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PubMed2001

[Importance and possibilities of general guidelines in family practice strategies--do we need 'basic guidelines' in general practice?].

General practice is distinguished particularly by complex patient problems and generic competencies to act and counsel as a family practitioner. Guidelines which are only centered on clinical topics like diagnoses, treatments etc. are not sufficient to support action and decision in general practice. The article proposes the concept of generic guidelines (basic guidelines) for family medicine. A need for basic guidelines in general practice is established in three areas: 1) cross sectional patient problems (e.g. care for immigrants, common strain and distress, counselling of screening procedures), 2) basic skills and strategies in family practice (e.g. problem-oriented consultation, home visits, patient information and informed consent), and 3) practice management and documentation. The development of generic guidelines seems to be difficult as the efforts to evidence-based professional practice are only recently started, but this is matched by the high importance of guidance for general practice, and certain concepts of family medicine support it. It is concluded that the development of basic guidelines in general practice will have a considerable impact on structuring the framework and fostering the quality improvement of general practice.

Counseling↗
PubMed2003

[An experimental evaluation of a hospital's internal clinical guideline system. Randomized, controlled crossover pilot study on the efficacy of Intranet-based guidelines for General Internal Medicine at the Park Clinic Weissenssee in Berlin]].

Randomised, controlled crossover pilot study on the efficacy of Intranet-based guidelines for General Internal Medicine at the Park-Klinik Weissensee in Berlin. As part of the evaluation programme for the intranet-based internal guideline system at the Park-Klinik Weissensee in Berlin, an experimental randomised, controlled trial was conducted in which 12 medical students in their final year were asked to solve 10 clinical vignettes each. A number of written and electronic sources of medical information was available. In addition, the students were allowed to use the internal guideline system for one half of the vignettes in a crossover fashion. There was a sample size-related non-significant trend in favour of the guideline system concerning the primary endpoint "time to right solution" (mean 2.8 min; 95% CI -1.6 to 7.3). A per-protocol-analysis revealed a great variability in the actual use of the guidelines available. There was an inverse "dose-response relationship" between the intensity of guideline usage and the endpoint.

Berlin↗
PubMed2005

National guidelines for the use of antibiotics in hospitalised adult patients: the SWAB guidelines revisited.

Since 1996, the Dutch Working Party on Antibiotic Policy (Stichting Werkgroep AntibioticaBeleid, SWAB) has been developing national guidelines for the use of antibiotics in hospitalised adult patients. As a result of both an inventory of the wishes of the users of these guidelines and the recently developed criteria for evidence-based guideline development, we have revised our format for the development of SWAB guidelines. By involving the members of the relevant professional societies and giving them the opportunity to comment on the guidelines at an early stage, we are aiming for a successful implementation of the guidelines in the hospitals.

Adult↗
PubMed1995

Enhancing physician adoption of practice guidelines. Dissemination of influenza vaccination guideline using a small-group consensus process.

BACKGROUND: A dissemination intervention to facilitate adoption of a preventive practice guideline (influenza vaccination for older adults) in group practices was developed and evaluated. The intervention, small-group consensus process, started with a physician expert presenting the guideline and followed with the group participating in a structured discussion of ways to implement the guideline that culminated in a public commitment (ie, "buy in") to adopt the guideline. METHODS: Thirteen group practices and their primary care physicians (mean size, 5) were assigned randomly to intervention or control arms. In each group practice, physicians in the intervention arm met for 1 hour. Control physicians participated in an unrelated discussion (non-steroidal drug use). Guideline adoption was determined by changes in physicians' vaccination rates that were obtained through prechart and postchart reviews of 51 physicians. Prequestionnaires and postquestionnaires measured influenza knowledge and prevention attitudes. RESULTS: Using analysis of covariance, the small-group consensus process was found to increase physician vaccination rates by 34% compared with the control arm (F (1,48) = 19.49). All intervention arm physicians increased vaccination rates from before to after compared with 54% of control arm physicians. Attitudes and knowledge did not change and were unrelated to increased vaccination rates. CONCLUSIONS: A case is made for the small-group consensus process as an effective utilization-focused dissemination method. Interventions based on group dynamics and sensitive to local practice contexts can be useful in facilitating adoption of guidelines by physicians in group practices.

Decision Making↗
PubMed1997

Development and use of a Guideline Entry Wizard to convert text clinical practice guidelines to a relational format.

Computerization of clinical practice guidelines (CPGs) has been proposed as one solution to enhance the use of guidelines in influencing standard clinical care. However, the conversion of text guidelines to the format required by a computer program is a major barrier. Clinicians who best understand the content of CPGs are typically ill equipped to convert textual guidelines into a computer accessible format. The potential of knowledge acquisition tools to assist in this process has been documented in the literature. In this paper we describe an application prototype, the Guideline Entry Wizard, created to assist in the conversion of text CPGs to a structured format within a relational database. We have tested this application through the input of information from several CPG. The application is a prototype for a more advanced tool. We have used this prototype to enter several CPGs and have demonstrated its effectiveness in inputting guideline content into a knowledge base.

Artificial Intelligence↗
PubMed1998

[Checklist for methodological quality of guidelines. A contribution to quality promotion of medical guidelines].

The society of physicians of Germany and the society of panel physicians laid down in the "assessment criteria for guidelines in medical care" what kind of demands the medical selfadministration makes on guidelines. This measure also had the goal to support and strengthen the efforts of the AWMF for guidelines of high value. On the basis of these assessment criteria, a tool was compiled for the systematic registration and documentation of quality criteria for good guidelines for the first time in areas of German language. This check list is guided by the structure and content of the "Criteria for Appraisal for National Guidelines" by the Scottish Intercollegiate Guidelines Network.

Germany↗
PubMed2004

Comments from the Behavioral Teratology Committee of the Japanese Teratology Society on OECD guideline for the testing of chemicals, proposal for a new guideline 426, developmental neurotoxicity study, draft document (September 2003).

In September 2003, a new revision of the draft guideline (Organization for Economic Co-operation and Development [OECD] Guideline for the Testing of Chemicals, Proposal for a New Guideline 426, Developmental Neurotoxicity Study) was distributed. The draft guideline consists of 51 paragraphs and an appendix. The National Coordinators were requested to arrange national expert reviews of the guideline proposal in their member countries. The member of the Behavioral Teratology (BT) Committee of the Japanese Teratology Society (JTS) reviewed, discussed and commented on the draft Test Guideline proposal. The BT Committee of the JTS also commented that the International Collaborative Study to validate this protocol should be definitely performed. These comments were sent to the OECD Secretariat. The BT Committee of the JTS expects that the comments are useful for further discussion.

Behavior↗
PubMed2001

Pathology and biology guidelines for resectable and unresectable neuroblastic tumors and bone marrow examination guidelines.

The recommendations concerning tumor and bone marrow handling for the evaluation of molecular-biologic and molecular-genetic and immunologic markers presented in this paper were developed by the SIOP Europe Neuroblastoma Pathology and Biology and Bone Marrow Group. Although the Guidelines were developed for neuroblastic tumors (neuroblastoma, ganglioneuroblastoma and ganglioneuroma), they are applicable to all other tumor entities as well. The paper is subdivided in three main parts. The Pathology Guidelines give an overview about the handling, sectioning and securing of tumor material in case of resectable and non-resectable neuroblastic tumors. The Guidelines encompass open biopsies, tru cut biopsies, fine needle aspirations, and bone marrow aspiration. The importance of the pathologic evaluation for the interpretation of the molecular-genetic and molecular-biologic results, which also includes the exact determination of the tumor cell content is stressed. Besides this, recommendations concerning tumor material obtained after cytotoxic therapy, immunohistologic and immuno-cytologic issues and lymph node examination are addressed. In the Biology Guidelines, the different methods for MYCN, chromosome 1p36 investigations and DNA content measurements are discussed and DNA probes are recommended. Furthermore, specified definitions and a common terminology already used in the SIOP Europe Neuroblastoma Group are presented. In the Bone Marrow Guidelines, recommendations concerning the methods to be employed are given and the most important pitfalls are demonstrated. Both the use of standardized methods and the application of a common language will, it is hoped, contribute to the quality and reliability of collected data and thus to a better comparability between and among research reports. These improvements should prove to be of great value for the affected patients.

Blotting, Southern↗
PubMed1998

1998 revision to the British HIV Association guidelines for antiretroviral treatment of HIV seropositive individuals. BHIVA Guidelines Writing Committee.

When the British HIV-1 Association (BHIVA) guidelines on the treatment of HIV-seropositive individuals with antiretrovirals were published in The Lancet in April 1997, it was clear that they would require updating on a frequent basis. The guidelines have been useful in ensuring that viral-load testing and combination therapy is widely available in the UK. However, standards of treatment are rapidly changing as new evidence becomes available. Since formulation of the guidelines, data from two large clinical endpoint studies have been presented that show superior clinical benefit for the use of triple therapy compared with dual therapy in treatment of both naive individuals and patients who have been given zidovudine. Here we update the BHIVA guidelines with a consensus drawn from a wide range of UK medical opinion. The guidelines include input from groups representing individuals living with HIV-1. A more detailed reflection of these views may be found in publications such as the National AIDS Manual and the AIDS Treatment Project's Doctor fax.

Anti-HIV Agents↗
PubMed1997

Practice guidelines for community-based parenteral anti-infective therapy. ISDA Practice Guidelines Committee.

This is the fourth in a series of practice guidelines commissioned by the Infectious Diseases Society of America through its Practice Guidelines Committee. The purpose of this guideline is to provide assistance to clinicians when making decisions on when and how to best administer parenteral antimicrobial therapy. The targeted providers are internists, pediatricians, family practitioners, and other providers of outpatient antiinfective therapy. Criteria for selecting the appropriate patients and settings to deliver therapy in the community are described. Panel members represented experts in adult and pediatric infectious diseases. The guidelines are evidence-based. A standard ranking system is used for the strength of the recommendations and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council. An executive summary and tables highlight the major recommendations.

Adult↗
PubMedDate not supplied

1999 World Health Organization-International Society of Hypertension Guidelines for the management of hypertension. Guidelines sub-committee of the World Health Organization.

The present Guidelines were prepared by the Guidelines Sub-Committee of the World Health Organization-International Society of Hypertension (WHO-ISH) Mild Hypertension Liaison Committee, the members of which are listed at the end of the text. These guidelines represent the fourth revision of the WHO-ISH Guidelines and were finalised after presentation and discussion at the 7th WHO-ISH Meeting on Hypertension, Fukuoka, Japan, 29th Sept-1st Oct, 1998. Previous versions of the Guidelines were published in Bull WHO 1993, 71:503-517 and J Hypertens 1993, 11:905-918.

Adult↗
PubMed1999

An evidence-based guideline for the management of heavy menstrual bleeding. Working Party for Guidelines for the Management of Heavy Menstrual Bleeding.

AIMS: The objective of this guideline is to provide evidence-based recommendations for the management of regular heavy menstrual bleeding in women with no detectable pathology. METHODS: A multidisciplinary working party was formed which met on four occasions over a 12 month period. The evidence from randomised controlled trials was summarised into evidence tables and guidelines were developed. A draft report was circulated in November 1997 prior to the final report which was published in July 1998. RESULTS: A diagnostic and treatment algorithm was produced (Figure 1) as well as a full text report. The cost of implementing the guideline was considered and overall net savings of $6 million were likely. CONCLUSIONS: An explicit evidence-based guideline on the management of heavy menstrual bleeding was produced. Both the Royal New Zealand College of Obstetricians and Gynaecologists and the Royal New Zealand College of General Practitioners endorsed this guideline.

Adult↗
PubMedDate not supplied

A comprehensive assessment of National Health Program Guidelines in Canada: management review and redirections. Guidelines developed under the auspices of the Federal, Provincial and Territorial Advisory Committee on Institutional and Medical Services (ACIMS).

A comprehensive audit of the Health Program Guidelines in Canada was undertaken between January and September 1992. This review examined the strategic effectiveness and operational efficiency of the guidelines developed under the auspices of the Federal, Provincial and Territorial Advisory Committee on Institutional and Medical Services (ACIMS). To assess the perceived management utility of the guidelines, over 185 structured mail questionnaires were sent to a random representative sample of health care managers stratified by type of health-related organization and Canadian province and territory. With a response rate of over 80.5%, a profile of management perceptions of the need for the current Program Guidelines was created. In tandem an internal review of the efficiency and effectiveness of the design and development of the Guidelines was conducted using over 45 structured interviews with key informants. Both components of the comprehensive audit provided the basis of report recommendations that are relevant to the Canadian health system community.

Canada↗
PubMedDate not supplied

Clinical practice guidelines in complementary and alternative medicine. An analysis of opportunities and obstacles. Practice and Policy Guidelines Panel, National Institutes of Health Office of Alternative Medicine.

An estimated 1 of 3 Americans uses some form of complementary and alternative medicine (CAM), such as acupuncture, homeopathy, or herbal medicine. In 1995, the National Institutes of Health Office of Alternative Medicine convened an expert panel to examine the role of clinical practice guidelines in CAM. The panel concluded that CAM practices currently are unsuitable for the development of evidence-based practice guidelines, in part because of the lack of relevant outcomes data from well-designed clinical trials. Moreover, the notions of standardization and appropriateness, inherent in guideline development, face challenging methodologic problems when applied to CAM, which considers many different treatment practices appropriate and encourages highly individualized care. Due to different belief systems and divergent theories about the nature of health and illness, CAM disciplines have fundamental differences in how they define target conditions, causes of disease, interventions, and outcome measures of effectiveness. These differences are even more striking when compared with those used by Western medicine. The panel made a series of recommendations on strategies to strengthen the evidence base for future guideline development in CAM and to meet better the current information needs of clinicians, patients, and guideline developers who seek information about CAM treatments.

Complementary Therapies↗
PubMed2006

Infection control guidelines for the cardiac catheterization laboratory: society guidelines revisited.

In the early years of diagnostic cardiac catheterization, strict sterile precautions were required for cutdown procedures. Thirteen years ago, when the original guidelines were written, the brachial arteriotomy was still frequently utilized, femoral closure devices were uncommon, "implantables," such as intracoronary stents and PFO/ASD closure devices, were in their infancy, and percutaneous valve replacement was not a consideration. In 2005, the cardiac catheterization laboratory is a complex interventional suite with percutaneous access routine and device implantation standard. Despite frequent device implantation, strict sterile precautions are often not observed. Reasons for this include a decline in brachial artery cutdown, limited postprocedure follow-up with few reported infections, limited use of hats and masks in televised cases, and lack of current guidelines. Proper sterile technique has the potential to decrease the patient infection rate. Hand washing remains the most important procedure for preventing infections. Caps, masks, gowns, and gloves help to protect the patient by maintaining a sterile field. Protection of personnel may be accomplished by proper gowning, gloving, and eye wear, disposal of contaminated equipment, and prevention and care of puncture wounds and lacerations. With the potential for acquired disease from blood-borne pathogens, the need for protective measures is as essential in the cardiac catheterization laboratory as is the standard Universal Precautions, which are applied throughout the hospital. All personnel should strongly consider vaccination for hepatitis B. Maintenance of the cardiac catheterization laboratory environment includes appropriate cleaning, limitation of traffic, and adequate ventilation. In an SCAI survey, members recommended an update on guidelines for infection control in the cardiac catheterization laboratory. The following revision of the original 1992 guidelines is written specifically to address the increased utilization of the catheterization laboratory as an interventional suite with device implantation. In this update, infection protection is divided into sections on the patient, the laboratory personnel, and the laboratory environment. Additionally, specific CDC recommendation sections highlight recommendations from other published guidelines.

Antibiotic Prophylaxis↗