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PubMed2005

Improving influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among adults aged <65 years at high risk: a report on recommendations of the Task Force on Community Preventive Services.

The Task Force on Community Preventive Services conducted systematic reviews to evaluate the effectiveness of interventions to improve targeted vaccination coverage (i.e., coverage with vaccines recommended for some but not all persons in an age range on the basis of risk for exposure or disease) among adults aged <65 years at high risk when implemented alone (single-component interventions) and in combination with other interventions (multicomponent interventions). A 1999 report by the Task Force examined the effectiveness of interventions to increase coverage with universally recommended vaccinations (i.e., vaccines recommended for all persons in particular age groups). Three targeted vaccinations recommended for populations at risk are addressed in this review: influenza, pneumococcal polysaccharide, and hepatitis B. The Task Force identified evidence that certain combinations of interventions have improved vaccination coverage. To increase targeted vaccination coverage, the Task Force recommends a combination of interventions that include selected interventions from two or three categories of interventions (i.e., increasing community demand for vaccinations, enhancing access to vaccination services, and provider- or system-based interventions). The Task Force also recommends provider reminders, when implemented alone, to improve targeted vaccination coverage. This report provides additional information about population-based interventions to improve the coverage of influenza, pneumococcal polysaccharide, and hepatitis B vaccines among populations at risk, briefly describes how the reviews were conducted, and provides information that can help in applying the interventions locally.

Adult↗
PubMed2004

[Harmonization for mesoamerican nutrient-based recommendations: regional unification or national specification?].

Mesoamerica, the area we focus for this paper, is a section of Latin America that extends from Central Mexico to Panama. The deliberations of international committees are the primary bases for their nutrient-based recommendations. To a smaller extent, the unique particularities of the bioavailability for one or another nutrient have been considered. The nutrient recommendations throughout the region are "relatively" uniform and mutually consistent with respect to: iron, iodine and most of the B-complex vitamins. discrepancies exist among the various sets of recommendations for other nutrients. A valid basis of harmonization would not be unification of recommendations across all nationalities, but rather assuring a consistency in the nutrient profile that is recommended provides the nutrient exposures and/or fills the body's reserves as best suits the goals of survival, growth, well-being and function within the ecological niche of the population. That the recommendations for nutrients must be satisfied from foods, foods that are accessible and culturally acceptable, and that approximate the parallel demands of food-based dietary guidelines, add additional constraints onto the process of enunciating the former.

Adolescent↗
PubMedDate not supplied

[New Nordic nutrition recommendations 2004. Physical activity as important as good nourishing food].

The 4th edition of the Nordic Nutrition Recommendations (NNR 2004) now includes detailed recommendations on daily physical activity. For adults a minimum of 30 minutes of daily physical activity of moderate intensity and/or vigorous intensity is recommended. More physical activity (about 60 minutes daily) may be needed for prevention of weight gain. For children a minimum of 60 minutes of physical activity every day is recommended. As in the 3rd edition, a limitation of the intake of saturated plus trans fatty acids to about 10 % of the total energy intake (E%) and of the total fat intake to 30 E% is recommended. The intake of carbohydrates and dietary fibre should increase, while the intake of refined sugars should not exceed 10 E%. The 4th edition includes changes in the recommended intakes for e.g. vitamin A, D and C and for folate.

Adolescent↗
PubMed2006

[The periodic health examination: a comparison of United States and Canadian recommendations].

OBJECTIVE: To compare recommendations of the Canadian Task Force on Preventive Health Care with those of the United States Preventive Services Task Force for periodic health examinations (PHEs), following the usual sequence of a medical interview. QUALITY OF EVIDENCE: Each task force reviewed the literature exhaustively and created a system of classification that indicated the quality of the evidence. MAIN MESSAGE: Two tables sum up the conclusions of the task forces with respect to preventive measures to be included in PHEs: one for adults generally and one for women specifically. Three other tables show measures for which recommendations are different or conflicting, as well as measures that might be excluded. Several forms and other materials for PHEs based on these comparisons can be found at http://medecinefamiliale.com/umf/emc/emp_guide.htm. Many recommendations are similar; in spite of this, many physicians fail to include them in PHEs. Certain factors could explain the differences between the recommendations, including the challenge of arriving at a standard scientific process for reviewing data, the fact that formulating recommendations is a social as well as a scientific process, and the fact that the CTFPHC is seriously underfunded. CONCLUSION: A scientific review of the literature, even when performed by experts using strict criteria, is not easy to standardize. The differences that our comparison revealed, some of which are substantial, highlight the need to further examine how recommendations are formulated. More research in this field would be helpful.

Adult↗
PubMed2006

Perioperative platelet transfusion. Recommendations of the French Health Products Safety Agency (AFSSAPS) 2003.

The aim of this paper is to present the recommendations of the Agence Française de Sécurité Sanitaire des Produits de Santé (AFSSaPS; French Safety Agency for Health Products). A panel of experts reviewed and graded the literature on platelet transfusions; recommendations were formulated. Threshold platelet counts (PC) for transfusions in the perioperative context have not been clearly defined and should be determined by the existence of hemorrhagic risk factors. In the case of commonly practiced invasive procedures, the recommendation is to transfuse in order to achieve PC > 50,000 x microL-1. In the absence of platelet dysfunction, regardless of the type of surgery, the standard hemorrhagic risk threshold for surgery is 50,000 x microL-1. It has not been proven that the risk threshold is different according to the type of surgery. For neurosurgery and ophthalmologic surgery involving the posterior segment of the eye, a PC of 100,000 x microL-11 is required. For axial regional anesthesia, a PC of 50,000 x microL-11 is sufficient for spinal anesthesia; a PC of 80,000 x microL-11 has been proposed for epidurals. During massive transfusion, prophylactic platelet infusion cannot be recommended beyond a loss of two blood volumes in less than 24 h (Professional Consensus). As for the therapeutic transfusion of plasma and/or platelets, as much as possible, platelet deficit should be documented with test results (PC and fibrinogen) before transfusing. In the event of bleeding, platelet transfusion may precede plasma infusion. However, although this recommendation has been the subject of several professional consensus agreements, it is not based on any randomized studies. Threshold PC for perioperative transfusions have not been clearly defined and most recommendations are the result of a professional consensus.

Humans↗
PubMed2006

Pregnancy prevention among women taking isotretinoin: failure to comply with the recommendations.

OBJECTIVE: To assess whether prescribing physicians advised female patients taking isotretinoin according to pregnancy prevention recommendations, whether women understood those recommendations, and whether women complied with recommendations to prevent pregnancy. DESIGN: Cross-sectional study designed to collect patients' self-reported information. Women were interviewed by telephone with a standardized questionnaire. SETTING: Quebec. PARTICIPANTS: Participants were recruited through pharmacies, medical clinics, and newspapers in Quebec. All subjects (45 women 14 years and older) were treated with isotretinoin at the time of the interview or in the preceding 6 months. MAIN OUTCOME MEASURES: Women's self-report of their physician's behaviour regarding prevention of pregnancy, women's comprehension of the information, and their level of compliance with recommendations. RESULTS: Prescribing physicians discussed the risks of teratogenesis with 93% of the women but gave written information to only 36% of them. Seventy-eight percent of the women admitted not using 2 contraceptive methods all the time during the treatment, and 3 women reported having had sexual intercourse without any contraception. Physicians prescribed a pregnancy test before treatment for 44% of the women. Only 18% of the women waited for their next menstrual period to begin isotretinoin treatment, and this advice was given by 20% of physicians. A statistically significant relationship between counseling and recommendations given by physicians and women's use of double contraception was highlighted. CONCLUSION: Female patients reported physicians did not always advise them according to recommendations concerning pregnancy prevention. Women understood the information received but did not fully comply. The extent of pregnancy prevention measures taken by physicians was linked to women's compliance. Further study exploring underlying reasons for women's noncompliance could provide information on changing such behaviour.

Adolescent↗
PubMed2006

A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults.

Hepatitis B vaccination is the most effective measure to prevent hepatitis B virus (HBV) infection and its consequences, including cirrhosis of the liver, liver cancer, liver failure, and death. In adults, ongoing HBV transmission occurs primarily among unvaccinated persons with behavioral risks for HBV transmission (e.g., heterosexuals with multiple sex partners, injection-drug users [IDUs], and men who have sex with men [MSM]) and among household contacts and sex partners of persons with chronic HBV infection. This report, the second of a two-part statement from the Advisory Committee on Immunization Practices (ACIP), provides updated recommendations to increase hepatitis B vaccination of adults at risk for HBV infection. The first part of the ACIP statement, which provided recommendations for immunization of infants, children, and adolescents, was published previously (CDC. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices [ACIP]. Part 1: immunization of infants, children, and adolescents. MMWR 2005;54[No. RR-16]:1-33). In settings in which a high proportion of adults have risks for HBV infection (e.g., sexually transmitted disease/human immunodeficiency virus testing and treatment facilities, drug-abuse treatment and prevention settings, health-care settings targeting services to IDUs, health-care settings targeting services to MSM, and correctional facilities), ACIP recommends universal hepatitis B vaccination for all unvaccinated adults. In other primary care and specialty medical settings in which adults at risk for HBV infection receive care, health-care providers should inform all patients about the health benefits of vaccination, including risks for HBV infection and persons for whom vaccination is recommended, and vaccinate adults who report risks for HBV infection and any adults requesting protection from HBV infection. To promote vaccination in all settings, health-care providers should implement standing orders to identify adults recommended for hepatitis B vaccination and administer vaccination as part of routine clinical services, not require acknowledgment of an HBV infection risk factor for adults to receive vaccine, and use available reimbursement mechanisms to remove financial barriers to hepatitis B vaccination.

Adult↗
PubMed1991

Update on adult immunization. Recommendations of the Immunization Practices Advisory Committee (ACIP).

This statement on adult immunization is a supplement to the "General Recommendations on Immunization" of the Immunization Practices Advisory Committee (ACIP) (1) and updates the previous supplement published in September 1984. This statement presents an overview on immunization for adults and makes specific immunization recommendations. The statement provides information on vaccine-preventable diseases; indications for use of vaccines, toxoids, and immune globulins recommended for adults; and specific side effects, adverse reactions, precautions, and contraindications associated with use of these immunobiologics. It also gives immunization recommendations for adults in specific age groups and for those who have special immunization requirements because of occupation, life-style, travel, environmental situations, and health status. This statement is a compendium of ACIP recommendations and will not be updated regularly. The ACIP periodically reviews individual immunization statements that are published in the MMWR. The reader must use the detailed, up-to-date individual statements in conjunction with this compendium to keep abreast of current information. A list of the current ACIP recommendations for specific diseases and vaccines can be found in Appendix 1.

Adolescent↗
PubMed1990

Recommended guidelines for infant hearing screening: analysis.

This paper has identified problems with the guidelines and the disadvantages of the ASHA protocol. Some of these are significant. Others are less important but represent issues that should be considered when designing an EID protocol. The problems and disadvantages are summarized below. 1. The guidelines should have estimated and cost and performance of the recommended protocol. 2. The guidelines should have identified the true advantage of ABR screening (lower cost) and the disadvantage (lower hit rate) as compared to other protocols. 3. The guidelines should have evaluated other possible protocols. 4. The guidelines recommended the same protocol for all facilities (with adequate resources) independent of local factors. 5. The guidelines recommended the same screening strategy for the ICN and the WBN when different protocols may be appropriate. 6. The guidelines reject ABR screening of all WBN infants as too expensive without estimates of cost. More importantly, this is a decision that should be made by local institutions or governments. 7. The screening protocol was developed without a detailed description of the diagnostic component of the EID protocol. 8. The guidelines should have provided more information to hospitals that do not have the resources necessary to implement the recommended protocol. 9. The recommended protocol requires significant in-patient testing that can cause problems with reimbursement. 10. Some infants at risk for progressive loss can be lost from follow-up. Apparently, the guidelines were developed using a subjective, experiential approach. Although clinical experience is important, subjective impressions can be subject to bias and error. Some type of quantitative analysis is essential when developing test protocols. Perhaps a more rigorous theoretical foundation is needed to focus research and guide the development of EID protocols. The ASHA protocol is reasonable, but there is little evidence indicating that it is superior to, or even as good as, other possible protocols. Like all protocols, it has advantages and disadvantages. That is not to say that all possible protocols are appropriate. For example, protocols that delay diagnostic testing beyond 6 months should be rejected if the goal is habilitation by 6 months. Protocols that use screening tests with extremely poor hit rates may be undesirable in most situations. There remains one fundamental question. Is it even appropriate to recommend a particular protocol when, by necessity, many important local factors must be ignored? Perhaps it would be better to provide the basic data and techniques that would permit audiologists to design EID protocols that are optimum for their own circumstances.

American Speech-Language-Hearing Association↗
PubMed1990

A controlled study of variation among family physicians in HIV screening recommendations.

The results of a study of screening recommendations for human immunodeficiency virus (HIV) by family physicians are reported. Of 209 family practice residents and clinical faculty from the four UCLA-affiliated family practice residency programs surveyed, 110 (53%) responded. Each physician was presented with an identical set of five clinical scenarios and asked to make an HIV screening decision in each case. The physicians were also asked to choose from a list of 11 physician roles the one role that best described why they chose to recommend or not recommend an HIV screening test in each particular scenario. Marked variation was observed among the physicians' HIV screening recommendations. The degree of variation was similar between residents and clinical faculty. The physicians predominantly cited concern for the patient's well-being over concern for the public's well-being in making their HIV screening decisions. Three physician roles, (1) to protect the patient from mental suffering, (2) to protect the unborn from disease, and (3) to optimize the patient's future health care, were the roles most cited when an HIV screening test was recommended. Two physician roles, (1) to protect the patient from mental suffering, and (2) to allocate limited health resources properly, were the roles most cited when an HIV screening test was not recommended.

AIDS Serodiagnosis↗
PubMed1989

Factors associated with the recommendation for endocarditis prophylaxis in mitral value prolapse.

We conducted a population-based study to examine the association between clinical and Doppler echocardiographic characteristics and physicians' recommendation for endocarditis prophylaxis. Of 127 consecutive Olmsted County, Minnesota, residents with newly documented isolated mitral valve prolapse, endocarditis prophylaxis was recommended three to four times more often in patients under 40 years compared with those more than 60 years of age. Using multiple logistic regression, for every 10-year increment in age, there was a 30% independent reduction in recommendations for endocarditis prophylaxis. Doppler evidence of mitral regurgitation was also independently associated with recommendations for endocarditis prophylaxis. Observations from physical examination, including systolic murmur and systolic click, were weakly associated with endocarditis prophylaxis recommendations. Mitral valve appearance (thickened vs not) was not associated with endocarditis prophylaxis. Although current recommendations for endocarditis prophylaxis and mitral valve prolapse do not address age and Doppler-detected mitral regurgitation, these variables are strongly associated with clinical decisions. Prospective, longitudinal, population-based studies are needed to define endocarditis risk further in subgroups with mitral valve prolapse to provide a more scientific basis for clinical decision making.

Adult↗
PubMed1989

Laboratory tests recommended by pharmacists in a skilled-nursing facility.

The types of laboratory tests recommended by pharmacists in a 185-bed skilled-nursing facility, the rate of physician acceptance of the recommendations, the reasons for and costs of the tests, and the outcomes of the tests were determined. Patients for whom laboratory tests had been recommended by a pharmacist from 1982 to 1987 were identified; this information had been taken from patients' charts during routine review by a pharmacist and entered into a computer database. The following information was recorded: type of laboratory test recommended, physician response to the recommendation, cost of the test, and outcome of the test. The investigator determined reasons for the recommendations by using the Department of Health and Human Services list of apparent irregularities that, if present, could indicate problems with drug therapy. During the study period, pharmacists requested 99 tests for 63 patients; physicians ordered 87 (87.9%) of those tests. Tests done most frequently were the SMA-6 (serum concentrations of sodium, potassium, chloride, glucose, blood urea nitrogen, and carbon dioxide), serum concentrations of various drugs, and anticoagulation studies. The reasons given most frequently for requesting the tests were routine monitoring, the most recent results being more than six months old, suspected drug toxicity or drug-drug interactions, and the need for information to determine whether drug therapy should continue. Results of 36 of the tests prompted a change in drug therapy, whereas 56 tests indicated that the current therapy was appropriate and safe.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnostic Tests, Routine↗
PubMed1988

Early childhood diet: recommendations of pediatric health care providers.

With the abundance of literature on cardiovascular disease (CVD) prevention during childhood, recommendations for restricted dietary sodium and fat intakes during infancy and childhood are both advocated for preventive health care and criticized because the safety is undetermined. Dietitians, nurse practitioners, and pediatricians were surveyed to determine what dietary recommendations they give to parents and what source of information most influenced their decisions. A fourth group, pediatricians with particular expertise in nutrition, were surveyed as well. The overall response rate was 76%, with a total usable sample of 252. In all professional groups, 54% had no preference for any one commercially prepared formula. More importance was given to sodium content than to fat composition of formulas. On the choice of whole, low-fat, or non-fat milk for both 1- and 6-year-old children, professional groups differed significantly. Dietitians and the subgroup of pediatricians with nutrition expertise were more likely to recommend milk with higher fat content than other professional groups. Recommendations for both sodium- and fat-modified diets for children depended on CVD risk, and opinions varied between groups. Pediatricians and nurse practitioners were more likely to recommend dietary modifications for children with higher CVD risk. The variation in dietary recommendations within and between professional groups strongly indicates the need for research on the safety and efficacy of dietary restrictions in childhood.

Animals↗
PubMed1984

Behaviorally anchored ranking scale versus letters of recommendation for evaluating residency candidates.

A behavioral scale and traditional letters of recommendation were compared as tools for evaluating applicants for a hospital pharmacy residency program. In designing the behaviorally anchored ranking scale (BARS), a list of desirable characteristics of hospital pharmacy residents was compiled and descriptions were written of effective, average, and ineffective performance for these characteristics. Twelve characteristics in three categories (professionalism, special skills, and character attributes) were used. Each person who had written a letter of recommendation for the 1983-84 hospital pharmacy residency program at the University of Texas Medical Branch in Galveston was also asked to complete a BARS form. Pharmacy administrators involved in the resident-selection process used the BARS criteria to evaluate all letters of recommendation; responses on the BARS forms were then analyzed. For 18 applicants, 46 letters of recommendation and 39 BARS forms were completed. Many of the BARS characteristics were not addressed in letters of recommendation. None of the letters commented on leadership quality. Ability to work with others was the BARS characteristic most often mentioned in the letters (58.7%). Of characteristics that were mentioned in both the letters and the BARS, 82.4% were ranked equally in both. Of all the letters and scales, 59% were not in agreement with each other. The BARS provided a clearer picture of the characteristics and qualities of a hospital pharmacy residency candidate than did the letters of recommendation.

Education, Pharmacy↗
PubMed1983

Recommendations for handling cytotoxic drugs in hospitals.

Recommended procedures for handling cytotoxic drugs in hospitals are presented. The recommended procedures are designed to reduce the number of opportunities for unnecessary contact with cytotoxic agents (CYTAs) by hospital personnel and to prevent contamination of the hospital environment and staff with cytotoxic agents. The recommendations incorporate elements of previously published and unpublished guidelines; they admittedly are based on informed judgment as well. Three sets of recommended procedures are presented, each offering a varying degree of protection. The number of cytotoxic drug doses prepared and administered is suggested as the determinant of which level of protection is followed. The cytotoxic workload index, defined as the number of CYTAs prepared or administered (or both) divided by the number of available staff hours, is proposed as a quantitative method of deciding which level of protection is required for a particular work station or work shift. The recommended procedures cover the following seven topic areas: general guidelines; apparel, equipment, and facilities; drug preparation; drug administration; housekeeping, waste disposal, and management of spills and contamination; medical surveillance of staff; and legal and personnel considerations. The recommended procedures and associated equipment are considered to be practical and to adequately protect hospital personnel from risks associated with handling cytotoxic agents.

Antineoplastic Agents↗
PubMed1994

Hepatitis B vaccine use in Cincinnati: a community's response to the AAP recommendation of universal hepatitis B immunization.

The Committee on Infectious Diseases of the American Academy of Pediatrics (AAP) recently recommended universal immunization of infants against hepatitis B virus (HBV). We surveyed all pediatricians and family practitioners with admitting privileges to our institution to determine their degree of approval of the AAP recommendation and the anticipated compliance with the recommendation. A questionnaire was sent to 86 family practitioners and 205 pediatricians; the response rate was 38% and 47%, respectively. The survey sought information regarding prior HBV immunization practices, planned HBV immunization strategies in the physician's office and hospital nursery, and the individual's opinion of the AAP recommendation. Only 21% of pediatricians and 12.5% of family practitioners anticipated giving HBV vaccine to all infants. An additional 22% of pediatricians and 28% of family practitioners planned to give HBV vaccine to infants who had the means to pay for the vaccine. Only a minority of physicians, 42.6% of pediatricians and 36.4% of family practitioners, approved of the AAP recommendation. We conclude that in our community there is widespread concern about the financial practicality and scientific merit of universal HBV immunization, and many practitioners will not comply with the AAP recommendation.

American Medical Association↗
PubMed1993

Appropriate uses of fluorides for children: guidelines from the Canadian Workshop on the Evaluation of Current Recommendations Concerning Fluorides.

OBJECTIVE: To prevent fluorosis caused by excessive fluoride ingestion by revising recommendations for fluoride intake by children. OPTIONS: Limiting fluoride ingestion from fluoridated water, fluoride supplements and fluoride dentifrices. OUTCOMES: Reduction in the prevalence of dental fluorosis and continued prevention of dental caries. EVIDENCE: Before the workshop, experts prepared comprehensive literature reviews of fluoride therapies, fluoride ingestion and the prevalence and causes of dental fluorosis. The papers, which were peer-reviewed, revised and circulated to the workshop participants, formed the basis of the workshop discussions. VALUES: Recommendations to limit fluoride intake were vigorously debated before being adopted as the consensus opinion of the workshop group. BENEFITS, HARMS AND COSTS: Decrease in the prevalence of dental fluorosis with continuing preventive effects of fluoride use. The only significant cost would be in preparing new, low-concentration fluoride products for distribution. RECOMMENDATIONS: Fluoride supplementation should be limited to children 3 years of age and older in areas where there is less than 0.3 ppm of fluoride in the water supply. Children in all areas should use only a "pea-sized" amount of fluoride dentifrice no more than twice daily under the supervision of an adult. VALIDATION: These recommendations are almost identical to changes to recommendations for the use of fluoride supplements recently proposed by a group of European countries. SPONSORS: The workshop was organized by Dr. D. Christopher Clark, of the University of British Columbia, and Drs. Hardy Limeback and Ralph C. Burgess, of the University of Toronto, and funded by Proctor and Gamble Inc., Toronto, the Medical Research Council of Canada and Health Canada (formerly the Department of National Health and Welfare). The recommendations were formally adopted by the Canadian Dental Association in April 1993.

Canada↗
PubMed1993

Variation in physicians' recommendations about revisit interval for three common conditions.

BACKGROUND: The appropriate revisit interval for most conditions is uncertain. This survey was done to gather information about physicians' recommendations on revisit intervals for three common conditions. METHODS: Data were gathered in a mailed survey of 116 primary care physicians in the University of California at San Francisco Collaborative Research Network. Physicians were given descriptions of three hypothetical patients, one with diabetes mellitus, one with angina, and one with hypertension, and were asked when they would recommend a follow-up visit for the condition. RESULTS: There were great variations in physicians' recommendations about revisit intervals for each hypothetical patient. Internists were significantly more likely than family physicians to recommend a longer revisit interval for the hypothetical patient with diabetes mellitus; a similar revisit pattern was found for the patient with hypertension. There were no significant associations with recommended revisit interval and many other physician characteristics. CONCLUSIONS: As interest in containing the cost and improving the efficiency of medical care increases, knowing how often patients ought to be seen will be a topic of increasing importance. A rational, information-based approach to the choice of revisit interval for common conditions could yield substantial savings in medical care costs. The existence of great variation in recommended revisit interval suggests that physicians are uncertain about what interval is best.

Aged↗