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At least 19 recordsLinked to original sources
PubMed1996

Consensus conference. Medical treatment of peptic ulcer disease. Practice guidelines. Practice Parameters Committee of the American College of Gastroenterology.

OBJECTIVE: To integrate the realization that peptic ulcer most commonly reflects infection with Helicobacter pylori or use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) into a disease management approach. PARTICIPANTS: Guidelines were outlined by the author and presented for review to the American College of Gastroenterology (ACG) Practice Parameters Committee, selected by the president of the ACG, and a panel of experts in peptic ulcer, selected by the committee. EVIDENCE AND CONSENSUS PROCESS: These guidelines were formulated following extensive review of the literature obtained by MEDLINE search and presented for detailed review and revision to unpublicized committee meetings on three occasions and to experts by mail. These recommendations are an official statement of the ACG and have been approved by the American Gastroenterological Association and the American Society for Gastroenterological Endoscopy. Firm recommendations are discriminated from reasonable suppositions pending definitive data. CONCLUSIONS: Since cure of H. pylori infection decreases recurrence rates and facilitates healing, antibiotic therapy is indicated for all H. pylori-infected ulcer patients. No optimal, simple antibiotic regimen has yet emerged. Simultaneous conventional ulcer therapy is recommended to facilitate symptom relief and healing. For refractory ulcers, only maximal acid inhibition offers advantage over continued conventional therapy; cure of H. pylori infection is likely to facilitate healing of refractory ulcers. Only with complicated or refractory ulcers should conventional maintenance therapy be continued, at least until successful H. pylori eradication is confirmed. A search for NSAID use is indicated for all ulcer patients. For NSAID-associated ulcers these drugs should be discontinued if possible and H. pylori, if present, should be cured.

Antacids↗
PubMed1996

The ethics of practice guidelines.

Practice guidelines, which are assistive tools for clinicians, have a long tradition in clinical medicine. Traditionally, these documents were developed by physicians to improve quality of care and can provide practitioners with valuable medical information and improve objectivity in medical decision making. Guidelines development by nonphysician groups is increasing. Guidelines are now intended to assist in decreasing costs, in reducing liability risk, and in utilization review, among other activities. Despite this enthusiasm for guidelines, their development is variable and validity remains largely untested. The intended clinical and nonclinical applications of guidelines require critical analysis. Practice guidelines are not inherently unethical. However, applications of nonmedical values combined with intense pressures on health care provision create an environment for guideline misuse. The ethical implications of practice guidelines are examined in our article.

Beneficence↗
PubMedDate not supplied

Occupational medicine practice guidelines.

Practice guidelines have become accepted "rules of the road" for many illnesses and injuries. Guidelines can be the basis for performance measures if they include a development step summarizing the available evidence for efficiency and effectiveness of maneuvers, tests, and treatments. They are particularly valuable for entities that have high degrees of variance in diagnostic accuracy, testing, and treatment. Periodic revision of guidelines can keep professional knowledge bases up to date. One must keep in mind that guidelines are just that--descriptions of normative data, observed best practices, expert consensus, or high-grade evidence. While they provide benchmarks for assessment and improvement, there may be good reasons why they do not apply to some patients. However, the exercise of justifying the differences can sharpen clinical judgment and improve outcomes.

Disability Evaluation↗
PubMed2003

[Issues of practice guideline].

"Practice Guideline (PG) or management guideline" is not an impeccable guideline but a tool to support a clinical decision, i.e., one of factors to make a clinical decision. When making a clinical decision, medical practice is finalized, taking into consideration of PG, patient's preference, social and national healthcare system. Even if PG provides a treatment method on the basis of high level evidences, we should not always uniformly apply to every patient. We can practice better with combination of PG, physician's expertise, patients' preference. When consulting PG, it is recommended to confirm in advance what society/organization prepared PG, purpose of preparation, preparation process, and developmental method, including social fairness whether healthcare cost is assumed in PG or whether industry is a substantial editor. As to the questions whose answer is not mentioned in PG, their controversial points have to be defined and assessed, retrieving literatures. This is so called implementation of "Evidence-Based Medicine (EBM)." The practice of EMB provides better evidences. PG is fated to be always outdated when published because new evidence will be additionally published, and therefore, it is always required to search for new evidences available at daily practice.

Antiparkinson Agents↗
PubMed1993

Implementation and evaluation of practice guidelines.

Practice guidelines for the management of deep vein thrombosis were implemented in a Problem-Oriented Patient Management System on the HELP Hospital Information System at the LDS Hospital. A hierarchical knowledge representation was used. The Problem-Oriented Patient Management System was designed to generate patient-specific guideline suggestions according to the clinical situation at the time of generation. A retrospective evaluation was used to compare the appropriateness of the generated guideline suggestions to the appropriateness of the attending physician's management decisions. A significantly higher proportion of guideline suggestions was evaluated to be appropriate, compared to the proportion of attending physician's management decisions found to be appropriate.

Evaluation Studies as Topic↗
PubMed2002

Surgical approaches to malignant melanoma. Practical guidelines.

Practical guidelines for the surgical approach to malignant melanoma are discussed in detail. Topics include diagnosis and proper biopsy technique; the appropriate preoperative metastatic workup; width of excision margins; treatment of the regional lymph nodes including cutaneous lymphoscintigraphy, intraoperative lymphatic mapping, and sentinel lymphadenectomy; postoperative follow-up schedules; management of local recurrence including surgical resection, isolated limb perfusion, intralesional therapy, adjuvant immunotherapy; management of special clinical situations including subungal melanoma, plantar melanoma, melanoma on the face, melanoma in pregnancy, and the treatment of lesions of uncertain diagnosis.

Biopsy, Needle↗
PubMed1997

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

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.

Clinical Trials as Topic↗
PubMedDate not supplied

Putting medical practice guidelines into practice: the cholesterol model.

As more and more medical practice guidelines are developed in the United States, commensurate evaluation efforts should assess their impact on professional practice and patient outcomes. We describe an ongoing research program designed to develop and test practice models for applying the 1988 Adult Treatment Panel Guidelines for the clinical management of high blood cholesterol. Four studies are evaluating different models to assist nonacademic community practices in the detection, evaluation, and treatment of high blood cholesterol. We have designed randomized controlled trials set in solo and small-group primary care practices of family or general practitioners and internists situated in rural, suburban, and urban settings. Patients include adult men and women who represent diverse socioeconomic and ethnic backgrounds. We are measuring rates of cholesterol screening; dietary and drug treatment and follow-up; changes in dietary intake and compliance with drug therapy; changes in quality of life and cost of intervention; and reduction in cholesterol level. Scheduled for completion in 1994, this program will provide insights into practical and effective methods of lipid management. It serves as a model for studying the application of health guidelines in the context of nonacademic primary care practices serving diverse patient populations.

Cholesterol↗
PubMed1997

Gastric cancer surgical practice guidelines. Gastric Cancer Practice Guideline Committee.

The data described above suggest that the current management of gastric carcinoma requires a surgical resection. Identification of the number of lymph nodes that may be involved with cancer is an important prognosticator. Resection of involved lymph nodes is likely to decrease the morbidity of locoregional recurrence. However, this has not been adequately addressed in the studies performed to date. Nonetheless, accurate staging is an essential goal of the primary therapy of gastric carcinoma. The limits of resection for a gastric cancer are outlined in the guidelines (see page 1068). Administration of adjuvant therapy, such as chemotherapy or radiation therapy, remains controversial and is the subject of ongoing clinical research. Until a prospective, randomized trial demonstrates a significant improvement in survival, there remains little or no basis for the addition of adjuvant therapy outside the context of a clinical trial.

Carcinoma↗
PubMed1989

Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians.

Guidelines for medical practice can contribute to improved care only if they succeed in moving actual practice closer to the behaviors the guidelines recommend. To assess the effect of such guidelines, we surveyed hospitals and obstetricians in Ontario before and after the release of a widely distributed and nationally endorsed consensus statement recommending decreases in the use of cesarean sections. These surveys, along with discharge data from hospitals reflecting actual practice, revealed that most obstetricians (87 to 94 percent) were aware of the guidelines and that most (82.5 to 85 percent) agreed with them. Attitudes toward the use of cesarean section were congruent with the recommendations even before their release. One third of the hospitals and obstetricians reported changing their practice as a consequence of the guidelines, and obstetricians reported rates of cesarean section in women with a previous cesarean section that were significantly reduced, in keeping with the recommendations (from 72.2 percent to 61.1 percent; P less than 0.01). The surveys also showed, however, that knowledge of the content of the recommendations was poor (67 percent correct responses). Furthermore, data on actual practice after the publication of the guidelines showed that the rates of cesarean section were 15 to 49 percent higher than the rates reported by obstetricians, and they showed only a slight change from the previous upward trend. We conclude that guidelines for practice may predispose physicians to consider changing their behavior, but that unless there are other incentives or the removal of disincentives, guidelines may be unlikely to effect rapid change in actual practice. We believe that incentives should operate at the local level, although they may include system-wide economic changes.

Cesarean Section↗
PubMed1989

Practice guidelines and practicing medicine. Are they compatible?

Various factors, including increased financial pressures on the health system, the rapidity of the introduction of technology, and data showing high levels of inappropriate care, will coalesce into a movement that will yield practice guidelines. If the guidelines are developed with the aid of the best methods and if they are applied constructively, then the twin goals of increased health of the American public and physician satisfaction can be achieved.

Clinical Protocols↗