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Biomedical subjects

S H Woolf

Publications and source records attributed to S H Woolf.

At least 55 records · Page 3Linked to original sources
PubMed1997

Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children.

PURPOSE: The American Urological Association convened the Pediatric Vesicoureteral Reflux Guidelines Panel to analyze the literature regarding available methods for treating vesicoureteral reflux diagnosed following a urinary tract infection in children and to make practice policy recommendations based on the treatment outcomes data insofar as the data permit. MATERIALS AND METHODS: The panel searched the MEDLINE data base for all articles from 1965 to 1994 on vesicoureteral reflux and systematically analyzed outcomes data for 7 treatment alternatives: 1) intermittent antibiotic therapy, 2) bladder training, 3) continuous antibiotic prophylaxis, 4) antibiotic prophylaxis and bladder training, 5) antibiotic prophylaxis, anticholinergics and bladder training, 6) open surgical repair and 7) endoscopic repair. Key outcomes identified were probability of reflux resolution, likelihood of developing pyelonephritis and scarring, and possibility of complications of medical and surgical treatment. RESULTS: Available outcomes data on the various treatment alternatives were summarized in tabular form and graphically, and the relative probabilities of possible outcomes were compared for each alternative. Treatment recommendations were based on scientific evidence and expert opinion. The panel concluded that only a few recommendations can be derived purely from scientific evidence of a beneficial effect on health outcomes. CONCLUSIONS: For most children the panel recommended continuous antibiotic prophylaxis as initial treatment. Surgery was recommended for children with persistent reflux and other indications, as specified in the document.

Child↗
PubMed1996

Developing evidence-based clinical practice guidelines: lessons learned by the US Preventive Services Task Force.

The US Preventive Services Task Force is an expert panel established by the federal government in 1984 to develop evidence-based practice guidelines on screening tests and other preventive services. Its recommendations are published elsewhere. This article explores the lessons learned in the process of developing and disseminating the recommendations. Topics include project organization (analytic philosophy, project sponsorship, panel composition, topic selection); the review of evidence (selecting outcome measures for judging effectiveness, constructing "causal pathways," searching the literature, rating the evidence, synthesizing the results); crafting recommendations (extrapolation, assessing magnitude, balancing risks and benefits, addressing costs, dealing with insufficient data, separating science from policy); peer review; collaboration with other groups; evaluating impact on clinicians' knowledge, attitudes, and behavior; updating recommendations; and defining a research agenda. The lessons learned suggest potential refinements in the future work of the task force and other groups engaged in guideline development.

Diffusion of Innovation↗
PubMed1995

Practice guidelines: what the family physician should know.

Practice guidelines that specify how to treat medical conditions and perform procedures are appearing with greater frequency in the medical literature. Their use by managed care plans, hospitals and government programs is expected to affect the practice of medicine substantially in the coming years. This article reviews the key information that family physicians should have in order to evaluate and use practice guidelines effectively: how they are developed; how they differ from textbooks, review articles and other sources of expert consultation; whether they promote "cookbook medicine"; when to modify one's clinical practice in response to new guidelines, and how to cope with conflicting recommendations. Practice guidelines can improve the quality of care by summarizing current evidence and expert opinion, but they can also reduce the quality of care if the recommendations are poorly supported by scientific evidence and clinical reasoning. Economic and medicolegal concerns can also influence the potential benefits and harms of practice guidelines. Since hundreds of practice guidelines are anticipated to be developed in the coming years, family physicians should become informed consumers of guidelines, avoid accepting them on face value, and ask specific questions to judge their quality.

Family Practice↗
PubMed1994

Public health perspective: the health policy implications of screening for prostate cancer.

The appropriateness of adopting a new screening policy depends on the burden of suffering from the disease, and on the effectiveness, potential harms and costs of screening. Prostate cancer clearly satisfies the first requirement but the relationship among its benefits, harms and costs is uncertain due to lack of data. Available screening tests (for example prostate specific antigen) can detect early stage disease but there is no evidence that clinical outcomes are improved by early detection. The potential harms of screening 28 million men older than 50 years include unnecessary interventions for thousands of men without disease or with clinically insignificant cancer. The billions of dollars required for this effort could displace resources away from health care services of proved benefit. Ongoing clinical trials are expected to provide needed data. In the meantime, public policy should emphasize preventive services of proved effectiveness. Patients should be informed of what is known and not known about the potential benefits and harms of prostate cancer detection before undergoing screening.

Clinical Trials as Topic↗
PubMed1994

Consensus development for producing diagnostic procedure guidelines: SPECT brain perfusion imaging with exametazime.

UNLABELLED: A method for developing diagnostic practice guidelines is presented in which a team of experts used a semiquantitative scoring system to reach consensus on a standard procedure for SPECT cerebral perfusion imaging. METHODS: An expert panel generated a list of elements that they thought were important for the optimal performance of cerebral perfusion imaging as the first phase of a modified Delphi panel technique. Panel members then scored each statement to indicate the importance of that statement for the performance of cerebral perfusion imaging. The scores were recorded for each statement and the average score, s.d. and variance for each statement were determined for each successive panel round. A total of three panel rounds were conducted. The change in average s.d. between scoring rounds was analyzed for significance using both parametric and nonparametric tests. RESULTS: The average s.d. decreased by 35% from 2.1 to 1.32 between the first and final panel round. This change in average s.d., which indicated enhanced consensus, was significant at p < 0.0001. Following consensus, all statements were grouped into four categories based on average score: critical elements, important elements, less important elements and elements of uncertain importance. This grouping formed the basis for a guideline summary narrative. Results were generated in 3 mo, at low cost and with clear documentation of rationale. CONCLUSION: Through simple adaptations of this methodology, expert panels that develop practice guidelines can replace informal discussion with systematic scoring methods to rate the quality of evidence, generalizability to practice conditions, appropriate indications and strength of recommendations.

Brain↗
PubMed1993

Practice guidelines: a new reality in medicine. III. Impact on patient care.

Practice guidelines are being introduced throughout medicine, but expectations about their impact on patient care depend on whether one is a clinician, patient, payer, administrator, or politician. Proponents hope that guidelines will enhance the knowledge, attitudes, and behavior of practitioners and will optimize health outcomes, costs, and malpractice decisions, but scientific evidence of these effects is limited. There are also concerns that guidelines could harm patient care. Clinicians worry that guidelines will promote "cookbook medicine," decrease their autonomy and income, and increase medicolegal liability. A particular concern relates to the expansion of enforcement programs that require clinicians to follow guidelines or face financial or other penalties. Guidelines can rarely define optimal care with certainty, due to poor science, imperfect analytic processes, and differences in patients. Recommendations are often worded in highly specific language that achieves clarity at the expense of scientific validity. Rigid enforcement of such guidelines could harm patients, interfere with the individualization of care, increase costs, and promote unfair judgments against clinicians who deviate from them for good reasons. A model that links the intensity of enforcement to the scientific and clinical quality of guidelines is proposed.

Health Knowledge, Attitudes, Practice↗