Guideline for schizophrenia: implementation status and attitude toward an upcoming living guideline.

The implementation status of clinical guidelines is, despite their important role in connecting research with practice, frequently not satisfactory. This study aims to investigate the implementation status of the current German guideline for schizophrenia. Moreover, the attitude toward a living guideline has been explored for the first time by presenting screenshots of the German schizophrenia guideline transferred to a digital living guideline format called MAGICapp. A cross-sectional online survey was performed under the participation of 17 hospitals for psychiatry and psychosomatic medicine in Southern Germany and one professional association for German neurologists and psychiatrists. 439 participants supplied sufficient data for analysis. 309 provided complete data sets. Regarding the current guideline for schizophrenia and key recommendations, a large awareness-to-adherence gap was found. Group comparisons between different professions (caregivers, medical doctors, psychologists/psychotherapists, psychosocial therapists) detected differences in the implementation status showing higher awareness and agreement with the schizophrenia guideline and its key recommendations among medical doctors compared to psychosocial therapists and caregivers. Moreover, we detected differences in the implementation status of the guideline as a whole and its key recommendations between specialist and assistant doctors. The attitude toward an upcoming living guideline was mostly positive, especially among younger healthcare professionals. Our findings confirm an awareness-to-adherence gap, not only for the current schizophrenia guideline in general but also for its key recommendations with apparent differences between professions. Overall, our results show promising positive attitudes toward the living guideline for schizophrenia among healthcare providers, suggesting that a living guideline may be a supportive tool in everyday clinical practice.

Effectiveness of autologous transfusion system in primary total hip and knee arthroplasty.

BACKGROUND: Autologous transfusion has become a cost-efficient and useful option in the treatment of patients with high blood loss following major orthopaedic surgery. However, the effectiveness of autologous transfusion in total joint replacement remains controversial. OBJECTIVE: The current study analyzed the efficacy of autologous transfusion with washed shed blood (WSB) in primary total knee and total hip arthroplasty (TKA, THA). METHODS: Between January 2011 and December 2011, patients being treated with a primary TKA (n=162) and/or THA (n=227) and who met the inclusion criteria were recruited to the study in consecutive fashion. RESULTS: The patient age, BMI and ASA scores showed no statistically significant correlation to the degree of blood loss, quantity of autotransfusion necessary or Hb differential in TKA patients. The use of an autologous transfusion system in TKA and THA is not correlated statistically to a reduction in the amount of allogenic or autologous transfusion. CONCLUSIONS: The use of the autotransfusion system does not correlate significantly with the amount of allogenic transfusion in TKA and THA in the current authors' patient cohort. Age, BMI and ASA score appeared not to exert significant influence on the total amount of autotransfusion or Hb difference.