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Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

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At least 163 records · Page 9Linked to original sources
PubMed2001

Formal consensus: the development of a national clinical guideline.

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.

Adult↗
PubMed1999

Pain management: tools of the trade.

Hospitals, pain consultants and academic centers around the country have developed patient interviews, treatment standards, pathways and guidelines to help clinicians treat pain more effectively. This special section features examples of several of the most useful tools, as well as resources for further exploration. Highlights include: standards of pain management, cardiovascular surgery standing orders, patient pain interview, guidelines and quality aides.

Hospitals↗
PubMed2001

New guideline: step up efforts to prevent and treat diabetic foot disorders.

Prevent and treat diabetic foot disorders before complications multiply. They're the most common reason for hospitalization among diabetic patients, and such problems are costing billions each year to treat. However, some simple preventive steps at the primary care level could go a long way toward preventing or alleviating the more serious complications of diabetic foot disorders. Check out these new guidelines and new strategies for dealing with this costly issue.

Diabetic Foot↗
PubMed2000

Organisation of services for acute stroke in Scotland--report of the Scottish stroke services audit.

An audit was undertaken of hospital service provision for acute strokes in Scotland, using as a template key recommendations in the four SIGN guidelines on management of stroke. A questionnaire and structured interview was undertaken of key personnel in the 43 Trusts and three directly managed units providing in-patient stroke care in Scotland, and the 15 Health Boards commissioning stroke care. All Trusts and Health Boards participated and a complete set of information for each was recorded on a data-base and analysed. This report gives an overview for 14 key components of an integrated stroke service with results presented in four bands according to Trust type determined by the number of strokes admitted. No Trust provided all key components and for a few components a lack of provision was widespread, e.g. fast-track assessment clinics for TIA and minor stroke, access to CT scanning within 48 hours. Variation occurred between Trusts of similar size, between Trusts of different sizes. Overall the Health Boards were at a preliminary stage in the development of stroke specific service specifications. The results of the audit are a view of stroke services around April 1998, and should enable commissioners and providers to consider how to progress implementation of the clinical guidelines on stroke care.

Acute Disease↗
PubMed2004

Toward improved guideline quality: using the COGS statement with GEM.

The Conference on Guideline Standardization (COGS) was convened to create a standardized documentation checklist for clinical practice guidelines in an effort to promote guideline quality and facilitate implementation. The statement was created by a multidisciplinary panel using a rigorous consensus development methodology. The Guideline Elements Model (GEM) provides a standardized approach to representing guideline documents using XML. In this work, we demonstrate the sufficiency of GEM for describing COGS components. Using the mapping between COGS and GEM elements we built an XSLT application to examine a guideline's adherence (or non-adherence) to the COGS checklist. Once a guideline has been marked up according to the GEM hierarchy, its knowledge content can be reused in multiple ways.

Congresses as Topic↗
PubMed1999

Psychosocial interventions for patients with cancer: what works and what doesn't.

With the successes that have been achieved in cancer care leading to patients surviving longer, the need for a variety of psychosocial intervention models is posing a new challenge to the field. This article reviews the general categories of interventions used most commonly: (1) education; (2) coping; (3) emotional support; and (4) psychotherapy. It provides a theoretical model for designing psychosocial interventions, and provides guidelines for assessing what works and what doesn't.

Adaptation, Psychological↗
PubMed1998

The cost of treating dyslipidaemia using National Cholesterol Education Program (NCEP) guidelines.

Coronary heart disease (CHD) is a major cause of death in industrialised countries and places a large burden on society in terms of healthcare resources and lost productivity. US National Cholesterol Education Program (NCEP) guidelines recommend aggressive lipid-modifying therapy for individuals at highest risk for CHD. It has been estimated that more than 50 million individuals in the US (more than one-third of the total population) are candidates for some form of dietary and/or pharmacological intervention to modify their lipid profiles. Most individuals who receive lipid-lowering drug therapy do not meet target goals set by the NCEP; thus, there is a large potential for increased use of drug therapy. Pharmacoeconomic analyses applying NCEP guidelines are sparse; however, available data (using direct costs) suggest that secondary prevention is more cost effective than primary prevention, but that costs associated with primary prevention are generally in line with those of accepted medical interventions. Cost-effectiveness ratios for secondary prevention improved when indirect costs were assessed in one study. A recent randomised prospective 54-week comparative study of statins in 662 patients with hypercholesterolaemia concurrently measured medical outcomes and economic data. Atorvastatin-treated patients were significantly more likely to achieve NCEP goals (overall and at the initial dosage), and to achieve these goals more quickly than patients treated with fluvastatin, lovastatin and simvastatin. The mean cost to reach NCEP goals was consequently lowest for atorvastatin. Results from pharmacoeconomic studies of primary and secondary prevention are therefore in support of NCEP treatment guidelines for hypercholesterolaemia.

Anticholesteremic Agents↗
PubMedDate not supplied

Perceptions and use of smoking cessation in nurse-midwives' practice.

The objective of this study was to examine Ohio nurse-midwives' perceptions and use of a smoking cessation protocol in assisting pregnant smokers. The total population of licensed Ohio nurse-midwives (n = 300) was surveyed by using a cross-sectional survey design. Only 4 of 10 items that assessed a nationally recommended method of promoting smoking cessation were done by 50% or more of respondents. Few nurse-midwives identified barriers to counseling pregnant patients who smoked, but the most common were lack of time (14%) and not knowing where to send pregnant smokers for treatment (14%). Most respondents believed that nicotine replacement therapy (NRT) would be most likely to reduce the number of pregnant smokers (74%), yet few (26%) were confident in their ability to prescribe/recommend nicotine replacement therapy. Respondents more likely to use 5 A's can be characterized as the following: had higher efficacy expectations in their ability to communicate issues about the 5 A's and had higher outcome expectations regarding the effects of using the 5 A's. Nurse-midwife training programs and continuing education needs to include current research in nicotine replacement therapy use in pregnant patients and 5 A's techniques to assist pregnant smokers in quitting.

Female↗
PubMedDate not supplied

Hand decontamination: what interventions improve compliance?

BACKGROUND: Haemodialysis units have traditionally been classified as high-risk areas in relation to infection control. Hand decontamination is the fundamental infection control practice, although this is not always performed optimally Deficiencies in the technique, frequency and appropriateness of this vital practice are frequently reported in health care journals. A literature search was carried out to determine what interventions improve compliance with hand decontamination practice. METHOD: A literature search was carried out of electronic databases from 1988-2000. Forty articles matched the key search words. When inclusion/exclusion criteria had been applied, seven primary research articles were found to be suitable. Appropriate tools were used to critically analyse the research. The findings were then synthesised into similar themes. FINDINGS: The interventions used in the seven articles utilised a combination of staff and patient education, feedback and motivational interventions to improve compliance. The evidence showed that these interventions met with different degrees of success. Multiple interventions were generally more successful than individual efforts. The improvement in hand decontamination practice often fell back to base line measurements after the intervention had ceased. IMPLICATIONS FOR PRACTICE: The findings can cautiously be used to improve practice. A combination of continuous, innovative education and motivation should improve and maintain this important skill.

Attitude of Health Personnel↗
PubMed2000

Clinical practice guidelines. Finding and appraising useful, relevant recommendations for geriatric care.

Practicing effective evidence-based medicine in the geriatric setting depends on routine review of the current literature and critical analysis of its relevance to the patient and condition in question. Clinical guidelines facilitate this approach and are readily available from an array of print and electronic resources. The recent growth in the number of published guidelines by medical associations, government agencies, and healthcare organizations makes determining their validity and applicability a challenging proposition. The Internet provides one of the most effective tools for quickly finding evidence-based guidelines. Appraisal involves several fundamental steps that can aid in determining whether the guidelines are valid--based on "best evidence"--and clinically relevant.

Aged↗