Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Practice Guidelines as Topic”

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.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed2003

Can surveying practitioners about their practices help identify priority clinical practice guideline topics?

BACKGROUND: Clinical practice guidelines are systematically developed statements designed to assist in patient and physician clinical decision making for specific clinical circumstances. In order to establish which guideline topics are priorities, practitioners were surveyed regarding their current practice. METHODS: One hundred ninety-seven practitioners in Ontario, Canada were mailed a survey exploring their current practice or opinion regarding the prophylactic use of anticonvulsant drugs in patients with malignant glioma who had never had a seizure. The survey consisted of seven questions regarding the relevance of a guideline on the subject to the practitioner's practice, the proportion of clinical cases involving anticonvulsant use, knowledge of existing guidelines on this topic, interest in reviewing a completed practice guideline and three clinical scenarios. RESULTS: There were 122 respondents who returned the survey (62% rate of return). Eighty percent of the practitioners who responded indicated that less than 25% of their clinical cases involved the use of anticonvulsants; however, only 16% of respondents indicated that a practice guideline would be irrelevant to their practice. Eighty percent of respondents volunteered to review a draft version of a practice guideline on the use of anticonvulsants. The survey presented the practitioners with three scenarios where anticonvulsants in patients with brain tumours may be appropriate: peri-operatively in patients without seizures, postoperatively in patients currently using anticonvulsants, and thirdly in patients not currently using anticonvulsants or undergoing surgery. In contrast to the third situation, the first two situations yielded considerable variation in practitioner response. CONCLUSION: The survey established that there is some variation present in the current practice of anticonvulsant use in the patients with brain tumours. Whether there is an optimal treatment practice has yet to be determined. Practitioners do seem to feel that a guideline on anticonvulsant use in warranted, and most practitioners would be interested in being part of the guideline development process.

Anticonvulsants↗
PubMedDate not supplied

Clinical management protocols: the bedside answer to clinical practice guidelines.

TOPIC: Clinical Management Protocols for trauma patients. PURPOSE: The goals and process for developing and implementing Clinical Management Protocols are presented. Protocol development and the differences between clinical practice guidelines, critical pathways, and clinical management protocols are discussed. SOURCES: Published literature, experience, and clinical expertise. CONCLUSIONS: Utilizing annotated algorithms, the protocols are designed for and driven by patient care based on patient need and require the collaboration of experts and trauma team members.

Algorithms↗
PubMed1995

Setting priorities and selecting topics for clinical practice guidelines.

Setting priorities and selecting topics are important steps in guidelines development, but they have received relatively little attention to date. Responses from a survey of guidelines stakeholders in Canada suggest that the health burden of a clinical condition on the population is an important factor in priority setting. Economic considerations, cast as either costs of treatment to the health care system or the economic burden of illness to society, are given varying importance by different stakeholder groups. Drawing on the literature and the survey results, the authors propose a framework for priority setting. Important issues requiring consideration include the role of public and community participation, the need for and appropriate emphasis on quantitative data regarding current practice and its variation, and mechanisms to link guidelines to health-policy development and management of the health care system.

Canada↗
PubMed2005

[Clinical practice variation in reduced fetal movements].

BACKGROUND: Reduced fetal movements imply a risk pregnancy. This condition is present in a significant proportion of pregnancies, but both the quality of information and that of clinical care is variable. MATERIAL AND METHODS: All delivery units in Eastern Norway and Bergen have registered all consultations for reduced fetal movements, as part of the international collaborative project "Fetal Movement Intervention Assessment" (Femina). Out of 23,933 deliveries, 1200 pregnancies were examined. In 1043 pregnancies the mother had spontaneously presented her concern over reduced fetal movements; these were included in analyses. Results are presented with a 95% confidence interval. RESULTS: Asphyxia, death, growth restriction or preterm birth occurred in 19.6% (16.6-22.6%) of cases, ranging between units from 9.1% to 26.5%. Standard procedures varied extensively; ultrasonography was used in 39.0% to 98.6% and Doppler in 4.5% to 74.6% of cases. There was an association between outcomes and the procedures used. Women who waited 24 hours with reduced or absent movements before contacting healthcare had increased risk. Among those with absent movements, 47% (42-52%) had such risk behaviour. INTERPRETATION: There is a need for quality improvements in the information to pregnant women as well as in the clinical management of affected pregnancies. This could have large health benefits. We propose new guidelines for information and management.

Cardiotocography↗
PubMed2005

[The practice guideline 'Anxiety disorders' (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The recommendations provided by the revised guideline 'Anxiety disorders' are well suited to every-day practice. The multidisciplinary approach reflects the increasing cooperation between primary and secondary care in the management of mental-health problems. The description of the various anxiety disorders and the questions that can be asked to elicit the symptoms will facilitate recognition. The indications for treatment with medication are clear: a limited number of antidepressants should be used. Although it is agreed that patient education is an important part of treatment, the guidelines could have described in more detail how this should be done. Cognitive-behavioural techniques may be used but this requires extra training; its effectiveness when used by general practitioners needs further study. This guideline will add to existing knowledge and improve the skills of general practitioners in dealing with anxiety.

Antidepressive Agents↗
PubMed2006

[The role of psychoeducation in the treatment of psychiatric inpatients].

Psychoeducation has proved to be a highly effective therapeutic method to reduce relapse and rehospitalization rates of schizophrenic patients. Education about their disease has good results on clinical course and especially on compliance. Despite evidence of effectiveness and the recommendations of evidence-based guidelines, psychoeducational programs are underutilized in clinical practice. Based on a review of the literature, we summarize the development and current state of research on psychoeducation. With regard to its broader use in psychiatric inpatient treatment, we examine potential barriers and possible improvements. Characteristics of a psychoeducational concept that meets the demands of the modern structure of psychiatric institutions are discussed. Essential issues are specificity in the traditional diagnosis of schizophrenia and applying integrative concepts to the mainly didactic method used today.

Humans↗
PubMed2001

Treatment recommendations versus treatment realities: recognizing the rift and understanding the consequences.

Depression is a treatable disorder, although it often requires long-term therapy. To aid physicians in the effective long-term management of depression, treatment guidelines have been established by a number of organizations with minimum treatment duration recommendations. Unfortunately, numerous studies document a significant disparity between these recommendations and clinical practice realities. In particular, studies have shown that fewer than half of treated patients receive the recommended duration of 6 months of continuation therapy. Other clinical practice studies have reported that early discontinuation from therapy is associated with a substantial increase in the risk of relapse or recurrence. Long-term treatment of depression in clinical practice settings may benefit from a closer approximation to the conditions found in clinical trial settings.

Antidepressive Agents↗
PubMed1995

Information in general medical practice: a qualitative approach.

The aims of the study reported here were to describe the information-related behavior of general medical practitioners, to study information communication in general practices, and to establish guidelines for good practice. General practitioners (GPs) were interviewed, and information and communication audits also involving other staff at the practices were undertaken. The main reasons why GPs needed information were for patient care, managing the practice, legal and ethical matters, and teaching trainee GPs. Most practices had problems with internal and external communication and the storage and retrieval of information. The main conclusion is that practices need to have an information strategy that considers human, manual, and computer aspects of information handling.

Appointments and Schedules↗
PubMedDate not supplied

Infection control practices in U.S. burn units.

The purpose of this study was to determine infection control procedures most commonly used in burn units in the United States. We used two data collection formats: a brief quantitative survey and a brief qualitative interview. Our response rate was 75% (104/139). We found wide variability in general infection control practices as well as in wound care practices in intensive care units. The majority of units reported having written infection control guidelines specific to the burn unit. Respondents noted challenges that burn injury presents to infection control. A broad range of techniques for preventing device- and procedure-related infection also were provided by respondents. Compliance with hand washing on the part of physicians and ancillary staff remains a major challenge. To improve the quality of infection control and reduce variation in practice, we must continue to monitor the types of practices that are delivered, provide feedback to providers on how they care for their patients, where evidence exists disseminate best practices, and build the evidence base through efficacy trials.

Burn Units↗
PubMed1999

Targeted intervention programs: creating a customized practice model to improve the treatment of allergic rhinitis in a managed care population.

OBJECTIVE: To develop an intervention program to improve health outcomes among patients with allergic rhinitis in a managed care environment. STUDY DESIGN: The Episodes of Care (EOC) team at Lovelace Health Systems selected allergic rhinitis for an intervention program because it was identified as one of the top 10 reasons for visits to primary care clinics. The intervention program was based on a multidisciplinary team process designed to create a customized provider and patient education program to alter inconsistence or deficiencies in the treatment of allergic rhinitis. PATIENTS AND METHODS: The EOC team researched literature and current practices and then identified inconsistencies in diagnostic and treatment patterns. Based on this research, the team developed guidelines and a provider education program. Intervention strategies were structured around decision points in a treatment protocol. More than 500 patients were monitored throughout the allergy season by using written and telephone surveys, symptom diaries, and encounter data. Measurable outcomes were established for provider and patient behavior. Patient outcomes were derived from a preventive behavior index and administrative data reporting usage of 5 classes of medication. RESULTS: Approximately 50% of providers altered their practice patterns as a result of the intervention program. Patient outcomes showed a decrease in the use of rescue medications, particularly antibiotics, and an increase in preventive measures in the treatment group compared with the control group. CONCLUSION: The EOC model resulted in positive changes in provider and patient behavior. The multidisciplinary approach resulted in broad provider participation.

Algorithms↗
PubMed1999

Preventing tuberculosis among HIV-infected persons: a survey of physicians' knowledge and practices.

BACKGROUND: Guidelines exist for screening, diagnosing, and preventing tuberculosis (TB) among HIV-infected persons, but their application and utility are unknown. METHODS: We conducted a survey of knowledge and practices among 1,300 physicians in the San Francisco Bay area to assess their practices towards TB among HIV-infected persons. RESULTS: Of 630 respondents, 350 (56%) provided care for HIV-infected persons. Thirty-four percent of the respondents had seen the most recent guidelines for preventing tuberculosis among HIV-infected persons; 65% routinely provide information to HIV-infected patients about the risks of exposure to Mycobacterium tuberculosis; 39% provide annual tuberculin skin testing (TST) to HIV-infected patients without a history of a positive test; 86% knew that >/=5-mm induration is considered a positive TST result in HIV-infected persons; and 47% provide a 12-month regimen of chemoprophylaxis for HIV-infected persons who have a positive TST but not active tuberculosis. Physician specialty and experience with HIV-infected persons were not strongly correlated; experience was a better predictor of correct knowledge and practices. CONCLUSIONS: Many physicians were not aware of the standards of care for preventing tuberculosis among HIV-infected patients, even in a geographic area with a high prevalence of M. tuberculosis and HIV.

AIDS-Related Opportunistic Infections↗
PubMed2001

[Randomized controlled trial of structured, individualized treatment of type 2 diabetes mellitus. The project of Diabetes Care in General Practice].

INTRODUCTION: We assessed the effect of a multifaceted intervention directed at general practitioners to improve type 2 diabetes care. MATERIALS AND METHODS: Three hundred and eleven Danish practices with 474 general practitioners were randomised to structured personal care (intervention group) or routine care (comparison group). Of 970 surviving patients (aged 40+ years) diagnosed with diabetes in 1989-1991, 874 (90.1%) were assessed after 6 years. Intervention comprised regular follow-up and individualized goal-setting, supported by reminders to doctors, clinical guidelines, feed-back, and continuing medical education. RESULTS: Predefined non-fatal outcomes and mortality were the same in both groups. The following risk factor levels were lower in the intervention patients than in the comparison patients: fasting plasma glucose (7.9 vs 8.7 mmol/l, medians, P = 0.0007), haemoglobin A1c (8.5 vs 9.0%, P < 0.0001, normal range 5.4-7.4%), systolic blood pressure (145 vs 150 mmHg, P = 0.0004), and cholesterols (6.0 vs 6.1 mmol/l, P = 0.029, baseline-adjusted). Both groups had sustained a weight loss since diagnosis (2.6 vs 2.0 kg). Metformin was the only drug used more frequently in the intervention group (24 vs 15%). Intervention doctors arranged more follow-up consultations, referred fewer patients to diabetes clinics, and were more optimistic in their goal-setting. DISCUSSION: In primary care, individualized goal-setting with educational and surveillance support may for at least six years bring risk factors of patients with type 2 diabetes to a level that in other trials has been shown to reduce diabetic complications, but without adverse weight gain.

Denmark↗
PubMed2002

Audit of primary care angina management in Sandwell, England.

This audit aimed to assess the identification and treatment of coronary risk factors, lifestyle advice given and use of drug therapy, among patients with angina in Sandwell. It was designed to help general practices evaluate their angina management, and highlight areas where practice could be improved. Criteria were based on Sandwell's published angina audit and local clinical guidelines. Each participating practice was asked to identify all patients with angina, from which a 10% sample was randomly selected. The notes of each selected patient were examined for evidence showing whether agreed standards of care had been achieved. Fifteen practices took part, and contributed data on a total of 358 patients. Of patients without contraindications, 66.5% were taking aspirin, 62.1% were prescribed short-acting nitrates and 58.4% were prescribed beta-blockers. Non-white patients were significantly less likely to receive short-acting nitrates (p < 0.001) and women were significantly less likely to receive beta-blockers (p < 0.01). A total of 83.5% of patients had received smoking cessation advice, 75.1% had weight advice, 75.1% were advised about alcohol use and 64.5% about exercise. Overall, 77.4% had a blood pressure check within the previous twelve months, 40.5% had their cholesterol measured and 33.5% had their blood glucose measured. Non-white patients were significantly less likely to receive smoking cessation, weight, exercise and alcohol advice and were less likely to have their blood pressure checked (all p < 0.0001). Patients aged 65 and over were significantly less likely to receive a cholesterol check (p < 0.0001). None of the auditable standards were actually met. This study shows that there is considerable scope to improve the management of angina patients, with particular regard to aspirin. We recommend that practices develop systems to ensure that the appropriate treatment, advice and checks are given to all patients with angina, paying particular attention to those from ethnic minority backgrounds.

Angina Pectoris↗
PubMed1999

The importance of randomized clinical trials and evidence-based medicine: a clinician's perspective.

Clinical evaluation of therapies for patient care has evolved during the twentieth century from a variety of scientific methods. As a result of medical, political, and economic changes that occurred in the 1990s, randomized clinical trials and evidence-based methods are presently in the forefront of the physician's thinking in the decision-making process for therapeutic interventions. A new standard of patient care has emerged during this process. This report provides a clinician's viewpoint of the importance and interpretation of evidence-based methods and suggests a strategy when such evidence does not exist.

Cardiovascular Diseases↗
PubMed2005

[Antimicrobially effective compounded medications. Clinical value and critical comments].

Triphenyl-methan dyes, traditionally used in dermatology should be reevaluated with caution. Their use should be limited due to the uncertain pharmacological-toxicological risk-benefit ratio and the lack of pharmacological quality of the raw substances. Sometimes antimicrobial activity is insufficient and the cytotoxic effects, along with the inhibition of wound healing, make these dyes less suitable for topical treatment in dermatology. Chinolinolsulfat (Chinosol) and Clioquinol should be used in low concentrations and only on small areas. Due to their negative benefit-risk profile ethracidinlactate-monohydrate (Rivanol) and phenylmercuri-borate (Mercuchrom) should not be used as topical antimicrobial substances. The present publication is intended to give practical recommendations on compounded medications for topical antimicrobial use. Even though some of the cited compounds must be considered critically, we recommend the topical use of chlorhexidine salts, polihexanide, triclosan, polyvidone iodide and silver compounds. Useful standardised compounded formulations containing these four groups are listed in the NRF (Neues Rezeptur Formularium: New German Pharmacopoeia for compounded medication).

Anti-Bacterial Agents↗
PubMed2006

[Light protection: principles of UV protection].

UV radiation is responsible for the induction of epithelial and melanocytic skin cancer, photoaging, and photodermatoses. UV protection is necessary to prevent damage caused by non-physiologic exposure. UV protection includes not only reduction of sun exposure but also use of sun protective filters, UV protective clothes, DNA repair enzymes, and antioxidant supplementation. Consumers are uncertain about the possibilities and limitations of commercial sun protection measures. Dermatologists must explain protective measures to the general public which continues to believe that UV-tanned skin is healthy. The sunscreen market is a highly competitive but lucrative market. The range of products with different designations and promises makes difficult for both consumers and dermatologists to determine what is sensible UV protection.

Humans↗
PubMed2005

[Fibromyalgia--an update].

Fibromyalgia is a common syndrome of unknown etiology characterized by chronic widespread pain and poly-symptomatic autonomic disturbances and often mental features. The American College of Rheumatology's classification criteria define fibromyalgia by widespread pain and 11 of 18 tender points. Fibromyalgia is a diagnosis of exclusion as long as stand none laboratory or technical tests. The major role in pathogenesis appears to be central and involves the subcortical pain modulation, psychical stress especially in early childhood, endocrinological and genetic factors. There is no evidence of abnormalities in muscle and tendon. The goal of therapy in fibromyalgia is pain, reduced physical function and sleep disturbance. Actual evidence of effects of pharmacological and nonpharmacological interventions are summarized. Tricyclic agents, aerobic exercises, patient education and combined therapies can reduce effectively symptoms and disability.

Analgesics↗
PubMed2004

[Which points deserve special attention in the new guidelines on X-ray use (testing guidelines for experts and quality assurance guidelines)?].

Two important guidelines for the application of X-rays in medicine became effective on 1 October 2003 and 1 December 2003. These are testing guidelines for experts and quality assurance guidelines. Both guidelines are very extensive and not always easy to interpret. In the present paper the authors try to explain in detail some chapters important for radiology and to make the necessary technical background transparent. Both authors took an essential part in forming the guidelines.

Certification↗