Guideline for the Management of Fever and Neutropenia in Children With Cancer and/or Undergoing Hematopoietic Stem-Cell Transplantation

2012 ◽  
Vol 30 (35) ◽  
pp. 4427-4438 ◽  
Author(s):  
Thomas Lehrnbecher ◽  
Robert Phillips ◽  
Sarah Alexander ◽  
Frank Alvaro ◽  
Fabianne Carlesse ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Initial Presentation ◽  
Local Context ◽  
Evidence Based ◽  
Children With Cancer ◽  
Level Of Evidence ◽  
Hematopoietic Stem ◽  
Assessment Development ◽  
Patient Advocate ◽  
Evaluation Approach

PurposeTo develop an evidence-based guideline for the empiric management of pediatric fever and neutropenia (FN).MethodsThe International Pediatric Fever and Neutropenia Guideline Panel is a multidisciplinary and multinational group composed of experts in pediatric oncology and infectious disease as well as a patient advocate. The Panel was convened for the purpose of creating this guideline. We followed previously validated procedures for creating evidence-based guidelines. Working groups focused on initial presentation, ongoing management, and empiric antifungal therapy. Each working group developed key clinical questions, conducted systematic reviews of the published literature, and compiled evidence summaries. The Grades of Recommendation Assessment, Development, and Evaluation approach was used to generate summaries, and evidence was classified as high, moderate, low, or very low based on methodologic considerations.ResultsRecommendations were made related to initial presentation (risk stratification, initial evaluation, and treatment), ongoing management (modification and cessation of empiric antibiotics), and empiric antifungal treatment (risk stratification, evaluation, and treatment) of pediatric FN. For each recommendation, the strength of the recommendation and level of evidence are presented.ConclusionThis guideline represents an evidence-based approach to FN specific to children with cancer. Although some recommendations are similar to adult-based guidelines, there are key distinctions in multiple areas. Implementation will require adaptation to the local context.

The effects of cryotherapy on pain and function in individuals with knee osteoarthritis: a systematic review of randomized controlled trials

2019 ◽  
Vol 33 (8) ◽  
pp. 1310-1319 ◽  
Author(s):  
Lucas Ogura Dantas ◽  
Roberta de Fátima Carreira Moreira ◽  
Flavia Maintinguer Norde ◽  
Paula Regina Mendes Silva Serrao ◽  
Francisco Alburquerque-Sendín ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Physical Function ◽  
Clinical Relevance ◽  
Meta Analysis ◽  
The Body ◽  
Keywords Knee ◽  
Level Of Evidence ◽  
Assessment Development ◽  
Evaluation Approach ◽  
The Mean

Objective:To investigate the effectiveness of cryotherapy on pain and physical function in knee osteoarthritis.Data sources:An electronic search was performed up to February 2019 on PubMed/MEDLINE, EMBASE, CINAHL, Lilacs, Cochrane, Web of Science, Ibecs, and Scielo databases with keywords knee osteoarthritis and cryotherapy.Methods:Two authors independently performed the study selection. All languages and publication dates were considered. The PEDro scale was used to assess the methodological quality of the studies, and the body of evidence was analyzed and synthesized using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The clinical relevance of the included studies was evaluated using the criteria proposed in the Cochrane Handbook for Systematic Reviews of Interventions.Results:Of the five studies, 202 subjects were included. All studies included participants with established knee osteoarthritis. The mean PEDro score was 4.20/10, and meta-analysis was not possible due to heterogeneity among the studies. The mean clinical relevance was 3/5. Only two studies were considered for analysis based on the GRADE approach, and low level of evidence was synthesized regarding the effectiveness of cryotherapy for pain management, knee stiffness, knee range of motion, and physical function. Application techniques, frequency, and duration did not affect outcomes.Conclusions:There were insufficient primary studies to draw any conclusions about the effectiveness of cryotherapy on pain and physical function on individuals with knee osteoarthritis.

scholarly journals Laboratory Workup of Lymphoma in Adults

2020 ◽  
Author(s):  
Steven H. Kroft ◽  
Cordelia E. Sever ◽  
Adam Bagg ◽  
Brooke Billman ◽  
Catherine Diefenbach ◽  
...  
Keyword(s):  
Diagnostic Testing ◽  
Clinical Pathology ◽  
Cost Effective ◽  
Primary Diagnosis ◽  
Aggressive Lymphoma ◽  
Evidence Based ◽  
Assessment Development ◽  
Evaluation Approach ◽  
Cost Effective Approach ◽  
American Society

Context.— The diagnostic workup of lymphoma continues to evolve rapidly as experience and discovery led to the addition of new clinicopathologic entities and techniques to differentiate them. The optimal clinically effective, efficient, and cost-effective approach to diagnosis that is safe for patients can be elusive, in both community-based and academic practice. Studies suggest that there is variation in practice in both settings. Objective.— To develop an evidence-based guideline for the preanalytic phase of testing, focusing on specimen requirements for the diagnostic evaluation of lymphoma. Design.— The American Society for Clinical Pathology, the College of American Pathologists, and the American Society of Hematology convened a panel of experts in the laboratory workup of lymphoma to develop evidence-based recommendations. The panel conducted a systematic review of literature to address key questions. Using the Grading of Recommendations Assessment, Development, and Evaluation approach, recommendations were derived based on the available evidence, strength of that evidence, and key judgements as defined in the Grading of Recommendations Assessment, Development, and Evaluation Evidence to Decision framework. Results.— Thirteen guideline statements were established to optimize specimen selection, ancillary diagnostic testing, and appropriate follow-up for safe and accurate diagnosis of indolent and aggressive lymphoma. Conclusions.— Primary diagnosis and classification of lymphoma can be achieved with a variety of specimens. Application of the recommendations can guide decisions on specimen suitability, diagnostic capabilities, and correct use of ancillary testing. Disease prevalence in patient populations, availability of ancillary testing, and diagnostic goals should be incorporated into algorithms tailored to each practice environment.

Komplementäre Therapien: Verlässliche Informationen richtig vermitteln

2020 ◽  
Vol 7 (4) ◽  
pp. 208-209
Author(s):  
Claudia M. Witt
Keyword(s):  
Standard Care ◽  
Decision Aid ◽  
Meta Analysis ◽  
Supplementary Information ◽  
Evidence Based ◽  
Healing Touch ◽  
Children With Cancer ◽  
Assessment Development ◽  
Group A ◽  
Randomized Control

<b>Purpose:</b> To develop an evidence-based decision aid for parents of children with cancer and to help guide them in the use of complementary and alternative medicine (CAM) for cancer care. <b>Methods:</b> This study had a mixed research design. The needs of parents were investigated by survey and focus group. A systematic review and meta-analysis were performed on the effectiveness of CAM using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Clinical experts were interviewed and a decision aid on CAM treatment for pain was developed. <b>Results:</b> Parents emphasized the importance of reliable information on CAM, focusing primarily on communication and a broad spectrum of complaints related to cancer treatment. The decision aid on CAM for pain included five modalities based on 11 randomized control trials (RCTs): hypnotherapy, mind-body techniques, massage, healing touch, and music therapy. Meta-analysis could be performed on hypnotherapy, which significantly reduced cancer-related procedural pain compared with standard care (MD, – 1.37; 95% CI, – 1.60, – 1.15; P &#x3c; 0.00001) and attention control (MD, – 1.13; 95% CI, – 1.34, – 0.94; P &#x3c; 0.00001), and massage, demonstrating no effect on pain compared with standard care (MD, – 0.77; 95% CI, – 1.82, 0.28; P = 0.15). Research evidence and supplementary information from clinical practice and patient were incorporated in a website-based decision aid. <b>Conclusions:</b> An evidence-based decision aid was developed to support parents of children with cancer in making decisions about CAM for pain management. Next steps will be to expand the website to include additional childhood cancer-related complaints and to evaluate its use in practice.

Empirical Antimicrobial Therapy of Neonates with Necrotizing Enterocolitis: A Systematic Review

2021 ◽  
Author(s):  
Daniele Donà ◽  
Andrea Gastaldi ◽  
Elisa Barbieri ◽  
Luca Bonadies ◽  
Jalemba Aluvaala ◽  
...  
Keyword(s):  
Necrotizing Enterocolitis ◽  
Empiric Therapy ◽  
Risk Of Bias ◽  
Current Evidence ◽  
Surgical Approaches ◽  
Evidence Based ◽  
Assessment Development ◽  
Evaluation Approach ◽  
Gentamicin Treatment ◽  
Empiric Antibiotic

Objective Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal tract characterized by ischemic necrosis of the intestinal mucosa, mostly affecting premature neonates. Management of NEC includes medical care and surgical approaches, with supportive care and empirical antibiotic therapy recommended to avoid any disease progression. However, there is still no clear evidence-based consensus on empiric antibiotic strategies or surgical timing. This study was aimed to review the available evidence on the effectiveness and safety of different antibiotic regimens for NEC. Study Design MEDLINE, EMBASE, Cochrane CENTRAL, and CINAHL databases were systematically searched through May 31, 2020. Randomized controlled trials (RCTs) and nonrandomized interventions reporting data on predefined outcomes related to NEC treatments were included. Clinical trials were assessed using the criteria and standard methods of the Cochrane risk of bias tool for randomized trials, while the risk of bias in nonrandomized studies of interventions was evaluated using the ROBINS-I tool. The certainty in evidence of each outcome's effects was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results Five studies were included in this review, two RCTs and three observational studies, for a total amount of 3,161 patients. One RCT compared the outcomes of parenteral (ampicillin plus gentamicin) and oral (gentamicin) treatment with parenteral only. Three studies (one RCT and two observational) evaluated adding anaerobic coverage to different parenteral regimens. The last observational study compared two different parenteral antibiotic combinations (ampicillin and gentamicin vs. cefotaxime and vancomycin). Conclusion No antimicrobial regimen has been shown to be superior to ampicillin and gentamicin in decreasing mortality and preventing clinical deterioration in NEC. The use of additional antibiotics providing anaerobic coverage, typically metronidazole, or use of other broad-spectrum regimens as first-line empiric therapy is not supported by the very limited current evidence. Well-conducted, appropriately sized comparative trials are needed to make evidence-based recommendations. Key Points

Bridging the Knowledge Gaps in Arrhythmogenic Cardiovascular Conditions: The Critical Role of Registries

2016 ◽  
Vol 10 (2) ◽  
pp. 1 ◽  
Author(s):  
Melody Hermel ◽  
Rebecca Duffy ◽  
Alexander Orfanos ◽  
Isabelle Hack ◽  
Shayna McEnteggart ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Natural History ◽  
Risk Stratification ◽  
Critical Role ◽  
Knowledge Gaps ◽  
Level Of Evidence ◽  
The Future

Cardiac registries have filled many gaps in knowledge related to arrhythmogenic cardiovascular conditions. Despite the less robust level of evidence available in registries when compared with clinical trials, registries have contributed a range of clinically useful information. In this review, the authors discuss the role that registries have played – related to diagnosis, natural history, risk stratification, treatment, and genetics of arrhythmogenic cardiovascular conditions – in closing knowledge gaps, and their role in the future.

scholarly journals Evidence-Based Design in Architectural Education: Designing the First Maggie’s Centre in Israel

2021 ◽  
pp. 193758672110079
Author(s):  
Nirit Putievsky Pilosof ◽  
Yasha Jacob Grobman
Keyword(s):  
Literature Review ◽  
Architectural Design ◽  
Early Stage ◽  
Scientific Research ◽  
Well Being ◽  
Architectural Education ◽  
Local Context ◽  
Evidence Based ◽  
Architecture Education ◽  
The Impact

Objective The study examines the integration of the Evidence-based Design (EBD) approach in healthcare architecture education in the context of an academic design studio. Background Previous research addressed the gap between scientific research and architectural practice and the lack of research on the use of the EBD approach in architectural education. Methods The research examines an undergraduate architectural studio to design a Maggie’s Centre for cancer care in Israel and evaluates the impact of the EBD approach on the design process and design outcomes. The research investigates the impact of the integration of three predesign tasks: (1) literature review of healing architecture research, (2) analysis and comparison of existing Maggie’s Centres, and (3) analysis of the context of the design project. Results The literature review of scientific research supported the conceptual design and development of the projects. The analysis of existing Maggie’s centers, which demonstrated the interpretation of the evidence by different architects, developed the students’ ability to evaluate EBD in practice critically, and the study of the projects’ local context led the students to define the relevance of the evidence to support their vision for the project. Conclusions The research demonstrates the advantages of practicing EBD at an early stage in healthcare architectural education to enhance awareness of the impact of architectural design on the users’ health and well-being and the potential to support creativity and innovative design. More studies in design studios are needed to assess the full impact of integrating EBD in architectural education.

scholarly journals “What is the actual goal of the pathway?”: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anh Ly ◽  
Roger Zemek ◽  
Bruce Wright ◽  
Jennifer Zwicker ◽  
Kathryn Schneider ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Clinical Pathways ◽  
Theoretical Domains Framework ◽  
Local Context ◽  
Emergency Department Physician ◽  
Evidence Based ◽  
Care Providers ◽  
Structured Interviews ◽  
Pediatric Concussion

Abstract Background Multiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion. Methods Semi-structured interviews were conducted from October 2017 to January 2018 with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation. Results The original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the issues discussed by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2–4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes. Conclusion Application of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to successfullly implement a concussion CP.

2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack

2017 ◽  
Vol 12 (3) ◽  
pp. 302-320 ◽  
Author(s):  
Yongjun Wang ◽  
Ming Liu ◽  
Chuanqiang Pu
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Evidence Based ◽  
Cerebrovascular Disorder ◽  
Level Of Evidence ◽  
Vascular Stenosis ◽  
Ischemic Attack

Ischemic stroke and transient ischemic attack (TIA) are the most common cerebrovascular disorder and leading cause of death in China. The Effective secondary prevention is the vital strategy for reducing stroke recurrence. The aim of this guideline is to provide the most updated evidence-based recommendation to clinical physicians from the prior version. Control of risk factors, intervention for vascular stenosis/occlusion, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke are all recommended, and the prevention of recurrent stroke in a variety of uncommon causes and subtype provided as well. We modified the level of evidence and recommendation according to part of results from domestic RCT in order to facility the clinical practice.

scholarly journals Assessment of Urban Agriculture for Evidence-Based Food Planning: A Case Study in Chengdu, China

2021 ◽  
Vol 13 (6) ◽  
pp. 3234
Author(s):  
Nan Wang ◽  
Li Zhu ◽  
Yuanhao Bing ◽  
Liwei Chen ◽  
Shulang Fei
Keyword(s):  
Urban Agriculture ◽  
Food System ◽  
Point Of View ◽  
Assessment Tools ◽  
Local Context ◽  
Evidence Based ◽  
Sustainable Food ◽  
Local Food System ◽  
Food Planning ◽  
Indicator Framework

Along the rapid pace of urbanization, urban agriculture is increasingly recognized as an important tool of sustainable food and nutrition supply, while contributing to the resilience and sustainability of cities from various dimensions. From a governance point of view, it is fundamental to systemically assess the urban agriculture based on local context for evidence-based food planning. In China, values of urban agriculture are being noticed in recent years, with attempts emerging to involve urban agriculture in urban planning and agriculture strategies. However, clear definition to identify the scope and holistic approaches to assess and monitor local urban agriculture are still lacking. The paper took Chengdu as the study area, to conduct a thorough assessment of the foundation, capacity, practices, functions, opportunities, and challenges of the urban agriculture locally. Building on these results, the study further developed an indicator framework tailored to Chengdu’s conditions and city objectives, for in-depth evaluation and monitoring of local urban agriculture by themes, following which a pilot in-depth assessment was conducted in Chengdu using the indicator framework. The outcome of this research for the first time provided an overall characterization of the urban agriculture in Chengdu and assessment tools tailored to urban agriculture in Chinese cities, establishing a good basis for strategic local food system planning and contributing to the formation of the Chinese paradigm in urban agriculture research.

Hemangioblastoma diagnosis and surveillance in von Hippel–Lindau disease: a consensus statement

2021 ◽  
pp. 1-6
Author(s):  
Kristin Huntoon ◽  
Matthew J. Shepard ◽  
Rimas V. Lukas ◽  
Ian E. McCutcheon ◽  
Anthony B. Daniels ◽  
...  
Keyword(s):  
Age At Onset ◽  
Benign Tumors ◽  
Expert Committee ◽  
Level Of Evidence ◽  
Von Hippel Lindau ◽  
Assessment Development ◽  
History Of ◽  
Von Hippel Lindau Disease ◽  
The Central Nervous System ◽  
Cancer Network

OBJECTIVE Hemangioblastomas are a frequent underlying cause of neurological morbidity and death in patients with von Hippel–Lindau disease (VHL). Although these benign tumors can cause significant neurological debility when undetected and untreated, unified evidence-based surveillance recommendations for VHL patients have not been established. To develop consensus recommendations, the VHL Alliance established an expert committee, named the International VHL Surveillance Guidelines Consortium, to define surveillance recommendations. METHODS The Central Nervous System (CNS) Hemangioblastoma Subcommittee of the Guidelines Consortium was formed as a multidisciplinary team of experts in the diagnosis and management of hemangioblastomas. Recommendations were formulated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) and National Comprehensive Cancer Network Categories of Evidence and Consensus categorization after a comprehensive literature review. RESULTS Published studies (n = 49) that discussed age at onset, MRI frequency, natural history of VHL, and the risks and benefits of surveillance were analyzed. Based on this analysis, the authors recommend that clinical evaluation (yearly) be used as the primary screening tool for hemangioblastomas in VHL. The subcommittee suggests that screening be performed between the ages of 11 and 65 years, or with the onset of symptoms, for synchronicity with other testing regimens in VHL. The subcommittee also recommends that baseline MRI be first performed at the age of 11 years (suggested 2B, level of evidence D) or after identification of neurological symptoms or signs (if earlier) and continue every 2 years (recommended 2A, level of evidence A). CONCLUSIONS The CNS Hemangioblastoma Subcommittee of the International VHL Surveillance Guidelines Consortium here proposes guidelines that aim to increase the early detection of VHL-associated hemangioblastomas to reduce their morbidity and mortality.

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