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Joseph Watine

Publications and source records attributed to Joseph Watine.

10 recordsLinked to original sources
PubMed2006

Molecular epidemiology of VIM-4 metallo-beta-lactamase-producing Pseudomonas sp. isolates in Hungary.

VIM metallo-beta-lactamase-producing serotype O11 or O12 Pseudomonas aeruginosa isolates infecting or colonizing 19 patients from seven hospitals in Hungary were characterized between October 2003 and November 2005. Macrorestriction analysis revealed the involvement of hospitals from three different towns in northwest Hungary in an outbreak caused by VIM-4-producing P. aeruginosa.

Base Sequence↗
PubMed2006

Conflict between guideline methodologic quality and recommendation validity: a potential problem for practitioners.

BACKGROUND: It is not clear if good methodologic quality in current practice guidelines necessarily leads to more valid recommendations, i.e., those that are supported with consistent research evidence or, when evidence is conflicting or lacking, with sufficient consensus among the guideline development team. To help clarify this issue, we assessed whether there is a link between methodologic quality and recommendation validity in practice guidelines for the use of laboratory tests in the management of patients with non-small cell lung cancer (NSCLC). METHODS: We conducted a systematic review of data on laboratory tests in NSCLC published in English or in French within the last 10 years and retrieved 11 practice guidelines for the use of these tests. The guidelines were critically appraised and scored for methodologic quality and recommendation validity based on the Appraisal of Guidelines Research and Evaluation (AGREE) criteria and on the systematic review. RESULTS: Overall, these 11 guidelines had considerable shortcomings in methodologic quality and, to a lesser extent, in recommendation validity. Practice guidelines with the best methodologic quality were not necessarily the most valid in their recommendations, and conversely. CONCLUSIONS: Poor methodologic quality and lack of recommendation validity in laboratory medicine call for methodologic standards of guideline development and for international collaboration of guideline development agencies. We advise readers of guidelines to critically evaluate the methods used as well as the content of the recommendations before adopting them for use in practice.

Carcinoma, Non-Small-Cell Lung↗
PubMed2005

Quality of guidelines for the laboratory management of diabetes mellitus.

BACKGROUND: There is increasing concern about the quality and reliability of practice guidelines, especially in the field of laboratory medicine, as most recommendations are developed by clinical specialty societies, often without involving laboratory professionals. Little information is available on the methodological quality of guidelines for the use of laboratory investigations in the care of specific diseases. We describe a pilot assessment of the most well-known guidelines for the diagnosis and monitoring of diabetes mellitus (DM). METHODS: Practice guidelines on DM published in English between 1999 and 2005 April were identified by systematic searching in Medline and international guideline databases. Fifty four DM guidelines were retrieved, of which 29 met our inclusion criteria. The four most widely used international guidelines (WHO, ADA, NACB, NICE) were selected for a critical appraisal of their methodological quality. This was carried out by seven independent assessors using a validated checklist, the AGREE Instrument. Twenty three guideline attributes arranged in six independent domains were investigated and the mean scores of assessors for each attribute and the aggregated scores for each domain were calculated. Cronbach's alpha and interclass correlations were calculated to measure internal consistency and reliability within each domain. The four guidelines were compared using one-way ANOVA and ANOVA using repeated measurements. RESULTS: The selected four guidelines on DM have significant shortcomings in demonstrating and/or reporting multidisciplinary stakeholder involvement in the guideline development process, evidence-based methodology for formulating recommendations, applicability of statements, and disclosing any conflicts of interest or reporting editorial independence. CONCLUSIONS: Poor quality and lack of explicitness of recommendations in laboratory medicine call for methodological standards of guideline development and reporting, and for an international collaboration of guideline development activities, to increase the internal and external validity of recommendations in laboratory practice.

Diabetes Mellitus↗
PubMed2004

Laboratory variables and stratification of metastatic colorectal cancer patients: recommendations for therapeutic trials and for clinical practice guidelines.

OBJECTIVE: To identify, through a systematic review of the literature, the laboratory variables that, in addition to performance status and to the degree of tumor invasion, would allow a more accurate stratification of metastatic colorectal cancer patients who participate in chemotherapy trials, with or without radiotherapy. SECONDARY AIM: To compare the results of our systematic review with the recommendations made in current clinical practice guidelines, and with the results of related systematic reviews. METHODS: Update of two recently published systematic reviews, without metaanalysis, following the recommendations of the International Federation of Clinical Chemistry and Laboratory Medicine, and taking into account the Consolidated Standards of Reporting Trials statement. RESULTS: Of 877 publications retrieved, reasonable exclusion and inclusion criteria allow us to include 15 studies in our systematic review, thus confirming the low quality of clinical research in laboratory medicine. Four variables were most often found "significant" in multivariate statistical analysis: pretherapeutic levels of laboratory tests (13/15, 87%), degree of tumor invasion (9/13, 69%), treatment, or response to treatment (6/9, 67%), and performance status (8/13, 62%). The laboratory variable whose measurements are quite often recommended in the 10 clinical practice guidelines or in the four related systematic reviews that we retrieved are carcinoembryonic antigen (CEA), and liver function tests to a lesser extent. CONCLUSIONS: Available evidence supports the recommendation that in all metastatic colorectal cancer patients who participate in therapeutic trials, the following pretreatment laboratory variables should be systematically measured: blood cell counts, and haemoglobin, plasma prothrombin time, serum alkaline phosphatase (ALP), lactate dehydrogenase, transaminases, albumin, bilirubin, and CEA. If other tests were to be added, gamma glutamyl transferase, and erythrocyte sedimentation rate might perhaps be proposed. Further studies would be necessary to support the addition to this list, of other tests [e.g., cancer antigen (CA) 19-9]. Rather than using laboratory variables according to arbitrary thresholds, it seems recommendable to use them as continuous variables, and if possible, in terms of kinetics. Many clinical practice guidelines do not use levels of evidence in order to grade the strength of their recommendations, but rather seem to be based on experts opinions which are not always in agreement with the results of systematic reviews.

Antineoplastic Agents↗
PubMed2004

Evidence-based guidelines in laboratory medicine: principles and methods.

BACKGROUND: Guidelines are commonly used tools for supporting medical decisions. Formulating evidence-based recommendations has become a leading principle in guideline development. AIM: This narrative review integrates the most recent methods of evidence-based guideline development and adapts those to the field of laboratory medicine. SUMMARY: We present a 10-step process and a list of criteria for the development of laboratory guidelines. Laboratory guidelines should be outcome oriented, be developed by a multidisciplinary team, and begin with a clear statement of the clinical question(s) that the use of the test(s) is addressing. The clinical questions define the type of study designs that offer the best evidence to answer those questions. Guidelines should be based on the critical appraisal and systematic review of literature and explicitly state the strength of evidence supporting each recommendation. Pragmatic considerations dictate that priority is given to topics with the highest clinical or economic impact. Scientific evidence is necessary but insufficient for recommendations, as considered judgment is required about benefits, harms, costs, and local applicability of recommendations. Formal consensus methods are needed when the evidence base is lacking or controversial. Guidelines should be disseminated widely and their impact monitored regularly. Regular reviewing is needed because the lack of timely updates is a major cause of nonadherence to guidelines. CONCLUSIONS: Guidelines should be developed in a transparent process by a multidisciplinary team, with graded recommendations based on critically appraised scientific studies. Systematic, standardized, and explicit methodology, adapted to laboratory medicine, should be followed when developing recommendations involving the use of laboratory tests.

Clinical Laboratory Techniques↗
PubMed2002

Are laboratory investigations recommended in current medical practice guidelines supported by available evidence?

It has been suggested that evidence-based laboratory medicine (EBLM) could help to improve the pertinence and accuracy of medical guidelines. In order to demonstrate this, we have used an EBLM approach (i.e. a systematic review) to examine three recently published guidelines that gave quite conflicting recommendations regarding the use of laboratory variables in the management of primary non-small cell lung cancer patients. In recommending the routine measurement of serum albumin, and, to a lesser extent, that of serum calcium in the pre-therapeutic prognostic evaluation of the advanced disease, the American Thoracic Society and the European Respiratory Society were probably correct with regard to calcium but perhaps mistaken regarding albumin. Some of the recommendations of the European Group on Tumour Markers regarding the usefulness of routine measurements of tumour markers (carcinoembryonic antigen (CEA), cancer antigen 125 (CA 125), tissue-polypeptide antigen (TPA)) in the pre- and/or post-therapeutic prognostic evaluation can also be criticised. In addition, the latter society as well as the Société de Pneumologie de Langue Française did not even try to list laboratory variables, others than tumour markers, that would be useful to stratify patients participating in clinical trials (i.e. lactate dehydrogenase (LDH), albumin, calcium, blood cell count, etc.), and the laboratory variables listed by the two former societies were probably not the right ones in this context: in particular LDH and tumour markers (fragments of cytokeratin 19 (Cyfra 21-1), tissue-polypeptide-specific antigen (TPS), neuron-specific enolase (NSE)) were not mentioned. Most, if not all of these discrepancies in the current medical practice guidelines might have been avoided had an EBLM approach been used by the authors.

Biomarkers, Tumor↗