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At least 307 records · Page 17Linked to original sources
PubMed2000

[Scandinavian guidelines for management of head injuries. Evidence-based management of minimal, mild and moderate head injuries].

The Scandinavian Neurotrauma Committee (SNC) was created by the Scandinavian Neurosurgical Society in order to develop evidence-based guidelines for improved care of neurotrauma patients. A MEDLINE search identified 475 papers dealing with the management of minimal, mild and moderate head injuries. Forty-two studies presenting Class II evidence on the initial management of such injuries were reviewed, and management guidelines were developed. Implementation of the Head Injury Severity Scale is advocated. Patients with Minimal injuries (no loss of consciousness (LOC), Glasgow Coma Scale (GCS) score 15) can be safely discharged. Routine early computerized tomography (CT) scan is recommended in cases with Mild injuries (history of LOC, GCS 14-15) and patients with normal scans may be discharged. CT scan and admission is mandatory in Moderate injuries (GCS 9-13). All patients with additional risk factors should be scanned and admitted. A flow-chart for clinical decision making and a Head Injury Instruction card is introduced. The SNC suggests guidelines that should be safe and cost-effective for the initial management of minimal, mild and moderate head injuries.

Consciousness↗
PubMed2000

[Guidelines for diagnosis and treatment of acute urinary tract problems in women].

BACKGROUND: Available guidelines for the management of symptoms of lower urinary tract infections (UTI) in women give conflicting recommendations. MATERIAL AND METHODS: We searched The Cochrane Library, Medline and other sources for evidence that met explicit inclusion criteria for the relevant options and outcomes identified. The validity of included studies was assessed. Draft recommendations were widely circulated and discussed in focus groups with patients and physician assistants. RESULTS: The probability that a woman with dysuria or frequency has bacteriuria, is 80%. The probability of UTI given a negative result of a dipstick test is 50%. Evidence suggests that antibiotics will rapidly relieve symptoms, but there are limited data from placebo-controlled randomised trials. Population based studies show that many women do not visit physicians for symptoms of UTI. Women with symptoms of UTI can be treated with antibiotics without examination of the urine. Women with earlier episodes of UTI can be offered treatment by telephone. Antibiotics for three days is sufficient based on eradication of bacteriuria. Women should be seen by a physician if the symptoms are atypical. INTERPRETATION: Implementing these guidelines could result in better service to women with UTIs. More evidence about the effects of antibiotics and other treatments is needed.

Anti-Bacterial Agents↗
PubMed2004

Reporting of ethical standards: differences between complementary and orthodox medicine journals?

OBJECTIVES: This study aimed at assessing whether there are differences in the reporting of ethical aspects of complementary and alternative medicine (CAM) and mainstream medical research. DESIGN: Review of published literature. SETTING: Research department of medical school. MAIN OUTCOME MEASURES: Reports of ethical aspects including adherence to clinical guidelines, ethical approval from ethics committees, consent of the patient, declaration of conflict of interest, and declaration of funding for a study. RESULTS: We included 21 articles from CAM journals, as well as 16 from equal impact factor mainstream (EIF) journals and 27 from high impact factor (HIF) journals. A statistically significant difference was found in the reporting of ethical approval: 62% of all CAM articles, 75% of the EIF and 93% of the HIF journal articles reported approval from ethics committees [chi2 = (2, n = 64) 6.631, p<0.05]. Regarding the reporting of obtaining patients' consent there were no statistically significant differences: 48% of all CAM articles, 38% of the EIF mainstream and 67% of the HIF mainstream journal articles explicitly stated that patients signed a consent form [chi2 = (2, n = 64) 3.813, p>.05]. High impact factor journals were more likely to report on ethical standards than other journals on conflicts of interests and sponsorship. However, they were less likely to report a reference to ethical guidelines. Articles from CAM journals had more strict reporting requirements than mainstream medicine journals with comparable impact factors. CONCLUSIONS: Differences exist between complementary and orthodox medical journals in the reporting of ethical aspects of trial design.

Codes of Ethics↗
PubMedDate not supplied

The role of the case manager in a disease management program.

Disease management programs provide new opportunities and roles for case managers to provide population-based healthcare to the chronically ill. This article identifies common components of disease management programs and examines roles assumed by case managers in disease management programs such as baseline assessment, performing economic analyses of diseases and their respective associated resource utilization, developing and/or implementing care guidelines or algorithms, educational interventions, disease management program implementation, and outcomes assessment. Areas of expertise needed to be an effective case manager in a disease management program are also identified.

Algorithms↗
PubMed2003

[Diabetes, hypertension and microalbuminuria in primary care].

Microalbuminuria has been widely appreciated in recent years to be a valuable risk marker for an increased cardiovascular disease morbidity and mortality. Thus guidelines for the treatment of type-2-diabetes in Germany and the US recommend an annual screening as soon as the diagnosis of diabetes is established and a quarterly control when microalbuminuria is present. While nationally representative epidemiologic data from the US have been available, data from Germany, especially from the primary care sector are missing. This is especially important in light of the gatekeeper function of the primary care physician. The "Hypertension and Diabetes Risk Screening Study" (HYDRA) has been identifying 37.8% of patients with hypertension and diabetes to have a positive dipstick test for microalbuminuria on the study day while only 12.5% of these are diagnosed by the doctor as having nephropathy. These patients additionally show a high burden of associated comorbidities and thus call for early detection and intervention especially because effective therapy is available. Although screening for microalbuminuria is recommended in the guidelines the value of a routine screening for microalbuminuria in primary care is under recognized.

Adult↗
PubMed2001

Clinical practice guidelines: necessary but not sufficient for evidence-based patient education and counseling.

While clinical practice guidelines provide direction for the management of specific diseases or particular clinical problems, there are major gaps between guidelines and their implementation. The purpose of this paper is to illustrate how an existing guideline can be used to develop an evidence-based patient education program. Congestive heart failure (CHF) represents a range of complex, chronic illnesses which offer little hope of cure yet require symptom management by health care providers, patients, and their families. Successful self-monitoring, self-care, and decision making are based on acquisition of appropriate knowledge and management skills. We describe a comprehensive teaching program in which the content was built on the clinical evidence from the Agency for Health Care Policy and Research recommendations for CHF, and the implementation process was built on adult education evidence, adapted to health issues and patient learning challenges.

Evidence-Based Medicine↗
PubMed1998

An introduction to colposcopy. Concepts, controversies and guidelines for practice.

Colposcopy is a clinical procedure used to investigate the health of the cervix and lower genital tract. This article is limited to an overview of the colposcopic examination. Colposcopy consists of four sequential steps visualization, assessment, sampling, and documentation and correlation. Since most women are dependent on their primary care providers for information and guidance, a post-colposcopic appointment will aid in the discussion of treatment options and help alleviate any fears or unanswered questions. Regardless of the treatment, stress the need for frequent follow-up exams for Pap smears or repeat colposcopy.

Colposcopy↗
PubMed2000

Evaluating "payback" on biomedical research from papers cited in clinical guidelines: applied bibliometric study.

OBJECTIVES: To develop a methodology for evaluating the impact of research on health care, and to characterise the papers cited on clinical guidelines. DESIGN: The bibliographic details of the papers cited in 15 clinical guidelines, developed in and for the United Kingdom, were collated and analysed with applied bibliometric techniques. RESULTS: The median age of papers cited in clinical guidelines was eight years; most papers were published by authors living in either the United States (36%) or the United Kingdom (25%)-this is two and a half times more than expected as about 10% of all biomedical outputs are published in the United Kingdom; and clinical guidelines do not cite basic research papers. CONCLUSION: Analysis of the evidence base of clinical guidelines may be one way of tracking the flow of knowledge from the laboratory to the clinic. Moreover, such analysis provides a useful, clinically relevant method for evaluating research outcomes and different strategies in research and development.

Bibliometrics↗
PubMed2003

Pressure ulcer prevention and management: the current evidence for care.

Pressure ulcers, a common occurrence across healthcare settings, are a costly phenomenon. Since the publication of the AHCPR Guidelines on Pressure Ulcer Prevention and Treatment in the 1990s, additional attention has been focused on pressure ulcer prevention and management. This article discusses current evidence regarding known causes of pressure ulcers, pressure ucler prevention, pressure ulcer classification and assessment, and interventions to effectively manage pressure ulcers.

Anti-Infective Agents, Local↗
PubMed2003

Audit of primary care and initial secondary care investigations set against RCOG guidelines as standard in cases of subfertility.

Subfertility affects one in seven couples in the United Kingdom and is associated with considerable patient stress and anxiety. The RCOG, with the publication of the evidence-based guidelines, gives us clear recommendations on the initial investigation of the infertile couple. Against these guidelines we audited patient care over a period of 5 months in a dedicated consultant-led infertility clinic. Our results show that a considerable number of patients failed to have the correct advice clearly documented, and the initial primary care investigations of mid-luteal progesterone and semen analysis were performed correctly with results available in only 33% and 2% of occasions, respectively. There were, however, areas where the guidelines were adhered to very efficiently. To improve care we recommend the use of an infertility referral form for use in primary care upon which the practitioners can fill in the appropriate details and be guided on the necessary investigations.

Alcohol Drinking↗
PubMed1999

Diagnosis and treatment of allergic rhinitis: primary care in an integrated health system setting.

The first point of contact for many patients presenting with allergy symptoms is the primary care physician. And in the managed care system, this initial primary care visit is essential. Guidelines for the primary care physician in diagnosing and treatment rhinitis as well as referring patients to allergy specialists are described. In addition, optimal medication usage for treating mild, moderate, and severe rhinitis is detailed.

Anti-Allergic Agents↗
PubMed1997

Development of oncology protocol using fluorine-18-FDG: one center's experience.

The major types of cancer studied at the authors' facility were colorectal (107 patients), head and neck (122 patients), gastric/esophageal (57 patients), lung (59 patients) and lymphoma (26 patients). This article presents guidelines and techniques for obtaining optimal PET studies. The authors devised these guidelines through trial and error and hope that by sharing them other facilities can avoid unnecessary mistakes and achieve better quality studies more efficiently.

Blood Glucose↗
PubMedDate not supplied

Getting evidence into practice using an asthma desktop tool.

BACKGROUND: Failure to utilise evidence in asthma care is leading to avoidable asthma symptoms for sufferers and costs to health services. OBJECTIVE: This article describes a collaboration between a division of general practice and a university department of general practice to improve uptake of evidence based asthma treatments and to better educate patients. DISCUSSION: The division of general practice drew upon lessons from university based research within its locality producing an 'asthma desktop tool'. This combined evidence based clinical guidance for practitioners with educational information for patients in paper and electronic formats. The tool has been provided to all local general practices, hospitals and pharmacists to facilitate uptake of best practice guidelines and enhance patient knowledge and understanding. The division has directly responded to university based research producing a practical solution to some of the identified problems. This demonstrates that with appropriate resources and support, divisions are well placed to translate research into practice, and combine with academic institutions to produce worthwhile results.

Academic Medical Centers↗
PubMed2005

Effectively starting and titrating intrathecal analgesic therapy in patients with refractory cancer pain.

Patients continue to suffer from pain despite their analgesic regimen and frequently from symptoms related to these interventions. This article describes the role that intrathecal analgesia may play in improving comfort for individuals experiencing refractory pain and/or symptoms of opioid therapy. Patient selection, staff education, institution requirements, medications, and titration guidelines also will be reviewed. Patients with cancer clearly deserve to achieve comfort; therefore, intrathecal therapy, which is a safe intervention, must be considered when refractory pain or symptoms occur.

Algorithms↗
PubMed2005

Hypertension guidelines, meta-analyses and clinical trials: do we assume too much?

Given fundamental differences in the recommendations in guidelines from major national and international committees, we cannot rely on them unquestioningly. Different antihypertensive agents are known to have differing effects according to age and race. Exchanging (rather than following guideline recommendations of adding to) an ineffective first-line antihypertensive drug can result in control of hypertension with monotherapy. Conclusions about a preferable first-line antihypertensive agent are limited by trial protocols with varying drug doses and questionable drug combinations. Guidelines are often based on meta-analyses of drugs of a particular class, which could ignore important differences between drugs within a class. Trials of 3-5 years cannot determine the long-term effects of drugs which patients often take for decades.

Antihypertensive Agents↗
PubMed2006

Developing guidelines for syringe driver management.

The aim of this project was to develop clinical practice guidelines for the use and administration of pharmacological agents for symptom control via syringe drivers within Australia. By developing evidence-based clinical practice guidelines for the use of this common device, this project aimed to improve patient outcomes, reduce practice variation, minimize errors and encourage more efficient use of resources. A literature review identified current literature regarding syringe driver management and an expert panel was assembled to assist in the development of the guidelines. The development of these practice guidelines provides an example of how palliative care practitioners can use a framework of contemporary evidence to enhance clinical practice.

Clinical Nursing Research↗
PubMed2004

[S2 guideline for infectious endocarditis].

Microbe-induced (infectious) endocarditis is an endovascular infection, caused mainly by bacteria, of cardiovascular structures. The major predilection site are the native heart valves, but involvement of implanted intracardiac foreign material is increasingly being seen. The mortality rate of infectious endocarditis depends on clinical factors and the causal agent, but also on the time of the establishment of the diagnosis and the initiation of appropriate treatment. In Germany, the current mortality rate ranges up to 18%. Between January 2003 and July 2004, with the aim of improving patient care and thus the outcome of this condition, a guideline commission worked out recommendations for the diagnosis, treatment and management of the disease for the use of general practitioners and hospital physicians, in particular microbiologists, infectiologists, cardiologists and cardiac surgeons. The basis for this guideline was the systematic search through the literature of the European guideline. On the 16th and 28th of June 2004, the entire guideline was formerly approved in a nominal group process.

Anti-Bacterial Agents↗