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At least 235 records · Page 13Linked to original sources
PubMed2000

Coronary artery disease and women: applying the guidelines for risk factor management.

Coronary artery disease (CAD) is the leading cause of death for women. In large part because of increased age at presentation and a greater frequency of concomitant morbidities, women who develop CAD have a poorer prognosis than do men. Although the long term outcome of revascularization procedures is good, the associated procedural morbidity and mortality in women is high. More emphasis should be placed on the primary and secondary prevention of CAD in women. Although women respond well to risk factor modification, including lipid-lowering therapies, recent data indicate that their awareness of risk factors and prevention strategies is poor. Physician risk factor assessment and adherence to current guideline recommendations are essential in preventing the development or progression of CAD in women.

Coronary Disease↗
PubMed2002

Updating evidence-based clinical guidelines.

OBJECTIVES: To report on the updating of two evidence-based guidelines. METHODS: Development of multi-disciplinary evidence-based guidelines within the North of England Evidence Based Guideline Development Programme. RESULTS: The guideline updating groups were multi-disciplinary although the balance of disciplines was different from the original development groups; the convening of the updating groups allowed refinement of both the skills within the groups and the overall size of the groups. As both groups were starting with a previous version of the guideline, defining the scope of the guideline was more straightforward and faster than when developing the guideline de novo. The process of evidence identification for both guidelines was again by systematic review. Updating the guidelines influenced recommendations in two ways: new evidence required new recommendations; and supplementary evidence in an existing area allowed refinement of recommendations. Overall savings within the guideline updating process (compared with initial development) were modest. The major costs of both the initial guideline development and the updating process were staff costs, which were identical for the two processes. CONCLUSIONS: There is little other experience to set alongside this paper. There is a need for further sharing of experiences and the development of explicit methods for informing decisions on when and how to update evidence-based guidelines.

Adult↗
PubMedDate not supplied

Pharmacotherapy of panic disorder: proposed guidelines for the family physician.

BACKGROUND: Efforts to improve the recognition and treatment of panic disorder in the primary care setting have not resulted in better outcomes. Studies show that even when physicians recognize panic disorder, they do not treat it adequately. Family physicians need specific diagnostic and treatment guidelines when they encounter a patient who has possible panic disorder. METHODS: Four psychiatrists with expertise in the pharmacotherapy of panic disorder and experience working in the primary care setting reviewed the available treatment literature and developed a consensus treatment algorithm for panic pharmacotherapy in the primary care setting. These proposed guidelines were reviewed for accuracy by 3 additional psychiatric experts and for their applicability to the primary care setting by 2 leading experts on the treatment of mental disorders in primary care. RESULTS: Guidelines for medication selection, dosing, titration, side-effect management, and maintenance treatment are proposed. Modifications for patients already on psychotropic medication are provided, and indications for psychiatric consultation are specified. CONCLUSIONS: Panic disorder is a highly treatable condition, and primary care physicians can deliver effective pharmacotherapy if specific guidelines are carefully followed.

Anti-Anxiety Agents↗
PubMedDate not supplied

The management of obesity.

With the ever increasing prevalence of obesity, it is a major priority in primary health care that effective strategies are implemented to curb this trend. This article aims to provide nurses with evidence-based guidelines for the treatment and prevention of obesity.

Anthropometry↗
PubMed2001

Reporting of conflicts of interest in guidelines of preventive and therapeutic interventions.

BACKGROUND: Guidelines published in major medical journals are very influential in determining clinical practice. It would be essential to evaluate whether conflicts of interests are disclosed in these publications. We evaluated the reporting of conflicts of interest and the factors that may affect such disclosure in a sample of 191 guidelines on therapeutic and/or preventive measures published in 6 major clinical journals (Annals of Internal Medicine, BMJ, JAMA, Lancet, New England Journal of Medicine, Pediatrics) in 1979, 1984, 1989, 1994 and 1999. RESULTS: Only 7 guidelines (3.7%) mentioned conflicts of interest and all were published in 1999 (17.5% (7/40) of guidelines published in 1999 alone). Reporting of conflicts of interest differed significantly by journal (p=0.026), availability of disclosure policy by the journal (p=0.043), source of funding (p < 0.001) and number of authors (p=0.004). In the entire database of 191 guidelines, a mere 18 authors disclosed a total of 24 potential conflicts of interest and most pertained to minor issues. CONCLUSIONS: Despite some recent improvement, reporting of conflicts of interest in clinical guidelines published in influential journals is largely neglected.

Clinical Trials as Topic↗
PubMedDate not supplied

The impact of asthma management guideline dissemination on the control of asthma in the community.

OBJECTIVE: To measure the impact of asthma management education on the control of asthma in the community. DESIGN: A cross-sectional study comparing three communities. SETTING: Three rural communities in southern Alberta. PATIENTS AND METHODS: A population sample of patients with asthma attending a pharmacy to fill a prescription for asthma medication were selected from three communities. Patients were asked to complete a questionnaire relating to their asthma management and control. INTERVENTION: Three levels of asthma management education were provided in the three communities with populations of 6000 to 10,000. The levels of education ranged from standard continuing medical education programs relating to the national asthma guidelines and a visiting asthma nurse educator to the establishment of an asthma clinic and a multiple-target, intensive education program for health professionals, town leaders, local media, schools and the public. The survey of the population with asthma was conducted approximately one year after the education program had been completed. RESULTS: A total of 327 completed questionnaires were submitted. Analysis showed that there was no significant difference that could be attributed to the intervention in the management of asthma or in the level of asthma control among the patients from the three communities. CONCLUSION: The more intense levels of education used to disseminate the content of the national asthma management guidelines did not translate into improved asthma control in the community.

Adult↗
PubMedDate not supplied

The effects of a theory-based training program on nurses' self-efficacy and behavior for smoking cessation counseling.

BACKGROUND: Cigarette smoking continues to put Americans at risk for serious health consequences and early death. Nurses play an important role in disseminating smoking cessation interventions to patients in the hospital. However, nurses are not prepared for smoking cessation counseling. METHOD: A quasi-experimental design was used. Fifteen nurses participated in the Clinical Practice Guideline "5 A's" brief intervention training program, completing a survey during three time periods. RESULTS: There were several statistically significant changes in the dependent variables for self-efficacy and behavior for smoking cessation counseling. CONCLUSION: Results of this study support further research and theory-based training for nurses.

Adult↗
PubMed1998

Breaking the barriers for improved glycaemic control: primary care and secondary care interface.

The prevalence of diabetes is predicted to increase dramatically over the next 30 years, mostly as a result of Type 2 diabetes. To manage this increased burden, the following measures must be implemented: diabetes care must be delivered in the most suitable locations; people with diabetes must remain in contact with the appropriate healthcare professionals; and health professionals must use the most effective methods to treat their patients. The structure for diabetes care suggested by the World Health Organization uses terminology that is familiar universally. The reality, in terms of what can be delivered at primary- and secondary-care level will, however, differ greatly according to the extent of service development and the resources available. The optimum forum for diabetes care should have the advantages of the primary-care setting and, when required, the main advantages of the secondary-care setting, i.e. specialized knowledge and more sophisticated facilities. In most healthcare systems, particularly those without financial disincentives to the patient to be followed up in hospital, the tendency remains for secondary care to 'capture' and retain patients for longer than is required clinically. The end results are the overloading of hospital services, inappropriate use of resources and the tendency for patients to default from care because of the relative inaccessibility and remoteness of the hospital service. Issues with special reference to different models of diabetes care, use of patient registers and clinical guidelines, and the perceptions of patients regarding the successful use of services are presented.

Blood Glucose↗
PubMedDate not supplied

JCAHO: meeting the standards for pain management.

Chronic, unrelieved pain costs approximately $100 billion per year. The impact of unrelieved pain has yet to be determined. Postoperatively, an individual has a 50-80% chance of having unrelieved moderately severe to severe pain sometime during the surgical period. In spite of knowing how to manage pain, we still have a long way to go. New and updated guidelines will assist in providing a basis for standardization in the future. This article focuses on the newly adopted JCAHO guidelines on pain management and their impact on the management of pain in the operative period.

Humans↗
PubMed1994

The effect of a materials-based intervention on knowledge of risk-based clinical prevention screening guidelines.

The release of the U.S. Preventive Services Task Force guidelines (GUIDELINES) introduces an opportunity to modify patient expectations about the timing of routine examinations. This randomized, controlled study examines the effect of a materials-based educational intervention on knowledge and beliefs about risk-based preventive screening guidelines. The study was conducted in a large multi-specialty group practice participating in a network model HMO in the upper midwest with over 250,000 members. Subjects were selected from patients of a primary care clinic in a suburban section of a major metropolitan area. A 48-page prevention guidebook based on the GUIDELINES was distributed to a randomly assigned treatment group of 200 patients enrolled in an HMO. A 22-item questionnaire on preventive health services that measured respondents' age-adjusted risks and knowledge of risk-based screening guidelines was sent to both experimental and control groups. A 69% response rate was achieved. chi 2 analysis and t-tests showed that the treatment group was significantly more accurate in identifying recommended GUIDELINES for colon examinations (digital rectal, stool occult, sigmoidoscopy), blood pressure, and Pap tests. No significant differences related to identifying GUIDELINES for mammograms and clinical breast examinations were found between the groups. Communications about new screening guidelines can yield positive but selective changes in knowledge and beliefs about appropriate screening intervals.

Communication↗
PubMed2002

Information recalled by women taking anti-epileptic drugs for epilepsy: a questionnaire study.

Women with epilepsy have different needs from men, particularly associated with childbearing. Despite clinical guidelines, the care of women with epilepsy remains suboptimal. The aim of this study was to establish whether women with epilepsy recall being given information on topics relating to childbearing. Design of study and methods included a postal questionnaire study of 795 women with epilepsy and of childbearing age. The respondents were identified through both general practices and hospital clinics as part of the Clinical Standards Advisory Group study into Epilepsy Services. Of those women who considered the questions personally relevant, 38-48% recalled receiving information about contraception, pre-pregnancy planning, folic acid and teratogenicity, with lower overall proportions among adolescent women. The proportions that recalled receiving information about vitamin K, safety in child-care and breast-feeding were lower at 12, 24 and 24%, respectively. While it is recognised that information provided may not be recalled, our results suggest that further measures are required to improve the effectiveness of information provision in the UK in relation to women of childbearing age with epilepsy.

Adolescent↗
PubMed1998

A qualitative assessment of randomized controlled trials in otolaryngology.

In 1996 the CONSORT statement made recommendations on the strict reporting of randomized controlled trials (RCT). This will facilitate the future assessment of such trials and will highlight those trials that have been performed suboptimally and whose results may be biased. We have devised a scoring system, based on CONSORT, to assess RCT quality and by reading each original paper in full we have now assessed the quality of trials published from 1966 to 1995. The mean score for trials identified was 7.3 out of a maximum 12 points. No one journal was significantly better than the others. Trials in rhinology are reported better than head and neck oncology trials (mean scores 7.6 and 6.5 respectively). The past 30 years has not seen an improvement in the quality of the trials. The reporting of RCTs in the ENT literature is poor. CONSORT guidelines now exist and trialists are encouraged to adopt them when conducting future clinical trials.

Head and Neck Neoplasms↗
PubMedDate not supplied

The nurse's role in bowel awareness.

Promoting good health and preventing ill health are part of the nurse's role, and using a model for health promotion in the colorectal nursing service is an effective way to improve patient care. This article considers referral guidelines for patients with suspected colorectal cancer and suggests methods of raising public awareness.

Colorectal Neoplasms↗
PubMed2004

Back pain and opioid seeking behaviour.

BACKGROUND: Back pain is a common presentation associated with opioid seeking behaviour. OBJECTIVE: This case study provides general practitioners with a practical approach to seeing patients with chronic pain whom they suspect of opioid dependence and describes a framework for managing chronic pain and dependence within the general practice setting. DISCUSSION: Back pain, with or without opioid dependence, is commonly encountered in general practice. General practitioners frequently find themselves caught between the desire to treat and relieve symptoms, and not wanting to cause or exacerbate dependence. Clear guidelines and access to support are often lacking.

Adult↗
PubMedDate not supplied

Translating psychosocial research findings into practice guidelines.

Evidence-based practice guidelines are increasingly used by healthcare professionals to guide patient care and effect positive patient outcomes. These guidelines are usually based on laboratory-based parameters and lack the psychosocial dimensions of patient care. The authors describe the process used by a hospital-based interdisciplinary team to successfully develop evidence-based psychosocial guidelines designed to foster hopefulness in pediatric patients with cancer, their families, and their healthcare providers. From these guidelines, 4 clinical care projects were developed and are described in this article.

Adolescent↗