Adapting lung cancer symptom investigation and referral guidelines for general practitioners in Australia: reflections on the utility of the ADAPTE framework.

RATIONALE: The ADAPTE framework was established to enhance efficiency in guideline development and to facilitate adaptation of high-quality clinical practice guidelines for a local context. It offers guideline developers a systematic methodology for guideline adaptation; however, the feasibility and usability of the process has not been widely evaluated. AIM: A pragmatic approach was undertaken throughout the evaluation of the ADATPE process throughout the development of a guide for general practitioners in Australia regarding the initial investigation of symptoms of lung cancer. At each step of the framework all members of the project team leading the development process reflected on the steps outlined in the ADAPTE. The reflections were collated into a lesson-learned log and analysed following completion of the project. RESULTS: Several opportunities for improvement were identified to improve usability and practicability of the ADAPTE framework. These items were both specific, in response to using steps and tools, and general issues concerned with the overall ADAPTE framework. Key challenges to using ADAPTE, highlighted in this study, were the lack of clarity about efficiency of the guideline adaptation process, level of assumed knowledge and expertise, and requirement of resources. In response to these challenges, modifications to the ADAPTE have been recommended. CONCLUSION: The ADAPTE framework offers an attractive alternative to de novo guideline synthesis in circumstances where high-quality, compatible guidelines already exist. Pending further evaluation, the modifications identified in this study may be applied to future versions of ADAPTE to improve usability and feasibility of the framework.

Solid versus liquid-satiety study in well-adjusted lap-band patients.

BACKGROUND: Patients following laparoscopic adjustable gastric banding (LAGB) are generally advised to avoid liquid calories, opt for solids and refrain from drinking with meals as this is believed to prolong satiety. The role of food consistency and satiety following LAGB is largely uninvestigated. The purpose of the study was to: (1) determine if food consistency impacts on post meal satiety in participants with well-adjusted LAGB and (2) compare the level of satiety achieved after consuming a solid versus a liquid meal between groups. METHODS: Twenty intervention (well-adjusted LAGB) and 20 control participants were recruited. All participants consumed three iso-caloric breakfasts that were randomised for nine mornings. Participants were asked to rate their satiety on visual analogue scales (VAS) at set times after the test meal. Areas under the curve (AUC) VAS scores were compared within and between groups. RESULTS: Solids (bars) with or without water provided greater satiety than the liquids (shakes) for both groups. Drinking water with the bar did influence satiety in the intervention group. For the intervention group (LAGB), AUC VAS values for the bar with water were 77.4 ± 11.2* and 72.4 ± 16.7* for the controls. CONCLUSION: Solid meals are more satisfying in both LAGB and non-LAGB individuals. However, a solid meal with accompanying water did not alter meal satiety.

Childhood obesity, BMI calculators, and medical software--time for an upgrade?

National Health and Medical Research Council (NHMRC) guidelines for the management of childhood obesity recommend active screening of children aged 2-18 years, and intervention for those with a body mass index (BMI) (kg/m2) above the 85th percentile for age and gender. However, guidelines and BMI for age percentile charts are not well utilised in the general practice setting. In addition, there is a tendency for clinicians and parents to visually underestimate body mass in children.

Quality and consistency of clinical practice guidelines for diagnosis and management of osteoarthritis of the hip and knee: a descriptive overview of published guidelines.

OBJECTIVE: To present a descriptive overview of the quality and recommendations of clinical practice guidelines (CPGs) on diagnosis or management of osteoarthritis (OA) of the hip and/or knee. DATA SOURCES: CPGs were identified from several research databases (MEDLINE, EMBASE and The Cochrane Library) and guideline-specific databases from 1966 to August 2005. GUIDELINE RETRIEVAL: Thirty-four relevant CPGs were identified. DATA EXTRACTION: Recommendations were extracted from CPGs and categorised into: assessment and diagnosis, pharmacological management, nonpharmacological management, complementary/alternative therapy, or surgery. The quality of the CPGs were assessed by two appraisers using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. DATA SYNTHESIS: Most recommendations for aspects of diagnosis and treatment of OA of the hip and/or knee were consistent among the CPGs included in this study. However, quality varied considerably, with few CPGs being "strongly recommended" according to the AGREE quality appraisal instrument. CONCLUSIONS: Given the number of CPGs available relevant to OA, and the consistency of recommendations within them, and considering the time and resources required for CPG development, future efforts to guide management of OA of the hip and/or knee may be better directed towards adapting existing CPGs to the local context, implementing practices known to be effective, and facilitating research to answer important questions where there is little evidence.