Weekly Review in Medicine – 3rd edition: November 18 to November 24
26 Nov, 2015 | 16:40h | UTCGUIDELINES
Management of blood transfusions – This new National Institute for Health and Care Excellence (NICE) guideline covers the assessment for and management of blood transfusions in adults, young people and children over 1 year old. The key points for red blood cell transfusion are:
– Use restrictive thresholds for patients who do not: 1) have major hemorrhage; 2) have acute coronary syndrome; or 3) need regular blood transfusions for chronic anemia.
– When using a restrictive threshold, consider a threshold of 7 g/dL and a hemoglobin target of 7-9 g/dl.
– For patients with acute coronary syndrome consider a threshold of 8 g/dL and a target of 8-10 g/dL after transfusion.
– Set individual thresholds and hemoglobin concentration targets for each patient who needs regular blood transfusions for chronic anemia.
– Consider single unit red blood cell transfusions for adults (or equivalent volumes calculated based on body weight for children or adults with low body weight) who do not have active bleeding. After each transfusion reassess clinically and check hemoglobin levels, and give further transfusions if needed.
The document also provides guidance for the use of platelets, fresh frozen plasma, cryoprecipitate and other aspects of blood transfusion in a clear and concise manner.
Preterm labor and birth – This new National Institute for Health and Care Excellence (NICE) guideline covers the care of women at increased risk of or with symptoms and signs of preterm labor (before 37 weeks) and women having a planned preterm birth. It aims to reduce the risks of preterm birth for the baby and describes treatments to prevent or delay early labor and birth.
Management of Hepatitis B – New American Association for the Study of Liver Diseases (AASLD) guidelines for treatment of chronic hepatitis B.
Management of Opportunistic Infections in HIV – AIDSinfo, a service of the U.S. Department of Health and Human Services (HHS) recently updated its Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents.
Contraception recommendations – New Canadian Contraception consensus (parts 1 and 2 of 4) covering: Contraception in Canada; Contraceptive Care and Access; and Emergency Contraception (Part 1) and also Natural Family Planning; Barrier Methods; and Permanent Contraception (Part 2).
Link to free full text – Part 1
Link to free full text – Part 2
Barrett’s Esophagus – New American College of Gastroenterology Guidelines on the Diagnosis and Management of Barrett’s Esophagus.
TRIALS AND REVIEWS
With the issue of antibiotic resistance becoming more important (see our 2nd weekly review to access worldwide campaigns addressing the issue), it is now clearer than ever that the decision to prescribe an antibiotic concerns more than just the patient and the doctor and that some kind of control seems warranted. This cluster randomized trial evaluated a multifaceted complex intervention that included audit reports and reminders through interactive, multimedia and electronic components integrated into routine care in order to improve antimicrobial prescribing for urinary tract infection in Irish general practice. The intervention improved the quality of prescribing according to the clinical practice guidelines in use, with increased avoidance of wide spectrum antibiotics as first line agents.
Link to summary and commentary in Medscape
GLOBAL HEALTH
Disease Control Priorities, 3rd edition (DCP3) – The Disease Control Priorities is a landmark publication in Global Health and is now in its 3rd edition. Produced and managed by the University of Washington’s Department of Global Health (UW-DGH), it provides the most up to date evidence on intervention efficacy and program effectiveness for the leading causes of global disease burden. It also provides economic evaluation of policy choices affecting the access, uptake, and quality of interventions and delivery platforms for low-and middle-income countries. Four volumes have been launched recently and are now available for free download:
Reproductive, Maternal, Newborn, and Child Health
Mental, Neurological, and Substance Use Disorders
The following volumes will be available soon:
Cardiovascular, Respiratory and Related Disorders
Injury Prevention and Environmental Health
Child & Adolescent Development
WEEKLY REVIEWS BY OTHERS
Richard Lehman’s journal review: 23 November 2015 – Interesting evidence-based review with critical commentaries on the latest “breakthrough” articles.
The 206th Critical Care Reviews Newsletter – A great selection of the latest publications in intensive care, a must read for those working in the field.