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Zanella, S., A. Vassiliadis, F. Buccelleti, F. Ricci, S. Verma, R. S. Bali, P. N. Agarwal, et al. "Topic: Inguinal Hernia — Influence of guidelines on daily practice." Hernia 19, S1 (April 2015): S261—S263. http://dx.doi.org/10.1007/bf03355367.
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Browman, G. P., M. N. Levine, E. A. Mohide, R. S. Hayward, K. I. Pritchard, A. Gafni, and A. Laupacis. "The practice guidelines development cycle: a conceptual tool for practice guidelines development and implementation." Journal of Clinical Oncology 13, no. 2 (February 1995): 502–12. http://dx.doi.org/10.1200/jco.1995.13.2.502.
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PURPOSE To develop a conceptual tool for the systematic development of cancer treatment practice guidelines. MATERIALS AND METHODS The guidelines development tool, the Practice Guidelines Development Cycle, was derived from observing an evidence-based practice guidelines initiative at a comprehensive cancer center in Ontario, Canada, and from a literature review that uncovered barriers to guidelines development and implementation. Based on the literature findings and direct observations of how clinicians struggled with evidence-based guidelines development, we evolved a framework to incorporate clinical and administrative factors (eg, costs) into evidence-based guidelines. Use of the Practice Guidelines Development Cycle is illustrated with a clinical example (the use of adjuvant systemic therapy in good-risk, node-negative premenopausal breast cancer patients). RESULTS The result is the Practice Guidelines Development Cycle, which consists of eight sequential steps, from topic selection to policy formulation. Independent validation of guidelines is included. The cycle products are the evidence-based recommendation, the practice guideline, and the practice policy. The main features of the cycle are emphasis on scientific evidence, acknowledgment of the roles of clinical experience and nonclinical (administrative) factors through consensus, and explicit separation of clinical and cost considerations in guidelines development. Twenty guidelines are currently in development. CONCLUSION Attention to the barriers of guidelines development and the sociocultural nature of clinical practice, and respect for clinical experience, can lead to improved strategies for guidelines development.
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Rosenfeld, Richard M., and Peter C. Wyer. "Stakeholder-Driven Quality Improvement: A Compelling Force for Clinical Practice Guidelines." Otolaryngology–Head and Neck Surgery 158, no. 1 (October 17, 2017): 16–20. http://dx.doi.org/10.1177/0194599817735500.
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Clinical practice guideline development should be driven by rigorous methodology, but what is less clear is where quality improvement enters the process: should it be a priority-guiding force, or should it enter only after recommendations are formulated? We argue for a stakeholder-driven approach to guideline development, with an overriding goal of quality improvement based on stakeholder perceptions of needs, uncertainties, and knowledge gaps. In contrast, the widely used topic-driven approach, which often makes recommendations based only on randomized controlled trials, is driven by epidemiologic purity and evidence rigor, with quality improvement a downstream consideration. The advantages of a stakeholder-driven versus a topic-driven approach are highlighted by comparisons of guidelines for otitis media with effusion, thyroid nodules, sepsis, and acute bacterial rhinosinusitis. These comparisons show that stakeholder-driven guidelines are more likely to address the quality improvement needs and pressing concerns of clinicians and patients, including understudied populations and patients with multiple chronic conditions. Conversely, a topic-driven approach often addresses “typical” patients, based on research that may not reflect the needs of high-risk groups excluded from studies because of ethical issues or a desire for purity of research design.
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Platz, Thomas. "Practice Guidelines in Neurorehabilitation." Neurology International Open 01, no. 03 (June 2017): E148—E152. http://dx.doi.org/10.1055/s-0043-103057.
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AbstractPractice guidelines are scientifically based practice recommendations. They can be consensus-based and provided by a single medical society (S1 guideline) or developed by a group of national medical societies with a structured consensus process (S2k guideline). S2k guidelines are a good opportunity to develop valid practice guidelines with a broad supporting base when health topics are either complex or when clinical evidence is limited. Evidence-based guidelines rest on a systematic search and critical appraisal of the available evidence and represent the highest quality level for guidelines; they can be developed by single medical societies (S2e guideline) or jointly by several national medical societies (S3 guideline). They reflect the state of the art and generate a high degree of confidence that their recommendations support optimal treatment. The German neurorehabilitation society (DGNR) provides evidence-based guidelines for motor rehabilitation after stroke (arm, mobility, spasticity).
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Choi, Sukgi, and Lorraine Nnacheta. "Clinical Practice Guidelines: AAO-HNSF Process for CPG Development and Topic Selection." Otolaryngology–Head and Neck Surgery 158, no. 2 (October 24, 2017): 219–21. http://dx.doi.org/10.1177/0194599817738526.
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The American Academy of Otolaryngology–Head and Neck Surgery has been developing clinical practice guidelines (CPGs) for use by its members and the public. The process of CPG development and the selection of topics for CPGs can be confusing. This commentary attempts to clarify this process and delineate the issues that are considered in topic selection.
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Somerfield, Mark R., Kari Bohlke, George P. Browman, Neelima Denduluri, Kaitlin Einhaus, Daniel F. Hayes, Alok A. Khorana, et al. "Innovations in American Society of Clinical Oncology Practice Guideline Development." Journal of Clinical Oncology 34, no. 26 (September 10, 2016): 3213–20. http://dx.doi.org/10.1200/jco.2016.68.3524.
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Since the beginning of its guidelines program in 1993, ASCO has continually sought ways to produce a greater number of guidelines while maintaining its commitment to using the rigorous development methods that minimize the biases that threaten the validity of practice recommendations. ASCO is implementing a range of guideline development and implementation innovations. In this article, we describe innovations that are designed to (1) integrate consideration of multiple chronic conditions into practice guidelines; (2) keep more of its guidelines current by applying evolving signals or (more) rapid, for-cause updating approaches; (3) increase the number of high-quality guidelines available to its membership through endorsement and adaptation of other groups’ products; (4) improve coverage of its members’ guideline needs through a new topic nomination process; and (5) enhance dissemination and promote implementation of ASCO guidelines in the oncology practice community through a network of volunteer ambassadors. We close with a summary of ASCO’s plans to facilitate the integration of data from its rapid learning system, CancerLinQ, into ASCO guidelines and to develop tactics through which guideline recommendations can be embedded in clinicians’ workflow in digital form. We highlight the challenges inherent in reconciling the need to provide clinicians with more interactive, point-of-care guidance with ASCO’s abiding commitment to methodologic rigor in guideline development.
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Brauer, Paula M. "Practice Guidelines: Pedantic Pontification or Pragmatic Progress? 2003 Ryley-Jeffs Memorial Lecture." Canadian Journal of Dietetic Practice and Research 64, no. 3 (September 2003): 142–46. http://dx.doi.org/10.3148/64.3.2003.142.
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Development and use of practice guidelines is one strategy to assist health professionals in translating research into practice. There has been a significant growth in the number of practice guidelines developed, with the increased focus on justifying health care costs and demonstrating outcomes. Quality and influence on established practice, however, has sometimes been lacking. Recognizing both the importance of practice guidelines and some of the controversies surrounding their quality and use, Dietitians of Canada convened a task group to make recommendations on future development. They reviewed the practice guideline programs of others and identified the key elements needed to ensure any dietetics-produced guidelines would be credible, feasible and applicable to clinical counselling, administration and community health promotion. In this memorial lecture, the chair of that task group briefly reviews the history of dietetic practice guidelines, new innovations in systematic review and consensus development methods, and specifically the Delphi process used to develop a new Dietetic Practice Guidelines Framework. The 34 elements of the framework direct overall management of the guideline development process, including topic nomination, systematic literature review, group judgment, and pilot testing.
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Loblaw, D. Andrew, Ann Alexis Prestrud, Mark R. Somerfield, Thomas K. Oliver, Melissa C. Brouwers, Robert K. Nam, Gary H. Lyman, and Ethan Basch. "American Society of Clinical Oncology Clinical Practice Guidelines: Formal Systematic Review–Based Consensus Methodology." Journal of Clinical Oncology 30, no. 25 (September 1, 2012): 3136–40. http://dx.doi.org/10.1200/jco.2012.42.0489.
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The American Society of Clinical Oncology (ASCO) guidelines program employs a systematic review–based methodology to produce evidence-based guidelines. This is consistent with the stance of the Institute of Medicine on guideline development, which is that high-quality evidence syntheses form the basis for recommendation development. In the absence of high-quality evidence, recommendation development becomes more complex. One option is to provide no recommendations or withdraw a guideline topic. However, it is often the areas of greatest uncertainty in which the evidentiary base is incomplete, and thus, guidelines are needed most. To provide recommendations in such circumstances, an explicit methodology is needed to ensure that a credible process is undertaken, and rigorous, reliable advice is provided. In 2010, the ASCO Board of Directors approved development of guideline recommendations using consensus methodology. A modified Delphi approach to recommendation development, based on the best available data identified in a systematic review, was piloted with an ASCO guideline. Consensus was achieved through the rating of a series of recommendations by a large group of clinicians, including academic and community-based content and methodology experts. A prespecified threshold of agreement was determined to indicate when consensus was achieved. Consensus was defined as agreement by ≥ 75% of raters. The formal consensus methodology used by ASCO enabled development of guideline recommendations on a challenging clinical issue based on limited evidence using a rigorous, transparent, and explicit method. This methodology is proposed for development of future ASCO guidelines on topics for which limited evidence is available.
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Swarm, Robert A., Judith A. Paice, Doralina L. Anghelescu, Madhuri Are, Justine Yang Bruce, Sorin Buga, Marcin Chwistek, et al. "Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology." Journal of the National Comprehensive Cancer Network 17, no. 8 (August 2019): 977–1007. http://dx.doi.org/10.6004/jnccn.2019.0038.
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In recent years, the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Adult Cancer Pain have undergone substantial revisions focusing on the appropriate and safe prescription of opioid analgesics, optimization of nonopioid analgesics and adjuvant medications, and integration of nonpharmacologic methods of cancer pain management. This selection highlights some of these changes, covering topics on management of adult cancer pain including pharmacologic interventions, nonpharmacologic interventions, and treatment of specific cancer pain syndromes. The complete version of the NCCN Guidelines for Adult Cancer Pain addresses additional aspects of this topic, including pathophysiologic classification of cancer pain syndromes, comprehensive pain assessment, management of pain crisis, ongoing care for cancer pain, pain in cancer survivors, and specialty consultations.
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Van Der Sanden, Wil J. M., Dirk G. Mettes, Richard P. T. M. Grol, Alphons J. M. Plasschaert, and Emiel H. Verdonschot. "Development of clinical practice guidelines for dentists: methods for topic selection." Community Dentistry and Oral Epidemiology 30, no. 4 (July 29, 2002): 313–19. http://dx.doi.org/10.1034/j.1600-0528.2002.00060.x.
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Krzyzanowska, M. K., C. Walker-Dilks, C. Atzema, A. Morris, R. Gupta, R. Halligan, T. Kouroukis, and K. McCann. "Approach to fever assessment in ambulatory cancer patients receiving chemotherapy: a clinical practice guideline." Current Oncology 23, no. 4 (August 8, 2016): 280. http://dx.doi.org/10.3747/co.23.3098.
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BackgroundThis guideline was prepared by the Fever Assessment Guideline Development Group, a group organized by the Program in Evidence-Based Care at the request of the Cancer Care Ontario Systemic Treatment Program. The mandate was to develop a standardized approach (in terms of definitions, information, and education) for the assessment of fever in cancer patients receiving chemotherapy.Methods The guideline development methods included a search for existing guidelines, literature searches in medline and embase for systematic reviews and primary studies, internal review by content and methodology experts, and external review by targeted experts and intended users.Results The search identified eight guidelines that had partial relevance to the topic of the present guideline and thirty-eight primary studies. The studies were mostly noncomparative prospective or retrospective studies. Few studies directly addressed the topic of fever except as one among many symptoms or adverse effects associated with chemotherapy. The recommendations concerning fever definition are supported mainly by other existing guidelines. No evidence was found that directly pertained to the assessment of fever before a diagnosis of febrile neutropenia was made. However, some studies evaluated approaches to symptom management that included fever among the symptoms. Few studies directly addressed information needs and resources for managing fever in cancer patients.Conclusions Fever in patients with cancer who are receiving systemic therapy is a common and potentially serious symptom that requires prompt assessment, but currently, evidence to inform best practices concerning when, where,and by whom that assessment is done is very limited.
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Garbi, Madalina. "National Institute for Health and Care Excellence clinical guidelines development principles and processes." Heart 107, no. 12 (February 23, 2021): 949–53. http://dx.doi.org/10.1136/heartjnl-2020-318661.
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Clinical guidelines are developed by professional societies and also, in England, by an independent non-departmental public body, the National Institute for Health and Care Excellence (NICE). Similarities and differences between these guidelines should be viewed in the context of different objectives, responsibilities and roles of guideline developers. This review describes the NICE clinical guidelines development principles and processes with the aim to provide the reader an informed perspective on the recommendations made. NICE clinical guidelines are developed by an appointed independent advisory committee comprising healthcare professionals as well as lay members, supported by a professional team comprising project managers, information specialists, systematic reviewers and health economists. Furthermore, registered stakeholders comprising organisations that have an interest in the guideline topic, or represent people whose practice or care may be directly affected by the guideline, are consulted on the draft scope and draft guidelines. NICE selects a limited number of high impact questions to be answered by the review of evidence, rather than cover a certain topic exhaustively as the clinical guidelines developed by professional societies may do. NICE clinical guidelines recommendations reflect both the clinical effectiveness and the cost-effectiveness of interventions.
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Stansfield, Claire, and Kristin Liabo. "Identifying Social Care Research Literature: Case Studies From Guideline Development." Evidence Based Library and Information Practice 12, no. 3 (September 18, 2017): 114. http://dx.doi.org/10.18438/b8m371.
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Objective – Systematic searching is central to guideline development, yet guidelines in social care present a challenge to systematic searching because they exist within a highly complex policy and service environment. The objective of this study was to highlight challenges and inform practice on identifying social care research literature, drawing on experiences from guideline development in social care.
Methods – The researchers reflected on the approaches to searching for research evidence to inform three guidelines. They evaluated the utility of major topic-focused bibliographic database sources through a) determining the yield of citations from the search strategies for two guidelines and b) identifying which databases contain the citations for three guidelines. The researchers also considered the proportion of different study types and their presence in certain databases.
Results – There were variations in the ability of the search terms to capture the studies from individual databases, even with low-precision searches. These were mitigated by searching a combination of databases and other resources that were specific to individual topics. A combination of eight databases was important for finding literature for the included topics. Multiple database searching also mitigates the currency of content, topic and study design focus, and consistency of indexing within individual databases.
Conclusion – Systematic searching for research evidence in social care requires considerable thought and development so that the search is fit for the particular purpose of supporting guidelines. This study highlights key challenges and reveals trends when utilising some commonly used databases.
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Golec, Sara J., and Alison R. Valier. "The Effect of Following Clinical Practice Guidelines on the Pain and Disability Outcomes of Patients With Low Back Pain—A Critically Appraised Topic." Journal of Sport Rehabilitation 27, no. 2 (March 1, 2018): 189–93. http://dx.doi.org/10.1123/jsr.2015-0185.
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Clinical Scenario: Health care clinicians are encouraged to practice according to the best available evidence for the purpose of improving patient outcomes. Clinical practice guidelines are one form of evidence that has been developed to enhance the care that patients receive for particular conditions. Low back pain is a common condition in rehabilitation medicine that places a significant financial burden on the healthcare system. Patients with low back pain often suffer great pain and disability that can last a long time, making effective and efficient care a priority. Several guidelines for the treatment of low back pain have been created; however, there is no consensus on whether following these guidelines will positively reduce the pain and disability experienced by patients. Clinical Question: Does adherence to clinical practice guidelines for patients with nonspecific low back pain reduce pain and disability? Summary of Key Findings: A total of 4 studies of level 3 or higher were found. Four studies noted an improvement in disability following guidelines adherent care. Two studies reported greater reduction in pain with guideline adherent care and 2 did not. Clinical Bottom Line: Moderate evidence exists to support adherence to clinical practice guidelines to improve pain and disability ratings in patients with nonspecific low back pain.
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Brouwers, Melissa C., Ellen Rawski, Lavannya Bahirathan, Karen Spithoff, and Caroline Zwaal. "SAGE directory of cancer guidelines." Journal of Clinical Oncology 30, no. 34_suppl (December 1, 2012): 306. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.306.
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306 Background: The Standards and Guidelines Evidence (SAGE) directory of cancer guidelines is a resource designed to facilitate evidence-based clinical practice, policy formation, and guideline adaptation, and reduce duplication in guideline development. Methods: Developed in 2008, SAGE is a publically available (www.cancerview.ca/sage), searchable database of English language cancer control guidelines and standards released since 2003. Qualifying guidelines in SAGE are rated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. These ratings can be used to measure trends in guideline quality. SAGE also documents guideline development status, including current guidelines, guidelines in progress, those in need of an update and guidelines undergoing updates. Results: SAGE contains over 1,900 indexed records from 271 developer organizations spanning 27 countries and international jurisdictions. There is considerable variability in guideline quality both within and across guideline developers, and AGREE II quality domains of applicability and editorial independence are the poorest performing. SAGE has the ability to provide information on guideline topic gaps and overlap, demonstrating that the majority of guidelines target breast, lung, colorectal and prostate cancers, and focus on the treatment stage of the cancer control continuum. This provides a channel of communication amongst organizational groups and facilitates guideline development partnerships. Conclusions: The value-add of SAGE to mitigate inconsistencies in guideline quality is the appraisal component of its records. It is the ultimate goal that SAGE will continue to assist efforts to leverage positive change in the field of practice guidelines, patient care and system performance in cancer control.
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Mayumi, Toshihiko. "Highlights of topic “Practice Guidelines for Primary Care of Acute Abdomen 2015”." Journal of Hepato-Biliary-Pancreatic Sciences 23, no. 1 (January 2016): 1–2. http://dx.doi.org/10.1002/jhbp.306.
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Adams, Susan, and Ann Marie McCarthy. "Evidence-Based Practice and School Nursing." Journal of School Nursing 21, no. 5 (October 2005): 258–65. http://dx.doi.org/10.1177/10598405050210050301.
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School nurses need to demonstrate that their practice is based on the best evidence available, which is usually data obtained from research. Evidence-based practice involves combining the best evidence available with nursing expertise and patient and family preferences to determine optimum care. Evidence-based practice guidelines are developed by carefully reviewing the available evidence on a topic and synthesizing this information into recommendations for practice. This article defines evidence-based practice and best evidence, describes the development of evidence-based practice guidelines, discusses factors that affect the use of research and evidence-based practice guidelines in school nursing, and reviews current sources of evidence-based practice guidelines for school nurses. Strategies that school nurses can use to incorporate evidence into their practice are discussed. One recommendation is that school nurses partner with nurse leaders and nurse researchers to develop evidence-based practice guidelines relevant to school nurse practice.
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Adams, Susan, and Ann Marie McCarthy. "Evidence-Based Practice Guidelines and School Nursing." Journal of School Nursing 23, no. 3 (June 2007): 128–36. http://dx.doi.org/10.1177/10598405070230030201.
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The use of evidence-based practice (EBP) has become the standard of health care practice. Nurses are expected to use best evidence on a wide range of topics, yet most nurses have limited time, resources, and/or skills to access and evaluate the quality of research and evidence needed to practice evidence-based nursing. EBP guidelines allow nurses and other health care workers to have research information collected, analyzed, and condensed into specific practice recommendations by experts. This article defines EBP guidelines and discusses the process of guideline development, including identification of topics, systematic literature searches, and evaluation and rating of research. Criteria for determining the quality of existing guidelines are reviewed. The steps needed to develop EBP guidelines specifically for school nursing are discussed.
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Segal, R., C. Zwaal, E. Green, J. R. Tomasone, A. Loblaw, T. Petrella, and The Exercise for People With Cancer Guideline Development Group. "Exercise for people with cancer: a clinical practice guideline." Current Oncology 24, no. 1 (February 28, 2017): 40. http://dx.doi.org/10.3747/co.24.3376.
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Background Development of this guideline was undertaken by the Exercise for People with Cancer Guideline Development Group, a group organized by Cancer Care Ontario’s Program in Evidence-Based Care (pebc). The purpose of the guideline was to provide guidance for clinicians with respect to exercise for patients living with cancer, focusing on the benefits of specific types of exercise, recommendations about screening requirements for new referrals, and safety concerns.Methods Consistent with the pebc’s standardized approach, a systematic search was conducted for existing guidelines, and systematic literature searches were performed in medline and embase for both systematic reviews and primary literature. Content and methodology experts performed an internal review, which was followed by an external review by targeted experts and intended users.Results The search identified three guidelines, eighteen systematic reviews, and twenty-nine randomized controlled trials with relevance to the topic. The present guideline provides recommendations for the duration, frequency, and intensity of exercise appropriate for people living with cancer. It also provides recommendations for pre-exercise assessment, safety concerns, and delivery models.Conclusions There is sufficient evidence to show that exercise provides benefits in quality of life and muscular and aerobic fitness for people with cancer both during and after treatment, and that it does not cause harm. The present guideline is intended to support the Canadian Society for Exercise Physiology’s Canadian physical activity guidelines. The recommendations are intended for clinicians and institutions treating cancer patients in Ontario, and for policymakers and program planners involved in the delivery of exercise programs for cancer patients.
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Ruggeri, Mirella. "Guidelines for treating mental illness: love them, hate them. Can the SIEP-DIRECT's Project serve in the search for a happy medium?" Epidemiology and Psychiatric Sciences 17, no. 4 (December 2008): 270–77. http://dx.doi.org/10.1017/s1121189x00000087.
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SUMMARYThis paper discusses some key aspects of the debate on the difficulties of incorporating scientific evidence into the daily work of clinicians in mental health services (MHS). It highlights the topics of: the utility of guidelines in this field, the ethical principles that should guide their utilisation, their limitations, obstacles impeding the diffusion of guidelines in psychiatry, and strategies that can be useful for overcoming the barriers to guideline implementation. The SIEP-DIRECT's ((DIscrepancy between Routine practice and Evidence in psychiatric Community Treatments on Schizophrenia) Project's potential role in fostering this advancement is discussed in detail. This Project developed a set of 103 indicators that operationalised the NICE clinical guidelines for schizophrenia recommendations and tested them in 19 MHS in Italy. A multi-step design was used to assess recommendation and indicator acceptability in the Italian context; provide an assessment of any current discrepancies between routine practice and guideline recommendations in the treatment of schizophrenia; and understand the reasons for any discrepancies that might emerge. This process, moreover, was instrumental in keeping the debate arising during conduction of this Project far from the excesses of hostility - and excesses of “bright-eyed enthusiasm” - that frequently influence discussion on topic. This Project therefore showed potential to serve in the search for a happy medium, that can facilitate the pursuit of a fundamental advancement in guideline implementation in mental health services.Declaration of Interest: None.
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Deng, Qi, Shaobo Ji, and Yun Wang. "Green IT practice disclosure." Journal of Information, Communication and Ethics in Society 15, no. 2 (May 8, 2017): 145–64. http://dx.doi.org/10.1108/jices-12-2016-0046.
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Purpose As an enabler of environmental sustainability, Green information technology (IT) has become an emerging topic of interest in both academic and business communities. Despite its importance, confusions exist in the content and scope of Green IT practice. The purpose of this paper is to provide an overview of the current state of Green IT practice. Design/methodology/approach First 14 widely accepted Green IT practice topics were identified from prior research and a taxonomy was developed to categorize them. Using the content analysis method, these topics were examined in the sustainability reports of 30 IT companies in 2014 Fortune 500. A quantity–quality portfolio framework was developed and applied to measure and assess the Green IT practices of the selected samples. Findings Currently, the Green IT practice is still in its infancy. Both research and practice attention are now focusing on IT’s direct impacts and enabling impacts, while overlooking the systemic impacts, on natural environment. The possible reasons for the current state and the recommendations for future research and practice are provided. Originality/value Theoretically, this paper identified 14 widely accepted Green IT practice topics and developed a taxonomy for categorizing them. The taxonomy and topics provide a theoretical basis for future examination on Green IT practice-related issues. Practically, the findings of this paper provide guidelines for Green IT practice and directions for both Green IT developers and adopters in their decision-making.
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Selby, Peter, Katie Hunter, Jess Rogers, Kelly Lang-Robertson, Sophie Soklaridis, Virginia Chow, Michèle Tremblay, et al. "How to adapt existing evidence-based clinical practice guidelines: a case example with smoking cessation guidelines in Canada." BMJ Open 7, no. 11 (November 2017): e016124. http://dx.doi.org/10.1136/bmjopen-2017-016124.
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ObjectiveTo develop and encourage the adoption of clinical practice guidelines (CPGs) for smoking cessation in Canada by engaging stakeholders in the adaptation of existing high-quality CPGs using principles of the ADAPTE framework.MethodsAn independent expert body in guideline review conducted a review and identified six existing CPGs, which met a priori criteria for quality and potential applicability to the local context. Summary statements were extracted and assigned a grade of recommendation and level of evidence by a second expert panel. Regional knowledge exchange brokers recruited additional stakeholders to build a multidisciplinary network of over 800 clinicians, researchers and decision-makers from across Canada. This interprofessional network and other stakeholders were offered various opportunities to provide input on the guideline both online and in person. We actively encouraged end-user input into the development and adaptation of the guidelines to ensure applicability to various practice settings and to promote adoption.ResultsThe final guideline contained 24 summary statements along with supporting clinical considerations, across six topic area sections. The guideline was adopted by various provincial/territorial and national government and non-governmental organisations.ConclusionsThis method can be applied in other jurisdictions to adapt existing high-quality smoking cessation CPGs to the local context and to facilitate subsequent adoption by various stakeholders.
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Lohr, Kathleen N. "Guidelines for Clinical Practice: What They are and Why They Count." Journal of Law, Medicine & Ethics 23, no. 1 (1995): 49–56. http://dx.doi.org/10.1111/j.1748-720x.1995.tb01330.x.
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Are clinical practice guidelines a means for improving the quality of health care? For saving money in the health care system? For solving the malpractice problem? For making the health care system work better for all? Or, are they a recipe for disaster? This overview sets out conceptual, definitional, and practical aspects of clinical practice guidelines as a broad framework for reflecting on the issue of what guidelines are and why they count. It draws mainly on work done since 1990 at the Institute of Medicine (IOM) and focuses on five questions. First, what are guidelines, and who develops them? Second, what criteria or principles should be used to create good guidelines? Third, what problems or pitfalls exist in developing and disseminating guidelines? Fourth, in what ways can guidelines help improve medical care, and in what ways will they not be as practical or useful, particularly with respect to quality of care? Finally, what ethical context might guide deliberations on this topic?
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Somerfield, Mark R., Kaitlin Einhaus, Karen L. Hagerty, Melissa C. Brouwers, Jerome Seidenfeld, and Gary H. Lyman. "American Society of Clinical Oncology Clinical Practice Guidelines: Opportunities and Challenges." Journal of Clinical Oncology 26, no. 24 (August 20, 2008): 4022–26. http://dx.doi.org/10.1200/jco.2008.17.7139.
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The American Society of Clinical Oncology (ASCO) published its first clinical practice guideline, which focused on the use of hematopoietic colony-stimulating factors, in 1994. Since then, ASCO has published 24 additional guidelines or technology assessments on a range of topics and is developing 11 additional guidelines. Guidelines are among ASCO's most valued products, according to membership surveys and data from the JCO.org Web site. However, the same data from ASCO members have highlighted a number of limitations to the guideline program. These relate to the timelines of guideline updates, difficulties locating guidelines and related products, and challenges to implementing ASCO guidelines in everyday clinical practice. This article outlines the concrete steps that the ASCO Health Services Committee (HSC) is taking to address these limitations, including the institution of a more aggressive guideline updating schedule, a transition from narrative to systematic literature reviews to support the practice recommendations, a new Board of Directors–approved policy to permit endorsement of other groups’ guidelines, and a robust Clinical Tools and Resources program that offers a range of guideline dissemination and implementation aids. Additional work is underway to establish stronger and deeper collaborations with practicing oncologists to expand their role in the review, field testing, and implementation of guideline clinical tools and resources. Finally, the HSC is discussing evaluation of the guidelines program to maximize the impact of ASCO clinical practice guidelines on clinical decision making and, ultimately, the quality of cancer care.
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Tong, Allison, Pamela Lopez-Vargas, Martin Howell, Richard Phoon, David Johnson, Denise Campbell, Rowan G. Walker, and Jonathan C. Craig. "Consumer involvement in topic and outcome selection in the development of clinical practice guidelines." Health Expectations 15, no. 4 (March 29, 2011): 410–23. http://dx.doi.org/10.1111/j.1369-7625.2011.00676.x.
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Cook, David A., Kristi J. Sorensen, Jane A. Linderbaum, Laurie J. Pencille, and Deborah J. Rhodes. "Information needs of generalists and specialists using online best-practice algorithms to answer clinical questions." Journal of the American Medical Informatics Association 24, no. 4 (February 19, 2017): 754–61. http://dx.doi.org/10.1093/jamia/ocx002.
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Abstract Objective: To better understand clinician information needs and learning opportunities by exploring the use of best-practice algorithms across different training levels and specialties. Methods: We developed interactive online algorithms (care process models [CPMs]) that integrate current guidelines, recent evidence, and local expertise to represent cross-disciplinary best practices for managing clinical problems. We reviewed CPM usage logs from January 2014 to June 2015 and compared usage across specialty and provider type. Results: During the study period, 4009 clinicians (2014 physicians in practice, 1117 resident physicians, and 878 nurse practitioners/physician assistants [NP/PAs]) viewed 140 CPMs a total of 81 764 times. Usage varied from 1 to 809 views per person, and from 9 to 4615 views per CPM. Residents and NP/PAs viewed CPMs more often than practicing physicians. Among 2742 users with known specialties, generalists (N = 1397) used CPMs more often (mean 31.8, median 7 views) than specialists (N = 1345; mean 6.8, median 2; P < .0001). The topics used by specialists largely aligned with topics within their specialties. The top 20% of available CPMs (28/140) collectively accounted for 61% of uses. In all, 2106 clinicians (52%) returned to the same CPM more than once (average 7.8 views per topic; median 4, maximum 195). Generalists revisited topics more often than specialists (mean 8.8 vs 5.1 views per topic; P < .0001). Conclusions: CPM usage varied widely across topics, specialties, and individual clinicians. Frequently viewed and recurrently viewed topics might warrant special attention. Specialists usually view topics within their specialty and may have unique information needs.
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Gausepohl, H. J., M. Haak, S. Knaebel, O. Linderkamp, T. Wetter, and S. Skonetzki. "HELEN, a Modular Framework for Representing and Implementing Clinical Practice Guidelines." Methods of Information in Medicine 43, no. 04 (2004): 413–26. http://dx.doi.org/10.1055/s-0038-1633885.
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Summary Objectives: In order to implement clinical practice guidelines for the Department of Neonatology of the Heidelberg University Medical Center we developed a modular framework consisting of tools for authoring, browsing and executing encoded clinical practice guidelines (CPGs). Methods: Based upon a comprehensive analysis of literature, we set up requirements for guideline representation systems. Additionally, we analyzed further aspects such as the critical appraisal and known bridges and barriers for implementing CPGs. Thereafter we went through an evolutionary spiral model to develop a comprehensive ontology. Within this model each cycle focuses on a certain topic of management and implementation of CPGs. Results: In order to bring the resulting ontology into practice we developed a framework consisting of a tool for authoring, a server for web-based browsing, and an engine for the execution of certain elements of CPGs. Based upon this framework we encoded and implemented several CPGs in varying medical domains. Conclusions: This paper shall present a practical framework for both authors and implementers of CPGs. We have shown the fruitful combination of different knowledge representations such as narrative text and algorithm for implementing CPGs. Finally, we introduced a possible approach for the explicit adaptation of CPGs in order to provide institution-specific recommendations and to support sharing with other medical institutions.
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Wolter, Stefan, Giancarlo Caccia Dominioni, Sebastian Hergeth, Fabio Tango, Stuart Whitehouse, and Frederik Naujoks. "Human–Vehicle Integration in the Code of Practice for Automated Driving." Information 11, no. 6 (May 27, 2020): 284. http://dx.doi.org/10.3390/info11060284.
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The advancement of SAE Level 3 automated driving systems requires best practices to guide the development process. In the past, the Code of Practice for the Design and Evaluation of ADAS served this role for SAE Level 1 and 2 systems. The challenges of Level 3 automation make it necessary to create a new Code of Practice for automated driving (CoP-AD) as part of the public-funded European project L3Pilot. It provides the developer with a comprehensive guideline on how to design and test automated driving functions, with a focus on highway driving and parking. A variety of areas such as Functional Safety, Cybersecurity, Ethics, and finally the Human–Vehicle Integration are part of it. This paper focuses on the latter, the Human Factors aspects addressed in the CoP-AD. The process of gathering the topics for this category is outlined in the body of the paper. Thorough literature reviews and workshops were part of it. A summary is given on the draft content of the CoP-AD Human–Vehicle Integration topics. This includes general Human Factors related guidelines as well as Mode Awareness, Trust, and Misuse. Driver Monitoring is highlighted as well, together with the topic of Controllability and the execution of Customer Clinics. Furthermore, the Training and Variability of Users is included. Finally, the application of the CoP-AD in the development process for Human-Vehicle Integration is illustrated.
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Friend, Nadia, Jade Hughes, Steve Kisely, Ratika Kumar, and Dan Siskind. "Appraisal of physical health guidelines for severe mental illness." Australian Health Review 44, no. 6 (2020): 904. http://dx.doi.org/10.1071/ah20080.
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ObjectivesThe aim of this study was to identify current physical health guidelines for severe mental illness (SMI) and appraise them using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument. MethodsRelevant research databases and grey literature were systematically searched to identify physical health guidelines for people with SMI. The grey literature was explored by web searches and targeted searches of the English websites of relevant peak bodies and government health agencies from Organisation for Economic Co-operation and Development countries. Included guidelines were independently appraised by two authors (NF and JH) using the AGREE II Instrument. ResultsOf the 5352 records screened, 33 were assessed for eligibility. Fifteen practice guidelines met the inclusion criteria. The median domain scores as rated by the AGREE II Instrument ranged from 17% to 69%. The World Health Organization guideline, which demonstrated a broad range of clinical recommendations and sound methodological rigour, was rated the best. ConclusionsMost guidelines scored poorly when rated by the AGREE II Instrument. However, these guidelines may still be useful in assisting evidence-based clinical practice. The methodological rigour of future guidelines can be improved by ensuring the AGREE II domains are addressed during the development phase. What is known about the topic?Compared with the general population, people with SMI experience greater chronic disease morbidity and mortality. There is limited evidence from randomised controlled trials to guide physical health care monitoring for people with SMI. Current guidelines and practice are largely based on expert consensus, clinical experience and good intentions. What does this paper add?Using the AGREE II Instrument, this paper appraises the current physical health guidelines for people with SMI. The attributes of the guidelines examined included the evidence base, clarity of presentation, applicability in the real world, the involvement of stakeholders and conflicts of interest of various parties involved in guideline development. What are the implications for practitioners?This review highlights the scarcity of high-quality and evidence-based guidelines for clinicians and researchers to address the physical health of people with SMI.
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Nease, Donald E., Matthew J. Simpson, Linda Zittleman, Jodi Summers Holtrop, Tristen L. Hall, Mary Fisher, Maret Felzien, and John M. Westfall. "Making the Random the Usual: Appreciative Inquiry/Boot Camp Translation—Developing Community-Oriented Evidence That Matters." Journal of Primary Care & Community Health 11 (January 2020): 215013272090417. http://dx.doi.org/10.1177/2150132720904176.
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Background: The evidence underlying clinical guidelines arising from typical scientific inquiry may not always match the needs and concerns of local communities. Our High Plains Research Network Community Advisory Council (HPRN CAC) identified a need for evidence regarding how to assist members of their community suffering from mental health issues to recognize their need for help and then obtain access to mental health care. The lack of evidence led our academic team to pursue linking Appreciative Inquiry with Boot Camp Translation (AI/BCT). This article describes the development and testing of this linked method. Method: We worked with the HPRN CAC and other communities affiliated with the State Networks of Colorado Ambulatory Practices and Partners (SNOCAP) practice-based research networks to identify 5 topics for testing of AI/BCT. For each topic, we developed AI interview recruitment strategies and guides with our community partners, conducted interviews, and analyzed the interview data. Resulting themes for each topic were then utilized by 5 groups with the BCT method to develop community relevant messages and materials to communicate the evidence generated in each AI set of interviews. At each stage for each topic, notes on adaptations, barriers, and successes were recorded by the project team. Results: Each topic successfully led to generation of community specific evidence, messages, and materials for dissemination using the AI/BCT method. Beyond this, 5 important lessons emerged regarding the AI/BCT method: Researchers must (1) first ensure whether the topic is a good fit for AI, (2) maintain a focus on “what works” throughout all stages, (3) recruit one or more experienced qualitative analysts, (4) ensure adequate time and resources for the extensive AI/BCT process, and (5) present AI findings to BCT participants in the context of existing evidence and the local community and allow time for community partners to ask questions and request additional data analyses to be done. Conclusions: AI/BCT represents an effective way of responding to a community’s need for evidence around a specific topic where standard evidence and/or guidelines do not exist. AI/BCT is a method for turning the “random” successes of individuals into “usual” practice at a community level.
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TP, Rajeev, and Shalini Krishnan. "GUIDELINES IN CLINICAL PRACTICE: A DICTUM OR A DAMN..?!" Journal of Health and Allied Sciences NU 05, no. 02 (June 2015): 092–96. http://dx.doi.org/10.1055/s-0040-1703900.
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AbstractClinical practice guidelines are systematically developed statements that assist practitioners to provide appropriate evidence-based care. They are often created by statutory bodies, expert associational advisory committees, government and regional offices and even individual hospital policy groups. The objectives of clinical guidelines are to standardize medical care, to raise the quality of care and to reduce several kinds of risks to the patient and health care provider. Implementation of clinical practice guidelines is a complex process and protocols with good quality, with clinical importance and prioritization of topics, and a user-friendly format are usually successful. In day to day clinical practice guidelines are not strictly followed. The merits and demerits of guideline based practice patterns have been analyzed here. There could be many reasons for the non adherence to protocol based medical practice which has to be addressed. A historical perspective of guidelines and a breach in standardized practice is also mentioned. As there can be fallacies in protocols; a clinical practice that is not strictly adhering with guidelines, should not be considered as a wrongful treatment strategy.
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Hodge, David R., Robin P. Bonifas, and Rita Jing-Ann Chou. "Spirituality and Older Adults: Ethical Guidelines to Enhance Service Provision." Advances in Social Work 11, no. 1 (March 18, 2010): 1–16. http://dx.doi.org/10.18060/262.
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Spirituality plays an important role in the lives of many older adults. Consequently, it is not surprising that gerontological social workers frequently engage spirituality in practice settings. The paucity of training gerontological workers have received on this topic, however, is a cause for concern. To help equip workers, three ethical principles are proposed to guide interactions in the area of spirituality. These principles can be summarized as: 1) client autonomy, 2) spiritual competence, and 3) professional competence. The application of these principles in practice settings will enhance the ability of gerontological social workers to interact with older adults’ spirituality in a professional and ethical manner.
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Kutywayo, A., C. S. Yah, N. P. Naidoo, M. Malotana, S. Dyani, and S. Mullick. "Implementing the Good Participatory Practice Guidelines in the Girls Achieve Power Trial in South Africa." SAGE Open 8, no. 4 (October 2018): 215824401880914. http://dx.doi.org/10.1177/2158244018809149.
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The Good Participatory Practice (GPP) guidelines provide a framework for stakeholder engagement within clinical trials, to ensure a study’s acceptability, feasibility, and improving the overall research quality; however, they have rarely been applied beyond this setting, and no literature exists on its application in adolescent research. A review of the 2011 GPP guidelines was undertaken to identify which 16 GPP topic areas could be applied and adapted for implementing an ecological asset building intervention, that is, the Girls Achieve Power (GAP Year) cluster randomized controlled trial for reducing school dropout and increasing reporting of gender-based violence in Gauteng and Western Cape province in South Africa. The 16 GPP topic areas were adapted and implemented to guide stakeholder engagement for GAP Year. We show the usability and adaptability of the GPP framework for guiding stakeholder engagement in non-clinical trials like GAP Year; however it requires adapting to respond to the unique needs of the beneficiaries.
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Ehrlich, Carolyn, Steve Kisely, Elizabeth Kendall, David Crompton, Elizabeth Crowe, and Ann Maree Liddy. "Active steps towards a healthier life for people with severe mental illness: a qualitative approach to understanding the potential for implementing change." Australian Health Review 37, no. 4 (2013): 423. http://dx.doi.org/10.1071/ah13062.
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Objective. Our health systems are failing to provide optimal physical care for people with severe mental illness. To address this gap, Queensland Health and General Practice Queensland in partnership developed a comprehensive package of guidelines and health messages. However, guidelines alone are likely to be inadequate motivators of change. The objective of this research was to qualitatively explore key stakeholders’ expectations about the implementation of guidelines, with the purpose of identifying potential interventions to support practice change. Method. Participants were recruited from the partnership governance committee. A semistructured interview guide was used to gather data. Using grounded-theory techniques, the data were analysed to identify key themes. Results. All stakeholders agreed that the purpose of developing comprehensive guidelines and health messages was to achieve change through innovation and the promotion of early intervention, reduction of avoidable admissions and sectoral integration. However, existing structures within the system were considered to be insurmountable barriers. Conclusion. Key stakeholders sought broader change than just guidelines and health messages developed by the partnership focussed specifically on awareness-raising about the physical care of people with severe mental illness. However, there was no clear consensus as to what that change should be. This mismatch between the goals and actions of such a large-scale initiative is problematic. Suggestions are made about how to address change. What is known about the topic? The physical and oral health of people with severe mental illness is poor. One response that is frequently used to improve the health of this population is to develop and implement guidelines for practice. However, oral healthcare is frequently omitted from guidelines for care. Moreover, guidelines are not always adopted in everyday practice. What does this paper add? This paper outlines a process of guideline development and includes investigation of the short- and long-term goals that a governing committee held for the implementation of guidelines for both the physical and oral healthcare of people with severe mental illness. Additionally, we explore gaps between a short-term focus for guideline implementation and the longer-term goals of achieving improved healthcare. What are the implications for practitioners? Cultural change is required if the physical and oral health of people with severe mental illness is to be improved. However, a mismatch between the goals and actions of large-scale initiatives is problematic. Thus, clearly identified avenues for realising long-term culture change are required if new practices are to be embedded in everyday routines. -->
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Marriott, Sarah. "Clinical Practice Guidelines: who needs them?" Psychiatric Bulletin 19, no. 7 (July 1995): 403–6. http://dx.doi.org/10.1192/pb.19.7.403.
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Clinical Practice Guidelines (CPGs) are systematically developed statements to assist practitioner and patient in clinical decisions about appropriate health care for specific clinical circumstances. The Royal College of Psychiatrists CPG Programme aims to develop clinical guidelines which are scientifically valid and acceptable to those affected by them. At the same time, CPGs must be responsive to advances in knowledge, and versatile enough for the demands of routine practice. Their development involves a number of stages and a variety of methods, built into a cycle of evaluation and review. The Programme has established priorities for clinical topics for CPG development through consultation with the mental health community. Well-developed CPGs would benefit clinicians, patients and purchasers of care. It Is now important to appraise their ability to change clinical practice, the associated direct and indirect costs, and their value as a medical technology. The clinical professions are in the strongest position to co-ordinate their development, and guide their evaluation.
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Robb, Nigel. "Providing safe and effective sedation training for primary dental care." Faculty Dental Journal 3, no. 2 (April 2012): 92–96. http://dx.doi.org/10.1308/204268512x13312096186442.
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There has been more written in terms of guidance, guidelines, advice and general perceived wisdom on the use of sedation in dentistry than on any other individual topic within the scope of dental practice. Despite all the efforts, confusion still seems to reign regarding standards of good practice and the training required to deliver care under conscious sedation in dentistry.
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Tanaka, Shinji, Yusuke Saitoh, Takahisa Matsuda, Masahiro Igarashi, Takayuki Matsumoto, Yasushi Iwao, Yasumoto Suzuki, et al. "Evidence-based clinical practice guidelines for management of colorectal polyps." Journal of Gastroenterology 56, no. 4 (March 12, 2021): 323–35. http://dx.doi.org/10.1007/s00535-021-01776-1.
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Abstract Background The Japanese Society of Gastroenterology (JSGE) published ‘‘Daicho Polyp Shinryo Guideline 2014′’ in Japanese and a part of this guideline was published in English as “Evidence-based clinical practice guidelines for management of colorectal polyps” in the Journal of Gastroenterology in 2015. A revised version of the Japanese-language guideline was published in 2020, and here we introduce a part of the contents of revised version. Methods The guideline committee discussed and drew up a series of clinical questions (CQs). Recommendation statements for the CQs were limited to items with multiple therapeutic options. Items with established conclusions that had 100% agreement with previous guidelines (background questions) and items with no (or old) evidence that are topics for future research (future research questions: FRQs) were given descriptions only. To address the CQs and FRQs, PubMed, ICHUSHI, and other sources were searched for relevant articles published in English from 1983 to October 2018 and articles published in Japanese from 1983 to November 2018. The Japan Medical Library Association was also commissioned to search for relevant materials. Manual searches were performed for questions with insufficient online references. Results The professional committee created 18 CQs and statements concerning the current concept and diagnosis/treatment of various colorectal polyps, including their epidemiology, screening, pathophysiology, definition and classification, diagnosis, management, practical treatment, complications, and surveillance after treatment, and other colorectal lesions (submucosal tumors, nonneoplastic polyps, polyposis, hereditary tumors, ulcerative colitis-associated tumors/carcinomas). Conclusions After evaluation by the moderators, evidence-based clinical practice guidelines for management of colorectal polyps were proposed for 2020. This report addresses the therapeutic related CQs introduced when formulating these guidelines.
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Winstead, Yvette. "Evaluating and Managing Uncomplicated Skin and Soft Tissue Infections Associated With Community-Associated Methicillin-Resistant Staphylococcus aureus for Outpatients: A Review of the Literature." Clinical Scholars Review 5, no. 2 (January 1, 2012): 98–105. http://dx.doi.org/10.1891/1939-2095.5.2.98.
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Purpose: The purpose of this literature review is to determine how clinicians evaluate and manage uncomplicated skin and soft tissue infections caused by Staphylococcus aureus. Data Source: The research topic is explored based on an electronic search for literature published between 2003 and 2008 in MEDLINE and PubMed. The following search terms were used to secure noteworthy academic studies: skin abscess incision and drainage, incision and drainage, skin and soft tissue abscesses, uncomplicated skin and soft tissue abscesses, and antibiotics for soft tissue infections. Conclusions: A clinical practice guideline based on evidence-based practice will provide clinicians with an appropriate treatment protocol for uncomplicated skin and soft tissue abscesses. An evidence-based clinical practice guideline has the potential to positively influence patient outcomes and eliminate the unnecessary use of antibiotics. Implications for Practice: The Centers for Disease Control and Prevention (CDC) guidelines for the management of skin and soft tissue infections should be adopted by all clinicians in an effort to standardize treatment. Furthermore, clinicians must stay informed about the epidemiological and treatment of emerging organisms in their patient populations.
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Fuchs, Eunice M., and Kathryn Von Rueden. "Sedation Management in the Mechanically Ventilated Critically Ill Patient." AACN Advanced Critical Care 19, no. 4 (October 1, 2008): 421–32. http://dx.doi.org/10.4037/15597768-2008-4008.
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Sedation management in the mechanically ventilated critically ill patient is a topic of continuing interest in the critical care literature. The wide variety of clinical practices described in the literature with regard to sedation management has limited the implementation of evidence-based practice guidelines. Common themes for a coherent sedation management strategy include articulation of indications for sedation, initial and daily evaluation of sedation goals, sedation-level assessment, appropriate sedative selection, effective sedation management strategy, and efficient sedation weaning strategy. We provide a summary of the literature on key aspects of sedation in clinical practice. Evidence-based recommendations are provided for clinicians involved in the management of sedation in mechanically ventilated patients.
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Elsner, Susanne, Martina Juergensen, Elke Faust, Achim Niesel, Louise Schreiber Pedersen, Peter Martin Rudnicki, and Annika Waldmann. "Urinary incontinence in women: treatment barriers and significance for Danish and German GPs." Family Practice 37, no. 3 (November 23, 2019): 367–73. http://dx.doi.org/10.1093/fampra/cmz077.
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Abstract Background Female urinary incontinence (UI) is common. Only scant information exists on the significance of UI for GPs’ consultations. Objectives (i) To assess the significance of female UI for GPs and to look at barriers that could be detrimental to treatment by comparing GPs from Denmark and Germany, with different health systems and access to UI guidelines. (ii) To assess whether GPs’ gender and age were relevant to the discussion of UI. Methods We conducted a cross-sectional survey. In the Fehmarn belt-region, a Danish–German border region, a self-developed questionnaire was sent to all the GPs (n = 930). Results In total, 407 GPs returned the questionnaire (43%); 403 questionnaires were analysed. Using a scale from 0 (never) to 10 (always), addressing UI was reported with an average score of 3.8 (SD: 2.1) among Danish and 3.5 (SD: 2.1) among German GPs. The topic was discussed more frequently with female (4.2; SD 2.2) than with male GPs (3.2; SD 2.0). Danish GPs estimated the prevalence among their female patients at 10% (SD: 8.0) and German GPs at 14% (SD: 11.2). 61% of the Danish and 19% of the German GPs used UI guidelines. German GPs significantly more often reported the barrier ‘uncertainty of how to treat UI’ [OR = 5.39 (95% CI: 2.8; 10.4)]. Conclusions In consultations with female GPs, UI was discussed significantly more frequently than with male GPs. Compared with the Danish GPs, German GPs stated significantly more uncertainties regarding UI treatment measures, and tended not to use UI guidelines.
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Buitrago, Giancarlo, Ricardo Sanchez, Felipe Zamora Rangel, Licet Villamizar, Daniel Anzola, and Monica Patricia Ballesteros. "S35– Elaboration of a topic prioritization instrument for the development of Clinical Practice Guidelines (CPGs) in Colombia." Otolaryngology–Head and Neck Surgery 143, no. 1_suppl (July 2010): 28–29. http://dx.doi.org/10.1016/j.otohns.2010.04.157.
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McKim, Douglas A., Jeremy Road, Monica Avendano, Steve Abdool, Fabien Côté, Nigel Duguid, Janet Fraser, et al. "Home Mechanical Ventilation: A Canadian Thoracic Society Clinical Practice Guideline." Canadian Respiratory Journal 18, no. 4 (2011): 197–215. http://dx.doi.org/10.1155/2011/139769.
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Increasing numbers of patients are surviving episodes of prolonged mechanical ventilation or benefitting from the recent availability of user-friendly noninvasive ventilators. Although many publications pertaining to specific aspects of home mechanical ventilation (HMV) exist, very few comprehensive guidelines that bring together all of the current literature on patients at risk for or using mechanical ventilatory support are available. The Canadian Thoracic Society HMV Guideline Committee has reviewed the available English literature on topics related to HMV in adults, and completed a detailed guideline that will help standardize and improve the assessment and management of individuals requiring noninvasive or invasive HMV. The guideline provides a disease-specific review of illnesses including amyotrophic lateral sclerosis, spinal cord injury, muscular dystrophies, myotonic dystrophy, kyphoscoliosis, post-polio syndrome, central hypoventilation syndrome, obesity hypoventilation syndrome, and chronic obstructive pulmonary disease as well as important common themes such as airway clearance and the process of transition to home. The guidelines have been extensively reviewed by international experts, allied health professionals and target audiences. They will be updated on a regular basis to incorporate any new information.
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Dodd, Katherine Claire, Hedley C. A. Emsley, Michael J. R. Desborough, and Suresh K. Chhetri. "Periprocedural antithrombotic management for lumbar puncture: Association of British Neurologists clinical guideline." Practical Neurology 18, no. 6 (August 28, 2018): 436–46. http://dx.doi.org/10.1136/practneurol-2017-001820.
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Lumbar puncture (LP) is an important and frequently performed invasive procedure for the diagnosis and management of neurological conditions. There is little in the neurological literature on the topic of periprocedural management of antithrombotics in patients undergoing LP. Current practice is therefore largely extrapolated from guidelines produced by anaesthetic bodies on neuraxial anaesthesia, haematology groups advising on periprocedural management of antiplatelet agents and anticoagulants, and by neuroradiology on imaging-guided spinal procedures. This paper summarises the existing literature on the topic and offers recommendations to guide periprocedural antithrombotic management for LP, based on the consolidation of the best available evidence.
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Acquisto, Nicole M., Giles W. Slocum, Matthew H. Bilhimer, Nadia I. Awad, Stephanie Baker Justice, Gregory F. Kelly, Therese Makhoul, et al. "Key articles and guidelines for the emergency medicine clinical pharmacist: 2011-2018 update." American Journal of Health-System Pharmacy 77, no. 16 (August 7, 2020): 1284–335. http://dx.doi.org/10.1093/ajhp/zxaa178.
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Abstract Purpose To summarize recently published research reports and practice guidelines on emergency medicine (EM)–related pharmacotherapy. Summary Our author group was composed of 14 EM pharmacists, who used a systematic process to determine main sections and topics for the update as well as pertinent literature for inclusion. Main sections and topics were determined using a modified Delphi method, author and peer reviewer groups were formed, and articles were selected based on a comprehensive literature review and several criteria for each author-reviewer pair. These criteria included the document “Oxford Centre for Evidence-based Medicine – Levels of Evidence (March 2009)” but also clinical implications, interest to reader, and belief that a publication was a “key article” for the practicing EM pharmacist. A total of 105 articles published from January 2011 through July 2018 were objectively selected for inclusion in this review. This was not intended as a complete representation of all available pertinent literature. The reviewed publications address the management of a wide variety of disease states and topic areas that are commonly found in the emergency department: analgesia and sedation, anticoagulation, cardiovascular emergencies, emergency preparedness, endocrine emergencies, infectious diseases, neurology, pharmacy services and patient safety, respiratory care, shock, substance abuse, toxicology, and trauma. Conclusion There are many important recent additions to the EM-related pharmacotherapy literature. As is evident with the surge of new studies, guidelines, and reviews in recent years, it is vital for the EM pharmacist to continue to stay current with advancing practice changes.
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Lunny, Carole, Cynthia Ramasubbu, Lorri Puil, Tracy Liu, Savannah Gerrish, Douglas M. Salzwedel, Barbara Mintzes, and James M. Wright. "Over half of clinical practice guidelines use non-systematic methods to inform recommendations: A methods study." PLOS ONE 16, no. 4 (April 22, 2021): e0250356. http://dx.doi.org/10.1371/journal.pone.0250356.
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Introduction Assessing the process used to synthesize the evidence in clinical practice guidelines enables users to determine the trustworthiness of the recommendations. Clinicians are increasingly dependent on guidelines to keep up with vast quantities of medical literature, and guidelines are followed to avoid malpractice suits. We aimed to assess whether systematic methods were used when synthesizing the evidence for guidelines; and to determine the type of review cited in support of recommendations. Methods Guidelines published in 2017 and 2018 were retrieved from the TRIP and Epistemonikos databases. We randomly sorted and sequentially screened clinical guidelines on all topics to select the first 50 that met our inclusion criteria. Our primary outcomes were the number of guidelines using either a systematic or non-systematic process to gather, assess, and synthesise evidence; and the numbers of recommendations within guidelines based on different types of evidence synthesis (systematic or non-systematic reviews). If a review was cited, we looked for evidence that it was critically appraised, and recorded which quality assessment tool was used. Finally, we examined the relation between the use of the GRADE approach, systematic review process, and type of funder. Results Of the 50 guidelines, 17 (34%) systematically synthesised the evidence to inform recommendations. These 17 guidelines clearly reported their objectives and eligibility criteria, conducted comprehensive search strategies, and assessed the quality of the studies. Of the 29/50 guidelines that included reviews, 6 (21%) assessed the risk of bias of the review. The quality of primary studies was reported in 30/50 (60%) guidelines. Conclusions High quality, systematic review products provide the best available evidence to inform guideline recommendations. Using non-systematic methods compromises the validity and reliability of the evidence used to inform guideline recommendations, leading to potentially misleading and untrustworthy results.
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Politoski, Gigi, Margaret Coolican, and Kathleen Casey. "Perspectives on Communication Issues among Transplant and Procurement Professionals, Transplant Recipients, and Donor Families." Journal of Transplant Coordination 6, no. 2 (June 1996): 78–83. http://dx.doi.org/10.1177/090591999600600208.
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Communication among professionals, donor families, and transplant recipients is a controversial topic. Traditionally, transplant and procurement professionals have made the decision about the type and frequency of information that a donor family and transplant recipient receive regarding one another, and relationships that might develop as a result. Information obtained through questionnaires demonstrated inconsistency in addressing donor family and transplant recipient needs for initial and follow-up information and communication—not only between clinical transplant and procurement donation coordinators, but within organizations involved in the care and support of these people. This wide variance regarding communication among all disciplines demonstrated a need for standardization of practice guidelines. Guidelines are being developed through collaboration of the major organizations involved in the care of donor families and transplant recipients to standardize communication practices throughout the United States.
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McCullough, Ricky W. "Practice insights on patient care—management overview for chemoradiation toxic mucositis—guidelines, guideline-supported therapies and high potency polymerized cross-linked sucralfate (ProThelial)." Journal of Oncology Pharmacy Practice 25, no. 2 (February 20, 2018): 409–22. http://dx.doi.org/10.1177/1078155218758864.
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Aim To offer a practice insight for the management of chemoradiation toxic mucositis. Method Review chemoradiation toxic mucositis, its pathobiology and breadth of symptom presentation. Review mucositis guidelines and guideline-supported anti-mucositis therapies. Offer guidance on guidelines and an abbreviated review of high potency cross-linked sucralfate for management of chemoradiation toxic mucositis. Result There are six major mucositis guidelines but only one that is current and regularly updated. Guidelines from the Multinational Association Supportive Cancer Care suggest 14 interventions gleaned from controlled trials, 12 of which are off-label uses of therapies that offer statistically significant but incrementally beneficial outcomes. Several evidence-based limitations of guidelines are discussed. Data on high potency polymerized cross-linked sucralfate confirming complete prevention and rapid (2–3 days) elimination, sustained throughout cancer treatment is verified as high quality evidence in accordance to standards adopted by Agency for Healthcare Research and Quality. A 96–97% reduction in mucositis duration qualifies as a positive Glasziou treatment effect, which is discussed as an additional measure of evidence-based medicine. Conclusion Statistically significant but fractional treatment effects of guideline-supported interventions are not likely to substantially alter the course of mucositis when it occurs nor completely prevent its onset. Complete prevention and rapid sustained elimination should be the goal, therefore high potency polymerized cross-linked sucralfate may be useful. Where guidelines fail, institution-based protocols led by oncology pharmacists could succeed. In an effort to eliminate toxic mucositis, enhance compliance to chemoradiation regimens, and improve survival, such protocols for practice may verify pharmacoeconomic benefits, if any, in using high potency polymerized cross-linked sucralfate to manage toxic mucositis.
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Dave, Manas, Ian Corbett, Graham Walton, and Kathy Wilson. "A review of good record keeping for conscious sedation in dentistry." Faculty Dental Journal 11, no. 2 (April 2020): 78–83. http://dx.doi.org/10.1308/rcsfdj.2020.78.
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Contemporaneous and thorough record keeping for conscious sedation in dentistry is good clinical practice; it is necessary to ensure patient safety and helps protect patients and clinicians (medicolegally). Clinicians providing a sedation service should be familiar with guidelines and their implementation. Record keeping for conscious sedation in dentistry is a useful audit topic in both primary and secondary care.
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Silva, Luis Bastiao, Rafael C. Jiménez, Niklas Blomberg, and José Luis Oliveira. "General guidelines for biomedical software development." F1000Research 6 (March 15, 2017): 273. http://dx.doi.org/10.12688/f1000research.10750.1.
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Most bioinformatics tools available today were not written by professional software developers, but by people that wanted to solve their own problems, using computational solutions and spending the minimum time and effort possible, since these were just the means to an end. Consequently, a vast number of software applications are currently available, hindering the task of identifying the utility and quality of each. At the same time, this situation has hindered regular adoption of these tools in clinical practice. Typically, they are not sufficiently developed to be used by most clinical researchers and practitioners. To address these issues, it is necessary to re-think how biomedical applications are built and adopt new strategies that ensure quality, efficiency, robustness, correctness and reusability of software components. We also need to engage end-users during the development process to ensure that applications fit their needs. In this review, we present a set of guidelines to support biomedical software development, with an explanation of how they can be implemented and what kind of open-source tools can be used for each specific topic.
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Silva, Luis Bastiao, Rafael C. Jimenez, Niklas Blomberg, and José Luis Oliveira. "General guidelines for biomedical software development." F1000Research 6 (July 12, 2017): 273. http://dx.doi.org/10.12688/f1000research.10750.2.
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Most bioinformatics tools available today were not written by professional software developers, but by people that wanted to solve their own problems, using computational solutions and spending the minimum time and effort possible, since these were just the means to an end. Consequently, a vast number of software applications are currently available, hindering the task of identifying the utility and quality of each. At the same time, this situation has hindered regular adoption of these tools in clinical practice. Typically, they are not sufficiently developed to be used by most clinical researchers and practitioners. To address these issues, it is necessary to re-think how biomedical applications are built and adopt new strategies that ensure quality, efficiency, robustness, correctness and reusability of software components. We also need to engage end-users during the development process to ensure that applications fit their needs. In this review, we present a set of guidelines to support biomedical software development, with an explanation of how they can be implemented and what kind of open-source tools can be used for each specific topic.