Practice Guidelines (practice + guideline)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Practice Guidelines

  • best practice guideline
  • clinical practice guideline

  • Selected Abstracts

    Are guidelines on use of colony-stimulating factors in solid cancers flawed?

    I. E. Haines
    Abstract In cancer care in Australia, we are very reliant on an array of expensive pharmaceuticals. Our use of these treatments is often based on multinational or foreign clinical studies. Oncologists are, to varying degrees, reliant on how the studies are interpreted by the writers of journal editorials, clinical guidelines and opinion pieces. Therefore it is important that these guidelines are balanced and evidence based. We have examined in detail one of the most influential and wide ranging clinical guidelines used in oncology, The American Society of Clinical Oncology (ASCO) 2006 Update of Recommendations for the use of White Blood Cell Factors: An Evidence-Based Clinical Practice Guideline. We have discussed in detail some of the controversial recommendations in this guideline and have exposed what we believe are some flaws in these recommendations. We would urge that we continue to be rigorous in our oversight of international research agendas and international clinical guidelines in the future. [source]

    Development of a Clinical Practice Guideline for Testing Nasogastric Tube Placement

    Sue Peter
    PURPOSE.,A Perth metropolitan hospital group standardized changes to nasogastric tube placement, including removal of the "whoosh test" and litmus paper, and introduction of pH testing. DESIGN AND METHODS.,,Two audits were conducted: bedside data collection at a pediatric hospital and a point-prevalence audit across seven hospitals. RESULTS.,,Aspirate was obtained for 97% of all tests and pH was , 5.5 for 84%, validating the practice changes. However, patients on continuous feeds and/or receiving acid-inhibiting medications had multiple pH testing fails. PRACTICE IMPLICATIONS.,Nasogastric tube placement continues to present a challenge for those high-risk patients on continuous feeds and/or receiving acid-inhibiting medications. [source]

    Clinical Practice Guideline for the Evaluation of Fever and Infection in Older Adult Residents of Long-Term Care Facilities: 2008 Update by the Infectious Diseases Society of America

    Kevin P. High MD
    Residents of long-term care facilities (LTCFs) are at great risk for infection. Most residents are older and have multiple comorbidities that complicate recognition of infection; for example, typically defined fever is absent in more than one-half of LTCF residents with serious infection. Furthermore, LTCFs often do not have the on-site equipment or personnel to evaluate suspected infection in the fashion typically performed in acute care hospitals. In recognition of the differences between LTCFs and hospitals with regard to hosts and resources present, the Infectious Diseases Society of America first provided guidelines for evaluation of fever and infection in LTCF residents in 2000. The guideline presented here represents the second edition, updated by data generated over the intervening 8 years. It focuses on the typical elderly person institutionalized with multiple chronic comorbidities and functional disabilities (e.g., a nursing home resident). Specific topic reviews and recommendations are provided with regard to what resources are typically available to evaluate suspected infection, what symptoms and signs suggest infection in a resident of an LTCF, who should initially evaluate the resident with suspected infection, what clinical evaluation should be performed, how LTCF staff can effectively communicate about possible infection with clinicians, and what laboratory tests should be ordered. Finally, a general outline of how a suspected outbreak of a specific infectious disease should be investigated in an LTCF is provided. [source]

    Guidelines Abstracted from the Department of Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Stroke Rehabilitation

    Miriam Rodin MD
    OBJECTIVES: To assist facilities in identifying those evidence-based processes of poststroke care that enhance measurable patient outcomes. The guideline(s) should be used by facilities (hospitals, subacute-care units and providers of long-term care) to implement a structured approach to improve rehabilitative practices and by clinicians to determine best interventions to achieve improved patient outcomes. OPTIONS: The guideline considers five elements of poststroke rehabilitation care: interdisciplinary teams; use of standardized assessments; intensity, timing, and duration of therapy; involvement of patients' families and caregivers in decision-making; and educational interventions for patients, families, and caregivers. Evidence, benefits, harms, and recommendations for each of the five designated elements and specific annotated recommendations for poststroke managements are presented separately. OUTCOMES: The overall guideline considers improvement in functional status measures as the primary outcome. Achieving community-dwelling status and preventing complications, death, and rehospitalization are also important outcomes. Costs are not specifically addressed. PARTICIPANTS: The Department of Veterans Affairs/Department of Defense (VA/DoD) Stroke Rehabilitation Working Group consisted of 28, largely VA and military hospital, representatives of medical and allied professions concerned with stroke diagnosis, management, and rehabilitation. Nine additional members with similar credentials served as the editorial committee. Technical consultation was contracted from ACS Federal Health Care, Inc., and the Center for Evidence-Based Practice, State University of New York,Upstate Medical University, Department of Family Medicine conducted evidence appraisal. Consensus was achieved over several years of facilitated group discussion and iterative evaluation of draft documents and supporting evidence. SPONSOR: The guideline was prepared under the auspices of the VA/DoD. No other source of support was identified in the document, or supporting documents. [source]

    Clinical Practice Guideline: Screening and Diagnosing Autism

    APRN-C, Mary Jo Goolsby EdD
    The clinical practice guideline (CPG) reviewed in this month's column concerns the screening and diagnosis of autism. Autism is the third most common developmental disability and affects more than 1 in 500 children, or nearly 400,000 people in the United States, in some form. Primary care providers of children, including pediatric nurse practitioners (PNPs) and family nurse practitioners (FNPs), should reasonably expect to care for at least one child with autism (CWA). The American Academy of Neurology (AAN) has therefore developed guidelines to help healthcare providers facilitate the early identification of children with autism. [source]

    Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

    Article first published online: 14 OCT 200
    Abstract The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline on the monitoring, management, and treatment of kidney transplant recipients is intended to assist the practitioner caring for adults and children after kidney transplantation. The guideline development process followed an evidence-based approach, and management recommendations are based on systematic reviews of relevant treatment trials. Critical appraisal of the quality of the evidence and the strength of recommendations followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach. The guideline makes recommendations for immunosuppression, graft monitoring, as well as prevention and treatment of infection, cardiovascular disease, malignancy, and other complications that are common in kidney transplant recipients, including hematological and bone disorders. Limitations of the evidence, especially on the lack of definitive clinical outcome trials, are discussed and suggestions are provided for future research. [source]

    Teaching received in caries prevention and perceived need for Best Practice Guidelines among recent graduates in Finland

    Miira M. Vehkalahti
    The present study evaluated teaching that recent graduates in Finland had received in caries prevention and their perceived need for updated Best Practice Guidelines. A two-page questionnaire was mailed to all dentists in Finland who had graduated from 1995 to 1998 (n = 390). After one reminder, the response rate was 46%. The closed questions covered teaching in 14 caries-preventive methods and its suggestions as to when and on whom to apply such methods. Each dentist's own opinion on the three most important methods for caries prevention in patients with various types of dentition was sought in open questions. The respondents reported that at dental school, on average 12.5 (SD = 2.4) of 14 aspects of caries prevention were covered in theoretical teaching, 5.5 (SD = 3.8) in demonstrations and 8.5 (SD = 3.0) in clinical training. The top four methods teaching suggested for every patient were toothbrushing (100%), use of fluoridated toothpaste (99%), interdental cleaning (98%), and use of xylitol (97%); followed by fluoride varnish (77%) and fissure sealants (54%). The three caries-preventive methods the respondents felt to be most useful were the same for all types of dentitions, in order of importance: (i) toothbrushing and use of fluoridated toothpaste, (ii) supplementary use of fluorides at home and (iii) healthy dietary habits, in particular, avoidance of sucrose. As regards clinical work, such teaching had served the respondents' real-life needs in patients' caries prevention either extremely (44%) or moderately (54%) well; 91% said, however, that they would benefit from nationwide Best Practice Guidelines. In conclusion, the recent graduates' emphasis on patient-active methods in caries prevention may indicate a change in the current policy favouring patient-passive methods. [source]

    The committee for revision of the Clinical Practice Guidelines for Hepatocellular Carcinoma

    Article first published online: 19 MAY 2010
    No abstract is available for this article. [source]

    Quality of histopathological reporting on melanoma and influence of use of a synoptic template

    HISTOPATHOLOGY, Issue 6 2010
    Lauren E Haydu
    Haydu L E, Holt P E, Karim R Z, Madronio C M, Thompson J F, Armstrong B K & Scolyer R A (2010) Histopathology56, 768,774 Quality of histopathological reporting on melanoma and influence of use of a synoptic template Aims:, To evaluate the quality of histopathological reporting for melanoma in a whole population, to assess the influence on quality of the use of a synoptic template and thus to provide an evidence base to guide improvement in reporting melanoma pathology. Methods and results:, Histopathology reports of all primary invasive melanomas notified to the New South Wales Central Cancer Registry between October 2006 and October 2007 (n = 3784) were reviewed. A detailed audit of histopathology reports for consecutively diagnosed primary invasive melanoma over 6 months (n = 2082) was performed to assess the quality of each report based on compliance with the 2008 Clinical Practice Guidelines for the Management of Melanoma in Australia and New Zealand. Only half of the initial excision specimen reports included the essential components necessary to stage a melanoma patient according to the 2002 American Joint Committee on Cancer/International Union Against Cancer melanoma staging system. Report format was strongly correlated with completeness and validity of reporting: reports in a synoptic format, with or without a descriptive component, achieved the highest quality levels. Conclusions:, Even in a population with a high incidence of melanoma, concordance of pathology reports with current guidelines was comparatively low. Wider adoption of synoptic reporting is likely to increase report quality. [source]

    World Gastroenterology Organization Practice Guidelines for the Diagnosis and Management of IBD in 2010

    Dr. Charles N. Bernstein Chairman
    Abstract Inflammatory bowel disease (IBD) represents a group of idiopathic, chronic, inflammatory intestinal conditions. Its two main disease categories are: Crohn's disease (CD) and ulcerative colitis (UC), which feature both overlapping and distinct clinical and pathological features. While these diseases have, in the past, been most evident in the developed world, their prevalence in the developing world has been gradually increasing in recent decades. This poses unique issues in diagnosis and management which have been scarcely addressed in the literature or in extant guidelines. Depending on the nature of the complaints, investigations to diagnose either form of IBD or to assess disease activity will vary and will also be influenced by geographic variations in other conditions that might mimic IBD. Similarly, therapy varies depending on the phenotype of the disease being treated and available resources. The World Gastroenterology Organization has, accordingly, developed guidelines for diagnosing and treating IBD using a cascade approach to account for variability in resources in countries around the world. Inflamm Bowel Dis 2010 [source]

    Best Practice Guidelines on Publication Ethics: a Publisher's Perspective

    Chris Graf
    Summary These Best Practice Guidelines on Publication Ethics describe Blackwell Publishing's position on the major ethical principles of academic publishing and review factors that may foster ethical behavior or create problems. The aims are to encourage discussion, to initiate changes where they are needed, and to provide practical guidance, in the form of Best Practice statements, to inform these changes. Blackwell Publishing recommends that editors adapt and adopt the suggestions outlined to best fit the needs of their own particular publishing environment. [source]

    An Exemplar of the Use of NNN Language in Developing Evidence-Based Practice Guidelines

    CRRN-A, Donald D. Kautz PhD
    PURPOSE. To explore the use of standardized language, NNN, in the development of evidence-based practice (EBP). DATA SOURCES. Published research and texts on family interventions, nursing diagnoses (NANDA-I), nursing interventions (NIC), and nursing outcomes (NOC). DATA ANALYSIS. Research literature was summarized and synthesized to determine levels of evidence for the NIC intervention Family Integrity Promotion. CONCLUSIONS. The authors advocate that a "standards of practice" category of levels of evidence be adopted for interventions not amenable to randomized controlled trials or for which a body of research has not been developed. Priorities for nursing family intervention research are identified. IMPLICATIONS FOR NURSING PRACTICE. The use of NANDA-I nursing diagnoses, NIC interventions, and NOC outcomes (NNN language) as research frameworks will facilitate the development of EBP guidelines and the use of appropriate outcome measures. [source]

    Evidence-based Clinical Practice Guidelines for Prostate Cancer (Summary , JUA 2006 Edition)

    Sadao Kamidono
    First page of article [source]

    Adherence to Pressure Ulcer Prevention Guidelines: Implications for Nursing Home Quality

    Debra Saliba MD
    OBJECTIVES: This study aims to assess overall nursing home (NH) implementation of pressure ulcer (PU) prevention guidelines and variation in implementation rates among a geographically diverse sample of NHs. DESIGN: Review of NH medical records. SETTING: A geographically diverse sample of 35 Veterans Health Administration NHs. PARTICIPANTS: A nested random sample of 834 residents free of PU on admission. MEASUREMENTS: Adherence to explicit quality review criteria based on the Agency for Healthcare Research and Quality Practice Guidelines for PU prevention was measured. Medical record review was used to determine overall and facility-specific adherence rates for 15 PU guideline recommendations and for a subset of six key recommendations judged as most critical. RESULTS: Six thousand two hundred eighty-three instances were identified in which one of the 15 guideline recommendations was applicable to a study patient based on a specific indication or resident characteristic in the medical record. NH clinicians adhered to the appropriate recommendation in 41% of these instances. For the six key recommendations, clinicians adhered in 50% of instances. NHs varied significantly in adherence to indicated guideline recommendations, ranging from 29% to 51% overall adherence across all 15 recommendations (P < .001) and from 24% to 75% across the six key recommendations (P < .001). Adherence rates for specific indications also varied, ranging from 94% (skin inspection) to 1% (education of residents or families). Standardized assessment of PU risk was identified as one of the most important and measurable recommendations. Clinicians performed this assessment in only 61% of patients for whom it was indicated. CONCLUSIONS: NHs' overall adherence to PU prevention guidelines is relatively low and is characterized by large variations between homes in adherence to many recommendations. The low level of adherence and high level of variation to many best-care practices for PU prevention indicate a continued need for quality improvement, particularly for some guidelines. [source]

    Nursing Best Practice Guidelines: reflecting on the obscene rise of the void

    Aim(s), Drawing on the work of Jean Baudrillard and Michel Foucault, the purpose of this article is to critique the evidence-based movement [and its derivatives , Nursing Best Practice Guidelines (NBPGs)] in vogue in all spheres of nursing. Background, NBPGs and their correlate institutions, such as the Registered Nurses' Association of Ontario (RNAO) and ,spotlight' hospitals, impede critical thinking on the part of nurses, and ultimately evacuate the social, political and ethical responsibilities that ought to distinguish the nursing profession. Evaluation, We contend that the entire NBPG movement is based on the illusion of scientific truth and a promise of ethical care that cannot be delivered in reality. We took as a case study the Registered Nurses' Association of Ontario (RNAO), in the province of Ontario, Canada. Key issues, NBPGs, along with the evidence-based movement upon which they are based, are a dangerous technology by which healthcare organizations seek to discipline, govern and regulate nursing work. Conclusion(s), Despite the remarkable institutional promotion of ,ready-made' and ,ready-to-use' guidelines, we demonstrate how the RNAO deploys BPGs as part of an ideological agenda that is scientifically, socially, politically and ethically unsound. Implications for nursing management, Collaborations between health care organizations and professional organizations can become problematic when the latter dictate nursing conduct in such a way that critical thinking is impeded. We believe that nurse managers need to understand that the evidence-based movement is the target of well-deserved critiques. These critiques should also be considered before implementing so-called ,Nursing Best Practice Guidelines' in health care milieux. [source]

    Health Care for the Homeless Assesses the Use of Adapted Clinical Practice Guidelines

    Aaron J. Strehlow RN, FNP-C
    COLUMN EDITOR: Mary Jo Goolsby This article describes a process of evaluating and adapting existing clinical practice guidelines (CPGs) for homeless individuals by different healthcare providers in multiple healthcare settings across the country. Data were collected using a standardized evaluation tool in nine sites across the United States. Clinicians completed an evaluation of the CPG after every use. Most clinicians used the CPG five times. Descriptive statistics were reported on the characteristics of the clinicians, and the utility of the guidelines and written comments. Clinicians had an average of 12 years of clinical experience, 8 years of which were specifically spent working with homeless individuals. Ninety-one percent of the clinicians practiced in urban settings. The majority of clinicians felt the adapted guidelines met evaluation criteria. The major weaknesses reported the delineation of outreach and case management activities. Results did not vary by clinicians' disciplines, years of experience, or any other indicators. Clients and clinicians providing primary care to homeless individuals may benefit from utilizing Health Care for the Homeless Clinicians' Network adapted CPGs to assure quality, evidenced-based care to a vulnerable population. [source]

    Implementing a Smoking Cessation Program for Pregnant Women Based on Current Clinical Practice Guidelines

    Lynne Buchanan APRN, PhDArticle first published online: 24 MAY 200
    Purpose To describe the U.S. Department of Health and Human Services clinical practice guideline for treating tobacco use and dependence and demonstrate how the guideline was utilized in a pilot program for a small sample of pregnant women (n=20) to help them decrease smoking. Data Sources A convenience sample of 20 pregnant women was recruited from a health maintenance organization at their initial prenatal contact either by telephone or in person. A comparison group of pregnant women (n=28) was used for analysis of outcomes. Conclusions Clinical results showed better outcomes for women in the pilot program when compared to a similar group who did not participate in the program. There was a statistically significant difference between the two groups in average number of cigarettes smoked per day at delivery and two weeks after delivery with pilot program participants reporting less smoking (p<.05). Women in both groups showed a pattern of returning to smoking after delivery of the baby. Implications for Practice Although a few tobacco users achieve permanent abstinence in first or second attempts, the majority continue to use tobacco for many years and typically cycle through many lapse and relapses before permanent abstinence. Ambulatory care systems need to be developed and funded to treat tobacco use and dependence over the life span. Recognition of the chronic nature of the problem and development of long term care delivery systems are needed to assist clients to achieve goals of permanent abstinence and better personal and family health. This cycle of lapse and relapse before permanent abstinence is typical and demonstrates the chronic nature of tobacco use and dependence and the need for long term follow-up. [source]

    Evaluating and Applying Clinical Practice Guidelines

    APRN-C, Mary Jo Goolsby EdD
    Clinical practice guidelines (CPG) hold great potential for providing a summary of large volumes of clinical evidence and a related set of practical recommendations. Nurse practitioners should become aware of the range of available CPGs and methods by which they can be evaluated for use. Appropriate evaluation of CPGs should include their overall reliability and validity, as well as their applicability in specific situations. This article provides an overview of an appropriate evaluation method and serves as an introduction to future columns presenting individual CPGs. [source]

    Practice Guidelines for Evaluation of Fever in Returning Travelers and Migrants

    Valérie D'Acremont
    Background Fever upon return from tropical or subtropical regions can be caused by diseases that are rapidly fatal if left untreated. The differential diagnosis is wide. Physicians often lack the necessary knowledge to appropriately take care of such patients. Objective To develop practice guidelines for the initial evaluation of patients presenting with fever upon return from a tropical or subtropical country in order to reduce delays and potential fatal outcomes and to improve knowledge of physicians. Target audience Medical personnel, usually physicians, who see the returning patients, primarily in an ambulatory setting or in an emergency department of a hospital and specialists in internal medicine, infectious diseases, and travel medicine. Method A systematic review of the literature,mainly extracted from the National Library of Medicine database,was performed between May 2000 and April 2001, using the keywords fever and/or travel and/or migrant and/or guidelines. Eventually, 250 articles were reviewed. The relevant elements of evidence were used in combination with expert knowledge to construct an algorithm with arborescence flagging the level of specialization required to deal with each situation. The proposed diagnoses and treatment plans are restricted to tropical or subtropical diseases (nonautochthonous diseases). The decision chart is accompanied with a detailed document that provides for each level of the tree the degree of evidence and the grade of recommendation as well as the key points of debate. Participants and consensus process Besides the 4 authors (2 specialists in travel/tropical medicine, 1 clinical epidemiologist, and 1 resident physician), a panel of 11 European physicians with different levels of expertise on travel medicine reviewed the guidelines. Thereafter, each point of the proposed recommendations was discussed with 15 experts in travel/tropical medicine from various continents. A final version was produced and submitted for evaluation to all participants. Conclusion Although the quality of evidence was limited by the paucity of clinical studies, these guidelines established with the support of a large and highly experienced panel should help physicians to deal with patients coming back from the Tropics with fever. [source]

    Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies.

    PSYCHO-ONCOLOGY, Issue 1 2003
    Edited by Edna B. Foa, Matthew J. Friedman., Terence M. Keane
    No abstract is available for this article. [source]

    Clinical Practice Guidelines for the Use of Axillary Sentinel Lymph Node Biopsy in Carcinoma of the Breast: Current Update

    THE BREAST JOURNAL, Issue 2 2004
    Gordon F. Schwartz MD, MBAArticle first published online: 10 MAR 200
    Abstract: Axillary sentinel lymph node biopsy (SLNB) has been adopted as a suitable alternative to traditional level I and II axillary dissection in the management of clinically node-negative (N0) breast cancers. There are two current techniques used to identify the sentinel node(s): radiopharmaceutical, technetium sulfur colloid, and isosulfan blue dye (used in the United States) and technetium-labeled albumin and patent blue dye (used in Europe). (The labeled albumin is not U.S. Food and Drug Administration [FDA] approved in the United States.) SLNB to replace axillary dissection should only be performed by surgeons and patient management teams with appropriate training and experience. Although both radiocolloid and blue dye are used together by most surgeons, and training should be in both techniques, some experienced surgeons use one or the other almost exclusively. In addition, surgical pathologists must recognize the need to examine these small specimens with great care, using a generally adopted protocol. Imprint cytology or frozen sections may be used, followed by additional sections for light microscopy. Immunochemical staining with cytokeratin or other techniques to identify "submicroscopic" metastasis is often used, but the results should not be used to influence clinical decisions with respect to adjuvant therapy. "Failed" SLNB implies the surgeon's failure to identify the sentinel nodes, in which case a complete dissection is performed. A "false-negative" SLNB implies the finding of metastasis in the excised sentinel nodes by light microscopy after a negative frozen section examination. Whether a false-negative SLNB mandates completion axillary dissection is controversial, with clinical trials currently under way to answer this question. Although SLNB was initiated to accompany breast-conserving treatment, it is equally useful in patients undergoing mastectomy. It is more difficult to perform with mastectomy. When using blue dye only, SLNB may require a separate incision because of time constraints between injection and identification of the blue-stained nodes; radiocolloid usually does not. Completion axillary dissection after false-negative SLNB is more difficult after mastectomy. SLNB is a useful procedure that may save 70% of women with clinically negative (N0) axillae and all of those with pathologically negative axillae from the morbidity of complete axillary dissection. Ideally the sentinel nodes should be able to identified in more than 95% of patients, with a false-negative rate of less than 5%. Until these rates can be achieved consistently, however, surgeons should not abandon traditional axillary dissection., [source]

    ASTS Recommended Practice Guidelines for Controlled Donation after Cardiac Death Organ Procurement and Transplantation

    D. J. Reich
    The American Society of Transplant Surgeons (ASTS) champions efforts to increase organ donation. Controlled donation after cardiac death (DCD) offers the family and the patient with a hopeless prognosis the option to donate when brain death criteria will not be met. Although DCD is increasing, this endeavor is still in the midst of development. DCD protocols, recovery techniques and organ acceptance criteria vary among organ procurement organizations and transplant centers. Growing enthusiasm for DCD has been tempered by the decreased yield of transplantable organs and less favorable posttransplant outcomes compared with donation after brain death. Logistics and ethics relevant to DCD engender discussion and debate among lay and medical communities. Regulatory oversight of the mandate to increase DCD and a recent lawsuit involving professional behavior during an attempted DCD have fueled scrutiny of this activity. Within this setting, the ASTS Council sought best-practice guidelines for controlled DCD organ donation and transplantation. The proposed guidelines are evidence based when possible. They cover many aspects of DCD kidney, liver and pancreas transplantation, including donor characteristics, consent, withdrawal of ventilatory support, operative technique, ischemia times, machine perfusion, recipient considerations and biliary issues. DCD organ transplantation involves unique challenges that these recommendations seek to address. [source]

    The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

    Article first published online: 18 MAR 200
    First page of article [source]

    Feedback on the Clinical Practice Guidelines for the Management of Delirium in Older People in Australia

    Geoff Jones
    No abstract is available for this article. [source]

    Management of Lower Urinary Tract Symptoms in Men

    Samantha Pillay
    This clinical update, written for the non-urologist, aims to highlight the important concepts behind understanding and treating men with uncomplicated lower urinary tract symptoms (LUTS). In the last five years there have been important changes in the preferred terminology and guidelines for managing men with voiding symptoms. In particular, the assessment of a patient's degree of bother is the most important factor when making management decisions for men with uncomplicated LUTS. Although this clinical update does not attempt to address the management of prostate cancer it does include some brief guidelines on prostate specific antigen (PSA) testing. The following information is based on the NH&MRC Clinical Practice Guidelines, published 1996 [1]. It is acknowledged that opinion remains divided among urologists concerning some of these guidelines. [source]

    Implementing Clinical Practice Guidelines in occupational therapy practice: Recommendations from the research evidence

    Mary Stergiou-Kita
    Background:,Clinical Practice Guidelines (CPGs) are prominent tools in evidence-based practice which integrate research evidence, clinical expertise and client input to develop recommendations for specific clinical circumstance. With the push to use research evidence in health care, it is anticipated that occupational therapists will become increasingly involved in implementing CPGs in practice. The research evidence has revealed several factors that can affect guideline uptake, and a variety of strategies that can facilitate implementation. Methods:,This narrative review examines the health-related literature in CPGs to answer the following questions. Based on the research evidence, (i) what are the factors that may influence guideline implementation? (ii) What implementation strategies may enhance guideline implementation? Results:,Factors within the guideline itself (e.g. quality, complexity and clarity), within the practitioner (e.g. experience, perceptions and beliefs), the patient (e.g. expectations and preferences) and the practice context (e.g. resource availability, organisational culture and opinion leaders) can all affect implementation success. Currently, there is no conclusive evidence to support the use of one implementation strategy over another, in all situations. The choice of implementation strategy must take into account the guideline to be implemented, the practice context and the anticipated challenges to implementation. Conclusions:,By understanding the factors that can influence implementation and the strategies for successful implementation, occupational therapists will be better prepared to implement guidelines. Recommendations to assist with guideline uptake and implementation are provided. [source]

    A review of guidelines on benign prostatic hyperplasia and lower urinary tract symptoms: are all guidelines the same?

    BJU INTERNATIONAL, Issue 9 2003
    J. Irani
    The Clinical Practice Guidelines on BPH/LUTS are examined by authors from London and Poitiers. They found in their review of the literature that the overall and methodological quality of such guidelines varies widely. They acknowledge the difficulties in developing careful guidelines, but suggest a formal appraisal of quality and methods, as these are the ones more likely to help urologists in decision-making. There are three papers on the prevalence of symptoms relating to lower tract conditions. The first examines male urinary incontinence in four European centres, the second nocturia and its effect on quality of life and sleep in a US community sample, and a further paper describes the prevalence diagnosis and treatment of prostatitis in Italy. A study from Sydney describes the authors use of the Inflow intra-urethral device for managing acontractile bladders in female patients. They found that the device provides an effective method of bladder drainage, with an acceptable side-effect profile and a significant improvement in quality of life. OBJECTIVE To compare overall and methodological quality with content in national and supra-national Clinical Practice Guidelines (CPGs) on benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS), as the purpose of CPGs is to reduce unwanted variation in practice and improve patient care by setting agreed standards based on the best available evidence. METHODS An electronic search was used to identify Internet-based national and supra-national CPGs on BPH and LUTS available in 2001. Two independent assessors analysed the content and appraised the methodological quality of the CPGs using an existing and validated instrument (St. George's Hospital Medical School Health Care Evaluation Unit Appraisal Instrument) comprising 37 items grouped into three broad areas, i.e. rigour of development, context and content, and clinical application. RESULTS Eight CPGs were suitable for appraisal; there was much variation in overall and methodological quality. There was agreement that a patient history and physical examination (including a digital rectal examination) should be used in all symptomatic men. In addition, patients' symptoms should be assessed using a validated symptom score, e.g. the International Prostate Symptom Score. There was considerable variation in the number and type of diagnostic tests recommended for routine assessment. CPGs scoring low on the appraisal instrument (indicating poor overall and methodological quality) were more likely to recommend more diagnostic tests than those scoring high. There was general agreement between the guidelines on the treatment of BPH/LUTS and the importance of the patient's involvement in making management decisions. Guideline quality was independent of local health resources and publication year. CONCLUSION The overall and methodological quality of CPGs on BPH/LUTS varies considerably. There appears to be an inverse relationship between guideline quality and the number of diagnostic tests recommended for routine assessment. Using CPGs of high quality may prevent men with BPH/LUTS being exposed to tests of doubtful utility. Although this may reduce both resource use and exposure to potential harm, moving to a more minimalist approach to diagnosis may itself be potentially harmful to patients. [source]

    Toward Improved Implementation of Evidence-based Clinical Algorithms: Clinical Practice Guidelines, Clinical Decision Rules, and Clinical Pathways

    Gary M. Gaddis MD
    This is a summary of the consensus-building workshop entitled "Guideline Implementation and Clinical Pathways," convened May 15, 2007, at the Academic Emergency Medicine Consensus Conference, "Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake." A new term, "evidence-based clinical algorithms" is suggested to encompass evidence-based information codified into clinical pathways, clinical practice guidelines, and clinical decision rules. Examples of poor knowledge translation (KT) relevant to the specialty of emergency medicine are identified, followed by brief descriptions of important research and concepts that inform the research recommendations. Four broad themes for research to improve the KT of evidence-based clinical algorithms are suggested: organizational factors, cognitive factors, social factors, and motivational factors. In all cases, research regarding optimizing KT for the subthemes identified by Glasziou and Haynes, "getting the evidence straight," and "getting the evidence used," are interwoven into the thematic research recommendations. Consensus was reached that the majority of research efforts to evaluate means to improve KT need to be centered on the factors that show promise to enhance "getting the evidence used," focused especially on organizational factors. [source]

    Australian Cancer Network Clinical Practice Guidelines for the Management of ocular and periocular Melanoma: an evidence-based literature analysis

    Simon E Skalicky MBBS
    Abstract Background:, With recent advances in the diagnosis and management of ocular and periocular melanoma, many of which are based on results from randomized control trials, there is an increasing need for an evidence-based review of the literature for the Australasian population. The Australian Cancer Network has recently redeveloped the evidence-based Clinical Practice Guidelines for the Management of Melanoma, including a chapter on ocular melanoma. These are the first evidence-based guidelines on ocular melanoma to be created by the Australian Cancer Network. Methods:, The primary research questions were formed and a detailed literature search was undertaken. Each relevant article was assessed and graded I,IV according to the level of evidence. Articles were grouped into bodies of evidence which were then assessed. Results:, A total of 107 relevant articles were identified and grouped into 12 bodies of evidence. Guidelines based on this analysis were formulated and graded. These are presented below. Conclusions:, The management of ocular melanoma has benefited from recent advances in imaging, molecular biology and cytogenetics, and tumours today are detected earlier and with greater accuracy than 25 years ago. With improved treatment ocular and periocular melanomas can be controlled locally, with good preservation of vision in many patients. However, there remains no cure for metastatic disease. [source]

    Amiodarone for Atrial Fibrillation Following Cardiac Surgery: Development of Clinical Practice Guidelines at a University Hospital

    Pharm D., Ujjaini Khanderia M.S.
    Abstract Atrial fibrillation (AF) usually develops within the first 72 h following cardiac surgery, and is often self-limiting. Within 48 h of acute onset of symptoms, approximately 50% of patients spontaneously convert to normal sinus rhythm. Thus, the relative risks and benefits of therapy must be carefully considered. The etiology of AF following cardiac surgery is similar to that in non-surgical patients except that pericardial inflammation and increased adrenergic tone play an increasingly important role. Further, AF after surgery may be associated with transient risk factors that resolve as the patient moves out from surgery, and the condition is less likely to recur compared to AF arising in other circumstances. Immediate heart rate control is important in preventing ischemia, tachycardia-induced cardiomyopathy, and left ventricular dilatation. At our institution, amiodarone is frequently used as a first-line drug for treating AF after cardiac surgery. Inconsistent prescribing practices, variable dosage regimens, and a lack of consensus regarding the appropriate use of amiodarone prompted the need for developing practice guidelines. Multidisciplinary collaboration between the departments of cardiac surgery, pharmacy, and anesthesiology led to the development of a protocol for postoperative AF. We review the clinical evidence from published trials and discuss our guidelines, defining amiodarone use for AF in the cardiac surgery setting. Copyright © 2007 Wiley Periodicals, Inc. [source]