health and Clinical Excellence's use of comparative effectiveness reviews and decision-making process on evidence-based standards, uptake of medical innovations, and investment for maximum health benefit

A Staff Educational Initiative to Improve the Use of Childhood Obesity Guideline Recommendations

Obesity affects one out every six children in the United States, which places them at risk for other chronic conditions such as cardiovascular disease, diabetes, and continued obesity into adulthood. Considering military children are more likely to enter the Armed Forces than their civilian counterparts, an increase in obesity among military families decreases the number of potential future military recruits who are physically eligible to serve. Despite this growing epidemic, providers report a lack of education and a low self-efficacy in the treatment of this condition. This doctorate of nursing practice study addresses this educational gap by attempting to improve participants knowledge within a military setting regarding the clinical practice guidelines for the assessment, prevention, and treatment of childhood obesity through an one hour educational inservice. The educational project was guided by the principles of the chronic care model and used the theories of adult learning in the formation of the inservice. The content was derived from current evidence and the clinical practice guidelines endorsed by the American Academy of Pediatrics. Twenty-seven participants attended the 1-hour educational inservice program and 24 completed a 9 question pretest and posttest knowledge survey (p\u3c0.00). Analysis of the data from this educational inservice found a significant improvement in participant knowledge between the pretest and posttest surveys. These findings suggest that it is feasible to offer a 1-hour inservice which can promote social change by significantly improving staff\u27s knowledge about the clinical practice guidelines on childhood obesity

Measuring Adherence to Evidence-Based Practice Guidelines for the Management of Hypertension in Women

Approximately 1 in 3 adults In the United States (U. S.) with approximately half being women have hypertension, a significant risk factor for cardiovascular disease (CVD) and stroke (Nwankwo, Yoon, Burt, & Gu, 2013). Nearly 70% of people who had a first heart attack, 80% of those who had a first stroke, and 75% of those who had congestive heart failure (CHF) have hypertension (Mozaffarian et al., 2013). Hypertension was the underlying or contributing cause of more than 375,000 deaths in 2011. Despite multiple publications of national hypertension guidelines, only 50% of adults with hypertension have their blood pressure under control (Nwankwo et al., 2013). One possible explanation for such a high rate of uncontrolled blood pressure is providers may not be adhering to hypertension guidelines. This capstone report is comprised of three manuscripts that focus on providers and their adherence to hypertension guidelines for women. The first manuscript presents a literature review pertaining to providers and their adherence to hypertension guidelines while discussing factors that affect their adherence such as patient age, gender, and comorbidities. The second manuscript presents an analysis of the 2014 Evidence-Based Practice Guideline for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8), using an adapted version of the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument (2001). The content used to compile the first two manuscripts led to a descriptive study, which examined providers and their adherence to the 2014 JNC 8 evidence-based practice guideline primarily in women at a primary care university clinic. The third and final manuscript consists of the details of this study, and presents some practical implications for improving provider adherence to these evidence-based guidelines