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Sample records for implementing clinical guidelines

  1. Developing clinical practice guidelines: reviewing, reporting, and publishing guidelines; updating guidelines; and the emerging issues of enhancing guideline implementability and accounting for comorbid conditions in guideline development

    PubMed Central

    2012-01-01

    Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this third paper we discuss the issues of: reviewing, reporting, and publishing guidelines; updating guidelines; and the two emerging issues of enhancing guideline implementability and how guideline developers should approach dealing with the issue of patients who will be the subject of guidelines having co-morbid conditions. PMID:22762242

  2. [General Strategies for Implementation of Clinical Practice Guidelines].

    PubMed

    Valenzuela-Flores, Adriana Abigail; Viniegra-Osorio, Arturo; Torres-Arreola, Laura Laura

    2015-01-01

    The need to use clinical practice guidelines (CPG) arises from the health conditions and problems that public health institutions in the country face. CPG are informative documents that help improve the quality of care processes and patient safety; having among its objectives, to reduce the variability of medical practice. The Instituto Mexicano del Seguro Social designed a strategic plan for the dissemination, implementation, monitoring and control of CPG to establish an applicable model in the medical units in the three levels of care at the Instituto. This paper summarizes some of the strategies of the plan that were made with the knowledge and experience of clinicians and managers, with which they intend to promote the adoption of the key recommendations of the guidelines, to promote a sense of belonging for health personnel, and to encourage changes in organizational culture.

  3. Incorporation of Pharmacogenomics into Routine Clinical Practice: the Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline Development Process

    PubMed Central

    Caudle, Kelly E.; Klein, Teri E.; Hoffman, James M.; Müller, Daniel J.; Whirl-Carrillo, Michelle; Gong, Li; McDonagh, Ellen M.; Sangkuhl, Katrin; Thorn, Caroline F.; Schwab, Matthias; Agúndez, José A.G.; Freimuth, Robert R.; Huser, Vojtech; Lee, Ming Ta Michael; Iwuchukwu, Otito F.; Crews, Kristine R.; Scott, Stuart A.; Wadelius, Mia; Swen, Jesse J.; Tyndale, Rachel F.; Stein, C. Michael; Roden, Dan; Relling, Mary V.; Williams, Marc S.; Johnson, Samuel G.

    2014-01-01

    The Clinical Pharmacogenetics Implementation Consortium (CPIC) publishes genotype-based drug guidelines to help clinicians understand how available genetic test results could be used to optimize drug therapy. CPIC has focused initially on well-known examples of pharmacogenomic associations that have been implemented in selected clinical settings, publishing nine to date. Each CPIC guideline adheres to a standardized format and includes a standard system for grading levels of evidence linking genotypes to phenotypes and assigning a level of strength to each prescribing recommendation. CPIC guidelines contain the necessary information to help clinicians translate patient-specific diplotypes for each gene into clinical phenotypes or drug dosing groups. This paper reviews the development process of the CPIC guidelines and compares this process to the Institute of Medicine’s Standards for Developing Trustworthy Clinical Practice Guidelines. PMID:24479687

  4. Incorporation of pharmacogenomics into routine clinical practice: the Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline development process.

    PubMed

    Caudle, Kelly E; Klein, Teri E; Hoffman, James M; Muller, Daniel J; Whirl-Carrillo, Michelle; Gong, Li; McDonagh, Ellen M; Sangkuhl, Katrin; Thorn, Caroline F; Schwab, Matthias; Agundez, Jose A G; Freimuth, Robert R; Huser, Vojtech; Lee, Ming Ta Michael; Iwuchukwu, Otito F; Crews, Kristine R; Scott, Stuart A; Wadelius, Mia; Swen, Jesse J; Tyndale, Rachel F; Stein, C Michael; Roden, Dan; Relling, Mary V; Williams, Marc S; Johnson, Samuel G

    2014-02-01

    The Clinical Pharmacogenetics Implementation Consortium (CPIC) publishes genotype-based drug guidelines to help clinicians understand how available genetic test results could be used to optimize drug therapy. CPIC has focused initially on well-known examples of pharmacogenomic associations that have been implemented in selected clinical settings, publishing nine to date. Each CPIC guideline adheres to a standardized format and includes a standard system for grading levels of evidence linking genotypes to phenotypes and assigning a level of strength to each prescribing recommendation. CPIC guidelines contain the necessary information to help clinicians translate patient-specific diplotypes for each gene into clinical phenotypes or drug dosing groups. This paper reviews the development process of the CPIC guidelines and compares this process to the Institute of Medicine's Standards for Developing Trustworthy Clinical Practice Guidelines.

  5. [Implementation of Study Results in Guidelines and Adherence to Guidelines in Clinical Practice].

    PubMed

    Waldfahrer, F

    2016-04-01

    Guidelines were introduced in hospital and practice-based otorhinolaryngology in the 1990s, and have been undergoing further development ever since. There are currently 20 guidelines on file at the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. The Society has cooperated in a further 34 guidelines. The quality of the guidelines has been continually improved by concrete specifications put forward by the Association of the Scientific Medical Societies in Germany [Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.]. Since increasing digitalisation has made access to scientific publications quicker and more simple, relevant study results can be incorporated in guidelines more easily today than in the analogue world. S2e and S3 guidelines must be based on a formal literature search with subsequent evaluation of the evidence. The consensus procedure for S2k guidelines is also regulated. However, the implementation of guidelines in routine medical practice must still be considered inadequate, and there is still a considerable need for improvement in adherence to these guidelines. PMID:27128403

  6. [Implementation of clinical practice guidelines: how can we close the evidence-practice gap?].

    PubMed

    Muche-Borowski, Cathleen; Nothacker, M; Kopp, I

    2015-01-01

    Guidelines are intended as instruments of knowledge transfer to support decision-making by physicians, other health professionals and patients in clinical practice and thereby contribute to quality improvements in healthcare. To date they are an indispensable tool for healthcare. Their benefit for patients can only be seen in application, i.e. the implementation of guideline recommendations. For successful implementation, implementability and practicability play a crucial role and these characteristics can be influenced and should be promoted by the guideline development group. In addition, a force field analysis to identify barriers against and facilitators for the implementation of specific guideline recommendations from the perspective of physicians and patients is recommended to guide the development of an individual implementation strategy and the selection of appropriate interventions. However, implementation cannot be achieved by the guideline development group alone and a universal implementation strategy does not exist. Therefore, a process using theory, analysis, experience and shared responsibility of stakeholders in healthcare is recommended, with the aim to achieve sustainable behavioral change and improve the quality of care by guideline-oriented behavior.

  7. Policies and Procedures That Facilitate Implementation of Evidence-Based Clinical Guidelines in U.S. Dental Schools.

    PubMed

    Polk, Deborah E; Nolan, Beth A D; Shah, Nilesh H; Weyant, Robert J

    2016-01-01

    The aim of this study was to determine the degree to which dental schools in the United States have policies and procedures in place that facilitate the implementation of evidence-based clinical guidelines. The authors sent surveys to all 65 U.S. dental schools in 2014; responses were obtained from 38 (58%). The results showed that, of the nine policies and procedures examined, only two were fully implemented by 50% or more of the responding schools: guidelines supported through clinical faculty education or available chairside (50%), and students informed of guidelines in both the classroom and clinic (65.8%). Although 92% of the respondents reported having an electronic health record, 80% of those were not using it to track compliance with guidelines. Five schools reported implementing more policies than the rest of the schools. The study found that the approach to implementing guidelines at most of the responding schools did not follow best practices although five schools had an exemplary set of policies and procedures to support guideline implementation. These results suggest that most dental schools are currently not implementing guidelines effectively and efficiently, but that the goal of schools' having a comprehensive implementation program for clinical guidelines is achievable since some are doing so. Future studies should determine whether interventions to improve implementation in dental schools are needed. PMID:26729681

  8. Do knowledge brokers facilitate implementation of the stroke guideline in clinical practice?

    PubMed Central

    2013-01-01

    Background The implementation of clinical practice guidelines in rehabilitation practice is often troublesome and incomplete. An intervention to enhance the implementation of guidelines is the knowledge transfer program built around the activities of a knowledge broker (KB). This study investigates the use of KBs to implement guideline recommendations for intensive therapy and physical activity for patients post-stroke in 22 stroke units in hospitals and rehabilitation centers in The Netherlands. Methods/Design This study includes a quantitative evaluation with a non controlled pre-post intervention design and a mixed methods process evaluation. From each stroke unit, enterprising nurses and therapists will be recruited and trained as KB. The KB will work for one year on the implementation of the guideline recommendations in their team. To evaluate the effectiveness of the KB, a questionnaire will be administered to patients, health professionals and KBs at baseline (T0) and after one year (T1). Furthermore, semi structured interviews with 5 KBs will be performed at T1. The primary outcome of this implementation project will be the support health professionals give patients to exercise and be physically active, as reported by patients and health professionals themselves. The support immediately after the intervention is compared with the support at the start of the intervention. Additionally we will explore the influence of socio-demographic characteristics of health professionals and determinants identified in the Theory of Planned Behavior (intention, attitude, subjective norm and perceived behavioral control) on the change of supportive behavior of health professionals. Finally, KBs will complete a questionnaire on their own psychological and social demographic characteristics and on organizational conditions needed for health-care improvement such as time, workforce, sponsoring and support from management. Discussion With this study we will gain insight in when

  9. [Guidelines for clinical practice].

    PubMed

    Vleugels, A M

    1997-01-01

    Clinical practice guidelines are systematically developed statements that are intended to support medical decision making in well-defined clinical situations. Essentially, their object is to reduce the variability in medical practice, to improve quality, and to make appropriated control of the financial resources possible. Internationally, ever more organisations, associations, and institutions are concerned with the development of guidelines in many different areas of care. Making implicit knowledge explicit is one of the associated advantages of guidelines: they have a potential utility in training, in process evaluation, and in the reevaluation of outcome studies. In liability issues, their existence has a double effect: they can be used to justify medical behaviour, and they constitute a generally accepted reference point. A derivative problem is the legal liability of the compilers of the guidelines. The principle of the guideline approach can be challenged academically: science cannot give a definition of optimal care with absolute certainty. What is called objectivity often rests on methodologically disputable analyses; also the opinion of opinion leaders is not always a guarantee for scientific soundness. Moreover, patients are not all identical: biological variability, situational factors, patient expectations, and other elements play a role in this differentiation. Clinicians are often hesitant with respect to clinical guidelines: they are afraid of cookbook medicine and curtailment of their professional autonomy. Patients fear reduction of individualization of care and the use of guidelines as a rationing instrument. The effects of the introduction of clinical practice guidelines on medical practice, on the results and on the cost of care vary but are generally considered to be favourable. The choice of appropriate strategies in development, dissemination, and implementation turns out to be of critical importance. The article ends with concrete

  10. Critical appraisal of clinical guidelines.

    PubMed

    Netsch, Debra S; Kluesner, Jean A

    2010-01-01

    Utilization of clinical guidelines is gaining in popularity due to their significant impact on clinical practice. While a plethora of guidelines exist, many are lacking in quality, based on current critical appraisal standards. It then becomes necessary for the end users of the guidelines to adopt or develop those that are deemed adequate for implementation. This often requires that users possess critical appraisal skills as they become proficient in discerning between guidelines of varying quality. This article provides direction and tools to support the critical appraisal process in the adoption of clinical guidelines. PMID:20838314

  11. Case study of an inter-professional and inter-organisational programme to adapt, implement and evaluate clinical guidelines in secondary care.

    PubMed

    Hall, L; Eccles, M

    2000-01-01

    This paper describes the implementation of a clinical guideline across three acute Trusts. A Clinical Effectiveness Steering Group identified prevention of venous thromboembolism as a health priority. A local guideline development group adapted the recommendations of an existing review and produced a local guideline. Then, a multidisciplinary implementation group developed the practical aspects of implementing guidelines into routine daily practice. They identified appropriate staff to carry out risk assessment and to administer appropriate prophylaxis, as necessary. They also produced a "guideline pack" containing a training resource manual and implementation aids. Following this a multiple strategy implementation programme was used to introduce the guidelines, and an evaluation was carried out eight to ten months after the introduction of the guidelines. The evaluation identified a number of areas for improving current practice. Guideline implementation is a complex, time-consuming process.

  12. Barriers of Clinical Practice Guidelines Development and Implementation in Developing Countries: A Case Study in Iran

    PubMed Central

    Baradaran-Seyed, Zahra; Nedjat, Sima; Yazdizadeh, Bahareh; Nedjat, Saharnaz; Majdzadeh, Reza

    2013-01-01

    Background: Knowledge products such as clinical practice guidelines (CPG) are vitally required for evidence-based medicine (EBM). Although the EBM, to some extent, has been attended during recent years, no result has achieved thus far. The current qualitative study is to identify the barriers to establishing development system and implementation of CPGs in Iran. Methods: Twelve semi-structured, in-depth interviews were conducted with a purposive sample of health policy and decision makers, the experts of development and or adaptation of CPGs, and the experts of EBM education and development. In addition, 11 policy-makers, decision-makers, and managers of the health system participated in a focus group discussion. The analysis of the study data was undertaken by thematic framework approach. Result: Six themes emerged in order of their frequency include practice environment, evidence-based health care system, individual professional, politician and political context, innovation (CPG) and patients. Most of the indications in the treatment environment focused on such sub-themes as regulations and rules, economical factors, organizational context, and social context. While the barriers related to the conditions of treatment environment, service provider and the features of innovation and patients had been identified before in other studies, very little attention has been paid to the evidence-based health care system and politician and political context Conclusion: The lack of an evidence-based healthcare system and a political macro support are mentioned as the key barriers in Iran as a developing country. The establishment of a system of development and implementation of CPGs as the evidence-based practice tools will not be possible, unless the barriers are removed. PMID:23626892

  13. The impact of postpartum haemorrhage management guidelines implemented in clinical practice: a systematic review of the literature.

    PubMed

    Nadisauskiene, Ruta J; Kliucinskas, Mindaugas; Dobozinskas, Paulius; Kacerauskiene, Justina

    2014-07-01

    Postpartum haemorrhage (PPH) is an urgent obstetric condition requiring an immediate response and a multidisciplinary approach. The aim of this study was to review PPH management guidelines implemented in clinical practice, to evaluate their impact regarding prevention, diagnosis and treatment, and to analyze how the numbers of PPH cases changed in the post-intervention period. A systematic search in the PubMed database was performed. The references of all included articles were examined. Studies evaluating the management of PPH and the impact on the numbers of cases of this pathology after the implementation of new or updated guidelines were involved in the analysis. Two reviewers independently examined the titles and abstracts of all identified citations, selected potentially eligible studies, and evaluated their full-text versions. Methodological quality was assessed using a checklist based on the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. We analyzed seven articles that evaluated the impact of new or updated guidelines for PPH management implemented in clinical practice. In four trials, the numbers of PPH cases declined after the intervention. Guidelines for PPH management can have a positive impact on the reduction of the number of PPH cases.

  14. Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis-clinical implementation in the diagnostic process.

    PubMed

    Rovira, Àlex; Wattjes, Mike P; Tintoré, Mar; Tur, Carmen; Yousry, Tarek A; Sormani, Maria P; De Stefano, Nicola; Filippi, Massimo; Auger, Cristina; Rocca, Maria A; Barkhof, Frederik; Fazekas, Franz; Kappos, Ludwig; Polman, Chris; Miller, David; Montalban, Xavier

    2015-08-01

    The clinical use of MRI in patients with multiple sclerosis (MS) has advanced markedly over the past few years. Technical improvements and continuously emerging data from clinical trials and observational studies have contributed to the enhanced performance of this tool for achieving a prompt diagnosis in patients with MS. The aim of this article is to provide guidelines for the implementation of MRI of the brain and spinal cord in the diagnosis of patients who are suspected of having MS. These guidelines are based on an extensive review of the recent literature, as well as on the personal experience of the members of the MAGNIMS (Magnetic Resonance Imaging in MS) network. We address the indications, timing, coverage, reporting and interpretation of MRI studies in patients with suspected MS. Our recommendations are intended to help radiologists and neurologists standardize and optimize the use of MRI in clinical practice for the diagnosis of MS.

  15. Clinical practice guidelines at an HMO: development and implementation in a quality improvement model.

    PubMed

    Gottlieb, L K; Margolis, C Z; Schoenbaum, S C

    1990-02-01

    Harvard Community Health Plan (HCHP) is adapting to clinical medicine the managerial principles and methods of quality improvement theory that were originally developed and successfully applied in industrial settings. An essential step in applying the quality improvement cycle to clinical medicine is the setting of standards or specifications for clinical care. HCHP has chosen to focus its standard-setting efforts on the development of clinical algorithms, which provide an excellent basis for specifying and communicating optimal care processes and for evaluating actual clinical care. When implemented effectively, clinical algorithms may improve quality and decrease costs by guiding clinicians toward more standardized, high-quality, cost-effective clinical strategies and by facilitating more valid measurement of clinical process and outcomes. This article describes the evolution, structure, methods, and future agenda of the Algorithm Based Clinical Quality Improvement Process (ABCQIP) at HCHP.

  16. Clinical Development and Implementation of an Institutional Guideline for Prospective EEG Monitoring and Reporting of Delayed Cerebral Ischemia.

    PubMed

    Muniz, Carlos F; Shenoy, Apeksha V; OʼConnor, Kathryn L; Bechek, Sophia C; Boyle, Emily J; Guanci, Mary M; Tehan, Tara M; Zafar, Sahar F; Cole, Andrew J; Patel, Aman B; Westover, Michael B; Rosenthal, Eric S

    2016-06-01

    Delayed cerebral ischemia (DCI) is the most common and disabling complication among patients admitted to the hospital for subarachnoid hemorrhage (SAH). Clinical and radiographic methods often fail to detect DCI early enough to avert irreversible injury. We assessed the clinical feasibility of implementing a continuous EEG (cEEG) ischemia monitoring service for early DCI detection as part of an institutional guideline. An institutional neuromonitoring guideline was designed by an interdisciplinary team of neurocritical care, clinical neurophysiology, and neurosurgery physicians and nursing staff and cEEG technologists. The interdisciplinary team focused on (1) selection criteria of high-risk patients, (2) minimization of safety concerns related to prolonged monitoring, (3) technical selection of quantitative and qualitative neurophysiologic parameters based on expert consensus and review of the literature, (4) a structured interpretation and reporting methodology, prompting direct patient evaluation and iterative neurocritical care, and (5) a two-layered quality assurance process including structured clinician interviews assessing events of neurologic worsening and an adjudicated consensus review of neuroimaging and medical records. The resulting guideline's clinical feasibility was then prospectively evaluated. The institutional SAH monitoring guideline used transcranial Doppler ultrasound and cEEG monitoring for vasospasm and ischemia monitoring in patients with either Fisher group 3 or Hunt-Hess grade IV or V SAH. Safety criteria focused on prevention of skin breakdown and agitation. Technical components included monitoring of transcranial Doppler ultrasound velocities and cEEG features, including quantitative alpha:delta ratio and percent alpha variability, qualitative evidence of new focal slowing, late-onset epileptiform activity, or overall worsening of background. Structured cEEG reports were introduced including verbal communication for findings concerning

  17. Clinical Development and Implementation of an Institutional Guideline for Prospective EEG Monitoring and Reporting of Delayed Cerebral Ischemia.

    PubMed

    Muniz, Carlos F; Shenoy, Apeksha V; OʼConnor, Kathryn L; Bechek, Sophia C; Boyle, Emily J; Guanci, Mary M; Tehan, Tara M; Zafar, Sahar F; Cole, Andrew J; Patel, Aman B; Westover, Michael B; Rosenthal, Eric S

    2016-06-01

    Delayed cerebral ischemia (DCI) is the most common and disabling complication among patients admitted to the hospital for subarachnoid hemorrhage (SAH). Clinical and radiographic methods often fail to detect DCI early enough to avert irreversible injury. We assessed the clinical feasibility of implementing a continuous EEG (cEEG) ischemia monitoring service for early DCI detection as part of an institutional guideline. An institutional neuromonitoring guideline was designed by an interdisciplinary team of neurocritical care, clinical neurophysiology, and neurosurgery physicians and nursing staff and cEEG technologists. The interdisciplinary team focused on (1) selection criteria of high-risk patients, (2) minimization of safety concerns related to prolonged monitoring, (3) technical selection of quantitative and qualitative neurophysiologic parameters based on expert consensus and review of the literature, (4) a structured interpretation and reporting methodology, prompting direct patient evaluation and iterative neurocritical care, and (5) a two-layered quality assurance process including structured clinician interviews assessing events of neurologic worsening and an adjudicated consensus review of neuroimaging and medical records. The resulting guideline's clinical feasibility was then prospectively evaluated. The institutional SAH monitoring guideline used transcranial Doppler ultrasound and cEEG monitoring for vasospasm and ischemia monitoring in patients with either Fisher group 3 or Hunt-Hess grade IV or V SAH. Safety criteria focused on prevention of skin breakdown and agitation. Technical components included monitoring of transcranial Doppler ultrasound velocities and cEEG features, including quantitative alpha:delta ratio and percent alpha variability, qualitative evidence of new focal slowing, late-onset epileptiform activity, or overall worsening of background. Structured cEEG reports were introduced including verbal communication for findings concerning

  18. A systematic approach to implementing and evaluating clinical guidelines: The results of fifteen years of Preventive Child Health Care guidelines in the Netherlands.

    PubMed

    Fleuren, Margot A H; van Dommelen, Paula; Dunnink, Trudy

    2015-07-01

    Preventive Child Health Care (PCHC) services are delivered to all children in the Netherlands by approximately 5500 doctors, nurses and doctor's assistants. In 1996, The Dutch Ministry of Health, Welfare and Sports asked for the development of evidence-based PCHC guidelines. Since 1998, twenty-five guidelines have been published. Levels of implementation affect outcomes and so implementation and evaluation of the actual use of guidelines are essential. At the outset, there was a national implementation plan with six main activities: a) determinant analysis before the implementation of a guideline, b) innovation strategies tailored to the determinants, c) dissemination to all professionals, d) ongoing evaluation of the awareness and use of the guidelines, e) trained implementation coordinator(s) in each PCHC organization and f) a national help desk. The awareness and use of the guidelines in random samples of doctors, nurses and doctor's assistants were surveyed using questionnaires. The respondents stated (on a 7-point scale) the proportion of all children they had exposed to given core elements in a guideline. The aim is for at least 90% of the professionals to be aware of the guideline and for 80% to perform the core elements for all (or nearly all) children. The six main activities, with the exception of ongoing evaluation, were gradually put into place, albeit only gradually, between 1998 and 2015 for all guidelines. In 2012, the use of individual core elements in all guidelines, dating from before 2012, varied from 28% to 100%. One guideline met both criteria of 90% awareness and 80% use, and three guidelines nearly met these criteria. Looking back on fifteen years of PCHC guidelines, we may conclude that the guidelines produced recently are implemented in accordance with the national implementation plan. Unfortunately, the evaluation of guideline use continues to be a difficulty. PMID:25982867

  19. The challenges of implementing ADHD clinical guidelines and research best evidence in routine clinical care settings: Delphi survey and mixed-methods study

    PubMed Central

    Taylor, John A.; Newell, Karen; Baldwin, Laurence; Sayal, Kapil; Hollis, Chris

    2016-01-01

    Background The landmark US Multimodal Treatment of ADHD (MTA) study established the benefits of individualised medication titration and optimisation strategies to improve short- to medium-term outcomes in attention-deficit hyperactivity disorder (ADHD). This individualised medication management approach was subsequently incorporated into the National Institute for Health and Care Excellence (NICE) ADHD Clinical Guidelines (NICE CG78). However, little is known about clinicians’ attitudes towards implementing these medication management strategies for ADHD in routine care. Aims To examine National Health Service (NHS) healthcare professionals’ consensus on ADHD medication management strategies. Method Using the Delphi method, we examined perceptions on the importance and feasibility of implementing 103 ADHD treatment statements from sources including the UK NICE ADHD guidelines and US medication management algorithms. Results Certain recommendations for ADHD medication management were judged as important and feasible to implement, including a stepwise titration of stimulant medication. Other recommendations were perceived as important but not feasible to implement in routine practice, such as weekly clinic follow-up with the family during titration and collection of follow-up symptom questionnaires. Conclusions Many of the key guideline recommendations for ADHD medication management are viewed by clinicians as important and feasible to implement. However, some recommendations present significant implementation challenges within the context of routine NHS clinical care in England. Declaration of interest C.H. and K.S. were members of the Guideline Development Group for the NICE ADHD Clinical Guideline (NICE CG78). Copyright and usage © 2016 The Royal College of Psychiatrists. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence. PMID:27703750

  20. IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT): Cluster randomised controlled trial study protocol

    PubMed Central

    McKenzie, Joanne E; French, Simon D; O'Connor, Denise A; Grimshaw, Jeremy M; Mortimer, Duncan; Michie, Susan; Francis, Jill; Spike, Neil; Schattner, Peter; Kent, Peter M; Buchbinder, Rachelle; Green, Sally E

    2008-01-01

    Background Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidence-based clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the control arm will receive access

  1. The clinical pharmacogenetics implementation consortium guideline for SLCO1B1 and simvastatin-induced myopathy: 2014 update.

    PubMed

    Ramsey, L B; Johnson, S G; Caudle, K E; Haidar, C E; Voora, D; Wilke, R A; Maxwell, W D; McLeod, H L; Krauss, R M; Roden, D M; Feng, Q; Cooper-DeHoff, R M; Gong, L; Klein, T E; Wadelius, M; Niemi, M

    2014-10-01

    Simvastatin is among the most commonly used prescription medications for cholesterol reduction. A single coding single-nucleotide polymorphism, rs4149056T>C, in SLCO1B1 increases systemic exposure to simvastatin and the risk of muscle toxicity. We summarize evidence from the literature supporting this association and provide therapeutic recommendations for simvastatin based on SLCO1B1 genotype. This article is an update to the 2012 Clinical Pharmacogenetics Implementation Consortium guideline for SLCO1B1 and simvastatin-induced myopathy.

  2. Clinical Pharmacogenetics Implementation Consortium Guidelines for Cytochrome P450 2D6 Genotype and Codeine Therapy: 2014 Update

    PubMed Central

    Crews, K R; Gaedigk, A; Dunnenberger, H M; Leeder, J S; Klein, T E; Caudle, K E; Haidar, C E; Shen, D D; Callaghan, J T; Sadhasivam, S; Prows, C A; Kharasch, E D; Skaar, T C

    2014-01-01

    Codeine is bioactivated to morphine, a strong opioid agonist, by the hepatic cytochrome P450 2D6 (CYP2D6); hence, the efficacy and safety of codeine are governed by CYP2D6 activity. Polymorphisms are a major cause of CYP2D6 variability. We summarize evidence from the literature supporting this association and provide therapeutic recommendations for codeine based on CYP2D6 genotype. This document is an update to the 2012 Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for CYP2D6 genotype and codeine therapy. PMID:24458010

  3. Effectiveness of a clinical practice guideline implementation strategy for patients with anxiety disorders in primary care: cluster randomized trial

    PubMed Central

    2011-01-01

    Background Anxiety is a common mental health problem seen in primary care. However, its management in clinical practice varies greatly. Clinical practice guidelines (CPGs) have the potential to reduce variations and improve the care received by patients by promoting interventions of proven benefit. However, uptake and adherence to their recommendations can be low. Method/design This study involves a community based on cluster randomized trial in primary healthcare centres in the Madrid Region (Spain). The project aims to determine whether the use of implementation strategy (including training session, information, opinion leader, reminders, audit, and feed-back) of CPG for patients with anxiety disorders in primary care is more effective than usual diffusion. The number of patients required is 296 (148 in each arm), all older than 18 years and diagnosed with generalized anxiety disorder, panic disorder, and panic attacks by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). They are chosen by consecutive sampling. The main outcome variable is the change in two or more points into Goldberg anxiety scale at six and twelve months. Secondary outcome variables include quality of life (EuroQol 5D), and degree of compliance with the CPG recommendations on treatment, information, and referrals to mental health services. Main effectiveness will be analyzed by comparing the patients percentage improvement on the Goldberg scale between the intervention group and the control group. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. Discussion There is a need to identify effective implementation strategies for CPG for the management of anxiety disorders present in primary care. Ensuring the appropriate uptake of guideline recommendations can reduce clinical variation and improve the care patients receive. Trial

  4. Guideline implementation: Surgical attire.

    PubMed

    Cowperthwaite, Liz; Holm, Rebecca L

    2015-02-01

    Surgical attire helps protect patients from microorganisms that may be shed from the hair and skin of perioperative personnel. The updated AORN "Guideline for surgical attire" provides guidance on scrub attire, shoes, head coverings, and masks worn in the semirestricted and restricted areas of the perioperative setting, as well as how to handle personal items (eg, jewelry, backpacks, cell phones) that may be taken into the perioperative suite. This article focuses on key points of the guideline to help perioperative personnel adhere to facility policies and regulatory requirements for attire. The key points address the potential benefits of wearing scrub attire made of antimicrobial fabric, covering the arms when in the restricted area of the surgical suite, removing or confining jewelry when wearing scrub attire, disinfecting personal items that will be taken into the perioperative suite, and sending reusable attire to a health care-accredited laundry facility after use. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  5. Dissemination Strategies to Improve Implementation of the PHS Smoking Cessation Guideline in MCH Public Health Clinics: Experimental Evaluation Results and Contextual Factors

    ERIC Educational Resources Information Center

    Manfredi, Clara; Cho, Young Ik; Warnecke, Richard; Saunders, Stephen; Sullivan, Myrtis

    2011-01-01

    We report results from an experimental study that tested the effectiveness of dissemination interventions to improve implementation of smoking cessation guidelines in maternal and child public health clinics. We additionally examine individual clinic results for contextual explanations not apparent from the experimental findings alone. Twelve…

  6. The Impact of Social Media on Dissemination and Implementation of Clinical Practice Guidelines: A Longitudinal Observational Study

    PubMed Central

    Gronseth, Gary; Dubinsky, Richard; Penfold-Murray, Rebecca; Cox, Julie; Bever Jr, Christopher; Martins, Yolanda; Rheaume, Carol; Shouse, Denise; Getchius, Thomas SD

    2015-01-01

    Background Evidence-based clinical practice guidelines (CPGs) are statements that provide recommendations to optimize patient care for a specific clinical problem or question. Merely reading a guideline rarely leads to implementation of recommendations. The American Academy of Neurology (AAN) has a formal process of guideline development and dissemination. The last few years have seen a burgeoning of social media such as Facebook, Twitter, and LinkedIn, and newer methods of dissemination such as podcasts and webinars. The role of these media in guideline dissemination has not been studied. Systematic evaluation of dissemination methods and comparison of the effectiveness of newer methods with traditional methods is not available. It is also not known whether specific dissemination methods may be more effectively targeted to specific audiences. Objective Our aim was to (1) develop an innovative dissemination strategy by adding social media-based dissemination methods to traditional methods for the AAN clinical practice guidelines “Complementary and alternative medicine in multiple sclerosis” (“CAM in MS”) and (2) evaluate whether the addition of social media outreach improves awareness of the CPG and knowledge of CPG recommendations, and affects implementation of those recommendations. Methods Outcomes were measured by four surveys in each of the two target populations: patients and physicians/clinicians (“physicians”). The primary outcome was the difference in participants’ intent to discuss use of complementary and alternative medicine (CAM) with their physicians or patients, respectively, after novel dissemination, as compared with that after traditional dissemination. Secondary outcomes were changes in awareness of the CPG, knowledge of CPG content, and behavior regarding CAM use in multiple sclerosis (MS). Results Response rates were 25.08% (622/2480) for physicians and 43.5% (348/800) for patients. Awareness of the CPG increased after traditional

  7. 10 CFR 960.3 - Implementation guidelines.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Implementation guidelines. 960.3 Section 960.3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3 Implementation guidelines. The guidelines of this...

  8. 10 CFR 960.3 - Implementation guidelines.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Implementation guidelines. 960.3 Section 960.3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3 Implementation guidelines. The guidelines of this...

  9. 10 CFR 960.3 - Implementation guidelines.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false Implementation guidelines. 960.3 Section 960.3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3 Implementation guidelines. The guidelines of this...

  10. 10 CFR 960.3 - Implementation guidelines.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false Implementation guidelines. 960.3 Section 960.3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3 Implementation guidelines. The guidelines of this...

  11. 10 CFR 960.3 - Implementation guidelines.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false Implementation guidelines. 960.3 Section 960.3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3 Implementation guidelines. The guidelines of this...

  12. Guideline Implementation: Processing Flexible Endoscopes.

    PubMed

    Bashaw, Marie A

    2016-09-01

    The updated AORN "Guideline for processing flexible endoscopes" provides guidance to perioperative, endoscopy, and sterile processing personnel for processing all types of reusable flexible endoscopes and accessories in all procedural settings. This article focuses on key points of the guideline to help perioperative personnel safely and effectively process flexible endoscopes to prevent infection transmission. The key points address verification of manual cleaning, mechanical cleaning and processing, storage in a drying cabinet, determination of maximum storage time before reprocessing is needed, and considerations for implementing a microbiologic surveillance program. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  13. Guideline Implementation: Processing Flexible Endoscopes.

    PubMed

    Bashaw, Marie A

    2016-09-01

    The updated AORN "Guideline for processing flexible endoscopes" provides guidance to perioperative, endoscopy, and sterile processing personnel for processing all types of reusable flexible endoscopes and accessories in all procedural settings. This article focuses on key points of the guideline to help perioperative personnel safely and effectively process flexible endoscopes to prevent infection transmission. The key points address verification of manual cleaning, mechanical cleaning and processing, storage in a drying cabinet, determination of maximum storage time before reprocessing is needed, and considerations for implementing a microbiologic surveillance program. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. PMID:27568535

  14. Clinical practice guideline dissemination and a new approach using Haddon matrix as a conceptual framework of evidence-based implementation strategies.

    PubMed

    Pang, Peter

    2010-01-01

    To err is human. Clinical practice guidelines (CPGs) are often not followed and lead to adverse outcomes. The issue on implementation of CPG is complex. A review of CPG implementation is done to identify the barriers and enablers. For the first time, a fishbone diagram is used to delineate the root-causes. And Haddon matrix is applied to help understand the complexity of evidence-based implementation (EBI) strategies. PMID:25214934

  15. Clinical practice guideline dissemination and a new approach using Haddon matrix as a conceptual framework of evidence-based implementation strategies.

    PubMed

    Pang, Peter

    2010-01-01

    To err is human. Clinical practice guidelines (CPGs) are often not followed and lead to adverse outcomes. The issue on implementation of CPG is complex. A review of CPG implementation is done to identify the barriers and enablers. For the first time, a fishbone diagram is used to delineate the root-causes. And Haddon matrix is applied to help understand the complexity of evidence-based implementation (EBI) strategies.

  16. GOSIP implementation guidelines

    SciTech Connect

    Van Norman, H.J.

    1996-07-01

    GOSIP (Government Open Systems Interconnection Profile) is a subset of ISO`s OSI protocol standards relevant to US Government operations. As a Federal Information Processing Standard (FIPS), GOSIP is required by law for all Federal agencies. Mandatory standards-based communications products are required when purchasing functionality equivalent to what is specified in GOSIP. This unprecedented requirement by the Federal government has caused considerable confusion concerning practical implementation of relatively immature and untested technologies. Many organizations already have substantial investment in one or more proprietary network architectures. This paper examines issues associated with conversion to the GOSIP system.

  17. Implementation of Out-of-Office Blood Pressure Monitoring in the Netherlands: From Clinical Guidelines to Patients' Adoption of Innovation.

    PubMed

    Carrera, Pricivel M; Lambooij, Mattijs S

    2015-10-01

    Out-of-office blood pressure monitoring is promoted by various clinical guidelines toward properly diagnosing and effectively managing hypertension and engaging the patient in their care process. In the Netherlands, however, the Dutch cardiovascular risk management (CVRM) guidelines do not explicitly prescribe 24-hour ambulatory blood pressure measurement (ABPM) and home BP measurement (HBPM). The aim of this descriptive study was to develop an understanding of patients' and physicians' acceptance and use of out-of-office BP monitoring in the Netherlands given the CVRM recommendations.Three small focus group discussions (FGDs) with patients and 1 FGD with physicians were conducted to explore the mechanisms behind the acceptance and use of out-of-office BP monitoring and reveal real-world challenges that limit the implementation of out-of-office BP monitoring methods. To facilitate the FGDs, an analytical framework based on the technology acceptance model (TAM), the theory of planned behavior and the model of personal computing utilization was developed to guide the FGDs and analysis of the transcriptions of each FGD.ABPM was the out-of-office BP monitoring method prescribed by physicians and used by patients. HBPM was not offered to patients even with patients' feedback of poor tolerance of ABPM. Even as there was little awareness about HBPM among patients, there were a few patients who owned and used sphygmomanometers. Patients professed and seemed to exhibit self-efficacy, whereas physicians had reservations about (all of their) patients' self-efficacy in properly using ABPM. Since negative experience with ABPM impacted patients' acceptance of ABPM, the interaction of factors that determined acceptance and use was found to be dynamic among patients but not for physicians.In reference to the CVRM guidelines, physicians implemented out-of-office BP monitoring but showed a strong preference for ABPM even where there is poor tolerance of the method. We found that

  18. [Evaluating the total incapacity to work: implementing French National Authority for Health guidelines in clinical practice].

    PubMed

    Chariot, Patrick; Bécache, Nathalie; François-Purssell, Irène; Dantchev, Nicolas; Delpla, Pierre-André; Fournier, Lionel; Proust, Bernard

    2013-10-01

    Total incapacity to work (TIW) is a legal concept that allows magistrates to assess the severity of violence against persons. The TIW is the duration of the victims' inability to fulfil their usual activities and is determined by physicians. Professional guidelines from the French National Authority for Health indicate that TIW applies both to physical and psychological problems. The law of 9 July 2010 makes explicit reference to TIW in cases of psychological violence and intimate partner harassment. Prosecutors base criminal penalties on the duration of TIW in cases of assault and battery. Whatever the physician, they should describe the mental state of the victim and identify the signs that may indicate the mental impact of reported assaults. Identifying combinations of symptoms can be useful in deciding whether the duration of TIW should be increased because of the psychic state. In case of stalking, assessment of TIW can allow prosecutors to link the reported facts to a criminal offence. In complex situations, the physician may be unable to assess a duration of TIW and can suggest expert assessment. In all cases, the duration of TIW needs to be based on functional criteria. The extent of harm to the life of relationships results from suffered violence, from the victim's reaction, and from the perception of their family and friends. In this area, we suggest to limit the first assessment of TIW to a few days and to reassess it later, according to real information reported by the victims, to careful observation of their behaviour, and to results of a questioning that should be as little suggestive as possible. At either end of the age scale and in case of preexisting functional impairment, assessment of TIW should take into account the actual and global capacity of the person before the assault.

  19. Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial

    PubMed Central

    2014-01-01

    Background Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence-based practice (EBP). There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy. The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden. Methods An implementation strategy based on theory and current evidence was developed. A tailored, multi-component implementation intervention, addressing earlier identified determinants, was carried out in three areas comprising 28 physical therapy practices including 277 physical therapists (PTs) (intervention group). In two adjacent areas, 171 PTs at 32 practices received no intervention (control group). The core component of the intervention was an implementation seminar with group discussions. Among other components were a website and email reminders. Data were collected at baseline and follow-up with a web-based questionnaire. Primary outcomes were the self-reported awareness of, knowledge of, access to, and use of guidelines. Secondary outcomes were self-reported attitudes toward EBP and guidelines. Analyses were performed using Pearson’s χ2 test and approximative z-test. Results 168 PTs (60.6%) in the intervention group and 88 PTs (51.5%) in the control group responded to the follow-up questionnaire. 186/277 PTs (67.1%) participated in the implementation seminars, of which 97 (52.2%) responded. The proportions of PTs reporting awareness of (absolute difference in change 20.6%, p = 0.023), knowledge where to find (20.4%, p = 0.007), access to (21.7%, p < 0.001), and frequent use of (9.5%, NS) guidelines increased more in the intervention group than in the control group. The proportion of PTs reporting frequent guideline use after participation in the implementation seminar was 15.2% (p = 0.043) higher than the

  20. Outcomes of Implementing an Evidence-Based Hypertension Clinical Guideline in an Academic Nurse Managed Health Center.

    PubMed

    Dyal, Brenda; Whyte, Maria; Blankenship, S Michele; Ford, Lynn Gallagher

    2016-02-01

    This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787. PMID:26765990

  1. When rheumatologists report that they agree with a guideline, does this mean that they practise the guideline in clinical practice? Results of the International Recommendation Implementation Study (IRIS)

    PubMed Central

    Gvozdenović, Emilia; Allaart, Cornelia F; van der Heijde, Désirée; Ferraccioli, Gianfranco; Smolen, Josef S; Huizinga, Tom W J; Landewé, Robert

    2016-01-01

    Introduction The European League Against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA) and the treat-to-target (T2T) principles have been developed in order to improve the treatment outcome of patients with RA, and have received broad attention. It is not clear, though, whether these recommendations are indeed followed up in clinical practice. Objective To investigate if rheumatologists that report to agree with existing guidelines indeed follow them up in clinical practice. Methods The International Recommendation Implementation Study (IRIS) included 132 participating rheumatologists from 14 countries. Participating rheumatologists received a questionnaire measuring their awareness/commitment with the EULAR/T2T recommendations and followed a dedicated educational programme. Subsequently, they were asked to enrol 5–10 patients with new-onset RA in the online IRIS database and monitor disease activity and treatment for a period of 1–2 years. Four recommendations (3 from the EULAR recommendations and one from the T2T recommendations) were selected on the basis of testability, and analysed with regard to compliance by participating rheumatologists. Results In total, 72 of the 132 participating rheumatologists contributed 378 patients to the database. Of these participants, 70 (98%) agreed upfront with the recommendation that disease-modifying antirheumatic drug (DMARD) therapy should be started as soon as possible after diagnosis in every patient; 69 (96%) of the rheumatologists agreed with the recommendation that methotrexate (MTX) should be part of the first treatment strategy. When measuring the actual performance, it was found that the recommendation on early DMARD start was met in 253 (67%) of the recorded patients, and the recommendation on MTX in 225 (60%) of the recorded patients. Of the participants, 60 (83%) agreed that composite measures should be recorded regularly, but only in 134(54%) of the patients were

  2. Guidelines International Network: toward international standards for clinical practice guidelines.

    PubMed

    Qaseem, Amir; Forland, Frode; Macbeth, Fergus; Ollenschläger, Günter; Phillips, Sue; van der Wees, Philip

    2012-04-01

    Guideline development processes vary substantially, and many guidelines do not meet basic quality criteria. Standards for guideline development can help organizations ensure that recommendations are evidence-based and can help users identify high-quality guidelines. Such organizations as the U.S. Institute of Medicine and the United Kingdom's National Institute for Health and Clinical Excellence have developed recommendations to define trustworthy guidelines within their locales. Many groups charged with guideline development find the lengthy list of standards developed by such organizations to be aspirational but infeasible to follow in entirety. Founded in 2002, the Guidelines International Network (G-I-N) is a network of guideline developers that includes 93 organizations and 89 individual members representing 46 countries. The G-I-N board of trustees recognized the importance of guideline development processes that are both rigorous and feasible even for modestly funded groups to implement and initiated an effort toward consensus about minimum standards for high-quality guidelines. In contrast to other existing standards for guideline development at national or local levels, the key components proposed by G-I-N will represent the consensus of an international, multidisciplinary group of active guideline developers. This article presents G-I-N's proposed set of key components for guideline development. These key components address panel composition, decision-making process, conflicts of interest, guideline objective, development methods, evidence review, basis of recommendations, ratings of evidence and recommendations, guideline review, updating processes, and funding. It is hoped that this article promotes discussion and eventual agreement on a set of international standards for guideline development.

  3. Impact of the Creation and Implementation of a Clinical Management Guideline for Personality Disorders in Reducing Use of Mechanical Restraints in a Psychiatric Inpatient Unit

    PubMed Central

    Fernandez-Rivas, Aranzazu; Bustamante, Sonia; Rico-Vilademoros, Fernando; Vivanco, Esther; Martinez, Karmele; Angel Vecino, Miguel; Martín, Melba; Herrera, Sonia; Rodriguez, Jorge; Saenz, Carlos

    2014-01-01

    Objective: To evaluate the impact of the implementation of a guideline for the management of personality disorders on reducing the frequency of use of mechanical restraints in a psychiatric inpatient unit. Method: This retrospective study was conducted in a psychiatric inpatient unit with 42 beds, which serves an urban area of 330,000 inhabitants. The sample consisted of all patients with a clinical diagnosis of personality disorder (DSM-IV-TR criteria) who were admitted to the unit from January 2010 to December 2010 and from January 2011 to December 2011 (ie, before and after, respectively, the implementation of the guideline). The guideline focused on cluster B disorders and follows a psychodynamic perspective. Results: Restraint use was reduced from 38 of 87 patients with personality disorders (43.7%) to 3 of 112 (2.7%), for a relative risk of 0.06 (95% CI, 0.02–0.19) and an absolute risk reduction of 41% (95% CI, 29.9%–51.6%). The risk of being discharged against medical advice increased after the intervention, with a relative risk of 1.84 (95% CI, 0.96–3.51). Restraint use in patients with other diagnoses was also reduced to a similar extent. Conclusions: The use of mechanical restraints was dramatically reduced after the implementation of a clinical practice guideline on personality disorders, suggesting that these coercive measures might be decreased in psychiatric inpatient units. PMID:25834763

  4. Guideline implementation: surgical instrument cleaning.

    PubMed

    Cowperthwaite, Liz; Holm, Rebecca L

    2015-05-01

    Cleaning, decontaminating, and handling instructions for instruments vary widely based on the type of instrument and the manufacturer. Processing instruments in accordance with the manufacturer's instructions can help prevent damage and keep devices in good working order. Most importantly, proper cleaning and disinfection may prevent transmission of pathogenic organisms from a contaminated device to a patient or health care worker. The updated AORN "Guideline for cleaning and care of surgical instruments" provides guidance on cleaning, decontaminating, transporting, inspecting, and storing instruments. This article focuses on key points of the guideline to help perioperative personnel implement appropriate instrument care protocols in their practice settings. The key points address timely cleaning and decontamination of instruments after use; appropriate heating, ventilation, and air conditioning parameters for the decontamination area; processing of ophthalmic instruments and laryngoscopes; and precautions to take with instruments used in cases of suspected prion disease. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. PMID:25946180

  5. Guideline implementation: surgical instrument cleaning.

    PubMed

    Cowperthwaite, Liz; Holm, Rebecca L

    2015-05-01

    Cleaning, decontaminating, and handling instructions for instruments vary widely based on the type of instrument and the manufacturer. Processing instruments in accordance with the manufacturer's instructions can help prevent damage and keep devices in good working order. Most importantly, proper cleaning and disinfection may prevent transmission of pathogenic organisms from a contaminated device to a patient or health care worker. The updated AORN "Guideline for cleaning and care of surgical instruments" provides guidance on cleaning, decontaminating, transporting, inspecting, and storing instruments. This article focuses on key points of the guideline to help perioperative personnel implement appropriate instrument care protocols in their practice settings. The key points address timely cleaning and decontamination of instruments after use; appropriate heating, ventilation, and air conditioning parameters for the decontamination area; processing of ophthalmic instruments and laryngoscopes; and precautions to take with instruments used in cases of suspected prion disease. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  6. A model for practice guideline adaptation and implementation: empowerment of the physician.

    PubMed

    Wise, C G; Billi, J E

    1995-09-01

    The Medical Center model of practice guideline adaptation and implementation uses local clinical leaders to evaluate nationally endorsed guidelines, adapt those guidelines for use in the local setting, work with support staff to develop and apply methods for guideline implementation, and assist the evaluation of clinical practice and outcomes data. The model described here combines the guideline dissemination techniques of clinical leadership, implementation, and data support and feedback. This model overcomes the failures of previous models by incorporating local physician involvement during every step of practice guideline selection, adaptation, implementation, and evaluation, and by supporting the physician leaders with quality data, resources to support guideline implementation, and outcomes assessment and feedback.

  7. A review of clinical practice guidelines for lung cancer

    PubMed Central

    Ball, David; Silvestri, Gerard A.

    2013-01-01

    Clinical practice guidelines are important evidence-based resources to guide complex clinical decision making. However, it is challenging for health professionals to keep abreast available guidelines and to know how and where to access relevant guidelines. This review examines currently available guidelines for lung cancer published in the English language. Important key features are listed for each identified guideline. The methodology, approaches to dissemination and implementation, and associated resources are summarised. General challenges in the area of guideline development are highlighted. The potential to collaborate more widely across lung cancer guideline developers by sharing literature searches and assessments is discussed. PMID:24163752

  8. Mapping ASTI patient's therapeutic-data model to virtual Medical Record: can VMR represent therapeutic data elements used by ASTI in clinical guideline implementations?

    PubMed

    Ebrahiminia, Vahid; Yasini, Mobin; Lamy, Jean Baptiste

    2013-01-01

    Lack of interoperability between health information systems is a major obstacle in implementing Clinical decision supports systems (CDSS) and their widespread disseminations. Virtual Medical Record (vMR) proposed by HL7 is a common data model for representing clinical information Inputs and outputs that can be used by CDSS and local clinical systems. A CDSS called ASTI used a similar model to represent clinical data and therapeutic history of patient. In order to evaluate the compatibility of ASTI with vMR, we started to map the ASTI model of representing patient's therapeutic data to vMR. We compared the data elements and associated terminologies used in ASTI and vMR and we evaluated the semantic fidelity between the models. Only one data element the qualitative description of drug dosage, did not match the vMR model. However, it can be calculated in the execution engine. The semantic fidelity was satisfactorily preserved in 12 of 17 elements mapped between the models. This model of ASTI seems compatible to vMR. Further work is necessary to evaluate the compatibility of clinical data model of ASTI to vMR and the use of vMR in implementing practice guidelines.

  9. [Clinical guideline 'Turner syndrome'].

    PubMed

    van den Akker, Erica L T; van Alfen, A A E M Janiëlle; Sas, Theo C J; Kerstens, Michiel N; Cools, Martine; Lambalk, Cornelis B

    2014-01-01

    Turner syndrome occurs in women who are missing one X chromosome. The most obvious symptoms are small stature and ovarian failure. Turner patients have an increased risk of a large number of disorders, and should therefore have lifelong medical supervision. Recent insights into patient management have been incorporated into the guidelines. Patients are increasingly involved in their own treatment. In patients with 45,X karyotype, Y-chromosomal material is actively sought in a larger number of cells and/or other tissues, using FISH. Pubertal induction therapy, if required, is initiated at an appropriate age. Egg donation or vitrification are new therapeutic options for fertility treatment. Monitoring for cardiac and vascular disease using cardiac ultrasound and MRI is performed more often, partly in connection with the risk of aortal dissection. The coordination of care of patients with Turner syndrome is concentrated in specialized centres in the Netherlands and Belgium.

  10. Total quality management implementation guidelines

    SciTech Connect

    Not Available

    1993-12-01

    These Guidelines were designed by the Energy Quality Council to help managers and supervisors in the Department of Energy Complex bring Total Quality Management to their organizations. Because the Department is composed of a rich mixture of diverse organizations, each with its own distinctive culture and quality history, these Guidelines are intended to be adapted by users to meet the particular needs of their organizations. For example, for organizations that are well along on their quality journeys and may already have achieved quality results, these Guidelines will provide a consistent methodology and terminology reference to foster their alignment with the overall Energy quality initiative. For organizations that are just beginning their quality journeys, these Guidelines will serve as a startup manual on quality principles applied in the Energy context.

  11. Development of clinical practice guidelines.

    PubMed

    Hollon, Steven D; Areán, Patricia A; Craske, Michelle G; Crawford, Kermit A; Kivlahan, Daniel R; Magnavita, Jeffrey J; Ollendick, Thomas H; Sexton, Thomas L; Spring, Bonnie; Bufka, Lynn F; Galper, Daniel I; Kurtzman, Howard

    2014-01-01

    Clinical practice guidelines (CPGs) are intended to improve mental, behavioral, and physical health by promoting clinical practices that are based on the best available evidence. The American Psychological Association (APA) is committed to generating patient-focused CPGs that are scientifically sound, clinically useful, and informative for psychologists, other health professionals, training programs, policy makers, and the public. The Institute of Medicine (IOM) 2011 standards for generating CPGs represent current best practices in the field. These standards involve multidisciplinary guideline development panels charged with generating recommendations based on comprehensive systematic reviews of the evidence. The IOM standards will guide the APA as it generates CPGs that can be used to inform the general public and the practice community regarding the benefits and harms of various treatment options. CPG recommendations are advisory rather than compulsory. When used appropriately, high-quality guidelines can facilitate shared decision making and identify gaps in knowledge.

  12. Implementation of quality control performance criteria and approved guidelines for upgrading of clinical chemistry laboratory procedures in Alexandria University hospitals.

    PubMed

    Rizk, Mohamed Moustafa M; el-Badawi, Nashwa A; Moez, Pacint E; Khattab, Azza A

    2009-03-01

    The aim of the present work was to assess the quality of work in Clinical Pathology Department, Alexandria Main University Hospital, Egypt; as regards the pre-analytical and analytical phases of testing; for later accreditation. This evaluation was performed using inspection sheets that were designed according to the CAP 2006 recommendations. All checklist questions that could not be answered "yes" were considered deficiencies and had to be corrected before being accredited. The questions were classified into ten groups; each group contained a number of questions concerning one of the pre-analytical and analytical assessment activities. We ranked our results into 4 categories according to the degree of fulfillment. The total number of questions that were answered "no" at the start and the end of the study accounted for 64/101 (63.4%) and 34/101 (33.7%) questions respectively. Most of the deficiencies were detected in the pre-analytical phase of the testing process; the first two checklists were used for the evaluation of this phase. At the start of the study, the degree of requirements fulfillment in checklist I and II were 0% and 21.1% respectively. By the end of the study the degree of fulfillment became, 85.7% and 63.2% respectively. Average number of sample rejection due to different causes was evaluated before and after implementing CAP recommendations; these causes include haemolysis, clotted serum, quantity not sufficient, and lost samples; the percentage of rejected samples before implementing CAP recommendations was 15.8%, 1.81%, 0.70%, and 0.51% respectively, while after implementing CAP recommendations it was 7%, 0.77%, 0.08%, and 0.05%, respectively. We concluded that the presence of standardized protocol for the pre-analytical activities had improved the quality of samples received by the lab, and we also concluded that accreditation allows laboratories to evaluate their performance, their compliance with the requirements of the accrediting association

  13. [Perspectives in guideline development and implementation in Germany].

    PubMed

    Kopp, I B

    2010-06-01

    Guidelines are important tools for improving knowledge management, processes and outcomes in health care. They aim to assisst both the clinical and the patient decision-making process, particularly in those areas of health care where considerable variation or potential for improvement exist. However, guidelines are often subject to substantial criticism by practicing clinicians. A prerequisite to improving the acceptance of guidelines is a systematic and methodically sound approach in guideline development. The German instrument for methodological guideline appraisal, DELBI, is intended to assist both guideline developers and users. However, this alone is insufficient. Implementation is a process requiring multifaceted strategies to promote behavior change. These include the provision of assistance for local adaptation and well-defined quality indicators for monitoring guideline adherence and quality of care. Additionally, possible links to existing quality management activities should be taken into account to avoid duplication of efforts.

  14. Guidelines for an effective SPDS implementation program

    SciTech Connect

    Blanch, P.M.; Wilkinson, C.D.

    1984-03-01

    Guidelines developed by the Nuclear Utility Task Action Committee for the implementation of a safety parameter display system (SPDS) are summarized. These guidelines reflect the consensus of nuclear utilities on how SPDS requirements, as set up by the Nuclear Regulatory Commission, could be met. This article includes a functional definition of SPDS and discussions of SPDS implementation plans, design bases, purchase specifications, training, integration and documentation, and verification and validation.

  15. Barriers and Strategies in Guideline Implementation-A Scoping Review.

    PubMed

    Fischer, Florian; Lange, Kerstin; Klose, Kristina; Greiner, Wolfgang; Kraemer, Alexander

    2016-01-01

    Research indicates that clinical guidelines are often not applied. The success of their implementation depends on the consideration of a variety of barriers and the use of adequate strategies to overcome them. Therefore, this scoping review aims to describe and categorize the most important barriers to guideline implementation. Furthermore, it provides an overview of different kinds of suitable strategies that are tailored to overcome these barriers. The search algorithm led to the identification of 1659 articles in PubMed. Overall, 69 articles were included in the data synthesis. The content of these articles was analysed by using a qualitative synthesis approach, to extract the most important information on barriers and strategies. The barriers to guideline implementation can be differentiated into personal factors, guideline-related factors, and external factors. The scoping review revealed the following aspects as central elements of successful strategies for guideline implementation: dissemination, education and training, social interaction, decision support systems and standing orders. Available evidence indicates that a structured implementation can improve adherence to guidelines. Therefore, the barriers to guideline implementation and adherence need to be analysed in advance so that strategies that are tailored to the specific setting and target groups can be developed. PMID:27417624

  16. Guidelines for Implementing Teletraining Systems.

    ERIC Educational Resources Information Center

    Chute, Alan G.

    Designed to provide change agents with a framework for planning and implementing successful teletraining systems, this paper discusses strategies for the introduction of sophisticated teletraining technology into corporate training programs without adversely affecting a client organization's social environment. Teletraining is defined as an…

  17. Gaining insight into the Clinical Practice Guideline development processes: qualitative study in a workshop to implement the GRADE proposal in Spain

    PubMed Central

    Calderón, Carlos; Rotaeche, Rafael; Etxebarria, Arritxu; Marzo, Mercé; Rico, Rosa; Barandiaran, Marta

    2006-01-01

    Background The GRADE method represents a new approach to grading the quality of evidence and strength of recommendations in the preparation of Clinical Practice Guidelines (CPG). In the context of a pilot study to assess the implementability of the system in Spain, we considered it relevant to gain an insight into the significance of the perceptions and attitudes expressed by the actual experts participating in the system try-out. Methods Qualitative research with an ethnographic approach, through non-participant observation and focus groups within the context of a consensus workshop in which 19 CPG experts participated to evaluate the GRADE proposal using 12 evidence tables taken from hypertension, asthma and arthritis CPGs. The interventions were recorded, under a guarantee of confidentiality. The transcriptions and field notes were analyzed, based on a sociological discourse analysis model, and the provisional findings were re-sent to participants in order to improve their validity. Results 1) Certain problems over procedure and terminology hindered the acceptance of this new method as a common reference system for the preparation of CPGs. 2). A greater closeness to clinical practice was accompanied by concerns over value judgments and subjectivity, with a demand for greater explicitness in the consensus process. 3). The type of "evidence" on which the guidelines are based, how and by whom the evidence is prepared, and what the role of the different actors should be, all constitute unresolved concerns in the CPG preparation and implementation processes. 4). The grading process is not neutral: professional background, prior experience and the degree of leadership all condition the participants' input and interactions. Conclusion The findings obtained allow the quantitative evaluation to be better interpreted and, in turn, go beyond the particularities of the GRADE method. Adaptation to the complexities of clinical practice, the need for carefully designed multi

  18. Hybrid specification, storage, retrieval and runtime application of clinical guidelines.

    PubMed

    Shahar, Y

    2006-06-01

    Clinical guidelines are a major tool in improving the quality of medical care. However, most guidelines are in free text, are not machine-comprehensible and are not easily accessible to clinicians at the point of care. We have designed and implemented a web-based, modular, distributed architecture, the Digital Electronic Guideline Library (DeGeL), which facilitates gradual conversion of clinical guidelines from text to a formal representation in the chosen target guideline ontology. The architecture supports guideline classification, semantic markup, context-sensitive search, browsing, run-time application and retrospective quality assessment. The DeGeL hybrid meta-ontology includes elements common to all guideline ontologies, such as semantic classification and domain knowledge; it also includes four content-representation formats: free text, semi-structured text, semi-formal representation and a formal representation. These formats support increasingly sophisticated computational tasks. Guidelines can thus be in a hybrid representation in which guidelines, and even parts of the same guideline, might exist at different formalisation levels. We have also developed and rigorously evaluated a methodology and an associated web-based tool, Uruz, for gradually structuring and semi-formalising free-text clinical guidelines. Finally, we have designed, implemented and evaluated a new approach, the hybrid runtime application model, for supporting runtime application of clinical guidelines that are not necessarily in a machine-comprehensible format; in particular, when the guideline is in a semi-formal representation and the patient's data are either in an electronic medical record or in a paper format. The tool implementing this new approach, the Spock module, is customised at this point to the Asbru guideline specification language and exploits the hybrid structure of guidelines in DeGeL. The Spock module also exploits our temporal-abstraction mediator to the patient

  19. A practical approach to implementing new CDC GBS guidelines.

    PubMed

    Hill, Shawna M; Bridges, Margie A; Knudsen, Alexis L; Vezeau, Toni M

    2013-01-01

    Group beta streptococcus (GBS) is a well-documented pathogen causing serious maternal and fetal morbidity and mortality. The CDC guidelines for managing clients who test positive for GBS in pregnancy were revised and published in 2010. However, CDC and extant literature provide limited guidance on implementation strategies for these new recommendations. Although several algorithms are included in the CDC (2010) document, none combine the maternal risk factors for practical and consistent implementation from pregnancy to newborn. In response to confusion upon initial education of these guidelines, we developed an algorithm for maternal intrapartum management. In addition, we clarified the CDC (2010) newborn algorithm in response to provider request. Without altering the recommendations, both algorithms provide clarification of the CDC (2010) guidelines. The nursing process provides an organizational structure for the discussion of our efforts to translate the complex guidelines into practice. This article could provide other facilities with tools for dealing with specific aspects of the complex clinical management of perinatal GBS.

  20. Implementation of Job Placement Services Guidelines.

    ERIC Educational Resources Information Center

    McGillicuddy (Shirley) & Associates, Sierra Madre, CA.

    The Implementation of Job Placement Services Guidelines Project was designed to strengthen placement programs and services for California community college vocational students, and for all students needing part-time employment to realize their educational goals. The project was designed to test the validity and relevance of quality indicators…

  1. Guidelines for Implementing Workplace Literacy Programs.

    ERIC Educational Resources Information Center

    Jester, Marie H.

    This document provides guidelines for implementing workplace literacy programs. Project leadership selection, characteristics and skills, education and experience, and roles and responsibilities are reviewed. Community and business involvement, partnership development, and the voluntary advisory council components of a marketing workplace literacy…

  2. Mentally Gifted Minor Program. Guidelines for Implementation.

    ERIC Educational Resources Information Center

    Sunnyvale Elementary School District, CA.

    Information and guidelines are presented for implementing a school district's Mentally Gifted Minor (MGM) Program, which operates within the regular school organization, under the administration of the school principal. Goals for an MGM program listed cover learning skills and cognitive and affective processes. Relevant California legislation on…

  3. Clinical practice guidelines in hypertension: a review.

    PubMed

    Álvarez-Vargas, Mayita Lizbeth; Galvez-Olortegui, José Kelvin; Galvez-Olortegui, Tomas Vladimir; Sosa-Rosado, José Manuel; Camacho-Saavedra, Luis Arturo

    2015-10-23

    The aim of this study is the methodological evaluation of Clinical Practice Guidelines (CPG) in hypertension. This is the first in a series of review articles, analysis, assessment in methodology and content of clinical practice guidelines in Cardiology. Of all clinical practice guidelines, three were selected and the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was used to assess each guide. The guidelines obtained the lowest score in the domain of applicability (mean 43.8%); while the highest score was for clarity of presentation (mean 81.5%). The lowest percentage was found in the applicability domain (European guideline) and the highest of all scores was found in two domains: scope and purpose, and clarity of presentation (Canadian guideline). Assessing the quality of the clinical practice guidelines analyzed, the Canadian is one with the best scores obtained by applying the AGREE II instrument, and it is advised to be used without modifications.

  4. Reporting guidelines for implementation and operational research.

    PubMed

    Hales, Simon; Lesher-Trevino, Ana; Ford, Nathan; Maher, Dermot; Ramsay, Andrew; Tran, Nhan

    2016-01-01

    In public health, implementation research is done to improve access to interventions that have been shown to work but have not reached many of the people who could benefit from them. Researchers identify practical problems facing public health programmes and aim to find solutions that improve health outcomes. In operational research, routinely-collected programme data are used to uncover ways of delivering more effective, efficient and equitable health care. As implementation research can address many types of questions, many research designs may be appropriate. Existing reporting guidelines partially cover the methods used in implementation and operational research, so we ran a consultation through the World Health Organization (WHO), the Alliance for Health Policy & Systems Research (AHPSR) and the Special Programme for Research and Training in Tropical Diseases (TDR) and developed guidelines to facilitate the funding, conduct, review and publishing of such studies. Our intention is to provide a practical reference for funders, researchers, policymakers, implementers, reviewers and editors working with implementation and operational research. This is an evolving field, so we plan to monitor the use of these guidelines and develop future versions as required.

  5. Reporting guidelines for implementation and operational research

    PubMed Central

    Lesher-Trevino, Ana; Ford, Nathan; Maher, Dermot; Ramsay, Andrew; Tran, Nhan

    2016-01-01

    Abstract In public health, implementation research is done to improve access to interventions that have been shown to work but have not reached many of the people who could benefit from them. Researchers identify practical problems facing public health programmes and aim to find solutions that improve health outcomes. In operational research, routinely-collected programme data are used to uncover ways of delivering more effective, efficient and equitable health care. As implementation research can address many types of questions, many research designs may be appropriate. Existing reporting guidelines partially cover the methods used in implementation and operational research, so we ran a consultation through the World Health Organization (WHO), the Alliance for Health Policy & Systems Research (AHPSR) and the Special Programme for Research and Training in Tropical Diseases (TDR) and developed guidelines to facilitate the funding, conduct, review and publishing of such studies. Our intention is to provide a practical reference for funders, researchers, policymakers, implementers, reviewers and editors working with implementation and operational research. This is an evolving field, so we plan to monitor the use of these guidelines and develop future versions as required. PMID:26769997

  6. Clinical practice guideline: tinnitus executive summary.

    PubMed

    Tunkel, David E; Bauer, Carol A; Sun, Gordon H; Rosenfeld, Richard M; Chandrasekhar, Sujana S; Cunningham, Eugene R; Archer, Sanford M; Blakley, Brian W; Carter, John M; Granieri, Evelyn C; Henry, James A; Hollingsworth, Deena; Khan, Fawad A; Mitchell, Scott; Monfared, Ashkan; Newman, Craig W; Omole, Folashade S; Phillips, C Douglas; Robinson, Shannon K; Taw, Malcolm B; Tyler, Richard S; Waguespack, Richard; Whamond, Elizabeth J

    2014-10-01

    The American Academy of Otolaryngology--Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Tinnitus. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 13 recommendations developed address the evaluation of patients with tinnitus, including selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology. It will then focus on the evaluation and treatment of patients with persistent primary tinnitus, with recommendations to guide the evaluation and measurement of the impact of tinnitus and to determine the most appropriate interventions to improve symptoms and quality of life for tinnitus sufferers. PMID:25274374

  7. Are clinical practice guidelines impartial?

    PubMed

    Cohen, Joshua

    2004-01-01

    In A Theory of Justice, John Rawls demands from citizens who decide upon principles of justice and the rules derived from such principles that they abstract from all particularities that constitute their identity as unique individuals. This demand is unrealistic in policy settings where actual policy-makers convene to provide guidance, establish rules regarding public good, and enact legislation. In practice, I argue, policy-makers, legislators, and others involved in developing social rules that pertain to distributive justice formulate such rules as reasonably partial spectators. To illustrate, I show how clinical practice guidelines are established and mediated by a reasonably partial expert panel whose partial action is publicly justifiable, yet whose claims to impartiality are not.

  8. Implementation of the Pain, Agitation, and Delirium Clinical Practice Guidelines and promoting patient mobility to prevent post-intensive care syndrome.

    PubMed

    Davidson, Judy E; Harvey, Maurene A; Bemis-Dougherty, Anita; Smith, James M; Hopkins, Ramona O

    2013-09-01

    Surviving critical illness is associated with persistent and severe physical, cognitive, and psychological morbidities. The Society of Critical Care Medicine has developed pain, agitation, and delirium guidelines and promoted mobility to improve care of critically ill patients. A task force has developed tools to facilitate and rapidly implement the translation of guideline care recommendations into practice. The Society of Critical Care Medicine has also assembled a task force to assess the long-term consequences of critical illness. This article will explore relationships between the pain, agitation, and delirium guidelines, mobility recommendations, and post-intensive care syndrome initiative. Implementation of the pain, agitation, and delirium guidelines taking into account current data regarding post-intensive care syndrome outcomes and potential interventions are an important first step toward improving outcomes for patients and their families. Research is needed to reduce the impact of long-term negative consequences of critical illness and to fully understand the best within- and post-ICU interventions, along with the optimal timing and dose of such interventions to produce the best long-term outcomes.

  9. [Asthma clinical practice guidelines: advantages and pitfalls].

    PubMed

    Plaza, Vicente; Bellido-Casado, Jesús; Alonso-Coello, Pablo; Rodrigo, Gustavo

    2009-01-01

    The Clinical Practice Guidelines on asthma have contributed towards unifying concepts and reaching a consensus on performances between different professional groups. However, they have failed in the overall improvement in the management of asthma, the final objective that they are meant to achieve. Today, almost 20 years after they appeared, the majority of asthmatic patients are still inadequately controlled, partly due to lack of follow up by doctors and the rest of health care staff who have to look after them. This lack of follow up of these recommendations is probably associated with a lack of well structured planning in their circulation and implementation. Also, although the recommendations of these guidelines agree in what is essential, they differ in other aspects, which in turn could be determining factors in clinical practice. The purpose of this article has been to establish the main differences in the recommendations that the principal clinical practice guidelines on the disease propose on the diagnosis, classification and treatment of asthma. To do this we have compared, The British Guideline on the Management of Asthma 2007, The Global Strategy for Asthma Management and Prevention/Global Initiative for Asthma 2006 (GINA), the National Prevention program for Education on Asthma (Programa Nacional de Prevención para la Educación del Asma) (NAEPP), the Spanish Guide for the Management of Asthma (Guía Española para el Manejo del Asma 2003) (GEMA) and the ALAT y SEPAR guides, Latin-America and Spain. Recommendations for the Prevention and Treatment of Asthma Exacerbation (América Latina y España. Recomendaciones para la Prevención y el Tratamiento de la Exacerbación Asmática 2008) (ALERTA).

  10. Implementing wound care guidelines: observations and recommendations from the bedside.

    PubMed

    Lloyd-Vossen, Jan

    2009-06-01

    The successful implementation of wound care guidelines requires an appreciation for the frustrations experienced by nurses trying to incorporate these tools into clinical practice. These frustrations or barriers to best wound care practice implementation are examined from the perspective of: 1) the practice environment, which must be understood; 2) the potential adopters, predominantly nurses seeking the best fit between evidence and their clinical practice setting; and 3) the evidence-based innovation created to change wound care practice at the point of care. Barriers identified include lack of available resources, time constraints, prescriptive guidelines that incorrectly assume details of the practice environment, and wound care product confusion. Recommendations to facilitate implementation from the bedside are discussed and include expanding guidelines to incorporate detailed educational content and dissemination strategies that serve to increase relevancy to everyday practice. Additional suggestions include decreasing wound care product confusion by developing standardized, function-based product nomenclature and improving the quality of wound care research to increase nurses' confidence in the evidence and resultant recommendations. Resources currently used to develop guidelines also should be utilized to create accompanying educational material to support the transfer and uptake of knowledge.

  11. Clinical implementation of pharmacogenetics.

    PubMed

    García-González, Xandra; Cabaleiro, Teresa; Herrero, María José; McLeod, Howard; López-Fernández, Luis A

    2016-03-01

    In the last decade, pharmacogenetic research has been performed in different fields. However, the application of pharmacogenetic findings to clinical practice has not been as fast as desirable. The current situation of clinical implementation of pharmacogenetics is discussed. This review focuses on the advances of pharmacogenomics to individualize cancer treatments, the relationship between pharmacogenetics and pharmacodynamics in the clinical course of transplant patients receiving a combination of immunosuppressive therapy, the needs and barriers facing pharmacogenetic clinical application, and the situation of pharmacogenetic testing in Spain. It is based on lectures presented by speakers of the Clinical Implementation of Pharmacogenetics Symposium at the VII Conference of the Spanish Pharmacogenetics and Pharmacogenomics Society, held in April 20, 2015. PMID:26751902

  12. Clinical Pharmacogenetics Implementation

    PubMed Central

    WEITZEL, KRISTIN W.; ELSEY, AMANDA R.; LANGAEE, TAIMOUR Y.; BURKLEY, BENJAMIN; NESSL, DAVID R.; OBENG, ANIWAA OWUSU; STALEY, BENJAMIN J.; DONG, HUI-JIA; ALLAN, ROBERT W.; LIU, J. FELIX; COOPER-DEHOFF, RHONDA M.; ANDERSON, R. DAVID; CONLON, MICHAEL; CLARE-SALZLER, MICHAEL J.; NELSON, DAVID R.; JOHNSON, JULIE A.

    2014-01-01

    Current challenges exist to widespread clinical implementation of genomic medicine and pharmacogenetics. The University of Florida (UF) Health Personalized Medicine Program (PMP) is a pharmacist-led, multidisciplinary initiative created in 2011 within the UF Clinical Translational Science Institute. Initial efforts focused on pharmacogenetics, with long-term goals to include expansion to disease-risk prediction and disease stratification. Herein we describe the processes for development of the program, the challenges that were encountered and the clinical acceptance by clinicians of the genomic medicine implementation. The initial clinical implementation of the UF PMP began in June 2012 and targeted clopidogrel use and the CYP2C19 genotype in patients undergoing left heart catheterization and percutaneous-coronary intervention (PCI). After 1 year, 1,097 patients undergoing left heart catheterization were genotyped preemptively, and 291 of those underwent subsequent PCI. Genotype results were reported to the medical record for 100% of genotyped patients. Eighty patients who underwent PCI had an actionable genotype, with drug therapy changes implemented in 56 individuals. Average turnaround time from blood draw to genotype result entry in the medical record was 3.5 business days. Seven different third party payors, including Medicare, reimbursed for the test during the first month of billing, with an 85% reimbursement rate for outpatient claims that were submitted in the first month. These data highlight multiple levels of success in clinical implementation of genomic medicine. PMID:24616371

  13. Ministry of Health clinical practice guidelines: depression.

    PubMed

    Chua, H C; Chan, L L; Chee, K S; Chen, Y H; Chin, S A; Chua, P L W; Fones, S L C; Fung, D; Khoo, C L; Kwek, S K D; Lim, E C L; Ling, J; Poh, P; Sim, K; Tan, B L; Tan, C H; Tan, L L; Tan, Y H C; Tay, W K; Yeo, C; Su, H C A

    2012-02-01

    The Ministry of Health (MOH) have updated the clinical practice guidelines on Depression to provide doctors and patients in Singapore with evidence-based treatment for depression. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Depression, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/home/Publications/guidelines/cpg/2012/depression.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

  14. Overcoming the obstacles of implementing infection prevention and control guidelines.

    PubMed

    Birgand, G; Johansson, A; Szilagyi, E; Lucet, J-C

    2015-12-01

    Reasons for a successful or unsuccessful implementation of infection prevention and control (IPC) guidelines are often multiple and interconnected. This article reviews key elements from the national to the individual level that contribute to the success of the implementation of IPC measures and gives perspectives for improvement. Governance approaches, modes of communication and formats of guidelines are discussed with a view to improve collaboration and transparency among actors. The culture of IPC influences practices and varies according to countries, specialties and healthcare providers. We describe important contextual aspects, such as relationships between actors and resources and behavioural features including professional background or experience. Behaviour change techniques providing goal-setting, feedback and action planning have proved effective in mobilizing participants and may be key to trigger social movements of implementation. The leadership of international societies in coordinating actions at international, national and institutional levels using multidisciplinary approaches and fostering collaboration among clinical microbiology, infectious diseases and IPC will be essential for success.

  15. Information technology tools to improve treatment of patients with depression: focus on guidelines implementation.

    PubMed

    Meglic, Matic; Ivanovski, Matic; Marusic, Andrej

    2008-06-01

    Information technology has the potential to improve and support the treatment of depression. Use of clinical guidelines can improve outcome of treatment, but implementation of guidelines is a demanding process and the resulting user compliance is often poor. Electronic health records, clinical decision support systems and other information technology tools seem at first glance to be a preferable way to implement clinical guidelines since they require user's active and problem oriented participation. This article reviews attempts made so far at use of information tools for implementation of clinical guidelines for depression treatment and discusses their effects. It turns out that there are few existing solutions, ambiguous effects and that usage is often limited. In future the factors determining development of successful electronic tools for clinical guidelines implementation will need to be further specified. Further research projects are underway in Slovenia to investigate these issues.

  16. Ontology-driven execution of clinical guidelines.

    PubMed

    Isern, David; Sánchez, David; Moreno, Antonio

    2012-08-01

    Clinical guidelines (CG) contain general descriptions, defined by health care organisations, of the way in which a particular pathology should be treated. Their adoption in daily care offers several benefits to both patients and practitioners, such as the standardisation of the delivered care and the reduction of errors, but, at the same time, there are several issues that limit their application. CGs are designed to cover a disease taking into account the available evidence but are not designed to be deployed in a particular hospital or healthcare institution. CGs include general recommendations that should be translated according the particular settings before adoption in daily care. This adoption should also specify accountable information about the responsible actors of performing actions in healthcare teams in order to avoid errors arising during delegation/assignment of tasks. In addition, this enactment is not performed taking into account a central knowledge base or a single actor. This paper proposes the combination of a multi-agent system modelling complex healthcare organisations and knowledge representation techniques in order to build a general framework for enabling the enactment of CGs in the context of a medical centre. As a main contribution, the ontological paradigm and the expressiveness of modern ontology languages are used to design, implement and exploit a medico-organisational ontology aimed to provide the semantics required to support the execution of clinical guidelines. The knowledge-driven guideline enactment is managed by a multi-agent system modelling in a distributed fashion the clinical entities involved in the care delivery.

  17. Clinical guidelines: proliferation and medicolegal significance.

    PubMed Central

    Hurwitz, B

    1994-01-01

    Guidelines seeking to influence and regulate clinical activity are currently gaining a new cultural ascendancy on both sides of the Atlantic. Statutory agencies may be charged with developing clinical guidelines, and civil courts, in deciding actions in negligence, could be influenced by standards of care expressed in guideline statements. Clinical guidelines are not accorded unchallengeable status: they have been subject to careful scrutiny by British and American courts to establish their authenticity and relevance. In the United States, compliance with clinical guidelines cannot be used as a defence against liability if a physician's conduct is held to have been negligent, and third party organisations can be held liable if their clinical guidelines are found to be a contributory cause of patient harm. Guidelines have not usurped the role of the expert witness in court. The importance the law attaches to customary practice means that atypical or bizarre guidelines are unlikely to be accepted as embodying a legally required standard of clinical care. PMID:10136259

  18. [Elaboration and critical evaluation of clinical guidelines].

    PubMed

    García Villar, C

    2015-11-01

    Clinical guidelines are documents to help professionals and patients select the best diagnostic or therapeutic option. Elaborating guidelines requires an efficient literature search and a critical evaluation of the articles found to select the most appropriate ones. After that, the recommendations are formulated and then must be externally evaluated before they can be disseminated. Even when the guidelines are very thorough and rigorous, it is important to know whether they fulfill all the methodological requisites before applying them. With this aim, various scales have been developed to critically appraise guidelines. Of these, the AGREE II instrument is currently the most widely used. This article explains the main steps in elaborating clinical guidelines and the main aspects that should be analyzed to know whether the guidelines are well written.

  19. [Elaboration and critical evaluation of clinical guidelines].

    PubMed

    García Villar, C

    2015-11-01

    Clinical guidelines are documents to help professionals and patients select the best diagnostic or therapeutic option. Elaborating guidelines requires an efficient literature search and a critical evaluation of the articles found to select the most appropriate ones. After that, the recommendations are formulated and then must be externally evaluated before they can be disseminated. Even when the guidelines are very thorough and rigorous, it is important to know whether they fulfill all the methodological requisites before applying them. With this aim, various scales have been developed to critically appraise guidelines. Of these, the AGREE II instrument is currently the most widely used. This article explains the main steps in elaborating clinical guidelines and the main aspects that should be analyzed to know whether the guidelines are well written. PMID:26545328

  20. Continuing Education, Guideline Implementation, and the Emerging Transdisciplinary Field of Knowledge Translation

    ERIC Educational Resources Information Center

    Davis, Dave

    2006-01-01

    This article discusses continuing education and the implementation of clinical practice guidelines or best evidence, quality improvement, and patient safety. Continuing education focuses on the perspective of the adult learner and is guided by well-established educational principles. In contrast, guideline implementation and related concepts…

  1. Guideline clinical nutrition in patients with stroke.

    PubMed

    Wirth, Rainer; Smoliner, Christine; Jäger, Martin; Warnecke, Tobias; Leischker, Andreas H; Dziewas, Rainer

    2013-12-01

    Stroke is regularly accompanied by dysphagia and other factors associated with decreased nutritional intake. Dysphagia with aspiration pneumonia and insufficient nutritional intake lead to worse outcome after stroke.This guideline is the first chapter of the guideline "Clinical Nutrition in Neurology" of the German Society for Clinical Nutrition (DGEM) which itself is one part of a comprehensive guideline about all areas of Clinical Nutrition. The thirty-one recommendations of the guideline are based on a systematic literature search and review, last updated December 31, 2011. All recommendations were discussed and consented at several consensus conferences with the entire DGEM guideline group. The recommendations underline the importance of an early screening and assessment of dysphagia and give advice for an evidence based and comprehensive nutritional management to avoid aspiration, malnutrition and dehydration.

  2. Pain, agitation, and delirium guidelines: nurses' involvement in development and implementation.

    PubMed

    Davidson, Judy E; Winkelman, Chris; Gélinas, Céline; Dermenchyan, Anna

    2015-06-01

    The 2013 American College of Critical Care Medicine/Society of Critical Care Medicine clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit serves as a living example of nurses' involvement in the development and implementation of professional guidelines. Nurses who served on this guideline-writing panel describe their experiences. Specific examples from the pain, agitation, and delirium guidelines for care are used to explore the roles of the nurse leader, nurse informaticist, staff nurse, and nurse researcher in relationship to guideline implementation. PMID:26033098

  3. Guidelines for Implementing Training Effectiveness Evaluation. Final Report.

    ERIC Educational Resources Information Center

    Semple, Clarence A.

    The document presents guidelines for planning, implementing, and documenting training effectiveness evaluations. The guidelines are intended to assist researchers in coping with many of the constraints associated with executing empirical research in operational settings. (NTIS)

  4. Curriculum Guidelines for Clinical Dental Hygiene.

    ERIC Educational Resources Information Center

    Journal of Dental Education, 1985

    1985-01-01

    The American Association of Dental Schools curriculum guidelines for clinical dental hygiene include definitions, notes on the interrelationship of courses, an overview of course objectives, and suggested primary educational goals, prerequisites, core content, specific objectives, sequencing, faculty, and facilities. (MSE)

  5. When Choosing Wisely meets clinical practice guidelines.

    PubMed

    Strech, Daniel; Follmann, Markus; Klemperer, David; Lelgemann, Monika; Ollenschläger, Günter; Raspe, Heiner; Nothacker, Monika

    2014-01-01

    The American Board of Internal Medicine (ABIM) Foundation launched the Choosing Wisely campaign in 2012 and until today convinced more than 50 US specialist societies to develop lists of interventions that may not improve people's health but are potentially harmful. We suggest combining these new efforts with the already existing efforts in clinical practice guideline development. Existing clinical practice guidelines facilitate a more participatory and evidence-based approach to the development of top 5 lists. In return, adding top 5 lists (for overuse and underuse) to existing clinical practice guidelines nicely addresses a neglected dimension to clinical practice guideline development, namely explicit information on which Do or Don't do recommendations are frequently disregarded in practice. PMID:25499114

  6. When Choosing Wisely meets clinical practice guidelines.

    PubMed

    Strech, Daniel; Follmann, Markus; Klemperer, David; Lelgemann, Monika; Ollenschläger, Günter; Raspe, Heiner; Nothacker, Monika

    2014-01-01

    The American Board of Internal Medicine (ABIM) Foundation launched the Choosing Wisely campaign in 2012 and until today convinced more than 50 US specialist societies to develop lists of interventions that may not improve people's health but are potentially harmful. We suggest combining these new efforts with the already existing efforts in clinical practice guideline development. Existing clinical practice guidelines facilitate a more participatory and evidence-based approach to the development of top 5 lists. In return, adding top 5 lists (for overuse and underuse) to existing clinical practice guidelines nicely addresses a neglected dimension to clinical practice guideline development, namely explicit information on which Do or Don't do recommendations are frequently disregarded in practice.

  7. Clinical practice guideline: Bell's Palsy executive summary.

    PubMed

    Baugh, Reginald F; Basura, Gregory J; Ishii, Lisa E; Schwartz, Seth R; Drumheller, Caitlin Murray; Burkholder, Rebecca; Deckard, Nathan A; Dawson, Cindy; Driscoll, Colin; Gillespie, M Boyd; Gurgel, Richard K; Halperin, John; Khalid, Ayesha N; Kumar, Kaparaboyna Ashok; Micco, Alan; Munsell, Debra; Rosenbaum, Steven; Vaughan, William

    2013-11-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Bell's Palsy. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 11 recommendations developed encourage accurate and efficient diagnosis and treatment and, when applicable, facilitate patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell's palsy. There are myriad treatment options for Bell's palsy; some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, there are numerous diagnostic tests available that are used in the evaluation of patients with Bell's palsy. Many of these tests are of questionable benefit in Bell's palsy. Furthermore, while patients with Bell's palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell's palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have an unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell's palsy.

  8. Clinical practice guideline: Bell's Palsy executive summary.

    PubMed

    Baugh, Reginald F; Basura, Gregory J; Ishii, Lisa E; Schwartz, Seth R; Drumheller, Caitlin Murray; Burkholder, Rebecca; Deckard, Nathan A; Dawson, Cindy; Driscoll, Colin; Gillespie, M Boyd; Gurgel, Richard K; Halperin, John; Khalid, Ayesha N; Kumar, Kaparaboyna Ashok; Micco, Alan; Munsell, Debra; Rosenbaum, Steven; Vaughan, William

    2013-11-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Bell's Palsy. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 11 recommendations developed encourage accurate and efficient diagnosis and treatment and, when applicable, facilitate patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell's palsy. There are myriad treatment options for Bell's palsy; some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, there are numerous diagnostic tests available that are used in the evaluation of patients with Bell's palsy. Many of these tests are of questionable benefit in Bell's palsy. Furthermore, while patients with Bell's palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell's palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have an unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell's palsy. PMID:24190889

  9. [From clinical practice guidelines towards quality assurance].

    PubMed

    Kopp, I B

    2011-02-01

    Clinical practice guidelines have been introduced to assist decision making at the bedside of individual patients. Guidelines are also increasingly regarded as being an indispensable part of professional quality systems. Guidelines are important tools to improve knowledge-management, processes and outcomes in healthcare. They aim to assist professional and patient decisions especially in those areas of healthcare where considerable variation or potential for improvement exist and they can provide a foundation for assessing and evaluating the quality and effectiveness of healthcare in terms of measuring processes and outcomes. Quality indicators or performance measures based on guideline recommendations are necessary to evaluate the usefulness of guidelines and the appropriateness of healthcare delivery. Guideline recommendations are the tools for healthcare professionals to develop strategies for quality improvement in case deviations from desired processes or outcomes are identified by the measurement of quality indicators.

  10. American Clinical Neurophysiology Society Guideline 7: Guidelines for EEG Reporting.

    PubMed

    Tatum, William O; Olga, Selioutski; Ochoa, Juan G; Munger Clary, Heidi; Cheek, Janna; Drislane, Frank; Tsuchida, Tammy N

    2016-08-01

    This EEG Guideline incorporates the practice of structuring a report of results obtained during routine adult electroencephalography. It is intended to reflect one of the current practices in reporting an EEG and serves as a revision of the previous guideline entitled "Writing an EEG Report." The goal of this guideline is not only to convey clinically relevant information, but also to improve interrater reliability for clinical and research use by standardizing the format of EEG reports. With this in mind, there is expanded documentation of the patient history to include more relevant clinical information that can affect the EEG recording and interpretation. Recommendations for the technical conditions of the recording are also enhanced to include post hoc review parameters and type of EEG recording. Sleep feature documentation is also expanded upon. More descriptive terms are included for background features and interictal discharges that are concordant with efforts to standardize terminology. In the clinical correlation section, examples of common clinical scenarios are now provided that encourages uniformity in reporting. Including digital samples of abnormal waveforms is now readily available with current EEG recording systems and may be beneficial in augmenting reports when controversial waveforms or important features are encountered.

  11. American Clinical Neurophysiology Society Guideline 7: Guidelines for EEG Reporting.

    PubMed

    Tatum, William O; Olga, Selioutski; Ochoa, Juan G; Munger Clary, Heidi; Cheek, Janna; Drislane, Frank; Tsuchida, Tammy N

    2016-08-01

    This EEG Guideline incorporates the practice of structuring a report of results obtained during routine adult electroencephalography. It is intended to reflect one of the current practices in reporting an EEG and serves as a revision of the previous guideline entitled "Writing an EEG Report." The goal of this guideline is not only to convey clinically relevant information, but also to improve interrater reliability for clinical and research use by standardizing the format of EEG reports. With this in mind, there is expanded documentation of the patient history to include more relevant clinical information that can affect the EEG recording and interpretation. Recommendations for the technical conditions of the recording are also enhanced to include post hoc review parameters and type of EEG recording. Sleep feature documentation is also expanded upon. More descriptive terms are included for background features and interictal discharges that are concordant with efforts to standardize terminology. In the clinical correlation section, examples of common clinical scenarios are now provided that encourages uniformity in reporting. Including digital samples of abnormal waveforms is now readily available with current EEG recording systems and may be beneficial in augmenting reports when controversial waveforms or important features are encountered. PMID:27482790

  12. Developing clinical practice guidelines for spinal cord medicine. Lessons learned.

    PubMed

    Biddle, A K; Fraher, E P

    2000-02-01

    This article describes the process used by the Consortium for Spinal Cord Medicine to develop evidence-based clinical practice guidelines for managing and treating individuals with spinal cord injury and provides important information on lessons learned and the potential problems to avoid. Issues to consider during the guideline development process include topic selection and explication, methods for selecting the panel chair and panel members, the writing of recommendations and supporting scientific rationales, peer-reviewing guidelines, and the process for disseminating, implementing, and evaluating guidelines. The applicability, advantages, and disadvantages of available evidence and guideline recommendation grading systems and issues arising from the lack of scientific evidence supporting particular recommendations are also discussed.

  13. Dentists United to Extinguish Tobacco (DUET): a study protocol for a cluster randomized, controlled trial for enhancing implementation of clinical practice guidelines for treating tobacco dependence in dental care settings

    PubMed Central

    2014-01-01

    Background Although dental care settings provide an exceptional opportunity to reach smokers and provide brief cessation advice and treatment to reduce oral and other tobacco-related health conditions, dental care providers demonstrate limited adherence to evidence-based guidelines for treatment of tobacco use and dependence. Methods/Design Guided by a multi-level, conceptual framework that emphasizes changes in provider beliefs and organizational characteristics as drivers of improvement in tobacco treatment delivery, the current protocol will use a cluster, randomized design and multiple data sources (patient exit interviews, provider surveys, site observations, chart audits, and semi-structured provider interviews) to study the process of implementing clinical practice guidelines for treating tobacco dependence in 18 public dental care clinics in New York City. The specific aims of this comparative-effectiveness research trial are to: compare the effectiveness of three promising strategies for implementation of tobacco use treatment guidelines—staff training and current best practices (CBP), CBP + provider performance feedback (PF), and CBP + PF + provider reimbursement for delivery of tobacco cessation treatment (pay-for-performance, or P4P); examine potential theory-driven mechanisms hypothesized to explain the comparative effectiveness of three strategies for implementation; and identify baseline organizational factors that influence the implementation of evidence-based tobacco use treatment practices in dental clinics. The primary outcome is change in providers’ tobacco treatment practices and the secondary outcomes are cost per quit, use of tobacco cessation treatments, quit attempts, and smoking abstinence. Discussion We hypothesize that the value of these promising implementation strategies is additive and that incorporating all three strategies (CBP, PF, and P4P) will be superior to CBP alone and CBP + PF in improving delivery of

  14. [Implementation of therapeutic hypothermia into clinical practice].

    PubMed

    Himmel, Friederike; Desch, Steffen; Wolfrum, Sebastian

    2015-08-01

    Implementation of mild therapeutic hypothermia after cardiac arrest into clinical practice is a continuing process. Although ILCOR recommendation was given in 2003, only 24% of the German hospitals reported the use of hypothermia in this setting in 2005. Growing evidence and most importantly the implementation of hypothermia into the guidelines led to a significant increase of acceptance of this therapeutic option leading to a user rate of 69% in 2009. Encouraged by the new guidelines from 2010 86% of German hospitals finally reported to use hypothermia after cardiac arrest routinely in 2012, a decade after publication of the mile stone studies. The phenomenon of a delayed implementation of hypothermia into clinical practice can be seen throughout the world as many surveys from different countries at different time points have shown. When hypothermia is used, hospitals go with the guidelines quite strictly with respect to indication, duration of treatment and target temperature. This strengthens the importance of guidelines in the process to implement new therapeutic options. However, although a recent study still promotes a strict target temperature management it questions the need for a markedly reduced target temperature of 33°C. It remains to be elucidated how this study will affect the daily routine in the hospitals and most interestingly how this study will change the coming guidelines in 2015. PMID:26261928

  15. Implementation of an automated guideline monitor for secondary prevention of acute myocardial infarction.

    PubMed Central

    Noirot, Laura A.; Blickensderfer, Amy; Christensen, Erin; Schaiff, Robyn; Kessels, Anthony; Braverman, Alan; Goldberg, Anne; Dunagan, William Claiborne; Bailey, Thomas C.

    2002-01-01

    Clinical practice guidelines can be used to help improve health care quality, but they are often not optimally implemented. Practice enabling and reinforcing techniques, such as clinical reminders and academic detailing are effective methods for translating guidelines into practice. Following a study showing that we could improve adherence to secondary prevention guidelines for acute myocardial infarction (AMI) using computerized alerts and academic detailing, we implemented an automated monitor to accomplish the same goal in a less labor-intensive manner. This paper describes the implementation of this production application. PMID:12463887

  16. Clinical practice guideline (update): Adult Sinusitis Executive Summary.

    PubMed

    Rosenfeld, Richard M; Piccirillo, Jay F; Chandrasekhar, Sujana S; Brook, Itzhak; Kumar, Kaparaboyna Ashok; Kramper, Maggie; Orlandi, Richard R; Palmer, James N; Patel, Zara M; Peters, Anju; Walsh, Sandra A; Corrigan, Maureen D

    2015-04-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation has published a supplement to this issue featuring the updated "Clinical Practice Guideline: Adult Sinusitis" as a supplement to Otolaryngology-Head and Neck Surgery. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 14 developed recommendations address diagnostic accuracy for adult rhinosinusitis, the appropriate use of ancillary tests to confirm diagnosis and guide management (including radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function), and the judicious use of systemic and topical therapy. Emphasis was also placed on identifying multiple chronic conditions that would modify management of rhinosinusitis, including asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia. An updated guideline is needed as a result of new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group. PMID:25833927

  17. Clinical Practice Guideline: Otitis Media with Effusion Executive Summary (Update).

    PubMed

    Rosenfeld, Richard M; Shin, Jennifer J; Schwartz, Seth R; Coggins, Robyn; Gagnon, Lisa; Hackell, Jesse M; Hoelting, David; Hunter, Lisa L; Kummer, Ann W; Payne, Spencer C; Poe, Dennis S; Veling, Maria; Vila, Peter M; Walsh, Sandra A; Corrigan, Maureen D

    2016-02-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation has published a supplement to this issue of Otolaryngology-Head and Neck Surgery featuring the updated "Clinical Practice Guideline: Otitis Media with Effusion." To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 18 recommendations developed emphasize diagnostic accuracy, identification of children who are most susceptible to developmental sequelae from otitis media with effusion, and education of clinicians and patients regarding the favorable natural history of most otitis media with effusion and the lack of efficacy for medical therapy (eg, steroids, antihistamines, decongestants). An updated guideline is needed due to new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group. PMID:26833645

  18. Procedures for Using Clinical Practice Guidelines

    ERIC Educational Resources Information Center

    Hargrove, Patricia; Griffer, Mona; Lund, Bonnie

    2008-01-01

    Purpose: This article provides information about clinical practice guidelines (CPGs) to facilitate their application to the practice of speech-language pathology. CPGs are sets of recommendations based on evidence, including expert clinical opinion, that have been developed by a panel of reviewers. In this article, CPGs are defined and their…

  19. Clinical Guidelines. Dental Hygiene Program.

    ERIC Educational Resources Information Center

    Branson, Bonnie

    This manual contains information concerning the policies and procedures of the Southern Illinois University-Carbondale Dental Hygiene Clinic. The manual is presented in a question/answer format for the information and convenience of dental hygiene students in the program, and is intended to answer their questions concerning clinical policies and…

  20. A cluster randomized controlled trial of a behavioral intervention to facilitate the development and implementation of clinical practice guidelines in Latin American maternity hospitals: the Guidelines Trial: Study protocol [ISRCTN82417627

    PubMed Central

    Althabe, Fernando; Buekens, Pierre; Bergel, Eduardo; Belizán, José M; Kropp, Nora; Wright, Linda; Goco, Norman; Moss, Nancy

    2005-01-01

    Background A significant proportion of the health care administered to women in Latin American maternity hospitals during labor and delivery has been demonstrated to be ineffective or harmful, whereas effective interventions remain underutilized. The routine use of episiotomies and the failure to use active management of the third stage of labor are good examples. Methods/Design The aim of this trial is to evaluate the effect of a multifaceted behavioral intervention on the use of two evidence-based birth practices, the selective use of episiotomies and active management of the third stage of labor (injection of 10 International Units of oxytocin). The intervention is based on behavioral and organizational change theories and was based on formative research. Twenty-four hospitals in three urban districts of Argentina and Uruguay will be randomized. Opinion leaders in the 12 intervention hospitals will be identified and trained to develop and implement evidence-based guidelines. They will then disseminate the guidelines using a multifaceted approach including academic detailing, reminders, and feedback on utilization rates. The 12 hospitals in the control group will continue with their standard in-service training activities. The main outcomes to be assessed are the rates of episiotomy and oxytocin use during the third stage of labor. Secondary outcomes will be perineal sutures, postpartum hemorrhages, and birth attendants' opinions. PMID:15823211

  1. Clinical guidelines and the fate of medical autonomy in Ontario.

    PubMed

    Rappolt, S G

    1997-04-01

    Conceptually, clinical guidelines and professional autonomy have a paradoxical relationship. Despite being the quintessence of medical knowledge at the corporate level, guidelines diminish the clinical autonomy of individual practitioners, and therefore threaten medicine's justification for its autonomy. Theorists have argued that professional autonomy will be retained through elite dominance of practitioners, while comparative research suggests that economic autonomy can be traded off to retain clinical autonomy. Under government pressure to regulate the growth of Ontario physicians' fee-for-service public expenditure, the profession's representative organization, the Ontario Medical Association (OMA), promoted voluntary clinical guidelines, hoping to both constrain costs and preserve professional control over the content of medical care. The OMA collaborated with the Ministry of Health in developing guidelines and establishing a provincial centre for health service research. Ontario's practitioners disregarded the OMA's exhortations to implement clinical guidelines, suggesting that in the absence of external constraints, practitioners can subvert elite dominance. However, practitioners' unchecked clinical and economic autonomy, combined with evidence of wide provincial variations in medical care, served to legitimize the government's increasingly unilateral control over the schedule of insured medical services, and, in 1993, their imposition of a global cap on physicians' fee-for-service income pool. When analysed in the context of ongoing Ministry-OMA relations, the failure of the OMA's guidelines strategy to constrain medical service costs has expedited an overall decline in medical autonomy in Ontario. The emergence and course of Ontario's clinical guidelines movement is consistent with the view that medical autonomy is contingent upon broad class forces, and the conceptualization of professional organizations as instruments for mediated occupational control

  2. Rationale, design, and implementation protocol of the Dutch clinical practice guideline Pain in patients with cancer: a cluster randomised controlled trial with short message service (SMS) and interactive voice response (IVR)

    PubMed Central

    2011-01-01

    Background One-half of patients with cancer have pain. In nearly one out of two cancer patients with pain, this was undertreated. Inadequate pain control still remains an important problem in this group of patients. Therefore, in 2008 a national, evidence-based multidisciplinary clinical practice guideline 'pain in patients with cancer' has been developed. Yet, publishing a guideline is not enough. Implementation is needed to improve pain management. An innovative implementation strategy, Short Message Service with Interactive Voice Response (SVS-IVR), has been developed and pilot tested. This study aims to evaluate on effectiveness of this strategy to improve pain reporting, pain measurement and adequate pain therapy. In addition, whether the active role of the patient and involvement of caregivers in pain management may change. Methods/design A cluster randomised controlled trial with two arms will be performed in six oncology outpatient clinics of hospitals in the Southeastern region of the Netherlands, with three hospitals in the intervention and three in the control condition. Follow-up measurements will be conducted in all hospitals to study the long-term effect of the intervention. The intervention includes training of professionals (medical oncologists, nurses, and general practitioners) and SMS-IVR to report pain in patients with cancer to improve pain reporting by patients, pain management by medical oncologists, nurses, and general practitioners, and decrease pain intensity. Discussion This innovative implementation strategy with technical tools and the involvement of patients, may enhance the use of the guideline 'pain in patients with cancer' for pain management. Short Message Service alerts may serve as a tool to support self-management of patients. Therefore, the SMS-IVR intervention may increase the feeling of having control over one's life. Trail registration Netherlands Trial Register (NTR): NTR2739 PMID:22142327

  3. [New European clinical guidelines on dyslipidemias].

    PubMed

    Matikainen, Niina; Taskinen, Marja-Riitta

    2012-01-01

    In the new European clinical guidelines on dyslipidemias, screening of the risk for cardiovascular diseace is recommended by using lipid assays for all patients who are at high risk due to their clinical characteristics, and for men over 40 years of age and women of over 50 years of age. The starting point in the guidelines is an assessment of individual total risk based on traditional risk factors, i.e. LDL cholesterol level, blood pressure, smoking and age. With respect of dyslipidemia, the effect of HDL cholesterol and triglyceride levels on the total risk is recommended to complement the information provided by the LDL cholesterol level.

  4. Use of clinical guidelines: perspectives from clinicians in paediatric and maternity hospitals in Kabul, Afghanistan.

    PubMed

    Graham, H; Tokhi, M; Edward, A; Salehi, A S; Turkmani, S; Duke, T; Bartlett, L

    2015-04-02

    This study explored the perceived value, role and reported use of clinical guidelines by clinicians in urban paediatric and maternity hospital settings, and the effect of current implementation strategies on clinician attitudes, knowledge and behaviour. A total of 63 clinicians from 7 paediatric and maternity hospitals in Kabul, Afghanistan participated in structured focus groups; content analysis methodology was used for identification and analysis of key themes. Seven sets of guidelines, protocols or standards were identified (including 5 WHO-endorsed guidelines). However, most are failing to achieve high levels of use. Factors associated with guideline use included: clinician involvement in guideline development; multidisciplinary training; demonstrable results; and positive clinician perceptions regarding guideline quality and contextual appropriateness. Implementation activities should fulfil 3 major objectives: promote guideline awareness and access; stimulate motivation among clinical guideline users; and actively facilitate adherence to guidelines.

  5. Guidelines for clinical supervision in health service psychology.

    PubMed

    2015-01-01

    This document outlines guidelines for supervision of students in health service psychology education and training programs. The goal was to capture optimal performance expectations for psychologists who supervise. It is based on the premises that supervisors (a) strive to achieve competence in the provision of supervision and (b) employ a competency-based, meta-theoretical approach to the supervision process. The Guidelines on Supervision were developed as a resource to inform education and training regarding the implementation of competency-based supervision. The Guidelines on Supervision build on the robust literatures on competency-based education and clinical supervision. They are organized around seven domains: supervisor competence; diversity; relationships; professionalism; assessment/evaluation/feedback; problems of professional competence, and ethical, legal, and regulatory considerations. The Guidelines on Supervision represent the collective effort of a task force convened by the American Psychological Association (APA) Board of Educational Affairs (BEA).

  6. [Clinical practice guidelines and knowledge management in healthcare].

    PubMed

    Ollenschläger, Günter

    2013-10-01

    Clinical practice guidelines are key tools for the translation of scientific evidence into everyday patient care. Therefore guidelines can act as cornerstones of evidence based knowledge management in healthcare, if they are trustworthy, and its recommendations are not biased by authors' conflict of interests. Good medical guidelines should be disseminated by means of virtual (digital/electronic) health libraries - together with implementation tools in context, such as guideline based algorithms, check lists, patient information, a.s.f. The article presents evidence based medical knowledge management using the German experiences as an example. It discusses future steps establishing evidence based health care by means of combining patient data, evidence from medical science and patient care routine, together with feedback systems for healthcare providers.

  7. [Clinical practice guidelines and knowledge management in healthcare].

    PubMed

    Ollenschläger, Günter

    2013-10-01

    Clinical practice guidelines are key tools for the translation of scientific evidence into everyday patient care. Therefore guidelines can act as cornerstones of evidence based knowledge management in healthcare, if they are trustworthy, and its recommendations are not biased by authors' conflict of interests. Good medical guidelines should be disseminated by means of virtual (digital/electronic) health libraries - together with implementation tools in context, such as guideline based algorithms, check lists, patient information, a.s.f. The article presents evidence based medical knowledge management using the German experiences as an example. It discusses future steps establishing evidence based health care by means of combining patient data, evidence from medical science and patient care routine, together with feedback systems for healthcare providers. PMID:24326702

  8. Clinical practice guideline: management of acute pancreatitis

    PubMed Central

    Greenberg, Joshua A.; Hsu, Jonathan; Bawazeer, Mohammad; Marshall, John; Friedrich, Jan O.; Nathens, Avery; Coburn, Natalie; May, Gary R.; Pearsall, Emily; McLeod, Robin S.

    2016-01-01

    There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality. Despite the availability of clinical practice guidelines for the management of acute pancreatitis, recent studies auditing the clinical management of the condition have shown important areas of noncompliance with evidence-based recommendations. This underscores the importance of creating understandable and implementable recommendations for the diagnosis and management of acute pancreatitis. The purpose of the present guideline is to provide evidence-based recommendations for the management of both mild and severe acute pancreatitis as well as the management of complications of acute pancreatitis and of gall stone–induced pancreatitis. Une hausse de l’incidence de pancréatite aiguë a été constatée à l’échelle mondiale. Malgré l’amélioration de l’accès aux soins et aux techniques d’imagerie et d’intervention, la pancréatite aiguë est toujours associée à une morbidité et une mortalité importantes. Bien qu’il existe des guides de pratique clinique pour la prise en charge de la pancréatite aiguë, des études récentes sur la vérification de la prise en charge clinique de cette affection révèlent des lacunes importantes dans la conformité aux recommandations fondées sur des données probantes. Ces résultats mettent en relief l’importance de formuler des recommandations compréhensibles et applicables pour le diagnostic et la prise en charge de la pancréatite aiguë. La présente ligne directrice vise à fournir des recommandations fondées sur des données probantes pour la prise en charge de la pancréatite aiguë, qu’elle soit bénigne ou grave, ainsi que de ses complications et de celles de la pancréatite causée par un calcul biliaire. PMID:27007094

  9. Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest.

    PubMed

    Eccles, Martin P; Grimshaw, Jeremy M; Shekelle, Paul; Schünemann, Holger J; Woolf, Steven

    2012-07-04

    Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s) for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement) and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development.

  10. Exceptions Handling within GLARE Clinical Guideline Framework

    PubMed Central

    Leonardi, Giorgio; Bottrighi, Alessio; Galliani, Gabriele; Terenziani, Paolo; Messina, Antonio; Corte, Francesco Della

    2012-01-01

    Computerized clinical guidelines (CIGs) are widely adopted in order to assist practitioner and patient decision making. However, a main problem in their adoption is the fact that, during guidelines executions on specific patients, unpredictable facts and conditions (henceforth called exceptions) may occur. A proper and immediate treatment of such exception is necessary, but most current software systems coping with CIGs do not support it. In this paper, we describe how the GLARE system has been extended to deal with exceptions in CIGs. PMID:23304323

  11. [Clinical practice guideline. Drug prescription in elderly].

    PubMed

    Peralta-Pedrero, María Luisa; Valdivia-Ibarra, Francisco Javier; Hernández-Manzano, Mario; Medina-Beltrán, Gustavo Rodrigo; Cordero-Guillén, Miguel Angel; Baca-Zúñiga, José; Cruz-Avelar, Agles; Aguilar-Salas, Ismael; Avalos-Mejía, Annia Marisol

    2013-01-01

    The process of prescribing a medication is complex and includes: deciding whether it is indicated, choosing the best option, determining the dose and the appropriate management scheme to the physiological condition of the patient, and monitoring effectiveness and toxicity. We have to inform patients about the expected side effects and indications for requesting a consultation. Specific clinical questions were designed based on the acronym PICOST. The search was made in the specific websites of clinical practice guidelines, was limited to the population of older adults, in English or Spanish. We used 10 related clinical practice guidelines, eight systematic reviews and five meta-analyses. Finally, we made a search of original articles or clinical reviews for specific topics. The development and validation of clinical practice guidelines for "rational drug prescriptions in the elderly" is intended to promote an improvement in the quality of prescription through the prevention and detection of inappropriate prescribing in the elderly and, as a result of this, a decrease in the adverse events by drugs, deterioration of health of patients and expenditure of resources.

  12. Nurses' intention to apply clinical practice guidelines.

    PubMed

    Kogan, Ella; Tabak, Nili

    2012-12-01

    Using Ajzen and Madden's Theory of Planned Behavior, this study investigates factors which influence nurses' intention to apply clinical practice guidelines in their daily ward work. A convenience sample of 91 nurses in internal medicine wards in three Israeli hospitals answered four questionnaires. Data were processed by Pearson correlation coefficients and multivariate regression. The main findings were that burnout was negatively correlated with the intention to work according to guidelines and that professionalism (in the sense of a tendency to follow taught procedure rather than personal judgment) was positively correlated with it. Furthermore, nurses who perceive their behavioral control and subjective norms to be positive will be the most determined to work according to guidelines, provided they personally command the necessary resources to do so. PMID:23447906

  13. Assisted Knowledge Discovery for the Maintenance of Clinical Guidelines

    PubMed Central

    Pasche, Emilie; Ruch, Patrick; Teodoro, Douglas; Huttner, Angela; Harbarth, Stephan; Gobeill, Julien; Wipfli, Rolf; Lovis, Christian

    2013-01-01

    Background Improving antibiotic prescribing practices is an important public-health priority given the widespread antimicrobial resistance. Establishing clinical practice guidelines is crucial to this effort, but their development is a complex task and their quality is directly related to the methodology and source of knowledge used. Objective We present the design and the evaluation of a tool (KART) that aims to facilitate the creation and maintenance of clinical practice guidelines based on information retrieval techniques. Methods KART consists of three main modules 1) a literature-based medical knowledge extraction module, which is built upon a specialized question-answering engine; 2) a module to normalize clinical recommendations based on automatic text categorizers; and 3) a module to manage clinical knowledge, which formalizes and stores clinical recommendations for further use. The evaluation of the usability and utility of KART followed the methodology of the cognitive walkthrough. Results KART was designed and implemented as a standalone web application. The quantitative evaluation of the medical knowledge extraction module showed that 53% of the clinical recommendations generated by KART are consistent with existing clinical guidelines. The user-based evaluation confirmed this result by showing that KART was able to find a relevant antibiotic for half of the clinical scenarios tested. The automatic normalization of the recommendation produced mixed results among end-users. Conclusions We have developed an innovative approach for the process of clinical guidelines development and maintenance in a context where available knowledge is increasing at a rate that cannot be sustained by humans. In contrast to existing knowledge authoring tools, KART not only provides assistance to normalize, formalize and store clinical recommendations, but also aims to facilitate knowledge building. PMID:23646153

  14. A case of standardization? Implementing health promotion guidelines in Denmark.

    PubMed

    Rod, Morten Hulvej; Høybye, Mette Terp

    2016-09-01

    Guidelines are increasingly used in an effort to standardize and systematize health practices at the local level and to promote evidence-based practice. The implementation of guidelines frequently faces problems, however, and standardization processes may in general have other outcomes than the ones envisioned by the makers of standards. In 2012, the Danish National Health Authorities introduced a set of health promotion guidelines that were meant to guide the decision making and priority setting of Denmark's 98 local governments. The guidelines provided recommendations for health promotion policies and interventions and were structured according to risk factors such as alcohol, smoking and physical activity. This article examines the process of implementation of the new Danish health promotion guidelines. The article is based on qualitative interviews and participant observation, focusing on the professional practices of health promotion officers in four local governments as well as the field of Danish health promotion more generally. The analysis highlights practices and episodes related to the implementation of the guidelines and takes inspiration from Timmermans and Epstein's sociology of standards and standardization. It remains an open question whether or not the guidelines lead to more standardized policies and interventions, but we suggest that the guidelines promote a risk factor-oriented approach as the dominant frame for knowledge, reasoning, decision making and priority setting in health promotion. We describe this process as a case of epistemic standardization. PMID:25912256

  15. A manual for implementing residual radioactive material guidelines

    SciTech Connect

    Gilbert, T.L.; Yu, C.; Yuan, Y.C.; Zielen, A.J.; Jusko, M.J.; Wallo, A. III

    1989-06-01

    This manual presents information for implementing US Department of Energy (DOE) guidelines for residual radioactive material at sites identified by the Formerly Utilized Sites Remedial Action Program (FUSRAP) and the Surplus Facilities Management Program (SFMP). It describes the analysis and models used to derive site-specific guidelines for allowable residual concentrations of radionuclides in soil and the design and use of the RESRAD computer code for calculating guideline values. It also describes procedures for implementing DOE policy for reducing residual radioactivity to levels that are as low as reasonably achievable. 36 refs., 16 figs, 22 tabs.

  16. Critical Evaluation of Oncology Clinical Practice Guidelines

    PubMed Central

    Reames, Bradley N.; Krell, Robert W.; Ponto, Sarah N.; Wong, Sandra L.

    2013-01-01

    Purpose Significant concerns exist regarding the content and reliability of oncology clinical practice guidelines (CPGs). The Institute of Medicine (IOM) report “Clinical Practice Guidelines We Can Trust” established standards for developing trustworthy CPGs. By using these standards as a benchmark, we sought to evaluate recent oncology guidelines. Methods CPGs and consensus statements addressing the screening, evaluation, or management of the four leading causes of cancer-related mortality in the United States (lung, breast, prostate, and colorectal cancers) published between January 2005 and December 2010 were identified. A standardized scoring system based on the eight IOM standards was used to critically evaluate the methodology, content, and disclosure policies of CPGs. All CPGs were given two scores; points were awarded for eight standards and 20 subcriteria. Results No CPG fully met all the IOM standards. The average overall scores were 2.75 of 8 possible standards and 8.24 of 20 possible subcriteria. Less than half the CPGs were based on a systematic review. Only half the CPG panels addressed conflicts of interest. Most did not comply with standards for inclusion of patient and public involvement in the development or review process, nor did they specify their process for updating. CPGs were most consistent with IOM standards for transparency, articulation of recommendations, and use of external review. Conclusion The vast majority of oncology CPGs fail to meet the IOM standards for trustworthy guidelines. On the basis of these results, there is still much to be done to make guidelines as methodologically sound and evidence-based as possible. PMID:23752105

  17. Implementation of Spanish adaptation of the European guidelines on cardiovascular disease prevention in primary care

    PubMed Central

    2013-01-01

    Background The successful implementation of cardiovascular disease (CVD) prevention guidelines relies heavily on primary care physicians (PCPs) providing risk factor evaluation, intervention and patient education. The aim of this study was to ascertain the degree of awareness and implementation of the Spanish adaptation of the European guidelines on CVD prevention in clinical practice (CEIPC guidelines) among PCPs. Methods A cross-sectional survey of PCPs was conducted in Spain between January and June 2011. A random sample of 1,390 PCPs was obtained and stratified by region. Data were collected by means of a self-administered questionnaire. Results More than half (58%) the physicians were aware of and knew the recommendations, and 62% of those claimed to use them in clinical practice, with general physicians (without any specialist accreditation) being less likely to so than family doctors. Most PCPs (60%) did not assess cardiovascular risk, with the limited time available in the surgery being cited as the greatest barrier by 81%. The main reason to be sceptical about recommendations, reported by 71% of physicians, was that there are too many guidelines. Almost half the doctors cited the lack of training and skills as the greatest barrier to the implementation of lifestyle and behavioural change recommendations. Conclusions Most PCPs were aware of the Spanish adaptation of the European guidelines on CVD prevention (CEIPC guidelines) and knew their content. However, only one third of PCPs used the guidelines in clinical practice and less than half CVD risk assessment tools. PMID:23506390

  18. Randomized Controlled Trial of Education and Feedback for Implementation of Guidelines for Acute Low Back Pain

    PubMed Central

    Schectman, Joel M; Schroth, W Scott; Verme, Dante; Voss, John D

    2003-01-01

    OBJECTIVE The effect of clinical guidelines on resource utilization for complex conditions with substantial barriers to clinician behavior change has not been well studied. We report the impact of a multifaceted guideline implementation intervention on primary care clinician utilization of radiologic and specialty services for the care of acute low back pain. DESIGN Physician groups were randomized to receive guideline education and individual feedback, supporting patient education materials, both, or neither. The impact on guideline adherence and resource utilization was evaluated during the 12-month period before and after implementation. PARTICIPANTS Fourteen physician groups with 120 primary care physician and associate practitioners from 2 group model HMO practices. INTERVENTIONS Guideline implementation utilized an education/audit/feedback model with local peer opinion leaders. The patient education component included written and videotaped materials on the care of low back pain. MAIN RESULTS The clinician intervention was associated with an absolute increase in guideline-consistent behavior of 5.4% in the intervention group versus a decline of 2.7% in the control group (P = .04). The patient education intervention produced no significant change in guideline-consistent behavior, but was poorly adopted. Patient characteristics including duration of pain, prior history of low back pain, and number of visits during the illness episode were strong predictors of service utilization and guideline-consistent behavior. CONCLUSIONS Implementation of an education and feedback-supported acute low back pain care guideline for primary care clinicians was associated with an increase in guideline-consistent behavior. Patient education materials did not enhance guideline effectiveness. Implementation barriers could limit the utility of this approach in usual care setttings. PMID:14521638

  19. Clinical practice guidelines: what are they and how should they be disseminated?

    PubMed

    Graham, Brent

    2014-08-01

    Clinical practice guidelines summarize the available evidence for patient management in a format that is easy for clinicians to use. These guidelines usually use methodologically rigorous principles for retrieving and evaluating the literature and for establishing consensus among work group members, but implementation by clinicians is often incomplete. The reasons why guidelines fail to gain widespread acceptance vary with the topic and clinician group. Successful dissemination of practice guidelines requires an understanding of the barriers to implementation and the use of multiple strategies to address these. This article examines the factors affecting implementation and the approaches to overcoming these obstacles.

  20. Canadian Clinical Practice Guidelines for Rosacea.

    PubMed

    Asai, Yuka; Tan, Jerry; Baibergenova, Akerke; Barankin, Benjamin; Cochrane, Chris L; Humphrey, Shannon; Lynde, Charles W; Marcoux, Danielle; Poulin, Yves; Rivers, Jason K; Sapijaszko, Mariusz; Sibbald, R Gary; Toole, John; Ulmer, Marcie; Zip, Catherine

    2016-09-01

    Rosacea is a chronic facial inflammatory dermatosis characterized by background facial erythema and flushing and may be accompanied by inflammatory papules and pustules, cutaneous fibrosis and hyperplasia known as phyma, and ocular involvement. These features can have adverse impact on quality of life, and ocular involvement can lead to visual dysfunction. The past decade has witnessed increased research into pathogenic pathways involved in rosacea and the introduction of novel treatment innovations. The objective of these guidelines is to offer evidence-based recommendations to assist Canadian health care providers in the diagnosis and management of rosacea. These guidelines were developed by an expert panel of Canadian dermatologists taking into consideration the balance of desirable and undesirable outcomes, the quality of supporting evidence, the values and preferences of patients, and the costs of treatment. The 2015 Cochrane review "Interventions in Rosacea" was used as a source of clinical trial evidence on which to base the recommendations. PMID:27207355

  1. Dissemination and implementation of guidelines for the treatment of asthma.

    PubMed

    Tan, W C; Aït-Khaled, N

    2006-07-01

    Asthma remains a serious global health problem that affects people of all ages. Many asthma management guidelines, both national and international, are available, but they are seldom implemented. The implementation of guidelines remains a challenge worldwide, as barriers exist at several levels. These barriers are generic, such as poverty, inadequate resources and poor infrastructure, or specific, such as organisational, health care provider and patient factors. The barriers are, however, potentially correctable, and the goal of guideline implementation is to translate evidence-based asthma management recommendations into real-life practice to improve patient health. This state of the art article reviews the challenges and current status of and strategies for asthma dissemination and implementation globally, and highlights the specific strategies for such improvement in developing countries.

  2. PROGRESS results: implementation in stroke guidelines.

    PubMed

    Donnan, Geoffrey A

    2003-06-01

    The most important issues facing clinicians is the transfer of evidence from clinical trials into practice. Physician, patient and community acceptance of the evidence are key components of this process. Although barriers to this exist, in the case of transfer of evidence from the Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS) into clinical practice, these are minimal. Hence, transfer of this information into clinical practice should put blood pressure lowering in place as the fourth major secondary prevention strategy for stroke. PMID:12953853

  3. Current clinical practice guidelines in atrial fibrillation: a review.

    PubMed

    Galvez-Olortegui, José Kelvin; Álvarez-Vargas, Mayita Lizbeth; Galvez-Olortegui, Tomas Vladimir; Godoy-Palomino, Armando; Camacho-Saavedra, Luis

    2016-01-14

    The aim of this study is the methodological evaluation of Clinical Practice Guidelines (CPG) in atrial fibrillation. This is the second in a series of articles of review, analysis, assessment in methodology and content of clinical practice guidelines in Cardiology. Among all clinical practice guidelines, we selected the American, Canadian and NICE (National Institute for Health and Care Excellence) guidelines. We used the AGREE (Appraisal of Guidelines for Research and Evaluation) II instrument for the assessment. In general, the guidelines obtained the lowest score in the applicability domain (mean 36.1%); while the highest score was for clarity of presentation (mean 93.5%). The lowest percentage was found in the editorial independence domain (Canadian guideline) and the highest of all scores in the applicability domain (NICE guideline). Regarding global quality, the NICE guideline obtained the AGREE II instrument best scores, followed by the American guideline, both recommended for use without modifications.

  4. Current clinical practice guidelines in atrial fibrillation: a review.

    PubMed

    Galvez-Olortegui, José Kelvin; Álvarez-Vargas, Mayita Lizbeth; Galvez-Olortegui, Tomas Vladimir; Godoy-Palomino, Armando; Camacho-Saavedra, Luis

    2016-01-01

    The aim of this study is the methodological evaluation of Clinical Practice Guidelines (CPG) in atrial fibrillation. This is the second in a series of articles of review, analysis, assessment in methodology and content of clinical practice guidelines in Cardiology. Among all clinical practice guidelines, we selected the American, Canadian and NICE (National Institute for Health and Care Excellence) guidelines. We used the AGREE (Appraisal of Guidelines for Research and Evaluation) II instrument for the assessment. In general, the guidelines obtained the lowest score in the applicability domain (mean 36.1%); while the highest score was for clarity of presentation (mean 93.5%). The lowest percentage was found in the editorial independence domain (Canadian guideline) and the highest of all scores in the applicability domain (NICE guideline). Regarding global quality, the NICE guideline obtained the AGREE II instrument best scores, followed by the American guideline, both recommended for use without modifications. PMID:26939036

  5. A national survey of implementation of guidelines for gestational diabetes mellitus.

    PubMed

    O'Higgins, A; Dunne, F; Lee, B; Smith, D; Turner, M J

    2014-09-01

    In 2010, national guidelines for the management of gestational diabetes mellitus (GDM) were published by the Health Service Executive (HSE). In 2012, a questionnaire was distributed to all maternity units to survey implementation of the guidelines. All units screened women for GDM, but used different screening tests with fifteen units (79%) using the recommended 75g OGTT, three units (16%) using a 100g OGTT and one unit (5%) using a 50g glucose challenge test. Optimal outcomes are best achieved through multidisciplinary diabetes-obstetric care and this was available in nine of the units (47%). The prevalence of GDM varied from 2.2 - 7.4%. Insulin usage varied from 15-56%. Six centres (31%) had not implemented the national guidelines in full because of lack of resources. Despite national endorsement of the guideline, significant variations remain in implementation. This may lead to differences in clinical outcomes depending on where a woman attends for obstetric care.

  6. Microcomputers in Schools: Policy and Implementation Guidelines.

    ERIC Educational Resources Information Center

    Commonwealth Secretariat, London (England).

    This report is about information technology in the classroom and is designed to provide information to anyone who might be involved in the planning and implementation of a national program for the introduction of computers into schools. The first of two sections of the report examines the background against which policy decisions can be made,…

  7. State Laws and Guidelines for Implementing RTI

    ERIC Educational Resources Information Center

    Zirkel, Perry A.; Thomas, Lisa B.

    2010-01-01

    The legal source of schools' use of response to intervention (RTI) is a matter of federal and state special education laws, although its implementation is largely a matter of general education practice. The only mention of RTI is in the Individuals With Disabilities Education Act (IDEA), and it is limited to identification of students with…

  8. Guideline adaptation and implementation planning: a prospective observational study

    PubMed Central

    2013-01-01

    Background Adaptation of high-quality practice guidelines for local use has been advanced as an efficient means to improve acceptability and applicability of evidence-informed care. In a pan-Canadian study, we examined how cancer care groups adapted pre-existing guidelines to their unique context and began implementation planning. Methods Using a mixed-methods, case-study design, five cases were purposefully sampled from self-identified groups and followed as they used a structured method and resources for guideline adaptation. Cases received the ADAPTE Collaboration toolkit, facilitation, methodological and logistical support, resources and assistance as required. Documentary and primary data collection methods captured individual case experience, including monthly summaries of meeting and field notes, email/telephone correspondence, and project records. Site visits, process audits, interviews, and a final evaluation forum with all cases contributed to a comprehensive account of participant experience. Results Study cases took 12 to >24 months to complete guideline adaptation. Although participants appreciated the structure, most found the ADAPTE method complex and lacking practical aspects. They needed assistance establishing individual guideline mandate and infrastructure, articulating health questions, executing search strategies, appraising evidence, and achieving consensus. Facilitation was described as a multi-faceted process, a team effort, and an essential ingredient for guideline adaptation. While front-line care providers implicitly identified implementation issues during adaptation, they identified a need to add an explicit implementation planning component. Conclusions Guideline adaptation is a positive initial step toward evidence-informed care, but adaptation (vs. ‘de novo’ development) did not meet expectations for reducing time or resource commitments. Undertaking adaptation is as much about the process (engagement and capacity building) as it

  9. Guidelines for Implementing Change: A Case Study

    NASA Astrophysics Data System (ADS)

    Masekela, Belinda; Nienaber, Rita

    To attain and sustain a competitive advantage organizations are continually faced with the need to change their structures, processes and technologies. Converting to new technology and implementing a new information management system in an organization results in inevitable changes in organizational procedures impacting on the people involved. A major problem encountered during this process is resistance to change, which may contribute to total failure of this system. Change management is the process that can be used to negate this impact and assist employees in transitioning to a new way of doing things.

  10. [On the attractiveness, implementation and evaluation of guidelines].

    PubMed

    Nothacker, Monika; Muche-Borowski, Cathleen; Kopp, Ina; Selbmann, Hans Konrad; Neugebauer, Edmund A M

    2013-01-01

    Principles and conditions for guideline implementation and evaluation were the subject of a workshop organised by the German Association of the Scientific Medical Societies (AWMF) and the German Network for Health Services Research (DNVF). This report reflects contents and discussions and suggests possible future activities. The workshop highlighted the need for conceptual frameworks, theory-driven research and concerted strategies. The reinforcement of strategic partnerships within the health care organisations is an indispensable prerequisite for successful guideline implementation and evaluation.(As supplied by author).

  11. Clinical trials and the new good clinical practice guideline in Japan. An economic perspective.

    PubMed

    Ono, S; Kodama, Y

    2000-08-01

    Japanese clinical trials have been drastically changing in response to the implementation of the International Conference on Harmonisation-Good Clinical Practice (ICH-GCP) guideline in 1997. The most important aim of the new guideline is to standardise the quality of clinical trials in the US, European Union and Japan, but it inevitably imposes substantial costs on investigators, sponsors and even patients in Japan. The study environment in Japan differs from that in the US in several ways: (i) historical lack of a formal requirement for informed consent; (ii) patients' attitudes to clinical trials in terms of expectation of positive outcomes; (iii) the implications of universal health insurance for trial participation; (iv) the historical absence of on-site monitoring by the sponsor, with the attendant effects on study quality; and (v) the lack of adequate financial and personnel support for the conduct of trials. Implementation of the new GCP guideline will improve the ethical and scientific quality of trials conducted in Japan. It may also lead to an improved relationship between medical professionals and patients if the requirement for explicit informed consent in clinical trials leads to the provision of a similar level of patient information in routine care and changes the traditional paternalistic attitude of physicians to patients. The initial response of the Japanese 'market' for clinical trials to the implementation of the ICH-GCP guideline has been clinical trial price increases and a decrease in the number of study contracts. These changes can be explained by applying a simple demand-supply scheme. Whether clinical trials undertaken in Japan become more or less attractive to the industry in the long term will depend on other factors such as international regulations on the acceptability of foreign clinical trials and the reform of domestic healthcare policies. PMID:11067647

  12. Developing clinical practice guidelines for epilepsy: A report from the ILAE Epilepsy Guidelines Working Group.

    PubMed

    Sauro, Khara M; Wiebe, Samuel; Perucca, Emilio; French, Jacqueline; Dunkley, Colin; de Marinis, Alejandro; Kirkpatrick, Martin; Jetté, Nathalie

    2015-12-01

    Clinical practice guidelines (CPGs) contain evidence-based recommendations to guide clinical care, policy development, and quality of care improvement. A recent systematic review of epilepsy guidelines identified considerable variability in the quality of available guidelines. Although excellent frameworks for CPG development exist, processes are not followed uniformly internationally, and resources to develop CPGs may be limited in certain settings. An International League Against Epilepsy (ILAE) working group was charged with proposing methodology to guide the development of future epilepsy-specific CPGs. A comprehensive literature search (1985-2014) identified articles related to CPG development and handbooks. Guideline handbooks were included if they were publicly available, and if their methodology had been used to develop CPGs. The working group's expertise also informed the creation of methodologies and processes to develop future CPGs for the ILAE. Five handbooks from North America (American Academy of Neurology), Europe (Scottish Intercollegiate Guidelines Network & National Institute for Health and Care Excellence), Australia (National Health and Medical Research Council), World Health Organization (WHO), and additional references were identified to produce evidence-based, consensus-driven methodology for development of epilepsy-specific CPGs. Key components of CPG development include the following: identifying the topic and defining the scope; establishing a working group; identifying and evaluating the evidence; formulating recommendations and determining strength of recommendations; obtaining peer reviews; dissemination, implementation, and auditing; and updating and retiring the CPG. A practical handbook and toolkit was developed. The resulting CPG development toolkit should facilitate the development of high-quality ILAE CPGs to improve the care of persons with epilepsy.

  13. Getting patients to target- implementing the guidelines.

    PubMed

    Giannuzzi, Pantaleo

    2012-11-01

    All coronary patients should be advised and have the opportunity to access a comprehensive cardiovascular prevention and rehabilitation programme, addressing all aspects of lifestyle - smoking cessation, healthy eating and being physically active - together with more effective management of blood pressure, lipids and glucose. To achieve the clinical benefits of a multidisciplinary and multifactorial prevention programme we need to integrate professional lifestyle interventions with effective risk factor management, and evidence based drug therapies, appropriately adapted to the medical, cultural, and economic setting of a country. The challenge is to engage and motivate cardiologists, physicians and health professionals to routinely practice high quality preventive cardiology in hospital and community, and a health care system which invests in prevention.

  14. Snomed CT implementation. Mapping guidelines facilitating reuse of data.

    PubMed

    Randorff Højen, A; Rosenbeck Gøeg, K

    2012-01-01

    Clinical practice as well as research and quality-assurance benefit from unambiguous clinical information resulting from the use of a common terminology like the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT). A common terminology is a necessity to enable consistent reuse of data, and supporting semantic interoperability. Managing use of terminology for large cross specialty Electronic Health Record systems (EHR systems) or just beyond the level of single EHR systems requires that mappings are kept consistent. The objective of this study is to provide a clear methodology for SNOMED CT mapping to enhance applicability of SNOMED CT despite incompleteness and redundancy. Such mapping guidelines are presented based on an in depth analysis of 14 different EHR templates retrieved from five Danish and Swedish EHR systems. Each mapping is assessed against defined quality criteria and mapping guidelines are specified. Future work will include guideline validation.

  15. Implementing practice guidelines for anxiety disorders in secondary mental health care: a case study

    PubMed Central

    2012-01-01

    Background Recent years have seen the large-scale development of clinical practice guidelines for mental disorders in several countries. In the Netherlands, more than ten multidisciplinary guidelines for mental health care have been developed since 2003. The first dealt with the treatment of anxiety disorders. An important question was whether it is feasible to implement these guidelines because implementing practice guidelines is often difficult. Although several implementation interventions have proven effective, there seems to be no ready-made strategy that works in all circumstances. Case description The Dutch multidisciplinary guidelines for anxiety disorders were implemented in a community mental health care centre, located in the east of the Netherlands. The centre provides secondary outpatient care. The unit within the centre that specializes in the treatment of anxiety disorders has 16 team members with diverse professional backgrounds. Important steps in the process of implementing the guidelines were analysing the care provided before start of the implementation to determine the goals for improvement, and analysing the context and target group for implementation. Based on these analyses, a tailor-made multifaceted implementation strategy was developed that combined the reorganization of the care process, the development of instruction materials, the organization of educational meetings and the use of continuous quality circles to improve adherence to guidelines. Discussion and evaluation Significant improvements in adherence rates were made in the aspect of care that was targeted for change. An increase was found in the number of patients being provided with recommended forms of psychotherapeutic treatment, ranging from 43% to 54% (p < 0.01). The delivery of adequate pharmacological treatment was not explicitly targeted for change remained constant. Conclusion The case study presented here shows that the implementation of practice guidelines for

  16. Osteoporosis guideline implementation in family medicine using electronic medical records

    PubMed Central

    Pritchard, Janet; Karampatos, Sarah; Ioannidis, George; Adachi, Jonathan; Thabane, Lehana; Nash, Lynn; Mehan, Upe; Kozak, Joseph; Feldman, Sid; Hirsch, Steve; Jovaisas, Algis V.; Cheung, Angela; Lohfeld, Lynne; Papaioannou, Alexandra

    2016-01-01

    Abstract Objective To identify family physicians’ learning needs related to osteoporosis care; determine family physicians’ preferred modes of learning; and identify barriers to using electronic medical records (EMRs) to implement osteoporosis guidelines in practice. Design Web-based survey. Setting Ontario. Participants Family physicians. Main outcome measures Quantitative and qualitative data about learning needs related to osteoporosis diagnosis and management; preferred mode of learning about guidelines; and barriers to using EMRs to implement guidelines. Results Of the 12 332 family physicians invited to participate in the survey, 8.5% and 7.0% provided partial or fully completed surveys, respectively. More than 80% of respondents agreed that the priority areas for education were as follows: selecting laboratory tests for secondary osteoporosis and interpreting the test results; interpreting bone mineral density results; determining appropriate circumstances for ordering anterior-posterior lumbar spine x-ray scans; and understanding duration, types, and adverse effects of pharmacotherapy. Qualitative analysis revealed that managing moderate-risk patients was a learning need. Continuing medical education was the preferred mode of learning. Approximately 80% of respondents agreed that the scarcity of EMR tools to aid in guideline implementation was a barrier to using guidelines, and 50% of respondents agreed that if EMR-embedded tools were available, time would limit their ability to use them. Conclusion This survey identified key diagnostic- and treatment-related topics in osteoporosis care that should be the focus of future continuing professional development for family physicians. Developers of EMR tools, physicians, and researchers aiming to implement guidelines to improve osteoporosis care should consider the potential barriers indicated in this study.

  17. Evaluation Guidelines for the Clinical and Translational Science Awards (CTSAs)

    PubMed Central

    Trochim, William M.; Rubio, Doris M.; Thomas, Veronica G.

    2014-01-01

    The National Center for Advancing Translational Sciences (NCATS), a part of the National Institutes of Health, currently funds the Clinical and Translational Science Awards (CTSAs), a national consortium of 61 medical research institutions in 30 states and the District of Columbia. The program seeks to transform the way biomedical research is conducted, speed the translation of laboratory discoveries into treatments for patients, engage communities in clinical research efforts, and train a new generation of clinical and translational researchers.. An endeavor as ambitious and complex as the CTSA program requires high-quality evaluations in order to show that the program is well implemented, efficiently managed, and demonstrably effective. In this article, the Evaluation Key Function Committee of the CTSA Consortium presents an overall framework for evaluating the CTSA program and offers policies to guide the evaluation work. The guidelines set forth are designed to serve as a tool for education within the CTSA community by illuminating key issues and practices that should be considered during evaluation planning, implementation, and utilization. Additionally, these guidelines can provide a basis for ongoing discussions about how the principles articulated in this article can most effectively be translated into operational reality. PMID:23919366

  18. Supporting a distributed execution of clinical guidelines.

    PubMed

    Bottrighi, Alessio; Molino, Gianpaolo; Montani, Stefania; Terenziani, Paolo; Torchio, Mauro

    2013-10-01

    Clinical guidelines (GL) play an important role in medical practice: the one of optimizing the quality of patient care on the basis of evidence based medicine. In order to achieve this goal, the interaction between different agents, who cooperate in the execution of the same GL, is a crucial issue. As a matter of fact, in many cases (e.g. in chronic disorders) the GL execution requires that patient treatment is not performed/completed in the hospital, but is continued in different contexts (e.g. at home, or in the general practitioner's ambulatory), under the responsibility of different agents. In this situation, the correct interaction and communication between the agents themselves is critical for the quality of care, and human resources coordination is a key issue to be addressed by the managers of the involved healthcare services. In this paper we describe how GLARE (Guideline Acquisition, Representation, and Execution), a computerized GL management system, has been extended in order to support such a need. In particular, we have provided: (i) an extension to GL actions representation languages, (ii) proper scheduling and (iii) querying services. By means of these enhancements we aimed at guaranteeing (1) treatment continuity and (2) responsibility assignment support in the various steps of a coordinated and distributed patient care process. We illustrate our approach by means of a practical case study. PMID:23942331

  19. Chapter 688 Implementation Guidelines and Instructions for Local School Districts.

    ERIC Educational Resources Information Center

    Massachusetts State Executive Office of Human Services, Boston.

    The booklet presents guidelines for implementing Massachusetts Chapter 688, which provides for a 2-year transitional process to plan for habilitative services for severely disabled young adults who will lose their entitlement to special education upon graduation or reaching the age of 22. The law is intended to serve individuals who traditionally…

  20. How to Implement the NCAA Financial Audit Guidelines.

    ERIC Educational Resources Information Center

    Connolly, Lawrence C., Jr.; And Others

    1987-01-01

    Suggestions for implementing new National Collegiate Athletic Association guidelines for intercollegiate athletics program financial audits include forming an internal task force, preparing an organization chart, choosing the type of audit, conducting a survey of booster groups, preparing a schedule of revenues and expenditures, selecting an…

  1. The Infectious Diseases Society of America Lyme guidelines: a cautionary tale about the development of clinical practice guidelines.

    PubMed

    Johnson, Lorraine; Stricker, Raphael B

    2010-06-09

    Flawed clinical practice guidelines may compromise patient care. Commercial conflicts of interest on panels that write treatment guidelines are particularly problematic, because panelists may have conflicting agendas that influence guideline recommendations. Historically, there has been no legal remedy for conflicts of interest on guidelines panels. However, in May 2008, the Attorney General of Connecticut concluded a ground-breaking antitrust investigation into the development of Lyme disease treatment guidelines by one of the largest medical societies in the United States, the Infectious Diseases Society of America (IDSA). Although the investigation found significant flaws in the IDSA guidelines development process, the subsequent review of the guidelines mandated by the settlement was compromised by a lack of impartiality at various stages of the IDSA review process. This article will examine the interplay between the recent calls for guidelines reform, the ethical canons of medicine, and due process considerations under antitrust laws as they apply to the formulation of the IDSA Lyme disease treatment guidelines. The article will also discuss pitfalls in the implementation of the IDSA antitrust settlement that should be avoided in the future.

  2. The Infectious Diseases Society of America Lyme guidelines: a cautionary tale about the development of clinical practice guidelines

    PubMed Central

    2010-01-01

    Flawed clinical practice guidelines may compromise patient care. Commercial conflicts of interest on panels that write treatment guidelines are particularly problematic, because panelists may have conflicting agendas that influence guideline recommendations. Historically, there has been no legal remedy for conflicts of interest on guidelines panels. However, in May 2008, the Attorney General of Connecticut concluded a ground-breaking antitrust investigation into the development of Lyme disease treatment guidelines by one of the largest medical societies in the United States, the Infectious Diseases Society of America (IDSA). Although the investigation found significant flaws in the IDSA guidelines development process, the subsequent review of the guidelines mandated by the settlement was compromised by a lack of impartiality at various stages of the IDSA review process. This article will examine the interplay between the recent calls for guidelines reform, the ethical canons of medicine, and due process considerations under antitrust laws as they apply to the formulation of the IDSA Lyme disease treatment guidelines. The article will also discuss pitfalls in the implementation of the IDSA antitrust settlement that should be avoided in the future. PMID:20529367

  3. Implementing Thrombosis Guidelines in Cancer Patients: A Review

    PubMed Central

    Farge-Bancel, Dominique; Bounameaux, Henri; Brenner, Benjamin; Büller, Harry R.; Kakkar, Ajay; Pabinger, Ingrid; Streiff, Michael; Debourdeau, Philippe

    2014-01-01

    Venous thromboembolism is a frequent and serious complication in patients with cancer. It is an independent prognostic factor of death in cancer patients and the second leading cause of death, but physicians often underestimate its importance, as well as the need for adequate prevention and treatment. Management of venous thromboembolism in patients with cancer requires the coordinated efforts of a wide range of clinicians, highlighting the importance of a multidisciplinary approach. However, a lack of consensus among various national and international clinical practice guidelines has contributed to knowledge and practice gaps among practitioners, and inconsistent approaches to venous thromboembolism. The 2013 international guidelines for thrombosis in cancer have sought to address these gaps by critically re-evaluating the evidence coming from clinical trials and synthesizing a number of guidelines documents. An individualized approach to prophylaxis is recommended for all patients. PMID:25386357

  4. Requirements for guidelines systems: implementation challenges and lessons from existing software-engineering efforts

    PubMed Central

    2012-01-01

    Background A large body of work in the clinical guidelines field has identified requirements for guideline systems, but there are formidable challenges in translating such requirements into production-quality systems that can be used in routine patient care. Detailed analysis of requirements from an implementation perspective can be useful in helping define sub-requirements to the point where they are implementable. Further, additional requirements emerge as a result of such analysis. During such an analysis, study of examples of existing, software-engineering efforts in non-biomedical fields can provide useful signposts to the implementer of a clinical guideline system. Methods In addition to requirements described by guideline-system authors, comparative reviews of such systems, and publications discussing information needs for guideline systems and clinical decision support systems in general, we have incorporated additional requirements related to production-system robustness and functionality from publications in the business workflow domain, in addition to drawing on our own experience in the development of the Proteus guideline system (http://proteme.org). Results The sub-requirements are discussed by conveniently grouping them into the categories used by the review of Isern and Moreno 2008. We cite previous work under each category and then provide sub-requirements under each category, and provide example of similar work in software-engineering efforts that have addressed a similar problem in a non-biomedical context. Conclusions When analyzing requirements from the implementation viewpoint, knowledge of successes and failures in related software-engineering efforts can guide implementers in the choice of effective design and development strategies. PMID:22405400

  5. Effectiveness of electronic guideline-based implementation systems in ambulatory care settings - a systematic review

    PubMed Central

    2009-01-01

    Background Electronic guideline-based decision support systems have been suggested to successfully deliver the knowledge embedded in clinical practice guidelines. A number of studies have already shown positive findings for decision support systems such as drug-dosing systems and computer-generated reminder systems for preventive care services. Methods A systematic literature search (1990 to December 2008) of the English literature indexed in the Medline database, Embase, the Cochrane Central Register of Controlled Trials, and CRD (DARE, HTA and NHS EED databases) was conducted to identify evaluation studies of electronic multi-step guideline implementation systems in ambulatory care settings. Important inclusion criterions were the multidimensionality of the guideline (the guideline needed to consist of several aspects or steps) and real-time interaction with the system during consultation. Clinical decision support systems such as one-time reminders for preventive care for which positive findings were shown in earlier reviews were excluded. Two comparisons were considered: electronic multidimensional guidelines versus usual care (comparison one) and electronic multidimensional guidelines versus other guideline implementation methods (comparison two). Results Twenty-seven publications were selected for analysis in this systematic review. Most designs were cluster randomized controlled trials investigating process outcomes more than patient outcomes. With success defined as at least 50% of the outcome variables being significant, none of the studies were successful in improving patient outcomes. Only seven of seventeen studies that investigated process outcomes showed improvements in process of care variables compared with the usual care group (comparison one). No incremental effect of the electronic implementation over the distribution of paper versions of the guideline was found, neither for the patient outcomes nor for the process outcomes (comparison two

  6. Innovations in American Society of Clinical Oncology Practice Guideline Development.

    PubMed

    Somerfield, Mark R; Bohlke, Kari; Browman, George P; Denduluri, Neelima; Einhaus, Kaitlin; Hayes, Daniel F; Khorana, Alok A; Miller, Robert S; Mohile, Supriya G; Oliver, Thomas K; Ortiz, Eduardo; Lyman, Gary H

    2016-09-10

    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.

  7. Clinical practice guideline: tonsillitis II. Surgical management.

    PubMed

    Windfuhr, Jochen P; Toepfner, Nicole; Steffen, Gregor; Waldfahrer, Frank; Berner, Reinhard

    2016-04-01

    In 2013, a total of 84,332 patients had undergone extracapsular tonsillectomies (TE) and 11,493 a tonsillotomy (TT) procedure in Germany. While the latter is increasingly performed, the number of the former is continually decreasing. However, a constant number of approximately 12,000 surgical procedures in terms of abscess-tonsillectomies or incision and drainage are annually performed in Germany to treat patients with a peritonsillar abscess. The purpose of this part of the clinical guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through the surgical treatment options to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical treatment options encompass intracapsular as well as extracapsular tonsil surgery and are related to three distinct entities: recurrent episodes of (1) acute tonsillitis, (2) peritonsillar abscess and (3) infectious mononucleosis. Conservative management of these entities is subject of part I of this guideline. (1) The quality of evidence for TE to resolve recurrent episodes of tonsillitis is moderate for children and low for adults. Conclusions concerning the efficacy of TE on the number of sore throat episodes per year are limited to 12 postoperative months in children and 5-6 months in adults. The impact of TE on the number of sore throat episodes per year in children is modest. Due to the heterogeneity of data, no firm conclusions on the effectiveness of TE in adults can be drawn. There is still an urgent need for further research to reliably estimate the value of TE compared to non-surgical therapy of tonsillitis/tonsillo-pharyngitis. The impact of TE on quality of life is considered as being positive, but further research is mandatory to establish appropriate inventories and standardized evaluation procedures, especially in children. In contrast to TE, TT or comparable procedures are characterized by a substantially lower postoperative

  8. The Digital electronic Guideline Library (DeGeL): a hybrid framework for representation and use of clinical guidelines.

    PubMed

    Shahar, Yuval; Young, Ohad; Shalom, Erez; Mayaffit, Alon; Moskovitch, Robert; Hessing, Alon; Galperin, Maya

    2004-01-01

    We propose to present a poster (and potentially also a demonstration of the implemented system) summarizing the current state of our work on a hybrid, multiple-format representation of clinical guidelines that facilitates conversion of guidelines from free text to a formal representation. We describe a distributed Web-based architecture (DeGeL) and a set of tools using the hybrid representation. The tools enable performing tasks such as guideline specification, semantic markup, search, retrieval, visualization, eligibility determination, runtime application and retrospective quality assessment. The representation includes four parallel formats: Free text (one or more original sources); semistructured text (labeled by the target guideline-ontology semantic labels); semiformal text (which includes some control specification); and a formal, machine-executable representation. The specification, indexing, search, retrieval, and browsing tools are essentially independent of the ontology chosen for guideline representation, but editing the semi-formal and formal formats requires ontology-specific tools, which we have developed in the case of the Asbru guideline-specification language. The four formats support increasingly sophisticated computational tasks. The hybrid guidelines are stored in a Web-based library. All tools, such as for runtime guideline application or retrospective quality assessment, are designed to operate on all representations. We demonstrate the hybrid framework by providing examples from the semantic markup and search tools.

  9. A physician order category-based clinical guideline comparison system.

    PubMed

    Yu, Hwan-Jeu; Shen, Chia-Ping; Dorjgochoo, Sarangerel; Chen, Chi-Huang; Wu, Jin-Ming; Lai, Mei-Shu; Tan, Ching-Ting; Jigjidsuren, Chinburen; Altangerel, Erdenebaatar; Lee, Hung-Chang; Hsueh, Chih-Wen; Chung, Yufang; Lai, Feipei

    2012-12-01

    Today, in order to provide high-quality medical services and to extend resources and reduce costs, many large hospitals have adopted clinical guidelines as a structured way to manage medical activities. However, customization of clinical guidelines in order to treat a large number of patients is a major challenge. In this paper, we present a physician order category-based clinical guideline comparison system. The system uses a preprocessor software to convert the clinical guidelines from a Microsoft Word document into XML format, and it can also compare clinical guidelines over the conceptual view such as the physician order category. The system has already been used to compare the HCC surgical clinical guidelines of Taiwan and Mongolia-resulting in some differences being found, for which possible causes were discussed. Therefore, it can be seen that our research provides a practical and convenient way in which to compare clinical guidelines based on physician order category-thereby saving time and enabling physicians to quickly resolve discrepancies and make necessary adjustments to clinical guidelines. PMID:22460565

  10. Ministry of Health Clinical Practice Guidelines: Diabetes Mellitus.

    PubMed

    Goh, S Y; Ang, S B; Bee, Y M; Chen, Y T; Gardner, D S; Ho, E T; Adaikan, K; Lee, Y C; Lee, C H; Lim, F S; Lim, H B; Lim, S C; Seow, J; Soh, A W; Sum, C F; Tai, E S; Thai, A C; Wong, T Y; Yap, F

    2014-06-01

    The Ministry of Health (MOH) have updated the clinical practice guidelines on Diabetes Mellitus to provide doctors and patients in Singapore with evidence-based treatment for diabetes mellitus. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Diabetes Mellitus, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

  11. Do guidelines influence the implementation of health programs? — Uganda’s experience

    PubMed Central

    2012-01-01

    Background A guideline contains processes and procedures intended to guide health service delivery. However, the presence of guidelines may not guarantee their implementation, which may be a result of weaknesses in the development process. This study was undertaken to describe the processes of developing health planning, services management, and clinical guidelines within the health sector in Uganda, with the goal of understanding how these processes facilitate or abate the utility of guidelines. Methods Qualitative and quantitative research methods were used to collect and analyze data. Data collection was undertaken at the levels of the central Ministry of Health, the district, and service delivery. Qualitative methods included review of documents, observations, and key informant interviews, as well as quantitative aspects included counting guidelines. Quantitative data were analyzed with Microsoft Excel, and qualitative data were analyzed using deductive content thematic analysis. Results There were 137 guidelines in the health sector, with programs related to Millennium Development Goals having the highest number (n = 83). The impetus for guideline development was stated in 78% of cases. Several guidelines duplicated content, and some conflicted with each other. The level of consultation varied, and some guidelines did not consider government-wide policies and circumstances at the service delivery level. Booklets were the main format of presentation, which was not tailored to the service delivery level. There was no framework for systematic dissemination, and target users were defined broadly in most cases. Over 60% of guidelines available at the central level were not available at the service delivery level, but there were good examples in isolated cases. There was no framework for systematic monitoring of use, evaluation, and review of guidelines. Suboptimal performance of the supervision framework that would encourage the use of guidelines, assess their

  12. Implementation of Anaphylaxis Management Guidelines: A Register-Based Study

    PubMed Central

    Grabenhenrich, Linus; Hompes, Stephanie; Gough, Hannah; Ruëff, Franziska; Scherer, Kathrin; Pföhler, Claudia; Treudler, Regina; Mahler, Vera; Hawranek, Thomas; Nemat, Katja; Koehli, Alice; Keil, Thomas; Worm, Margitta

    2012-01-01

    Background Anaphylaxis management guidelines recommend the use of intramuscular adrenaline in severe reactions, complemented by antihistamines and corticoids; secondary prevention includes allergen avoidance and provision of self-applicable first aid drugs. Gaps between recommendations and their implementation have been reported, but only in confined settings. Hence, we analysed nation-wide data on the management of anaphylaxis, evaluating the implementation of guidelines. Methods Within the anaphylaxis registry, allergy referral centres across Germany, Austria and Switzerland provided data on severe anaphylaxis cases. Based on patient records, details on reaction circumstances, diagnostic workup and treatment were collected via online questionnaire. Report of anaphylaxis through emergency physicians allowed for validation of registry data. Results 2114 severe anaphylaxis patients from 58 centres were included. 8% received adrenaline intravenously, 4% intramuscularly; 50% antihistamines, and 51% corticoids. Validation data indicated moderate underreporting of first aid drugs in the Registry. 20% received specific instructions at the time of the reaction; 81% were provided with prophylactic first aid drugs at any time. Conclusion There is a distinct discrepancy between current anaphylaxis management guidelines and their implementation. To improve patient care, a revised approach for medical education and training on the management of severe anaphylaxis is warranted. PMID:22590513

  13. Applying artificial intelligence to clinical guidelines: the GLARE approach.

    PubMed

    Terenziani, Paolo; Montani, Stefania; Bottrighi, Alessio; Molino, Gianpaolo; Torchio, Mauro

    2008-01-01

    We present GLARE, a domain-independent system for acquiring, representing and executing clinical guidelines (GL). GLARE is characterized by the adoption of Artificial Intelligence (AI) techniques in the definition and implementation of the system. First of all, a high-level and user-friendly knowledge representation language has been designed. Second, a user-friendly acquisition tool, which provides expert physicians with various forms of help, has been implemented. Third, a tool for executing GL on a specific patient has been made available. At all the levels above, advanced AI techniques have been exploited, in order to enhance flexibility and user-friendliness and to provide decision support. Specifically, this chapter focuses on the methods we have developed in order to cope with (i) automatic resource-based adaptation of GL, (ii) representation and reasoning about temporal constraints in GL, (iii) decision making support, and (iv) model-based verification. We stress that, although we have devised such techniques within the GLARE project, they are mostly system-independent, so that they might be applied to other guideline management systems.

  14. The U.S. prevention of cardiovascular disease guidelines and implications for implementation in LMIC.

    PubMed

    Wong, Nathan D; Moran, Andrew E

    2014-12-01

    The 2013 guidelines for the Prevention of Cardiovascular Disease released by the American College of Cardiology and the American Heart Association included guidelines of assessment of cardiovascular disease (CVD) risk, lifestyle management, management of overweight and obesity, and treatment of blood cholesterol. In addition, there were also 2014 guidelines on hypertension management released by members appointed to the Eighth Joint National Committee. Taken together, these guidelines, though extensively discussed and disseminated in the United States, have not been widely recognized beyond the United States, nor have their implications been considered for lower- and middle-income developing countries. With an estimated 80% of the global burden in CVD occurring in developing countries, it is important to develop strategies to adequately detect those at increased CVD risk and to manage their risk through lifestyle and where appropriate, pharmacologic means. Though certain aspects of each guideline may be suitable for implementation globally, including in developing countries, other recommendations would be unrealistic for many countries based on local epidemiology and resources. CVD prevention priorities can be set using guidance from recently published CVD prevention guidelines if appropriately modified to the context of lower- and middle-income developing countries. Establishment of global CVD prevention standards and rapid adaptation and dissemination of clinical guidelines are of paramount importance if we are to make significant progress into achieving World Health Organization 2025 goals to reduce the burden from CVD and other noncommunicable diseases. PMID:25592799

  15. Considerations on the Improved Integration of Medical Guidelines into Routine Clinical Practice – a Review and Concept Proposal

    PubMed Central

    Beckmann, M. W.; Schlieter, H.; Richter, P.; Wesselmann, S.

    2016-01-01

    Medical guidelines have become established as the standard for the comprehensive synopsis of all available information (scientific trials, expert opinion) on diagnosis and treatment recommendations. The transfer of guidelines to clinical practice and subsequent monitoring has however proven difficult. In particular the potential interaction between guideline developers and guideline users has not been fully utilised. This review article analyses the status quo and existing methodological and technical information solutions supporting the guideline life cycle. It is shown that there are numerous innovative developments that in isolation do not provide comprehensive support. The vision of the “Living Guidelines 2.0” is therefore presented. This outlines the merging of guideline development and implementation on the basis of clinical pathways and guideline-based quality control, and building on this, the generation of information for guideline development and research. PMID:27134291

  16. Methodology manual for European Association for Cardio-Thoracic Surgery (EACTS) clinical guidelines.

    PubMed

    Sousa-Uva, Miguel; Head, Stuart J; Thielmann, Matthias; Cardillo, Giuseppe; Benedetto, Umberto; Czerny, Martin; Dunning, Joel; Castella, Manuel; Gudbjartsson, Tomas; Howell, Neil; Hazekamp, Mark; Kolh, Philippe; Beyersdorf, Friedhelm; Pagano, Domenico; Kappetein, A Pieter

    2015-12-01

    The goal of all clinical guidelines is to assist patients and practitioners in making healthcare decisions. However, clinical guidelines have been questioned about their quality, transparency and independence. Based on the revision of manuals by other scientific cardiothoracic organizations, this document provides instructions for the development of European Association for Cardio-Thoracic Surgery (EACTS) clinical guidelines and other types of evidence-based documents. Four key areas have been addressed: (i) selection of taskforce members and transparency of relations with the industry, (ii) methods for critical appraisal of medical evidence, (iii) rules for writing recommendations and (iv) review process. It is hoped that, by adopting this methodology, clinical guidelines produced by the EACTS will be well balanced, objective and, importantly, trusted by physicians and patients who benefit from their implementation.

  17. Guide to clinical practice guidelines: the current state of play

    PubMed Central

    Kredo, Tamara; Bernhardsson, Susanne; Machingaidze, Shingai; Young, Taryn; Louw, Quinette; Ochodo, Eleanor; Grimmer, Karen

    2016-01-01

    Introduction Extensive research has been undertaken over the last 30 years on the methods underpinning clinical practice guidelines (CPGs), including their development, updating, reporting, tailoring for specific purposes, implementation and evaluation. This has resulted in an increasing number of terms, tools and acronyms. Over time, CPGs have shifted from opinion-based to evidence-informed, including increasingly sophisticated methodologies and implementation strategies, and thus keeping abreast of evolution in this field of research can be challenging. Methods This article collates findings from an extensive document search, to provide a guide describing standards, methods and systems reported in the current CPG methodology and implementation literature. This guide is targeted at those working in health care quality and safety and responsible for either commissioning, researching or delivering health care. It is presented in a way that can be updated as the field expands. Conclusion CPG development and implementation have attracted the most international interest and activity, whilst CPG updating, adopting (with or without contextualization), adapting and impact evaluation are less well addressed. PMID:26796486

  18. Clinical Practice Guidelines for Endoscope Reprocessing

    PubMed Central

    Oh, Hyun Jin

    2015-01-01

    Gastrointestinal endoscopy is effective and safe for the screening, diagnosis, and treatment of gastrointestinal disease. However, issues regarding endoscope-transmitted infections are emerging. Many countries have established and continuously revise guidelines for endoscope reprocessing in order to prevent infections. While there are common processes used in endoscope reprocessing, differences exist among these guidelines. It is important that the reprocessing of gastrointestinal endoscopes be carried out in accordance with the recommendations for each step of the process. PMID:26473117

  19. Representing clinical guidelines in UMl: a comparative study.

    PubMed

    Hederman, Lucy; Smutek, Daniel; Wade, Vincent; Knape, Thomas

    2002-01-01

    Clinical guidelines can be represented using models, such as GLIF, specifically designed for healthcare guidelines. This paper demonstrates that they can also be modelled using a mainstream business modelling language such as UML. The paper presents a guideline in GLIF and as UML activity diagrams, and then presents a mapping of GLIF primitives to UML. The potential benefits of using a mainstream modelling language are outlined. These include availability of advanced modelling tools, transfer between modelling tools, and automation via business workflow technology.

  20. Defining ‘elderly’ in clinical practice guidelines for pharmacotherapy

    PubMed Central

    Singh, Shamsher; Bajorek., Beata

    2014-01-01

    Objective: To identify how ‘elderly’ patients are defined and considered within Australian clinical guidelines for the use of pharmacotherapy. Method: Guidelines pertaining to the use of pharmacotherapy, focusing on conditions described in National Health Priority Areas, were identified using databases (Medline, Google Scholar) and organisation websites (Department of Health and Ageing, National Heart Foundation, National Health and Medical Research Council). Guidelines were reviewed and qualitatively analysed to identify any references or definitions of ‘elderly’ persons. Results: Among the 20 guidelines reviewed, 3 defined ‘elderly’ by chronological age (i.e., years since birth) while the remaining 17 guidelines did not define ‘elderly’ in any way. All 20 guidelines used the term ‘elderly’, whilst some guidelines provided age (chronological)-based dosage recommendations suggesting an ageist or generalist approach in their representation of ‘elderly’, for which rationale was seldom provided. Thematic analysis of the statements revealed five key themes regarding how ‘elderly’ was considered within the guidelines, broadly describing ‘elderly’ persons as being frail and with altered pharmacology. Some guidelines also highlighted the limited evidence base to direct clinical decision-making. A continuum of perceptions of ageing also emerged out of the identified themes. Conclusion: Clinical practice guidelines currently do not adequately define ‘elderly’ persons and provide limited guidance on how to apply treatment recommendations to older persons. The representation of ‘elderly’ in guidelines needs to be less based on chronological age or generic definitions focusing more on establishing a direct link between an individual patient’s characteristics and the pharmacology of their prescribed medication. Clinical guidelines that do not offer any practical descriptions of the features of ageing that are specifically related to the

  1. Diversity in clinical guidelines: the role of repertoires of evaluation.

    PubMed

    Moreira, Tiago

    2005-05-01

    Clinical practice guidelines are one of the main tools by which clinicians, policy makers and patients hope to make health care less variable, more reliable and efficient, but there is little understanding of the processes by which clinical guidance is put together by guideline groups. This paper describes the social organisation of knowledge within clinical practice guideline development processes by drawing on the sociology of situated judgement. Two guideline development processes were observed, and the development group meetings (N = 21) recorded and analysed qualitatively. Data analysis suggested that clinical guidance comes to existence through the combination of repertoires of evaluation, organised around four different epistemic criteria: robustness, usability, acceptability and adequacy. This research provides a detailed and layered understanding of the knowledge dynamics involved in developing recommendations for appropriate health care for specific clinical circumstance.

  2. The development of a guideline implementability tool (GUIDE-IT): a qualitative study of family physician perspectives

    PubMed Central

    2014-01-01

    Background The potential of clinical practice guidelines has not been realized due to inconsistent adoption in clinical practice. Optimising intrinsic characteristics of guidelines (e.g., its wording and format) that are associated with uptake (as perceived by their end users) may have potential. Using findings from a realist review on guideline uptake and consultation with experts in guideline development, we designed a conceptual version of a future tool called Guideline Implementability Tool (GUIDE-IT). The tool will aim to involve family physicians in the guideline development process by providing a process to assess draft guideline recommendations. This feedback will then be given back to developers to consider when finalizing the recommendations. As guideline characteristics are best assessed by end-users, the objectives of the current study were to explore how family physicians perceive guideline implementability, and to determine what components should comprise the final GUIDE-IT prototype. Methods We conducted a qualitative study with family physicians inToronto, Ontario. Two experienced investigators conducted one-hour interviews with family physicians using a semi-structured interview guide to 1) elicit feedback on perceptions on guideline implementability; 2) to generate a discussion in response to three draft recommendations; and 3) to provide feedback on the conceptual GUIDE-IT. Sessions were audio taped and transcribed verbatim. Data collection and analysis were guided by content analyses. Results 20 family physicians participated. They perceived guideline uptake according to facilitators and barriers across 6 categories of guideline implementability (format, content, language, usability, development, and the practice environment). Participants’ feedback on 3 draft guideline recommendations were grouped according to guideline perception, cognition, and agreement. When asked to comment on GUIDE-IT, most respondents believed that the tool would be

  3. Wiki-Based Clinical Practice Guidelines for the Management of Adult Onset Sarcoma: A New Paradigm in Sarcoma Evidence

    PubMed Central

    Neuhaus, S. J.; Thomas, D.; Desai, J.; Vuletich, C.; von Dincklage, J.; Olver, I.

    2015-01-01

    In 2013 Australia introduced Wiki-based Clinical Practice Guidelines for the Management of Adult Onset Sarcoma. These guidelines utilized a customized MediaWiki software application for guideline development and are the first evidence-based guidelines for clinical management of sarcoma. This paper presents our experience with developing and implementing web-based interactive guidelines and reviews some of the challenges and lessons from adopting an evidence-based (rather than consensus-based) approach to clinical sarcoma guidelines. Digital guidelines can be easily updated with new evidence, continuously reviewed and widely disseminated. They provide an accessible method of enabling clinicians and consumers to access evidence-based clinical practice recommendations and, as evidenced by over 2000 views in the first four months after release, with 49% of those visits being from countries outside of Australia. The lessons learned have relevance to other rare cancers in addition to the international sarcoma community. PMID:25784832

  4. Knowledge translation in emergency medical services: A qualitative survey of barriers to guideline implementation

    PubMed Central

    Bigham, Blair L.; Aufderheide, Tom P.; Davis, Daniel P.; Powell, Judy; Donn, Stuart; Suffoletto, Brian; Nafziger, Sarah; Stouffer, John; Morrison, Laurie J.

    2010-01-01

    Background The American Heart Association (AHA) released guidelines to improve survival rates from out-of-hospital cardiac arrest in 2005. We sought to identify what barriers delayed the implementation of these guidelines in EMS agencies. Methods We surveyed 178 EMS agencies as part of a larger quantitative survey regarding guideline implementation and conducted a single-question semi-structured interview using the Grounded Theory method. We asked “What barriersm if any, delayed implementation of the (2005 AHA) guidelines in your EMS agency?” Data were coded and member validation was employed to verify our findings. Results 176/178 agencies completed the quantitative survey. Qualitative data collection ceased after reaching theoretical saturation with 34 interviews. Ten unique barriers were identified. We categorized these ten barriers into three themes. The theme Instruction Delays (reported by 41% of respondents) included three barriers: booking/training instructors (9%), receiving training materials (15%), and scheduling staff for training (18%). The second theme, Defibrillator Delays (38%), included two barriers; reprogramming defibrillators (24%) and receiving new defibrillators to replace non-upgradeable units (15%). The third theme was Decision-Making (38%) and included five barriers; coordinating with allied agencies (9%), government regulators such as state and provincial health authorities (9%), medical direction and base hospitals (9%), ROC participation (9%), and internal crises (3%). Conclusion Many barriers contributed to delays in the implementation of the 2005 AHA guidelines in EMS agencies. These identified barriers should be proactively addressed prior to the 2010 Guidelines to facilitate rapid translation of science into clinical practice. PMID:20398994

  5. Formal consensus: the development of a national clinical guideline

    PubMed Central

    Rycroft-Malone, J

    2001-01-01

    Background—There is currently a political enthusiasm for the development and use of clinical guidelines despite, paradoxically, there being relatively few healthcare issues that have a sound research evidence base. As decisions have to be made even where there is an undetermined evidence base and that limiting recommendations to where evidence exists may reduce the scope of guidelines, thus limiting their value to practitioners, guideline developers have to rely on various different sources of evidence and adapt their methods accordingly. This paper outlines a method for guideline development which incorporates a consensus process devised to tackle the challenges of a variable research evidence base for the development of a national clinical guideline on risk assessment and prevention of pressure ulcers. Method—To inform the recommendations of the guideline a formal consensus process based on a nominal group technique was used to incorporate three strands of evidence: research, clinical expertise, and patient experience. Results—The recommendations for this guideline were derived directly from the statements agreed in the formal consensus process and from key evidence-based findings from the systematic reviews. The existing format of the statements that participants had rated allowed a straightforward revision to "active" recommendations, thus reducing further risk of subjectivity entering into the process. Conclusions—The method outlined proved to be a practical and systematic way of integrating a number of different evidence sources. The resultant guideline is a mixture of research based and consensus based recommendations. Given the lack of available guidance on how to mix research with expert opinion and patient experiences, the method used for the development of this guideline has been outlined so that other guideline developers may use, adapt, and test it further. Key Words: guidelines; guideline development; formal consensus process; nominal group

  6. Clinical practice guidelines for mild traumatic brain injury and persistent symptoms

    PubMed Central

    Marshall, Shawn; Bayley, Mark; McCullagh, Scott; Velikonja, Diana; Berrigan, Lindsay

    2012-01-01

    Abstract Objective To outline new guidelines for the management of mild traumatic brain injury (MTBI) and persistent postconcussive symptoms (PPCS) in order to provide information and direction to physicians managing patients’ recovery from MTBI. Quality of evidence A search for existing clinical practice guidelines addressing MTBI and a systematic review of the literature evaluating treatment of PPCS were conducted. Because little guidance on the management of PPCS was found within the traumatic brain injury field, a second search was completed for clinical practice guidelines and systematic reviews that addressed management of these common symptoms in the general population. Health care professionals representing a range of disciplines from across Canada and abroad were brought together at an expert consensus conference to review the existing guidelines and evidence and to attempt to develop a comprehensive guideline for the management of MTBI and PPCS. Main message A modified Delphi process was used to create 71 recommendations that address the diagnosis and management of MTBI and PPCS. In addition, numerous resources and tools were included in the guideline to aid in the implementation of the recommendations. Conclusion A clinical practice guideline was developed to aid health care professionals in implementing evidence-based, best-practice care for the challenging population of individuals who experience PPCS following MTBI. PMID:22518895

  7. Implementing guidelines for the treatment of acute otitis media.

    PubMed

    Barenkamp, Stephen J

    2006-01-01

    The recently published Clinical Practice Guideline for the Diagnosis and Management of Acute Otitis Media represents a sincere effort by the AAP andthe AAFP to provide management guidelines for the practitioner based upon the best scientific evidence available. Despite many years of research and hundreds of clinical studies addressing various aspects of the epidemiology, clinical presentation, and treatment of acute otitis media, important questions remain unaddressed or have been addressed in a less than optimal fashion. These gaps in knowledge and deficiencies in several of the studies that formed the scientific basis for the proposed guidelines are the major reasons behind continued disagreement over certain recommendations. Until more comprehensive and careful analyses can be performed, disagreements are likely to persist. Even so, there is general agreement about most of the recommendations made in these guidelines, and these recommendations will provide a very valuable framework for the practicing physician as he or she cares for children with acute otitis media. To briefly review the major points, first is the critical importance of accurately diagnosing acute otitis media using a combination of clinical findings and observable abnormalities of the tympanic membrane and middle ear space. Particularly important is the differentiation of acute otitis media from otitis media with effusion. Second is the value of treating the pain associated with acute otitis media as a regular component of care, irrespective of any decision concerning antimicrobial treatment. Third is the option, for a select group of older patients with nonsevere disease, of withholding antimicrobial therapy for the first 48 to 72 hours, if close follow-up and active parental involvement can be guaranteed. Fourth is the recommendation that if an antimicrobial agent is used, high-dose amoxicillin (80 to 90 mg/kg/d) is the treatment of choice for most children at the time of initial presentation

  8. Implementing distress management guidelines in ambulatory oncology: a quality improvement project.

    PubMed

    Hammelef, Karen J; Friese, Christopher R; Breslin, Tara M; Riba, Michelle; Schneider, Susan M

    2014-01-01

    Distress assessment and referral to psychosocial services is an essential component of evidence-based oncologic nursing care. Oncology nurses have an opportunity to address patient distress needs through leadership of implementation programs and support for the positive outcomes that engaging in psychosocial services provides. This quality improvement project was conducted to evaluate the feasibility and utility of the National Comprehensive Cancer Network's distress management clinical practice guidelines in ambulatory oncology. A theoretical framework guided the process design that included staff education, screening, and management in a cohort implementation project with historical control. PMID:24480661

  9. The clinical algorithm nosology: a method for comparing algorithmic guidelines.

    PubMed

    Pearson, S D; Margolis, C Z; Davis, S; Schreier, L K; Gottlieb, L K

    1992-01-01

    Concern regarding the cost and quality of medical care has led to a proliferation of competing clinical practice guidelines. No technique has been described for determining objectively the degree of similarity between alternative guidelines for the same clinical problem. The authors describe the development of the Clinical Algorithm Nosology (CAN), a new method to compare one form of guideline: the clinical algorithm. The CAN measures overall design complexity independent of algorithm content, qualitatively describes the clinical differences between two alternative algorithms, and then scores the degree of similarity between them. CAN algorithm design-complexity scores correlated highly with clinicians' estimates of complexity on an ordinal scale (r = 0.86). Five pairs of clinical algorithms addressing three topics (gallstone lithotripsy, thyroid nodule, and sinusitis) were selected for interrater reliability testing of the CAN clinical-similarity scoring system. Raters categorized the similarity of algorithm pathways in alternative algorithms as "identical," "similar," or "different." Interrater agreement was achieved on 85/109 scores (80%), weighted kappa statistic, k = 0.73. It is concluded that the CAN is a valid method for determining the structural complexity of clinical algorithms, and a reliable method for describing differences and scoring the similarity between algorithms for the same clinical problem. In the future, the CAN may serve to evaluate the reliability of algorithm development programs, and to support providers and purchasers in choosing among alternative clinical guidelines.

  10. Thou shalt versus thou shalt not: a meta-synthesis of GPs' attitudes to clinical practice guidelines

    PubMed Central

    Carlsen, Benedicte; Glenton, Claire; Pope, Catherine

    2007-01-01

    Background GPs' adherence to clinical practice guidelines is variable. Barriers to guideline implementation have been identified but qualitative studies have not been synthesised to explore what underpins these attitudes. Aim To explore and synthesise qualitative research on GPs' attitudes to and experiences with clinical practice guidelines. Design of study Systematic review and meta-synthesis of qualitative studies. Method PubMed, CINAHL, EMBASE, Social Science Citation Index, and Science Citation Index were used as data sources, and independent data extraction was carried out. Discrepancies were resolved by consensus. Initial thematic analysis was conducted, followed by interpretative synthesis. Results Seventeen studies met the inclusion criteria. Five were excluded following quality appraisal. Twelve papers were synthesised which reported research in the UK, US, Canada, and the Netherlands, and covered different clinical guideline topics. Six themes were identified: questioning the guidelines, GPs' experience, preserving the doctor–patient relationship, professional responsibility, practical issues, and guideline format. Comparative analysis and synthesis revealed that GPs' reasons for not following guidelines differed according to whether the guideline in question was prescriptive, in that it encouraged a certain type of behaviour or treatment, or proscriptive, in that it discouraged certain treatments or behaviours. Conclusion Previous analyses of guidelines have focused on professional attitudes and organisational barriers to adherence. This synthesis suggests that the purpose of the guideline, whether its aims are prescriptive or proscriptive, may influence if and how guidelines are received and implemented. PMID:18252073

  11. How Public Health Nurses Identify and Intervene in Child Maltreatment Based on the National Clinical Guideline

    PubMed Central

    Eija, Paavilainen; Mika, Helminen; Aune, Flinck; Leila, Lehtomäki

    2014-01-01

    Objectives. To describe how Finnish public health nurses identify and intervene in child maltreatment and how they implement the National Clinical Guideline in their work. Design and Sample. Cross-sectional survey of 367 public health nurses in Finland. Measures. A web-based questionnaire developed based on the content areas of the guideline: identifying, intervening, and implementing. Results. The respondents reported they identify child maltreatment moderately (mean 3.38), intervene in it better (4.15), and implement the guideline moderately (3.43, scale between 1 and 6). Those with experience of working with maltreated children reported they identify them better (P < 0.001), intervene better (P < 0.001), and implement the guideline better (P < 0.001) than those with no experience. This difference was also found for those who were aware of the guideline, had read it, and participated in training on child maltreatment, as compared to those who were not aware of the guideline, had not read it, or had not participated in such training. Conclusions. The public health nurses worked quite well with children who had experienced maltreatment and families. However, the results point out several developmental targets for increasing training on child maltreatment, for devising recommendations for child maltreatment, and for applying these recommendations systematically in practice. PMID:25505986

  12. Development of clinical policies and guidelines in acute settings.

    PubMed

    Collins, Sean; Patel, Seraphim

    This article outlines a model for developing policies and discusses some of the issues involved in the process of writing, approving and disseminating clinical policies and guidelines. It does not seek to dwell on policy drafting per se because guidance is readily available that can help authors to write and implement policies using evidence-based practice, research, implementation and audit skills. Any individual policy, however, does not exist in a vacuum, but in a network of related policies. There is relatively little practical guidance, literature or debate about the methodology that can be applied to developing an organisational policy framework, or how an understanding of this context can help those planning to develop a policy for their organisation. The article draws on the authors' experiences of policy development from the perspective of an acute NHS trust and discusses the challenges of developing a proactive and co-ordinated approach to policy work. It concludes with a recognition of some useful internal and external checks that can help policy authors to identify the extent to which policy is translated into practice.

  13. Attitudes and Perceptions about Clinical Guidelines: A Qualitative Study with Spanish Physicians

    PubMed Central

    Solà, Ivan; Carrasco, José Miguel; Díaz del Campo, Petra; Gracia, Javier; Orrego, Carola; Martínez, Flora; Kotzeva, Anna; Guillamón, Imma; Calderón, Enrique; de Gaminde, Idoia; Louro, Arturo; Rotaeche, Rafael; Salcedo, Flavia; Velázquez, Paola; Alonso-Coello, Pablo

    2014-01-01

    Background Clinical guidelines (CGs) are popular for healthcare decision making but their acceptability and use by healthcare providers is influenced by numerous factors. Some of these factors are professional-related, such as knowledge and perceptions of and attitudes toward CGs in general. The aim of our study was to evaluate attitudes and perceptions of Spanish physicians towards CGs. Methods We coordinated six discussion groups with a total of 46 physicians. The participants were drawn from 12 medical specialties from both specialized and primary care. We recorded the sessions and transcribed the content verbatim. We analyzed the data using an approach based on the grounded theory. Results We identified two main constructs that defined the physicians' perceptions towards guidelines: knowledge and usefulness. “Knowledge” defined the theoretical meanings of guidelines, while “Usefulness” referred to the pragmatic approach to guidelines. These constructs were interrelated through a series of categories such as confidence, usability, accessibility, dissemination and formats. Conclusions In our study, the constructs that impacted most on physician's attitudes to clinical guidelines were knowledge and usefulness. The tension between the theoretical and the pragmatic constructs determined the attitudes and how physicians use guidelines. Groups developing guidelines should ask relevant clinical questions and develop implementable and context specific recommendations. Developers should be explicit and consistent in the development and presentation of recommendations. PMID:24505253

  14. Evidence for Clinical Implementation of Pharmacogenomics in Cardiac Drugs

    PubMed Central

    Kaufman, Amy L.; Spitz, Jared; Jacobs, Michael; Sorrentino, Matthew; Yuen, Shennin; Danahey, Keith; Saner, Donald; Klein, Teri E.; Altman, Russ B.; Ratain, Mark J.; O’Donnell, Peter H.

    2015-01-01

    Objective To comprehensively assess the pharmacogenomic evidence of routinely-used drugs for clinical utility. Methods From January 2, 2011 to May 31, 2013, we assessed 71 drugs by identifying all drug/genetic variant combinations with published clinical pharmacogenomic evidence. Literature supporting each drug/variant pair was assessed for study design and methodology, outcomes, statistical significance, and clinical relevance. Proposed clinical summaries were formally scored using a modified AGREE (Appraisal of Guidelines for Research and Evaluation) II instrument, including recommendation for or against guideline implementation. Results Positive pharmacogenomic findings were identified for 51 of 71 cardiovascular drugs (71.8%) representing 884 unique drug/variant pairs from 597 publications. After analysis for quality and clinical relevance, 92 drug/variant pairs were proposed for translation into clinical summaries, encompassing 23 drugs (32.4% of drugs reviewed). All were found recommended for clinical implementation using AGREE, with average overall quality scores of 5.18 (out of 7.0; range 3.67 to 7.0; SD 0.91). Drug guidelines had highest scores in AGREE domain 1 (Scope) (average 91.9 out of 100; SD 6.1), and moderate but still robust scores in domain 3 (Rigour) (average 73.1; SD 11.1), domain 4 (Clarity) (average 67.8; SD 12.5), and domain 5 (Applicability) (average 65.8; SD 10). The drugs clopidogrel (CYP2C19), metoprolol (CYP2D6), simvastatin (rs4149056), dabigatran (rs2244613), hydralazine (rs1799983, rs1799998), and warfarin (CYP2C9/VKORC1) were distinguished by the highest scores. Eight of the 10 most commonly-prescribed drugs warranted translation guidelines summarizing clinical pharmacogenomic information. Conclusions Considerable clinically actionable pharmacogenomic information for cardiovascular drugs exists, supporting the idea that consideration of such information when prescribing is warranted. PMID:26046407

  15. Guidelines to Clinical Experiences in Teacher Education. Position Paper 3.

    ERIC Educational Resources Information Center

    Association of Teacher Educators, Reston, VA.

    This document, a collection of guidelines for clinical experience in teacher education, is divided into eight sections with two appendixes. These sections are as follows: Frame of Reference; Aims of Clinical Experiences, which stresses that the experiences should be complementary to the humanistic, behavioral, and pedagogical studies for becoming…

  16. Enhancing implementation of tobacco use prevention and cessation counselling guideline among dental providers: a cluster randomised controlled trial

    PubMed Central

    2011-01-01

    Background Tobacco use adversely affects oral health. Tobacco use prevention and cessation (TUPAC) counselling guidelines recommend that healthcare providers ask about each patient's tobacco use, assess the patient's readiness and willingness to stop, document tobacco use habits, advise the patient to stop, assist and help in quitting, and arrange monitoring of progress at follow-up appointments. Adherence to such guidelines, especially among dental providers, is poor. To improve guideline implementation, it is essential to understand factors influencing it and find effective ways to influence those factors. The aim of the present study protocol is to introduce a theory-based approach to diagnose implementation difficulties of TUPAC counselling guidelines among dental providers. Methods Theories of behaviour change have been used to identify key theoretical domains relevant to the behaviours of healthcare providers involved in implementing clinical guidelines. These theoretical domains will inform the development of a questionnaire aimed at assessing the implementation of the TUPAC counselling guidelines among Finnish municipal dental providers. Specific items will be drawn from the guidelines and the literature on TUPAC studies. After identifying potential implementation difficulties, we will design two interventions using theories of behaviour change to link them with relevant behaviour change techniques aiming to improve guideline adherence. For assessing the implementation of TUPAC guidelines, the electronic dental record audit and self-reported questionnaires will be used. Discussion To improve guideline adherence, the theoretical-domains approach could provide a comprehensive basis for assessing implementation difficulties, as well as designing and evaluating interventions. After having identified implementation difficulties, we will design and test two interventions to enhance TUPAC guideline adherence. Using the cluster randomised controlled design, we aim

  17. Report on activities and attitudes of organizations active in the clinical practice guidelines field.

    PubMed

    Carter, A O; Battista, R N; Hodge, M J; Lewis, S; Basinski, A; Davis, D

    1995-10-01

    The organizing committee of a workshop on clinical practice guidelines (CPGs) surveyed invited organizations on their attitudes and activities related to five topics to be covered during the workshop sessions: organizational roles, priority setting, guidelines implementation, guidelines evaluation and development of a network of those active in the CPG field. Organizational roles: The national specialty societies were felt to have the largest role to play; the smallest roles were assigned to consumers, who were seen to have a role mainly in priority setting, and to industry and government, both of which were seen to have primarily a funding role. Many barriers to collaboration were identified, the solutions to all of which appeared to be better communication, establishment of common principles and clear role definitions. Priority setting: There was considerable agreement on the criteria that should be used to set priorities for CPG activities: the burden of disease on population health, the state of scientific knowledge, the cost of treatment and the economic burden of disease on society were seen as important factors, whereas the costs of guidelines development and practitioner interest in guidelines development were seen as less important. Organizations were unable to give much information on how they set priorities. Guidelines implementation: Most of the organizations surveyed did not actively try to ensure the implementation of guidelines, although a considerable minority devoted resources to implementation. The 38% of organizations that implemented guidelines actively listed a wide variety of activities, including training, use of local opinion leaders, information technology, local consensus processes and counter detailing. Guidelines evaluation: Formal evaluation of guidelines was undertaken by fewer than 13% of the responding organizations. All the evaluations incorporated assessments before and after guideline implementation, and some used primary patient

  18. Barriers to guideline implementation and educational needs of general practitioners regarding heart failure: a qualitative study

    PubMed Central

    Peters-Klimm, Frank; Natanzon, Iris; Müller-Tasch, Thomas; Ludt, Sabine; Nikendei, Christoph; Lossnitzer, Nicole; Szecsenyi, Joachim; Herzog, Wolfgang; Jünger, Jana

    2012-01-01

    Objectives: A clinical practice guideline (CPG) contains specifically developed recommendations that can serve physicians as a decision aid in evidence-based practice. The implementation of heart failure (HF) CPGs represents a challenge in general practice. As part of the development of a tailored curriculum, aim of this study was to identify barriers of guideline adherence and needs for medical education (CME) in HF care. Methods: We conducted a modified focus group with elements of a workshop of three hours duration. Thirteen GPs collected and discussed together and parallel in smaller groups barriers of guideline implementation. Afterwards they performed a needs assessment for a tailored CME curriculum for chronic HF. The content of the discussions was analysed qualitatively according to Mayring and categorised thematically. Results: Barriers of guideline adherence were found in the following areas: doctor: procedural knowledge (knowledge gaps), communicative and organisational skills (e.g. time management) and attitude (dissatisfaction with time-money-relation). Patients: individual case-related problems (multimorbidity, psychiatric comorbidity, expectations and beliefs). Doctor and patient: Adherence and barriers of communication. Main measures for improvement of care concerned the areas of the identified barriers of guideline adherence with the focus on application-oriented training of the abovementioned procedural knowledge and skills, but also the supply of tools (like patient information leaflets) and patient education. Conclusion: For a CME-curriculum for HF tailored to the needs of GPs, a comprehensive educational approach seems necessary. It should be broad-based and include elements of knowledge and skills to be addressed and trained case-related. Additional elements should include support in the implementation of organisational processes in the practice and patient education. PMID:22737201

  19. Korean clinical practice guideline for benign prostatic hyperplasia

    PubMed Central

    Yeo, Jeong Kyun; Choi, Hun; Bae, Jae Hyun; Kim, Jae Heon; Yang, Seong Ok; Oh, Chul Young; Cho, Young Sam; Kim, Kyoung Woo

    2016-01-01

    In 2014, the Korean Urological Association organized the Benign Prostatic Hyperplasia Guideline Developing Committee composed of experts in the field of benign prostatic hyperplasia (BPH) with the participation of the Korean Academy of Family Medicine and the Korean Continence Society to develop a Korean clinical practice guideline for BPH. The purpose of this clinical practice guideline is to provide current and comprehensive recommendations for the evaluation and treatment of BPH. The committee developed the guideline mainly by adapting existing guidelines and partially by using the de novo method. A comprehensive literature review was carried out primarily from 2009 to 2013 by using medical search engines including data from Korea. Based on the published evidence, recommendations were synthesized, and the level of evidence of the recommendations was determined by using methods adapted from the 2011 Oxford Centre for Evidence-Based Medicine. Meta-analysis was done for one key question and four recommendations. A draft guideline was reviewed by expert peer reviewers and discussed at an expert consensus meeting until final agreement was achieved. This evidence-based guideline for BPH provides recommendations to primary practitioners and urologists for the diagnosis and treatment of BPH in men older than 40 years. PMID:26966724

  20. Guidelines for the nonpharmacologic management of migraine in clinical practice

    PubMed Central

    Pryse-Phillips, W E; Dodick, D W; Edmeads, J G; Gawel, M J; Nelson, R F; Purdy, R A; Robinson, G; Stirling, D; Worthington, I

    1998-01-01

    OBJECTIVE: To provide physicians and allied health care professionals with guidelines for the nonpharmacologic management of migraine in clinical practice. OPTIONS: The full range and quality of nonpharmacologic therapies available for the management of migraine. OUTCOMES: Improvement in the nonpharmacologic management of migraine. EVIDENCE AND VALUES: The creation of the guidelines followed a needs assessment by members of the Canadian Headache Society and included a statement of objectives; development of guidelines by multidisciplinary working groups using information from literature reviews and other resources; comparison of alternative clinical pathways and description of how published data were analysed; definition of the level of evidence for data in each case; evaluation and revision of the guidelines at a consensus conference held in Ottawa on Oct. 27-29, 1995; redrafting and insertion of tables showing key variables and data from various studies and tables of data with recommendations; and reassessment by all conference participants. BENEFITS, HARMS AND COSTS: Augmentation of the use of nonpharmacologic therapies for the acute and prophylactic management of migraine is likely to lead to substantial benefits in both human and economic terms. RECOMMENDATIONS: Both the avoidance of migraine trigger factors and the use of nonpharmacologic therapies have a part to play in overall migraine management. VALIDATION: The guidelines are based on consensus of Canadian experts in neurology, emergency medicine, psychiatry, psychology and family medicine, and consumers. Previous guidelines did not exist. Field testing of the guidelines is in progress. PMID:9679487

  1. A Model of Ambiguity and Vagueness in Clinical Practice Guideline Recommendations

    PubMed Central

    Codish, Shlomi; Shiffman, Richard N.

    2005-01-01

    Ambiguity and vagueness in clinical practice guidelines reduce the likelihood of clinician adherence. They lead to inconsistent interpretation and, in turn, to inappropriate practice variation and medical errors. Resolving ambiguity and vagueness is an essential step in the computerized implementation of clinical practice guidelines. Successful resolution of ambiguity and vagueness requires an understanding of their characteristics, yet ambiguity and vagueness have not been differentiated, classified and described in medical context. In this paper, we propose a tri-axial model to describe ambiguity and vagueness in clinical practice guidelines: differentiation of true ambiguity from vagueness, classification of ambiguity and vagueness, intentionality and components involved. Our goals in introducing this model are: (a) to provide guidance to guideline authors to enable them to reduce inadvertent use of ambiguous or vague language, (b) to improve transparency when vague language is used deliberately and (c) to create a framework for the development of tools to apply the model during authoring and implementation of clinical practice guidelines. PMID:16779019

  2. Relevance of guideline-based ICD indications to clinical practice.

    PubMed

    Al-Jefairi, Nora; Burri, Haran

    2014-01-01

    The implantable cardioverter-defibrillator (ICD) has established itself as life-saving therapy in patients at risk for sudden cardiac death. Remarkable technological advances have made ICDs easier and safer to implant, with improved therapeutic and diagnostic functions and reduced morbidity. Guidelines on ICD indications have been proposed by American and European scientific societies since a number of years, based upon trials and expert opinion. In the context of variable economic and political constraints, it is questionable whether these guidelines may be applied to all settings. This review discusses the guideline-based indications, critically examines their applicability to clinical practice, and discusses alternatives to ICD therapy.

  3. Developing a Clinical Diabetes Guideline in Diabetes Research Network in Iran

    PubMed Central

    NASLI-ESFAHANI, Ensieh; PEIMANI, Maryam; RAMBOD, Camelia; OMIDVAR, Maryam; LARIJANI, Bagher

    2014-01-01

    Abstract Development of evidence-based clinical guidelines to raising standards of medical care in diabetes is a core element of coping with the global diabetes epidemic. The purpose of this study was to develop a systematic clinical diabetes guideline from the latest scientific evidences and also to localize its recommendations according to regional and cultural needs of our society. Searches were conducted using NICE, SIGN, WDPCP, IDF, JDC, ADA, AACE, ICSI, CDA, AMDA, IDC, NyDoH guidelines which were examined and criticized and scored using Agree method. Guidelines which got higher score in some important areas of Agree scale including: rigor of development, clarity and comprehensiveness of the recommendations and applicability, especially in the climatic conditions of our country were selected. The existing recommendations were extracted by committee members and supporting evidences of each recommendation were determined based on the sources listed in the clinical guideline. Recommendations grading were classified from grade A to D based on the quality of their supporting evidences (BEL1-5). This guideline covered all areas related to diabetes including screening and diagnosis, lifestyle modification and patient education, management, complications and hypoglycemia. Regarding capacities of this guideline and lack of comprehensive and updated guidelines in our country and region, it is suggested that designing a pilot study to implement this Learner-centered guideline and finding its weaknesses can lead to patient care improvement and also propel us towards our goal to design a comprehensive guideline in compliance with regional and national needs in Middle East. PMID:26110142

  4. A semantically enriched clinical guideline model enabling deployment in heterogeneous healthcare environments.

    PubMed

    Laleci, Gokce B; Dogac, Asuman

    2009-03-01

    Clinical guidelines are developed to assist healthcare practitioners to make decisions on patient's medical problems, and as such they communicate with external applications to retrieve patient data to initiate medical actions through clinical workflows, and transmit information to alert/reminder systems. The interoperability problems in the healthcare information technology domain prevent wider deployment of clinical guidelines because each deployment requires a tedious custom adaptation phase. In this paper, we provide machine-processable mechanisms that express the semantics of clinical guideline interfaces so that automated processes can be used to access the clinical resources for guideline deployment and execution. To be able to deploy the semantically extended guidelines to healthcare settings semiautomatically, the underlying application's semantics must also be available. We describe how this can be achieved based on two prominent implementation technologies in use in the eHealth domain: integrating healthcare enterprise cross-enterprise document sharing integration profile for discovering and exchanging electronic healthcare records and Web service technology for interacting with the clinical workflows and wireless medical sensor devices. The system described in this paper is realized within the scope of the SAPHIRE Project. PMID:19171525

  5. Applying the knowledge to action framework to plan a strategy for implementing breast cancer screening guidelines: an interprofessional perspective.

    PubMed

    Munce, Sarah; Kastner, Monika; Cramm, Heidi; Lal, Shalini; Deschêne, Sarah-Maude; Auais, Mohammad; Stacey, Dawn; Brouwers, Melissa

    2013-09-01

    Integrated knowledge translation (IKT) interventions may be one solution to improving the uptake of clinical guidelines. IKT research initiatives are particularly relevant for breast cancer research and initiatives targeting the implementation of clinical guidelines and guideline implementation initiatives, where collaboration with an interdisciplinary team of practitioners, patients, caregivers, and policy makers is needed for producing optimum patient outcomes. The objective of this paper was to describe the process of developing an IKT strategy that could be used by guideline developers to improve the uptake of their new clinical practice guidelines on breast cancer screening. An interprofessional group of students as well as two faculty members met six times over three days at the KT Canada Summer Institute in 2011. The team used all of the phases of the action cycle in the Knowledge to Action Framework as an organizing framework. While the entire framework was used, the step involving assessing barriers to knowledge use was judged to be particularly relevant in anticipating implementation problems and being able to inform the specific KT interventions that would be appropriate to mitigate these challenges and to accomplish goals and outcomes. This activity also underscored the importance of group process and teamwork in IKT. We propose that an a priori assessment of barriers to knowledge use (i.e., level and corresponding barriers), along with the other phases of the Knowledge to Action Framework, is a strategic approach for KT strategy development, implementation, and evaluation planning and could be used in the future planning of KT strategies.

  6. Fertility preservation during cancer treatment: clinical guidelines

    PubMed Central

    Rodriguez-Wallberg, Kenny A; Oktay, Kutluk

    2014-01-01

    The majority of children, adolescents, and young adults diagnosed with cancer today will become long-term survivors. The threat to fertility that cancer treatments pose to young patients cannot be prevented in many cases, and thus research into methods for fertility preservation is developing, aiming at offering cancer patients the ability to have biologically related children in the future. This paper discusses the current status of fertility preservation methods when infertility risks are related to surgical oncologic treatments, radiation therapy, or chemotherapy. Several scientific groups and societies have developed consensus documents and guidelines for fertility preservation. Decisions about fertility and imminent potentially gonadotoxic therapies must be made rapidly. Timely and complete information on the impact of cancer treatment on fertility and fertility preservation options should be presented to all patients when a cancer treatment is planned. PMID:24623991

  7. Guidelines for clinical use of CBCT: a review

    PubMed Central

    O'Malley, L; Taylor, K; Glenny, A-M

    2015-01-01

    Objectives: To identify guidelines on the clinical use of CBCT in dental and maxillofacial radiology, in particular selection criteria, to consider how they were produced, to appraise their quality objectively and to compare their recommendations. Methods: A literature search using MEDLINE (Ovid®) was undertaken prospectively from 1 January 2000 to identify published material classifiable as “guidelines” pertaining to the use of CBCT in dentistry. This was supplemented by searches on websites, an internet search engine, hand searching of theses and by information from personal contacts. Quality assessment of publications was performed using the AGREE II instrument. Publications were examined for areas of agreement and disagreement. Results: 26 publications were identified, 11 of which were specifically written to give guidelines on the clinical use of CBCT and contained sections on selection criteria. The remainder were a heterogeneous mixture of publications that included guidelines relating to CBCT. Two had used a formal evidence-based approach for guideline development and two used consensus methods. The quality of publications was frequently low as assessed using AGREE II, with many lacking evidence of adequate methodology. There was broad agreement between publications on clinical use, apart from treatment planning, in implant dentistry. Conclusions: Reporting of guideline development is often poorly presented. Guideline development panels should aim to perform and report their work using the AGREE II instrument as a template to raise standards and avoid the risk of suspicions of bias. PMID:25270063

  8. 48 CFR 47.403 - Guidelines for implementation of the Fly America Act.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... implementation of the Fly America Act. 47.403 Section 47.403 Federal Acquisition Regulations System FEDERAL... Guidelines for implementation of the Fly America Act. This section 47.403 is based on the Guidelines for Implementation of the Fly America Act (case number B-138942), issued by the Comptroller General of the...

  9. 48 CFR 47.403 - Guidelines for implementation of the Fly America Act.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... implementation of the Fly America Act. 47.403 Section 47.403 Federal Acquisition Regulations System FEDERAL... Guidelines for implementation of the Fly America Act. This section 47.403 is based on the Guidelines for Implementation of the Fly America Act (case number B-138942), issued by the Comptroller General of the...

  10. 48 CFR 47.403 - Guidelines for implementation of the Fly America Act.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... implementation of the Fly America Act. 47.403 Section 47.403 Federal Acquisition Regulations System FEDERAL... Guidelines for implementation of the Fly America Act. This section 47.403 is based on the Guidelines for Implementation of the Fly America Act (case number B-138942), issued by the Comptroller General of the...

  11. 48 CFR 47.403 - Guidelines for implementation of the Fly America Act.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... implementation of the Fly America Act. 47.403 Section 47.403 Federal Acquisition Regulations System FEDERAL... Guidelines for implementation of the Fly America Act. This section 47.403 is based on the Guidelines for Implementation of the Fly America Act (case number B-138942), issued by the Comptroller General of the...

  12. 48 CFR 47.403 - Guidelines for implementation of the Fly America Act.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... implementation of the Fly America Act. 47.403 Section 47.403 Federal Acquisition Regulations System FEDERAL... Guidelines for implementation of the Fly America Act. This section 47.403 is based on the Guidelines for Implementation of the Fly America Act (case number B-138942), issued by the Comptroller General of the...

  13. [Measuring quality in the German Guideline Programme in Oncology (GGPO)—methodology and implementation].

    PubMed

    Nothacker, Monika; Muche-Borowski, Cathleen; Kopp, Ina B

    2014-01-01

    The German Guideline Programme in Oncology (GGPO) is a joint initiative between the German Cancer Society, the Association of the Scientific Medical Societies in Germany and German Cancer Aid. In accordance with the aims of the German National Cancer Plan, the GGPO supports the systematic development of high-quality guidelines. To enhance implementation and evaluation, the suggestion of performance measures (PMs) derived from guideline recommendations following a standardised methodology is obligatory within the GGPO. For this purpose, PM teams are convened representing the multidisciplinary guideline development groups including clinical experts, methodologists and patient representatives as well as those organisations that take an active part in and share responsibility for documentation and quality improvement, i.e., clinical cancer registries, certified cancer centres and, if appropriate, the institution responsible for external quality assurance according to the German Social Code (SGB). The primary selection criteria for PMs include strength of the underlying recommendation (strong, grade A), existing potential for improvement of care and measurability. The premises of data economy and standardised documentation are taken into account. Between May 2008 and July 2014, 12 guidelines with suggestions for 100 PMs have been published. The majority of the suggested performance measures is captured by the specific documentation requirements of the clinical cancer registries and certified cancer centres. This creates a solid basis for an active quality management and re-evaluation of the suggested PMs. In addition, the suspension of measures should be considered if improvement has been achieved on a broad scale and for a longer period in order to concentrate on a quality-oriented, economic documentation.

  14. [Measuring quality in the German Guideline Programme in Oncology (GGPO)—methodology and implementation].

    PubMed

    Nothacker, Monika; Muche-Borowski, Cathleen; Kopp, Ina B

    2014-01-01

    The German Guideline Programme in Oncology (GGPO) is a joint initiative between the German Cancer Society, the Association of the Scientific Medical Societies in Germany and German Cancer Aid. In accordance with the aims of the German National Cancer Plan, the GGPO supports the systematic development of high-quality guidelines. To enhance implementation and evaluation, the suggestion of performance measures (PMs) derived from guideline recommendations following a standardised methodology is obligatory within the GGPO. For this purpose, PM teams are convened representing the multidisciplinary guideline development groups including clinical experts, methodologists and patient representatives as well as those organisations that take an active part in and share responsibility for documentation and quality improvement, i.e., clinical cancer registries, certified cancer centres and, if appropriate, the institution responsible for external quality assurance according to the German Social Code (SGB). The primary selection criteria for PMs include strength of the underlying recommendation (strong, grade A), existing potential for improvement of care and measurability. The premises of data economy and standardised documentation are taken into account. Between May 2008 and July 2014, 12 guidelines with suggestions for 100 PMs have been published. The majority of the suggested performance measures is captured by the specific documentation requirements of the clinical cancer registries and certified cancer centres. This creates a solid basis for an active quality management and re-evaluation of the suggested PMs. In addition, the suspension of measures should be considered if improvement has been achieved on a broad scale and for a longer period in order to concentrate on a quality-oriented, economic documentation. PMID:25523845

  15. Efficient management of multi-version clinical guidelines.

    PubMed

    Grandi, Fabio; Mandreoli, Federica; Martoglia, Riccardo

    2012-12-01

    Clinical medicine and health-care developments in recent years testified a tremendous increase in the number of available guidelines, i.e., "best practices" encoding and standardizing care procedures for a given disease. Clinical guidelines are subject to continuous development and revision by committees of expert physicians and health authorities and, thus, multiple versions coexist as a consequence of the clinical and healthcare activities. Moreover, several alternatives are usually included in order to make the guidelines as general as possible, making them difficult to handle both in manual and automated fashions. In this work, we will introduce techniques to model and to provide efficient personalized access to very large collections of multi-version clinical guidelines, which can be stored both in textual and in executable format in an XML repository. In this way, multiple temporal perspectives, patient profile and context information can be used by an automated personalization service to efficiently build on demand a guideline version tailored to a specific use case. PMID:22890019

  16. The validity of recommendations from clinical guidelines: a survival analysis

    PubMed Central

    García, Laura Martínez; Sanabria, Andrea Juliana; Álvarez, Elvira García; Trujillo-Martín, Maria Mar; Etxeandia-Ikobaltzeta, Itziar; Kotzeva, Anna; Rigau, David; Louro-González, Arturo; Barajas-Nava, Leticia; del Campo, Petra Díaz; Estrada, Maria-Dolors; Solà, Ivan; Gracia, Javier; Salcedo-Fernandez, Flavia; Lawson, Jennifer; Haynes, R. Brian; Alonso-Coello, Pablo

    2014-01-01

    Background: Clinical guidelines should be updated to maintain their validity. Our aim was to estimate the length of time before recommendations become outdated. Methods: We used a retrospective cohort design and included recommendations from clinical guidelines developed in the Spanish National Health System clinical guideline program since 2008. We performed a descriptive analysis of references, recommendations and resources used, and a survival analysis of recommendations using the Kaplan–Meier method. Results: We included 113 recommendations from 4 clinical guidelines with a median of 4 years since the most recent search (range 3.9–4.4 yr). We retrieved 39 136 references (range 3343–14 787) using an exhaustive literature search, 668 of which were related to the recommendations in our sample. We identified 69 (10.3%) key references, corresponding to 25 (22.1%) recommendations that required updating. Ninety-two percent (95% confidence interval 86.9–97.0) of the recommendations were valid 1 year after their development. This probability decreased at 2 (85.7%), 3 (81.3%) and 4 years (77.8%). Interpretation: Recommendations quickly become outdated, with 1 out of 5 recommendations being out of date after 3 years. Waiting more than 3 years to review a guideline is potentially too long. PMID:25200758

  17. Enhanced implementation of low back pain guidelines in general practice: study protocol of a cluster randomised controlled trial

    PubMed Central

    2013-01-01

    Background Evidence-based clinical practice guidelines may improve treatment quality, but the uptake of guideline recommendations is often incomplete and slow. Recently new low back pain guidelines are being launched in Denmark. The guidelines are considered to reduce personal and public costs. The aim of this study is to evaluate whether a complex, multifaceted implementation strategy of the low back pain guidelines will reduce secondary care referral and improve patient outcomes compared to the usual simple implementation strategy. Methods/design In a two-armed cluster randomised trial, 100 general practices (clusters) and 2,700 patients aged 18 to 65 years from the North Denmark region will be included. Practices are randomly allocated 1:1 to a simple or a complex implementation strategy. Intervention practices will receive a complex implementation strategy, including guideline facilitator visits, stratification tools, and quality reports on low back pain treatment. Primary outcome is referral to secondary care. Secondary outcomes are pain, physical function, health-related quality of life, patient satisfaction with care and treatment outcome, employment status, and sick leave. Primary and secondary outcomes pertain to the patient level. Assessments of outcomes are blinded and follow the intention-to-treat principle. Additionally, a process assessment will evaluate the degree to which the intervention elements will be delivered as planned, as well as measure changes in beliefs and behaviours among general practitioners and patients. Discussion This study provides knowledge concerning the process and effect of an intervention to implement low back pain guidelines in general practice, and will provide insight on essential elements to include in future implementation strategies in general practice. Trial registration Registered as NCT01699256 on ClinicalTrials.gov. PMID:24139140

  18. Healthcare professionals' intentions to use clinical guidelines: a survey using the theory of planned behaviour

    PubMed Central

    2010-01-01

    Background Finnish clinical guidelines are evolving toward integration of knowledge modules into the electronic health record in the Evidence-Based Medicine electronic Decision Support project. It therefore became important to study which factors affect professionals' intention to use clinical guidelines generally in their decision-making on patient care. A theory-based approach is a possible solution to explore determinants of professionals' behaviour. The study's aim was to produce baseline information for developers and implementers by using the theory of planned behaviour. Methods A cross-sectional internet-based survey was carried out in Finnish healthcare organisations within three hospital districts. The target population (n = 2,252) included physicians, nurses, and other professionals, of whom 806 participated. Indicators of the intention to use clinical guidelines were observed by using a theory-based questionnaire. The main data analysis was done by means of multiple linear regressions. Results The results indicated that all theory-based variables--the attitude toward the behaviour, the subjective norm, and the perceived behaviour control--were important factors associated with the professionals' intention to use clinical practice guidelines for their area of specialisation in the decisions they would make on the care of patients in the next three months. In addition, both the nurse and the physician factors had positive (p < 0.01) effects on this intention in comparison to other professionals. In the similar models for all professions, the strongest factor for the physicians was the perceived behaviour control, while the key factor for the nurses and the other professionals was the subjective norm. This means that context- and guideline-based factors either facilitate or hinder the intention to use clinical guidelines among physicians and, correspondingly, normative beliefs related to social pressures do so for nurses and other healthcare professionals

  19. Rethinking the Role of Clinical Practice Guidelines in Pharmacy Education.

    PubMed

    Brown, Daniel L

    2015-12-25

    Clinical practice guidelines (CPGs) play a major role in pharmacy education. Students learn to locate, retrieve, and apply CPGs in didactic coursework and practice experiences. However, they often memorize and quote recommendations without critical analysis, which tends to undermine their clinical growth. Students should become genuine drug experts, based on strong critical-thinking skills and the ability to assimilate extensive clinical and scientific knowledge. Clinical practice guidelines improve health care, and students should be familiar with them, but there are legitimate criticisms of CPGs, stemming largely from potential conflicts of interest and limitations in the quality and scope of available evidence. Despite such flaws, CPGs can be used to facilitate the clinical growth of students if the emphasis is placed on critically analyzing and evaluating CPG recommendations, as opposed to blindly accepting them. From that perspective, the role that CPGs have come to play in education may need to be reconsidered.

  20. Rethinking the Role of Clinical Practice Guidelines in Pharmacy Education

    PubMed Central

    2015-01-01

    Clinical practice guidelines (CPGs) play a major role in pharmacy education. Students learn to locate, retrieve, and apply CPGs in didactic coursework and practice experiences. However, they often memorize and quote recommendations without critical analysis, which tends to undermine their clinical growth. Students should become genuine drug experts, based on strong critical-thinking skills and the ability to assimilate extensive clinical and scientific knowledge. Clinical practice guidelines improve health care, and students should be familiar with them, but there are legitimate criticisms of CPGs, stemming largely from potential conflicts of interest and limitations in the quality and scope of available evidence. Despite such flaws, CPGs can be used to facilitate the clinical growth of students if the emphasis is placed on critically analyzing and evaluating CPG recommendations, as opposed to blindly accepting them. From that perspective, the role that CPGs have come to play in education may need to be reconsidered. PMID:26889060

  1. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care

    PubMed Central

    van Tulder, Maurits; Lin, Chung-Wei Christine; Macedo, Luciana G.; McAuley, James; Maher, Chris

    2010-01-01

    health care systems. The implementation of these clinical guidelines remains a challenge for clinical practice and research. PMID:20602122

  2. Guideline implementation for breast healthcare in low- and middle-income countries: early detection resource allocation.

    PubMed

    Yip, Cheng-Har; Smith, Robert A; Anderson, Benjamin O; Miller, Anthony B; Thomas, David B; Ang, Eng-Suan; Caffarella, Rosemary S; Corbex, Marilys; Kreps, Gary L; McTiernan, Anne

    2008-10-15

    A key determinant of breast cancer outcome in any population is the degree to which cancers are detected at early stages of disease. Populations in which cancers are detected at earlier stages have lower breast cancer mortality rates. The Breast Health Global Initiative (BHGI) held its third Global Summit in Budapest, Hungary in October 2007, bringing together internationally recognized experts to address the implementation of breast healthcare guidelines for early detection, diagnosis, and treatment in low- and middle-income countries (LMCs). A multidisciplinary panel of experts specifically addressed the implementation of BHGI guidelines for the early detection of disease as they related to resource allocation for public education and awareness, cancer detection methods, and evaluation goals. Public education and awareness are the key first steps, because early detection programs cannot be successful if the public is unaware of the value of early detection. The effectiveness and efficiency of screening modalities, including screening mammography, clinical breast examination (CBE), and breast self-examination, were reviewed in the context of resource availability and population-based need by the panel. Social and cultural barriers should be considered when early detection programs are being established, and the evaluation of early detection programs should include the use of well developed, methodologically sound process metrics to determine the effectiveness of program implementation. The approach and scope of any screening program will determine the success of any early detection program as measured by cancer stage at diagnosis and will drive the breadth of resource allocation needed for program implementation. PMID:18837017

  3. Clinical Practice Guideline for Vitamin D

    NASA Technical Reports Server (NTRS)

    Tarver, William J.

    2013-01-01

    Vitamin D and its metabolites have clinical significance because they play a critical function in calcium homeostasis and bone metabolism. Although not all of the pathologic mechanisms have been adequately described, vitamin D insufficiency and deficiency, as measured by low levels of 25-OH vitamin D, are associated with a variety of clinical conditions including osteoporosis, falls and fractures in the elderly, decreased immune function, bone pain, and possibly colon cancer and cardiovascular health.2 Apart from inadequate dietary intake, patients may present with low levels of vitamin D if they receive inadequate sunlight. The astronaut population is potentially vulnerable to low levels of vitamin D for several reasons. Firstly, they may train for long periods in Star City, Russia, which by virtue of its northern latitude receives less sunlight in winter months. Secondly, astronauts are deprived of sunlight while aboard the International Space Station (ISS). In addition, ISS crew members are exposed to microgravity for prolonged durations and are likely to develop low bone mineral density despite the use of countermeasures. Therefore, closely monitoring and maintaining adequate vitamin D levels is important for the astronaut corps.

  4. Using multimodal mining to drive clinical guidelines development.

    PubMed

    Pasche, Emilie; Gobeill, Julien; Teodoro, Douglas; Vishnyakova, Dina; Gaudinat, Arnaud; Ruch, Patrick; Lovis, Christian

    2011-01-01

    We present exploratory investigations of multimodal mining to help designing clinical guidelines for antibiotherapy. Our approach is based on the assumption that combining various sources of data, such as the literature, a clinical datawarehouse, as well as information regarding costs will result in better recommendations. Compared to our baseline recommendation system based on a question-answering engine built on top of PubMed, an improvement of +16% is observed when clinical data (i.e. resistance profiles) are injected into the model. In complement to PubMed, an alternative search strategy is reported, which is significantly improved by the use of the combined multimodal approach. These results suggest that combining literature-based discovery with structured data mining can significantly improve effectiveness of decision-support systems for authors of clinical practice guidelines. PMID:21893795

  5. Using multimodal mining to drive clinical guidelines development.

    PubMed

    Pasche, Emilie; Gobeill, Julien; Teodoro, Douglas; Vishnyakova, Dina; Gaudinat, Arnaud; Ruch, Patrick; Lovis, Christian

    2011-01-01

    We present exploratory investigations of multimodal mining to help designing clinical guidelines for antibiotherapy. Our approach is based on the assumption that combining various sources of data, such as the literature, a clinical datawarehouse, as well as information regarding costs will result in better recommendations. Compared to our baseline recommendation system based on a question-answering engine built on top of PubMed, an improvement of +16% is observed when clinical data (i.e. resistance profiles) are injected into the model. In complement to PubMed, an alternative search strategy is reported, which is significantly improved by the use of the combined multimodal approach. These results suggest that combining literature-based discovery with structured data mining can significantly improve effectiveness of decision-support systems for authors of clinical practice guidelines.

  6. Biliary tract cancers: SEOM clinical guidelines.

    PubMed

    Benavides, M; Antón, A; Gallego, J; Gómez, M A; Jiménez-Gordo, A; La Casta, A; Laquente, B; Macarulla, T; Rodríguez-Mowbray, J R; Maurel, J

    2015-12-01

    Biliary tract cancer (BTC) is an uncommon and highly fatal malignancy. It is composed of three main different entities; Gall bladder carcinoma (GBC), intrahepatic cholangiocarcinoma (iCC) and extrahepatic cholangiocarcinoma (eCC) sharing different genetic, risk factors and clinical presentation. Multidetector-row computed tomography (MDCT) and magnetic resonance cholangio-pancreatography (MRCP) are the more important diagnostic techniques. Surgery is the only potentially curative therapy but disease recurrence is frequent. Treatment with chemotherapy, radiotherapy or both has not demonstrated survival benefit in the adjuvant setting. Cisplatin plus gemcitabine constitutes the gold standard in metastatic disease. New ongoing studies mainly in the adjuvant and neoadjuvant setting along with molecular research will hopefully help to improve survival and quality of life of this disease. PMID:26607930

  7. Clinical Practice Guidelines for Cutaneous Lymphomas.

    PubMed

    Sutton, Angela M; Hurley, M Yadira

    2015-01-01

    Primary cutaneous lymphomas are non-Hodgkin lymphomas, which are broadly divided into cutaneous T-cell lymphomas and cutaneous B-cell lymphomas. These classifications include numerous distinct entities, all with varying clinical presentations and disease courses. Herein, we will review the cutaneous T-cell lymphomas, including Mycosis Fungoides, Sézary syndrome, CD30+ lymphoproliferative disorders, as well as other less common entities. Cutaneous B-cell lymphomas will also be discussed, including primary cutaneous marginal zoned lymphoma, cutaneous follicle-center lymphoma, diffuse large B-cell lymphoma, leg type, as well as other less common entities. Accurate and early diagnosis is key, as the treatment and prognosis varies significantly between conditions. PMID:26455060

  8. Representation of Clinical Practice Guidelines in Conventional and Augmented Decision Tables

    PubMed Central

    Shiffman, Richard N.

    1997-01-01

    Abstract Objective: To develop a knowledge representation model for clinical practice guidelines that is linguistically adequate, comprehensible, reusable, and maintainable. Design: Decision tables provide the basic framework for the proposed knowledge representation model. Guideline logic is represented as rules in conventional decision tables. These tables are augmented by layers where collateral information is recorded in slots beneath the logic. Results: Decision tables organize rules into cohesive rule sets wherein complex logic is clarified. Decision table rule sets may be verified to assure completeness and consistency. Optimization and display of rule sets as sequential decision trees may enhance the comprehensibility of the logic. The modularity of the rule formats may facilitate maintenance. The augmentation layers provide links to descriptive language, information sources, decision variable characteristics, costs and expected values of policies, and evidence sources and quality. Conclusion: Augmented decision tables can serve as a unifying knowledge representation for developers and implementers of clinical practice guidelines. PMID:9292844

  9. Clinical imaging guidelines part 2: Risks, benefits, barriers, and solutions.

    PubMed

    Malone, James; del Rosario-Perez, Maria; Van Bladel, Lodewijk; Jung, Seung Eun; Holmberg, Ola; Bettmann, Michael A

    2015-02-01

    A recent international meeting was convened by two United Nations bodies to focus on international collaboration on clinical appropriateness/referral guidelines for use in medical imaging. This paper, the second of 4 from this technical meeting, addresses barriers to the successful development/deployment of clinical imaging guidelines and means of overcoming them. It reflects the discussions of the attendees, and the issues identified are treated under 7 headings: ■ Practical Strategy for Development and Deployment of Guidelines; ■ Governance Arrangements and Concerns with Deployment of Guidelines; ■ Finance, Sustainability, Reimbursement, and Related Issues; ■ Identifying Benefits and Radiation Risks from Radiological Examinations; ■ Information Given to Patients and the Public, and Consent Issues; ■ Special Concerns Related to Pregnancy; and ■ The Research Agenda. Examples of topics identified include the observation that guideline development is a global task and there is no case for continuing it as the project of the few professional organizations that have been brave enough to make the long-term commitment required. Advocacy for guidelines should include the expectations that they will facilitate: (1) better health care delivery; (2) lower cost of that delivery; with (3) reduced radiation dose and associated health risks. Radiation protection issues should not be isolated; rather, they should be integrated with the overall health care picture. The type of dose/radiation risk information to be provided with guidelines should include the uncertainty involved and advice on application of the precautionary principle with patients. This principle may be taken as an extension of the well-established medical principle of "first do no harm." PMID:25652302

  10. Developing and Implementing Health and Sustainability Guidelines for Institutional Food Service123

    PubMed Central

    Kimmons, Joel; Jones, Sonya; McPeak, Holly H.; Bowden, Brian

    2012-01-01

    Health and sustainability guidelines for institutional food service are directed at improving dietary intake and increasing the ecological benefits of the food system. The development and implementation of institutional food service guidelines, such as the Health and Human Services (HHS) and General Services Administration (GSA) Health and Sustainability Guidelines for Federal Concessions and Vending Operations (HHS/GSA Guidelines), have the potential to improve the health and sustainability of the food system. Institutional guidelines assist staff, managers, and vendors in aligning the food environment at food service venues with healthier and more sustainable choices and practices. Guideline specifics and their effective implementation depend on the size, culture, nature, and management structure of an institution and the individuals affected. They may be applied anywhere food is sold, served, or consumed. Changing institutional food service practice requires comprehensive analysis, engagement, and education of all relevant stakeholders including institutional management, members of the food supply chain, and customers. Current examples of food service guidelines presented here are the HHS and GSA Health and Sustainability Guidelines for Federal Concessions and Vending Operations, which translate evidence-based recommendations on health and sustainability into institutional food service practices and are currently being implemented at the federal level. Developing and implementing guidelines has the potential to improve long-term population health outcomes while simultaneously benefitting the food system. Nutritionists, public health practitioners, and researchers should consider working with institutions to develop, implement, and evaluate food service guidelines for health and sustainability. PMID:22585909

  11. Developing and implementing health and sustainability guidelines for institutional food service.

    PubMed

    Kimmons, Joel; Jones, Sonya; McPeak, Holly H; Bowden, Brian

    2012-05-01

    Health and sustainability guidelines for institutional food service are directed at improving dietary intake and increasing the ecological benefits of the food system. The development and implementation of institutional food service guidelines, such as the Health and Human Services (HHS) and General Services Administration (GSA) Health and Sustainability Guidelines for Federal Concessions and Vending Operations (HHS/GSA Guidelines), have the potential to improve the health and sustainability of the food system. Institutional guidelines assist staff, managers, and vendors in aligning the food environment at food service venues with healthier and more sustainable choices and practices. Guideline specifics and their effective implementation depend on the size, culture, nature, and management structure of an institution and the individuals affected. They may be applied anywhere food is sold, served, or consumed. Changing institutional food service practice requires comprehensive analysis, engagement, and education of all relevant stakeholders including institutional management, members of the food supply chain, and customers. Current examples of food service guidelines presented here are the HHS and GSA Health and Sustainability Guidelines for Federal Concessions and Vending Operations, which translate evidence-based recommendations on health and sustainability into institutional food service practices and are currently being implemented at the federal level. Developing and implementing guidelines has the potential to improve long-term population health outcomes while simultaneously benefitting the food system. Nutritionists, public health practitioners, and researchers should consider working with institutions to develop, implement, and evaluate food service guidelines for health and sustainability. PMID:22585909

  12. Developing and implementing health and sustainability guidelines for institutional food service.

    PubMed

    Kimmons, Joel; Jones, Sonya; McPeak, Holly H; Bowden, Brian

    2012-05-01

    Health and sustainability guidelines for institutional food service are directed at improving dietary intake and increasing the ecological benefits of the food system. The development and implementation of institutional food service guidelines, such as the Health and Human Services (HHS) and General Services Administration (GSA) Health and Sustainability Guidelines for Federal Concessions and Vending Operations (HHS/GSA Guidelines), have the potential to improve the health and sustainability of the food system. Institutional guidelines assist staff, managers, and vendors in aligning the food environment at food service venues with healthier and more sustainable choices and practices. Guideline specifics and their effective implementation depend on the size, culture, nature, and management structure of an institution and the individuals affected. They may be applied anywhere food is sold, served, or consumed. Changing institutional food service practice requires comprehensive analysis, engagement, and education of all relevant stakeholders including institutional management, members of the food supply chain, and customers. Current examples of food service guidelines presented here are the HHS and GSA Health and Sustainability Guidelines for Federal Concessions and Vending Operations, which translate evidence-based recommendations on health and sustainability into institutional food service practices and are currently being implemented at the federal level. Developing and implementing guidelines has the potential to improve long-term population health outcomes while simultaneously benefitting the food system. Nutritionists, public health practitioners, and researchers should consider working with institutions to develop, implement, and evaluate food service guidelines for health and sustainability.

  13. Clinical Pathway and Monthly Feedback Improve Adherence to Antibiotic Guideline Recommendations for Community-Acquired Pneumonia

    PubMed Central

    Almatar, Maher; Peterson, Gregory M.; Thompson, Angus; McKenzie, Duncan; Anderson, Tara; Zaidi, Syed Tabish R.

    2016-01-01

    Background Compliance with community-acquired pneumonia (CAP) guidelines remains poor despite a substantial body of evidence indicating that guideline-concordant care improves patient outcomes. The aim of this study was to compare the relative effectiveness of a general educational and a targeted emergency department intervention on improving physicians’ concordance with CAP guidelines. Methods Two distinct interventions were implemented over specific time periods. The first intervention was educational, focusing on the development of local CAP guidelines and their dissemination through hospital-wide educational programmes. The second intervention was a targeted one for the emergency department, where a clinical pathway for the initial management of CAP patients was introduced, followed by monthly feedback to the emergency department (ED) physicians about concordance rates with the guidelines. Data on the concordance rate to CAP guidelines was collected from a retrospective chart review. Results A total of 398 eligible patient records were reviewed to measure concordance to CAP guidelines over the study period. Concordance rates during the baseline and educational intervention periods were similar (28.1% vs. 31.2%; p > 0.05). Significantly more patients were treated in accordance with the CAP guidelines after the ED focused intervention when compared to the baseline (61.5% vs. 28.1%; p < 0.05) or educational period (61.5% vs. 31.2%; p < 0.05). Conclusions A targeted intervention with a CAP clinical pathway and monthly feedback was a successful strategy to increase adherence to empirical antibiotic recommendations in CAP guidelines. PMID:27454581

  14. Automating Identification of Multiple Chronic Conditions in Clinical Practice Guidelines

    PubMed Central

    Leung, Tiffany I.; Jalal, Hawre; Zulman, Donna M.; Dumontier, Michel; Owens, Douglas K.; Musen, Mark A.; Goldstein, Mary K.

    2015-01-01

    Many clinical practice guidelines (CPGs) are intended to provide evidence-based guidance to clinicians on a single disease, and are frequently considered inadequate when caring for patients with multiple chronic conditions (MCC), or two or more chronic conditions. It is unclear to what degree disease-specific CPGs provide guidance about MCC. In this study, we develop a method for extracting knowledge from single-disease chronic condition CPGs to determine how frequently they mention commonly co-occurring chronic diseases. We focus on 15 highly prevalent chronic conditions. We use publicly available resources, including a repository of guideline summaries from the National Guideline Clearinghouse to build a text corpus, a data dictionary of ICD-9 codes from the Medicare Chronic Conditions Data Warehouse (CCW) to construct an initial list of disease terms, and disease synonyms from the National Center for Biomedical Ontology to enhance the list of disease terms. First, for each disease guideline, we determined the frequency of comorbid condition mentions (a disease-comorbidity pair) by exactly matching disease synonyms in the text corpus. Then, we developed an annotated reference standard using a sample subset of guidelines. We used this reference standard to evaluate our approach. Then, we compared the co-prevalence of common pairs of chronic conditions from Medicare CCW data to the frequency of disease-comorbidity pairs in CPGs. Our results show that some disease-comorbidity pairs occur more frequently in CPGs than others. Sixty-one (29.0%) of 210 possible disease-comorbidity pairs occurred zero times; for example, no guideline on chronic kidney disease mentioned depression, while heart failure guidelines mentioned ischemic heart disease the most frequently. Our method adequately identifies comorbid chronic conditions in CPG recommendations with precision 0.82, recall 0.75, and F-measure 0.78. Our work identifies knowledge currently embedded in the free text of

  15. Automating Identification of Multiple Chronic Conditions in Clinical Practice Guidelines.

    PubMed

    Leung, Tiffany I; Jalal, Hawre; Zulman, Donna M; Dumontier, Michel; Owens, Douglas K; Musen, Mark A; Goldstein, Mary K

    2015-01-01

    Many clinical practice guidelines (CPGs) are intended to provide evidence-based guidance to clinicians on a single disease, and are frequently considered inadequate when caring for patients with multiple chronic conditions (MCC), or two or more chronic conditions. It is unclear to what degree disease-specific CPGs provide guidance about MCC. In this study, we develop a method for extracting knowledge from single-disease chronic condition CPGs to determine how frequently they mention commonly co-occurring chronic diseases. We focus on 15 highly prevalent chronic conditions. We use publicly available resources, including a repository of guideline summaries from the National Guideline Clearinghouse to build a text corpus, a data dictionary of ICD-9 codes from the Medicare Chronic Conditions Data Warehouse (CCW) to construct an initial list of disease terms, and disease synonyms from the National Center for Biomedical Ontology to enhance the list of disease terms. First, for each disease guideline, we determined the frequency of comorbid condition mentions (a disease-comorbidity pair) by exactly matching disease synonyms in the text corpus. Then, we developed an annotated reference standard using a sample subset of guidelines. We used this reference standard to evaluate our approach. Then, we compared the co-prevalence of common pairs of chronic conditions from Medicare CCW data to the frequency of disease-comorbidity pairs in CPGs. Our results show that some disease-comorbidity pairs occur more frequently in CPGs than others. Sixty-one (29.0%) of 210 possible disease-comorbidity pairs occurred zero times; for example, no guideline on chronic kidney disease mentioned depression, while heart failure guidelines mentioned ischemic heart disease the most frequently. Our method adequately identifies comorbid chronic conditions in CPG recommendations with precision 0.82, recall 0.75, and F-measure 0.78. Our work identifies knowledge currently embedded in the free text of

  16. Developing clinical guidelines: how much rigour is required?

    PubMed

    Haroon, Munib; Ranmal, Rita; McElroy, Helen; Dudley, Jan

    2015-04-01

    Clinical guidelines that are rigorously developed play a fundamental role in improving healthcare and reducing unnecessary variations in practice. National guidelines are increasingly used by healthcare professionals, patients and commissioners; however, national bodies are unable to meet the demand for guidance on all topics. There are fewer resources available for guidance produced locally or by specialty groups, and it is necessary to achieve a balance between pragmatism and rigour while conforming to the widely accepted norms of what constitutes a good guideline. This paper introduces the key concepts around this topic with suggestions for those interested in developing their own guideline. An example of challenges encountered in generating high-quality clinical guidance is given in box 1. Box 1 Challenges in guideline development Professor Johnson runs a local developmental paediatrics service with eight other colleagues. All have different ways of managing children with PAVING syndrome. This was difficult for patients and staff and has led to disagreements on how certain patients should be managed. As a result, Professor Johnson developed a Guideline Development Group to look at the management of PAVING syndrome. The group identified 12 clinical questions (including diagnosis, exclusion of comorbidities, treatment modalities), searched the PubMed database and found some useful evidence that they used to formulate key recommendations. For one question about behavioural therapy, PubMed did not suggest any evidence so they informally arrived at a consensus among themselves and wrote up their guideline. On the back of this success, they applied for the guideline to be endorsed or supported by the Royal College of Paediatrics and Child Health (RCPCH). To their frustration, it was turned down on methodological grounds. Professor Johnson wrote to the RCPCH saying that he was "pretty peeved that the PAVING syndrome guideline had been rejected" for the College

  17. Not of One Mind: Mental Models of Clinical Practice Guidelines in the Veterans Health Administration

    PubMed Central

    Hysong, Sylvia J; Best, Richard G; Pugh, Jacqueline A; Moore, Frank I

    2005-01-01

    Objective The purpose of this paper is to present differences in mental models of clinical practice guidelines (CPGs) among 15 Veterans Health Administration (VHA) facilities throughout the United States. Data Sources Two hundred and forty-four employees from 15 different VHA facilities across four service networks around the country were invited to participate. Participants were selected from different levels throughout each service setting from primary care personnel to facility leadership. Study Design This qualitative study used purposive sampling, a semistructured interview process for data collection, and grounded theory techniques for analysis. Data Collection A semistructured interview was used to collect information on participants' mental models of CPGs, as well as implementation strategies and barriers in their facility. Findings Analysis of these interviews using grounded theory techniques indicated that there was wide variability in employees' mental models of CPGs. Findings also indicated that high-performing facilities exhibited both (a) a clear, focused shared mental model of guidelines and (b) a tendency to use performance feedback as a learning opportunity, thus suggesting that a shared mental model is a necessary but not sufficient step toward successful guideline implementation. Conclusions We conclude that a clear shared mental model of guidelines, in combination with a learning orientation toward feedback are important components for successful guideline implementation and improved quality of care. PMID:15960693

  18. [Reflections on 20 years of clinical practice guideline programmes in Germany: what is their impact?].

    PubMed

    Nothacker, Monika; Muche-Borowski, Cathleen; Kopp, Ina B

    2014-01-01

    Following a recommendation of the National Advisory Council for the Concerted Action in Health Care, the Association of the Scientific Medical Societies (AWMF) have promoted, supported and coordinated the development of clinical practice guidelines in Germany since 1995. The allocation of the responsibility for guideline development in the scientific societies corresponded to the principle of subsidiarity, in contrast to other countries counting on government-organised guideline programmes. To fulfil internationally consented criteria of high-quality guidelines, a quality improvement system was established relying on frequent assessments of the current state. Today, high-quality clinical practice guidelines developed by the scientific societies organised under the umbrella of the AWMF are an indispensable tool for various initiatives to improve healthcare in the German healthcare system. The next challenging goal is to establish a theory-driven framework allowing for a systematic implementation and evaluation of guidelines in Germany on the basis of existing approaches. However, success in this endeavour will require further research and funding.

  19. Improving clinical practice guidelines for the 21st century. Attitudinal barriers and not technology are the main challenges.

    PubMed

    Browman, G P

    2000-01-01

    Through the use of three scenarios, this paper presents the challenges for clinical practice guidelines in the 21st century. Such challenges relate to technological developments to improve the efficiency and pace of the development process, to ensure that clinical practice guidelines are kept up to date, and to facilitate implementation of guidelines in the clinical setting. To improve and ensure the validity of the content of clinical practice guidelines, we need to address the important problem of publication bias, for which researchers, granting agencies, industry, and journal editors share responsibility. This means insisting on registration of trials at their inception, and incentives backed up by rules for funding and peer review publication that would promote behaviors to avoid publication bias. The more difficult challenges for clinical practice guidelines relate to what are referred to as attitudinal factors. To achieve optimal efficiencies in development and maintenance of clinical practice guidelines, we need to promote cooperation among various information resource providers internationally and to stress partnership over leadership. Finally, there need to be reconciliation of the different stakeholder perspectives of the value and purpose of clinical practice guidelines so that they are used appropriately as aids to decision making and are not abused as tools for controlling clinical practice.

  20. [Agreements and disagreements among the main clinical practice guidelines].

    PubMed

    Calderón Montero, A

    2014-07-01

    Diabetes mellitus has an enormous health and social impact and its incidence is rising exponentially in the industrialized world as a result of unhealthy lifestyles. In the last few years, research in this field has increased, leading to the development of new drugs and new indications. Consequently, numerous updates of clinical practice guidelines for diabetes have been published in the last 12 months, which provide health professionals with an up-to-date view of therapeutic possibilities. The present article reviews the guidelines with the greatest scientific impact and discusses areas of agreement and disagreement among these documents.

  1. [Management of type 2 diabetes: from guidelines to clinical practice].

    PubMed

    Ahluwalia, Rupa; Vora, Jiten

    2010-09-01

    The current era is seeing an unprecedented rise in the incidence of type 2 diabetes, related to increasing adiposity levels. In addition, the complex nature of the disease with a much younger patient group than before makes prescribing a challenging task for physicians today. The advent of incretin based agents makes therapeutics exciting but warrants judicious use given the higher prescription costs and limited safety data. At the same time, mounting evidence not only supports a "treat early" approach but also cautions against achieving tight glycaemic control too quickly in certain patient groups particularly those of long disease duration and evidence of cardiovascular disease. In this conundrum, guidelines help to bring the best clinical evidence closer to practise. In this chapter, we discuss the latest clinical guidelines for management of type 2 diabetes based on recommendations from the American Diabetes Association, the European Association for the Study of Diabetes and the National Institute of Clinical Excellence (UK). At the same time we highlight the limitations of guidelines as they are unable to provide options for all "real life" scenarios. Though guidelines are instrumental in bringing evidence closer to practise, it is ultimately up to the clinician to rationalise therapy as per the needs of the individual patient. At the same time, it is also crucial to achieve meaningful outcomes in patients' lives especially in the current "pay for performance" culture in health care with the aim of providing world class care to each and every patient with diabetes. PMID:21420532

  2. Quality improvement for neonatal nurses, part II: using a PDSA quality improvement cycle approach to implement an oral feeding progression guideline for premature infants.

    PubMed

    Marcellus, Lenora; Harrison, Adele; Mackinnon, Kathleen

    2012-01-01

    The development of clinical practice guidelines involving multiple health care providers presents a challenge in the neonatal intensive care unit (NICU). Implementation and evaluation of the guideline is as important as the development of the guideline itself. We explored the use of a quality improvement approach in the implementation of a feeding framework. A Plan-Do-Study-Act (PDSA) quality improvement cycle model was used to implement and evaluate a stepwise oral infant feeding guideline with emphasis on parent and care provider satisfaction. Three PDSA cycles were conducted, with each cycle resulting in modifications to use of the framework and development of knowledge translation and parent education techniques and tools. A PDSA cycle approach can be used effectively in guideline implementation and evaluation involving multidisciplinary health care professionals. This is Part II of a two-part series. Part I introduced the concept of quality improvement and tools for advancing practice changes.

  3. Application of Agree II Instrument for Appraisal of Postpartum Hemorrhage Clinical Practice Guidelines in Bosnia and Herzegovina

    PubMed Central

    Novo, Ahmed; Subotic-popovic, Andreja; Strbac, Savka; Kandic, Alma; Horga, Mihai

    2016-01-01

    Introduction: Federal Minister of Health and Minister of Health and Social Welfare of the Republika Srpska as a Governmental health authorities in Federation of Bosnia and Herzegovina (FBiH) and the Republika Srpska nominated/appointed health professionals as their representatives to a multidisciplinary Guidelines Adaptation Group (GAG). This group started with its work in September 2015. The main purpose of the guidelines development exercise is to develop guidelines with worldwide recognized methodology for clinical guidelines development and adaptation. At the end of this consultancy, GAG would have develop a clinical practice guideline on Postpartum hemorrhage (PPH) through the adaptation method, starting from published international clinical guidelines and adapting it according to the country specific requirements. Methodology: During the process of identifying the best guideline for adaptation, the GAG had to pass several steps. One of the crucial steps was to identify the questions related to clinical practice and health policy for which answers are needed to be addressed by the guideline. These questions included relevant issues regarding the topic area such as diagnosis, prognosis, intervention, service delivery, and training. After that, six guidelines have been researched by the six members of the GAG to see if they answered the identified questions. Evaluating the methodological quality of the selected clinical guidelines was a second essential step before deciding which ones could best fit the needs and interests. AGREE II instrument has been chosen as methods for evaluating clinical guideline quality and appropriateness. Four appraisers conducted the assessment of each of the selected guidelines for PPH. All appraisers passed the training for the AGREE II instrument before conducting appraisals, as recommended by the AGREE collaboration. Each of the four guidelines was rated independently with the AGREE II tool by each appraiser. Results: The highest

  4. Barriers Against Implementing Blunt Abdominal Trauma Guidelines in a Hospital: A Qualitative Study

    PubMed Central

    Zaboli, Rouhollah; Tofighi, Shahram; Aghighi, Ali; Shokouh, Seyyed Javad Hosaini; Naraghi, Nader; Goodarzi, Hassan

    2016-01-01

    Introduction Clinical practice guidelines are structured recommendations that help physicians and patients to make proper decisions when dealing with a specific clinical condition. Because blunt abdominal trauma causes a various range of mild, single-system, and multisystem injuries, early detection will help to reduce mortality and resulting disability. Emergency treatment should be initiated based on CPGs. This study aimed to determine the variables affecting implementing blunt abdominal trauma CPGs in an Iranian hospital. Methods This study was conducted as a qualitative and phenomenology study in the Family Hospital in Tehran (Iran) in 2015. The research population included eight experts and key people in the area of blunt abdominal trauma clinical practice guidelines. Sampling was based on purposive and nonrandom methods. A semistructured interview was done for the data collection. A framework method was applied for the data analysis by using Atlas.ti software. Results After framework analyzing and various reviewing and deleting and combining the codes from 251 codes obtained, 15 families and five super families were extracted, including technical knowledge barriers, economical barriers, barriers related to deployment and monitoring, political will barriers, and managing barriers. Conclusion Structural reform is needed for eliminating the defects available in the healthcare system. As with most of the codes, subconcepts and concepts are classified into the field of human resources; it seems that the education and knowledge will be more important than other resources such as capital and equipment. PMID:27757191

  5. Economic Evaluation of Active Implementation versus Guideline Dissemination for Evidence-Based Care of Acute Low-Back Pain in a General Practice Setting

    PubMed Central

    Mortimer, Duncan; French, Simon D.; McKenzie, Joanne E.; O′Connor, Denise A.; Green, Sally E.

    2013-01-01

    Introduction The development and publication of clinical practice guidelines for acute low-back pain has resulted in evidence-based recommendations that have the potential to improve the quality and safety of care for acute low-back pain. Development and dissemination of guidelines may not, however, be sufficient to produce improvements in clinical practice; further investment in active implementation of guideline recommendations may be required. Further research is required to quantify the trade-off between the additional upfront cost of active implementation of guideline recommendations for low-back pain and any resulting improvements in clinical practice. Methods Cost-effectiveness analysis alongside the IMPLEMENT trial from a health sector perspective to compare active implementation of guideline recommendations via the IMPLEMENT intervention (plus standard dissemination) against standard dissemination alone. Results The base-case analysis suggests that delivery of the IMPLEMENT intervention dominates standard dissemination (less costly and more effective), yielding savings of $135 per x-ray referral avoided (-$462.93/3.43). However, confidence intervals around point estimates for the primary outcome suggest that – irrespective of willingness to pay (WTP) – we cannot be at least 95% confident that the IMPLEMENT intervention differs in value from standard dissemination. Conclusions Our findings demonstrate that moving beyond development and dissemination to active implementation entails a significant additional upfront investment that may not be offset by health gains and/or reductions in health service utilization of sufficient magnitude to render active implementation cost-effective. PMID:24146767

  6. Sustainability of professionals’ adherence to clinical practice guidelines in medical care: a systematic review

    PubMed Central

    Ament, Stephanie M C; de Groot, Jeanny J A; Maessen, José M C; Dirksen, Carmen D; van der Weijden, Trudy; Kleijnen, Jos

    2015-01-01

    Objectives To evaluate (1) the state of the art in sustainability research and (2) the outcomes of professionals’ adherence to guideline recommendations in medical practice. Design Systematic review. Data sources Searches were conducted until August 2015 in MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and the Guidelines International Network (GIN) library. A snowball strategy, in which reference sections of other reviews and of included papers were searched, was used to identify additional papers. Eligibility criteria Studies needed to be focused on sustainability and on professionals’ adherence to clinical practice guidelines in medical care. Studies had to include at least 2 measurements: 1 before (PRE) or immediately after implementation (EARLY POST) and 1 measurement longer than 1 year after active implementation (LATE POST). Results The search retrieved 4219 items, of which 14 studies met the inclusion criteria, involving 18 sustainability evaluations. The mean timeframe between the end of active implementation and the sustainability evaluation was 2.6 years (minimum 1.5–maximum 7.0). The studies were heterogeneous with respect to their methodology. Sustainability was considered to be successful if performance in terms of professionals’ adherence was fully maintained in the late postimplementation phase. Long-term sustainability of professionals’ adherence was reported in 7 out of 18 evaluations, adherence was not sustained in 6 evaluations, 4 evaluations showed mixed sustainability results and in 1 evaluation it was unclear whether the professional adherence was sustained. Conclusions (2) Professionals’ adherence to a clinical practice guideline in medical care decreased after more than 1 year after implementation in about half of the cases. (1) Owing to the limited number of studies, the absence of a uniform definition, the high risk of bias, and the mixed results of studies, no firm conclusion about the

  7. [How to implement a guideline from theory to practice: the example of the venous thromboembolism prophylaxis].

    PubMed

    Paiva, Edison F; Rocha, Ana T C

    2009-01-01

    The objective of this manuscript is to discuss the existing barriers for the dissemination of medical guidelines, and to present strategies that facilitate the adaptation of the recommendations into clinical practice. The literature shows that it usually takes several years until new scientific evidence is adopted in current practice, even when there is obvious impact in patients' morbidity and mortality. There are some examples where more than thirty years have elapsed since the first case reports about the use of a effective therapy were published until its utilization became routine. That is the case of fibrinolysis for the treatment of acute myocardial infarction. Some of the main barriers for the implementation of new recommendations are: the lack of knowledge of a new guideline, personal resistance to changes, uncertainty about the efficacy of the proposed recommendation, fear of potential side-effects, difficulties in remembering the recommendations, inexistence of institutional policies reinforcing the recommendation and even economical restrains. In order to overcome these barriers a strategy that involves a program with multiple tools is always the best. That must include the implementation of easy-to-use algorithms, continuous medical education materials and lectures, electronic or paper alerts, tools to facilitate evaluation and prescription, and periodic audits to show results to the practitioners involved in the process. It is also fundamental that the medical societies involved with the specific medical issue support the program for its scientific and ethical soundness. The creation of multidisciplinary committees in each institution and the inclusion of opinion leaders that have pro-active and lasting attitudes are the key-points for the program's success. In this manuscript we use as an example the implementation of a guideline for venous thromboembolism prophylaxis, but the concepts described here can be easily applied to any other guideline

  8. Computerization of workflows, guidelines, and care pathways: a review of implementation challenges for process-oriented health information systems

    PubMed Central

    Roudsari, Abdul

    2011-01-01

    Objective There is a need to integrate the various theoretical frameworks and formalisms for modeling clinical guidelines, workflows, and pathways, in order to move beyond providing support for individual clinical decisions and toward the provision of process-oriented, patient-centered, health information systems (HIS). In this review, we analyze the challenges in developing process-oriented HIS that formally model guidelines, workflows, and care pathways. Methods A qualitative meta-synthesis was performed on studies published in English between 1995 and 2010 that addressed the modeling process and reported the exposition of a new methodology, model, system implementation, or system architecture. Thematic analysis, principal component analysis (PCA) and data visualisation techniques were used to identify and cluster the underlying implementation ‘challenge’ themes. Results One hundred and eight relevant studies were selected for review. Twenty-five underlying ‘challenge’ themes were identified. These were clustered into 10 distinct groups, from which a conceptual model of the implementation process was developed. Discussion and conclusion We found that the development of systems supporting individual clinical decisions is evolving toward the implementation of adaptable care pathways on the semantic web, incorporating formal, clinical, and organizational ontologies, and the use of workflow management systems. These architectures now need to be implemented and evaluated on a wider scale within clinical settings. PMID:21724740

  9. Analysing clinical practice guidelines. A method of documentary analysis.

    PubMed

    Appleton, J V; Cowley, S

    1997-05-01

    This paper will describe a method of documentary analysis used in a study examining the validity of clinical guidelines issued to health visitors to assist them in identifying families requiring increased health visitor support. This forms the preliminary work for a wider study examining how health visitors decide to increase support to vulnerable families. Although a number of published research texts discuss the value of records and documents as important data sources for health service researchers, there is relatively little information available about the processes of documentary analysis. This paper offers one method for analysing clinical practice guidelines, it describes the development of a critique and analysis tool and explores the strengths and weaknesses of this particular analysis instrument.

  10. [Clinical guidelines for the prevention of infective endocarditis].

    PubMed

    Pérez-Lescure Picarzo, J; Crespo Marcos, D; Centeno Malfaz, F

    2014-03-01

    This article sets out the recommendations for the prevention of infective endocarditis (IE), contained in the guidelines developed by the American Heart Association (AHA) and the European Society of Cardiology (ESC), from which the recommendations of the Spanish Society of Paediatric Cardiology and Congenital Heart Disease have been agreed. In recent years, there has been a considerable change in the recommendations for the prevention of IE, mainly due to the lack of evidence on the effectiveness of antibiotic prophylaxis in prevention, and the risk of the development of antibiotic resistance. The main change is a reduction of the indications for antibiotic prophylaxis, both in terms of patients and procedures considered at risk. Clinical practice guidelines and recommendations should assist health professionals in making clinical decisions in their daily practice. However, the ultimate judgment regarding the care of a particular patient must be taken by the physician responsible.

  11. Assessing biocomputational modelling in transforming clinical guidelines for osteoporosis management.

    PubMed

    Thiel, Rainer; Viceconti, Marco; Stroetmann, Karl

    2011-01-01

    Biocomputational modelling as developed by the European Virtual Physiological Human (VPH) Initiative is the area of ICT most likely to revolutionise in the longer term the practice of medicine. Using the example of osteoporosis management, a socio-economic assessment framework is presented that captures how the transformation of clinical guidelines through VPH models can be evaluated. Applied to the Osteoporotic Virtual Physiological Human Project, a consequent benefit-cost analysis delivers promising results, both methodologically and substantially. PMID:21893787

  12. Operational Earthquake Forecasting: Proposed Guidelines for Implementation (Invited)

    NASA Astrophysics Data System (ADS)

    Jordan, T. H.

    2010-12-01

    The goal of operational earthquake forecasting (OEF) is to provide the public with authoritative information about how seismic hazards are changing with time. During periods of high seismic activity, short-term earthquake forecasts based on empirical statistical models can attain nominal probability gains in excess of 100 relative to the long-term forecasts used in probabilistic seismic hazard analysis (PSHA). Prospective experiments are underway by the Collaboratory for the Study of Earthquake Predictability (CSEP) to evaluate the reliability and skill of these seismicity-based forecasts in a variety of tectonic environments. How such information should be used for civil protection is by no means clear, because even with hundredfold increases, the probabilities of large earthquakes typically remain small, rarely exceeding a few percent over forecasting intervals of days or weeks. Civil protection agencies have been understandably cautious in implementing formal procedures for OEF in this sort of “low-probability environment.” Nevertheless, the need to move more quickly towards OEF has been underscored by recent experiences, such as the 2009 L’Aquila earthquake sequence and other seismic crises in which an anxious public has been confused by informal, inconsistent earthquake forecasts. Whether scientists like it or not, rising public expectations for real-time information, accelerated by the use of social media, will require civil protection agencies to develop sources of authoritative information about the short-term earthquake probabilities. In this presentation, I will discuss guidelines for the implementation of OEF informed by my experience on the California Earthquake Prediction Evaluation Council, convened by CalEMA, and the International Commission on Earthquake Forecasting, convened by the Italian government following the L’Aquila disaster. (a) Public sources of information on short-term probabilities should be authoritative, scientific, open, and

  13. Implementing Bright Futures guidelines for well-child care in North Carolina.

    PubMed

    Foy, Jane Meschan

    2013-01-01

    The Bright Futures guidelines published by the American Academy of Pediatrics offer a comprehensive agenda for improving the health of people from birth to age 21 years. The guidelines are the culmination of a century of multidisciplinary, multiorganizational efforts in the United States to prevent illness and promote health in children and adolescents, and, in turn, the adults they become. Regulations interpreting the Patient Protection and Affordable Care Act (ACA) specifically state that group health plans must, at a minimum, provide coverage for the preventive services recommended in the Bright Futures guidelines. Thus the ACA will be an impetus for implementation of the guidelines. This issue brief describes the genesis, history, and development of the guidelines. In addition, it briefly touches on each of the commentaries and other articles contained in this issue of the NCMJ dedicated to the implementation of Bright Futures guidelines.

  14. Japanese Society of Clinical Oncology clinical practice guidelines 2010 for antiemesis in oncology: executive summary.

    PubMed

    Takeuchi, Hideki; Saeki, Toshiaki; Aiba, Keisuke; Tamura, Kazuo; Aogi, Kenjiro; Eguchi, Kenji; Okita, Kenji; Kagami, Yoshikazu; Tanaka, Ryuhei; Nakagawa, Kazuhiko; Fujii, Hirofumi; Boku, Narikazu; Wada, Makoto; Akechi, Tatsuo; Udagawa, Yasuhiro; Okawa, Yutaka; Onozawa, Yusuke; Sasaki, Hidenori; Shima, Yasuo; Shimoyama, Naohito; Takeda, Masayuki; Nishidate, Toshihiko; Yamamoto, Akifumi; Ikeda, Tadashi; Hirata, Koichi

    2016-02-01

    The purpose of this article is to disseminate the standard of antiemetic therapy for Japanese clinical oncologists. On the basis of the Appraisal of Guidelines for Research and Evaluation II instrument, which reflects evidence-based clinical practice guidelines, a working group of the Japanese Society of Clinical Oncology (JSCO) reviewed clinical practice guidelines for antiemesis and performed a systematic review of evidence-based domestic practice guidelines for antiemetic therapy in Japan. In addition, because health-insurance systems in Japan are different from those in other countries, a consensus was reached regarding standard treatments for chemotherapy that induce nausea and vomiting. Current evidence was collected by use of MEDLINE, from materials from meetings of the American Society of Clinical Oncology National Comprehensive Cancer Network, and from European Society of Medical Oncology/Multinational Association of Supportive Care in Cancer guidelines for antiemesis. Initially, 21 clinical questions (CQ) were selected on the basis of CQs from other guidelines. Patients treated with highly emetic agents should receive a serotonin (5-hydroxytryptamine; 5HT3) receptor antagonist, dexamethasone, and a neurokinin 1 receptor antagonist. For patients with moderate emetic risk, 5HT3 receptor antagonists and dexamethasone were recommended, whereas for those receiving chemotherapy with low emetic risk dexamethasone only is recommended. Patients receiving high-emetic-risk radiation therapy should also receive a 5HT3 receptor antagonist. In this paper the 2010 JSCO clinical practice guidelines for antiemesis are presented in English; they reveal high concordance of Japanese medical circumstances with other antiemetic guidelines that are similarly based on evidence.

  15. How to translate therapeutic recommendations in clinical practice guidelines into rules for critiquing physician prescriptions? Methods and application to five guidelines

    PubMed Central

    2010-01-01

    Background Clinical practice guidelines give recommendations about what to do in various medical situations, including therapeutical recommendations for drug prescription. An effective way to computerize these recommendations is to design critiquing decision support systems, i.e. systems that criticize the physician's prescription when it does not conform to the guidelines. These systems are commonly based on a list of "if conditions then criticism" rules. However, writing these rules from the guidelines is not a trivial task. The objective of this article is to propose methods that (1) simplify the implementation of guidelines' therapeutical recommendations in critiquing systems by automatically translating structured therapeutical recommendations into a list of "if conditions then criticize" rules, and (2) can generate an appropriate textual label to explain to the physician why his/her prescription is not recommended. Methods We worked on the therapeutic recommendations in five clinical practice guidelines concerning chronic diseases related to the management of cardiovascular risk. We evaluated the system using a test base of more than 2000 cases. Results Algorithms for automatically translating therapeutical recommendations into "if conditions then criticize" rules are presented. Eight generic recommendations are also proposed; they are guideline-independent, and can be used as default behaviour for handling various situations that are usually implicit in the guidelines, such as decreasing the dose of a poorly tolerated drug. Finally, we provide models and methods for generating a human-readable textual critique. The system was successfully evaluated on the test base. Conclusion We show that it is possible to criticize physicians' prescriptions starting from a structured clinical guideline, and to provide clear explanations. We are now planning a randomized clinical trial to evaluate the impact of the system on practices. PMID:20509903

  16. Creating Shareable Clinical Decision Support Rules for a Pharmacogenomics Clinical Guideline Using Structured Knowledge Representation

    PubMed Central

    Linan, Margaret K.; Sottara, Davide; Freimuth, Robert R.

    2015-01-01

    Pharmacogenomics (PGx) guidelines contain drug-gene relationships, therapeutic and clinical recommendations from which clinical decision support (CDS) rules can be extracted, rendered and then delivered through clinical decision support systems (CDSS) to provide clinicians with just-in-time information at the point of care. Several tools exist that can be used to generate CDS rules that are based on computer interpretable guidelines (CIG), but none have been previously applied to the PGx domain. We utilized the Unified Modeling Language (UML), the Health Level 7 virtual medical record (HL7 vMR) model, and standard terminologies to represent the semantics and decision logic derived from a PGx guideline, which were then mapped to the Health eDecisions (HeD) schema. The modeling and extraction processes developed here demonstrate how structured knowledge representations can be used to support the creation of shareable CDS rules from PGx guidelines. PMID:26958298

  17. Korean clinical practice guidelines: otitis media in children.

    PubMed

    Lee, Hyo-Jeong; Park, Su-Kyoung; Choi, Kyu Young; Park, Su Eun; Chun, Young Myung; Kim, Kyu-Sung; Park, Shi-Nae; Cho, Yang-Sun; Kim, Young-Jae; Kim, Hyung-Jong; Korean Otologic Society

    2012-08-01

    Acute otitis media (AOM) and otitis media with effusion (OME) are common infections in children, and their diagnosis and treatment have significant impacts on the health of children and the costs of providing national medical care. In 2009, the Korean Otologic Society organized a committee composed of experts in the field of otolaryngology, pediatrics, and family medicine to develop Korean clinical practice guidelines (CPG) for otitis media in children with the goal of meeting regional medical and social needs in Korea. For this purpose, the committee adapted existing guidelines. A comprehensive literature review was carried out primarily from 2004 to 2009 using medical search engines including data from Korea. A draft was written after a national questionnaire survey and several public audits, and it was editorially supervised by senior advisors before publication of the final report. These evidence-based guidelines for the management of otitis media in children provide recommendations to primary practitioners for the diagnosis and treatment of children younger than 15 yr old with uncomplicated AOM and OME. The guidelines include recommendations regarding diagnosis, treatment options, prevention and parent education, medical records, referral, and complementary/alternative medicine for treating pediatric otitis media.

  18. Korean Clinical Practice Guidelines: Otitis Media in Children

    PubMed Central

    Lee, Hyo-Jeong; Park, Su-Kyoung; Choi, Kyu Young; Park, Su Eun; Chun, Young Myung; Kim, Kyu-Sung; Park, Shi-Nae; Cho, Yang-Sun; Kim, Young-Jae

    2012-01-01

    Acute otitis media (AOM) and otitis media with effusion (OME) are common infections in children, and their diagnosis and treatment have significant impacts on the health of children and the costs of providing national medical care. In 2009, the Korean Otologic Society organized a committee composed of experts in the field of otolaryngology, pediatrics, and family medicine to develop Korean clinical practice guidelines (CPG) for otitis media in children with the goal of meeting regional medical and social needs in Korea. For this purpose, the committee adapted existing guidelines. A comprehensive literature review was carried out primarily from 2004 to 2009 using medical search engines including data from Korea. A draft was written after a national questionnaire survey and several public audits, and it was editorially supervised by senior advisors before publication of the final report. These evidence-based guidelines for the management of otitis media in children provide recommendations to primary practitioners for the diagnosis and treatment of children younger than 15 yr old with uncomplicated AOM and OME. The guidelines include recommendations regarding diagnosis, treatment options, prevention and parent education, medical records, referral, and complementary/alternative medicine for treating pediatric otitis media. PMID:22876048

  19. Updated Clinical Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders.

    PubMed

    Hoyme, H Eugene; Kalberg, Wendy O; Elliott, Amy J; Blankenship, Jason; Buckley, David; Marais, Anna-Susan; Manning, Melanie A; Robinson, Luther K; Adam, Margaret P; Abdul-Rahman, Omar; Jewett, Tamison; Coles, Claire D; Chambers, Christina; Jones, Kenneth L; Adnams, Colleen M; Shah, Prachi E; Riley, Edward P; Charness, Michael E; Warren, Kenneth R; May, Philip A

    2016-08-01

    The adverse effects of prenatal alcohol exposure constitute a continuum of disabilities (fetal alcohol spectrum disorders [FASD]). In 1996, the Institute of Medicine established diagnostic categories delineating the spectrum but not specifying clinical criteria by which diagnoses could be assigned. In 2005, the authors published practical guidelines operationalizing the Institute of Medicine categories, allowing for standardization of FASD diagnoses in clinical settings. The purpose of the current report is to present updated diagnostic guidelines based on a thorough review of the literature and the authors' combined expertise based on the evaluation of >10 000 children for potential FASD in clinical settings and in epidemiologic studies in conjunction with National Institute on Alcohol Abuse and Alcoholism-funded studies, the Collaborative Initiative on Fetal Alcohol Spectrum Disorders, and the Collaboration on FASD Prevalence. The guidelines were formulated through conference calls and meetings held at National Institute on Alcohol Abuse and Alcoholism offices in Rockville, MD. Specific areas addressed include the following: precise definition of documented prenatal alcohol exposure; neurobehavioral criteria for diagnosis of fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder; revised diagnostic criteria for alcohol-related birth defects; an updated comprehensive research dysmorphology scoring system; and a new lip/philtrum guide for the white population, incorporating a 45-degree view. The guidelines reflect consensus among a large and experienced cadre of FASD investigators in the fields of dysmorphology, epidemiology, neurology, psychology, developmental/behavioral pediatrics, and educational diagnostics. Their improved clarity and specificity will guide clinicians in accurate diagnosis of infants and children prenatally exposed to alcohol. PMID:27464676

  20. Updated Clinical Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders.

    PubMed

    Hoyme, H Eugene; Kalberg, Wendy O; Elliott, Amy J; Blankenship, Jason; Buckley, David; Marais, Anna-Susan; Manning, Melanie A; Robinson, Luther K; Adam, Margaret P; Abdul-Rahman, Omar; Jewett, Tamison; Coles, Claire D; Chambers, Christina; Jones, Kenneth L; Adnams, Colleen M; Shah, Prachi E; Riley, Edward P; Charness, Michael E; Warren, Kenneth R; May, Philip A

    2016-08-01

    The adverse effects of prenatal alcohol exposure constitute a continuum of disabilities (fetal alcohol spectrum disorders [FASD]). In 1996, the Institute of Medicine established diagnostic categories delineating the spectrum but not specifying clinical criteria by which diagnoses could be assigned. In 2005, the authors published practical guidelines operationalizing the Institute of Medicine categories, allowing for standardization of FASD diagnoses in clinical settings. The purpose of the current report is to present updated diagnostic guidelines based on a thorough review of the literature and the authors' combined expertise based on the evaluation of >10 000 children for potential FASD in clinical settings and in epidemiologic studies in conjunction with National Institute on Alcohol Abuse and Alcoholism-funded studies, the Collaborative Initiative on Fetal Alcohol Spectrum Disorders, and the Collaboration on FASD Prevalence. The guidelines were formulated through conference calls and meetings held at National Institute on Alcohol Abuse and Alcoholism offices in Rockville, MD. Specific areas addressed include the following: precise definition of documented prenatal alcohol exposure; neurobehavioral criteria for diagnosis of fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder; revised diagnostic criteria for alcohol-related birth defects; an updated comprehensive research dysmorphology scoring system; and a new lip/philtrum guide for the white population, incorporating a 45-degree view. The guidelines reflect consensus among a large and experienced cadre of FASD investigators in the fields of dysmorphology, epidemiology, neurology, psychology, developmental/behavioral pediatrics, and educational diagnostics. Their improved clarity and specificity will guide clinicians in accurate diagnosis of infants and children prenatally exposed to alcohol.

  1. Pressure Ulcers in Adults: Prediction and Prevention. Clinical Practice Guideline Number 3.

    ERIC Educational Resources Information Center

    Agency for Health Care Policy and Research (DHHS/PHS), Rockville, MD.

    This package includes a clinical practice guideline, quick reference guide for clinicians, and patient's guide to predicting and preventing pressure ulcers in adults. The clinical practice guideline includes the following: overview of the incidence and prevalence of pressure ulcers; clinical practice guideline (introduction, risk assessment tools…

  2. 49 CFR Appendix C to Part 224 - Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports C Appendix C to Part 224 Transportation Other Regulations... REFLECTORIZATION OF RAIL FREIGHT ROLLING STOCK Pt. 224, App. C Appendix C to Part 224—Guidelines for...

  3. 49 CFR Appendix C to Part 224 - Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 4 2014-10-01 2014-10-01 false Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports C Appendix C to Part 224 Transportation Other Regulations... REFLECTORIZATION OF RAIL FREIGHT ROLLING STOCK Pt. 224, App. C Appendix C to Part 224—Guidelines for...

  4. 49 CFR Appendix C to Part 224 - Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 4 2013-10-01 2013-10-01 false Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports C Appendix C to Part 224 Transportation Other Regulations... REFLECTORIZATION OF RAIL FREIGHT ROLLING STOCK Pt. 224, App. C Appendix C to Part 224—Guidelines for...

  5. Association for Counselor Education and Supervision Guidelines for Research Mentorship: Development and Implementation

    ERIC Educational Resources Information Center

    Borders, L. DiAnne; Wester, Kelly L.; Granello, Darcy Haag; Chang, Catherine Y.; Hays, Danica G.; Pepperell, Jennifer; Spurgeon, Shawn L.

    2012-01-01

    The authors describe guidelines endorsed by the Association for Counselor Education and Supervision for research mentorship, including characteristics of mentors and mentees. Suggestions for implementing the guidelines at the individual, program, institution, and professional levels are focused on enhancing mentoring relationships as well as…

  6. Consumer Education in the Secondary Curriculum: Guidelines for Implementation.

    ERIC Educational Resources Information Center

    Pennsylvania State Dept. of Education, Harrisburg. Bureau of General and Academic Education.

    Guidelines are suggested here for integrating consumer subject matter into existing secondary curricula, developing a team approach, or developing a systems approach that involves the entire school and community rather than offering a separate consumer education course. Any or all of the above suggestions might be utilized within a school…

  7. [How to write, how to implement and how to evaluate a practice guideline in order to improve quality of care?].

    PubMed

    Moret, L; Lefort, C; Terrien, N

    2012-11-01

    Initiatives of clinical practices improvement have been gradually developing in France for 20 years. Nevertheless, effective implementation of change is still difficult for numerous reasons. The use of clinical practices guidelines is one of the different ways of improvement. It is however necessary to adapt these national guidelines to the specificities of the hospital and the team, to ensure implementation and appropriation by the professionals. These recommendations are thus translated into applicable and concrete standard operating procedures. These documents have to be built by and for the concerned professionals. They are also communication and training tools, precise, directive, uniform in terms of presentation and attractive visually. Once drafted, they have to be distributed widely to the professionals to facilitate implementation. The simple distribution of the recommendations is insufficient to modify the clinical practices and require association of several methods of promotion for an optimal appropriation. How then to make sure of their effective use? Practices evaluation is one of the steps of continuous professional development, including continuous training and analysis of clinical practices by using methods promoted by the "Haute Autorité de santé". One of them is the clinical audit; use of method assessing non-pertinent treatment is interesting too. Analysis of the non-conformities and gaps between theory and practice allows identifying various possible causes (professional, institutional, organizational or personal) in order to implement corrective action plans, in a logic of continuous improvement. PMID:23039956

  8. BARRIERS TO IMPLEMENT THE NATIONAL GUIDELINES ON NEWBORN CARE IN A RURAL MOUNTAINOUS PROVINCE OF VIETNAM

    PubMed Central

    Thi, Le Minh; Ha, BuiThiThu; Hoa, Dinh Thi Phuong

    2016-01-01

    Reducing the disparity in neonatal health among regions to ensure every mother and her newborn receive the health care they need is a priority in Vietnam. This study was conducted to assess the barriers in implementing the National guidelines on newborn care in a rural mountainous province of Vietnam. Qualitative methods were applied with 28 in-depth interviews and 4 focus group discussions in DakNong province. The results showed that there exist many barriers in implementing the national guideline in newborn care services. There is a big gap between health policy development and policy implementation. The Vietnam government had approved a good strategy and guidelines. Efforts now need to focus on implementing the national guideline and improving quality of care. PMID:27516812

  9. Challenges and guidelines for clinical trial of herbal drugs.

    PubMed

    Parveen, Abida; Parveen, Bushra; Parveen, Rabea; Ahmad, Sayeed

    2015-01-01

    World Health Organization (WHO) has defined herbal medicines as finished labeled medicinal product that contain an active ingredient, aerial, or underground parts of the plant or other plant material or combinations. According to a report of WHO, about 80% of the world population is reported to rely on traditional medicine for their primary health care needs. Even in the developed countries, complementary or alternative medicine is gaining popularity. A report of a global survey on national policy on traditional medicine and regulation of herbal medicines indicated that about 50 countries including China, Japan, and Germany already have their national policy and laws on regulations of traditional medicines. Herbal drugs possess a long history of its use and better patient tolerance. These are cheaper and easily available in countries like India due to rich agro culture conditions. However, reckless utilization of resources threatens the sustainability of several plant species. Traditional medicines are governed by the Drugs and Cosmetics Act of 1940 and the Drugs and Cosmetics Rules of 1945. In 1959, the Government of India amended the Drugs and Cosmetics Act to include drugs that are derived from traditional Indian medicine. In 1993, the guidelines for the safety and efficacy of herbal medicines developed by an expert committee directed that the procedures laid down by the office of the Drug Controller General of India for allopathic drugs should be followed for all traditional and herbal products to enter into clinical trials for any therapeutic condition. However, there are certain loop holes in the clinical trials of herbal drugs as the lack of stringent bylaws and regulations. Hence, a deep insight of important challenges and major regulatory guidelines for clinical trial of herbal drugs and botanicals is discussed in the present communication. There is lack of scientific evidence to evaluate safety and efficacy of herbal drugs. The quality of the trial drug

  10. Challenges and guidelines for clinical trial of herbal drugs.

    PubMed

    Parveen, Abida; Parveen, Bushra; Parveen, Rabea; Ahmad, Sayeed

    2015-01-01

    World Health Organization (WHO) has defined herbal medicines as finished labeled medicinal product that contain an active ingredient, aerial, or underground parts of the plant or other plant material or combinations. According to a report of WHO, about 80% of the world population is reported to rely on traditional medicine for their primary health care needs. Even in the developed countries, complementary or alternative medicine is gaining popularity. A report of a global survey on national policy on traditional medicine and regulation of herbal medicines indicated that about 50 countries including China, Japan, and Germany already have their national policy and laws on regulations of traditional medicines. Herbal drugs possess a long history of its use and better patient tolerance. These are cheaper and easily available in countries like India due to rich agro culture conditions. However, reckless utilization of resources threatens the sustainability of several plant species. Traditional medicines are governed by the Drugs and Cosmetics Act of 1940 and the Drugs and Cosmetics Rules of 1945. In 1959, the Government of India amended the Drugs and Cosmetics Act to include drugs that are derived from traditional Indian medicine. In 1993, the guidelines for the safety and efficacy of herbal medicines developed by an expert committee directed that the procedures laid down by the office of the Drug Controller General of India for allopathic drugs should be followed for all traditional and herbal products to enter into clinical trials for any therapeutic condition. However, there are certain loop holes in the clinical trials of herbal drugs as the lack of stringent bylaws and regulations. Hence, a deep insight of important challenges and major regulatory guidelines for clinical trial of herbal drugs and botanicals is discussed in the present communication. There is lack of scientific evidence to evaluate safety and efficacy of herbal drugs. The quality of the trial drug

  11. [The strategic impact of clinical practice guidelines in nursing on the managerial function of supervision].

    PubMed

    Romero, José Antonio Vinagre; Heredero, Carmen De Pablos

    2013-10-01

    Clinical practice guidelines in nursing (CPG-N) are tools that allow the necessary knowledge that frequently remains specialist-internalised to be made explicit. These tools are a complement to risk adjustment systems (RAS), reinforcing their effectiveness and permitting a rationalisation of healthcare costs. This theoretical study defends the importance of building and using CPG-Ns as instruments to support the figure of the nursing supervisor in order to optimise the implementation of R&D and hospital quality strategies, enabling clinical excellence in nursing processes and cost-efficient reallocation of economic resources through their linear integration with SARs.

  12. Translating guidelines into practice: a systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines

    PubMed Central

    Davis, D A; Taylor-Vaisey, A

    1997-01-01

    OBJECTIVE: To recommend effective strategies for implementing clinical practice guidelines (CPGs). DATA SOURCES: The Research and Development Resource Base in Continuing Medical Education, maintained by the University of Toronto, was searched, as was MEDLINE from January 1990 to June 1996, inclusive, with the use of the MeSH heading "practice guidelines" and relevant text words. STUDY SELECTION: Studies of CPG implementation strategies and reviews of such studies were selected. Randomized controlled trials and trials that objectively measured physicians' performance or health care outcomes were emphasized. DATA EXTRACTION: Articles were reviewed to determine the effect of various factors on the adoption of guidelines. DATA SYNTHESIS: The articles showed that CPG dissemination or implementation processes have mixed results. Variables that affect the adoption of guidelines include qualities of the guidelines, characteristics of the health care professional, characteristics of the practice setting, incentives, regulation and patient factors. Specific strategies fell into 2 categories: primary strategies involving mailing or publication of the actual guidelines and secondary interventional strategies to reinforce the guidelines. The interventions were shown to be weak (didactic, traditional continuing medical education and mailings), moderately effective (audit and feedback, especially concurrent, targeted to specific providers and delivered by peers or opinion leaders) and relatively strong (reminder systems, academic detailing and multiple interventions). CONCLUSIONS: The evidence shows serious deficiencies in the adoption of CPGs in practice. Future implementation strategies must overcome this failure through an understanding of the forces and variables influencing practice and through the use of methods that are practice- and community-based rather than didactic. PMID:9275952

  13. Evidence-based clinical practice guidelines for irritable bowel syndrome.

    PubMed

    Fukudo, Shin; Kaneko, Hiroshi; Akiho, Hirotada; Inamori, Masahiko; Endo, Yuka; Okumura, Toshikatsu; Kanazawa, Motoyori; Kamiya, Takeshi; Sato, Ken; Chiba, Toshimi; Furuta, Kenji; Yamato, Shigeru; Arakawa, Tetsuo; Fujiyama, Yoshihide; Azuma, Takeshi; Fujimoto, Kazuma; Mine, Tetsuya; Miura, Soichiro; Kinoshita, Yoshikazu; Sugano, Kentaro; Shimosegawa, Tooru

    2015-01-01

    New strategies for the care of irritable bowel syndrome (IBS) are developing and several novel treatments have been globally produced. New methods of care should be customized geographically because each country has a specific medical system, life style, eating habit, gut microbiota, genes and so on. Several clinical guidelines for IBS have been proposed and the Japanese Society of Gastroenterology (JSGE) subsequently developed evidence-based clinical practice guidelines for IBS. Sixty-two clinical questions (CQs) comprising 1 definition, 6 epidemiology, 6 pathophysiology, 10 diagnosis, 30 treatment, 4 prognosis, and 5 complications were proposed and statements were made to answer to CQs. A diagnosis algorithm and a three-step treatment was provided for patients with chronic abdominal pain or abdominal discomfort and/or abnormal bowel movement. If more than one alarm symptom/sign, risk factor and/or routine examination is positive, colonoscopy is indicated. If all of them, or the subsequent colonoscopy, are/is negative, Rome III or compatible criteria is applied. After IBS diagnosis, step 1 therapy consisting of diet therapy, behavioral modification and gut-targeted pharmacotherapy is indicated for four weeks. Non-responders to step 1 therapy proceed to the second step that includes psychopharmacological agents and simple psychotherapy for four weeks. In the third step, for patients non-responsive to step 2 therapy, a combination of gut-targeted pharmacotherapy, psychopharmacological treatments and/or specific psychotherapy is/are indicated. Clinical guidelines and consensus for IBS treatment in Japan are well suited for Japanese IBS patients; as such, they may provide useful insight for IBS treatment in other countries around the world. PMID:25500976

  14. Development of the Draft Clinical Guideline on How to Resuscitate Dying Patients in the Iranian Context: A Study Protocol

    PubMed Central

    Cheraghi, Mohammad Ali; Bahramnezhad, Fatemeh; Mehrdad, Neda; Zendehdel, Kazem

    2016-01-01

    Introduction: The guidelines can be used as a model to guide the implementation of the best options and a suitable framework for clinical decisions. Even a guideline can largely help in challenging problems such as not to resuscitate with high cultural and value load. The guidelines try to improve the health care quality through reducing the treatment costs and variety of care measures. This study aimed to prepare a draft of clinical guidelines with the main aim of designing and drafting the clinical guideline on resuscitation in dying patients. Methodology: After selecting the subject of this guideline, in the first meeting of the team members of drafting the guideline, the guideline scope was determined. Then, the literature review done without time limitation, through searching electronic bibliographic information and internet databases and sites such as Medline, EMBASE, Springer, Blackwell Synergy, Elsevier, Scopus, Cochran Library and also databases including SID, Iran Medex, and Magiran. The experts will be the interviewed, and the interviews are directed content analysis. Conclusion: Finally, recommendations will be formed by nominal group technique. This study protocol includes informative information for designing and conducting of health professionals intending to create a direct on qualitative, theoretical, philosophical, spiritual, and moral health aspects. PMID:27559265

  15. [Clinical practice guidelines for assessment and treatment of transsexualism. SEEN Identity and Sexual Differentiation Group (GIDSEEN)].

    PubMed

    Moreno-Pérez, Oscar; Esteva De Antonio, Isabel

    2012-01-01

    Transsexual patients can only be diagnosed and treated at functional gender identity Units with provision of high quality care, development of clinical practice guidelines, and interdisciplinary working groups. The therapeutic process has three mainstays: initial psychological diagnostic evaluation and psychotherapy, endocrinological evaluation and hormone therapy, and sex reassignment surgery. Cross-sex hormone therapy is essential for the anatomical and psychological transition process in duly selected patients. Hormones help optimize real-life sex identity, improve quality of life, and limit psychiatric co-morbidities often associated to lack of treatment. Development of this clinical practice guideline addresses the need for implementing a coordinated action protocol for comprehensive health care for transgender people in the National Health System.

  16. Prevention of catheter-associated urinary tract infection: implementation strategies of international guidelines1

    PubMed Central

    Andrade, Vera Lúcia Fonseca; Fernandes, Filipa Alexandra Veludo

    2016-01-01

    Objective to describe strategies used by health professionals on the implementation of the Centers for Disease Control and Prevention guidelines for the prevention of urinary infection related to catheterism. Method systematic review on literature based on data from CINAHL(r), Nursing & Allied Health Collection, Cochrane Plus Collection, MedicLatina, MEDLINE(r), Academic Search Complete, ACS - American Chemical Society, Health Reference Center Academic, Nursing Reference Center, ScienceDirect Journals and Wiley Online Library. A sample of 13 articles was selected. Results studies have highlighted the decrease of urinary tract infection related to catheterism through reminder systems to decrease of people submitted to urinary catheterism, audits about nursing professionals practice and bundles expansion. Conclusion the present review systemizes the knowledge of used strategies by health professionals on introduction to international recommendations, describing a rate decrease of such infection in clinical practice. PMID:27027676

  17. A framework for a distributed, hybrid, multiple-ontology clinical-guideline library, and automated guideline-support tools.

    PubMed

    Shahar, Yuval; Young, Ohad; Shalom, Erez; Galperin, Maya; Mayaffit, Alon; Moskovitch, Robert; Hessing, Alon

    2004-10-01

    Clinical guidelines are a major tool in improving the quality of medical care. However, most guidelines are in free text, not in a formal, executable format, and are not easily accessible to clinicians at the point of care. We introduce a Web-based, modular, distributed architecture, the Digital Electronic Guideline Library (DeGeL), which facilitates gradual conversion of clinical guidelines from text to a formal representation in chosen target guideline ontology. The architecture supports guideline classification, semantic markup, context-sensitive search, browsing, run-time application, and retrospective quality assessment. The DeGeL hybrid meta-ontology includes elements common to all guideline ontologies, such as semantic classification and domain knowledge; it also includes four content-representation formats: free text, semi-structured text, semi-formal representation, and a formal representation. These formats support increasingly sophisticated computational tasks. The DeGeL tools for support of guideline-based care operate, at some level, on all guideline ontologies. We have demonstrated the feasibility of the architecture and the tools for several guideline ontologies, including Asbru and GEM.

  18. Pressure ulcer prevention and treatment: transforming research findings into consensus based clinical guidelines.

    PubMed

    Lewis, Matthew; Pearson, Alan; Ward, Cathy

    2003-04-01

    The translation of research findings into practice guidelines is an important aspect in maintaining the currency of practice and adding value to research. While there has been a large amount of published literature regarding the treatment and prevention of pressure ulcers, very few studies have attempted to provide clear clinical guidelines. The present study proposes a model to transform research into clinical guidelines whilst developing a series of guidelines that can be applied to a variety of clinical settings. PMID:12694478

  19. Clinical guidelines for the management of craniofacial fibrous dysplasia.

    PubMed

    Lee, J S; FitzGibbon, E J; Chen, Y R; Kim, H J; Lustig, L R; Akintoye, S O; Collins, M T; Kaban, L B

    2012-05-24

    Fibrous dysplasia (FD) is a non-malignant condition caused by post-zygotic, activating mutations of the GNAS gene that results in inhibition of the differentiation and proliferation of bone-forming stromal cells and leads to the replacement of normal bone and marrow by fibrous tissue and woven bone. The phenotype is variable and may be isolated to a single skeletal site or multiple sites and sometimes is associated with extraskeletal manifestations in the skin and/or endocrine organs (McCune-Albright syndrome). The clinical behavior and progression of FD may also vary, thereby making the management of this condition difficult with few established clinical guidelines. This paper provides a clinically-focused comprehensive description of craniofacial FD, its natural progression, the components of the diagnostic evaluation and the multi-disciplinary management, and considerations for future research. PMID:22640797

  20. [Kawasaki disease: interdisciplinary and intersocieties consensus (clinical guidelines). Brief version].

    PubMed

    2016-08-01

    Kawasaki disease is an acute self-limiting systemic vasculitis. It is the most common cause of acquired heart disease, with the risk of developing coronary artery aneurysms, myocardial infarction and sudden death. Diagnosis is based on the presence of fever in addition to other clinical criteria. The quarter of the Kawasaki disease patients have "incomplete" presentation. Treatment with intravenous immunoglobulin within ten days of fever onset improves clinical outcomes and reduces the incidence of coronary artery dilation to less than 5%. Non-responders to standard therapy have shown a successful response with the use of corticosteroids and/or biological agents. The long-term management must be delineated according to the degree of coronary involvement in a multidisciplinary manner. To facilitate the pediatrician's diagnosis, treatment and monitoring of Kawasaki disease, a group of experts from the Argentine Society of Pediatrics and the Argentine Society of Cardiology carried out a consensus to develop practical clinical guidelines. PMID:27399018

  1. [Kawasaki disease: interdisciplinary and intersocieties consensus (clinical guidelines). Brief version].

    PubMed

    2016-08-01

    Kawasaki disease is an acute self-limiting systemic vasculitis. It is the most common cause of acquired heart disease, with the risk of developing coronary artery aneurysms, myocardial infarction and sudden death. Diagnosis is based on the presence of fever in addition to other clinical criteria. The quarter of the Kawasaki disease patients have "incomplete" presentation. Treatment with intravenous immunoglobulin within ten days of fever onset improves clinical outcomes and reduces the incidence of coronary artery dilation to less than 5%. Non-responders to standard therapy have shown a successful response with the use of corticosteroids and/or biological agents. The long-term management must be delineated according to the degree of coronary involvement in a multidisciplinary manner. To facilitate the pediatrician's diagnosis, treatment and monitoring of Kawasaki disease, a group of experts from the Argentine Society of Pediatrics and the Argentine Society of Cardiology carried out a consensus to develop practical clinical guidelines.

  2. Clinical digital photography: implementation of clinical photography for everyday practice.

    PubMed

    Shorey, Robert; Moore, Kenneth

    2009-03-01

    Clinical photography requires a regimented system of image acquisition similar to the regimentation needed for dental radiographs. Clinical digital photographic equipment is rapidly advancing. To achieve the best image quality and resolution, digital single-lens reflex systems are necessary. DSLR clinical systems are made of three components: camera body, macro lens, and flash attachment. Other ancillary equipment is necessary to achieve appropriate clinical image reveals and composition. Recommendations are given to assist in the implementation of clinical photography in the dental practice. PMID:19830983

  3. Clinical ladder program implementation: a project guide.

    PubMed

    Ko, Yu Kyung; Yu, Soyoung

    2014-11-01

    This article describes the development of a clinical ladder program (CLP) implementation linked to a promotion system for nurses. The CLP task force developed criteria for each level of performance and a performance evaluation tool reflecting the self-motivation of the applicant for professional development. One year after implementation, the number of nurses taking graduate courses increased, and 7 nurses were promoted to nurse manager positions. PMID:25340927

  4. Clinical ladder program implementation: a project guide.

    PubMed

    Ko, Yu Kyung; Yu, Soyoung

    2014-11-01

    This article describes the development of a clinical ladder program (CLP) implementation linked to a promotion system for nurses. The CLP task force developed criteria for each level of performance and a performance evaluation tool reflecting the self-motivation of the applicant for professional development. One year after implementation, the number of nurses taking graduate courses increased, and 7 nurses were promoted to nurse manager positions.

  5. A Distributed, Collaborative, Structuring Model for a Clinical-Guideline Digital-Library

    PubMed Central

    Shahar, Yuval; Shalom, Erez; Mayaffit, Alon; Young, Ohad; Galperin, Maya; Martins, Susana; Goldstein, Mary

    2003-01-01

    The Digital Electronic Guideline Library (DeGeL) is a Web-based framework and a set of distributed tools that facilitate gradual conversion of clinical guidelines from free text, through semi-structured text, to a fully structured, executable representation. Thus, guidelines exist in a hybrid, multiple-format representation The three formats support increasingly sophisticated computational tasks. The tools perform semantic markup, classification, search, and browsing, and support computational modules that we are developing, for run-time application and retrospective quality assessment. We describe the DeGeL architecture and its collaborative-authoring authorization model, which is based on (1) multiple medical-specialty authoring groups, each including a group manager who controls group authorizations, and (2) a hierarchical authorization model based on the different functions involved in the hybrid guideline-specification process. We have implemented the core modules of the DeGeL architecture and demonstrated distributed markup and retrieval using the knowledge roles of two guidelines ontologies (Asbru and GEM). We are currently evaluating several of the DeGeL tools. PMID:14728241

  6. A distributed, collaborative, structuring model for a clinical-guideline digital-library.

    PubMed

    Shahar, Yuval; Shalom, Erez; Mayaffit, Alon; Young, Ohad; Galperin, Maya; Martins, Susana; Goldstein, Mary

    2003-01-01

    The Digital Electronic Guideline Library (DeGeL) is a Web-based framework and a set of distributed tools that facilitate gradual conversion of clinical guidelines from free text, through semi-structured text, to a fully structured, executable representation. Thus, guidelines exist in a hybrid, multiple-format representation The three formats support increasingly sophisticated computational tasks. The tools perform semantic markup, classification, search, and browsing, and support computational modules that we are developing, for run-time application and retrospective quality assessment. We describe the DeGeL architecture and its collaborative-authoring authorization model, which is based on (1) multiple medical-specialty authoring groups, each including a group manager who controls group authorizations, and (2) a hierarchical authorization model based on the different functions involved in the hybrid guideline-specification process. We have implemented the core modules of the DeGeL architecture and demonstrated distributed markup and retrieval using the knowledge roles of two guidelines ontologies (Asbru and GEM). We are currently evaluating several of the DeGeL tools.

  7. Application of Clinical Practice Guidelines for Pain, Agitation, and Delirium.

    PubMed

    Krupp, Anna; Balas, Michele C

    2016-06-01

    Critically ill patients experience several severe, distressing, and often life-altering symptoms during their intensive care unit stay. A clinical practice guideline released by the American College of Critical Care Medicine provides a template for improving the care and outcomes of the critically ill through evidence-based pain, agitation, and delirium assessment, prevention, and management. Key strategies include the use of valid and reliable assessment tools, setting a desired sedation level target, a focus on light sedation, choosing appropriate sedative medications, the use of nonpharmacologic symptom management strategies, and engaging and empowering patients and their family to play an active role in their intensive care unit care.

  8. Guidelines (1988) for training in clinical laboratory management

    PubMed Central

    de Cediel, N.; Fraser, C. G.; Deom, A.; Josefsson, L.; Worth, H. G. J.; Zinder, O.

    1989-01-01

    Trainees in laboratory medicine must develop skills in laboratory management. Guidelines are detailed for laboratory staff in training, directors responsible for staff development and professional bodies wishing to generate material appropriate to their needs. The syllabus delineates the knowledge base required and includes laboratory planning and organization, control of operations, methodology and instrumentation, data management and statistics, financial management, clinical use of tests, communication, personnel management and training and research and development. Methods for achievement of the skills required are suggested. A bibliography of IFCC publications and other material is provided to assist in training in laboratory management. PMID:18925217

  9. Implementing caries risk assessment and clinical interventions.

    PubMed

    Young, Douglas A; Featherstone, John D B

    2010-07-01

    This article suggests a practical methodology to implement the scientific information presented in the earlier articles into clinical practice. The Caries Balance/Imbalance Model and a practical caries risk assessment procedure for patients aged 6 years through adult illustrate evidence-based treatment options. Neither the forms nor the clinical protocols are meant to imply that there is currently only one correct way that this can be achieved; they are used in this article only as examples.

  10. Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline

    PubMed Central

    Nieman, Lynnette K.; Biller, Beverly M. K.; Findling, James W.; Murad, M. Hassan; Newell-Price, John; Savage, Martin O.; Tabarin, Antoine

    2015-01-01

    Objective: The objective is to formulate clinical practice guidelines for treating Cushing's syndrome. Participants: Participants include an Endocrine Society-appointed Task Force of experts, a methodologist, and a medical writer. The European Society for Endocrinology co-sponsored the guideline. Evidence: The Task Force used the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned three systematic reviews and used the best available evidence from other published systematic reviews and individual studies. Consensus Process: The Task Force achieved consensus through one group meeting, several conference calls, and numerous e-mail communications. Committees and members of The Endocrine Society and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. Conclusions: Treatment of Cushing's syndrome is essential to reduce mortality and associated comorbidities. Effective treatment includes the normalization of cortisol levels or action. It also includes the normalization of comorbidities via directly treating the cause of Cushing's syndrome and by adjunctive treatments (eg, antihypertensives). Surgical resection of the causal lesion(s) is generally the first-line approach. The choice of second-line treatments, including medication, bilateral adrenalectomy, and radiation therapy (for corticotrope tumors), must be individualized to each patient. PMID:26222757

  11. Clinical Practice Guidelines: Whose Practice Are We Guiding?

    PubMed

    Harvey, Morgan; Bowe, Sarah N; Laury, Adrienne M

    2016-09-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has just released an update to the clinical practice guideline (CPG) on otitis media with effusion. This common condition is frequently managed by primary care providers; however, their awareness and utilization of the AAO-HNSF CPGs are unknown. We performed a cross-sectional survey to assess familiarity with otologic diagnoses, evaluation skills, and guidelines. Only 38.5% of respondents use pneumatic otoscopy, and roughly 50% utilize a CPG for management of otitis media or for referral for tympanostomy tube insertion. Providers predominantly use the acute otitis media guideline from the American Academy of Pediatrics. In this single-institution study, providers are largely unaware of the AAO-HNSF CPGs and could benefit from additional training, including workshops taught by otolaryngologists within individual health care systems or development of a national otolaryngology medical student curriculum. A more immediate option includes referencing our CPGs on specialty societies' websites or newsletters. PMID:27329423

  12. Audit and feedback and clinical practice guideline adherence: Making feedback actionable

    PubMed Central

    Hysong, Sylvia J; Best, Richard G; Pugh, Jacqueline A

    2006-01-01

    Background As a strategy for improving clinical practice guideline (CPG) adherence, audit and feedback (A&F) has been found to be variably effective, yet A&F research has not investigated the impact of feedback characteristics on its effectiveness. This paper explores how high performing facilities (HPF) and low performing facilities (LPF) differ in the way they use clinical audit data for feedback purposes. Method Descriptive, qualitative, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low adherence to six CPGs, as measured by external chart review audits. One-hundred and two employees involved with outpatient CPG implementation across the six facilities participated in one-hour semi-structured interviews where they discussed strategies, facilitators and barriers to implementing CPGs. Interviews were analyzed using techniques from the grounded theory method. Results High performers provided timely, individualized, non-punitive feedback to providers, whereas low performers were more variable in their timeliness and non-punitiveness and relied on more standardized, facility-level reports. The concept of actionable feedback emerged as the core category from the data, around which timeliness, individualization, non-punitiveness, and customizability can be hierarchically ordered. Conclusion Facilities with a successful record of guideline adherence tend to deliver more timely, individualized and non-punitive feedback to providers about their adherence than facilities with a poor record of guideline adherence. Consistent with findings from organizational research, feedback intervention characteristics may influence the feedback's effectiveness at changing desired behaviors. PMID:16722539

  13. Implementation of curriculum guidelines for pharmacology and pharmacotherapeutics in FNP graduate programs: a national survey.

    PubMed

    Morris, N S; Possidente, C J; Muskus, C

    2001-01-01

    Model Pharmacology and Pharmacotherapeutics Curriculum Guidelines were developed by the National Council of State Boards of Nursing and the National Organization of Nurse Practitioner Faculties and published in 1998. To date, no publication of evaluation of adoption or adherence to these guidelines is available. The purpose of this survey was to determine how family nurse practitioner programs incorporate the guidelines into their curriculum. A mailed self-report questionnaire to 193 schools yielded a 41% response rate. Eighty-five percent (n = 68) of the programs have not yet fully integrated the guidelines into their curriculum. Difficulties addressing the extensive content within a 3-credit course and the challenges of teaching students with varied clinical backgrounds and knowledge levels were frequently cited. Although further study of achievement of the guidelines is necessary, an increase in credit allocation, consideration of a conceptual approach to the topic, and use of varied teaching strategies may make achievement of the guidelines more realistic.

  14. Facilitators and barriers to implementing clinical care pathways

    PubMed Central

    2010-01-01

    Background The promotion of care pathways in the recent Governmental health policy reports of Lord Darzi is likely to increase efforts to promote the use of care pathways in the NHS. Evidence on the process of pathway implementation, however, is sparse and variations in how organisations go about the implementation process are likely to be large. This paper summarises what is known about factors which help or hinder clinicians in adopting and putting care pathways into practice, and which consequently promote or hinder the implementation of scientific evidence in clinical practice. Discussion Care pathways can provide patients with clear expectations of their care, provide a means of measuring patient's progress, promote teamwork on a multi-disciplinary team, facilitate the use of guidelines, and may act as a basis for a payment system. In order to achieve adequate implementation, however, facilitators and barriers must be considered, planned for, and incorporated directly into the pathway with full engagement among clinical and management staff. Barriers and/or facilitators may be present at each stage of development, implementation and evaluation; and, barriers at any stage can impede successful implementation. Important considerations to be made are ensuring the inclusion of all types of staff, plans for evaluating and incorporating continuous improvements, allowing for organisational adaptations and promoting the use of multifaceted interventions. Summary Although there is a dearth of information regarding the successful implementation of care pathways, evidence is available which may be applied when implementing a care pathway. Multifaceted interventions which incorporate all staff and facilitate organisational adaptations must be seriously considered and incorporated alongside care pathways in a continuous manner. In order to better understand the mechanism upon which care pathways are effective, however, more research specifically addressing conditions under

  15. Implementing human factors in clinical practice

    PubMed Central

    Timmons, Stephen; Baxendale, Bryn; Buttery, Andrew; Miles, Giulia; Roe, Bridget; Browes, Simon

    2015-01-01

    Objectives To understand whether aviation-derived human factors training is acceptable and useful to healthcare professionals. To understand whether and how healthcare professionals have been able to implement human factors approaches to patient safety in their own area of clinical practice. Methods Qualitative, longitudinal study using semi-structured interviews and focus groups, of a multiprofessional group of UK NHS staff (from the emergency department and operating theatres) who have received aviation-derived human factors training. Results The human factors training was evaluated positively, and thought to be both acceptable and relevant to practice. However, the staff found it harder to implement what they had learned in their own clinical areas, and this was principally attributed to features of the informal organisational cultures. Conclusions In order to successfully apply human factors approaches in hospital, careful consideration needs to be given to the local context and informal culture of clinical practice. PMID:24631959

  16. Evidence-based clinical practice guidelines for liver cirrhosis 2015.

    PubMed

    Fukui, Hiroshi; Saito, Hidetsugu; Ueno, Yoshiyuki; Uto, Hirofumi; Obara, Katsutoshi; Sakaida, Isao; Shibuya, Akitaka; Seike, Masataka; Nagoshi, Sumiko; Segawa, Makoto; Tsubouchi, Hirohito; Moriwaki, Hisataka; Kato, Akinobu; Hashimoto, Etsuko; Michitaka, Kojiro; Murawaki, Toshikazu; Sugano, Kentaro; Watanabe, Mamoru; Shimosegawa, Tooru

    2016-07-01

    The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V2 receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for

  17. Evidence-based clinical practice guidelines for liver cirrhosis 2015.

    PubMed

    Fukui, Hiroshi; Saito, Hidetsugu; Ueno, Yoshiyuki; Uto, Hirofumi; Obara, Katsutoshi; Sakaida, Isao; Shibuya, Akitaka; Seike, Masataka; Nagoshi, Sumiko; Segawa, Makoto; Tsubouchi, Hirohito; Moriwaki, Hisataka; Kato, Akinobu; Hashimoto, Etsuko; Michitaka, Kojiro; Murawaki, Toshikazu; Sugano, Kentaro; Watanabe, Mamoru; Shimosegawa, Tooru

    2016-07-01

    The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V2 receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for

  18. 32 CFR 2004.11 - Agency Implementing Regulations, Internal Rules, or Guidelines [102(b)(3)].

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Agency Implementing Regulations, Internal Rules, or Guidelines . 2004.11 Section 2004.11 National Defense Other Regulations Relating to National... INDUSTRIAL SECURITY PROGRAM DIRECTIVE NO. 1 Implementation and Oversight § 2004.11 Agency...

  19. Implementation of National Guidelines for Healthy School Meals: The Relationship between Process and Outcome

    ERIC Educational Resources Information Center

    Holthe, Asle; Larsen, Torill; Samdal, Oddrun

    2011-01-01

    The implementation of policy interventions at the school level is often considered an organizational change process. The main goal of the present study was to examine the degree of implementation of Norwegian national guidelines for healthy school meals and how organizational capacity at the school level contributed to the degree of…

  20. Quality of the Development of Traumatic Brain Injury Clinical Practice Guidelines: A Systematic Review.

    PubMed

    Patel, Anjni; Vieira, Mateus Mazorra Coelho; Abraham, John; Reid, Nick; Tran, Tu; Tomecsek, Kevin; Vissoci, João Ricardo N; Eucker, Stephanie; Gerardo, Charles J; Staton, Catherine A

    2016-01-01

    Traumatic brain injury (TBI) is a leading cause of death worldwide and is increasing exponentially particularly in low and middle income countries (LMIC). To inform the development of a standard Clinical Practice Guideline (CPG) for the acute management of TBI that can be implemented specifically for limited resource settings, we conducted a systematic review to identify and assess the quality of all currently available CPGs on acute TBI using the AGREE II instrument. In accordance with PRISMA guidelines, from April 2013 to December 2015 we searched MEDLINE, EMBASE, Google Scholar and the Duke University Medical Center Library Guidelines for peer-reviewed published Clinical Practice Guidelines on the acute management of TBI (less than 24 hours), for any level of traumatic brain injury in both high and low income settings. A comprehensive reference and citation analysis was performed. CPGs found were assessed using the AGREE II instrument by five independent reviewers and scores were aggregated and reported in percentage of total possible score. An initial 2742 articles were evaluated with an additional 98 articles from the citation and reference analysis, yielding 273 full texts examined. A total of 24 final CPGs were included, of which 23 were from high income countries (HIC) and 1 from LMIC. Based on the AGREE II instrument, the best score on overall assessment was 100.0 for the CPG from the National Institute for Health and Clinical Excellence (NIHCE, 2007), followed by the New Zealand Guidelines Group (NZ, 2006) and the National Clinical Guideline (SIGN, 2009) both with a score of 96.7. The CPG from a LMIC had lower scores than CPGs from higher income settings. Our study identified and evaluated 24 CPGs with the highest scores in clarity and presentation, scope and purpose, and rigor of development. Most of these CPGs were developed in HICs, with limited applicability or utility for resource limited settings. Stakeholder involvement, Applicability, and

  1. Quality of the Development of Traumatic Brain Injury Clinical Practice Guidelines: A Systematic Review

    PubMed Central

    Patel, Anjni; Vieira, Mateus Mazorra Coelho; Abraham, John; Reid, Nick; Tran, Tu; Tomecsek, Kevin; Vissoci, João Ricardo N.; Eucker, Stephanie; Gerardo, Charles J.; Staton, Catherine A.

    2016-01-01

    Traumatic brain injury (TBI) is a leading cause of death worldwide and is increasing exponentially particularly in low and middle income countries (LMIC). To inform the development of a standard Clinical Practice Guideline (CPG) for the acute management of TBI that can be implemented specifically for limited resource settings, we conducted a systematic review to identify and assess the quality of all currently available CPGs on acute TBI using the AGREE II instrument. In accordance with PRISMA guidelines, from April 2013 to December 2015 we searched MEDLINE, EMBASE, Google Scholar and the Duke University Medical Center Library Guidelines for peer-reviewed published Clinical Practice Guidelines on the acute management of TBI (less than 24 hours), for any level of traumatic brain injury in both high and low income settings. A comprehensive reference and citation analysis was performed. CPGs found were assessed using the AGREE II instrument by five independent reviewers and scores were aggregated and reported in percentage of total possible score. An initial 2742 articles were evaluated with an additional 98 articles from the citation and reference analysis, yielding 273 full texts examined. A total of 24 final CPGs were included, of which 23 were from high income countries (HIC) and 1 from LMIC. Based on the AGREE II instrument, the best score on overall assessment was 100.0 for the CPG from the National Institute for Health and Clinical Excellence (NIHCE, 2007), followed by the New Zealand Guidelines Group (NZ, 2006) and the National Clinical Guideline (SIGN, 2009) both with a score of 96.7. The CPG from a LMIC had lower scores than CPGs from higher income settings. Our study identified and evaluated 24 CPGs with the highest scores in clarity and presentation, scope and purpose, and rigor of development. Most of these CPGs were developed in HICs, with limited applicability or utility for resource limited settings. Stakeholder involvement, Applicability, and

  2. Identifying students with learning disabilities: the effect of implementing statewide guidelines.

    PubMed

    McLeskey, J; Waldron, N L

    1991-10-01

    Methods for identifying students with learning disabilities continue to be an area of controversy. The present investigation examined the impact of implementing statewide guidelines for the identification of these students. Data were collected from multidisciplinary team reports on 718 students with learning disabilities who were referred and labeled during the 1983-84 school year (before implementation of statewide learning disability guidelines) and 790 students who were identified during 1987-88 (after implementation of the guidelines). The results of the study revealed that the statewide guidelines significantly changed the characteristics of students who were identified. After the implementation of the guidelines, students with much more severe academic problems were identified. These students were much more likely to have a severe discrepancy and be chronically failing in the regular classroom. However, even with explicit, widely accepted guidelines, approximately one third of all students identified in 1987-88 failed to meet the stated criteria for identification. The implications of these findings for professional practice and future research are discussed. PMID:1940608

  3. Canadian clinical practice guidelines for acute and chronic rhinosinusitis

    PubMed Central

    2011-01-01

    completeness, yet covers relevant information, offers summaries of areas where considerable evidence exists, and provides recommendations with an assessment of strength of the evidence base and degree of endorsement by the multidisciplinary expert group preparing the document. These guidelines have been copublished in both Allergy, Asthma & Clinical Immunology and the Journal of Otolaryngology-Head and Neck Surgery. PMID:21310056

  4. NHMRC guidelines for clinical practice for ASD and PTSD.

    PubMed

    Ladd, Gary

    2008-03-01

    Dear Editor, Recently I described the case of a scuba instructor suffering from acute stress disorder (ASD), a type of post-traumatic stress disorder (PTSD), following the death of one of her students. The treatment described was a combination of eye movement desensitization and reprocessing (EMDR) and cognitive-behavioural therapy (CBT) exposure based exercises. As it happens, in August the Australian Centre for Post Traumatic Mental Health published Australian clinical practice guidelines for ASD and PTSD. These have been endorsed by the National Health and Medical Research Council (NHMRC). The treatment described in the diver injury case is consistent with these guidelines. The NHMRC guidelines suggest that immediately following a traumatic episode (e.g., diver death or serious injury) the most helpful response is to offer psychological first aid. This includes providing information on traumatic stress reactions, encouraging self care and using available social support. It is recommended that the medical practitioner monitor the patient, watching for improvement, plateau or deterioration, and be ready to offer assistance or appropriate referral if needed. The guidelines recommend the use of trauma-focused psychological therapy as the first-line intervention for ASD and PTSD. EMDR, with in vivo exposure included, and CBT are considered the most effective treatments. If medication is required, selective serotonin re-uptake inhibitor antidepressants are considered the best choice. For the benefit and convenience of patients and practitioners, the NHMRC guidelines and a comprehensive set of information guides on ASD and PTSD are available online as pdf file downloads at http://www.acpmh.unimelb.edu.au. An update in Medical Journal of Australia provides traumatic stress information for medical practitioners including screening questions that can be used to identify patients suffering with ASD and PTSD. This article is available online at: http

  5. Development of evidence-based clinical practice guidelines (CPGs): comparing approaches

    PubMed Central

    Turner, Tari; Misso, Marie; Harris, Claire; Green, Sally

    2008-01-01

    Background While the potential of clinical practice guidelines (CPGs) to support implementation of evidence has been demonstrated, it is not currently being achieved. CPGs are both poorly developed and ineffectively implemented. To improve clinical practice and health outcomes, both well-developed CPGs and effective methods of CPG implementation are needed. We sought to establish whether there is agreement on the fundamental characteristics of an evidence-based CPG development process and to explore whether the level of guidance provided in CPG development handbooks is sufficient for people using these handbooks to be able to apply it. Methods CPG development handbooks were identified through a broad search of published and grey literature. Documents published in English produced by national or international organisations purporting to support development of evidence-based CPGs were included. A list of 14 key elements of a CPG development process was developed. Two authors read each handbook. For each handbook a judgement was made as to how it addressed each element; assigned as: 'mentioned and clear guidance provided', 'mentioned but limited practical detail provided ', or 'not mentioned'. Results Six CPG development handbooks were included. These were produced by the Council of Europe, the National Health and Medical Research Council of Australia, the National Institute for Health and Clinical Excellence in the UK, the New Zealand Guidelines Group, the Scottish Intercollegiate Guideline Network, and the World Health Organization (WHO). There was strong concordance between the handbooks on the key elements of an evidence-based CPG development process. All six of the handbooks require and provide guidance on establishment of a multidisciplinary guideline development group, involvement of consumers, identification of clinical questions or problems, systematic searches for and appraisal of research evidence, a process for drafting recommendations, consultation with

  6. Antifungal Clinical Trials and Guidelines: What We Know and Do Not Know

    PubMed Central

    Pappas, Peter G.

    2014-01-01

    For over the last three decades, extensive testing of antifungal compounds in clinical trials has been essential to the development of treatment guidelines for the most common invasive fungal infections, including cryptococcosis, candidiasis, aspergillosis, and the endemic fungi. These guidelines have greatly helped guide clinicians in the management of these complicated diseases. The data on which most of these guidelines are based are among the most widely recognized and cited clinical trials comparing antimicrobial agents. Unfortunately, there are many unanswered questions with respect to the diagnosis and treatment of these emerging disorders. Regarding treatment, there is a need for more clinically effective and less toxic agents. The current armamentarium of antifungal agents represents important progress over gold standard agents such as amphotericin B, but there is much progress to be made. With respect to diagnostics, mycology has generally lagged behind other disciplines in microbiology, as there are very few rapid, sensitive, specific, and point-of-care diagnostics. The ability to implement therapies for at-risk patients based on positive early diagnostic signals would greatly enhance the ability to intervene with appropriate antifungal therapy in a more targeted and specific manner. This article will review some of the major advances, as well as significant challenges that remain in the management of invasive mycoses. PMID:25368017

  7. Codifying Implementation Guidelines for a Collaborative Improvement Initiative

    ERIC Educational Resources Information Center

    Coughlan, Paul; Coghlan, David

    2008-01-01

    The application of action learning in inter-organizational settings is largely undeveloped. This article presents a description of and reflection on an action learning approach to enabling collaborative improvement in the extended manufacturing enterprise. The article focuses in particular on implementing the action learning approach. However, the…

  8. School-Based Management: Rationale and Implementation Guidelines.

    ERIC Educational Resources Information Center

    Oswald, Lori Jo

    1995-01-01

    School-based management (SBM), the decentralization of decision-making authority to the school site, comes in many variations. However, all forms of SBM require a rethinking of how and where budgeting, curriculum, and personnel decisions are made. This bulletin provides an overview of what SBM is and how it is implemented by summarizing some of…

  9. [Critical issues in clinical practice guidelines for geriatric care].

    PubMed

    Zanetti, Ermellina

    2014-01-01

    Behavioral and psychological symptoms of dementia(BPSD) are one of the most disturbing issues in the management of patients, both for caregivers and health care personnel. Aim of this paper is to critically appraise the available guidelines on the non pharmacological management of BPSD. Some effective interventions such as person centred care, communication skills e dementia care mapping are not mentioned while interventions of dubious efficacy (aromatherapy, per therapy, light therapy or music therapy) are proposed. The variability in the expression of behavioral disorders and the different causes suggest an accurate tailoring of the interventions, based on the assessment of the patient, the organization and the environment. Further studies are necessary to improve the implementation of the non drug strategies for the management of BPSDs. PMID:25532924

  10. [Critical issues in clinical practice guidelines for geriatric care].

    PubMed

    Zanetti, Ermellina

    2014-01-01

    Behavioral and psychological symptoms of dementia(BPSD) are one of the most disturbing issues in the management of patients, both for caregivers and health care personnel. Aim of this paper is to critically appraise the available guidelines on the non pharmacological management of BPSD. Some effective interventions such as person centred care, communication skills e dementia care mapping are not mentioned while interventions of dubious efficacy (aromatherapy, per therapy, light therapy or music therapy) are proposed. The variability in the expression of behavioral disorders and the different causes suggest an accurate tailoring of the interventions, based on the assessment of the patient, the organization and the environment. Further studies are necessary to improve the implementation of the non drug strategies for the management of BPSDs.

  11. Pilot Study of a Clinical Pathway Implementation in Rectal Cancer

    PubMed Central

    Uña, Esther; López-Lara, Francisco

    2010-01-01

    Background: Rectal cancer is a highly prevalent disease which needs a multidisciplinary approach to be treated. The absence of specific protocols implies a significant and unjustifiable variability among the different professionals involved in this disease. The purpose is to develop a clinical pathway based on the analysis process and aims to reduce this variability and to reduce unnecessary costs. Methods: We created a multidisciplinary team with contributors from every clinical area involved in the diagnosis and treatment in this disease. We held periodic meetings to agree on a protocol based on the best available clinical practice guidelines. Once we had agreed on the protocol, we implemented its use as a standard in our institution. Every patient older than 18 years who was diagnosed with rectal cancer was considered a candidate to be treated via the pathway. Results: We evaluated 48 patients during the course of this study. Every parameter measured was improved after the implementation of the pathway, except the proportion of patients with 12 nodes or more analysed. The perception that our patients had about this project was very good. Conclusions: Clinical pathways are needed to improve the quality of health care. This kind of project helps reduce hospital costs and optimizes the use of limited resources. On the other hand, unexplained variability is also reduced, with consequent benefits for the patients. PMID:21151842

  12. Asthma Management in Educational Settings: Implementing Guideline-Based Care in Washington State Schools.

    PubMed

    Evans-Agnew, Robin A; Klein, Nicole; Lecce, Sally

    2015-11-01

    Managing asthma in the schools is complex and requires careful planning. This article highlights key steps in implementing guideline-based care for children with asthma in Washington State schools: assessing students, establishing acuity, communicating with parents, and training staff. Advance planning can improve outcomes for students, parents, and school staff in managing this complex and prevalent disease. NASN recently developed asthma management guidelines. Developing state-specific guidelines provides an opportunity to speak specifically to state laws and nurse practice acts while also reinforcing the importance of specialized practice to school nurses, school administrators and teachers, parents, and students. PMID:26515566

  13. DOE-EPRI On-Line Monitoring Implementation Guidelines

    SciTech Connect

    E. Davis, R. Bickford

    2003-01-02

    Industry and EPRI experience at several plants has shown on-line monitoring to be very effective in identifying out-of-calibration instrument channels or indications of equipment-degradation problems. The EPRI implementation project for on-line monitoring has demonstrated the feasability of on-line monitoring at several participating nuclear plants. The results have been very enouraging, and substantial progress is anticipated in the coming years.

  14. Guideline Adherence in Outpatient Clinics for Chronic Obstructive Pulmonary Disease: Results from a Clinical Audit

    PubMed Central

    López-Campos, Jose L.; Abad Arranz, Maria; Calero-Acuña, Carmen; Romero-Valero, Fernando; Ayerbe-García, Ruth; Hidalgo-Molina, Antonio; Aguilar-Pérez-Grovas, Ricardo I.; García-Gil, Francisco; Casas-Maldonado, Francisco; Caballero-Ballesteros, Laura; Sánchez-Palop, María; Pérez-Tejero, Dolores; Segado, Alejandro; Calvo-Bonachera, Jose; Hernández-Sierra, Bárbara; Doménech, Adolfo; Arroyo-Varela, Macarena; González-Vargas, Francisco; Cruz-Rueda, Juan J.

    2016-01-01

    Objectives Previous clinical audits of COPD have provided relevant information about medical intervention in exacerbation admissions. The present study aims to evaluate adherence to current guidelines in COPD through a clinical audit. Methods This is a pilot clinical audit performed in hospital outpatient respiratory clinics in Andalusia, Spain (eight provinces with more than 8 million inhabitants), including 9 centers (20% of the public centers in the area) between 2013 and 2014. Cases with an established diagnosis of COPD based on risk factors, clinical symptoms, and a post-bronchodilator FEV1/FVC ratio of less than 0.70 were deemed eligible. The performance of the outpatient clinics was benchmarked against three guidance documents available at the time of the audit. The appropriateness of the performance was categorized as excellent (>80%), good (60−80%), adequate (40−59%), inadequate (20−39%), and highly inadequate (<20%). Results During the audit, 621 clinical records were audited. Adherence to the different guidelines presented a considerable variability among the different participating hospitals, with an excellent or good adherence for symptom recording, MRC or CAT use, smoking status evaluation, spirometry, or bronchodilation therapy. The most outstanding areas for improvement were the use of the BODE index, the monitoring of treatments, the determination of alpha1-antitrypsin, the performance of exercise testing, and vaccination recommendations. Conclusions The present study reflects the situation of clinical care for COPD patients in specialized secondary care outpatient clinics. Adherence to clinical guidelines shows considerable variability in outpatient clinics managing COPD patients, and some aspects of the clinical care can clearly be improved. PMID:26985822

  15. Swiss clinical practice guidelines on field cancerization of the skin.

    PubMed

    Hofbauer, Günther; Anliker, Mark; Boehncke, Wolf-Henning; Brand, Christoph; Braun, Ralph; Gaide, Olivier; Hafner, Jürg; Hunger, Robert; Itin, Peter; Kaeuper, Gina; Lautenschlager, Stephan; Mainetti, Carlo; Streit, Markus

    2014-01-01

    Actinic keratosis (AK) affects millions of people worldwide, and its prevalence continues to increase. AK lesions are caused by chronic ultraviolet radiation exposure, and the presence of two or more AK lesions along with photodamage should raise the consideration of a diagnosis of field cancerization. Effective treatment of individual lesions as well as field cancerization is essential for good long-term outcomes. The Swiss Registry of Actinic Keratosis Treatment (REAKT) Working Group has developed clinical practice guidelines for the treatment of field cancerization in patients who present with AK. These guidelines are intended to serve as a resource for physicians as to the most appropriate treatment and management of AK and field cancerization based on current evidence and the combined practical experience of the authors. Treatment of AK and field cancerization should be driven by consideration of relevant patient, disease, and treatment factors, and appropriate treatment decisions will differ from patient to patient. Prevention measures and screening recommendations are discussed, and special considerations related to management of immunocompromised patients are provided. PMID:25539459

  16. [Clinical practice guideline 'Complex regional pain syndrome type I'].

    PubMed

    Perez, R S G M; Zollinger, P E; Dijkstra, P U; Thomassen-Hilgersom, I L; Zuurmond, W W A; Rosenbrand, C J G M; Geertzen, J H B

    2007-07-28

    The development and treatment ofthe complex regional pain syndrome type I (CRPS-I) are a subject of much discussion. Using the method for the development ofevidence-based guidelines, a multidisciplinary guideline for the diagnosis and treatment of this syndrome has been drawn up. The diagnosis of CRPS-I is based on the clinical observation of signs and symptoms. For pain treatment, the WHO analgesic ladder is advised up to step z. In case of pain ofa neuropathic nature, anticonvulsants and tricyclic antidepressants may be considered. For the treatment ofinflammatory symptoms, free-radical scavengers (dimethylsulphoxide or acetylcysteine) are advised. In order to enhance peripheral blood flow, vasodilatory medication may be considered. Percutaneous sympathetic blockades may be used for a cold extremity ifvasodilatory medication produces insufficient effect. To decrease functional limitations, standardised physiotherapy and occupational therapy are advised. To prevent the occurrence of CRPS-I after wrist fractures, the use of vitamin C is recommended. Adequate perioperative analgesia, limitation of operation time and limited use of bloodlessness are advised for the secondary prevention of CRPS-I. Use of regional anaesthetic techniques can also be considered in this connection.

  17. OpenEHR-based representation of guideline compliance data through the example of stroke clinical practice guidelines.

    PubMed

    Anani, Nadim; Chen, Rong; Prazeres Moreira, Tiago; Koch, Sabine

    2012-01-01

    In light of the lack of integration between electronic health records and decision support, this research explores how semantic electronic health record technology, particularly openEHR, can be used to represent clinical practice guidelines (CPGs). We used the tool Visual Understanding Environment (VUE) to build a graphical representation of the European ischaemic stroke clinical management guidelines. We used openEHR archetypes to conceptually support this process and also to represent clinical concepts in stroke treatment compliance criteria. Our results show that, as an intermediate step in authoring computer-interpretable guidelines, an openEHR-based representation of CPGs and their compliance criteria supports the process of identifying the relevant knowledge and data elements in the care process to be modelled. It further eases the separation of the CPGs into data and logic components and is useful as a communication means for guideline verification by clinicians. Additionally, we retrieved existing and authored new openEHR archetypes for the acute stroke clinical management process. We conclude that openEHR-based guideline and compliance data representations may be a promising first step in building future decision support applications that are well connected to the electronic health record, can be useful in locating discrepancies between different sets of guidelines within the same care context and provide a helpful tool for driving the archetype authoring and review process. PMID:22874238

  18. Clinical guidelines for management of patients under Lieutenant Governor's Warrants.

    PubMed

    Akhtar, S N

    1986-12-01

    This paper examines three categories of mentally abnormal offenders who are held under Lieutenant Governor's Warrants. It explores the psychiatric-legal issues in cases of pre-trial (not fit to stand trial) and post-trial (not guilty by reason of insanity) L.G.W.'s. An attempt is made to provide a structure for such psychiatric-legal evaluations. Clinical guidelines are offered about the objectives, the assumptions and the criteria which form the basis of such evaluations. Suggestions are made for collection of relevant data which should inform psychiatric and legal judgement-making in this area. The role of the psychotropic medication in N.G.I. cases is discussed. It is recommended that whenever medically feasible, a controlled drug-free trial should be carried out in N.G.I. cases prior to their final release, in order to unambiguously establish their need for medication.

  19. [Formula: see text]Official Position of the American Academy of Clinical Neuropsychology (AACN): Guidelines for Practicum Training in Clinical Neuropsychology.

    PubMed

    Nelson, Aaron P; Roper, Brad L; Slomine, Beth S; Morrison, Chris; Greher, Michael R; Janusz, Jennifer; Larson, Jennifer C; Meadows, Mary-Ellen; Ready, Rebecca E; Rivera Mindt, Monica; Whiteside, Doug M; Willment, Kim; Wodushek, Thomas R

    2015-01-01

    Practical experience is central to the education and training of neuropsychologists, beginning in graduate school and extending through postdoctoral fellowship. However, historically, little attention has been given to the structure and requirements of practicum training in clinical neuropsychology. A working group of senior-level neuropsychologists, as well as a current postdoctoral fellow, all from a diverse range of settings (The AACN Practicum Guidelines Workgroup), was formed to propose guidelines for practicum training in clinical neuropsychology. The Workgroup reviewed relevant literature and sought input from professional organizations involved in education and training in neuropsychology. The proposed guidelines provide a definition of practicum training in clinical neuropsychology, detail entry and exit criteria across competencies relevant to practicum training in clinical neuropsychology, and discuss the relationship between doctoral training programs and practicum training sites. The proposed guidelines also provide a methodology for competency-based evaluation of clinical neuropsychology practicum trainees and outline characteristics and features that are integral to an effective training environment. Although the guidelines discussed below may not be implemented in their entirety across all clinical neuropsychology practicum training sites, they are consistent with the latest developments in competency-based education.

  20. [Formula: see text]Official Position of the American Academy of Clinical Neuropsychology (AACN): Guidelines for Practicum Training in Clinical Neuropsychology.

    PubMed

    Nelson, Aaron P; Roper, Brad L; Slomine, Beth S; Morrison, Chris; Greher, Michael R; Janusz, Jennifer; Larson, Jennifer C; Meadows, Mary-Ellen; Ready, Rebecca E; Rivera Mindt, Monica; Whiteside, Doug M; Willment, Kim; Wodushek, Thomas R

    2015-01-01

    Practical experience is central to the education and training of neuropsychologists, beginning in graduate school and extending through postdoctoral fellowship. However, historically, little attention has been given to the structure and requirements of practicum training in clinical neuropsychology. A working group of senior-level neuropsychologists, as well as a current postdoctoral fellow, all from a diverse range of settings (The AACN Practicum Guidelines Workgroup), was formed to propose guidelines for practicum training in clinical neuropsychology. The Workgroup reviewed relevant literature and sought input from professional organizations involved in education and training in neuropsychology. The proposed guidelines provide a definition of practicum training in clinical neuropsychology, detail entry and exit criteria across competencies relevant to practicum training in clinical neuropsychology, and discuss the relationship between doctoral training programs and practicum training sites. The proposed guidelines also provide a methodology for competency-based evaluation of clinical neuropsychology practicum trainees and outline characteristics and features that are integral to an effective training environment. Although the guidelines discussed below may not be implemented in their entirety across all clinical neuropsychology practicum training sites, they are consistent with the latest developments in competency-based education. PMID:26753742

  1. Guidelines for the implementation of an open source information system

    SciTech Connect

    Doak, J.; Howell, J.A.

    1995-08-01

    This work was initially performed for the International Atomic Energy Agency (IAEA) to help with the Open Source Task of the 93 + 2 Initiative; however, the information should be of interest to anyone working with open sources. The authors cover all aspects of an open source information system (OSIS) including, for example, identifying relevant sources, understanding copyright issues, and making information available to analysts. They foresee this document as a reference point that implementors of a system could augment for their particular needs. The primary organization of this document focuses on specific aspects, or components, of an OSIS; they describe each component and often make specific recommendations for its implementation. This document also contains a section discussing the process of collecting open source data and a section containing miscellaneous information. The appendix contains a listing of various providers, producers, and databases that the authors have come across in their research.

  2. Early Experiences from a guideline-based computerized clinical decision support for stroke prevention in atrial fibrillation.

    PubMed

    Chen, Rong; Valladares, Carlos; Corbal, Iago; Anani, Nadim; Koch, Sabine

    2013-01-01

    Atrial fibrillation (AF) affects 1-2% of the population. Twenty percent of all strokes are caused by AF. In this study, we represented the clinical knowledge in the European Society of Cardiology guideline using Guideline Definition Language (GDL), a format that binds openEHR archetypes, rule languages, and reference terminologies together. The computerized guidelines are applied to electronic health record (EHR) data retrospectively in order to identify possible gaps between current clinical practice and optimal care recommended by the evidence-based guidelines. Treatment compliance is checked in two patient groups: one received treatment from a cardiologist who is responsible for AF treatment in the region (n=514) and the other was a much larger patient group from the whole region (n=8130). The compliance checking shows the cardiologist group has substantially higher percentage of compliant treatment compared with that of the general population group. Based on this important finding, we are now implementing at-point-of-care clinical decision support reusing the same computerized guideline knowledge in GDL format in order to increase the guideline adherence of the treatment. PMID:23920553

  3. [Explanation of Evidence-based Guidelines of Clinical Practice with Acupuncture and Moxibustion: Adult Bronchial Asthma].

    PubMed

    Jiao, Yue; Wu, Zhongchao; Zhou, Wenna; Si, Xiaohua; Wang, Jingjing; Zhou, Jincao; Chen, Zhongjie; Li, Rongjun; Zhao, Xiaoguang; Xiao, Liwei

    2016-05-01

    The development and compilation of Evidence-based Guidelines of Clinical Practice with Acupuncture and Moxibustion: Adult Bronchial Asthma are introduced from three aspects, named the guideline methodology, the guideline structure and the guideline content. Based on the acupuncture-moxibustion practice and clinical research, the evidence-based medicine method is adopted. During the development and compilation of the guideline, the characteristics and advantages of acupuncture and moxibustion are specially considered in the treatment of this disease; the latest optimum evidences at home and abroad, experts' experience and patients' value are closely integrated with each other. Additionally, the worldwide accepted assessments of evidence quality and the recommendation (GRADE system) are combined with the clinical evidences of the ancient and modern famous acupuncture-moxibustion experts, and the clinical research evidences are with the experts' consensus to the large extent. The purpose of the guideline is to provide the maximal guidance to the clinical physicians.

  4. [Explanation of Evidence-based Guidelines of Clinical Practice with Acupuncture and Moxibustion: Adult Bronchial Asthma].

    PubMed

    Jiao, Yue; Wu, Zhongchao; Zhou, Wenna; Si, Xiaohua; Wang, Jingjing; Zhou, Jincao; Chen, Zhongjie; Li, Rongjun; Zhao, Xiaoguang; Xiao, Liwei

    2016-05-01

    The development and compilation of Evidence-based Guidelines of Clinical Practice with Acupuncture and Moxibustion: Adult Bronchial Asthma are introduced from three aspects, named the guideline methodology, the guideline structure and the guideline content. Based on the acupuncture-moxibustion practice and clinical research, the evidence-based medicine method is adopted. During the development and compilation of the guideline, the characteristics and advantages of acupuncture and moxibustion are specially considered in the treatment of this disease; the latest optimum evidences at home and abroad, experts' experience and patients' value are closely integrated with each other. Additionally, the worldwide accepted assessments of evidence quality and the recommendation (GRADE system) are combined with the clinical evidences of the ancient and modern famous acupuncture-moxibustion experts, and the clinical research evidences are with the experts' consensus to the large extent. The purpose of the guideline is to provide the maximal guidance to the clinical physicians. PMID:27509620

  5. Managing Conflicts of Interest in the UK National Institute for Health and Care Excellence (NICE) Clinical Guidelines Programme: Qualitative Study

    PubMed Central

    Graham, Tanya; Alderson, Phil; Stokes, Tim

    2015-01-01

    Background There is international concern that conflicts of interest (COI) may bias clinical guideline development and render it untrustworthy. Guideline COI policies exist with the aim of reducing this bias but it is not known how such policies are interpreted and used by guideline producing organisations. This study sought to determine how conflicts of interest (COIs) are disclosed and managed by a national clinical guideline developer (NICE: the UK National Institute for Health and Care Excellence). Methods Qualitative study using semi-structured telephone interviews with 14 key informants: 8 senior staff of NICE’s guideline development centres and 6 chairs of guideline development groups (GDGs). We conducted a thematic analysis. Results Participants regard the NICE COI policy as comprehensive leading to transparent and independent guidance. The application of the NICE COI policy is, however, not straightforward and clarity could be improved. Disclosure of COI relies on self reporting and guideline developers have to take “on trust” the information they receive, certain types of COI (non-financial) are difficult to categorise and manage and disclosed COI can impact on the ability to recruit clinical experts to GDGs. Participants considered it both disruptive and stressful to exclude members from GDG meetings when required by the COI policy. Nonetheless the impact of this disruption can be minimised with good group chairing skills. Conclusions We consider that the successful implementation of a COI policy in clinical guideline development requires clear policies and procedures, appropriate training of GDG chairs and an evaluation of how the policy is used in practice. PMID:25811754

  6. [Implementing clinical pathways: some practical notes].

    PubMed

    Raggi, F; Montella, M T; Lazzari, C; Ciotti, E; Longanesi, A; Nardacchione, V; Bernardi, R; Cacciari, P

    2012-01-01

    The traditional biomedical paradigm is no longer a guarantee of quality for health care, facing increasingly difficult challenges caused by chronic diseases and increasingly fragmented resources that current healthcare systems are dealing with. Health care organizations, considered to be the most complex enterprises of the modern era, must be able to focus on the flow of patients, integrating primary and secondary care through tools such as the Integrated Care Pathways (ICP). This brief discussion attempts to define the ICP its purposes, the elements that characterize it, its limitations and the mechanisms to push for a successful implementation. In order to highlight the elements and basic steps for the creation of an ICP, the authors have compared five different clinical pathways, whose implementation they have contributed to. The comparison was made using two grids: the first showing the essential elements for the definition of lCP and the second one with features that can facilitate their effectiveness. The conclusions of the work show what, pursuing the construction of a pathway, we must never forget: to analyze the gap between the clinical-care activities performed and the theoretical framework provided by the evidence; to see the barriers to change that may impede the implementation; to involve all actors in the system, with particular attention to patients and their associations, and finally to provide a plan for information and education, addressed to health professionals and patients as well. PMID:22755502

  7. An Evaluation of Web-Based Clinical Practice Guidelines for Managing Problems Associated with Cannabis Use

    PubMed Central

    Turner, Michael W; Rooke, Sally E; Langton, Julia M; Gates, Peter J

    2012-01-01

    Background Cannabis is the most widely used illicit substance, and multiple treatment options and avenues exist for managing its use. There has been an increase in the development of clinical practice guidelines (CPGs) to improve standards of care in this area, many of which are disseminated online. However, little is known about the quality and accessibility of these online CPGs. Objective The purpose of study 1 was to determine the extent to which cannabis-related CPGs disseminated online adhere to established methodological standards. The purpose of study 2 was to determine if treatment providers are familiar with these guidelines and to assess their perceived quality of these guidelines. Methods Study 1 involved a systematic search using the Google Scholar search engine and the National Drugs Sector Information Service (NDSIS) website of the Alcohol and Other Drugs Council of Australia (ADCA) to identify CPGs disseminated online. To be included in the current study, CPGs needed to be free of charge and provide guidance on psychological interventions for reducing cannabis use. Four trained reviewers independently assessed the quality of the 7 identified guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Study 2 assessed 166 Australian cannabis-use treatment providers’ (mean age = 45.47 years, SD 12.14) familiarity with and opinions of these 7 guidelines using an online survey. Treatment providers were recruited using online advertisements that directed volunteers to a link to complete the survey, which was posted online for 6 months (January to June 2012). Primary study outcomes included quality scores and rates of guideline familiarity, guideline use, and discovery methods. Results Based on the AGREE II, the quality of CPGs varied considerably. Across different reporting domains, adherence to methodological standards ranged from 0% to 92%. Quality was lowest in the domains of rigor of development (50%), applicability (46

  8. Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management.

    PubMed

    Windfuhr, Jochen P; Toepfner, Nicole; Steffen, Gregor; Waldfahrer, Frank; Berner, Reinhard

    2016-04-01

    More than 120,000 patients are treated annually in Germany to resolve repeated episodes of acute tonsillitis. Therapy is aiming at symptom regression, avoidance of complications, reduction in the number of disease-related absences in school or at work, increased cost-effectiveness and improved quality of life. The purpose of this part of the guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through different conservative treatment options in order to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical management in terms of intracapsular as well as extracapsular tonsillectomy (i.e. tonsillotomy) is the subject of part II of this guideline. To estimate the probability of tonsillitis caused by β-hemolytic streptococci, a diagnostic scoring system according to Centor or McIsaac is suggested. If therapy is considered, a positive score of ≥3 should lead to pharyngeal swab or rapid test or culture in order to identify β-hemolytic streptococci. Routinely performed blood tests for acute tonsillitis are not indicated. After acute streptococcal tonsillitis, there is no need to repeat a pharyngeal swab or any other routine blood tests, urine examinations or cardiological diagnostics such as ECG. The determination of the antistreptolysin O-titer (ASLO titer) and other antistreptococcal antibody titers do not have any value in relation to acute tonsillitis with or without pharyngitis and should not be performed. First-line therapy of β-hemolytic streptococci consists of oral penicillin. Instead of phenoxymethylpenicillin-potassium (penicillin V potassium), also phenoxymethlpenicillin-benzathine with a clearly longer half-life can be used. Oral intake for 7 days of one of both the drugs is recommended. Alternative treatment with oral cephalosporins (e.g. cefadroxil, cefalexin) is indicated only in cases of penicillin failure, frequent recurrences, and whenever a more

  9. [The impact of guidelines, standards and economic restrictions on clinical decision-making processes].

    PubMed

    Linden, Michael

    2004-05-01

    Guidelines aim at improving clinical decision-making. Contrary to textbooks and reviews that want to improve medical knowledge, guidelines try to influence medical behaviour. Scientific models of clinical decision-making such as the action theory and empirical data on the effects of guidelines suggest that guidelines will not always reach their goals but can instead even lead to a deterioration in the quality of medical care. Therefore there is a need for controlled clinical trials to investigate whether guideline-exposed physicians yield better patient outcomes than guideline-naïve physicians. Guidelines should only be regarded as evidence-based if their positive effects have been empirically demonstrated. PMID:15250387

  10. [Clinical practice guideline. Traumatic urethral stenosis in males].

    PubMed

    Serrano-Brambila, Eduardo Alonso; Moreno-Alcázar, Othón Martino; Neri-Páez, Edgar; Sánchez-Martínez, Luis Carlos; Hernández-Ordóñez, Octavio Francisco; Morales-Morales, Arturo; Basavilvazo-Rodríguez, M Antonia; Torres-Arreola, Laura del Pilar; Valenzuela-Flores, Adriana Abigail; Hernández-Valencia, Marcelino

    2013-01-01

    The incidence of urethral stenosis in Mexico had not been documented. At the Centro Médico Nacional La Raza, during the year 2010, 629 patients with urethral stenosis were attended as outpatient consultation: 85 % with previous urethral stenosis and 15 % with urethral treatment complication. Urethral stenosis is a chronic illness, with multiple etiological origins and the handling is controversial. It has a great negative impact for the patients and the recurrence reaches 85 %. The treatment consisted of an invasive approach (urethral dilations, endoscopy procedure) and open surgery (urethroplasty). The World Health Organization and World Alliance take the world challenge about the urinary tract infections associated with the attention of patients, focused on urethral stenosis. The objective of the following clinical guide is to offer to the health professional a clinical tool for making decisions in the handling of the hardship or masculine urethral stenosis, based on the best available evidence, carrying out in systematized form with bibliographical research using validated terms of the MeSH: urethral structures, in the databases Trip database, PubMed, Guideline Clearinghouse, Cochrane Library and Ovid.

  11. [Clinical practice guideline. Traumatic urethral stenosis in males].

    PubMed

    Serrano-Brambila, Eduardo Alonso; Moreno-Alcázar, Othón Martino; Neri-Páez, Edgar; Sánchez-Martínez, Luis Carlos; Hernández-Ordóñez, Octavio Francisco; Morales-Morales, Arturo; Basavilvazo-Rodríguez, M Antonia; Torres-Arreola, Laura del Pilar; Valenzuela-Flores, Adriana Abigail; Hernández-Valencia, Marcelino

    2013-01-01

    The incidence of urethral stenosis in Mexico had not been documented. At the Centro Médico Nacional La Raza, during the year 2010, 629 patients with urethral stenosis were attended as outpatient consultation: 85 % with previous urethral stenosis and 15 % with urethral treatment complication. Urethral stenosis is a chronic illness, with multiple etiological origins and the handling is controversial. It has a great negative impact for the patients and the recurrence reaches 85 %. The treatment consisted of an invasive approach (urethral dilations, endoscopy procedure) and open surgery (urethroplasty). The World Health Organization and World Alliance take the world challenge about the urinary tract infections associated with the attention of patients, focused on urethral stenosis. The objective of the following clinical guide is to offer to the health professional a clinical tool for making decisions in the handling of the hardship or masculine urethral stenosis, based on the best available evidence, carrying out in systematized form with bibliographical research using validated terms of the MeSH: urethral structures, in the databases Trip database, PubMed, Guideline Clearinghouse, Cochrane Library and Ovid. PMID:24021082

  12. Clinical Practice Guidelines and Consensus Statements in Oncology – An Assessment of Their Methodological Quality

    PubMed Central

    Jacobs, Carmel; Graham, Ian D.; Makarski, Julie; Chassé, Michaël; Fergusson, Dean; Hutton, Brian; Clemons, Mark

    2014-01-01

    Background Consensus statements and clinical practice guidelines are widely available for enhancing the care of cancer patients. Despite subtle differences in their definition and purpose, these terms are often used interchangeably. We systematically assessed the methodological quality of consensus statements and clinical practice guidelines published in three commonly read, geographically diverse, cancer-specific journals. Methods Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine’s standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. Methods Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. Findings Thirty-four consensus statements and 67 clinical practice guidelines were evaluated. The rigour of development score for consensus statements over the three journals was 32% lower than that of clinical practice guidelines. The editorial independence score was 15% lower for consensus statements than clinical practice guidelines. One journal

  13. Implementing guidelines on reporting research using animals (ARRIVE etc.): new requirements for publication in BJP.

    PubMed

    McGrath, John C; Lilley, Elliot

    2015-07-01

    The ARRIVE guidelines have been implemented in BJP for 4 years with the aim of increasing transparency in reporting experiments involving animals. BJP has assessed our success in implementing them and concluded that we could do better. This editorial discusses the issues and explains how we are changing our requirements for authors to report their findings in experiments involving animals. This is one of a series of editorials discussing updates to the BJP Instructions to Authors.

  14. Identification of attributes that promote the adoption and implementation of 2005 Dietary Guidelines for Americans

    Technology Transfer Automated Retrieval System (TEKTRAN)

    As part of a larger study, this research was to identify attributes of the Dietary Guidelines for Americans (DGAs) that would promote their adoption and implementation by participants in a nutrition intervention. Project procedures were guided by the Diffusion of Innovations (DOI) theory. To identif...

  15. Web-Based Social Work Courses: Guidelines for Developing and Implementing an Online Environment

    ERIC Educational Resources Information Center

    Dawson, Beverly Araujo; Fenster, Judy

    2015-01-01

    Although web-based courses in schools of social work have proliferated over the past decade, the literature contains few guidelines on steps that schools can take to develop such courses. Using Knowles's framework, which delineates tasks and themes involved in implementing e-learning in social work education, this article describes the cultivation…

  16. 75 FR 4769 - Availability of Grant Funds and Proposed Implementation Guidelines; Withdrawal of Solicitation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-29

    ... notice entitled ``Availability of Grant Funds for Fiscal Year 2010'' (75 FR 3092). Included in that... Proposed Implementation Guidelines; Withdrawal of Solicitation for the Marine Aquaculture Initiative AGENCY... solicitation of applications for the NOAA Marine Aquaculture Initiative 2010, which was published in the...

  17. Development of clinical practice guidelines for patients with comorbidity and multiple diseases.

    PubMed

    Bernabeu-Wittel, M; Alonso-Coello, P; Rico-Blázquez, M; Rotaeche Del Campo, R; Sánchez Gómez, S; Casariego Vales, E

    2014-01-01

    The management of patients with comorbidity and polypathology represents a challenge for all healthcare systems. Clinical practice guidelines (CPGs) have limitations when applied to this population. The aim of this study is to propose the terminology and methodology for optimally approach comorbidity and polypathology in the CPGs. Based on a literature review, we suggest a number of proposals for the approach in different phases of CPG preparation, with special attention to the inclusion of clusters of comorbidity in the initial questions the implementation of indirect evidence, the burden of disease management for patients and their environment, when establishing recommendations, as well as the strategies of dissemination and implementation. These proposals should be developed in greater depth with the implication of more agents in order to have valid and useful tools for this population.

  18. [Development of clinical practice guidelines for patients with comorbidity and multiple diseases].

    PubMed

    Bernabeu-Wittel, M; Alonso-Coello, P; Rico-Blázquez, M; Rotaeche del Campo, R; Sánchez Gómez, S; Casariego Vales, E

    2014-01-01

    The management of patients with comorbidity and polypathology represents a challenge for all healthcare systems. Clinical practice guidelines (CPGs) have limitations when applied to this population. The aim of this study is to propose the terminology and methodology for optimally approach comorbidity and polypathology in the CPGs. Based on a literature review, we suggest a number of proposals for the approach in different phases of CPG preparation, with special attention to the inclusion of clusters of comorbidity in the initial questions the implementation of indirect evidence, the burden of disease management for patients and their environment, when establishing recommendations, as well as the strategies of dissemination and implementation. These proposals should be developed in greater depth with the implication of more agents in order to have valid and useful tools for this population.

  19. Burden of diabetic foot disorders, guidelines for management and disparities in implementation in Europe: a systematic literature review.

    PubMed

    van Acker, Kristien; Léger, Philippe; Hartemann, Agnes; Chawla, Abhineet; Siddiqui, Mohd Kashif

    2014-11-01

    The study aimed to assess the economic and quality of life burden of diabetic foot disorders and to identify disparities in the recommendations from guidelines and the current clinical practice across the EU5 (Spain, Italy, France, UK and Germany) countries. Literature search of electronic databases (MEDLINE®, Embase® and Cochrane Database of Systematic Reviews) was undertaken. English language studies investigating economic and resource burden, quality of life and management of diabetic foot disease in the EU5 countries were included. Additionally, websites were screened for guidelines and current management practices in diabetic foot complication in EU5. Diabetic foot complications accounted for a total annual cost of €509m in the UK and €430 per diabetic patient in Germany, during 2001. The cost of diabetic foot complications increased with disease severity, with hospitalizations (41%) and amputation (9%) incurring 50% of the cost. Medical devices (orthopaedic shoes, shoe lifts and walking aids) were the most frequently utilized resources. Patients with diabetic foot complications experienced worsened quality of life, especially in those undergoing amputations and with non-healed ulcers or recurrent ulcers. Although guidelines advocate the use of multidisciplinary foot care teams, the utilization of multidisciplinary foot care teams was suboptimal. We conclude that diabetic foot disorders demonstrated substantial economic burden and have detrimental effect on quality of life, with more impairment in physical domain. Implementation of the guidelines and set-up of multidisciplinary clinics for holistic management of the diabetic foot disorders varies across Europe and remains suboptimal. Hence, guidelines need to be reinforced to prevent diabetic foot complications and to achieve limb salvage if complications are unpreventable.

  20. Ethnic specific recommendations in clinical practice guidelines: a first exploratory comparison between guidelines from the USA, Canada, the UK, and the Netherlands

    PubMed Central

    Manna, D; Bruijnzeels, M; Mokkink, H; Berg, M

    2003-01-01

    Objectives: To investigate whether clinical practice guidelines in different countries take ethnic differences between patients into consideration and to assess the scientific foundation of such ethnic specific recommendations. Design: Analysis of the primary care sections of clinical practice guidelines. Setting: Primary care practice guidelines for type 2 diabetes mellitus, hypertension, and asthma developed in the USA, Canada, the UK, and the Netherlands. Main outcome measures: Enumeration of the ethnic specific information and recommendations in the guidelines, and the scientific basis and strength of this evidence. Results: Different guidelines do address ethnic differences between patients, but to a varying extent. The USA guidelines contained the most ethnic specific statements and the Dutch guidelines the least. Most ethnic specific statements were backed by scientific evidence, usually arising from descriptive studies or narrative reviews. Conclusion: The attention given to ethnic differences between patients in clinical guidelines varies between countries. Guideline developers should be aware of the potential problems of ignoring differences in ethnicity. PMID:14532367

  1. Interprofessional Implementation of a Pain/Sedation Guideline on a Trauma Intensive Care Unit.

    PubMed

    Sacco, Tara L; LaRiccia, Brenton

    2016-01-01

    Trauma patients experience pain and agitation during their hospitalization. Many complications have been noted both in the absence of symptom management and the in presence of oversedation/narcotization. To combat noted untoward effects of pain and sedation management, an interprofessional team convened to develop a pain and sedation guideline for use in a trauma intensive care unit. Guideline development began with a comprehensive review of the literature. With the input of unit stakeholders, a nurse-driven analgosedation guideline was implemented for a 6-month trial. During this time, unit champions were integral to successful trial execution. Outcome measurement included patient and unit outcomes, nursing satisfaction, and a pre- and postimplementation patient comparison. Following implementation, unit length of stay decreased by 4.16% and there was a 17.81% decrease in average time on the ventilator following the initiation of weaning. Patient reports of nurse sensitivity and responsiveness to pain increased from 93.7 to 94.9. Nurses reported satisfaction with the practice change and improvements in care. In comparing pre- and postimplementation patient data, there was a significant decrease in mean analgesic treatment duration and an increase in the use of antipsychotics for delirium management. Following the trial period, this guideline was permanently adopted across the adult critical care service. The development of a nurse-driven analgosedation guideline was noted to be both feasible and successful. PMID:27163223

  2. Implementation of WHO guidelines on management of severe malnutrition in hospitals in Africa.

    PubMed Central

    Deen, Jacqueline L.; Funk, Matthias; Guevara, Victor C.; Saloojee, Haroon; Doe, James Y.; Palmer, Ayo; Weber, Martin W.

    2003-01-01

    OBJECTIVE: To investigate the problems, benefits, feasibility, and sustainability of implementation of WHO guidelines on management of severe malnutrition. METHODS: A postal survey invited staff from 12 African hospitals to participate in the study. Five hospitals were evaluated and two were selected to take part in the study: a district hospital in South Africa and a mission hospital in Ghana. At an initial visit, an experienced paediatrician reviewed the situation in the hospitals and introduced the principles of the guidelines through a participatory approach. During a second visit about six months later, the paediatrician reviewed the feasibility and sustainability of the introduced changes and helped find solutions to problems. At a final visit after one year, the paediatrician reassessed the overall situation. FINDINGS: Malnutrition management practices improved at both hospitals. Measures against hypoglycaemia, hypothermia, and infection were strengthened. Early, frequent feeding was established as a routine practice. Some micronutrients for inclusion in the diet were not locally available and needed to be imported. Problems were encountered with monitoring of weight gain and introducing a rehydration solution for malnutrition. CONCLUSION: Implementation of the main principles of the WHO guidelines on severe malnutrition was feasible, affordable, and sustainable at two African hospitals. The guidelines could be improved by including suggestions on how to adapt specific recommendations to local situations. The guidelines are well supported by experience and published reports, but more information is needed about some components and their impact on mortality. PMID:12764489

  3. Improving the execution of clinical guidelines and temporal data abstraction high-frequency domains.

    PubMed

    Seyfang, Andreas; Paesold, Michael; Votruba, Peter; Miksch, Silvia

    2008-01-01

    The execution of clinical guidelines and protocols (CGPs) is a challenging task in high-frequency domains such as Intensive Care Units. On the one hand, sophisticated temporal data abstraction is required to match the low-level information from monitoring devices and electronic patient records with the high-level concepts in the CGPs. On the other hand, the frequency of the data delivered by monitoring devices mandates a highly efficient implementation of the reasoning engine which handles both data abstraction and execution of the guideline. The language Asbru represents CGPs as a hierarchy of skeletal plans and integrates intelligent temporal data abstraction with plan execution to bridge the gap between measurements and concepts in CGPs. We present our Asbru interpreter, which compiles abstraction rules and plans into a network of abstraction modules by the system. This network performs the content of the plans triggered by the arriving patient data. Our approach evaluated to be efficient enough to handle high-frequency data while coping with complex guidelines and temporal data abstraction.

  4. Hospitals’ readiness to implement clinical governance

    PubMed Central

    Ebadi Fardazar, Farbod; Safari, Hossein; Habibi, Farhad; Akbari Haghighi, Feyzollah; Rezapour, Aziz

    2015-01-01

    Background: Quality of health services is one of the most important factors for delivery of these services. Regarding the importance and vital role of quality in the health sector, a concept known as "Clinical Governance" (CG) has been introduced into the health area which aims to enhance quality of health services. Thus, this study aimed to assess private and public hospitals’ readiness to implement CG in Iran. Methods: This descriptive and cross-sectional study was carried out in 2012. Four hundred thirty participants including doctors, nurses, diagnostic departments personnel, and support staff were chosen randomly from four hospitals (equally divided into private and public hospitals). Clinical Governance Climate Questionnaire (CGCQ) was used for data collection. Finally, data were entered into the SPSS 18 and were analyzed using statistical methods. Results: Among the CG dimensions, "organizational learning" and "planned and integrated quality improvement program" scored the highest and the lowest respectively for both types of hospitals. Hospitals demonstrated the worst condition with regard to the latter dimension. Furthermore, both types of hospitals had positive picture regarding "training and development opportunities". Private hospitals scored better than public ones in all dimensions but there was only a significant difference in "proactive risk management" dimension between both types of hospitals (P< 0.05). Conclusion: Hospitals’ readiness for CG implementation was "average or weak". In order to implement CG successfully, it is essential to have a quality-centered culture, a culture specified by less paperwork, more self-sufficiency, and flexibility in hospitals’ affairs as well as centring on shared vision and goals with an emphasis on continuous improvement and innovation. PMID:25674566

  5. Ministry of Health Clinical Practice Guidelines: Prevention, Diagnosis and Management of Tuberculosis

    PubMed Central

    Wang, Yee Tang Sonny; Chee, Cynthia Bin Eng; Hsu, Li Yang; Jagadesan, Raghuram; Kaw, Gregory Jon Leng; Kong, Po Marn; Lew, Yii Jen; Lim, Choon Seng; Lim, Ting Ting Jayne; Lu, Kuo Fan Mark; Ooi, Peng Lim; Sng, Li-Hwei; Thoon, Koh Cheng

    2016-01-01

    The Ministry of Health (MOH) has developed the clinical practice guidelines on Prevention, Diagnosis and Management of Tuberculosis to provide doctors and patients in Singapore with evidence-based treatment for tuberculosis. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Prevention, Diagnosis and Management of Tuberculosis, for the information of SMJ readers. The chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines. PMID:26996216

  6. Academy of Medicine-Ministry of Health Clinical Practice Guidelines: Attention Deficit Hyperactivity Disorder

    PubMed Central

    Fung, Daniel SS; Lim, Choon Guan; Wong, John Chee Meng; Ng, Koon Hock; Cheok, Christopher Cheng Soon; Kiing, Jennifer Sie Hee; Chong, Shang Chee; Lou, June; Daniel, Mary Lourdes; Ong, Desmond; Low, Charity; Aljunied, Sharifah Mariam; Choi, Pui Meng; Mehrotra, Kala; Kee, Carolyn; Leung, Ivy; Yen, Lee Chen; Wong, Geraldine; Lee, Poh Yin; Chin, Bella; Ng, Hwee Chien

    2014-01-01

    The Academy of Medicine (AMS) and the Ministry of Health (MOH) have developed the clinical practice guidelines on Attention Deficit Hyperactivity Disorder (ADHD) to provide doctors and patients in Singapore with evidence-based treatment for ADHD. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on ADHD, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines. PMID:25189301

  7. Method to integrate clinical guidelines into the electronic health record (EHR) by applying the archetypes approach.

    PubMed

    Garcia, Diego; Moro, Claudia Maria Cabral; Cicogna, Paulo Eduardo; Carvalho, Deborah Ribeiro

    2013-01-01

    Clinical guidelines are documents that assist healthcare professionals, facilitating and standardizing diagnosis, management, and treatment in specific areas. Computerized guidelines as decision support systems (DSS) attempt to increase the performance of tasks and facilitate the use of guidelines. Most DSS are not integrated into the electronic health record (EHR), ordering some degree of rework especially related to data collection. This study's objective was to present a method for integrating clinical guidelines into the EHR. The study developed first a way to identify data and rules contained in the guidelines, and then incorporate rules into an archetype-based EHR. The proposed method tested was anemia treatment in the Chronic Kidney Disease Guideline. The phases of the method are: data and rules identification; archetypes elaboration; rules definition and inclusion in inference engine; and DSS-EHR integration and validation. The main feature of the proposed method is that it is generic and can be applied toany type of guideline. PMID:23920682

  8. Implementation of the SSHAC Guidelines for Level 3 and 4 PSHAs - Experience Gained from Actual Applications

    USGS Publications Warehouse

    Hanks, Thomas C.; Abrahamson, Norm A.; Boore, David M.; Coppersmith, Kevin J.; Knepprath, Nichole E.

    2009-01-01

    In April 1997, after four years of deliberations, the Senior Seismic Hazard Analysis Committee released its report 'Recommendations for Probabilistic Seismic Hazard Analysis: Guidance on Uncertainty and Use of Experts' through the U.S. Nuclear Regulatory Commission as NUREG/CR-6372, hereafter SSHAC (1997). Known informally ever since as the 'SSHAC Guidelines', SSHAC (1997) addresses why and how multiple expert opinions - and the intrinsic uncertainties that attend them - should be used in Probabilistic Seismic Hazard Analyses (PSHA) for critical facilities such as commercial nuclear power plants. Ten years later, in September 2007, the U.S. Geological Survey (USGS) entered into a 13-month agreement with the U.S. Nuclear Regulatory Commission (NRC) titled 'Practical Procedures for Implementation of the SSHAC Guidelines and for Updating PSHAs'. The NRC was interested in understanding and documenting lessons learned from recent PSHAs conducted at the higher SSHAC Levels (3 and 4) and in gaining input from the seismic community for updating PSHAs as new information became available. This study increased in importance in anticipation of new applications for nuclear power facilities at both existing and new sites. The intent of this project was not to replace the SSHAC Guidelines but to supplement them with the experience gained from putting the SSHAC Guidelines to work in practical applications. During the course of this project, we also learned that updating PSHAs for existing nuclear power facilities involves very different issues from the implementation of the SSHAC Guidelines for new facilities. As such, we report our findings and recommendations from this study in two separate documents, this being the first. The SSHAC Guidelines were written without regard to whether the PSHAs to which they would be applied were site-specific or regional in scope. Most of the experience gained to date from high-level SSHAC studies has been for site-specific cases, although three

  9. Facilitating comfort for hospitalized patients using non-pharmacological measures: preliminary development of clinical practice guidelines.

    PubMed

    Williams, Anne M; Davies, Anne; Griffiths, Gareth

    2009-06-01

    Nurses often use non-pharmacological measures to facilitate comfort for patients within the hospital setting. However, guidelines for use of these measures are commonly inadequate or absent. This paper presents 12 clinical practice guidelines that were developed from the findings of a literature review into non-pharmacological measures that are thought to facilitate patient comfort. The non-pharmacological measures addressed in these guidelines are: Aromotherapy, Distraction, Guided Imagery, Laughter, Massage, Music, Reiki, Heat or Cold, Meditation, Reflexology, Reposition and Transcutaneous Electrical Nerve Stimulation. These are preliminary guidelines for the use of non-pharmacological measures and further research and development of such guidelines is recommended.

  10. Towards computerizing intensive care sedation guidelines: design of a rule-based architecture for automated execution of clinical guidelines

    PubMed Central

    2010-01-01

    Background Computerized ICUs rely on software services to convey the medical condition of their patients as well as assisting the staff in taking treatment decisions. Such services are useful for following clinical guidelines quickly and accurately. However, the development of services is often time-consuming and error-prone. Consequently, many care-related activities are still conducted based on manually constructed guidelines. These are often ambiguous, which leads to unnecessary variations in treatments and costs. The goal of this paper is to present a semi-automatic verification and translation framework capable of turning manually constructed diagrams into ready-to-use programs. This framework combines the strengths of the manual and service-oriented approaches while decreasing their disadvantages. The aim is to close the gap in communication between the IT and the medical domain. This leads to a less time-consuming and error-prone development phase and a shorter clinical evaluation phase. Methods A framework is proposed that semi-automatically translates a clinical guideline, expressed as an XML-based flow chart, into a Drools Rule Flow by employing semantic technologies such as ontologies and SWRL. An overview of the architecture is given and all the technology choices are thoroughly motivated. Finally, it is shown how this framework can be integrated into a service-oriented architecture (SOA). Results The applicability of the Drools Rule language to express clinical guidelines is evaluated by translating an example guideline, namely the sedation protocol used for the anaesthetization of patients, to a Drools Rule Flow and executing and deploying this Rule-based application as a part of a SOA. The results show that the performance of Drools is comparable to other technologies such as Web Services and increases with the number of decision nodes present in the Rule Flow. Most delays are introduced by loading the Rule Flows. Conclusions The framework is an

  11. Application of radiotherapy for hepatocellular carcinoma in current clinical practice guidelines

    PubMed Central

    Rim, Chai Hong; Seong, Jinsil

    2016-01-01

    In oncologic practice, treatment guidelines provide appropriate treatment strategies based on evidence. Currently, many guidelines are used, including those of the European Association for the Study of the Liver and European Organization for Research and Treatment of Cancer (EASL-EORTC), National Comprehensive Cancer Network (NCCN), Asia-Pacific Primary Liver Cancer Expert (APPLE), and Korean Liver Cancer Study Group and National Cancer Centre (KLCSG-NCC). Although radiotherapy is commonly used in clinical practice, some guidelines do not accept it as a standard treatment modality. In this review, we will investigate the clinical practice guidelines currently used, and discuss the application of radiotherapy. PMID:27730805

  12. EMRs and Clinical IS Implementation in Hospitals: A Statewide Survey

    ERIC Educational Resources Information Center

    Jaana, Mirou; Ward, Marcia M.; Bahensky, James A.

    2012-01-01

    Purpose: Present an overview of clinical information systems (IS) in hospitals and analyze the level of electronic medical records (EMR) implementation in relation to clinical IS capabilities and organizational characteristics. Methods: We developed a survey instrument measuring clinical IS implementation and classified clinical IS across 5 EMR…

  13. Guidelines for Creating, Implementing, and Evaluating Mind-Body Programs in a Military Healthcare Setting.

    PubMed

    Smith, Katherine; Firth, Kimberly; Smeeding, Sandra; Wolever, Ruth; Kaufman, Joanna; Delgado, Roxana; Bellanti, Dawn; Xenakis, Lea

    2016-01-01

    Research suggests that the development of mind-body skills can improve individual and family resilience, particularly related to the stresses of illness, trauma, and caregiving. To operationalize the research evidence that mind-body skills help with health and recovery, Samueli Institute, in partnership with experts in mind-body programming, created a set of guidelines for developing and evaluating mind-body programs for service members, veterans, and their families. The Guidelines for Creating, Implementing, and Evaluating Mind-Body Programs in a Military Healthcare Setting outline key strategies and issues to consider when developing, implementing, and evaluating a mind-body focused family empowerment approach in a military healthcare setting. Although these guidelines were developed specifically for a military setting, most of the same principles can be applied to the development of programs in the civilian setting as well. The guidelines particularly address issues unique to mind-body programs, such as choosing evidence-based modalities, licensure and credentialing, safety and contraindications, and choosing evaluation measures that capture the holistic nature of these types of programs. The guidelines are practical, practice-based guidelines, developed by experts in the fields of program development and evaluation, mind-body therapies, patient- and family-centered care, as well as, experts in military and veteran's health systems. They provide a flexible framework to create mind-body family empowerment programs and describe important issues that program developers and evaluators are encouraged to address to ensure the development of the most impactful, successful, evidence-supported programs possible.

  14. Analysis of Existing Guidelines for the Systematic Planning Process of Clinical Registries.

    PubMed

    Löpprich, Martin; Knaup, Petra

    2016-01-01

    Clinical registries are a powerful method to observe the clinical practice and natural disease history. In contrast to clinical trials, where guidelines and standardized methods exist and are mandatory, only a few initiatives have published methodological guidelines for clinical registries. The objective of this paper was to review these guidelines and systematically assess their completeness, usability and feasibility according to a SWOT analysis. The results show that each guideline has its own strengths and weaknesses. While one supports the systematic planning process, the other discusses clinical registries in great detail. However, the feasibility was mostly limited and the special requirements of clinical registries, their flexible, expandable and adaptable technological structure was not addressed consistently. PMID:27577423

  15. Analysis of Existing Guidelines for the Systematic Planning Process of Clinical Registries.

    PubMed

    Löpprich, Martin; Knaup, Petra

    2016-01-01

    Clinical registries are a powerful method to observe the clinical practice and natural disease history. In contrast to clinical trials, where guidelines and standardized methods exist and are mandatory, only a few initiatives have published methodological guidelines for clinical registries. The objective of this paper was to review these guidelines and systematically assess their completeness, usability and feasibility according to a SWOT analysis. The results show that each guideline has its own strengths and weaknesses. While one supports the systematic planning process, the other discusses clinical registries in great detail. However, the feasibility was mostly limited and the special requirements of clinical registries, their flexible, expandable and adaptable technological structure was not addressed consistently.

  16. Reconciling Multiple Hypertension Guidelines to Promote Effective Clinical Practice.

    PubMed

    Salvo, Marissa; White, C Michael

    2014-06-20

    The new Joint National Committee 8 (JNC-8) blood pressure guidelines were recently published, and there are some major changes from JNC-7. There are also differences between JNC-8 and hypertension guidelines created by major organizations in North America and around the world published from 2013 to the present. In the face of conflicting evidence, it is difficult for practicing clinicians to reconcile these differences and to incorporate new guidance into their practice. This commentary will identify similarities and differences between guidelines, provide some literature context in the areas of differing recommendations, and then provide advice to enhance patient care. PMID:24951309

  17. Agreement among ASES members on the AAOS Clinical Practice Guidelines.

    PubMed

    Paxton, E Scott; Matzon, Jonas L; Narzikul, Alexa C; Beredjiklian, Pedro K; Abboud, Joseph A

    2015-03-01

    The American Academy of Orthopaedic Surgeons (AAOS) has recently developed several clinical practice guidelines (CPG) involving upper extremity conditions. The purpose of the current study was to evaluate the practice patterns of members of the American Shoulder and Elbow Society (ASES) with regard to the CPGs. An e-mail survey was sent to the 340 members of the ASES. The survey contained 40 questions involving the subject matter of the 2 existing AAOS CPGs pertaining specifically to the shoulder: Optimizing the Management of Rotator Cuff Problems and the Treatment of Glenohumeral Joint Arthritis. Overall, 98 responses were obtained, for a response rate of 29%. Only 19 of 47 CPGs were not "inconclusive" and a recommendation was actually made. A majority (more than 50%) of surgeons agreed with 17 (90%) of 19 of these AAOS recommendations. A strong majority (more than 80%) adhered to 13 (68%) of 19 recommendations. There were 4 consensus recommendations, and more than 50% agreed with all of them. Of the 5 moderate recommendations, more than 50% agreed with 4 of them. There were 10 weak recommendations, and more than 50% of surgeons agreed with 9 of them. There was more than 80% agreement on 18 of 28 inconclusive recommendations. Although the AAOS CPGs are not meant to be fixed protocols, they are intended to unify treatment and/or diagnosis of common problems based on the best evidence available. Despite the majority of the AAOS CPG recommendations for rotator cuff problems and glenohumeral arthritis being inconclusive, most surgeons agree with most of the CPG recommendations.

  18. Performance of Implementing Guideline Driven Cervical Cancer Screening Measures in an Inner City Hospital System

    PubMed Central

    Wieland, Daryl L.; Reimers, Laura L.; Wu, Eijean; Nathan, Lisa M.; Gruenberg, Tammy; Abadi, Maria; Einstein, Mark H.

    2013-01-01

    Objective In 2006, the American Society for Colposcopy and Cervical Pathology (ASCCP) updated evidence based guidelines recommending screening intervals for women with abnormal cervical cytology. In our low-income inner city population, we sought to improve performance by uniformly applying the guidelines to all patients. We report the prospective performance of a comprehensive tracking, evidence-based algorithmically driven call-back and appointment scheduling system for cervical cancer screening in a resource-limited inner city population. Materials and Methods Outreach efforts were formalized with algorithm-based protocols for triage to colposcopy, with universal adherence to evidence-based guidelines. During implementation from August 2006 through July 2008, we prospectively tracked performance using the electronic medical record with administrative and pathology reports to determine performance variables such as the total number of Pap tests, colposcopy visits, and the distribution of abnormal cytology and histology results, including all CIN 2,3 diagnoses. Results 86,257 gynecologic visits and 41,527 Pap tests were performed system-wide during this period of widespread and uniform implementation of standard cervical cancer screening guidelines. The number of Pap tests performed per month varied little. The incidence of CIN 1 significantly decreased from 117/171 (68.4%) the first tracked month to 52/95 (54.7%) the last tracked month (p=0.04). The monthly incidence rate of CIN 2,3, including incident cervical cancers did not change. The total number of colposcopy visits declined, resulting in a 50% decrease in costs related to colposcopy services and approximately a 12% decrease in costs related to excisional biopsies. Conclusions Adherence to cervical cancer screening guidelines reduced the number of unnecessary colposcopies without increasing numbers of potentially missed CIN 2,3 lesions, including cervical cancer. Uniform implementation of administrative

  19. Clinical guidelines for postpartum women and infants in primary care–a systematic review

    PubMed Central

    2014-01-01

    Background While many women and infants have an uneventful course during the postpartum period, others experience significant morbidity. Effective postpartum care in the community can prevent short, medium and long-term consequences of unrecognised and poorly managed problems. The use of rigorously developed, evidence-based guidelines has the potential to improve patient care, impact on policy and ensure consistency of care across health sectors. This study aims to compare the scope and content, and assess the quality of clinical guidelines about routine postpartum care in primary care. Methods PubMed, the National Guideline Clearing House, Google, Google Scholar and relevant college websites were searched for relevant guidelines. All guidelines regarding routine postpartum care published in English between 2002 and 2012 were considered and screened using explicit selection criteria. The scope and recommendations contained in the guidelines were compared and the quality of the guidelines was independently assessed by two authors using the AGREE II instrument. Results Six guidelines from Australia (2), the United Kingdom (UK) (3) and the United States of America (USA) (1), were included. The scope of the guidelines varied greatly. However, guideline recommendations were generally consistent except for the use of the Edinburgh Postnatal Depression Scale for mood disorder screening and the suggested time of routine visits. Some recommendations lacked evidence to support them, and levels or grades of evidence varied between guidelines. The quality of most guidelines was adequate. Of the six AGREE II domains, applicability and editorial independence scored the lowest, and scope, purpose and clarity of presentation scored the highest. Conclusions Only one guideline provided comprehensive recommendations for the care of postpartum women and their infants. As well as considering the need for region specific guidelines, further research is needed to strengthen the evidence

  20. Setting Global Standards for Stem Cell Research and Clinical Translation: The 2016 ISSCR Guidelines.

    PubMed

    Daley, George Q; Hyun, Insoo; Apperley, Jane F; Barker, Roger A; Benvenisty, Nissim; Bredenoord, Annelien L; Breuer, Christopher K; Caulfield, Timothy; Cedars, Marcelle I; Frey-Vasconcells, Joyce; Heslop, Helen E; Jin, Ying; Lee, Richard T; McCabe, Christopher; Munsie, Megan; Murry, Charles E; Piantadosi, Steven; Rao, Mahendra; Rooke, Heather M; Sipp, Douglas; Studer, Lorenz; Sugarman, Jeremy; Takahashi, Masayo; Zimmerman, Mark; Kimmelman, Jonathan

    2016-06-14

    The International Society for Stem Cell Research (ISSCR) presents its 2016 Guidelines for Stem Cell Research and Clinical Translation (ISSCR, 2016). The 2016 guidelines reflect the revision and extension of two past sets of guidelines (ISSCR, 2006; ISSCR, 2008) to address new and emerging areas of stem cell discovery and application and evolving ethical, social, and policy challenges. These guidelines provide an integrated set of principles and best practices to drive progress in basic, translational, and clinical research. The guidelines demand rigor, oversight, and transparency in all aspects of practice, providing confidence to practitioners and public alike that stem cell science can proceed efficiently and remain responsive to public and patient interests. Here, we highlight key elements and recommendations in the guidelines and summarize the recommendations and deliberations behind them.

  1. Ministry of Health clinical practice guidelines: Management of Rhinosinusitis and Allergic Rhinitis.

    PubMed

    Siow, J K; Alshaikh, N A; Balakrishnan, A; Chan, K O; Chao, S S; Goh, L G; Hwang, S Y; Lee, C Y; Leong, J L; Lim, L; Menon, A; Sethi, D S; Tan, H; Wang, D Y

    2010-03-01

    The Ministry of Health publishes national clinical practice guidelines to provide doctors and patients in Singapore with evidence-based guidance on managing important medical conditions. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the Ministry of Health clinical practice guidelines on Management of Rhinosinusitis and Allergic Rhinitis, for the information of readers of the Singapore Medical Journal. Chapters, page and figure numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website (http://www.moh.gov.sg/mohcorp/publications.aspx?id=24046). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

  2. Setting Global Standards for Stem Cell Research and Clinical Translation: The 2016 ISSCR Guidelines.

    PubMed

    Daley, George Q; Hyun, Insoo; Apperley, Jane F; Barker, Roger A; Benvenisty, Nissim; Bredenoord, Annelien L; Breuer, Christopher K; Caulfield, Timothy; Cedars, Marcelle I; Frey-Vasconcells, Joyce; Heslop, Helen E; Jin, Ying; Lee, Richard T; McCabe, Christopher; Munsie, Megan; Murry, Charles E; Piantadosi, Steven; Rao, Mahendra; Rooke, Heather M; Sipp, Douglas; Studer, Lorenz; Sugarman, Jeremy; Takahashi, Masayo; Zimmerman, Mark; Kimmelman, Jonathan

    2016-06-14

    The International Society for Stem Cell Research (ISSCR) presents its 2016 Guidelines for Stem Cell Research and Clinical Translation (ISSCR, 2016). The 2016 guidelines reflect the revision and extension of two past sets of guidelines (ISSCR, 2006; ISSCR, 2008) to address new and emerging areas of stem cell discovery and application and evolving ethical, social, and policy challenges. These guidelines provide an integrated set of principles and best practices to drive progress in basic, translational, and clinical research. The guidelines demand rigor, oversight, and transparency in all aspects of practice, providing confidence to practitioners and public alike that stem cell science can proceed efficiently and remain responsive to public and patient interests. Here, we highlight key elements and recommendations in the guidelines and summarize the recommendations and deliberations behind them. PMID:27185282

  3. Uncertain Expertise and the Limitations of Clinical Guidelines in Transgender Healthcare.

    PubMed

    Shuster, Stef M

    2016-09-01

    To alleviate uncertainty in the specialized field of transgender medicine, mental and physical healthcare providers have introduced the rhetoric of evidence-based medicine (EBM) in clinical guidelines to help inform medical decision making. However there are no diagnostic tests to assess the effectiveness of transgender medical interventions and no scientific evidence to support the guidelines. Using in-depth interviews with a purposive sample of 23 healthcare providers, I found that providers invoked two strategies for negotiating the guidelines. Some used the rhetoric of EBM and closely followed clinical guidelines to contain uncertainty. Others flexibly interpreted the guidelines to embrace uncertainty. These findings raise questions about the effectiveness of EBM and guidelines in medical decision making. While trans medicine involves an identity and not a biomedical illness, providers use the same strategies to respond to uncertainty as they may in other medical arenas. PMID:27601408

  4. Guidelines for the Clinical Use of Electronic Mail with Patients

    PubMed Central

    Kane, Beverley; Sands, Daniel Z.

    1998-01-01

    Guidelines regarding patient—provider electronic mail are presented. The intent is to provide guidance concerning computer-based communications between clinicians and patients within a contractual relationship in which the health-care provider has taken on an explicit measure of responsibility for the client's care. The guidelines address two interrelated aspects: effective interaction between the clinician and patient, and observance of medicolegal prudence. Recommendations for site-specific policy formulation are included. PMID:9452989

  5. SEOM clinical guidelines in metastatic breast cancer 2015.

    PubMed

    Gavilá, J; Lopez-Tarruella, S; Saura, C; Muñoz, M; Oliveira, M; De la Cruz-Merino, L; Morales, S; Alvarez, I; Virizuela, J A; Martin, M

    2015-12-01

    Metastatic breast cancer is essentially an incurable disease. However, recent advances have resulted in a significant improvement of overall survival. The SEOM guidelines are intended to make evidence-based recommendations on how to manage patients with metastatic breast cancer to achieve the best patient outcomes based on a rational use of the currently available therapies. To assign a level of certainty and a grade of recommendation the United States Preventive Services Task Force guidelines methodology was selected as reference.

  6. Analysis Treatment Guideline versus Clinical Practice Protocol in Patients Hospitalized due to Heart Failure

    PubMed Central

    Corrêa, Alessandra da Graça; Makdisse, Marcia; Katz, Marcelo; Santana, Thamires Campos; Yokota, Paula Kiyomi Onaga; Galvão, Tatiana de Fatima Gonçalves; Bacal, Fernando

    2016-01-01

    Background Despite the availability of guidelines for treatment of heart failure (HF), only a few studies have assessed how hospitals adhere to the recommended therapies. Objectives Compare the rates of adherence to the prescription of angiotensin-converting enzyme inhibitor or angiotensin II receptor blockers (ACEI/ARB) at hospital discharge, which is considered a quality indicator by the Joint Commission International, and to the prescription of beta-blockers at hospital discharge, which is recommended by national and international guidelines, in a hospital with a case management program to supervise the implementation of a clinical practice protocol (HCP) and another hospital that follows treatment guidelines (HCG). Methods Prospective observational study that evaluated patients consecutively admitted to both hospitals due to decompensated HF between August 1st, 2006, and December 31st, 2008. We used as comparing parameters the prescription rates of beta-blockers and ACEI/ARB at hospital discharge and in-hospital mortality. Results We analyzed 1,052 patients (30% female, mean age 70.6 ± 14.1 years), 381 (36%) of whom were seen at HCG and 781 (64%) at HCP. The prescription rates of beta-blockers at discharge at HCG and HCP were both 69% (p = 0.458), whereas those of ACEI/ARB were 83% and 86%, respectively (p = 0.162). In-hospital mortality rates were 16.5% at HCP and 27.8% at HCG (p < 0.001). Conclusion There was no difference in prescription rates of beta-blocker and ACEI/ARB at hospital discharge between the institutions, but HCP had lower in-hospital mortality. This difference in mortality may be attributed to different clinical characteristics of the patients in both hospitals. PMID:26815461

  7. Development of a theory- and evidence-based intervention to enhance implementation of physical therapy guidelines for the management of low back pain

    PubMed Central

    2014-01-01

    Background Systematic planning could improve the generally moderate effectiveness of interventions to enhance adherence to clinical practice guidelines. The aim of our study was to demonstrate how the process of Intervention Mapping was used to develop an intervention to address the lack of adherence to the national CPG for low back pain by Dutch physical therapists. Methods We systematically developed a program to improve adherence to the Dutch physical therapy guidelines for low back pain. Based on multi-method formative research, we formulated program and change objectives. Selected theory-based methods of change and practical applications were combined into an intervention program. Implementation and evaluation plans were developed. Results Formative research revealed influential determinants for physical therapists and practice quality managers. Self-regulation was appropriate because both the physical therapists and the practice managers needed to monitor current practice and make and implement plans for change. The program stimulated interaction between practice levels by emphasizing collective goal setting. It combined practical applications, such as knowledge transfer and discussion-and-feedback, based on theory-based methods, such as consciousness raising and active learning. The implementation plan incorporated the wider environment. The evaluation plan included an effect and process evaluation. Conclusions Intervention Mapping is a useful framework for formative data in program planning in the field of clinical guideline implementation. However, a decision aid to select determinants of guideline adherence identified in the formative research to analyse the problem may increase the efficiency of the application of the Intervention Mapping process. PMID:24428945

  8. Clinical guidelines and the management of hypertension: a between-practice and guideline comparison.

    PubMed Central

    Fahey, T; Peters, T J

    1997-01-01

    It has previously been demonstrated that individual general practitioners (GPs) diagnose and treat at different levels of blood pressure and according to different risk factor profiles. This study sought to examine the variation in the achievement of control of hypertension in a sample of 20 treated hypertensive patients in 18 UK general practices. There was a marked between-practice variation in the percentage of patients with controlled hypertension. Practices appear to apply different hypertension guidelines to patients consistently, with significant correlations across practices in seven out of ten possible guideline combinations. There remains marked variation in the management of hypertension between different general practices in the UK. Factors other than recommendations in guidelines appear to be responsible for this variation. PMID:9519521

  9. A New Security Paradigm for Anti-Counterfeiting: Guidelines and an Implementation Roadmap

    NASA Astrophysics Data System (ADS)

    Lehtonen, Mikko

    Product counterfeitingand piracy continue to plague brand and trademark owners across industry sectors. This chapter analyses the reasons for ineffectiveness of past technical anti-counterfeitingstrategies and formulates managerial guidelines for effective use of RFID in anti-counterfeiting. An implementation roadmap toward secure authentication of products tagged with EPC Gen-2 tags is proposed and possible supply chain locations for product checks are discussed.

  10. Opinions and perceptions regarding the impact of new regulatory guidelines: A survey in Indian Clinical Trial Investigators

    PubMed Central

    Kadam, Rashmi; Borde, Sanghratna; Madas, Sapna; Nagarkar, Aarti; Salvi, Sundeep; Limaye, Sneha

    2016-01-01

    Background: Clinical research in India experienced dramatic changes with series of stringent guidelines introduced by regulatory authorities. These guidelines posed significant challenges for the clinical trial industry. Objective: To assess the perceptions and opinion of Indian Investigators about the new regulatory guidelines. Methods: We developed a survey questionnaire on recent regulatory guidelines which was hosted on a web portal. Seventy-three investigators from India participated in the survey. Results: Central registration of Ethics Committees (ECs) was agreed by 90.1% participants, 76.8% participants agreed to compensation of subjects for study related Serious Adverse Events (SAE's). The compulsion to include government sites in clinical trials was not agreed by 49.3% participants while 21.2% agreed to it. Restriction on a number of trials per investigator was agreed by 49.3% of participants while 40.9% disagreed. Participants (50.7%) disagreed to the introduction of audio-video (AV) recording of informed consent, 36.6% agreed and 12.7% were neutral. Discussion: Participants observed that post central registration; ECs have improved systems with adequate member composition, functional Standard Operating Procedures, and timely approvals. Participants agreed that compensation of study related SAE's would assure subject protection and safety. The introduction of AV consenting was strongly debated sighting sociocultural issues in the implementation of the same. Conclusion: Participants endorsed guidelines pertaining to the central registration of ECs, SAE related compensation. Restrictions on a number of trials per investigator and AV consenting were debated ardently. The response of the survey participants who are clinical trial investigators in India showed general acceptance, effectiveness and anticipated compliance to the new regulatory guidelines. PMID:27141474

  11. [Clinical practice guidelines for systemic lupus erythematosus: Recommendations for general clinical management].

    PubMed

    Trujillo-Martín, María M; Rúa-Figueroa Fernández de Larrinoa, Iñigo; Ruíz-Irastorza, Guillermo; Pego-Reigosa, José María; Sabio Sánchez, José Mario; Serrano-Aguilar, Pedro

    2016-05-01

    Systemic lupus erythematosus (SLE) is a complex rheumatic multisystemic disease of autoimmune origin with significant potential morbidity and mortality. It is one of the most common autoimmune diseases with an estimated prevalence of 20-150 cases per 100,000 inhabitants. The clinical spectrum of SLE is wide and variable both in clinical manifestations and severity. This prompted the Spanish Ministry of Health, Social Services and Equality to promote and fund the development of a clinical practice guideline (CPG) for the clinical care of SLE patients within the Programme of CPG in the National Health System which coordinates GuiaSalud. This CPG is is intended as the reference tool in the Spanish National Health System in order to support the comprehensive clinical management of people with SLE by all health professionals involved, regardless of specialty and level of care, helping to standardize and improve the quality of clinical decisions in our context in order to improve the health outcomes of the people affected. The purpose of this document is to present and discuss the rationale of the recommendations on the general management of SLE, specifically, clinical follow-up, general therapeutic approach, healthy lifestyles, photoprotection, and training programmes for patients. These recommendations are based on the best available scientific evidence, on discussion and the consensus of expert groups. PMID:26975887

  12. [Clinical practice guidelines for systemic lupus erythematosus: Recommendations for general clinical management].

    PubMed

    Trujillo-Martín, María M; Rúa-Figueroa Fernández de Larrinoa, Iñigo; Ruíz-Irastorza, Guillermo; Pego-Reigosa, José María; Sabio Sánchez, José Mario; Serrano-Aguilar, Pedro

    2016-05-01

    Systemic lupus erythematosus (SLE) is a complex rheumatic multisystemic disease of autoimmune origin with significant potential morbidity and mortality. It is one of the most common autoimmune diseases with an estimated prevalence of 20-150 cases per 100,000 inhabitants. The clinical spectrum of SLE is wide and variable both in clinical manifestations and severity. This prompted the Spanish Ministry of Health, Social Services and Equality to promote and fund the development of a clinical practice guideline (CPG) for the clinical care of SLE patients within the Programme of CPG in the National Health System which coordinates GuiaSalud. This CPG is is intended as the reference tool in the Spanish National Health System in order to support the comprehensive clinical management of people with SLE by all health professionals involved, regardless of specialty and level of care, helping to standardize and improve the quality of clinical decisions in our context in order to improve the health outcomes of the people affected. The purpose of this document is to present and discuss the rationale of the recommendations on the general management of SLE, specifically, clinical follow-up, general therapeutic approach, healthy lifestyles, photoprotection, and training programmes for patients. These recommendations are based on the best available scientific evidence, on discussion and the consensus of expert groups.

  13. Staff experiences in implementing guidelines for Kangaroo Mother Care--a qualitative study.

    PubMed

    Wallin, Lars; Rudberg, Agneta; Gunningberg, Lena

    2005-01-01

    The aim of this study was to investigate staff experiences in implementing guidelines for Kangaroo Mother Care in neonatal care. The study was part of a randomized controlled trial, the overall goal of which was to assess the impact of external facilitation. A total of eight focus group interviews were held at two intervention and two control units. The establishment of a change team to implement the guideline resulted in activities that impacted staff behaviour, which in turn was perceived to influence patients' well-being. The guideline and contextual factors, such as leadership and staff colleagues' attitudes, were of significant importance in that process. The study intervention--facilitation--promoted implementation activities and was highly appreciated by the change teams. However, reviewing the development of events at one of the control units, the provided facilitation appeared to be no more effective than an improvement-focused organizational culture in which the nurse manager was actively involved in the change process. Overall, learning and behaviour change seemed to be a social phenomenon, something that greatly benefited from people's interaction with one another.

  14. Clinical guidelines of non-alcoholic fatty liver disease: A systematic review

    PubMed Central

    Zhu, Jin-Zhou; Hollis-Hansen, Kelseanna; Wan, Xing-Yong; Fei, Su-Juan; Pang, Xun-Lei; Meng, Fan-Dong; Yu, Chao-Hui; Li, You-Ming

    2016-01-01

    AIM To perform a systematic review to grade guidelines and present recommendations for clinical management of non-alcoholic fatty liver disease (NAFLD). METHODS A database search was conducted on PubMed for guidelines published before May 2016, supplemented by reviewing relevant websites. The Appraisal of Guidelines for Research and Evaluation (ARGEE) Instrument II was a tool designed to appraise the methodological rigor and transparency in which a clinical guideline is developed and it is used internationally. It was used to appraise the quality of guidelines in this study. The inclusion criteria include: clinical NAFLD guidelines for adults, published in English, and released by governmental agencies or key organizations. RESULTS Eleven guidelines were included in this study. Since 2007, guidelines have been released in Asia (3 in China, 1 in South Korea, and 1 in Japan), Europe (1 in Italy), America (1 in United States and 1 in Chile) and three international agencies [European associations joint, Asia-Pacific Working Party and World Gastroenterology Organization (WGO)]. Using the ARGEE II instrument, we found US 2012 and Europe 2016 had the highest scores, especially in the areas of rigor of development and applicability. Additionally, Italy 2010 and Korea 2013 also presented comprehensive content, rigorous procedures and good applicability. And WGO 2014 offered various algorithms for clinical practice. Lastly, a practical algorithm for the clinical management was developed, based on the recommended guidelines. CONCLUSION This is the first systematic review of NAFLD guidelines. It may yield insights for physicians and policy-makers in the development and application of guidelines.

  15. Clinical guidelines of non-alcoholic fatty liver disease: A systematic review

    PubMed Central

    Zhu, Jin-Zhou; Hollis-Hansen, Kelseanna; Wan, Xing-Yong; Fei, Su-Juan; Pang, Xun-Lei; Meng, Fan-Dong; Yu, Chao-Hui; Li, You-Ming

    2016-01-01

    AIM To perform a systematic review to grade guidelines and present recommendations for clinical management of non-alcoholic fatty liver disease (NAFLD). METHODS A database search was conducted on PubMed for guidelines published before May 2016, supplemented by reviewing relevant websites. The Appraisal of Guidelines for Research and Evaluation (ARGEE) Instrument II was a tool designed to appraise the methodological rigor and transparency in which a clinical guideline is developed and it is used internationally. It was used to appraise the quality of guidelines in this study. The inclusion criteria include: clinical NAFLD guidelines for adults, published in English, and released by governmental agencies or key organizations. RESULTS Eleven guidelines were included in this study. Since 2007, guidelines have been released in Asia (3 in China, 1 in South Korea, and 1 in Japan), Europe (1 in Italy), America (1 in United States and 1 in Chile) and three international agencies [European associations joint, Asia-Pacific Working Party and World Gastroenterology Organization (WGO)]. Using the ARGEE II instrument, we found US 2012 and Europe 2016 had the highest scores, especially in the areas of rigor of development and applicability. Additionally, Italy 2010 and Korea 2013 also presented comprehensive content, rigorous procedures and good applicability. And WGO 2014 offered various algorithms for clinical practice. Lastly, a practical algorithm for the clinical management was developed, based on the recommended guidelines. CONCLUSION This is the first systematic review of NAFLD guidelines. It may yield insights for physicians and policy-makers in the development and application of guidelines. PMID:27688665

  16. Guidelines for Implementing Advanced Distribution Management Systems-Requirements for DMS Integration with DERMS and Microgrids

    SciTech Connect

    Wang, Jianhui; Chen, Chen; Lu, Xiaonan

    2015-08-01

    This guideline focuses on the integration of DMS with DERMS and microgrids connected to the distribution grid by defining generic and fundamental design and implementation principles and strategies. It starts by addressing the current status, objectives, and core functionalities of each system, and then discusses the new challenges and the common principles of DMS design and implementation for integration with DERMS and microgrids to realize enhanced grid operation reliability and quality power delivery to consumers while also achieving the maximum energy economics from the DER and microgrid connections.

  17. School Based Health Clinics: A Guide to Implementing Programs.

    ERIC Educational Resources Information Center

    Hadley, Elaine M.; And Others

    Extensive guidelines for the development of a comprehensive school-based health clinic at the middle, junior, or senior high school levels are presented. School-based clinics usually provide the primary health care services needed by adolescents: health maintenance examinations and assessments; diagnosis and treatment of acute and chronic…

  18. A UML approach to process modelling of clinical practice guidelines for enactment.

    PubMed

    Knape, T; Hederman, L; Wade, V P; Gargan, M; Harris, C; Rahman, Y

    2003-01-01

    Although clinical practice guidelines (CPGs) have been suggested as a means of encapsulating best practice in evidence-based medical treatment, their usage in clinical environments has been disappointing. Criticisms of guideline representations have been that they are predominantly narrative and are difficult to incorporate into clinical information systems. This paper analyses the use of UML process modelling techniques for guideline representation and proposes the automated generation of executable guidelines using XMI. This hybrid UML-XMI approach provides flexible authoring of guideline decision and control structures whilst integrating appropriate data flow. It also uses an open XMI standard interface to allow the use of authoring tools and process control systems from multiple vendors. The paper first surveys CPG modelling formalisms followed by a brief introduction to process modelling in UMI. Furthermore, the modelling of CPGs in UML is presented leading to a case study of encoding a diabetes mellitus CPG using UML.

  19. Assessing Language Competence: Guidelines for Assisting Persons with Limited English Proficiency in Research and Clinical Settings.

    ERIC Educational Resources Information Center

    Acevedo, Marcela C.; Reyes, Carla J.; Annett, Robert D.; Lopez, Edith M.

    2003-01-01

    Current guidelines indicate that therapeutic interactions must be in the client's primary language. This article addresses the ethical dilemmas faced by monolingual clinicians and researchers who must assess the foreign language competence of an interpreter. Guidelines are proposed for assessing language competence of staff in clinical and…

  20. Opinion leaders vs audit and feedback to implement practice guidelines. Delivery after previous cesarean section.

    PubMed

    Lomas, J; Enkin, M; Anderson, G M; Hannah, W J; Vayda, E; Singer, J

    1991-05-01

    A randomized controlled trial with 76 physicians in 16 community hospitals evaluated audit and feedback and local opinion leader education as methods of encouraging compliance with a guideline for the management of women with a previous cesarean section. The guideline recommended clinical actions to increase trial of labor and vaginal birth rates. Charts for all 3552 cases in the study groups were audited. After 24 months the trial of labor and vaginal birth rates in the audit and feedback group were no different from those in the control group, but rates were 46% and 85% higher, respectively, among physicians educated by an opinion leader. Duration of hospital stay was lower in the opinion leader education group than in the other two groups. The overall cesarean section rate was reduced only in the opinion leader education group. There were no adverse clinical outcomes attributable to the interventions. The use of opinion leaders improved the quality of care. PMID:2013952

  1. From clinical requirement to personalized wellness decision support: a data-driven framework for computer-supported guideline refinement.

    PubMed

    Hsueh, Pei-Yun; Lan, Ci-Wei; Deng, Vincent; Zhu, Xinxin

    2012-01-01

    Personalized wellness decision support has gained significant attention, owing to the shift to a patient-centric paradigm in healthcare domains, and the consequent availability of a wealth of patient-related data. Despite the success of data-driven analytics in improving practice outcome, there is a gap towards their deployment in guideline-based practice. In this paper we report on findings related to computer-supported guideline refinement, which maps a patient's guideline requirements to personalized recommendations that suit the patient's current context. In particular, we present a novel data-driven personalization framework, casting the mapping task as a statistical decision problem in search of a solution to maximize expected utility. The proposed framework is well suited to produce personalized recommendations based on not only clinical factors but contextual factors that reflect individual differences in non-clinical settings. We then describe its implementation within the guideline-based clinical decision support system and discuss opportunities and challenges looking forward. PMID:22874232

  2. From clinical requirement to personalized wellness decision support: a data-driven framework for computer-supported guideline refinement.

    PubMed

    Hsueh, Pei-Yun; Lan, Ci-Wei; Deng, Vincent; Zhu, Xinxin

    2012-01-01

    Personalized wellness decision support has gained significant attention, owing to the shift to a patient-centric paradigm in healthcare domains, and the consequent availability of a wealth of patient-related data. Despite the success of data-driven analytics in improving practice outcome, there is a gap towards their deployment in guideline-based practice. In this paper we report on findings related to computer-supported guideline refinement, which maps a patient's guideline requirements to personalized recommendations that suit the patient's current context. In particular, we present a novel data-driven personalization framework, casting the mapping task as a statistical decision problem in search of a solution to maximize expected utility. The proposed framework is well suited to produce personalized recommendations based on not only clinical factors but contextual factors that reflect individual differences in non-clinical settings. We then describe its implementation within the guideline-based clinical decision support system and discuss opportunities and challenges looking forward.

  3. Developing knowledge resources to support precision medicine: principles from the Clinical Pharmacogenetics Implementation Consortium (CPIC).

    PubMed

    Hoffman, James M; Dunnenberger, Henry M; Kevin Hicks, J; Caudle, Kelly E; Whirl Carrillo, Michelle; Freimuth, Robert R; Williams, Marc S; Klein, Teri E; Peterson, Josh F

    2016-07-01

    To move beyond a select few genes/drugs, the successful adoption of pharmacogenomics into routine clinical care requires a curated and machine-readable database of pharmacogenomic knowledge suitable for use in an electronic health record (EHR) with clinical decision support (CDS). Recognizing that EHR vendors do not yet provide a standard set of CDS functions for pharmacogenetics, the Clinical Pharmacogenetics Implementation Consortium (CPIC) Informatics Working Group is developing and systematically incorporating a set of EHR-agnostic implementation resources into all CPIC guidelines. These resources illustrate how to integrate pharmacogenomic test results in clinical information systems with CDS to facilitate the use of patient genomic data at the point of care. Based on our collective experience creating existing CPIC resources and implementing pharmacogenomics at our practice sites, we outline principles to define the key features of future knowledge bases and discuss the importance of these knowledge resources for pharmacogenomics and ultimately precision medicine.

  4. Implementation of asthma guidelines to West Australian community pharmacies: an exploratory, quasi-experimental study

    PubMed Central

    Trevenen, Michelle; Murray, Kevin; Kendall, Peter A; Schneider, Carl R; Clifford, Rhonda

    2016-01-01

    Objectives Pharmacy assistants are often the first point of contact for patients presenting in community pharmacies. The current role of pharmacy assistants in the supply of asthma-reliever medications (short-acting β-agonists) was identified as a barrier to appropriate guideline-based care. The aim of this research was to devise and evaluate a team-based intervention to formalise the role of pharmacy assistants and to improve asthma guideline-based care in community pharmacy. Design A controlled pre-post intervention study was conducted in 336 metropolitan pharmacies located in Perth, Western Australia. Pharmacies were stratified into 2 groups (187 intervention and 149 control) based on known confounders for asthma control. The intervention was designed using a common-sense approach and resources developed included a checklist, videos and web page. Delivery was via workshops (25 pharmacies) or academic detailing (162 pharmacies). Pharmacy practice was assessed preintervention and postintervention via covert simulated patient methodology. Primary outcome measures included patient medical referral, device use demonstration and counselling, internal referral and/or direct involvement of a pharmacist in consultations. Results There was a significant increase in patient medical referral in intervention pharmacies from 32% to 47% (p=0.0007) from preintervention to postintervention, while control pharmacies showed a non-significant decrease from 50% to 44% (p=0.22). Device counselling was not routinely carried out at any stage or in any cohort of this research and no significant changes in internal referral were observed. Conclusions Increases in medical referral indicate that asthma guideline compliance can be improved in community pharmacy if implementation employs a team-based approach and involves pharmacy assistants. However, results were variable and the intervention did not improve practice related to device counselling or internal referral/pharmacist involvement

  5. Implementation of national guidelines for the prevention and treatment of overweight and obesity in children and adolescents: a phenomenographic analysis of public health nurses’ perceptions

    PubMed Central

    Nordstrand, Aina; Fridlund, Bengt; Sollesnes, Ragnhild

    2016-01-01

    Objective To explore and describe how public health nurses (PHNs) perceive the implementation of national guidelines for the prevention and treatment of overweight and obesity among children and adolescents in well-baby clinics and school health services. Design, sample, and measurements An explorative descriptive design was carried out through individual interviews with 18 PHNs and analysed according to the phenomenographic tradition. Results Four implementation strategies were described and assigned a metaphor: the structured PHN, pragmatic PHN, critical PHN, and the resigned PHN. Competence, patient receptiveness, internal consensus, interdisciplinary collaboration, resources, and organizational embedding were the determinants identified that most frequently affect implementation, and these determinants were distributed at different levels of the organization. The extent of facilitation seemed to determine which implementation strategy would be used. Conclusions How PHNs implemented the guidelines for overweight and obesity were affected by determinants at different organizational levels. Contextual facilitation of implementation seemed better in larger organizations, but factors such as leadership, drive, and experience compensated in smaller municipalities. The implementation of guidelines was hindered when the barriers exceeded the benefits. PMID:27543411

  6. Implementation of surveillance of invasive mosquitoes in Belgium according to the ECDC guidelines

    PubMed Central

    2014-01-01

    Background In 2012, the new guidelines for the surveillance of IMS in Europe, produced by the European Centre for Disease Prevention and Control (ECDC), were tested in Belgium. This study aimed at (1) testing the usefulness and applicability in the field of the ECDC guidelines for the surveillance of IMS in Europe and (2) surveying IMS throughout Belgium. Methods First, the scenarios, which Belgium is facing, were identified according to the ECDC guidelines. Second, the surveillance strategy and the methods were identified based on the guidelines and adjusted to the Belgium context. Two areas colonised by IMS and 20 potential points of entry (PoE) were selected. Mosquito Magnet Liberty Plus (CO2-baited) traps (23) and oviposition traps (147) were set-up, and larval sampling was performed monthly or bi-monthly from July till October 2012. Finally, the costs and workload of the surveillance activities were compared to the estimates provided by the ECDC guidelines. Results Surveillance at 20 potential PoE (complying with scenario 1) revealed that no new IMS were established in Belgium. Surveillance at two sites colonised by IMS (scenario 2) indicated that although control measures have drastically reduced the Ae. j. japonicus population this species is still present. Furthermore, Ae. koreicus is permanently established. For both scenarios, the problems encountered are discussed and recommendations are given. In addition, the actual workload was lower than the estimated workload, while the actual costs were higher than the estimated ones. Conclusions The ECDC guidelines are helpful, applicable and efficient to implement surveillance of IMS in Belgium. Recommendations were customised to the local context (political demands, salary and investment costs, and existing expertise). The workload and costs related to the preparatory phase (i.e., planning, contacts with the PoE, writing a protocol) were found to be missing in the cost evaluation suggested in the guidelines

  7. Sunscreen compliance with regional clinical practice guidelines and product labeling standards in New Zealand.

    PubMed

    Sporer, Matthias E; Mathy, Joanna E; Kenealy, John; Mathy, Jon A

    2016-03-01

    INTRODUCTION For general practitioners, practice nurses and community pharmacists in New Zealand, a core duty is to educate patients about sun protection. We aimed to evaluate compliance of locally available sunscreens with regional clinical practice guidelines and sunscreen labelling standards, to assist clinicians in advising consumers on sunscreen selection. METHODS We audited all sunscreens available at two Auckland stores for three New Zealand sunscreen retailers. We then assessed compliance with accepted regional clinical practice guidelines for sun protection from the New Zealand Guidelines Group. We further assessed compliance with regional Australia/New Zealand consumer standards for sunscreen labelling. RESULTS All sunscreens satisfied clinical guidelines for broad-spectrum protection, and 99% of sunscreens met or exceeded clinical guidelines for minimal Sun Protection Factor. Compliance with regional standardized labelling guidelines is voluntary in New Zealand and 27% of audited sunscreens were not fully compliant with SPF labelling standards. DISCUSSION Sunscreens were generally compliant with clinical guidelines for minimal sun protection. However there was substantial noncompliance with regional recommendations for standardized sunscreen labelling. Primary health care clinicians should be aware that this labelling noncompliance may mislead patients into thinking some sunscreens offer more sun protection than they do. Mandatory compliance with the latest regional labelling standards would simplify sunscreen selection by New Zealand consumers. KEYWORDS Sunscreen; Sun Protection Factor; SPF; Skin Neoplasms; Melanoma; Skin Cancer Prevention. PMID:27477372

  8. Effectiveness of implementation strategies in improving physician adherence to guideline recommendations in heart failure: a systematic review protocol

    PubMed Central

    Van Spall, Harriette G C; Shanbhag, Deepti; Gabizon, Itzhak; Ibrahim, Quazi; Graham, Ian D; Harlos, Karen; Haynes, R Brian; Connolly, Stuart J

    2016-01-01

    Introduction The uptake of Clinical Practice Guideline (CPG) recommendations that improve outcomes in heart failure (HF) remains suboptimal. We will conduct a systematic review to identify implementation strategies that improve physician adherence to class I recommendations, those with clear evidence that benefits outweigh the risks. We will use American, Canadian and European HF guidelines as our reference. Methods and analysis We will conduct a literature search in the databases of MEDLINE, EMBASE, HEALTHSTAR, CINAHL, Cochrane Library, Campbell Collaboration, Joanna Briggs Institute Evidence Based Practice, Centre for Reviews and Dissemination and Evidence Based Practice Centres. We will include prospective studies evaluating implementation interventions aimed at improving uptake of class I CPG recommendations in HF. We will extract data in duplicate. We will classify interventions according to their level of application (ie, provider, organisation, systems level) and common underlying characteristics (eg, education, decision-support, financial incentives) using the Cochrane Effective Practice and Organisation of Care Taxonomy. We will assess the impact of the intervention on adherence to the CPGs. Outcomes will include proportion of eligible patients who were: prescribed a CPG-recommended pharmacological treatment; referred for device consideration; provided self-care education at discharge; and provided left ventricular function assessment. We will include clinical outcomes such as hospitalisations, readmissions and mortality, if data is available. We will identify the common elements of successful and failing interventions, and examine the context in which they were applied, using the Process Redesign contextual framework. We will synthesise the results narratively and, if appropriate, will pool results for meta-analysis. Discussion and dissemination In this review, we will assess the impact of implementation strategies and contextual factors on physician

  9. The Use of Systematic Reviews and Reporting Guidelines to Advance the Implementation of the 3Rs

    PubMed Central

    Avey, Marc T; Fenwick, Nicole; Griffin, Gilly

    2015-01-01

    In 1959, Russell and Burch published The Principles of Humane Experimental Technique, which included concrete advice on factors that they considered would govern progress in the implementation of these principles (enunciated as the 3Rs [Replacement, Reduction, and Refinement in animal-based studies]). One challenge to the implementation of the 3Rs was identified as information retrieval. Here, we further explore this challenge—the need for ‘research on research’—and the role that systematic reviews and reporting guidelines can play in implementation of the 3Rs. First, we examine the 2-fold nature of the challenge of information retrieval: 1) the identification of relevant publications spread throughout a large population of nonrelevant publications and 2) the incomplete reporting of relevant details within those publications. Second, we evaluate how systematic reviews and reporting guidelines can be used generally to address this challenge. Third, we assess the explicit reporting of the 3Rs in a cohort of preclinical animal systematic reviews. Our results show that Reduction methods are the most commonly reported by authors of systematic reviews but that, in general, reporting on how findings relate to the 3Rs is limited at best. Although systematic reviews are excellent tools for resolving the challenge of information retrieval, their utility for making progress in implementation of the 3Rs may be limited unless authors improve their reporting of these principles. PMID:25836961

  10. The use of systematic reviews and reporting guidelines to advance the implementation of the 3Rs.

    PubMed

    Avey, Marc T; Fenwick, Nicole; Griffin, Gilly

    2015-03-01

    In 1959, Russell and Burch published The Principles of Humane Experimental Technique, which included concrete advice on factors that they considered would govern progress in the implementation of these principles (enunciated as the 3Rs [Replacement, Reduction, and Refinement in animal-based studies]). One challenge to the implementation of the 3Rs was identified as information retrieval. Here, we further explore this challenge-the need for 'research on research'-and the role that systematic reviews and reporting guidelines can play in implementation of the 3Rs. First, we examine the 2-fold nature of the challenge of information retrieval: 1) the identification of relevant publications spread throughout a large population of nonrelevant publications and 2) the incomplete reporting of relevant details within those publications. Second, we evaluate how systematic reviews and reporting guidelines can be used generally to address this challenge. Third, we assess the explicit reporting of the 3Rs in a cohort of preclinical animal systematic reviews. Our results show that Reduction methods are the most commonly reported by authors of systematic reviews but that, in general, reporting on how findings relate to the 3Rs is limited at best. Although systematic reviews are excellent tools for resolving the challenge of information retrieval, their utility for making progress in implementation of the 3Rs may be limited unless authors improve their reporting of these principles. PMID:25836961

  11. Recent clinical management of antithrombotic agents for gastrointestinal endoscopy after revision of guidelines in Japan.

    PubMed

    Ono, Satoshi; Fujishiro, Mitsuhiro; Ikeda, Yuichi; Komuro, Issei; Koike, Kazuhiko

    2015-09-01

    In 2012, the Japan Gastroenterological Endoscopy Society (JGES) revised guidelines for the management of gastrointestinal endoscopy for patients using antithrombotic agents. The conventional guidelines emphasized reducing the bleeding risk that accompanies gastrointestinal endoscopy, but the present guidelines prioritize reduction of thromboembolism risk during discontinuation of antithrombotic agents, which is consistent with Western guidelines. When the advantages outweigh the disadvantages, the guidelines permit endoscopic biopsy and high-bleeding-risk procedures without discontinuation of selected antithrombotic agents. These guidelines created a paradigm shift that has slowly, but surely, changed clinical daily practice in Japan. As a result, endoscopic biopsy without discontinuation of antithrombotic agents has been widely accepted, although solid evidence for its support is still lacking. Additionally, feasibility of high-bleeding-risk procedures without discontinuation of selected antithrombotic agents is also controversial because evidence newly acquired after publication of the present guidelines is low in evidence level. Consequently, clinical studies with a high evidence level, including randomized controlled studies, are mandatory to establish reliable upcoming guidelines. At the same time, under the present guidelines, the accomplishment of such studies in Japan is expected.

  12. Manual for implementing residual radioactive material guidelines using RESRAD, Version 5.0

    SciTech Connect

    Yu, C.; Zielen, A.J.; Cheng, J.J.

    1993-09-01

    This manual presents information for implementing US Department of Energy (DOE) guidelines for residual radioactive material. It describes the analysis and models used to derive site-specific guidelines for allowable residual concentrations of radionuclides in soil and the design and use of the RESRAD computer code for calculating doses, risks, and guideline values. It also describes procedures for implementing DOE policy for reducing residual radioactivity to levels that are as low as reasonably achievable. Two new pathways, radon inhalation and soil ingestion, have been added to RESRAD. Twenty-seven new radionuclides have also been added, and the cutoff half-life for associated radionuclides has been reduced to six months. Other major improvements to the RESRAD code include the ability to run sensitivity analyses, the addition of graphical output, user-specified dose factors, updated databases, an improved groundwater transport model, optional input of a groundwater concentration and a solubility constant, special models for tritium and carbon-14, calculation of cancer incidence risk, and the use of a mouse with menus.

  13. Saudi Oncology Society clinical management guidelines for urinary bladder cancer

    PubMed Central

    Al Othman, Khaled; Bazarbashi, Shouki; Balaraj, Khalid; Al Otaibi, Mohamed; Kamal, Baher; Al Oraifi, Ibraheem; Al Saeed, Eyad; Al Gamdi, Khalid; Jubran, Ali; Salah, Ahmad; Al Shareef, Jalal; Zekri, Jamal

    2011-01-01

    In this report guidelines for the evaluation, medical and surgical management of transitional cell carcinoma of urinary bladder is presented. It is categorized according to the stage of the disease using the tumor node metastasis staging system, 7th edition. The recommendations are presented with supporting level of evidence. PMID:21673850

  14. SEOM clinical guidelines in early-stage breast cancer 2015.

    PubMed

    Garcia-Saenz, J A; Bermejo, B; Estevez, L G; Palomo, A G; Gonzalez-Farre, X; Margeli, M; Pernas, S; Servitja, S; Rodriguez, C A; Ciruelos, E

    2015-12-01

    Breast cancer is a major public health problem. Despite remarkable advances in early diagnosis and treatment, one in three women may have metastases since diagnosis. Better understanding of prognostic and predictive factors allows us to select the most appropriate adjuvant therapy in each patient. In these guidelines, we summarize current evidence for the medical management of early-stage breast cancer.

  15. Effectiveness of an implementation strategy for a breastfeeding guideline in Primary Care: cluster randomised trial

    PubMed Central

    2011-01-01

    Background The protection and promotion of breastfeeding is considered a priority in Europe where only 22% of infants less than 6 months old are exclusively breastfed. In Spain this percentage reaches 24.8% but in our city it falls to 18.26%. Various studies emphasise that the improvement of these results should be based upon the training of health professionals. Following the recommendations of a breastfeeding guide can modify the practice of health professionals and improve results with respect to exclusively or predominatly breastfed children at 6 months of age. Method/Design This study involves a community based cluster randomized trial in primary healthcare centres in Leganés (Madrid, Spain). The project aims to determine whether the use of an implementation strategy (including training session, information distribution, opinion leader) of a breastfeeding guideline in primary care is more effective than usual diffusion. The number of patients required will be 240 (120 in each arm). It will be included all the mothers of infants born during the study period (6 months) who come to the health centre on the first visit of the child care programme and who give their consent to participate. The main outcome variable is the exclusive o predominant breastfeeding at 6 moths of age.. Main effectiveness will be analyzed by comparing the percentage of infants with exclusive or predominant breastfeeding at 6 months between the intervention group and the control group. All statistical tests will be performed with intention to treat. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. Discussion Strategies need to be found which facilitate the giving of effective advice on breastfeeding by professionals and which provide support to women during the breastfeeding period. By applying the guide's recommendations, clinical

  16. Clinical Guidelines: A NICE Way to Introduce Cost-Effectiveness Considerations?

    PubMed

    Drummond, Michael

    2016-01-01

    The National Institute for Health and Care Excellence (NICE) in the United Kingdom initiated its clinical guidelines program in 2001 and more than 200 guidelines have been produced to date. As with most of NICE's other programs, the clinical guidelines program also must take into account the relative costs and benefits of interventions when deciding whether to recommend them. The three main advantages of the program are that 1) it represents an important collaboration with the medical profession, thereby increasing the likelihood of recommendations being adopted; 2) the guidelines provide an opportunity to review all aspects of the clinical pathway, rather than focusing on only the adoption of a new technology; and 3) the guidelines offer the potential to discuss disinvestment as well as new investment. All the guidelines contain a systematic review of the relevant economic evaluation literature, and the 12 guidelines published from January 1 to August 31, 2015, contain 28 de novo economic analyses. The main challenges encountered in the guidelines program are that 1) there is an inevitable tension in advising on the quality of care that individual patients could expect while recognizing the broader public health objectives of equity, fairness, and efficiency; 2) the impact of economics is sometimes lessened because of the lack of time to conduct de novo analyses; and 3) unlike NICE's technology appraisal program, the adoption of recommendations is not mandatory for the UK National Health Service. PMID:27565268

  17. Syntactic parsing of clinical text: guideline and corpus development with handling ill-formed sentences

    PubMed Central

    Fan, Jung-wei; Yang, Elly W; Jiang, Min; Prasad, Rashmi; Loomis, Richard M; Zisook, Daniel S; Denny, Josh C; Xu, Hua; Huang, Yang

    2013-01-01

    Objective To develop, evaluate, and share: (1) syntactic parsing guidelines for clinical text, with a new approach to handling ill-formed sentences; and (2) a clinical Treebank annotated according to the guidelines. To document the process and findings for readers with similar interest. Methods Using random samples from a shared natural language processing challenge dataset, we developed a handbook of domain-customized syntactic parsing guidelines based on iterative annotation and adjudication between two institutions. Special considerations were incorporated into the guidelines for handling ill-formed sentences, which are common in clinical text. Intra- and inter-annotator agreement rates were used to evaluate consistency in following the guidelines. Quantitative and qualitative properties of the annotated Treebank, as well as its use to retrain a statistical parser, were reported. Results A supplement to the Penn Treebank II guidelines was developed for annotating clinical sentences. After three iterations of annotation and adjudication on 450 sentences, the annotators reached an F-measure agreement rate of 0.930 (while intra-annotator rate was 0.948) on a final independent set. A total of 1100 sentences from progress notes were annotated that demonstrated domain-specific linguistic features. A statistical parser retrained with combined general English (mainly news text) annotations and our annotations achieved an accuracy of 0.811 (higher than models trained purely with either general or clinical sentences alone). Both the guidelines and syntactic annotations are made available at https://sourceforge.net/projects/medicaltreebank. Conclusions We developed guidelines for parsing clinical text and annotated a corpus accordingly. The high intra- and inter-annotator agreement rates showed decent consistency in following the guidelines. The corpus was shown to be useful in retraining a statistical parser that achieved moderate accuracy. PMID:23907286

  18. A Systematic Review of Recent Clinical Practice Guidelines on the Diagnosis, Assessment and Management of Hypertension

    PubMed Central

    Al-Ansary, Lubna A.; Tricco, Andrea C.; Adi, Yaser; Bawazeer, Ghada; Perrier, Laure; Al-Ghonaim, Mohammed; AlYousefi, Nada; Tashkandi, Mariam; Straus, Sharon E.

    2013-01-01

    Background Despite the availability of clinical practice guidelines (CPGs), optimal hypertension control is not achieved in many parts of the world; one of the challenges is the volume of guidelines on this topic and their variable quality. To systematically review the quality, methodology, and consistency of recommendations of recently-developed national CPGs on the diagnosis, assessment and the management of hypertension. Methodology/Principal Findings MEDLINE, EMBASE, guidelines' websites and Google were searched for CPGs written in English on the general management of hypertension in any clinical setting published between January 2006 and September 2011. Four raters independently appraised each CPG using the AGREE-II instrument and 2 reviewers independently extracted the data. Conflicts were resolved by discussion or the involvement of an additional reviewer. Eleven CPGs were identified. The overall quality ranged from 2.5 to 6 out of 7 on the AGREE-II tool. The highest scores were for “clarity of presentation” (44.4% −88.9%) and the lowest were for “rigour of development” (8.3%–30% for 9 CGPs). None of them clearly reported being newly developed or adapted. Only one reported having a patient representative in its development team. Systematic reviews were not consistently used and only 2 up-to-date Cochrane reviews were cited. Two CPGs graded some recommendations and related that to levels (but not quality) of evidence. The CPGs' recommendations on assessment and non-pharmacological management were fairly consistent. Guidelines varied in the selection of first-line treatment, adjustment of therapy and drug combinations. Important specific aspects of care (e.g. resistant hypertension) were ignored by 6/11 CPGs. The CPGs varied in methodological quality, suggesting that their implementation might not result in less variation of care or in better health-related outcomes. Conclusions/Significance More efforts are needed to promote the realistic approach

  19. [Draft of guidelines for human body dissection for clinical anatomy education and research and commentary].

    PubMed

    Shichinohe, Toshiaki; Kondo, Satoshi; Ide, Chizuka; Higuchi, Norio; Aiso, Sadakazu; Sakai, Tatsuo; Matsumura, George; Yoshida, Kazunari; Kobayashi, Eiji; Tatsumi, Haruyuki; Yaginuma, Hiroyuki; Hishikawa, Shuji; Sugimoto, Maki; Izawa, Yoshimitsu; Imanishi, Nobuaki

    2011-06-01

    This article analyses the Draft of Guidelines for Human Body Dissection for Clinical Anatomy Education and Research drawn by the Study Group for Future Training Systems of Surgical Skills and Procedures established by the Fiscal Year 2010 research program of the Ministry of Health, Labor and Welfare. The purpose of the Draft of Guidelines is: First, to lay out the required basic guidelines for human cadaver usage to allow medical and dental faculty to conduct clinical education and research in accordance with existing regulations. Second, the guidelines are expected to give physicians a regulatory framework to carry out cadaver training in accordance with the current legal framework. This article explains the Draft of Guidelines in detail, outlines the future of cadaver training, and describes issues which must still be solved.

  20. [Draft of Guidelines for Human Body Dissection for Clinical Anatomy Education and Research and commentary].

    PubMed

    Shichinohe, Toshiaki; Kondo, Satoshi; Ide, Chizuka; Higuchi, Norio; Aiso, Sadakazu; Sakai, Tatsuo; Matsumura, George; Yoshida, Kazunari; Kobayashi, Eiji; Tatsumi, Haruyuki; Yaginuma, Hiroyuki; Hishikawa, Shuji; Sugimoto, Maki; Izawa, Yoshimitsu; Imanishi, Nobuaki

    2011-07-01

    This article analyses the Draft of Guidelines for Human Body Dissection for Clinical Anatomy Education and Research drawn by the Study Group for Future Training Systems of Surgical Skills and Procedures established by the Fiscal Year 2010 research program of the Ministry of Health, Labor and Welfare. The purpose of the Draft of Guidelines is: First, to lay out the required basic guidelines for human cadaver usage to allow medical and dental faculty to conduct clinical education and research in accordance with existing regulations. Second, the guidelines are expected to give physicians a regulatory framework to carry out cadaver training in accordance with the current legal framework. This article explains the Draft of Guidelines in detail, outlines the future of cadaver training, and describes issues which must still be solved.

  1. Barriers and enablers to implementing multiple stroke guideline recommendations: a qualitative study

    PubMed Central

    2013-01-01

    Background Translating evidence into practice is an important final step in the process of evidence-based practice. Medical record audits can be used to examine how well practice compares with published evidence, and identify evidence-practice gaps. After providing audit feedback to professionals, local barriers to practice change can be identified and targetted with focussed behaviour change interventions. This study aimed to identify barriers and enablers to implementing multiple stroke guideline recommendations at one Australian stroke unit. Methods A qualitative methodology was used. A sample of 28 allied health, nursing and medical professionals participated in a group or individual interview. These interviews occurred after staff had received audit feedback and identified areas for practice change. Questions focused on barriers and enablers to implementing guideline recommendations about management of: upper limb sensory impairments, mobility including sitting balance; vision; anxiety and depression; neglect; swallowing; communication; education for stroke survivors and carers; advice about return to work and driving. Qualitative data were analysed for themes using theoretical domains described by Michie and colleagues (2005). Results Six group and two individual interviews were conducted, involving six disciplines. Barriers were different across disciplines. The six key barriers identified were: (1) Beliefs about capabilities of individual professionals and their discipline, and about patient capabilities (2) Beliefs about the consequences, positive and negative, of implementing the recommendations (3) Memory of, and attention to, best practices (4) Knowledge and skills required to implement best practice; (5) Intention and motivation to implement best practice, and (6) Resources. Some barriers were also enablers to change. For example, occupational therapists required new knowledge and skills (a barrier), to better manage sensation and neglect impairments

  2. Non-vitamin K antagonist oral anticoagulants and atrial fibrillation guidelines in practice: barriers to and strategies for optimal implementation

    PubMed Central

    Camm, A. John; Pinto, Fausto J.; Hankey, Graeme J.; Andreotti, Felicita; Hobbs, F.D. Richard

    2015-01-01

    Stroke is a leading cause of morbidity and mortality worldwide. Atrial fibrillation (AF) is an independent risk factor for stroke, increasing the risk five-fold. Strokes in patients with AF are more likely than other embolic strokes to be fatal or cause severe disability and are associated with higher healthcare costs, but they are also preventable. Current guidelines recommend that all patients with AF who are at risk of stroke should receive anticoagulation. However, despite this guidance, registry data indicate that anticoagulation is still widely underused. With a focus on the 2012 update of the European Society of Cardiology (ESC) guidelines for the management of AF, the Action for Stroke Prevention alliance writing group have identified key reasons for the suboptimal implementation of the guidelines at a global, regional, and local level, with an emphasis on access restrictions to guideline-recommended therapies. Following identification of these barriers, the group has developed an expert consensus on strategies to augment the implementation of current guidelines, including practical, educational, and access-related measures. The potential impact of healthcare quality measures for stroke prevention on guideline implementation is also explored. By providing practical guidance on how to improve implementation of the ESC guidelines, or region-specific modifications of these guidelines, the aim is to reduce the potentially devastating impact that stroke can have on patients, their families and their carers. PMID:26116685

  3. Guidelines for Technology Infrastructure in Connecticut Schools: An Implementation Guide for the Connecticut Statewide Educational Technology Plan.

    ERIC Educational Resources Information Center

    Center for Educational Leadership and Technology, Inc., Marlborough, MA.

    This document presents guidelines and recommendations for development of a technology infrastructure in Connecticut public schools that conforms to national industry standards for voice, video, and data communications. The guidelines present information on the state statutes regarding facilities implementation and describe industry standards.…

  4. [European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. Spanish adaptation of the CEIPC 2008].

    PubMed

    Lobos, J M; Royo-Bordonada, M A; Brotons, C; Alvarez-Sala, L; Armario, P; Maiques, A; Mauricio, D; Sans, S; Villar, F; Lizcano, A; Gil-Núñez, A; de Alvaro, F; Conthe, P; Luengo, E; del Río, A; Rico, O; de Santiago, A; Vargas, M A; Martíonez, M; Lizarbe, V

    2009-09-01

    We present the Spanish adaptation made by the CEIPC of the European Guidelines on Cardiovascular Disease Prevention (CVD) in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD through the management of its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care medical doctors in promoting a healthy life style, based on increasing physical activity, change dietary habits, and non smoking. The therapeutic goal is to achieve a Blood Pressure < 140/90 mmHg, but among patients with diabetes, chronic kidney disease, or definite CVD, the objective is <130/80 mmHg. Serum cholesterol should be < 200 mg/dl and cLDL<130 mg/dl, although among patients with CVD or diabetes, the objective is <100 mg/dl (80 mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, to reach body mass index (BMI) guided and waist circumference objectives. In diabetic type 2 patients, the objective is glycated haemoglobin <7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to transfer the recommendations established into the daily clinical practice.

  5. Guidelines for lumbar spine radiography in acute low back pain: effect of implementation in an accident and emergency department.

    PubMed Central

    Tracey, N. G.; Martin, J. B.; McKinstry, C. S.; Mathew, B. M.

    1994-01-01

    Guidelines for lumbar spine radiography were agreed by consultation between staff in the radiology, accident and emergency and neurosurgical departments of a large teaching hospital. Study of 322 consecutive patients over an eight month period showed that the proportion of patients referred for radiography was reduced from 48.4% to 27.2% following introduction of the guidelines (p = 0.0002). Successful use of such guidelines requires cooperation between clinical and radiological staff and frequent review of performance. PMID:8658989

  6. Implementing Peer Evaluation of Clinical Teaching

    ERIC Educational Resources Information Center

    Laske, Rita Ann

    2013-01-01

    Clinical education provides the nursing student opportunities to learn the practice of nursing. In the clinical setting, the nursing student applies classroom knowledge to the real patient care situation. The clinical instructor facilitates this important process by assisting students to integrate knowledge into their practice, improve their…

  7. [Problems and strategies in developing Chinese medicine evidence-based clinical practice guidelines].

    PubMed

    Wang, Bo; Zhan, Si-yan; Liu, Bao-yan

    2011-11-01

    Some problems are confronted in the development of Chinese medicine (CM) evidence-based clinical practice guidelines in the aspects of individualized treatment, quality of research, reporting bias, safety assessment, and so on. After comprehensive retrieving of current methods for developing evidence-based clinical practice guidelines in the field of complementary and alternative medicine, and an optimal combining with widely accepted standardized methods in evidence-based clinical practice guidelines for allopathic medicine, we put forward strategies for these aforesaid problems. In terms of individualized treatment, practical randomized control trials could be considered for inclusion. In terms of quality of research, the method to formulate guideline recommendations was proposed in case of insufficient evidence. In terms of reporting bias, commonly used databases in complementary and alternative medicine were listed. In terms of safety evaluation, GRADE system was suggested to adopt.

  8. Chronic kidney disease guideline implementation in primary care: a qualitative report from the TRANSLATE CKD study

    PubMed Central

    Vest, Bonnie M.; York, Trevor R.M.; Sand, Jessica; Fox, Chester H.; Kahn, Linda S.

    2016-01-01

    Background Primary care physicians (PCPs) are optimally situated to identify and manage early-stage chronic kidney disease (CKD). Nonetheless, studies have documented suboptimal PCP understanding, awareness, and management of early CKD. The TRANSLATE CKD study is an ongoing national mixed-methods cluster randomized control trial that examines the implementation of evidence-based guidelines for CKD into primary care practice. Methods As part of mixed-methods process evaluation, semi-structured interviews were conducted by phone with 27 providers participating in the study. Interviews were audio-taped and transcribed. Thematic content analysis was used to identify themes. Themes were categorized according to the four domains of Normalization Process Theory (NPT). Results Identified themes illuminated the complex work undertaken in primary care practices to manage CKD. Barriers to guideline implementation were identified in each of the four NPT domains, including: 1) lack of knowledge and understanding around CKD (coherence), 2) difficulties engaging providers and patients in CKD management (cognitive participation), 3) limited time and competing demands (collective action), and 4) challenges obtaining and utilizing data to monitor progress (reflexive monitoring). Conclusions Addressing the barriers to implementation with concrete interventions at the levels at which they occur, informed by NPT, will ultimately improve the quality of CKD patient care. PMID:26355134

  9. Active surveillance for prostate cancer: a narrative review of clinical guidelines.

    PubMed

    Bruinsma, Sophie M; Bangma, Chris H; Carroll, Peter R; Leapman, Michael S; Rannikko, Antti; Petrides, Neophytos; Weerakoon, Mahesha; Bokhorst, Leonard P; Roobol, Monique J

    2016-03-01

    In the past decade active surveillance (AS) of men with localized prostate cancer has become an increasingly popular management option, and a range of clinical guidelines have been published on this topic. Existing guidelines regarding AS for prostate cancer vary widely, but predominantly state that the most suitable patients for AS are those with pretreatment clinical stage T1c or T2 tumours, serum PSA levels <10 ng/ml, biopsy Gleason scores of 6 or less, a maximum of one or two tumour-positive biopsy core samples and/or a maximum of 50% of cancer per core sample. Following initiation of an AS programme, most guidelines recommend serial serum PSA measurements, digital rectal examinations and surveillance biopsies to check for and identify pathological indications of tumour progression. Definitions of disease reclassification and progression differ among guidelines and multiple criteria for initiation of definitive treatment are proposed. The variety of descriptions of criteria for clinically insignificant prostate cancer indicates a lack of consensus on optimal AS and intervention thresholds. A single set of guidelines are needed in order to reduce variations in clinical practice and to optimize clinical decision-making. To enable truly evidence-based guidelines, further research that combines existing evidence, while also gathering information from more long-term studies is needed. PMID:26813955

  10. Clinical imaging guidelines part 4: challenges in identifying, engaging and collaborating with stakeholders.

    PubMed

    Bettmann, Michael A; Oikarinen, Helja; Rehani, Madan; Holmberg, Ola; del Rosario Perez, Maria; Naidoo, Anusha; Do, Kyung-Hyun; Dreyer, Keith; Ebdon-Jackson, Steve

    2015-04-01

    The effective development and use of clinical imaging guidelines requires an understanding of who the stakeholders are, what their interests in the process are, and what roles they should play. If the appropriate stakeholders are not engaged in the right roles, it is unlikely that clinical imaging guidelines will be successfully developed, relied on, and actually used. Some stakeholders are obvious: for the development of clinical imaging guidelines, both imagers and those who request examinations, such as general practitioners, internists, and medical specialists, must be involved. To gain acceptance, other relevant groups are stakeholders, including medical societies, other health care professionals, insurers, health IT experts and vendors, and patients. The role of stakeholders must be dictated by their specific interest. For some, involvement in the creation of guidelines is the right role. For others, such as regulators or insurers, reviews or invitations to comment are required, and for others, such as medical educators, it is probably sufficient to provide information and create awareness. Only through a careful consideration of who the stakeholders are and what are their interests are the successful development, acceptance, and use of clinical imaging guidelines likely to occur. Future efforts must focus on collaboration, particularly among groups that create clinical imaging guidelines and those that can support their use, and on regulatory roles and mandates. PMID:25842016

  11. Considering Cost-Effectiveness in Cardiology Clinical Guidelines: Progress and Prospects.

    PubMed

    Hlatky, Mark A

    2016-01-01

    Since the 1980s, when the American College of Cardiology (ACC) and the American Heart Association (AHA) established a joint task force to examine the use of cardiovascular procedures and therapies, cardiologists have been leaders in the development of clinical practice guidelines. The ACC/AHA guidelines development process has evolved considerably over the last 30 or more years. Guidelines now focus on clinical conditions, such as angina, instead of procedures, such as bypass surgery. There is a formal organizational structure, with dedicated staff, a standing committee on practice guidelines, and specific panels of volunteer experts on each topic. This process tightly manages conflicts of interest and strives for evidence-based, as opposed to opinion-based, guidelines, with a clear citation of the supporting evidence. Traditional clinical guidelines consider only what is best for the individual patient, and have explicitly not considered the cost to society. Nevertheless, in many guidelines development meetings, high cost was implicitly considered: if a procedure was extremely costly, the evidence needed to be very strong. The Guidelines Committee recognized that cost considerations ought to be made more transparent, and that the evidence on economic value should be explicitly cited when available. These considerations were formalized by a recent white paper on incorporating economic considerations into ACC/AHA guidelines. In considering value, it is necessary to assess the quality of the evidence as well as to define levels of value. The next ACC/AHA guideline will incorporate value as a part of its recommendations. This will be an evidence-based process in which published economic assessments relating to key questions will be reviewed.

  12. UK National Clinical Guidelines in Paediatric Dentistry: stainless steel preformed crowns for primary molars.

    PubMed

    Kindelan, S A; Day, P; Nichol, R; Willmott, N; Fayle, S A

    2008-11-01

    This revised Clinical Guideline in Paediatric Dentistry replaces the previously published sixth guideline (Fayle SA. Int J Paediatr Dent 1999; 9: 311-314). The process of guideline production began in 1994, resulting in first publication in 1997. Each guideline has been circulated widely for consultation to all UK consultants in paediatric dentistry, council members of the British Society of Paediatric Dentistry (BSPD), and to people of related specialities recognized to have expertise in the subject. The final version of this guideline is produced from a combination of this input and thorough review of the published literature. The intention is to encourage improvement in clinical practice and to stimulate research and clinical audit in areas where scientific evidence is inadequate. Evidence underlying recommendations is scored according to the SIGN classification and guidelines should be read in this context. Further details regarding the process of paediatric dentistry guideline production in the UK is described in the Int J Paediatr Dent 1997; 7: 267-268.

  13. The European Bioanalysis Forum community's evaluation, interpretation and implementation of the European Medicines Agency guideline on Bioanalytical Method Validation.

    PubMed

    van Amsterdam, Peter; Companjen, Arjen; Brudny-Kloeppel, Margarete; Golob, Michaela; Luedtke, Silke; Timmerman, Philip

    2013-03-01

    The European Medicines Agency's (EMA) 2011 guideline on bioanalytical method validation (BMV) was evaluated and subsequently intensely discussed by the European Bioanalysis Forum (EBF) during a 2-day workshop (EBF Workshop on the implementation of the EMA guideline on BMV, Château de Limelette, Limelette, Belgium, 15-16 March 2012). The goal of the evaluation and discussions was to come to a uniform interpretation of the guideline and thus to help facilitate a smooth implementation at our laboratories. Up front preparations for the workshop by dedicated teams concentrated on challenges on implementation: ambiguities, technical or operational challenges and issues in general. In addition, common understandings were identified as well as main differences to the 2011 US FDA guideline. The guideline was perceived as being well written with a clear structure, separating method validation from sample analysis and treating all relevant aspects one-by-one in a logical order. It is the first BMV guideline clearly addressing the specifics for ligand binding assays and it shows a good match with current scientific thinking. The EBF community considers the EMA BMV guideline an excellent basis for countries that are in the process of developing or updating their own BMV guideline.

  14. Mitigation of adverse interactions in pairs of clinical practice guidelines using constraint logic programming.

    PubMed

    Wilk, Szymon; Michalowski, Wojtek; Michalowski, Martin; Farion, Ken; Hing, Marisela Mainegra; Mohapatra, Subhra

    2013-04-01

    We propose a new method to mitigate (identify and address) adverse interactions (drug-drug or drug-disease) that occur when a patient with comorbid diseases is managed according to two concurrently applied clinical practice guidelines (CPGs). A lack of methods to facilitate the concurrent application of CPGs severely limits their use in clinical practice and the development of such methods is one of the grand challenges for clinical decision support. The proposed method responds to this challenge. We introduce and formally define logical models of CPGs and other related concepts, and develop the mitigation algorithm that operates on these concepts. In the algorithm we combine domain knowledge encoded as interaction and revision operators using the constraint logic programming (CLP) paradigm. The operators characterize adverse interactions and describe revisions to logical models required to address these interactions, while CLP allows us to efficiently solve the logical models - a solution represents a feasible therapy that may be safely applied to a patient. The mitigation algorithm accepts two CPGs and available (likely incomplete) patient information. It reports whether mitigation has been successful or not, and on success it gives a feasible therapy and points at identified interactions (if any) together with the revisions that address them. Thus, we consider the mitigation algorithm as an alerting tool to support a physician in the concurrent application of CPGs that can be implemented as a component of a clinical decision support system. We illustrate our method in the context of two clinical scenarios involving a patient with duodenal ulcer who experiences an episode of transient ischemic attack.

  15. Validation of antibiotic susceptibility testing guidelines in a routine clinical microbiology laboratory exemplifies general key challenges in setting clinical breakpoints.

    PubMed

    Hombach, Michael; Courvalin, Patrice; Böttger, Erik C

    2014-07-01

    This study critically evaluated the new European Committee for Antimicrobial Susceptibility Testing (EUCAST) antibiotic susceptibility testing guidelines on the basis of a large set of disk diffusion diameters determined for clinical isolates. We report several paradigmatic problems that illustrate key issues in the selection of clinical susceptibility breakpoints, which are of general importance not only for EUCAST but for all guidelines systems, i.e., (i) the need for species-specific determinations of clinical breakpoints/epidemiological cutoffs (ECOFFs), (ii) problems arising from pooling data from various sources, and (iii) the importance of the antibiotic disk content for separating non-wild-type and wild-type populations.

  16. Measuring legal implementation of the international guidelines on HIV/AIDS and human rights.

    PubMed

    Watchirs, H

    2001-01-01

    With over 36 million people now living with the virus and over 21 million people dying of AIDS in the last two decades, HIV/AIDS is a global health and security problem. These shocking figures eclipse the human toll of many wars, and reveal in themselves that human rights are not being respected, protected, or fulfilled, either through negligent omissions or violations. A human rights approach to the epidemic was advocated early by advocates such as Jonathan Mann, who recognized that infections thrived in conditions of inequality. This approach was crystallized in the International Guidelines on HIV/AIDS and Human Rights that were developed at the Second International Consultation in 1996 convened by UNAIDS and the Office of the High Commissioner for Human Rights. The Guidelines cover three main areas: improving governmental responses in terms of multisectoral responsibility and accountability; widespread law reform and legal support services; and supporting increased private sector and community participation in effective responses to the epidemic. This article focuses on the half of the twelve Guidelines that concern rights that are justiciable and amenable to law reform. It highlights the responsibilities of States Parties to human rights treaties, as they bear the principal burden of the obligations to implement. PMID:11837019

  17. Standardized Clinical Assessment And Management Plans (SCAMPs) Provide A Better Alternative To Clinical Practice Guidelines

    PubMed Central

    Farias, Michael; Jenkins, Kathy; Lock, James; Rathod, Rahul; Newburger, Jane; Bates, David W.; Safran, Dana G.; Friedman, Kevin; Greenberg, Josh

    2014-01-01

    Variability in medical practice in the United States leads to higher costs without achieving better patient outcomes. Clinical practice guidelines, which are intended to reduce variation and improve care, have several drawbacks that limit the extent of buy-in by clinicians. In contrast, standardized clinical assessment and management plans (SCAMPs) offer a clinician-designed approach to promoting care standardization that accommodates patients’ individual differences, respects providers’ clinical acumen, and keeps pace with the rapid growth of medical knowledge. Since early 2009 more than 12,000 patients have been enrolled in forty-nine SCAMPs in nine states and Washington, D.C. In one example, a SCAMP was credited with increasing clinicians’ rate of compliance with a recommended specialist referral for children from 19.6 percent to 75 percent. In another example, SCAMPs were associated with an 11–51 percent decrease in total medical expenses for six conditions when compared with a historical cohort. Innovative tools such as SCAMPs should be carefully examined by policy makers searching for methods to promote the delivery of high-quality, cost-effective care. PMID:23650325

  18. Combining clinical judgment with guidelines for the management of type 2 diabetes: overall standards of comprehensive care.

    PubMed

    Yacoub, Tamer G

    2014-05-01

    The rising toll of type 2 diabetes mellitus (T2DM) on patients and society has resulted in a wide variety of guidelines and therapies to address the need to combat this trend. Given the heterogeneity of T2DM and the different responses patients have to therapies, as well as the continued need for patients to institute lifestyle changes, guidelines published by the American Diabetes Association/European Association for the Study of Diabetes and the American Association of Clinical Endocrinologists/American College of Endocrinology have in recent years increased the focus on personalized and patient-centered care. How to best assimilate the overall standards of care for T2DM into clinical practice remains a challenge. The 4 pillars of effective diabetes management are a unifying framework and approach to clinical practice that can be integrated with the latest diabetes guidelines. These 4 pillars are lifestyle modifications involving (1) diet, (2) exercise, (3) a system to monitor preprandial and postprandial blood glucose and glycated hemoglobin levels, and (4) pharmacologic intervention when required. This article reviews the overall standards of care for T2DM, focusing on the first 3 nonpharmacologic pillars, and provides suggestions for integrating this approach with the current American Diabetes Association and American Association of Clinical Endocrinologists/American College of Endocrinology guidelines. Barriers to effective implementation of exercise programs, diets, and monitoring of blood glucose levels are discussed along with clinical strategies to overcome these barriers and achieve effective glycemic control and lifestyle changes for patients with T2DM. Personalized approaches to the management of T2DM are also reviewed.

  19. Evolution of clinical practice guidelines: evidence supporting expanded use of medicines.

    PubMed

    Dubois, Robert W; Dean, Bonnie B

    2006-08-01

    Previous studies have shown that the primary factor underlying increased spending on pharmaceuticals has been the rising utilization of medications, rather than increases in unit drug price. This study examined the evolution of clinical practice guidelines to assess possible reasons for the rising drug volume. Clinical practice guidelines from 1970 to the present were reviewed for the six most prevalent treatable medical conditions/risk factors listed as priority areas by the Institute of Medicine. We searched the National Guidelines Clearinghouse, PubMed and Medline databases, and Web sites of relevant national organizations for US clinical practice guidelines published through January 2005. Information pertaining to the therapeutic regimen (eg, the frequency and duration of recommended treatment, when treatment should be initiated, the patient population for whom the guideline was intended) was abstracted and entered into evidence tables. Changes in guidelines were distributed across three themes that recommended evidence-based increases in medication use, including: (1) changes in the size of the treatable population; (2) changes in the number and type of recommended pharmaceutical therapeutic options, including movement from monotherapy to combination therapy, treatment of comorbidities, and use of newer types of medicines; and (3) changes in the therapeutic regimen, including a shift from episodic care to preventive and chronic care. Many of these changes point to an important, but not often noticed, addition of secondary prevention of disease effects to the objectives of medical care. These trends are likely to continue with important economic, clinical, and policy ramifications.

  20. Improving children's nutrition environments: A survey of adoption and implementation of nutrition guidelines in recreational facilities

    PubMed Central

    2011-01-01

    Background Although the mandate of recreational facilities is to enhance well-being, many offer foods inconsistent with recommendations for healthy eating. Little is known regarding recreational facility food environments and how they might be improved, as few studies exist. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are intended to ensure access to healthy food choices in schools, childcare and recreational facilities. This study investigated awareness, adoption and implementation of the ANGCY among recreational facilities in Alberta, Canada, one year following their release. Methods A cross-sectional telephone survey was conducted from June - December, 2009 (n = 151) with managers of publicly funded recreational facilities that served food. The questionnaire included 10 closed and 7 open ended questions to assess the organizational priority for healthy eating, awareness, adoption and implementation of the ANGCY. Chi-squared tests examined quantitative variables, while qualitative data were analysed using directed content analysis. Greenhalgh's model of diffusion of complex innovations within health service organizations constituted the theoretical framework for the study. Results One half of respondents had heard of the ANGCY, however their knowledge of them was limited. Although 51% of facilities had made changes to improve the nutritional quality of foods offered in the past year, only a small fraction (11%) of these changes were motivated by the ANGCY. At the time of the survey, 14% of facilities had adopted the ANGCY and 6% had implemented them. Barriers to adoption and implementation were primarily related to perceived negative attributes of the ANGCY, the inner (organizational) context, and negative feedback received during the implementation process. Managers strongly perceived that implementing nutrition guidelines would limit their profit-making ability. Conclusions If fully adopted and implemented, the ANGCY have the potential to

  1. Creative implementation of 3Rs principles within industry programs: beyond regulations and guidelines.

    PubMed

    Bratcher, Natalie A; Reinhard, Gregory R

    2015-03-01

    The industry involved with using animals as an essential part of research has supported the theory and philosophy of the 3Rs for years. However, both the culture and approach surrounding the 3Rs is evolving rapidly, and many institutions are attempting to surpass the regulations and guidelines to implement the 3Rs for improved science and animal welfare. Regulatory documents and guidelines such as the Animal Welfare Act, the Guide for the Care and Use of Laboratory Animals, the Public Health Service Policy on Humane Care and Use of Laboratory Animals, and the US Government Principles for the Utilization and Care of Vertebrate Animals Used in Testing, Research, and Training clearly outline how the IACUC should address the 3Rs, but there are many additional paradigms and resources that an institution can use to promote the 3Rs creatively. We review the legal mandates and guidelines that institutions must or should follow, and we present some creative approaches toward their compliance, including the creation of full-time dedicated 3Rs roles as well as temporary 3Rs-focused positions such as visiting scientist and postdoctoral fellowships and internships. We also discuss how to creatively achieve 3Rs progress through internal committees and working groups, involvement in 3Rs consortia, recognizing 3Rs advances through awards programs, and creating 3Rs volunteer opportunities. Adherence to regulations and guidelines creates a solid foundation for good animal care and science, and creative 3Rs approaches enable the growth of a robust animal welfare culture that enhances the potential for 3Rs benefits to animals and science.

  2. Creative Implementation of 3Rs Principles within Industry Programs: Beyond Regulations and Guidelines

    PubMed Central

    Bratcher, Natalie A; Reinhard, Gregory R

    2015-01-01

    The industry involved with using animals as an essential part of research has supported the theory and philosophy of the 3Rs for years. However, both the culture and approach surrounding the 3Rs is evolving rapidly, and many institutions are attempting to surpass the regulations and guidelines to implement the 3Rs for improved science and animal welfare. Regulatory documents and guidelines such as the Animal Welfare Act, the Guide for the Care and Use of Laboratory Animals, the Public Health Service Policy on Humane Care and Use of Laboratory Animals, and the US Government Principles for the Utilization and Care of Vertebrate Animals Used in Testing, Research, and Training clearly outline how the IACUC should address the 3Rs, but there are many additional paradigms and resources that an institution can use to promote the 3Rs creatively. We review the legal mandates and guidelines that institutions must or should follow, and we present some creative approaches toward their compliance, including the creation of full-time dedicated 3Rs roles as well as temporary 3Rs-focused positions such as visiting scientist and postdoctoral fellowships and internships. We also discuss how to creatively achieve 3Rs progress through internal committees and working groups, involvement in 3Rs consortia, recognizing 3Rs advances through awards programs, and creating 3Rs volunteer opportunities. Adherence to regulations and guidelines creates a solid foundation for good animal care and science, and creative 3Rs approaches enable the growth of a robust animal welfare culture that enhances the potential for 3Rs benefits to animals and science. PMID:25836958

  3. Implementation of pregnancy weight management and obesity guidelines: a meta-synthesis of healthcare professionals' barriers and facilitators using the Theoretical Domains Framework.

    PubMed

    Heslehurst, N; Newham, J; Maniatopoulos, G; Fleetwood, C; Robalino, S; Rankin, J

    2014-06-01

    Obesity in pregnancy is rising and is associated with severe health consequences for both the mother and the child. There is an increasing international focus on guidelines to manage the clinical risks of maternal obesity, and for pregnancy weight management. However, passive dissemination of guidelines is not effective and more active strategies are required for effective guideline implementation into practice. Implementation of guidelines is a form of healthcare professional behaviour change, and therefore implementation strategies should be based on appropriate behaviour change theory. This systematic review aimed to identify the determinants of healthcare professionals' behaviours in relation to maternal obesity and weight management. Twenty-five studies were included. Data synthesis of the existing international qualitative and quantitative evidence base used the Theoretical Domains Framework to identify the barriers and facilitators to healthcare professionals' maternal obesity and weight management practice. The domains most frequently identified included 'knowledge', 'beliefs about consequences' and 'environmental context and resources'. Healthcare professionals' weight management practice had the most barriers compared with any other area of maternal obesity practice. The results of this review will be used to inform the development of an intervention to support healthcare professional behaviour change.

  4. Canadian clinical practice guidelines for invasive candidiasis in adults

    PubMed Central

    Bow, Eric J; Evans, Gerald; Fuller, Jeff; Laverdière, Michel; Rotstein, Coleman; Rennie, Robert; Shafran, Stephen D; Sheppard, Don; Carle, Sylvie; Phillips, Peter; Vinh, Donald C

    2010-01-01

    Candidemia and invasive candidiasis (C/IC) are life-threatening opportunistic infections that add excess morbidity, mortality and cost to the management of patients with a range of potentially curable underlying conditions. The Association of Medical Microbiology and Infectious Disease Canada developed evidence-based guidelines for the approach to the diagnosis and management of these infections in the ever-increasing population of at-risk adult patients in the health care system. Over the past few years, a new and broader understanding of the epidemiology and pathogenesis of C/IC has emerged and has been coupled with the availability of new antifungal agents and defined strategies for targeting groups at risk including, but not limited to, acute leukemia patients, hematopoietic stem cell transplants and solid organ transplants, and critical care unit patients. Accordingly, these guidelines have focused on patients at risk for C/IC, and on approaches of prevention, early therapy for suspected but unproven infection, and targeted therapy for probable and proven infection. PMID:22132006

  5. A commentary on the 2015 Canadian Clinical Practice Guidelines in glutamine supplementation to parenteral nutrition.

    PubMed

    Leguina-Ruzzi, Alberto

    2016-01-08

    Glutamine is one of the conditionally essential free amino acids with multiple biological functions. Its supplementation to parenteral nutrition has been widely used for the management of complications in intensive care. However, controversial clinical reports have generated reluctance in the use of this pharmaco-nutrient. In this commentary, we address the impact of four studies that influenced the recommendations on glutamine supplementation by the Canadian Clinical Practice Guide 2015. Because of the importance of this guideline in clinical practice, we strongly believe that a more rigorous and critical evaluation is required to support recommendations in future guidelines.

  6. The GuideView System for Interactive, Structured, Multi-modal Delivery of Clinical Guidelines

    NASA Technical Reports Server (NTRS)

    Iyengar, Sriram; Florez-Arango, Jose; Garcia, Carlos Andres

    2009-01-01

    GuideView is a computerized clinical guideline system which delivers clinical guidelines in an easy-to-understand and easy-to-use package. It may potentially enhance the quality of medical care or allow non-medical personnel to provide acceptable levels of care in situations where physicians or nurses may not be available. Such a system can be very valuable during space flight missions when a physician is not readily available, or perhaps the designated medical personnel is unable to provide care. Complex clinical guidelines are broken into simple steps. At each step clinical information is presented in multiple modes, including voice,audio, text, pictures, and video. Users can respond via mouse clicks or via voice navigation. GuideView can also interact with medical sensors using wireless or wired connections. The system's interface is illustrated and the results of a usability study are presented.

  7. Evaluating acceptance and user experience of a guideline-based clinical decision support system execution platform.

    PubMed

    Buenestado, David; Elorz, Javier; Pérez-Yarza, Eduardo G; Iruetaguena, Ander; Segundo, Unai; Barrena, Raúl; Pikatza, Juan M

    2013-04-01

    This study aims to determine what the initial disposition of physicians towards the use of Clinical Decision Support Systems (CDSS) based on Computerised Clinical Guidelines and Protocols (CCGP) is; and whether their prolonged utilisation has a positive effect on their intention to adopt them in the future. For a period of 3 months, 8 volunteer paediatricians monitored each up to 10 asthmatic patients using two CCGPs deployed in the-GuidesMed CDSS. A Technology Acceptance Model (TAM) questionnaire was supplied to them before and after using the system. Results from both questionnaires are analysed searching for significant improvements in opinion between them. An additional survey was performed to analyse the usability of the system. It was found that initial disposition of physicians towards e-GuidesMed is good. Improvement between the pre and post iterations of the TAM questionnaire has been found to be statistically significant. Nonetheless, slightly lower values in the Compatibility and Habit variables show that participants perceive possible difficulties to integrate e-GuidesMed into their daily routine. The variable Facilitators shows the highest correlation with the Intention to Use. Usability of the system has also been rated very high and, in this regard, no fundamental flaw has been detected. Initial views towards e-GuidesMed are positive, and become reinforced after continued utilisation of the system. In order to achieve an effective implementation, it becomes essential to facilitate conditions to integrate the system into the physician's daily routine.

  8. [European Guidelines on Cardiovascular Disease Prevention in Clinical Practice: CEIPC 2008 Spanish adaptation].

    PubMed

    Lobos, José M; Royo-Bordonada, Miguel A; Brotons, Carlos; Alvarez-Sala, Luís; Armario, Pedro; Maiques, Antonio; Mauricio, Dídac; Sans, Susana; Villar, Fernando; Lizcano, Angel; Gil-Núñez, Antonio; Alvaro, Fernando de; Conthe, Pedro; Luengo, Emilio; Río, Alfonso Del; Cortés-Rico, Olga; Santiago, Ana de; Vargas, Miguel A; Martínez, Mercedes; Lizarbe, Vicenta

    2008-01-01

    We present the Spanish adaptation from the CEIPC of the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD by means of dealing with its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care medical doctors in promoting a healthy life style, based on increasing physical activity, change dietary habits, and non smoking. The therapeutic goal is to achieve a Blood Pressure <140/90 mmHg, but among patients with diabetes, chronic kidney disease, or definite CVD, the objective is <130/80 mmHg. Serum cholesterol should be <200 mg/dl and cLDL <130 mg/dl, although among patients with CVD or diabetes, the objective is <100 mg/dl (80 mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, with the objective guided by BMI -body mass index- and waist circumference. In diabetic type 2 patients, the objective is glycated haemoglobin <7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to put the recommendations into practice.

  9. [European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. CEIPC 2008 Spanish adaptation].

    PubMed

    Lobos, J M; Royo-Bordonada, M A; Brotons, C; Alvarez-Sala, L; Armario, P; Maiques, A; Mauricio, D; Sans, S; Villar, F; Lizcano, A; Gil-Núñez, A; de Alvaro, F; Conthe, P; Luengo, E; Del Río, A; Cortés, O; de Santiago, A; Varga, M A; Martínez, M; Lizarbe, V

    2009-06-01

    The present CEIPC Spanish adaptation of the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD by means of dealing with its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care doctors in promoting a healthy life style, based on increasing physical activity, changing dietary habits, and not smoking. The therapeutic goal is to achieve a Blood Pressure < 140/90 mmHg, but in patients with diabetes, chronic kidney disease, or definite CVD, the objective is < 130/80 mmHg. Serum cholesterol should be < 200 mg/dl and cLDL < 130 mg/dl, although in patients with CVD or diabetes, the objective is < 100 mg/dl (80 mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, with the objective guided by body mass index and waist circumference. In diabetic type 2 patients, the objective is glycated haemoglobin < 7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to put the recommendations into practice.

  10. [European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. CEIPC 2008 Spanish Adaptation].

    PubMed

    Lobos Bejarano, José M A; Royo-Bordonada, Miguel Angel; Brotons, Carlos; Alvarez-Sala, Luís; Armario, Pedro; Maiques, Antonio; Mauricio, Dídac; Sans, Susana; Villar, Fernando; Lizcano, Angel; Gil-Núñez, Antonio; de Alvaro, Fernando; Conthe, Pedro; Luengo, Emilio; Del Río, Alfonso; Cortés, Olga; de Santiago, Ana; Vargas, Miguel A; Martínez, Mercedes; Lizarbe, Vicenta

    2009-08-01

    The present CEIPC Spanish adaptation of the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD by means of dealing with its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care doctors in promoting a healthy life style, based on increasing physical activity, changing dietary habits, and not smoking. The therapeutic goal is to achieve a Blood Pressure<140/90mmHg, but in patients with diabetes, chronic kidney disease, or definite CVD, the objective is<130/80mmHg. Serum cholesterol should be<200mg/dl and cLDL<130mg/dl, although in patients with CVD or diabetes, the objective is<100mg/dl (80mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, with the objective guided by body mass index and waist circumference. In diabetic type 2 patients, the objective is glycated haemoglobin<7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to put the recommendations into practice.

  11. Study on the methodology of developing evidence-based clinical practice guidelines of Chinese medicine.

    PubMed

    Chen, Zheng-guang; Luo, Hui; Xu, Shan; Yang, Yan; Wang, Shou-chuan

    2015-11-01

    At present, evidence-based clinical practice guideline (EBCPG) is the main mode of developing clinical practice guidelines (CPGs) in the world, but in China, most of CPGs of Chinese medicine (CM) are still guidelines based on expert consensus. The objective of this study is to construct initially the methodology of developing EBCPGs of CM and to promote the development of standardization of CM. Based on the development of "Guideline for Diagnosis and Treatment of Common Pediatric Diseases in CM", the methodology of developing EBCPG of CM was explored by analyzing the pertinent literature and considering the characteristics of CM. In this study, the key problem was to put forward the suggestion and strategies. However, due to the methodology study of developing EBCPG of CM is still in the initial stage, there are still some problems which need further study.

  12. Reconciling pairs of concurrently used clinical practice guidelines using Constraint Logic Programming.

    PubMed

    Wilk, Szymon; Michalowski, Martin; Michalowski, Wojtek; Hing, Marisela Mainegra; Farion, Ken

    2011-01-01

    This paper describes a new methodological approach to reconciling adverse and contradictory activities (called points of contention) occurring when a patient is managed according to two or more concurrently used clinical practice guidelines (CPGs). The need to address these inconsistencies occurs when a patient with more than one disease, each of which is a comorbid condition, has to be managed according to different treatment regimens. We propose an automatic procedure that constructs a mathematical guideline model using the Constraint Logic Programming (CLP) methodology, uses this model to identify and mitigate encountered points of contention, and revises the considered CPGs accordingly. The proposed procedure is used as an alerting mechanism and coupled with a guideline execution engine warns the physician about potential problems with the concurrent application of two or more guidelines. We illustrate the operation of our procedure in a clinical scenario describing simultaneous use of CPGs for duodenal ulcer and transient ischemic attack. PMID:22195153

  13. Reconciling pairs of concurrently used clinical practice guidelines using Constraint Logic Programming.

    PubMed

    Wilk, Szymon; Michalowski, Martin; Michalowski, Wojtek; Hing, Marisela Mainegra; Farion, Ken

    2011-01-01

    This paper describes a new methodological approach to reconciling adverse and contradictory activities (called points of contention) occurring when a patient is managed according to two or more concurrently used clinical practice guidelines (CPGs). The need to address these inconsistencies occurs when a patient with more than one disease, each of which is a comorbid condition, has to be managed according to different treatment regimens. We propose an automatic procedure that constructs a mathematical guideline model using the Constraint Logic Programming (CLP) methodology, uses this model to identify and mitigate encountered points of contention, and revises the considered CPGs accordingly. The proposed procedure is used as an alerting mechanism and coupled with a guideline execution engine warns the physician about potential problems with the concurrent application of two or more guidelines. We illustrate the operation of our procedure in a clinical scenario describing simultaneous use of CPGs for duodenal ulcer and transient ischemic attack.

  14. Guidelines for Standard Photography in Gross and Clinical Anatomy

    ERIC Educational Resources Information Center

    Barut, Cagatay; Ertilav, Hakan

    2011-01-01

    Photography has a widespread usage in medicine and anatomy. In this review, authors focused on the usage of photography in gross and clinical anatomy. Photography in gross and clinical anatomy is not only essential for accurate documentation of morphological findings but also important in sharing knowledge and experience. Photographs of cadavers…

  15. What is the Asian Consensus Statement on NCCN clinical practice guidelines in oncology (NCCN-ACS)?

    PubMed

    Akaza, Hideyuki

    2016-04-01

    Cancer treatment guidelines are compiled on the basis of established evidence. Such evidence is obtained from epidemiological, pathological and pharmacological study and, most importantly of all, the information gained from clinical trials. However, very little of the kind of evidence that is required for the compilation of treatment guidelines is actually obtained from Asian countries. When one considers the ethnic differences and disparities in medical care, coupled with the tremendous cultural diversity that characterize the Asian region, it would be difficult to conclude that there is currently sufficient evidence that could form the basis for the formulation of guidelines that would be relevant and applicable to all Asian countries. An urgent issue that needs to be addressed in order to achieve a breakthrough in this difficult situation is to build up a body of evidence at an advanced level that is specific to the Asian region and Asian ethnicities. For the interim, however, it is also necessary to efficiently incorporate evidence that has been obtained in Western countries. Furthermore, an effective method of utilizing guidelines that have already been compiled in Western countries is considered to be not by simply translating them into local languages, but rather to engage in a process of adaptation, whereby the guidelines are adjusted or modified to match the circumstances of a particular country or region. The NCCN Clinical Practice Guidelines-Asian Consensus Statement (NCCN-ACS) documents have been compiled with this intention in mind, utilizing the NCCN guidelines that are widely used internationally.

  16. [Development and Quality Evaluation of Evidence-based Clinical Practice Guidelines of Chinese Medicine].

    PubMed

    Jiang, Yue-rong; Chen, Ke-ji

    2016-01-01

    More attentions have been paid to the development of evidence-based clinical practice guidelines (ECPGs) of Chinese medicine (CM). International guideline evaluation instruments such as Appraisal of Guidelines for Research and Evaluation (AGREE I) has been gradually applied in ECPGs quality evaluation of CM. Nowadays, there are some certain methodological defects in partial ECPGs of Chinese medicine, with relatively low applicability and slowly update. It is suggested to establish technical specifications of CM-ECPGs in accordance with the characteristics of CM and international general specification, strengthen the quality evaluation of CM-ECPGs, attach great importance to the regularly update as well as popularization and application of CM-ECPGs.

  17. [Managing of the patient with dyspepsia. Clinical Practice Guideline. Update 2012].

    PubMed

    Gisbert, Javier P; Calvet Calvo, Xavier; Ferrándiz Santos, Juan; Mascort Roca, Juan José; Alonso-Coello, Pablo; Marzo Castillejo, Mercè

    2012-12-01

    The "Preparation of Clinical Practice Guidelines in Digestive Diseases, from Primary Care to Specialist Care" Program, is a joint project by the Spanish Gastroenterology Association (AEG), the Spanish Society of Family and Community Medicine (SEMFyC), and the IberoAmerican Cochrane Center (CCI). We present the update of the Guidelines on the Management of Dyspepsia, which was published in 2003. The essential criteria provided in the AGREE (Appraisal of Guidelines, Research and Evaluation for Europe) Instrument were taken into account in the preparation of this document. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to classify the scientific evidence and strengthen the recommendations.

  18. Implementing the American Academy of Pediatrics Attention-Deficit/Hyperactivity Disorder Diagnostic Guidelines in Primary Care Settings

    PubMed Central

    Leslie, Laurel K.; Weckerly, Jill; Plemmons, Dena; Landsverk, John; Eastman, Sarita

    2006-01-01

    Objectives To evaluate the feasibility of the San Diego Attention-Deficit/Hyperactivity Disorder Project (SANDAP) protocol, a pediatric community-initiated quality improvement effort to foster implementation of the American Academy of Pediatrics (AAP) attention-deficit/hyperactivity disorder (ADHD) diagnostic guidelines, and to identify any additional barriers to providing evidence-based ADHD evaluative care. Methods Seven research-naïve primary care offices in the San Diego area were recruited to participate. Offices were trained in the SANDAP protocol, which included 1) physician education, 2) a standardized assessment packet for parents and teachers, 3) an ADHD coordinator to assist in collection and collation of the assessment packet components, 4) educational materials for clinicians, parents, and teachers, in the form of handouts and a website, and 5) flowcharts delineating local paths for referral to medical subspecialists, mental health practitioners, and school-based professionals. The assessment packet included the parent and teacher versions of the Vanderbilt ADHD Diagnostic Rating Scales. In this study, we chose a conservative interpretation of the AAP ADHD guidelines for diagnosing ADHD, requiring that a child met criteria for ADHD on both the parent and teacher rating scales. A mixed-method analytic strategy was used to address feasibility and barriers, including quantitative surveys with parents and teachers and qualitative debriefing sessions conducted an average of 3 times per year with pediatricians and office staff members. Results Between December 2000 and April 2003, 159 children were consecutively enrolled for evaluation of school and/or behavioral problems. Clinically, only 44% of the children met criteria for ADHD on both the parent and teacher scales, and 73.5% of those children were categorized as having the combined subtype. More than 40% of the subjects demonstrated discrepant results on the Vanderbilt scales, with only the parent or

  19. Announcement: Clinical Practice Guidelines Published for Treatment of Drug-Susceptible Tuberculosis.

    PubMed

    2016-01-01

    The American Thoracic Society, CDC, and the Infectious Diseases Society of America (IDSA) have jointly sponsored the development of guidelines for the treatment of drug-susceptible tuberculosis, which were published by IDSA in Clinical Infectious Diseases on August 11, 2016 (1) and are available through IDSA (http://www.idsociety.org/Index.aspx) and CDC (http://www.cdc.gov/tb/publications/guidelines/treatment.htm). PMID:27537009

  20. Two Years Later: Journals Are Not Yet Enforcing the ARRIVE Guidelines on Reporting Standards for Pre-Clinical Animal Studies

    PubMed Central

    Baker, David; Lidster, Katie; Sottomayor, Ana; Amor, Sandra

    2014-01-01

    There is growing concern that poor experimental design and lack of transparent reporting contribute to the frequent failure of pre-clinical animal studies to translate into treatments for human disease. In 2010, the Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines were introduced to help improve reporting standards. They were published in PLOS Biology and endorsed by funding agencies and publishers and their journals, including PLOS, Nature research journals, and other top-tier journals. Yet our analysis of papers published in PLOS and Nature journals indicates that there has been very little improvement in reporting standards since then. This suggests that authors, referees, and editors generally are ignoring guidelines, and the editorial endorsement is yet to be effectively implemented. PMID:24409096

  1. Two years later: journals are not yet enforcing the ARRIVE guidelines on reporting standards for pre-clinical animal studies.

    PubMed

    Baker, David; Lidster, Katie; Sottomayor, Ana; Amor, Sandra

    2014-01-01

    There is growing concern that poor experimental design and lack of transparent reporting contribute to the frequent failure of pre-clinical animal studies to translate into treatments for human disease. In 2010, the Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines were introduced to help improve reporting standards. They were published in PLOS Biology and endorsed by funding agencies and publishers and their journals, including PLOS, Nature research journals, and other top-tier journals. Yet our analysis of papers published in PLOS and Nature journals indicates that there has been very little improvement in reporting standards since then. This suggests that authors, referees, and editors generally are ignoring guidelines, and the editorial endorsement is yet to be effectively implemented.

  2. MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): the new generation guideline implementation.

    PubMed

    Bousquet, J; Schunemann, H J; Fonseca, J; Samolinski, B; Bachert, C; Canonica, G W; Casale, T; Cruz, A A; Demoly, P; Hellings, P; Valiulis, A; Wickman, M; Zuberbier, T; Bosnic-Anticevitch, S; Bedbrook, A; Bergmann, K C; Caimmi, D; Dahl, R; Fokkens, W J; Grisle, I; Lodrup Carlsen, K; Mullol, J; Muraro, A; Palkonen, S; Papadopoulos, N; Passalacqua, G; Ryan, D; Valovirta, E; Yorgancioglu, A; Aberer, W; Agache, I; Adachi, M; Akdis, C A; Akdis, M; Annesi-Maesano, I; Ansotegui, I J; Anto, J M; Arnavielhe, S; Arshad, H; Baiardini, I; Baigenzhin, A K; Barbara, C; Bateman, E D; Beghé, B; Bel, E H; Ben Kheder, A; Bennoor, K S; Benson, M; Bewick, M; Bieber, T; Bindslev-Jensen, C; Bjermer, L; Blain, H; Boner, A L; Boulet, L P; Bonini, M; Bonini, S; Bosse, I; Bourret, R; Bousquet, P J; Braido, F; Briggs, A H; Brightling, C E; Brozek, J; Buhl, R; Burney, P G; Bush, A; Caballero-Fonseca, F; Calderon, M A; Camargos, P A M; Camuzat, T; Carlsen, K H; Carr, W; Cepeda Sarabia, A M; Chavannes, N H; Chatzi, L; Chen, Y Z; Chiron, R; Chkhartishvili, E; Chuchalin, A G; Ciprandi, G; Cirule, I; Correia de Sousa, J; Cox, L; Crooks, G; Costa, D J; Custovic, A; Dahlen, S E; Darsow, U; De Carlo, G; De Blay, F; Dedeu, T; Deleanu, D; Denburg, J A; Devillier, P; Didier, A; Dinh-Xuan, A T; Dokic, D; Douagui, H; Dray, G; Dubakiene, R; Durham, S R; Dykewicz, M S; El-Gamal, Y; Emuzyte, R; Fink Wagner, A; Fletcher, M; Fiocchi, A; Forastiere, F; Gamkrelidze, A; Gemicioğlu, B; Gereda, J E; González Diaz, S; Gotua, M; Grouse, L; Guzmán, M A; Haahtela, T; Hellquist-Dahl, B; Heinrich, J; Horak, F; Hourihane, J O 'b; Howarth, P; Humbert, M; Hyland, M E; Ivancevich, J C; Jares, E J; Johnston, S L; Joos, G; Jonquet, O; Jung, K S; Just, J; Kaidashev, I; Kalayci, O; Kalyoncu, A F; Keil, T; Keith, P K; Khaltaev, N; Klimek, L; Koffi N'Goran, B; Kolek, V; Koppelman, G H; Kowalski, M L; Kull, I; Kuna, P; Kvedariene, V; Lambrecht, B; Lau, S; Larenas-Linnemann, D; Laune, D; Le, L T T; Lieberman, P; Lipworth, B; Li, J; Louis, R; Magard, Y; Magnan, A; Mahboub, B; Majer, I; Makela, M J; Manning, P; De Manuel Keenoy, E; Marshall, G D; Masjedi, M R; Maurer, M; Mavale-Manuel, S; Melén, E; Melo-Gomes, E; Meltzer, E O; Merk, H; Miculinic, N; Mihaltan, F; Milenkovic, B; Mohammad, Y; Molimard, M; Momas, I; Montilla-Santana, A; Morais-Almeida, M; Mösges, R; Namazova-Baranova, L; Naclerio, R; Neou, A; Neffen, H; Nekam, K; Niggemann, B; Nyembue, T D; O'Hehir, R E; Ohta, K; Okamoto, Y; Okubo, K; Ouedraogo, S; Paggiaro, P; Pali-Schöll, I; Palmer, S; Panzner, P; Papi, A; Park, H S; Pavord, I; Pawankar, R; Pfaar, O; Picard, R; Pigearias, B; Pin, I; Plavec, D; Pohl, W; Popov, T A; Portejoie, F; Postma, D; Potter, P; Price, D; Rabe, K F; Raciborski, F; Radier Pontal, F; Repka-Ramirez, S; Robalo-Cordeiro, C; Rolland, C; Rosado-Pinto, J; Reitamo, S; Rodenas, F; Roman Rodriguez, M; Romano, A; Rosario, N; Rosenwasser, L; Rottem, M; Sanchez-Borges, M; Scadding, G K; Serrano, E; Schmid-Grendelmeier, P; Sheikh, A; Simons, F E R; Sisul, J C; Skrindo, I; Smit, H A; Solé, D; Sooronbaev, T; Spranger, O; Stelmach, R; Strandberg, T; Sunyer, J; Thijs, C; Todo-Bom, A; Triggiani, M; Valenta, R; Valero, A L; van Hage, M; Vandenplas, O; Vezzani, G; Vichyanond, P; Viegi, G; Wagenmann, M; Walker, S; Wang, D Y; Wahn, U; Williams, D M; Wright, J; Yawn, B P; Yiallouros, P K; Yusuf, O M; Zar, H J; Zernotti, M E; Zhang, L; Zhong, N; Zidarn, M; Mercier, J

    2015-11-01

    Several unmet needs have been identified in allergic rhinitis: identification of the time of onset of the pollen season, optimal control of rhinitis and comorbidities, patient stratification, multidisciplinary team for integrated care pathways, innovation in clinical trials and, above all, patient empowerment. MASK-rhinitis (MACVIA-ARIA Sentinel NetworK for allergic rhinitis) is a simple system centred around the patient which was devised to fill many of these gaps using Information and Communications Technology (ICT) tools and a clinical decision support system (CDSS) based on the most widely used guideline in allergic rhinitis and its asthma comorbidity (ARIA 2015 revision). It is one of the implementation systems of Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Three tools are used for the electronic monitoring of allergic diseases: a cell phone-based daily visual analogue scale (VAS) assessment of disease control, CARAT (Control of Allergic Rhinitis and Asthma Test) and e-Allergy screening (premedical system of early diagnosis of allergy and asthma based on online tools). These tools are combined with a clinical decision support system (CDSS) and are available in many languages. An e-CRF and an e-learning tool complete MASK. MASK is flexible and other tools can be added. It appears to be an advanced, global and integrated ICT answer for many unmet needs in allergic diseases which will improve policies and standards. PMID:26148220

  3. MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): the new generation guideline implementation.

    PubMed

    Bousquet, J; Schunemann, H J; Fonseca, J; Samolinski, B; Bachert, C; Canonica, G W; Casale, T; Cruz, A A; Demoly, P; Hellings, P; Valiulis, A; Wickman, M; Zuberbier, T; Bosnic-Anticevitch, S; Bedbrook, A; Bergmann, K C; Caimmi, D; Dahl, R; Fokkens, W J; Grisle, I; Lodrup Carlsen, K; Mullol, J; Muraro, A; Palkonen, S; Papadopoulos, N; Passalacqua, G; Ryan, D; Valovirta, E; Yorgancioglu, A; Aberer, W; Agache, I; Adachi, M; Akdis, C A; Akdis, M; Annesi-Maesano, I; Ansotegui, I J; Anto, J M; Arnavielhe, S; Arshad, H; Baiardini, I; Baigenzhin, A K; Barbara, C; Bateman, E D; Beghé, B; Bel, E H; Ben Kheder, A; Bennoor, K S; Benson, M; Bewick, M; Bieber, T; Bindslev-Jensen, C; Bjermer, L; Blain, H; Boner, A L; Boulet, L P; Bonini, M; Bonini, S; Bosse, I; Bourret, R; Bousquet, P J; Braido, F; Briggs, A H; Brightling, C E; Brozek, J; Buhl, R; Burney, P G; Bush, A; Caballero-Fonseca, F; Calderon, M A; Camargos, P A M; Camuzat, T; Carlsen, K H; Carr, W; Cepeda Sarabia, A M; Chavannes, N H; Chatzi, L; Chen, Y Z; Chiron, R; Chkhartishvili, E; Chuchalin, A G; Ciprandi, G; Cirule, I; Correia de Sousa, J; Cox, L; Crooks, G; Costa, D J; Custovic, A; Dahlen, S E; Darsow, U; De Carlo, G; De Blay, F; Dedeu, T; Deleanu, D; Denburg, J A; Devillier, P; Didier, A; Dinh-Xuan, A T; Dokic, D; Douagui, H; Dray, G; Dubakiene, R; Durham, S R; Dykewicz, M S; El-Gamal, Y; Emuzyte, R; Fink Wagner, A; Fletcher, M; Fiocchi, A; Forastiere, F; Gamkrelidze, A; Gemicioğlu, B; Gereda, J E; González Diaz, S; Gotua, M; Grouse, L; Guzmán, M A; Haahtela, T; Hellquist-Dahl, B; Heinrich, J; Horak, F; Hourihane, J O 'b; Howarth, P; Humbert, M; Hyland, M E; Ivancevich, J C; Jares, E J; Johnston, S L; Joos, G; Jonquet, O; Jung, K S; Just, J; Kaidashev, I; Kalayci, O; Kalyoncu, A F; Keil, T; Keith, P K; Khaltaev, N; Klimek, L; Koffi N'Goran, B; Kolek, V; Koppelman, G H; Kowalski, M L; Kull, I; Kuna, P; Kvedariene, V; Lambrecht, B; Lau, S; Larenas-Linnemann, D; Laune, D; Le, L T T; Lieberman, P; Lipworth, B; Li, J; Louis, R; Magard, Y; Magnan, A; Mahboub, B; Majer, I; Makela, M J; Manning, P; De Manuel Keenoy, E; Marshall, G D; Masjedi, M R; Maurer, M; Mavale-Manuel, S; Melén, E; Melo-Gomes, E; Meltzer, E O; Merk, H; Miculinic, N; Mihaltan, F; Milenkovic, B; Mohammad, Y; Molimard, M; Momas, I; Montilla-Santana, A; Morais-Almeida, M; Mösges, R; Namazova-Baranova, L; Naclerio, R; Neou, A; Neffen, H; Nekam, K; Niggemann, B; Nyembue, T D; O'Hehir, R E; Ohta, K; Okamoto, Y; Okubo, K; Ouedraogo, S; Paggiaro, P; Pali-Schöll, I; Palmer, S; Panzner, P; Papi, A; Park, H S; Pavord, I; Pawankar, R; Pfaar, O; Picard, R; Pigearias, B; Pin, I; Plavec, D; Pohl, W; Popov, T A; Portejoie, F; Postma, D; Potter, P; Price, D; Rabe, K F; Raciborski, F; Radier Pontal, F; Repka-Ramirez, S; Robalo-Cordeiro, C; Rolland, C; Rosado-Pinto, J; Reitamo, S; Rodenas, F; Roman Rodriguez, M; Romano, A; Rosario, N; Rosenwasser, L; Rottem, M; Sanchez-Borges, M; Scadding, G K; Serrano, E; Schmid-Grendelmeier, P; Sheikh, A; Simons, F E R; Sisul, J C; Skrindo, I; Smit, H A; Solé, D; Sooronbaev, T; Spranger, O; Stelmach, R; Strandberg, T; Sunyer, J; Thijs, C; Todo-Bom, A; Triggiani, M; Valenta, R; Valero, A L; van Hage, M; Vandenplas, O; Vezzani, G; Vichyanond, P; Viegi, G; Wagenmann, M; Walker, S; Wang, D Y; Wahn, U; Williams, D M; Wright, J; Yawn, B P; Yiallouros, P K; Yusuf, O M; Zar, H J; Zernotti, M E; Zhang, L; Zhong, N; Zidarn, M; Mercier, J

    2015-11-01

    Several unmet needs have been identified in allergic rhinitis: identification of the time of onset of the pollen season, optimal control of rhinitis and comorbidities, patient stratification, multidisciplinary team for integrated care pathways, innovation in clinical trials and, above all, patient empowerment. MASK-rhinitis (MACVIA-ARIA Sentinel NetworK for allergic rhinitis) is a simple system centred around the patient which was devised to fill many of these gaps using Information and Communications Technology (ICT) tools and a clinical decision support system (CDSS) based on the most widely used guideline in allergic rhinitis and its asthma comorbidity (ARIA 2015 revision). It is one of the implementation systems of Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Three tools are used for the electronic monitoring of allergic diseases: a cell phone-based daily visual analogue scale (VAS) assessment of disease control, CARAT (Control of Allergic Rhinitis and Asthma Test) and e-Allergy screening (premedical system of early diagnosis of allergy and asthma based on online tools). These tools are combined with a clinical decision support system (CDSS) and are available in many languages. An e-CRF and an e-learning tool complete MASK. MASK is flexible and other tools can be added. It appears to be an advanced, global and integrated ICT answer for many unmet needs in allergic diseases which will improve policies and standards.

  4. The ethics of a clinical trial when the protocol clashes with international guidelines.

    PubMed

    Lan, N T N; Thu, N T N; Duc, N H; Lan, N N; Lien, T T X; Dung, N H; Taburet, A-M; Laureillard, D; Borand, L; Quillet, C; Lagarde, D; Pym, A; Connolly, C; Lienhardt, C; Rekacewicz, C; Harries, A D

    2013-06-21

    Due to their nature and complexity, clinical trials often take some time to launch after the protocol has been designed and ethics approval obtained. During this time, there may be changes in international treatment guidelines and recommendations that result in a conflict between study protocol and recommended international best practice. Here, we describe the situation that arose in a pharmacokinetic study on the use of two different doses of rifabutin in patients with human immunodeficiency virus-associated tuberculosis who initiated antiretroviral therapy (ART) with a lopinavir-ritonavir-based regimen in South Africa and Viet Nam. The study protocol specified that ART should be started 10 weeks after the start of anti-tuberculosis treatment. The study in South Africa was approved in June 2008, went ahead as scheduled and was completed in August 2010. The study in Viet Nam was approved in October 2008 and was started in June 2010. A few weeks later, the World Health Organization released their 2010 guidelines for adult ART; one of its strong recommendations (with moderate quality of evidence) was that ART should be started 2-8 weeks after the start of anti-tuberculosis treatment. Emerging scientific evidence also supported this recommendation. The investigators felt that the Viet Nam study protocol was in conflict with recommended international best practice, and the trial was stopped in October 2010. An amended study protocol in which ART was started at 2 weeks was developed and implemented. The ethics issues around this decision and the need to change the study protocol are discussed in this article.

  5. Methods of cognitive analysis to support the design and evaluation of biomedical systems: the case of clinical practice guidelines.

    PubMed

    Patel, V L; Arocha, J F; Diermeier, M; Greenes, R A; Shortliffe, E H

    2001-02-01

    This article provides a theoretical and methodological framework for the use of cognitive analysis to support the representation of biomedical knowledge and the design of clinical systems, using clinical-practice guidelines (CPGs) as an example. We propose that propositional and semantic analyses, when used as part of the system-development process, can improve the validity, usability, and comprehension of the resulting biomedical applications. The framework we propose is based on a large body of research on the study of how people mentally represent information and subsequently use it for problem solving. This research encompasses many areas of psychology, but the more important ones are the study of memory and the study of comprehension. Of particular relevance is research devoted to investigating the comprehension and memory of language, expressed verbally or in text. In addition, research on how contextual variables affect performance is informative because these psychological processes are influenced by situational variables (e.g., setting, culture). One important factor limiting the acceptance and use of clinical-practice guidelines (CPGs) may be the mismatch between a guideline's recommended actions and the physician-user's mental models of what seems appropriate in a given case. Furthermore, CPGs can be semantically complex, often composed of elaborate collections of prescribed procedures with logical gaps or contradictions that can promote ambiguity and hence frustration on the part of those who attempt to use them. An improved understanding of the semantics and structure of CPGs may help to improve such matching, and ultimately the comprehensibility and usability of CPGs. Cognitive methods of analysis can help guideline designers and system builders throughout the development process, from the conceptual design of a computer-based system to its implementation phases. By studying how guideline creators and developers represent guidelines, both mentally and

  6. Optimal management of Alzheimer’s disease patients: Clinical guidelines and family advice

    PubMed Central

    Haberstroh, Julia; Hampel, Harald; Pantel, Johannes

    2010-01-01

    Family members provide most of the patient care and administer most of the treatments to patients with Alzheimer’s disease (AD). Family caregivers have an important impact on clinical outcomes, such as quality of life (QoL). As a consequence of this service, family caregivers suffer high rates of psychological and physical illness as well as social and financial burdens. Hence, it is important to involve family caregivers in multimodal treatment settings and provide interventions that are both suitable and specifically tailored to their needs. In recent years, several clinical guidelines have been presented worldwide for evidence-based treatment of AD and other forms of dementia. Most of these guidelines have considered family advice as integral to the optimal clinical management of AD. This article reviews current and internationally relevant guidelines with emphasis on recommendations concerning family advice. PMID:20520788

  7. Implementing a Clinical Experience for Student Trainers.

    ERIC Educational Resources Information Center

    Compton, Rod

    Clinical experiences offered to students preparing to become athletic trainers at East Carolina University (North Carolina) are diverse and multiple. The program acquaints students with actual medical practices in sports medicine by allowing them to observe experienced trainers and doctors at work as well as providing opportunities for practical…

  8. A Cluster-randomized Trial of a Centralized Clinical Pharmacy Cardiovascular Risk Service to Improve Guideline Adherence

    PubMed Central

    Carter, Barry L.; Coffey, Christopher S.; Chrischilles, Elizabeth A.; Ardery, Gail; Ecklund, Dixie; Gryzlak, Brian; Vander Weg, Mark W.; James, Paul A.; Christensen, Alan J.; Parker, Christopher P.; Gums, Tyler; Finkelstein, Rachel J; Uribe, Liz; Polgreen, Linnea A.

    2015-01-01

    Background Numerous studies have demonstrated the value of including pharmacists in team-based care to improve adherence to cardiovascular (CV) guidelines, medication adherence and risk factor control but there is limited information on whether these models can be successfully implemented more widely in diverse settings and populations. The purpose of this study is to evaluate whether a centralized, web-based CV risk service (CVRS) managed by clinical pharmacists will improve guideline adherence in multiple primary care medical offices with diverse geographic and patient characteristics. Methods This study is a prospective trial in 20 primary care offices stratified by the percent of under-represented minorities and then randomized to either the CVRS intervention or usual care. The intervention will last for 12 months and all subjects will have research visits at baseline and 12 months. The primary outcome is the difference in guideline adherence between groups. Data will also be abstracted from the medical record at 24 months to determine if the intervention effect is sustained after it is discontinued. Conclusions This study expects to enroll subjects through 2016 with results expected in 2019. This study will provide information on whether a distant, centralized CV risk service can be implemented in large numbers of medical offices, if it is effective in diverse populations, and if the effect can be sustained long-term. PMID:26111939

  9. Guidelines for a graph-theoretic implementation of structural equation modeling

    USGS Publications Warehouse

    Grace, James B.; Schoolmaster, Donald R.; Guntenspergen, Glenn R.; Little, Amanda M.; Mitchell, Brian R.; Miller, Kathryn M.; Schweiger, E. William

    2012-01-01

    Structural equation modeling (SEM) is increasingly being chosen by researchers as a framework for gaining scientific insights from the quantitative analyses of data. New ideas and methods emerging from the study of causality, influences from the field of graphical modeling, and advances in statistics are expanding the rigor, capability, and even purpose of SEM. Guidelines for implementing the expanded capabilities of SEM are currently lacking. In this paper we describe new developments in SEM that we believe constitute a third-generation of the methodology. Most characteristic of this new approach is the generalization of the structural equation model as a causal graph. In this generalization, analyses are based on graph theoretic principles rather than analyses of matrices. Also, new devices such as metamodels and causal diagrams, as well as an increased emphasis on queries and probabilistic reasoning, are now included. Estimation under a graph theory framework permits the use of Bayesian or likelihood methods. The guidelines presented start from a declaration of the goals of the analysis. We then discuss how theory frames the modeling process, requirements for causal interpretation, model specification choices, selection of estimation method, model evaluation options, and use of queries, both to summarize retrospective results and for prospective analyses. The illustrative example presented involves monitoring data from wetlands on Mount Desert Island, home of Acadia National Park. Our presentation walks through the decision process involved in developing and evaluating models, as well as drawing inferences from the resulting prediction equations. In addition to evaluating hypotheses about the connections between human activities and biotic responses, we illustrate how the structural equation (SE) model can be queried to understand how interventions might take advantage of an environmental threshold to limit Typha invasions. The guidelines presented provide for

  10. Compliance with clinical trial registration and reporting guidelines by Latin American and Caribbean journals.

    PubMed

    Reveiz, Ludovic; Villanueva, Eleana; Iko, Chimaraoke; Simera, Iveta

    2013-06-01

    The objective of this study was to determine to what extent Latin American and Caribbean biomedical journals have endorsed and complied with clinical trial registration and reporting guidelines. A search of randomized clinical trials was carried out using the LILACS database. The randomized clinical trials identified through the search were assessed to determine whether trial registration and CONSORT guidance was mentioned. Information regarding endorsement of the ICMJE, trial registration and other reporting guidelines was extracted from the online instructions for authors of the journals included in the study. The search identified 477 references. We assessed a random sample of 240 titles of which 101 were randomized clinical trials published in 56 journals. Trial registration was reported in 19.8% of the randomized clinical trials, 6.9% were prospectively registered and 3% mentioned CONSORT. The ICMJE was mentioned by 68% of the journals and 36% of journals required trial registration. Fewer journals provided advice on reporting guidelines: CONSORT (13%), PRISMA (1.8%), STROBE (1.8%), and the EQUATOR network (3.6%). Wider endorsement of trial registration and adherence to reporting guidelines is necessary in clinical trials conducted in Latin America and the Caribbean.

  11. The updating of clinical practice guidelines: insights from an international survey

    PubMed Central

    2011-01-01

    Background Clinical practice guidelines (CPGs) have become increasingly popular, and the methodology to develop guidelines has evolved enormously. However, little attention has been given to the updating process, in contrast to the appraisal of the available literature. We conducted an international survey to identify current practices in CPG updating and explored the need to standardize and improve the methods. Methods We developed a questionnaire (28 items) based on a review of the existing literature about guideline updating and expert comments. We carried out the survey between March and July 2009, and it was sent by email to 106 institutions: 69 members of the Guidelines International Network who declared that they developed CPGs; 30 institutions included in the U.S. National Guideline Clearinghouse database that published more than 20 CPGs; and 7 institutions selected by an expert committee. Results Forty-four institutions answered the questionnaire (42% response rate). In the final analysis, 39 completed questionnaires were included. Thirty-six institutions (92%) reported that they update their guidelines. Thirty-one institutions (86%) have a formal procedure for updating their guidelines, and 19 (53%) have a formal procedure for deciding when a guideline becomes out of date. Institutions describe the process as moderately rigorous (36%) or acknowledge that it could certainly be more rigorous (36%). Twenty-two institutions (61%) alert guideline users on their website when a guideline is older than three to five years or when there is a risk of being outdated. Twenty-five institutions (64%) support the concept of "living guidelines," which are continuously monitored and updated. Eighteen institutions (46%) have plans to design a protocol to improve their guideline-updating process, and 21 (54%) are willing to share resources with other organizations. Conclusions Our study is the first to describe the process of updating CPGs among prominent guideline

  12. Clinical Practice Guideline of Acute Respiratory Distress Syndrome

    PubMed Central

    Cho, Young-Jae; Moon, Jae Young; Shin, Ein-Soon; Kim, Je Hyeong; Jung, Hoon; Park, So Young; Kim, Ho Cheol; Sim, Yun Su; Rhee, Chin Kook; Lim, Jaemin; Lee, Seok Jeong; Lee, Won-Yeon; Lee, Hyun Jeong; Kwak, Sang Hyun; Kang, Eun Kyeong; Chung, Kyung Soo

    2016-01-01

    There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients. PMID:27790273

  13. Guidelines for the clinical application of the LCP.

    PubMed

    Gautier, Emanuel; Sommer, Christoph

    2003-11-01

    The Locking Compression Plate (LCP), in combination with the LISS and the PHILOS, is part of a new plate generation requiring an adapted surgical technique and new thinking about commonly used concepts of internal fixation using plates. The following guidelines are needed to avoid failures and possible complications in the hands of surgeons not yet confident with the new implant philosophy. The importance of the reduction technique and minimal-invasive plate insertion and fixation is addressed to keep bone viability undisturbed. Understanding of mechanical background for choosing the proper implant length and the type and number of screws is essential to obtain a sound fixation with a high plate span ratio and a low plate screw density. A high plate span ration decreases the load onto the plate. A high working length of the plate in turn reduces the screw loading, thus fewer screws need to be inserted and the plate screw density can be kept low. Knowledge of the working length of the screw is helpful for the proper choice of monocortical or bicortical screws. Selection is done according to the quality of the bone structure and is important to avoid problems at the screw thread bone interface with potential pullout of screws and secondary displacement. Conclusive rules are given at the end of this chapter.

  14. Guidelines for clinical engineering programs--Part I: guidelines for electrical isolation; Part II: performance evaluation of clinical engineering programs.

    PubMed

    Ridgway, M

    1980-01-01

    This series presents guidelines for: electrically isolated inputs and outputs; measuring the performance of hospital biomedical engineering programs; evaluating the risk of electric shock in hospitals; and for isolated power in anesthetizing locations. In Part I, specific recommendations are given for the use of insulated approach, battery-powered monitors in surgery, and for isolation requirements for devices connected to cardiac leads. In Part II, checklists are provided for the self-evaluation of an in-house, biomedical engineering staff. Parts III and IV, in future issues of this Journal, will include discussion of the theoretical electrical hazard potential in reference to the use of isolated power systems. The question of whether isolated power should be required in all anesthetizing locations will be discussed in Part IV.

  15. 78 FR 17679 - Implementation of the Updated American Veterinary Medical Association Guidelines for the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-22

    ... Association Guidelines for the Euthanasia of Animals: 2013 Edition SUMMARY: The National Institutes of Health... the American Veterinary Medical Association (AVMA) Guidelines for the Euthanasia of Animals: 2013... updated Guidelines. DATES: Public concerns regarding the updated AVMA Guidelines for the Euthanasia...

  16. Pediatric guidelines for dyslipidemia.

    PubMed

    Daniels, Stephen R

    2015-01-01

    Clinical guidelines are developed to assist clinicians in complex clinical decision making. Modern guideline development includes a systematic review and grading of relevant literature and then using the evidence review to construct recommendations for clinical care which are also graded regarding the level of evidence supporting them. Pediatric guidelines for dyslipidemia were first published in 1992. There was then a gap during which no formal guidelines were developed. In 2011, the National Heart, Lung, and Blood Institute Integrated Guidelines for Cardiovascular Disease Risk Reduction in Children were published. This included an evidence review and clinical recommendations regarding dyslipidemia. This review process began in 2006. The evidence review ended in 2008, and they were published in 2011 because of an extensive and prolonged review process. These guidelines recommend universal screening for dyslipidemia at age 9 to 11 y with a focus on identifying young individuals with genetic dyslipidemia such as familial hypercholesterolemia. The guidelines also include lifestyle recommendations and recommendations for pharmacologic treatment for children with markedly elevated low-density lipoprotein cholesterol. The guideline process should include review of the implementation of guidelines in practice and should also include ongoing review of the guidelines with respect to a growing evidence base with new research findings.

  17. The Non-Verbal Child: Some Clinical Guidelines.

    ERIC Educational Resources Information Center

    Stark, Joel; And Others

    Selected principles and procedures related to language training for nonverbal children are presented. The participating children are 3 to 6 years of age and are enrolled at a clinic for a minimal of 3 hours of individual therapy a week. The language problems vary considerably. The possibility of some central nervous system dysfunction is thought…

  18. Ills from the womb? A critical examination of clinical guidelines for obesity in pregnancy.

    PubMed

    Jette, Shannon; Rail, Geneviève

    2013-07-01

    In this article, we critically examine the clinical guidelines for obesity in pregnancy put forth by the Society of Obstetricians and Gynaecologists of Canada (SOGC) that are underpinned by the rules of Evidence-Based Medicine (EBM), a system of ranking knowledge that promises to provide unbiased evidence about the effectiveness of treatments. While the SOGC guidelines are intended to direct health practitioners on 'best practice' as they address pregnancy weight gain with clients in the clinical context, we question their usefulness, arguing that despite their commitment to objectivity, they remain mired in cultural biases that stigmatize large female bodies and associates them to 'unfit' mothers.

  19. Genesis of Changes to Legislation and Guidelines that Regulate Clinical Trials.

    PubMed

    Davis, Brian

    2015-01-01

    The genesis of changes to legislation and guidelines that regulate the development and licensing of medicines is complex and involves discussion and negotiation among a large number of people with different aims, interests and starting points. Those proposing a change to the way clinical trials are conducted need therefore to promote their proposal within the groups established for bringing forward changes to the guidance and legislation by participation in or responding to consultations. This paper reviews established European Union, United Kingdom and International procedures that would have to be used to introduce changes to clinical trials guidelines and legislation.

  20. Literature review with PGI guidelines for delineation of clinical target volume for intact carcinoma cervix.

    PubMed

    Bansal, Anshuma; Patel, Firuza D; Rai, Bhavana; Gulia, Abhishek; Dhanireddy, Bhaswanth; Sharma, S C

    2013-01-01

    For definitive treatment of carcinoma cervix with conformal radiation techniques, accurate target delineation is vitally important, yet a consensus definition of clinical target volume (CTV) remains variable within the literature. The aim of the present article is to review the guidelines for CTV delineation published in the literature and to present the guidelines practiced at our institute. For this a literature pub med/medline search was performed from January 2000 to December 2012 and reviewed to identify published articles on guidelines for CTV primary and pelvic lymph node (LN) delineation for carcinoma cervix. Taking into consideration the traditional bony landmark based fields for treating cancer cervix, the knowledge of the patterns of disease spread and recurrence and the findings from imaging studies identifying typical anatomic distributions of areas at risk of harbouring subclinical disease, the differences in various guidelines have been analyzed and discussed. The CTV in cervical cancer consists of the CTV nodal and CTV primary. In all the published guidelines, CTV nodal consists of common iliac, external iliac, internal iliac, pre-sacral and obturator group of lymph nodes, and CTV primary consists of the gross tumor volume, uterine cervix, uterine corpus, parametrium, upper third of vagina and uterosacral ligaments. The various guidelines differ however, in the definition for these individual component structures. This is the first report to provide the complete set of guidelines for delineating both the CTV primary and CTV nodal in combination.

  1. Health Promotion Board–Ministry of Health Clinical Practice Guidelines: Obesity

    PubMed Central

    Lee, Yung Seng; Biddle, Stuart; Chan, Mei Fen; Cheng, Anton; Cheong, Magdalin; Chong, Yap Seng; Foo, Ling Li; Lee, Chung Horn; Lim, Su Chi; Ong, Wee Sian; Pang, Jonathan; Pasupathy, Shanker; Sloan, Robert; Seow, Mollie; Soon, Grace; Tan, Benedict; Tan, Thiam Chye; Teo, Soo Lay; Tham, Kwang Wei; van Dam, Rob M; Wang, John

    2016-01-01

    The Health Promotion Board (HPB) has developed the Clinical Practice Guidelines (CPG) on Obesity to provide health professionals in Singapore with recommendations for evidence-based interventions for obesity. This article summarises the introduction, epidemiology and executive summary of the key recommendations from the HPB-MOH CPG on Obesity for the information of SMJ readers. The chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Health Promotion Board website: http://www.hpb.gov.sg/cpg-obesity. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines. PMID:27353244

  2. Measure Guideline: Implementing a Plenum Truss for a Compact Air Distribution System

    SciTech Connect

    Burdick, A.

    2013-10-01

    This Measure Guideline presents the steps to implement a compact duct system inside an attic bulkhead (plenum truss) of a one-story, slab-on-grade home. In a compact duct design, ductwork runs are reduced in length to yield a smaller and more compact duct system. Less energy will be lost through ductwork if the ducts are contained within the thermal enclosure of the house. These measures are intended for the production builder working to meet the 2012 International Energy Conservation Code (IECC) requirements and keep the ductwork within the thermal enclosure of the house. This measure of bringing the heating, ventilation and air conditioning (HVAC) equipment and ductwork within the thermal enclosure of the house is appropriate for the builder wishing to avoid cathedralizing the insulation in the attic space (i.e., locating it at the underside of the roof deck rather than along the attic floor) or adding dropped soffits.

  3. Measure Guideline: Implementing a Plenum Truss for a Compact Air Distribution System

    SciTech Connect

    Burdick, A.

    2013-10-01

    This Measure Guideline presents the steps to implement a compact duct system inside an attic bulkhead (plenum truss) of a one-story, slab-on-grade (SOG) home. In a compact duct design, ductwork runs are reduced in length to yield a smaller and more compact duct system. Less energy will be lost through ductwork if the ducts are contained within the thermal enclosure of the house. These measures are intended for the production builder working to meet the 2012 International Energy Conservation Code (IECC) requirements and keep the ductwork within the thermal enclosure of the house. This measure of bringing the heating, ventilation and air conditioning (HVAC) equipment and ductwork within the thermal enclosure of the house is appropriate for the builder wishing to avoid cathedralizing the insulation in the attic space (i.e., locating it at the underside of the roof deck rather than along the attic floor) or adding dropped soffits.

  4. Reducing inadvertent clinical errors: Guidelines from functional analytic psychotherapy.

    PubMed

    Tsai, Mavis; Mandell, Tien; Maitland, Daniel; Kanter, Jonathan; Kohlenberg, Robert J

    2016-09-01

    Two common types of clinical errors, inadvertently reinforcing client problem behaviors or inadvertently punishing client improvements, are conceptualized from the viewpoint of Functional Analytic Psychotherapy (FAP), a treatment that harnesses the power of the therapeutic relationship. Understanding the functions of client behaviors such as incessant talking and over compliance can lead to more compassionate and effective intervention, and a functional analysis of seemingly problematic behaviors such as silence and lack of cooperation indicate how they may be client improvements. Suggestions are provided for how to more accurately conceptualize whether client behaviors are problems or improvements, and to increase awareness of therapist vulnerabilities that can lead to errors. While FAP is rooted in a functional contextual philosophy, the goal of this article is to offer a framework that crosses theoretical boundaries to decrease the likelihood of clinical errors and to facilitate client growth. (PsycINFO Database Record PMID:27631862

  5. Implementation of EU discharge guidelines at IVAR's Regional Wastewater Treatment Plant of North Jaeren, Stavanger, Norway.

    PubMed

    Tornes, O

    2001-01-01

    Norway is a leading country on wastewater treatment comprising chemical precipitation processes. This is because Norwegian effluent standards to the North Sea have traditionally focused on phosphorus removal. In most cases, chemical treatment therefore has been considered to give lower investment and operating costs than biological treatment. Norwegian wastewater policy and management is based on the EU guidelines resulting from the EEA (European Economic Area) Agreement. According to the 1991 Urban Wastewater Treatment Directive, this will in most cases require secondary treatment. However, primary treatment can be accepted for plants larger than 10,000 PT with effluents to less sensitive coastal areas, if no negative environmental impacts can be proved. The main objective of the Regional Water, Sewerage and Waste Company (IVAR) is to comply with the prevailing effluent limits at lowest possible cost. During the past four years, IVAR has therefore undertaken comprehensive optimising of the precipitation process including full-scale experiments with different coagulant dosing control systems and different types of coagulants. IVAR also accomplished a feasibility study of introducing biological treatment as an alternative to chemical treatment. Under the prevailing frame conditions of discharge requirements and sludge deposit costs, it is not economically feasible to change to organic coagulants or biological treatment. This conclusion might have to be altered resulting from the implementation of new EU regulations and increasing sludge deposit costs. This paper presents results from full-scale experiments, extracts from the feasibility study and a comparison of costs. Furthermore, the practical consequences of implementing the EU-guidelines are discussed.

  6. Clinical guideline for diagnosis and management of melioidosis.

    PubMed

    Inglis, Timothy J J; Rolim, Dionne B; Rodriguez, Jorge L N

    2006-01-01

    Melioidosis is an emerging infection in Brazil and neighbouring South American countries. The wide range of clinical presentations include severe community-acquired pneumonia, septicaemia, central nervous system infection and less severe soft tissue infection. Diagnosis depends heavily on the clinical microbiology laboratory for culture. Burkholderia pseudomallei, the bacterial cause of melioidosis, is easily cultured from blood, sputum and other clinical samples. However, B. pseudomallei can be difficult to identify reliably, and can be confused with closely related bacteria, some of which may be dismissed as insignificant culture contaminants. Serological tests can help to support a diagnosis of melioidosis, but by themselves do not provide a definitive diagnosis. The use of a laboratory discovery pathway can help reduce the risk of missing atypical B. pseudomallei isolates. Recommended antibiotic treatment for severe infection is either intravenous Ceftazidime or Meropenem for several weeks, followed by up to 20 weeks oral treatment with a combination of trimethoprim-sulphamethoxazole and doxycycline. Consistent use of diagnostic microbiology to confirm the diagnosis, and rigorous treatment of severe infection with the correct antibiotics in two stages; acute and eradication, will contribute to a reduction in mortality from melioidosis. PMID:16547571

  7. Common errors and clinical guidelines for manual muscle testing: "the arm test" and other inaccurate procedures

    PubMed Central

    Schmitt, Walter H; Cuthbert, Scott C

    2008-01-01

    Background The manual muscle test (MMT) has been offered as a chiropractic assessment tool that may help diagnose neuromusculoskeletal dysfunction. We contend that due to the number of manipulative practitioners using this test as part of the assessment of patients, clinical guidelines for the MMT are required to heighten the accuracy in the use of this tool. Objective To present essential operational definitions of the MMT for chiropractors and other clinicians that should improve the reliability of the MMT as a diagnostic test. Controversy about the usefulness and reliability of the MMT for chiropractic diagnosis is ongoing, and clinical guidelines about the MMT are needed to resolve confusion regarding the MMT as used in clinical practice as well as the evaluation of experimental evidence concerning its use. Discussion We expect that the resistance to accept the MMT as a reliable and valid diagnostic tool will continue within some portions of the manipulative professions if clinical guidelines for the use of MMT methods are not established and accepted. Unreliable assessments of this method of diagnosis will continue when non-standard MMT research papers are considered representative of the methods used by properly trained clinicians. Conclusion Practitioners who employ the MMT should use these clinical guidelines for improving their use of the MMT in their assessments of muscle dysfunction in patients with musculoskeletal pain. PMID:19099575

  8. Recruiting egg donors online: an analysis of IVF clinic and agency websites’ adherence to ASRM guidelines

    PubMed Central

    Keehn, Jason; Holwell, Eve; Abdul-Karim, Ruqayyah; Chin, Lisa Judy; Leu, Cheng-Shiun; Sauer, Mark V.; Klitzman, Robert

    2012-01-01

    OBJECTIVE To examine compliance with ASRM's ethical guidelines regarding trait-based payment variation, presentation of risks and minimum recruitment age. DESIGN In June 2010, we systematically examined 207 websites, of which 102 were egg donor agency or IVF clinic websites that both recruited online and displayed compensation amounts. SETTING The Internet MAIN OUTCOME MEASURES Mention of increased payment for particular donor traits, recruitment age below 21, noting risks to donors. RESULTS Of the 102 sites, considerable numbers were non-compliant with ASRM's guidelines that prohibit varying compensation based on a donor's traits (34%), recommend an age of 21 or above (41%) and presentation of risks alongside compensation (56%). Trait-based payment variation was associated with being an agency rather than a clinic (p<.001), location in the West (p<.001), not being endorsed by ASRM or SART (p<.001), and referring to ASRM's guidelines about compensation (p<.001). Of sites mentioning traits, prior donation success was the most commonly paid for trait (64%). CONCLUSION Our data, the first to systematically analyze agency and clinic websites reveal that a large proportion do not follow ASRM's guidelines. These data have critical implications for policy, practice and research, suggesting needs for consideration of possible changes in guidelines, and/or improvements in compliance and monitoring by ASRM or others. PMID:22840240

  9. Clinical practice guidelines for prophylaxis of venous thomboembolism in cancer patients.

    PubMed

    Frere, Corinne; Farge, Dominique

    2016-09-27

    Symptomatic venous thromboembolism (VTE) occurs 4-7 times more frequently in cancer patients as compared to non-cancer patients. A significant number of risk factors, which can be subcategorised as patient-, cancer- or treatment-related, have been shown to influence the risk of VTE during malignancy and further incorporated in risk-assessment models. Safe and efficient thromboprophylaxis regimens allow substantial decreased in VTE rates, since VTE is most often a largely preventable disease, but thromboprophylaxis remains underused in cancer compared to non-cancer patients. If thromboprophylaxis is warranted in cancer patients undergoing surgery or hospitalised for acute medical illness or with a lower mobility in the absence of contraindications to anticoagulants, its benefit remains controversial in outpatients and may be limited to locally advanced or metastatic pancreatic or lung cancer treated with chemotherapy. The International Initiative on Thrombosis and Cancer-CME free mobile app (ios and android), based on the International Clinical Practice Guidelines (CPG), facilitates their implementation and dissemination of knowledge worldwide so as to improve VTE treatment and prophylaxis in cancer patients. PMID:27608595

  10. Developing clinical practice guidelines: types of evidence and outcomes; values and economics, synthesis, grading, and presentation and deriving recommendations

    PubMed Central

    2012-01-01

    Clinical practice guidelines are one of the foundations of efforts to improve healthcare. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearinghouses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this second paper, we discuss issues of identifying and synthesizing evidence: deciding what type of evidence and outcomes to include in guidelines; integrating values into a guideline; incorporating economic considerations; synthesis, grading, and presentation of evidence; and moving from evidence to recommendations. PMID:22762158

  11. KDOQI US commentary on the 2013 KDIGO Clinical Practice Guideline for Lipid Management in CKD.

    PubMed

    Sarnak, Mark J; Bloom, Roy; Muntner, Paul; Rahman, Mahboob; Saland, Jeffrey M; Wilson, Peter W F; Fried, Linda

    2015-03-01

    The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) guideline for management of dyslipidemia in chronic kidney disease (CKD) was published in 2003. Since then, considerable evidence, including randomized controlled trials of statin therapy in adults with CKD, has helped better define medical treatments for dyslipidemia. In light of the new evidence, KDIGO (Kidney Disease: Improving Global Outcomes) formed a work group for the management of dyslipidemia in patients with CKD. This work group developed a new guideline that contains substantial changes from the prior KDOQI guideline. KDIGO recommends treatment of dyslipidemia in patients with CKD primarily based on risk for coronary heart disease, which is driven in large part by age. The KDIGO guideline does not recommend using low-density lipoprotein cholesterol level as a guide for identifying individuals with CKD to be treated or as treatment targets. Initiation of statin treatment is no longer recommended in dialysis patients. To assist US practitioners in interpreting and applying the KDIGO guideline, NKF-KDOQI convened a work group to write a commentary on this guideline. For the most part, our work group agreed with the recommendations of the KDIGO guideline, although we describe several areas in which we believe the guideline statements are either too strong or need to be more nuanced, areas of uncertainty and inconsistency, as well as additional research recommendations. The target audience for the KDIGO guideline includes nephrologists, primary care practitioners, and non-nephrology specialists such as cardiologists and endocrinologists. As such, we also put the current recommendations into the context of other clinical practice recommendations for cholesterol treatment.

  12. Improving biological relevancy of transcriptional biomarkers experiments by applying the MIQE guidelines to pre-clinical and clinical trials.

    PubMed

    Dooms, M; Chango, A; Barbour, E; Pouillart, P; Abdel Nour, A M

    2013-01-01

    The "Minimum Information for the Publication of qPCR Experiments" (MIQE [3]) guidelines are very much targeted at basic research experiments and have to our knowledge not been applied to qPCR assays carried out in the context of clinical trials. This report details the use of the MIQE qPCR app for iPhone (App Store, Apple) to assess the MIQE compliance of one clinical and five pre-clinical trials. This resulted in the need to include 14 modifications that make the guidelines more relevant for the assessment of this special type of application. We also discuss the need for flexibility, since while some parameters increase experimental quality, they also require more reagents and more time, which is not always feasible in a clinical setting. PMID:22910527

  13. Implementing ACCM critical care guidelines for septic shock management in a Cuban pediatric intensive care unit.

    PubMed

    Cartaya, José M; Rovira, Luis E; Segredo, Yamilet; Alvarez, Idalys; Acevedo, Yoandra; Moya, Ariel

    2014-01-01

    INTRODUCTION Sepsis is the most common direct cause of death worldwide and septic shock the syndrome's most serious complication. In 2002, the pediatric intensive care unit of the José Luis Miranda Pediatric University Hospital in Santa Clara (Villa Clara Province), Cuba, began implementing the recently published guidelines of the American College of Critical Care Medicine (ACCM) for management of pediatric and neonatal septic shock, observing a drop in case fatality from 34.6% to 19% between the years 2003 and 2007. ACCM updated these Guidelines in 2007. OBJECTIVE Describe experiences with the use of the 2007 ACCM updated Guidelines and discuss their possible impact in reducing case fatality. METHODS Between 2008 and 2010, a study was conducted of 280 children and adolescents, from newborns through 18 years, admitted to the pediatric intensive care unit with a diagnosis of septic shock. The diagnostic and therapeutic criteria used were those recommended in the ACCM's 2007 updated Guidelines. The dependent variable was case fatality. Independent variables were age, sex, comorbidity or prior chronic disease, origin and course of sepsis, hemodynamic state, blood glucose level, hyperglycemia, organ dysfunction, volume of fluid therapy administered, use of mechanical ventilation and therapeutic response. RESULTS In the 3-year period, 28-day case fatality was 11.1% (31/280). A total of 45 patients had comorbidities, with 14 deaths and a case fatality rate of 31.1% vs. 7.2% (17/235) in previously healthy patients. Cold shock with a hemodynamic state of low cardiac output and high systemic vascular resistance predominated (68.9%), with low cardiac output and low systemic vascular resistance the least common type (12.5%), but the one with highest case fatality (34.4%). Hyperglycemia was present in 39.6% of patients, with 15.3% case fatality; case fatality was higher (25.6%) when hyperglycemia was in the 10-15.9 mmol/L range. Fluid therapy of 40-100 mL/kg was administered

  14. Challenges in implementing the new BASHH guidelines for the management of gonorrhoea.

    PubMed

    Rodgers, S; Murgatroyd, M; Perez, K; Kingston, M; Lee, V

    2014-02-01

    Neisseria gonorrhoeae has progressively developed reduced sensitivity to different classes of antibiotics. The British Association for Sexual Health and HIV (BASHH) updated guidelines for the diagnosis and management of gonorrhoea in 2011. New recommendations include an increased dose of ceftriaxone with adjuvant use of azithromycin, as well as test of cure (TOC) in all cases. We present an audit of adherence to new antibiotic prescribing guidelines as well as TOC uptake in an inner city genitourinary medicine clinic. Among the 271 (242 male, 29 female) patients included, 96% (n = 260) received the new first-line treatment. Test of cure uptake was found to be suboptimal at 55% (n = 149) with the majority (67%) of these taking place within 20 days of treatment. The new first-line treatment for gonorrhoea is feasible and generally accepted by patients. However the TOC uptake is low, emphasising the need for robust follow-up and recall policies. Further study is required into the optimal timing for TOC.

  15. [Clinical guidelines for infantile-onset Pompe disease].

    PubMed

    Pascual-Pascual, S I; Nascimento, A; Fernandez-Llamazares, C M; Medrano-Lopez, C; Villalobos-Pinto, E; Martinez-Moreno, M; Ley, M; Manrique-Rodriguez, S; Blasco-Alonso, J

    2016-09-16

    Infantile-onset Pompe disease has a fatal prognosis in the short term unless it is diagnosed at an early stage and enzyme replacement therapy is not started as soon as possible. A group of specialists from different disciplines involved in this disease have reviewed the current scientific evidence and have drawn up an agreed series of recommendations on the diagnosis, treatment and follow-up of patients. We recommend establishing enzyme treatment in any patient with symptomatic Pompe disease with onset within the first year of life, with a clinical and enzymatic diagnosis, and once the CRIM (cross-reactive immunological material) status is known.

  16. [Clinical guidelines for infantile-onset Pompe disease].

    PubMed

    Pascual-Pascual, S I; Nascimento, A; Fernandez-Llamazares, C M; Medrano-Lopez, C; Villalobos-Pinto, E; Martinez-Moreno, M; Ley, M; Manrique-Rodriguez, S; Blasco-Alonso, J

    2016-09-16

    Infantile-onset Pompe disease has a fatal prognosis in the short term unless it is diagnosed at an early stage and enzyme replacement therapy is not started as soon as possible. A group of specialists from different disciplines involved in this disease have reviewed the current scientific evidence and have drawn up an agreed series of recommendations on the diagnosis, treatment and follow-up of patients. We recommend establishing enzyme treatment in any patient with symptomatic Pompe disease with onset within the first year of life, with a clinical and enzymatic diagnosis, and once the CRIM (cross-reactive immunological material) status is known. PMID:27600742

  17. Methodology guideline for clinical studies investigating traditional Chinese medicine and integrative medicine: executive summary.

    PubMed

    Liu, Jian-Ping; Chen, Ke-Ji

    2015-10-01

    This guideline aims to provide a methodological guidance for clinical studies in TCM and integrative medicine in terms of study design, execution, and reporting. The commonly used methods including experimental and observational methods were introduced in this guideline such as randomized clinical trials, cohort study, case-control study, case series, and qualitative method which can be incorporated into above quantitative methods. The guideline can be used for the evaluation of therapeutic effect of TCM therapies or their combination with conventional therapy. TCM therapy refers to one of the followings or their combination: herbal medicine, acupuncture, moxibustion, cupping, Taichi/Qigong, and Guasha,Tuina (therapeutic massage). It is also suitable for research and development of ethnopharmaceuticals or folk medicine.

  18. Methodology guideline for clinical studies investigating traditional Chinese medicine and integrative medicine: executive summary.

    PubMed

    Liu, Jian-Ping; Chen, Ke-Ji

    2015-10-01

    This guideline aims to provide a methodological guidance for clinical studies in TCM and integrative medicine in terms of study design, execution, and reporting. The commonly used methods including experimental and observational methods were introduced in this guideline such as randomized clinical trials, cohort study, case-control study, case series, and qualitative method which can be incorporated into above quantitative methods. The guideline can be used for the evaluation of therapeutic effect of TCM therapies or their combination with conventional therapy. TCM therapy refers to one of the followings or their combination: herbal medicine, acupuncture, moxibustion, cupping, Taichi/Qigong, and Guasha,Tuina (therapeutic massage). It is also suitable for research and development of ethnopharmaceuticals or folk medicine. PMID:26615617

  19. [Clinical practice guideline. Diagnosis and treatment of postmenopausal and perinemopausia].

    PubMed

    Alvarado-García, Alberto; Hernández-Quijano, Tomás; Hernández-Valencia, Marcelino; Negrín-Pérez, Miriam Concepción; Ríos-Castillo, Brendha; Valencia-Pérez, Gregorio Urbano; Vital-Reyes, Víctor Saúl; Basavilvazo-Rodríguez, María Antonia; Torres-Arreola, Laura Pilar; Ortiz-Luna, Guillermo Federico; Sánchez-Aguirre, Fernando; Montaño-Uscanga, Armando

    2015-01-01

    Post-menopause is the period of life where a deep decline occurs in circulating estrogen levels, inducing the appearance of psycho and somatic symptoms. The classification to understand the chronology of reproductive aging in women (known as STRAW) determines the clinical and endocrine changes contemplating menstrual cycles, symptoms, measurements of FSH, LH, inhibin B, anti-Mullerian hormone , and follicular account. The diagnosis of menopause is established by the absence of menstruation for 12 months or more. The most frequent clinical manifestations of the climacteric syndrome transition to menopause are menstrual disorders, vasomotor symptoms (flushes and/or sweats) and genitourinary manifestations. The assessment of women in the peri- or postmenopause aims to develop: cervicovaginal cytology , lipid profile , serum glucose, basal Mammography at least a year before, pelvic ultrasound, urinalysis, serum TSH, Densitometry in patients older than 60 years if there is no recourse can be applied and FRAX. Drug therapy for the treatment of disorders of the transition to menopause or menopause is divided into: hormone therapy (HT) based estrogens and progestin hormone not being the most recommended the serotonin reuptake inhibitors and norepinephrine, clonidine, gabapentin or veralipride.

  20. Developing and implementing computerized protocols for standardization of clinical decisions.

    PubMed

    Morris, A H

    2000-03-01

    Humans have only a limited ability to incorporate information in decision making. In certain situations, the mismatch between this limitation and the availability of extensive information contributes to the varying performance and high error rate of clinical decision makers. Variation in clinical practice is due in part to clinicians' poor compliance with guidelines and recommended therapies. The use of decision-support tools is a response to both the information revolution and poor compliance. Computerized protocols used to deliver decision support can be configured to contain much more detail than textual guidelines or paper-based flow diagrams. Such protocols can generate patient-specific instructions for therapy that can be carried out with little interclinician variability; however, clinicians must be willing to modify personal styles of clinical management. Protocols need not be perfect. Several defensible and reasonable approaches are available for clinical problems. However, one of these reasonable approaches must be chosen and incorporated into the protocol to promote consistent clinical decisions. This reasoning is the basis of an explicit method of decision support that allows the rigorous evaluation of interventions, including use of the protocols themselves. Computerized protocols for mechanical ventilation and management of intravenous fluid and hemodynamic factors in patients with the acute respiratory distress syndrome provide case studies for this discussion. PMID:10691588

  1. Developing and implementing computerized protocols for standardization of clinical decisions.

    PubMed

    Morris, A H

    2000-03-01

    Humans have only a limited ability to incorporate information in decision making. In certain situations, the mismatch between this limitation and the availability of extensive information contributes to the varying performance and high error rate of clinical decision makers. Variation in clinical practice is due in part to clinicians' poor compliance with guidelines and recommended therapies. The use of decision-support tools is a response to both the information revolution and poor compliance. Computerized protocols used to deliver decision support can be configured to contain much more detail than textual guidelines or paper-based flow diagrams. Such protocols can generate patient-specific instructions for therapy that can be carried out with little interclinician variability; however, clinicians must be willing to modify personal styles of clinical management. Protocols need not be perfect. Several defensible and reasonable approaches are available for clinical problems. However, one of these reasonable approaches must be chosen and incorporated into the protocol to promote consistent clinical decisions. This reasoning is the basis of an explicit method of decision support that allows the rigorous evaluation of interventions, including use of the protocols themselves. Computerized protocols for mechanical ventilation and management of intravenous fluid and hemodynamic factors in patients with the acute respiratory distress syndrome provide case studies for this discussion.

  2. [International clinical practice guidelines and management of rheumatology in Madagascar].

    PubMed

    Ralandison, S; Rafalimanana, E; Rakotonirainy, H; Rabenja, R

    2012-02-01

    Developed countries issue recommendations regarding healthcare that aren't constantly appropriate for emergent countries. We suggest some remarks concerning rheumatology in Madagascar, taking account of scientific data, medical ethics, equality and equity. We have studied the minimal cost of care of medical conditions found in our hospital department if we were to follow international recommendations for their management. Then, we have estimated treatment expenses as a percentage of the SMIC (Malagasy minimum monthly salary). Out of 517 patients examined yearly, we have found 62.8% osteoarthritis cases, 6.3% rheumatoid arthritis (RA), and 4,2% septic arthritis. Therefore, the first month of treatment for an arthritis of the knee would absorb 147.3% of the SMIC; diagnosis and treatment of a case of septic arthritis would take up 1762.8% of the minimum wage, and a case of RA without biotherapy would require 175%. According to the American College of Rheumatology criteria which are used as a reference, the treatment of an arthritis of the knee would take only 23% of the SMIC. Caring for septic arthritis would demand 57.5% of the SMIC and while it would yield more arguments for diagnosis such as clinical examination, CRP, and Gram coloration on joint liquid aspiration. We can proceed to RA diagnosis with an acceptable security through precise clinical examination, blood cell count, ESR, CRP, rheumatoid factor and radiography. This means 56% of the SMIC. From this 517 patients, our suggestions would reduce the expense by 35,850% of the SMIC per year. The allocation of such funds onto the treatment of complicated forms of rheumatism would be fair. By refining and evaluating these suggestions, we would come up with appropriate recommendations for emergent countries.

  3. Radix entomolaris: 2 case reports and clinical guidelines for endodontic management.

    PubMed

    Latha, S Jothi; Velmurugan, N; Kavitha, M; Kumar, A R Pradeep

    2014-01-01

    Variations in dental anatomy and root canal systems are often reported in the dental literature. Among them, Radix entomolaris (RE) is the presence of an additional lingual root in mandibular molars. Though RE appears relatively infrequently, knowledge of the condition will aid in its management. This article presents 2 case reports of RE and clinical guidelines for endodontic management.

  4. Quality Chemical Dependency Treatment in an Era of Cost Containment: Clinical Guidelines for Practitioners.

    ERIC Educational Resources Information Center

    Pacione, Tony; Jaskula, Diane

    1994-01-01

    Offers three clinical guidelines designed to deliver quality chemical dependency care that is cost effective: use least restrictive level of care most likely to initiate abstinence; assess likelihood of treatment failure at level of care chosen and risks to client if treatment fails; and identify treatment failure quickly and move client to more…

  5. Developing and implementing the Active Design Guidelines in New York City.

    PubMed

    Lee, Karen K

    2012-01-01

    Physical inactivity is a leading cause of death in the United States and globally and is also associated with several additional leading causes of death, including obesity, high blood pressure and high blood glucose. The built environment plays a critical role in promoting or discouraging physical activity among adults and children. To create a healthier and more physically active city, a working group comprising several New York City agencies, including the Departments of Design and Construction, Health and Mental Hygiene, Transportation and City Planning, and in collaboration with design organizations and academics, published the Active Design Guidelines (ADG; ) in January 2010. The ADG is a manual of evidence-based and best-practice strategies for increasing physical activity in the design and construction of neighborhoods, streets and buildings. The commentary discusses key activities and events leading up to the publication as well as current implementation activities. It also shares the lessons learned that could assist other communities interested in improving their built environments in developing and implementing similar activities and initiatives.

  6. Current practices and guidelines for clinical next-generation sequencing oncology testing

    PubMed Central

    Strom, Samuel P.

    2016-01-01

    Next-generation sequencing (NGS) has been rapidly integrated into molecular pathology, dramatically increasing the breadth genomic of information available to oncologists and their patients. This review will explore the ways in which this new technology is currently applied to bolster care for patients with solid tumors and hematological malignancies, focusing on practices and guidelines for assessing the technical validity and clinical utility of DNA variants identified during clinical NGS oncology testing. PMID:27144058

  7. Clinical practice guideline development manual: A quality-driven approach for translating evidence into action

    PubMed Central

    Rosenfeld, Richard M.; Shiffman, Richard N.

    2010-01-01

    Background Guidelines translate best evidence into best practice. A well-crafted guideline promotes quality by reducing healthcare variations, improving diagnostic accuracy, promoting effective therapy, and discouraging ineffective – or potentially harmful – interventions. Despite a plethora of published guidelines, methodology is often poorly defined and varies greatly within and among organizations. Purpose This manual describes the principles and practices used successfully by the American Academy of Otolaryngology – Head and Neck Surgery to produce quality-driven, evidence-based guidelines using efficient and transparent methodology for action-ready recommendations with multi-disciplinary applicability. The development process, which allows moving from conception to completion in twelve months, emphasizes a logical sequence of key action statements supported by amplifying text, evidence profiles, and recommendation grades that link action to evidence. Conclusions As clinical practice guidelines become more prominent as a key metric of quality healthcare, organizations must develop efficient production strategies that balance rigor and pragmatism. Equally important, clinicians must become savvy in understanding what guidelines are – and are not – and how they are best utilized to improve care. The information in this manual should help clinicians and organizations achieve these goals. PMID:19464525

  8. The new production theory for health care through clinical reengineering: a study of clinical guidelines--Part II.

    PubMed

    Sharp, J R

    1995-01-01

    In Part I of this two-part article, in the December 1994 issue of the journal, the author discussed the manufacturing theories of Peter Drucker in terms of their applicability for the health care field. He concluded that Drucker's four principles and practices of manufacturing--statistical quality control, manufacturing accounting, modular organization, and systems approach--do have application to the health care system. Clinical guidelines, a variation on the Drucker theory, are a specific example of the manufacturing process in health. The performance to date of some guidelines and their implications for the health care reform debate are discussed in Part II of the article. PMID:10139603

  9. A survey of clinical training in music therapy: degree of compliance with NAMT guidelines.

    PubMed

    Braswell, C; Decuir, A; Brooks, D M

    1985-01-01

    This study compared the experiences and responsibilities of music therapy interns with requirements outlined in the Guidelines for Establishing and Maintaining Music Therapy Clinical Training Programs (National Association for Music Therapy, Inc., 1983). Subjects were 134 music therapy clinical training directors and 75 music therapy interns. Results from the intern survey indicated that over 80% of the interns were more than satisfied with their clinical training experiences. However, the data revealed several areas of concern. First, 75% of the directors and 92% of the responding interns were female; this response suggests that music therapy is not recognized as a viable career choice among male music majors. In addition, 22% of the responding clinical training facilities were not affiliated with the closest NAMT-approved college or university; reported range between these facilities and the nearest university was 5 to 1,500 miles, with a mean of 392 miles. The authors concluded that the affiliate process is often meaningless. While the Guidelines require training in "Administrative skills, i.e., budgeting, program proposals, organizational structures," nearly 63% of intern respondents had not received such training. The authors recommend that the Guidelines be rewritten and professionally printed, that interns and clinical training directors be required to complete annual questionnaires, and that the affiliation between clinical training facility and academic institution be strengthened. PMID:10271938

  10. Impact of WHO 2010 Guidelines on Antiretroviral Therapy Initiation among Patients with HIV-Associated Tuberculosis in Clinics with and without Onsite HIV Services in the Democratic Republic of Congo.

    PubMed

    Yotebieng, Marcel; Tabala, Martine; Batumbula, Marie Louise; Wenzi, Landry; Basaki, Emmanuel; Mungoyo, Eugenie; Mangala, Richard; Behets, Frieda

    2016-01-01

    Background. We assessed the impact of WHO's 2010 guidelines that removed the requirement of CD4 count before ART, on timely initiation of ART among HIV/TB patients in the Democratic Republic of Congo (DRC). Methods. Data collected to monitor implementation of provider initiated HIV testing and counseling (PITC) and linkage to HIV care from 65 and 13 TB clinics in Kinshasa and Kisangani, respectively, between November 2010 and June 2013. Results. Prior to the WHO's 2010 guidelines, in Kinshasa, 79.1% (401/507) of HIV/TB patients referred for HIV services were initiated on ART in clinics with onsite ART services compared to 50.0% (63/123) in clinics without. Following the implementation of the new guidelines, 89.8% (714/795) and 93.0% (345/371) of HIV/TB patients referred for HIV services were initiated on ART, respectively, in clinics with onsite and without onsite ART services. Similarly, in Kisangani, 69.7% (53/120) and 36.4% (16/44) in clinics with and without onsite ART service, respectively, were initiated on ART prior to the 2010 guidelines and 88.8% (135/152) and 72.6% (106/146), respectively, after the new guidelines. Conclusion. Though implementation of the 2010 guidelines increased the proportion of HIV/TB patients initiated on ART substantially, it remained below the 100% target, particularly in clinics without onsite ART services. PMID:27595020

  11. Impact of WHO 2010 Guidelines on Antiretroviral Therapy Initiation among Patients with HIV-Associated Tuberculosis in Clinics with and without Onsite HIV Services in the Democratic Republic of Congo

    PubMed Central

    Tabala, Martine; Batumbula, Marie Louise; Wenzi, Landry; Basaki, Emmanuel; Mungoyo, Eugenie; Mangala, Richard; Behets, Frieda

    2016-01-01

    Background. We assessed the impact of WHO's 2010 guidelines that removed the requirement of CD4 count before ART, on timely initiation of ART among HIV/TB patients in the Democratic Republic of Congo (DRC). Methods. Data collected to monitor implementation of provider initiated HIV testing and counseling (PITC) and linkage to HIV care from 65 and 13 TB clinics in Kinshasa and Kisangani, respectively, between November 2010 and June 2013. Results. Prior to the WHO's 2010 guidelines, in Kinshasa, 79.1% (401/507) of HIV/TB patients referred for HIV services were initiated on ART in clinics with onsite ART services compared to 50.0% (63/123) in clinics without. Following the implementation of the new guidelines, 89.8% (714/795) and 93.0% (345/371) of HIV/TB patients referred for HIV services were initiated on ART, respectively, in clinics with onsite and without onsite ART services. Similarly, in Kisangani, 69.7% (53/120) and 36.4% (16/44) in clinics with and without onsite ART service, respectively, were initiated on ART prior to the 2010 guidelines and 88.8% (135/152) and 72.6% (106/146), respectively, after the new guidelines. Conclusion. Though implementation of the 2010 guidelines increased the proportion of HIV/TB patients initiated on ART substantially, it remained below the 100% target, particularly in clinics without onsite ART services. PMID:27595020

  12. Advance care planning for residents in aged care facilities: what is best practice and how can evidence-based guidelines be implemented?

    PubMed

    Lyon, Cheryl

    2007-12-01

    Background  Advance care planning in a residential care setting aims to assist residents to make decisions about future healthcare and to improve end-of-life care through medical and care staff knowing and respecting the wishes of the resident. The process enables individuals and others who are important to them, to reflect on what is important to the resident including their beliefs/values and preferences about care when they are dying. This paper describes a project conducted as part of the Joanna Briggs Institute Clinical Aged Care Fellowship Program implemented at the Manningham Centre in metropolitan Melbourne in a unit providing services for 46 low and high care residents. Objectives  The objectives of the study were to document implementation of best practice in advance care planning in a residential aged care facility using a cycle of audit, feedback and re-audit cycle audit with a clinical audit software program, the Practical Application of Clinical Evidence System. The evidence-based guidelines found in 'Guidelines for a Palliative Approach in Residential Aged Care' were used to inform the process of clinical practice review and to develop a program to implement advance care planning. Results  The pre-implementation audit results showed that advance care planning practice was not based on high level evidence as initial compliance with five audit criteria was 0%. The barriers to implementation that became apparent during the feedback stage included the challenge of creating a culture where advance care planning policy, protocols and guidelines could be implemented, and advance care planning discussions held, by adequately prepared health professionals and carers. Opportunities were made to equip the resident to discuss their wishes with family, friends and healthcare staff. Some residents made the decision to take steps to formally document those wishes and/or appoint a Medical Enduring Power of Attorney to act on behalf of the resident when they

  13. Quality Assessment of Clinical Practice Guidelines Developed by Professional Societies in Turkey

    PubMed Central

    Yaşar, Ilknur; Kahveci, Rabia; Baydar Artantaş, Aylin; Ayhan Başer, Duygu; Gökşin Cihan, Fatma; Şencan, Irfan; Koç, Esra Meltem; Özkara, Adem

    2016-01-01

    Background Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. There is a limited number of studies on guidelines in Turkey. The quality of Ministry of Health guidelines have formerly been assessed whereas there is no information on the other guidelines developed in the country. Aim This study aims to assess the quality of CPGs that are developed by professional societies that work for the health sector in Turkey, and compare the findings with international guidelines. Methodology Professional societies that work for the health sector were determined by using the data obtained from the Ministry of Internal Affairs. Inclusion and exclusion criteria were defined for selecting the CPGs. Guidelines containing recommendations about disease management to the doctors, accessible online, developed within the past 5 years, citing references for recommendations, about the diseases over 1% prevalence according to the “Statistical Yearbook of Turkey 2012” were included in the study. The quality of CPGs were assessed with the AGREE II instrument, which is an internationally recognized tool for this purpose. Four independent reviewers, who did not participate in the development of the selected guidelines and were trained in CPG appraisal, used the AGREE instrument for assessment of the selected guidelines. Findings 47 professional societies were defined which provided access to CPGs in their websites; 3 of them were only open to members so these could not be reached. 8 CPGs from 7 societies were selected from a total of 401 CPGs from 44 societies. The mean scores of the domains of the guidelines which were assessed by the AGREE II tool were; Scope and purpose: 64%, stakeholder involvement: 37.9%, rigour of development: 35.3%, clarity and presentation: 77.9%, applicability: 49.0% and editorial independence: 46.0%. Conclusion This is the first

  14. Knowledge translation: a case study on pneumonia research and clinical guidelines in a low- income country

    PubMed Central

    2014-01-01

    Background The process and effectiveness of knowledge translation (KT) interventions targeting policymakers are rarely reported. In Cambodia, a low-income country (LIC), an intervention aiming to provide evidence-based knowledge on pneumonia to health authorities was developed to help update pediatric and adult national clinical guidelines. Through a case study, we assessed the effectiveness of this KT intervention, with the goal of identifying the barriers to KT and suggest strategies to facilitate KT in similar settings. Methods An extensive search for all relevant sources of data documenting the processes of updating adult and pediatric pneumonia guidelines was done. Documents included among others, reports, meeting minutes, and email correspondences. The study was conducted in successive phases: an appraisal of the content of both adult and pediatric pneumonia guidelines; an appraisal of the quality of guidelines by independent experts, using the AGREE-II instrument; a description and modeling of the KT process within the guidelines updating system, using the Unified Modeling Language (UML) tools 2.2; and the listing of the barriers and facilitators to KT we identified during the study. Results The first appraisal showed that the integration of the KT key messages in pediatric and adult guidelines varied with a better efficiency in the pediatric guidelines. The overall AGREE-II quality assessments scored 37% and 44% for adult and pediatric guidelines, respectively. Scores were lowest for the domains of ‘rigor of development’ and ‘editorial independence.’ The UML analysis highlighted that time frames and constraints of the involved stakeholders greatly differed and that there were several missed opportunities to translate on evidence into the adult pneumonia guideline. Seventeen facilitating factors and 18 potential barriers to KT were identified. Main barriers were related to the absence of a clear mandate from the Ministry of Health for the researchers

  15. Implementation of the NCSS Guidelines for Teaching Science-Related Social Issues: Exemplar Lessons.

    ERIC Educational Resources Information Center

    Otto, Robert A., Ed.

    This document contains the Guidelines for Teaching Science-Related Social Issues adopted in 1982 by the National Council for the Social Studies and 10 examplar lessons each keyed to particular guidelines and drawing upon contemporary issues. The premise upon which the guidelines are based is that science is a social issue and that the examination…

  16. Report on the RCDS-CDHSRU workshop on developing clinical guidelines/standards of practice.

    PubMed

    Leake, J L; Main, P A; Woodward, G L

    1996-07-01

    Investigators from the Community Dental Health Services Research Unit (CDHSRU) held a workshop to test a model for developing clinical guidelines/standards of practice, which are required under the Regulated Health Professions Legislation. Forty-two individuals from Ontario and Canada, including dentists, representatives of the public, and professionals, participated in the three-day workshop, held under the auspices of the quality assurance committee of the Royal College of Dental Surgeons of Ontario (RCDS). Through direct experience, workshop participants sought to learn each of the steps, as defined by the literature, involved in clinical guideline development. Ultimately, they hoped to recommend steps for RCDS to follow in developing standards of practice. To ensure that a realistic and valid model emerged from the workshop, a real topic, namely the management of smooth surface enamel lesions in permanent teeth, was used to develop and test clinical guidelines. Prior to the workshop, participants were sent literature on one of five aspects of the topic, as well as papers describing the methodology of critically appraising the literature, and partially-completed templates outlining the basic steps to be followed. During the first evening and first morning of the workshop, participants listened to presentations on the development of clinical guidelines, the prevalence of smooth surface lesions, the role of economics in guideline development, and the necessary considerations in writing clinical guidelines. Under the leadership of trained facilitators, they then worked in small groups to write evidence-based recommendations and report them to the other workshop participants for feedback. Using this feedback, they returned to their groups to revise their recommendations and work on the workshop's overall recommendations to the RCDS. The day concluded in the evening, when the workshop facilitators and coordinators met to edit the groups' recommendations into a

  17. [Review of the 2008 revision of the ethical guidelines for clinical studies].

    PubMed

    Imoto, Masakatsu

    2010-05-01

    The ethical guidelines for clinical studies were revised in 2008 and enforced in April 2009. This was the second revision but first regular revision and largely reviewed. In particular, articles under the purview of the Institutional Review Board (IRB) for clinical studies are reviewed and enhanced. This additional role further increases the authority of the IRB, and those who fix the IRB must exhibit the activity of the IRB to the public and report to the MHLW annually. The provision of compensation for clinical studies on the evaluation of drugs and medical devices has been added to this version of the ethical guidelines. The compensation for interventional clinical studies using drugs and medical devices has not yet been decided, similar to "chiken," which is defined in pharmaceutical affairs laws (PAL). Since April 2009, some insurance offices have started offering special insurance covers for clinical studies. New registration rules have been established for clinical studies. Moreover, there is now a database for clinical study registration called "Japan Primary Registries Network (JPRN)," which is certified by WHO. This database comprises 3 open databases, which were originally independent, related to clinical trials in Japan. They are however under the purview of the National Institute of Public Health. This institution works in collaboration with the "International Clinical Trials Registry Platform (ICTRP)" of WHO.

  18. [Croatian guidelines for nutrition in the elderly, part II--clinical nutrition].

    PubMed

    Krznarić, Zeljko; Bender, Darija Vranesić; Kelecić, Dina Ljubas; Reiner, Zeljko; Roksandić, Spomenka Tomek; Kekez, Domina; Pavić, Tajana

    2011-01-01

    Malnutrition and sarcopenia are frequent in the hospitalized and institutionalized elderly. They have negative consequences on morbidity, mortality, function and quality of life. Enteral and parenteral nutrition are valid options in the malnourished elderly, both in the hospital and at home. Elderly patients share most indications and complications with adult patients, even though more focus needs to be put on function and quality of life than on mortality. In these guidelines we discuss the indications and special considerations of enteral and parenteral nutrition in geriatric patients as well as guidelines for clinical nutrition in three common pathologies in the elderly: decubital ulcers, dysphagia and dementia.

  19. Reconciling the clinical practice guidelines on Bell's palsy from the AAO-HNSF and the AAN.

    PubMed

    Schwartz, Seth R; Jones, Stephanie L; Getchius, Thomas S D; Gronseth, Gary S

    2014-05-01

    Bell's palsy, named after the Scottish anatomist, Sir Charles Bell, is the most common acute mononeuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. In the past 2 years, both the American Academy of Neurology (AAN) and the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) have published clinical practice guidelines aimed to improve the quality of care and outcomes for patients diagnosed with Bell's palsy. This commentary aims to address the similarities and differences in the scope and final recommendations made by each guideline development group.

  20. Reconciling the clinical practice guidelines on Bell's palsy from the AAO-HNSF and the AAN.

    PubMed

    Schwartz, Seth R; Jones, Stephanie L; Getchius, Thomas S D; Gronseth, Gary S

    2014-05-27

    Bell palsy, named after the Scottish anatomist Sir Charles Bell, is the most common acute mononeuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. In the past 2 years, both the American Academy of Neurology and the Academy of Otolaryngology-Head and Neck Surgery Foundation have published clinical practice guidelines aimed at improving the quality of care and outcomes for patients diagnosed with Bell palsy. This commentary aims to address the similarities and differences in the scope and final recommendations made by each guideline development group. PMID:24793182

  1. The significance of clinical practice guidelines on adult varicocele detection and management

    PubMed Central

    Shridharani, Anand; Owen, Ryan C; Elkelany, Osama O; Kim, Edward D

    2016-01-01

    Varicoceles are the most common correctable etiology of male factor infertility. However, the detection and management of varicoceles have not been standardized. This has led to decades of debate regarding the effect of varicocele on male infertility and subsequently whether repair leads to an improved fertility status. The current body of evidence investigating the role of varicocele and varicocelectomy is weak and conflicting. The stance taken by the AUA and ASRM suggests that there is insufficient outcomes data to support evidenced-based guidelines, citing evidence used to provide current recommendations are generally of a low quality level. On the other hand, the EAU Guidelines give a level 1a of evidence for management of varicoceles that are clinically palpable, associated with subnormal semen analyses and having otherwise unexplained fertility. Besides aiding with clinical varicocele detection and management, clinical practice opinion statements and guidelines aim to direct and strengthen the infrastructure of future studies. We review the current status of opinion statements and guidelines in varicocele and management detection with focus on their application in practice. PMID:26806081

  2. Academy of Medicine-Ministry of Health Clinical Practice Guidelines: Assessment and Management of Infertility at Primary Healthcare Level

    PubMed Central

    Loh, Seong Feei; Agarwal, Rachna; Chan, Jerry; Chia, Sing Joo; Cho, Li Wei; Lim, Lean Huat; Lau, Matthew Sie Kuei; Loh, Sheila Kia Ee; Hendricks, Marianne Sybille; Nair, Suresh; Quah, Joanne Hui Min; Tan, Heng Hao; Wong, PC; Yeong, Cheng Toh; Yu, Su Ling

    2014-01-01

    The Academy of Medicine (AMS) and Ministry of Health (MOH) have developed the clinical practice guidelines on Assessment and Management of Infertility at Primary Healthcare Level to provide doctors and patients in Singapore with evidence-based treatment for infertility. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the AMS-MOH clinical practice guidelines on Assessment and Management of Infertility at Primary Healthcare Level, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_ medical/2013/cpgmed_infertility.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines. PMID:24570313

  3. Academy of Medicine-Ministry of Health Clinical Practice Guidelines: assessment and management of infertility at primary healthcare level.

    PubMed

    Loh, Seong Feei; Agarwal, Rachna