PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Guidelines”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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

At least 271 records · Page 15Linked to original sources
PubMed1997

Surfing the best practice guidelines: national clinical guideline clearinghouse in development.

The growth in development and usage of clinical guidelines during the last five years has been remarkable. Not only are health care practitioners reaching for what's deemed to be the best in protocols and practice, consumers, too, are looking toward standards and guidelines as they become more educated about the quality and quantity of health care services they should be receiving.

Computer Communication Networks↗
PubMed1987

Proposed guidelines for screening of metabolic and endocrine diseases of dependent neonates of the U.S. Armed Forces. Derived from a survey of state guidelines for neonatal screening of metabolic diseases.

State regulations for neonatal screening for metabolic diseases do not optimally serve the needs of the dependents of the U.S. Armed Forces. Guidelines are therefore proposed for the neonatal screening for metabolic disease based both on responses received across the United States and on the unique needs of the U.S. Armed Forces. The guidelines agree with the policies outlined by various national medical and scientific organizations. It is suggested that neonates be screened for phenylketonuria (PKU), hypothyroidism, galactosemia, and maple syrup urine disease (MSUD). The screening program is cost-effective and feasible. Prior to implementing the program throughout the U.S. military, a pilot program based at the Armed Forces Institute of Pathology should be started.

Costs and Cost Analysis↗
PubMed2006

Improving the use of research evidence in guideline development: 15. Disseminating and implementing guidelines.

BACKGROUND: The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the 15th of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. OBJECTIVES: In this review we address strategies for the implementation of recommendations in health care. METHODS: We examined overviews of systematic reviews of interventions to improve health care delivery and health care systems prepared by the Cochrane Effective Practice and Organisation of Care (EPOC) group. We also conducted searches using PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. KEY QUESTIONS AND ANSWERS: What should WHO do to disseminate and facilitate the uptake of recommendations? WHO should choose strategies to implement their guidelines from among those which have been evaluated positively in the published literature on implementation research Because the evidence base is weak and modest to moderate effects, at best, can be anticipated, WHO should promote rigorous evaluations of implementation strategies. What should be done at headquarters, by regional offices and in countries? Adaptation and implementation of WHO guidelines should be done locally, at the national or sub-national level. WHO headquarters and regional offices should support the development and evaluation of implementation strategies by local authorities.

Journal Article↗
PubMed1998

Clinical management guidelines for osteoporosis in Hong Kong The working group for formulating clinical management guidelines for osteoporosis in Hong Kong.

The following guidelines provide a basis for the management of osteoporosis for the practising physician in Hong Kong. The guidelines have been compiled by a working group that represents the specialties concerned with osteoporosis and summarise the current management of osteoporosis based on available published evidence and relevant local experience.

Journal Article↗
PubMed1999

Guidelines for referral and management of systemic lupus erythematosus in adults. American College of Rheumatology Ad Hoc Committee on Systemic Lupus Erythematosus Guidelines.

SLE is a complex disorder with variable presentations, course, and prognosis. Since its prevalence is only 1/1,000, most primary care physicians and general internists will not have sufficient experience in the management of moderate-to-severe life-threatening disease. The major tasks of the primary care physician in the diagnosis and management of patients with SLE include early diagnosis, appropriate referral, monitoring patients with mild, stable disease, and collaboration with a specialist in the management of severe disease. Guidelines for the initial evaluation, reasons for referral, and management of mild and severe SLE are provided.

Adult↗
PubMed2004

EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines).

OBJECTIVE: To provide the first update of the EAU guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO). METHODS: A systematic literature review was conducted based on the results of a MEDLINE search concentrating on the years 1999-2003. In combination with expert opinions recommendations were made on the usefulness of diagnostic tests, therapeutic options and follow-up. RESULTS: During initial assessment the following tests are recommended: medical history, physical examination including digital-rectal examination, International Prostate Symptom Score, urinalysis, serum creatinine and prostate specific antigen measurement, uroflowmetry and post-void residual volume. All other tests are optional or not recommended. Aim of treatment is to improve LUTS and quality of life and to prevent severe BPE-related complications. Development of a 5alpha-reductase type I and II inhibitor and the data of the MTOPS trial providing scientific evidence for a combination therapy were the most significant innovations since the first version. Finally a more detailed knowledge on the natural history with identification of several risk factors for progression is the basis for a risk-profile orientated (preventive) therapy. CONCLUSIONS: Updated recommendations for assessment, treatment, and follow-up of patients with LUTS due to BPO are presented.

Europe↗
PubMed2005

Guidelines for implementation of patient self-testing and patient self-management of oral anticoagulation. International consensus guidelines prepared by International Self-Monitoring Association for Oral Anticoagulation.

AIMS: This document provides health care professionals involved in initiating and monitoring oral anticoagulation therapy with guidelines for the provision of safe and effective patient self-testing/patient self-management of oral anticoagulation. METHODS AND RESULTS: The consensus group has critically reviewed the literature and compared the results of usual care (UC) vs. anticoagulation clinic and patient self-management/patient self-testing (PSM/PST). The education and training of patients for self-monitoring are described, together with the suitability of patients, the effect on quality of life and cost-effectiveness. The consensus agrees that patient self-testing and patient self-management are effective methods of monitoring oral anticoagulation therapy, providing outcomes at least as good as, and possibly better than, those achieved with an anticoagulation clinic. All patients must be appropriately selected and trained. Currently available self-testing/self-management devices give INR results which are comparable with those obtained in laboratory testing. The most frequent testing frequency is weekly but lower frequency of testing can be justified based on institutional or patient conditions. CONCLUSIONS: The consensus agrees that there are several points in favour of PST/PSM, for example, a higher degree of medical safety, increased patient education, improved response to changes in lifestyle, increased independence for the patient and improved quality of life.

Administration, Oral↗
PubMed1996

[Guidelines on treatment of hypertension in the elderly, 1995--a tentative plan for comprehensive research projects on aging and health-- Members of the Research Group for "Guidelines on Treatment of Hypertension in the Elderly", Comprehensive Research Projects on Aging and Health, the Ministry of Health and Welfare of Japan].

We propose the following guidelines for treatment of hypertension in the elderly. 1. Indications for Treatment. 1) Age: Lifestyle modification is recommended for patients aged 85 years and older. Antihypertensive therapy should be limited to patients in whom the merit of the treatment is obvious. 2) Blood pressure: Systolic BP > 160 mmHg, diastolic BP > 90 approximately 10 mmHg. Systolic BP < age + 100 mmHg for those aged 70 years and older. Patients with mild hypertension (140-160/ 90-95 mmHg) associated with cardiovascular disease should be considered for antihypertensive drug therapy. 2. Goal of Therapy for BP: The goal BP in elderly patients is higher than that in younger patients (BP reduction of 10-20 mmHg for systolic BP and 5-10 mmHg for diastolic BP). In general, 140-160/< 90 mmHg is recommended as the goal. However, lowering the BP below 150/85 should be done with caution. 3. Rate of Lowering BP: Start with half the usual dose, observe at the same dose for at least four weeks, and reach the target BP over two months. Increasing the dose of antihypertensive drugs should be done very slowly. 4. Lifestyle Modification: 1) Dietary modification: (1) Reduction of sodium intake is highly effective in elderly patients due to their high salt-sensitivity. NaCl intake of less than 10 g/day is recommended. Serum Na+ should be occasionally measured. (2) Potassium supplementation is recommended, but with caution in patients with renal insufficiency. (3) Sufficient intake of calcium and magnesium is recommended. (4) Reduce saturated fatty acids. Intake of fish is recommended. (2) Regular physical activity: Recommended exercise for patients aged 60 years and older: peak heart rate 110/minute, for 30-40 minutes a day, 3-5 days a week. (3) Weight reduction. (4) Moderation of alcohol intake, smoking cessation. 5. Pharmacologic Treatment: 1) Initial drug therapy. First choice: Long-acting (once or twice a day) Ca antagonists or ACE inhibitors. Second choice: Thiazide diuretics (combined with potassium-sparing diuretic). 2) Combination therapy. (1) For patients without complications, either of the following is recommended. i) Ca antagoinst + ACE inhibitor, ii) ACE inhibitor + Ca antagonist (or low-dose diuretics), iii) diuretic + Ca antagonist (or ACE inhibitor), iv) beta-blockers, alpha 1-blockers, alpha + beta blockers can be used according to the patho-physiological state of the patient. (2) For patients with complications. Drug(s) should be selected according to each complication. 3) Relatively contraindicated drugs. beta-Blockers and alpha 1-blockers are relatively contraindicated in elderly patients with hypertension in Japan. Centrally acting agents such as reserpine, methyldopa and clonidine are also relatively contraindicated beta-Blockers are contraindicated in patients with congestive heart failure, arteriosclerosis obliterans, chronic obstructive pulmonary disease, diabetes mellitus (or glucose intolerance), or bradycardia. These conditions are often present in elderly subjects. Elderly subjects are susceptible to alpha 1-blocker-induced orthostatic hypotension, since their baroreceptor reflex is diminished. Orthostatic hypotension may cause falls and bone fractures in the elderly.

Aged↗
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↗
PubMedDate not supplied

Educating APNs for implementing the guidelines for adolescents in Bright futures: guidelines of health supervision of infants, children, and adolescents.

As the scope of what constitutes health and the range of determinants of health-promoting and compromising behaviors among adolescents are expanded, APNs must be well prepared to be powerful influences in the lives of all adolescents. The guidelines offered by Bright Futures challenge nurse educators to prepare APNs who possess the core competencies to knowledgeably address the health issues and concerns of all adolescents in multiple settings. The American Academy of Nursing Expert Panel's recommendations contained herein, if implemented, will further enhance the capabilities of graduate programs to prepare APNs to provide developmentally and culturally relevant disease prevention and health promotion care to adolescents and their families.

Adolescent↗
PubMed2000

Guidelines based on the principle 'First, do no harm'. New guidelines on tracheal tube confirmation and prevention of dislodgment.

In summary, this editorial and the one on pulse check point out another area in which a total reliance on evidence-based guidelines amy do our patients a disservice. The debate over dropping the pulse check hinged less on the strength of the evidence and more on the widespread clinical principle of fear of false-negative errors. The discussion of secondary confirmation of tracheal tube placement also lacks a strong base of evidence that identifies the one best technique of tube confirmation for patients with a pulse versus those without a pulse. The principles of the zero-risk intervention and first, do no harm come into play in this situation. We must deal with the growing awareness of the fact that tracheal intubation is not only a potentially lethal intervention but now is also a confirmed lethal intervention, and at a much higher death rate than has ever been suspected. Factors that contribute to the transformation of the tracheal tube from a life-saving to a death-causing intervention are being identified by honest and open researchers. National societies in emergency medicine are responding appropriately. We strongly recommend shifting from making an evidence-based recommendation to instead making a principle-based recommendation--killing our patients is unacceptable; we must act on the widespread concept regarding errors in medicine. We must adopt zero-risk interventions in all possible situations.

Humans↗
PubMed1999

Best practice guidelines for the management of women with epilepsy. The Women with Epilepsy Guidelines Development Group.

Clinical guidelines for the treatment of epilepsy have been published. A statement on management issues for women with epilepsy has recently been produced by the American Academy of Neurology which has raised awareness of the issues facing women with epilepsy. The communication presented here aims to review current literature on specific issues relating to women with epilepsy, and proposes graded recommendations for its management within a UK health care framework.

Abnormalities, Drug-Induced↗
PubMed2006

Surgical Infection Society guideline: prophylactic antibiotic use in open fractures: an evidence-based guideline.

BACKGROUND: Prolonged courses of broad-spectrum antibiotics are often cited as the standard of care for prevention of infective complications of open fractures. The origins of these recommendations are obscure, however, and multi-drug-resistant systemic infections attributable to antibiotic overuse are common life-threatening problems in current intensive care unit practice. OBJECTIVE: To review systematically the effects of prophylactic antibiotic administration on the incidence of infections complicating open fractures. DATA SOURCES: Computerized bibliographic search of published research and citation review of relevant articles. STUDY SELECTION: All published clinical trials claiming to evaluate, or cited elsewhere as being authoritative regarding, the role of antibiotics in open fracture management were identified and then evaluated according to published guidelines for evidence-based medicine. Only small studies (<20 patients), practice surveys, pharmacokinetic studies, and reviews or duplicative publications presenting primary data already considered were excluded from analysis. DATA EXTRACTION: Information on demographics, study dates, fracture grade, antibiotic type, duration and route of administration, surgical interventions, infection-related outcomes, and the methodologic quality of the studies was extracted by the authors. The primary results were submitted to the Therapeutic Agents Committee of the Surgical Infection Society for review prior to creation of the final consensus document. DATA SYNTHESIS: Current antibiotic management of open fractures is based on a small number of studies that generally are more than 30 years old and do not reflect current management priorities in trauma and critical care. With a few noteworthy exceptions, these primary studies suffer from a variety of methodologic problems, including co-mingling of prospective and retrospective data sets, absence of or inappropriate statistical analysis, lack of blinding, or failure of randomization. CONCLUSIONS: The data support the conclusion that a short course of first-generation cephalosporins, begun as soon as possible after injury, significantly lowers the risk of infection when used in combination with prompt, modern orthopedic fracture wound management. There is insufficient evidence to support other common management practices, such as prolonged courses or repeated short courses of antibiotics, the use of antibiotic coverage extending to gram-negative bacilli or clostridial species, or the use of local antibiotic therapies such as beads. Large, randomized, blinded trials are needed to prove or disprove the value of these traditional approaches. Such trials should be performed in patients with high-grade fractures who (1) are well-stratified according to the degree of local injury and (2) undergo standardized fracture and wound management. Trials also must be powered to study the effects of extended antibiotic coverage on nosocomial infections. Antibiotic regimens confirmed to improve local fracture outcomes in such studies could then be used rationally, balancing the risks of local fracture-related infections and of multi-drug-resistant systemic infections to achieve optimal global outcomes.

Antibiotic Prophylaxis↗
PubMed2000

Harmonization of Dementia Drug Guidelines (United States and Europe): a report of the International Working Group for the Harmonization for Dementia Drug Guidelines.

The International Working Group for the Harmonization of Dementia Drug Guidelines has been active for more than 5 years attempting to improve the efficiency of international drug development. A virtual organization was formed of clinicians, scientists, industries, participants, and regulators from various nations around the world. This article summarizes a variety of conferences and physicians' papers focusing on aspects of trials ranging from diagnosis, assessment, and trial design to pharmacoeconomics and ethics.

Alzheimer Disease↗
PubMed2005

Improved survival with clinical guidelines? Evaluation of a quality register linked to clinical guidelines for ovarian cancer in the western health care region in Sweden between 1 September 1993 and 1 June 1998.

BACKGROUND: New clinical guidelines (CGs) for ovarian cancer in the western health care region in Sweden were established, beginning in September 1993 and still in effect. METHODS: A retrospective evaluation of 5 years of quality registration linked to CGs for ovarian cancer in this region was undertaken. The study material comprised 718 patients. Relative survival rates for the studied patients were compared with National Cancer Register data for the western health care region during the same period. The National Cancer Register data were also used to compare survival rate during the studied period and the preceding 5-year period. RESULTS: Relative 5-year survival rate in our material was 46.1%. Relative survival in western Sweden during the studied period was found to be improved compared with that during the preceding period (P<0.02). CONCLUSIONS: The CGs have led to an improved, tighter organization, with fewer clinicians in special 'tumor teams' performing more aggressive tumor reduction surgery. Chemotherapy prescription is centralized, while the actual administration is decentralized. This has probably been important for the good 5-year survival results.

Chemotherapy, Adjuvant↗
PubMed2006

Task force guidelines handbook: EFNS guidelines on diagnosis and management of fatty acid mitochondrial disorders.

Guidelines in the diagnosis and current dietary treatment of long-chain fatty acid (LCFA) defects have been collected according to evidence-based medicine. Since the identification of carnitine and carnitine palmitoyltransferase deficiency more than 25 years ago, nearly every enzymatic step required for beta-oxidation has been associated with an inherited metabolic disorder. These disorders effectively preclude the use of body fat as an energy source. Clinical consequences can range from no symptoms to severe manifestations including cardiomyopathy, hypoglycaemia, peripheral neuropathy and sudden death. A diet high in carbohydrates, diet with medium-chain triglycerides and reduced amount of LCFA has a beneficial effect (class IV evidence) and in appropriate deficiency states carnitine and riboflavin are used (good practice points).

Advisory Committees↗
PubMed2004

Inclusion of albumin as a target in therapy guidelines: guidelines for chronic kidney disease.

Slowing the rate of progression of chronic kidney disease (CKD) as a fundamental management goal has been greatly assisted by the development of clinical practice guidelines under the aegis of the National Kidney Foundation, through the K/DOQI process. Reductions in urinary protein and albumin excretion play important roles in these treatment strategies, with numerous studies describing short- and long-term successes in these endeavors. These approaches may also reduce the risks of cardiovascular and cerebrovascular morbidity and mortality, and of developing new onset diabetes mellitus. With enhanced sensitivity assays for urinary albumin, and the near-term availability of point-of-service testing, we will have the opportunity to address reduction of urinary albumin excretion as a defined goal and critical element in management of CKD. Carefully conducted clinical trials are needed to establish the utility of these assays, and to define optimal strategies for reducing urinary albumin excretion. With the successful outcomes of these studies, the reduction of urinary albumin excretion will receive its due emphasis in the management of patients with CKD.

Albuminuria↗