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PubMed2005

[The scientific basis of current official dietary recommendations in relation to pregnancy].

The Danish Nutrition Council has examined the latest scientific literature on nutrition during pregnancy to evaluate the basis for the existing official recommendations. The recommendation to overweight women to gain only eight kilo should be accompanied with a recommendation to lose weight pre-conceptionally. Individualised recommendations should be provided in the prevention of iron deficiency, and the recommendation for calcium should include information on quantity. The recommendation of periconceptional folic acid supplementation does not benefit unplanned pregnancies. Arguments exist for adding a recommendation for vitamin D.

Denmark↗
PubMed2005

Recommendations for bone mineral density reporting in Canada.

OBJECTIVE: To propose a set of recommendations for optimal bone mineral density (BMD) reporting in postmenopausal women and older men and to provide clinicians with both a BMD diagnostic category and a useful tool to assess an individual's risk of osteoporotic fracture. OPTIONS: The current methods of BMD reporting were reviewed. In this document, we propose that an individual's 10-year absolute fracture risk, rather than BMD alone, be used for fracture risk categorization. Consequently, age, sex, BMD, fragility fracture history, and glucocorticoid use are the basis for the approach outlined in this document. OUTCOMES: An optimal BMD report as proposed in this document will provide clinicians with both a BMD diagnostic category and a useful tool to assess an individual's risk of osteoporotic fracture. A BMD report format, a checklist, and a patient questionnaire are meant to further encourage its use. EVIDENCE: All recommendations were developed using a consensus from clinicians and experts in the field of BMD testing and a standard method for the evaluation and citation of the supporting evidence. VALUES: These recommendations were developed by a multidisciplinary working group under the auspices of the Scientific Advisory Council of the Osteoporosis Society of Canada and the Canadian Association of Radiologists. BENEFITS, HARM, AND COSTS: Optimal BMD reports help the practitioner to assess an individual's risk for osteoporotic fracture and to decide whether medical therapy is warranted. RECOMMENDATIONS: The BMD report should include: patient identifiers. Dual-energy X-ray absorptiometry (DXA) scanner identifier. BMD results expressed in absolute values (g/cm2; 3 decimal places) and T-score (1 decimal place) for lumbar spine; proximal femur (total hip, femoral neck, and trochanter); and an alternate site (forearm BMD preferred: 1/3 radius, 33% radius or proximal radius) if either hip or spine is not valid. A statement about any limitations due to artifacts, if present. The fracture risk category (low, moderate, or high) as determined by using Tables 3 and 4 and by including major clinical factors that modify absolute fracture risk probability (with an indication of the corresponding absolute 10-year fracture risk of <10%, 10-20%, or >20%). A statement as to whether the change is statistically significant or not for serial measurements. The BMD centre's least significant change for each skeletal site (in g/cm2) should be included. VALIDATION: Recommendations were based on consensus opinion. Since these are the first Canadian recommendations integrating clinical risk factors in a quantitative fracture risk assessment, it is anticipated that these "Recommendations for BMD Reporting in Canada" will be a work in progress and will be updated periodically to accommodate advances in this field.

Absorptiometry, Photon↗
PubMed2006

Standardized documentation of drug recommendations in discharge letters--a contribution to quality management in cooperative care.

OBJECTIVES: To analyze the necessity and potential usefulness of a computerized physician order entry (CPOE) system in supporting the writing of pharmacotherapeutic recommendations in discharge letters. METHODS: Systematic analysis of drug recommendations in discharge letters of a hospital providing tertiary care, structured interviews with in-hospital prescribers, and focus groups with general practitioners who admit patients to this hospital. RESULTS: We analyzed 1800 randomly selected discharge letters, 1205 of which contained pharmacotherapeutic recommendations. The frequencies, structure, and quality of these recommendations varied considerably between departments. Nearly 16% of the recommendations contained both proprietary (brand) and non-proprietary names (active ingredient). Interviewed clinicians expressed interest in CPOE systems that check for contraindications and interactions between drugs, suggest cheaper products, and automatically insert active ingredients when omitted. The focus group sessions confirmed that the pharmacotherapeutic recommendations in current discharge letters do not effectively support daily clinical practice. CONCLUSIONS: Documenting active ingredients as well as brand names in drug therapy recommendations is currently not part of clinical practice. Computerized decision support can help to optimise the structure and communication of therapeutic information across interfaces and can be a quality factor with considerable influence on process quality, outcome quality, and costs of cooperative patient care.

Continuity of Patient Care↗
PubMed1991

Physician recommendations for screening mammography: results of a survey using clinical vignettes.

BACKGROUND: Although experts estimate that 30% of breast cancer deaths could be prevented if women were screened according to published guidelines, fewer than 50% of physicians follow screening mammography guidelines, and fewer than 30% of women are screened with mammography. METHODS: Physician recommendations for screening mammography were examined in a questionnaire mailed to 300 randomly selected physicians of the Ohio Academy of Family Physicians. Physicians responded with their likelihood of recommending screening mammography to 24 clinical vignettes that high-lighted patient, mammographic, and encounter characteristics. RESULTS: Seventy-one percent responded. Ninety-one percent reported almost always recommending screening mammography to a 55-year-old woman at her yearly examination. They were significantly less likely to recommend mammography to women who were young (40 years old), were old (70 years old), were poor, had small breasts, had painful mammograms, did not want the doctor to look for cancer, lived in a nursing home, or were retarded. Physicians recommended mammography less often when the mammography unit was far away or produced poor quality films or ambiguous interpretations. When physicians ran behind schedule, perceived a more urgent medical problem during the encounter, or saw a woman for an acute visit, they recommended mammography significantly less often. CONCLUSIONS: Patient, mammographic, and encounter characteristics significantly limit physician recommendations for screening mammography as assessed by clinical vignettes. These characteristics must be addressed if breast cancer mortality is to be reduced with early screening.

Adult↗
PubMed1986

Compliance of neonatal nurse practitioners with gentamicin pharmacokinetic recommendations.

The compliance of nurse practitioners in a neonatal intensive-care center with gentamicin dosage recommendations from a pharmacokinetic consultation service was determined. Medical and pharmacokinetic dosage data were collected retrospectively from the medical records and pharmacokinetic consultation records of eligible neonates as soon as they had completed gentamicin therapy. Neonates for whom pharmacokinetic dosage recommendations had been followed by each of four neonatal nurse practitioners (NNPs) were compared with neonates for whom recommendations had not been followed to identify patient characteristics that might have influenced NNP compliance with the recommendations. Each NNP also completed a questionnaire designed to elicit information about professional and behavioral characteristics that might be associated with compliance. Data were collected for a total of 98 neonates. Discriminant analysis revealed no significant differences between the two groups of neonates. Although the NNPs perceived themselves to be in high compliance with the pharmacokinetic recommendations, the actual group compliance rate was 43%. Neonatal nurse practitioners may require special education in the proper use of pharmacokinetic dosage recommendations even if they perceive themselves to be compliant with those recommendations.

Gentamicins↗
PubMed1995

[Do Type-I diabetics eat a diet in accordance with recommendations?].

The nutritional habits regarding intake of calories, carbohydrates, fat and protein of 25 nonobese type-I diabetic subjects were compared with the recommendations given at onset of diabetes by a dietician and with the official recommendations of the American Diabetes Association. Food questionnaires indicated that the subjects currently ate 39% more calories than originally recommended by the dietician. The carbohydrate part of total energy was 4 +/- 7% and thereby lower than recommended by the dietician and officially by the professional society (55%). Fat consumption was 38 +/- 7% of total energy and therefore higher than recommended (30%). 17.2% of total energy was fat with saturated fatty acids (recommendation: maximum 8 to 10%). Protein consumption was 1.25 +/- 0.35 g/kg BW/d and thereby above the recommended amounts (0.8 g/kg BW/d). Thus, dietary counseling of type-I diabetic subjects at disease onset is frequently hypocaloric, probably because of lack of appetite. Patients show a tendency to add fat and protein calories thereafter, instead of increasing carbohydrate intake. Dietary habits of type I diabetic subjects should therefore be re-evaluated periodically by a dietician and adjusted to the individual requirements and to the official guidelines.

Adult↗
PubMed1994

Do gastroenterologists themselves follow the American Cancer Society recommendations for colorectal cancer screening?

OBJECTIVE: Colorectal cancer is a leading cause of mortality from cancer in the United States. Unfortunately, many patients already have advanced disease by the time symptoms occur. Screening of asymptomatic persons offers the potential of detecting the disease at its early and curable stages. The American Cancer Society (ACS) screening recommendations are the most widely employed in this country. We sought to determine whether gastroenterologists themselves follow the ACS recommendations, and if not, to determine their reasons for not doing so. We also looked at gastroenterologists' use of diets and supplements that might reduce the likelihood of colorectal cancer. METHOD: A questionnaire was mailed out to all gastroenterologists with U.S. addresses listed in the American College of Gastroenterology membership directory. RESULTS: Of 1466 respondents, 330 were excluded because they were at high risk for colorectal cancer or were not gastroenterologists. This left 875 gastroenterologists age 40 years and over and 261 gastroenterologists under age 40 for analysis. Overall, 68% of respondents felt the ACS recommendations were adequate; 32% did not. Of those who disagreed with the ACS recommendations, 58% preferred screening colonoscopy, and 22% preferred flexible sigmoidoscopy without annual fecal occult blood testing. Of gastroenterologists age 40 and over, 38% strictly followed the ACS recommendations themselves, 39% partially, and 23% did not follow them. Fifty percent of those who did not strictly follow the recommendations believed they were adequate but procrastinated or "did not have the time" to follow them. Overall, 82% of gastroenterologists said they used a high fiber diet, 68% used a diet low in fat, 18% used a calcium supplement, and 25% used aspirin regularly. CONCLUSIONS: Although two-thirds of gastroenterologists agreed with the ACS recommendations, only 38% themselves followed them strictly. Of the approximately one-third of gastroenterologists who considered them inadequate, a majority preferred screening colonoscopy. Gastroenterologists were more aggressive in following dietary practices that might help prevent colorectal cancer development than they were in undergoing screening.

Adult↗
PubMed1993

Establishing reference values from adults: recommendation on procedures for the preparation of individuals, collection of blood, and handling and storage of specimens. Committee on Reference Values of the Scandinavian Society for Clinical Chemistry.

The concentrations of blood components are influenced by a number of preanalytical factors, the importance of which varies [1]. Therefore it is necessary to standardize the specimen collection, as was done by the Committee on Reference Values of the Scandinavian Society for Clinical Chemistry and Clinical Physiology, which in 1975 published its recommendation on the production of reference values in clinical chemistry [2]. It was the very first recommendation of its kind. Since then, new information has accumulated, and it has become necessary to revise the part concerning the preparation of subjects for blood collection, the collection procedure itself, and the subsequent handling of the specimen. Also, The International Federation of Clinical Chemistry (Expert Panel on Theory of Reference Values) has produced its own recommendation [3]. The recommendation described below replaces pp. 39-44 of the former Scandinavian recommendation [2]. The procedure described below is designed for the collection of specimens for the measurement of the majority of components in blood and specimen collection from the cubital vein is described. It can be easily adapted for the collection of blood from other vessels [4]. Certain laboratory investigations require a special protocol. In that case, the preparation of the subject prior to and during specimen collection as well as the procedure itself should be described in sufficient detail to permit reproduction by adequately trained personnel. In any project designed to produce reference values the same protocol for the preparation of individuals and specimen collection should be used throughout the project. The protocol should be described in detail. Thus, it is not satisfactory to state only that the present recommendation was followed. Each section of the recommendation is followed by a check list for points which should be taken into account.

Adult↗
PubMed1996

Adhering to inpatient geriatric consultation recommendations.

BACKGROUND: The purpose of this study was to evaluate the rate of and factors associated with attending physicians' adherence to geriatric consultation recommendations in an urban community hospital. METHODS: A retrospective review was performed of the charts of 47 patients referred for inpatient geriatric consultation over the previous 1 1/2-year period. Study variables included patient and attending physician demographics, length of stay in hospital before geriatric consultation, status of patient on discharge, level of expertise of consultant, number of diagnoses per patient, and types and number of recommendations per patient made by consultant and acted upon by attending physicians. RESULTS: The recommendations made included medical (23.4%), medication (28.6%), laboratory (15.8%), radiological (2.6%), nutritional (11.7%), psychosocial (7.7%), skin care (1.6%), rehabilitative (6.4%), and other (2.2%). The percentage of total recommendations acted upon was 55.5%. By multivariate analysis, decreasing length of time prior to consultation was statistically associated with referring physician adherence to consultation recommendations (P=.03). Slightly more than 40% of the variability in adherence was explained by this single variable. CONCLUSIONS: Inpatient geriatric consultations are aimed at providing a comprehensive assessment for attending physicians. Recommendations are acted upon more than 50% of the time. Physician adherence to recommendations does not appear to be dependent on patient or physician demographic variables, but to some extent, adherence is associated with less time in the hospital prior to consultation. This is a relatively new concept in hospital medicine.

Adult↗
PubMed1996

Recommendations of the Panel on Cost-effectiveness in Health and Medicine.

OBJECTIVE: To develop consensus-based recommendations for the conduct of cost-effectiveness analysis (CEA). This article, the second in a 3-part series, describes the basis for recommendations constituting the reference case analysis, the set of practices developed to guide CEAs that inform societal resource allocation decisions, and the content of these recommendations. PARTICIPANTS: The Panel on Cost-Effectiveness in Health and Medicine, a nonfederal panel with expertise in CEA, clinical medicine, ethics, and health outcomes measurement, was convened by the US Public Health Service (PHS). EVIDENCE: The panel reviewed the theoretical foundations of CEA, current practices, and alternative methods used in analyses. Recommendations were developed on the basis of theory where possible, but tempered by ethical and pragmatic considerations, as well as the needs of users. CONSENSUS PROCESS: The panel developed recommendations through 2 1/2 years of discussions. Comments on preliminary drafts prepared by panel working groups were solicited from federal government methodologists, health agency officials, and academic methodologists. CONCLUSIONS: The panel's methodological recommendations address (1) components belonging in the numerator and denominator of a cost-effectiveness (C/E) ratio; (2) measuring resource use in the numerator of a C/E ratio; (3) valuing health consequences in the denominator of a C/E ratio; (4) estimating effectiveness of interventions; (5) incorporating time preference and discounting; and (6) handling uncertainty. Recommendations are subject to the ¿rule of reason,¿ balancing the burden engendered by a practice with its importance to a study. If researchers follow a standard set of methods in CEA, the quality and comparability of studies, and their ultimate utility, can be much improved.

Cost-Benefit Analysis↗
PubMed1996

Immunization of adolescents. Recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Medical Association.

This report concerning the immunization of adolescents (i.e., persons 11-21 years of age, as defined by the American Medical Association [AMA] and the American Academy of Pediatrics [AAP]) is a supplement to previous publications (i.e., MMWR 1994;43[No. RR-1]1-38; the AAP 1994 Red Book: Report of the Committee on Infectious Diseases; Summary of Policy Recommendations for Periodic Health Examination, August 1996 from the American Academy of Family Physicians [AAFP]; and AMA Guidelines for Adolescent Preventive Services [GAPS]: Recommendations and Rationale). This report presents a new strategy to improve the delivery of vaccination services to adolescents and to integrate recommendations for vaccination with other preventive services provided to adolescents. This new strategy emphasizes vaccination of adolescents 11-12 years of age by establishing a routine visit to their health-care providers. Specifically, the purposes of this visit are to a) vaccinate adolescents who have not been previously vaccinated with varicella virus vaccine, hepatitis B vaccine, or the second dose of the measles, mumps, and rubella (MMR) vaccine; b) provide a booster dose of tetanus and diphtheria toxoids; c) administer other vaccines that may be recommended for certain adolescents; and d) provide other recommended preventive services. The recommendations for vaccination of adolescents are based on new or current information for each vaccine. The most recent recommendations from ACIP, AAP, AAFP, and AMA concerning specific vaccines and delivery of preventive services should be consulted for details (Exhibit 2).

Adolescent↗
PubMed1997

Poliomyelitis prevention in the United States: introduction of a sequential vaccination schedule of inactivated poliovirus vaccine followed by oral poliovirus vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP)

These revised recommendations of the Advisory Committee on Immunization Practices (ACIP) replace recommendations on poliomyelitis issued in 1982 and 1987, and present a new ACIP poliovirus vaccination policy that increases reliance on inactivated poliovirus vaccine (IPV). This change in policy is the most substantive since the introduction of oral poliovirus vaccine (OPV) in 1961. ACIP has determined that the risk-benefit ratio associated with the exclusive use of OPV for routine immunization has changed because of rapid progress in global polio eradication efforts. In particular, the relative benefits of OPV to the U.S. population have diminished because of the elimination of wild-virus-associated poliomyelitis in the Western Hemisphere and the reduced threat of poliovirus importation into the United States. The risk for vaccine-associated poliomyelitis caused by OPV is now judged less acceptable because of the diminished risk for wild-virus-associated disease (indigenous or imported). Consequently, ACIP recommends a transition policy that will increase use of IPV and decrease use of OPV during the next 3-5 years. The revised recommendations include three options for poliovirus vaccination, all of which meet acceptable standards of care: sequential vaccination with IPV followed by OPV, OPV alone, or IPV alone. For overall public health benefit, ACIP recommends a sequential vaccination schedule of two doses of IPV followed by two doses of OPV for routine childhood vaccination. Vaccination schedules that include OPV alone or IPV alone are also acceptable and are preferred in some situations (e.g., IPV alone is recommended for children who are immunosuppressed; OPV alone is preferred for children who begin the primary vaccination schedule after 6 months of age). Implementation of these recommendations should reduce the risk for vaccine-associated paralytic poliomyelitis and facilitate a transition to exclusive use of IPV following further progress in global polio eradication.

Adult↗
PubMed1997

Patient characteristics and lifestyle recommendations in the treatment of gastroesophageal reflux disease.

BACKGROUND: The objectives of this study were to describe the patient-reported frequency with which health care providers recommend lifestyle changes to patients with GERD (gastroesophageal reflux disease) with respect to patient characteristics, eg, sex, age, body mass index, tobacco use, alcohol use, type of health insurance, and clinic location (rural vs urban). METHODS: The study was conducted in a five-center, university-based family practice in southeastern West Virginia. The first 50 patients enrolled in a prospective quality-of-life study of patients with GERD were used as the sample population. Telephone surveys administered immediately following the diagnosis of GERD included seven specific questions on lifestyle modification that may have been recommended by primary health care providers during the clinic visit. Patient-reported data were obtained from baseline surveys. RESULTS: Five of seven (71%) lifestyle modification recommendations were reported by less than 50% of patients as being received from health care providers. Patients aged 60 years or older were less likely to report receiving recommendations than those younger than 60 years (P = .0002), and patients with a body mass index greater than 30 were more likely to report receiving eating-related recommendations (P = .047). Heavier smokers were more likely to report receiving recommendations than lighter smokers (P = .0001). CONCLUSIONS: Based on patient report, health care providers recommended lifestyle modifications to a modest percentage of patients with GERD and modified counseling for specific patient characteristics, such as age, body mass index, smoking, and alcohol consumption. Additional prospective research using physician report and observation as well as patient report, and more numerous patient cohorts, is needed.

Adult↗
PubMed1997

[Local anesthetics--maximum recommended doses].

"Maximum doses" determined up to now do not take account of such important pharmacokinetic and toxicological data as: 1) the dependence of blood levels measured on the technique of regional anaesthesia, 2) and the raised toxicity of a local anaesthetic solution containing adrenaline following inadvertent intravascular (intravenous) injection. A maximum dose recommendation differs according to the technique of local anaesthesia for A: subcutaneous injection, B: injection in regions of high absorption, C: single injection (perineural, e.g. plexus), D: protracted injection (catheter, combined techniques), E: injection into vasoactive regions (near to the spinal cord, spinal, epidural, sympathetic). This sequential categorization also underscores the need to select appropriate techniques as well as concomitant monitoring according to the technique of administration and to the expected and possible plasma level curve. The "maximum recommended doses" (in mg) of mepivacaine for use with the above five different techniques of regional anaesthesia are (doses together with the vasoconstrictor adrenaline are in brackets): A: 400 (500), B: 200, C: 400 (500), D: 500, E: 1-25 ml; those for lidocaine: A: 400 (500), B: 200, C: 400 (500), D: 500, E: 1-25 ml, for prilocaine: A: 600, B: 300, C: 600, D: 700, E: 1-25 ml, for bupivacaine: A: 150, B: 75, C: 150, D: 200, E: 1-25 ml, for etidocaine: A: 300, B: 150, C: 300, D: 300, E: up to 25 ml (no spinal anaesthesia). These "recommended maximum doses" are low for zones of raised absorption and higher for techniques of protracted injection. For prilocaine, bupivacaine and etidocaine, the "maximum recommended doses" are the same regardless of whether or not the solutions contain adrenaline. The preparation containing adrenaline is limited by the total adrenaline content (0.25 mg). The dose spectrum must be specified for all injections carried out close to the spinal cord because of the specific risk: even very tiny volumes can have an intensive effect and they involve high risks. The values specified for techniques C and D also restrict the overall dose for the techniques specified under E when high doses are necessary. The amount of the repetition dose of bupivacaine can be reliably given as 30 mg/h. Recommended maximum doses given here relate to normal conditions (70 kg body weight). They must be varied individually depending on the body weight and condition of the patient. Recommended maximum doses are of orientative significance, they do not constitute a maximum dose. There is no quantitative limit for ropivaccine because the recommended techniques do not allow higher volumes of this long acting local anaesthetic.

Adult↗
PubMedDate not supplied

The effect of health insurance coverage on the appropriate use of recommended clinical preventive services.

INTRODUCTION: Lack of health insurance coverage has been shown to reduce use of some preventive services. However, even when care is free or fully covered by insurance, clinical preventive services are not used at recommended levels. This study investigates the impact of different levels of health insurance coverage (ranging from none, some, most, and all preventive services covered) on the use of recommended clinical preventive services for adult men and women. METHODS: Logistic regression was used to estimate the effect of different levels of health insurance coverage for preventive care on the probability of receiving six different clinical preventive services including periodic health exam, blood pressure screening, cholesterol screening, Pap smear, clinical breast exam, and screening mammography, as well as all recommended services for a given age and gender group. The study sample of adults ages 18 to 64 is from the Centers for Disease Control's 1991 Behavioral Risk Factor Surveillance System (BRFSS) (n = 53,981). RESULTS: The results demonstrate a positive and statistically significant dose-response relationship between level of health insurance coverage for preventive care and receipt of recommended preventive services in adult men and women. The odds ratios (ORs) of men who had full coverage for preventive care receiving recommended preventive services compared to men with no coverage for preventive care ranged from 1.8 to 2.8. For women the ORs were 1.2 to 2.0. The ORs for men with "most" preventive services covered compared to none covered ranged from 1.3 to 2.1, and for women from 1.2 to 2.0. CONCLUSIONS: The level of health insurance coverage for preventive care is one of the most important determinants of receipt of recommended preventive services for adult men and women 18-64 years of age. These results suggest that comprehensive health insurance coverage for clinical preventive care may significantly increase receipt of recommended preventive services for this population.

Adolescent↗
PubMed1998

An update of mechanical oral hygiene practices: evidence-based recommendations for disease prevention.

PURPOSE: This review updates the mechanical oral hygiene practices discussed at a 1986 State-of-the-Science Workshop. METHODS: The 1984-1995 MEDLINE database was searched and appropriate studies that used disease outcome measurements were located and selected. Recommendations were made based on the levels of evidence concept. RECOMMENDATIONS: 1) There is good evidence to recommend: toothbrushing twice daily with fluoridated toothpaste; using oscillating-rotating or counter-rotational-action electric toothbrushes; flossing for adults; personal supragingival irrigation as an adjunct to toothbrushing; and scaling of disease active sites for the treatment of periodontal diseases. 2) There is moderate evidence to recommend: using any soft-bristled manual toothbrush; using wooden interdental cleaners; scaling of disease active sites every three to four months for patients with histories of moderate/severe periodontitis; scaling of disease active sites at intervals of > or = 6 months for most patients, based on patient need; and removal of restoration overhangs. 3) There is moderate evidence to not recommend: use of vibrating, rotating or sonic action electric toothbrushes; using foam brushes; flossing for children; using interdental brushes; gingival massage; and tongue brushing or scraping. 4) There is good evidence to not recommend: subgingival scaling for patients with no signs of active disease; and polishing for disease prevention. CONCLUSIONS: Consistent with the 1986 workshop report, the 1996 recommendations emphasize the importance of personal oral hygiene and the provision of professional treatment when personal care fails to prevent disease.

Adult↗
PubMed1998

Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP).

These revised recommendations of the Advisory Committee on Immunization Practices (ACIP) on measles, mumps, and rubella prevention supersede recommendations published in 1989 and 1990. This statement summarizes the goals and current strategies for measles, rubella, and congenital rubella syndrome (CRS) elimination and for mumps reduction in the United States. Changes from previous recommendations include: Emphasis on the use of combined MMR vaccine for most indications; A change in the recommended age for routine vaccination to 12-15 months for the first dose of MMR, and to 4-6 years for the second dose of MMR; A recommendation that all states take immediate steps to implement a two dose MMR requirement for school entry and any additional measures needed to ensure that all school-aged children are vaccinated with two doses of MMR by 2001; A clarification of the role of serologic screening to determine immunity; A change in the criteria for determining acceptable evidence of rubella immunity; A recommendation that all persons who work in health-care facilities have acceptable evidence of measles and rubella immunity; Changes in the recommended interval between administration of immune globulin and measles vaccination; and Updated information on adverse events and contraindications, particularly for persons with severe HIV infection, persons with a history of egg allergy or gelatin allergy, persons with a history of thrombocytopenia, and persons receiving steroid therapy.

Adolescent↗
PubMed1998

[Standards, Options, and Recommendations for using erythropoietin in cancerology].

UNLABELLED: The "Standards, Options and Recommendations" (SOR), started in 1993, are a collaborative project between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcomes for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary experts group, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop a clinical practice guideline with definitions of Standards, Options and Recommendations for the use of recombinant human erythropoietin (rHuEPO) in oncology. METHODS: Data have been identified by literature search using Medline (up to march 1996) and Current Contents (up to october 1996) and personal references lists. The main end points considered were hemoglobin level, haematocrit, quality of life, transfusion requirements, incidence and length of hospital stays, efficacy of cancer treatment, safety and costs. Once the guideline was defined, the document was submitted to 39 reviewers for peer review, and to the medical committees of the 20 French Cancer Centres for review and agreement. RESULTS: The key recommendations are: 1) the use of recombinant human erythropoietin in oncology is validated for chemotherapy-induced anemia when the chemotherapeutic regimen contains platinum. In other cases, we recommend to suggest patients participating in prospective clinical trials; 2) for chemotherapy (platinum based)-induced anemia, the benefits/risks ratio for anemia therapy (i.e. transfusion or erythropoietin therapy) must be analysed for each individual patient; 3) we recommend participation in studies to identify predictive factors for non-response to erythropoietin therapy to select non-responding patients; 4) to investigate the clinical benefit of erythropoietin therapy for anemia due to intensive cytotoxic chemotherapy and radiation therapy, we recommend to suggest patients participating in large multicentre phase III trials; 5) at the present time, there is insufficient evidence to recommend the use of erythropoietin therapy in children.

Anemia↗