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PubMed2000

Practical guidelines for clinicians who treat patients with amiodarone. Practice Guidelines Subcommittee, North American Society of Pacing and Electrophysiology.

Amiodarone has become an important drug for the treatment of supraventricular and ventricular arrhythmias, in short-term inpatient and outpatient settings. It may also have a role in affecting outcome in patients at high risk for arrhythmic events and sudden death; its place among available therapies is being established in clinical trials.

Administration, Oral↗
PubMed2006

Making clinical decisions using a clinical practice guideline.

Clinical practice guidelines are statements developed from best evidence about clinically relevant appropriate care. A simulated patient case is presented to demonstrate how to use a CPG in decision-making in determining a clinical decision. Conceptualized knowledge management software templates are provided to explain a process by which best evidence is retrieved from a primary, centralized network database. Templates describe the process of converting a clinical question into a research question, retrieving best evidence, and performing data analysis for the outcome of individualizing and optimizing a clinical decision. Templates also describe the reciprocation of information to update CPGs by translational researchers who manage and build the primary, centralized network database.

Aged, 80 and over↗
PubMedDate not supplied

Best practice guidelines.

Best practice guidelines and multidisciplinary pathways of care are becoming an established and essential feature of clinical practice. They can be seen in a wide variety of clinical settings ranging right across the primary, secondary and tertiary health and social care spectrums. The 1997 White Paper places strong emphasis on quality and consistency of care delivery and gives assurances of performance measurements, integrated care (Wilson, 1996) and clinical governance. It suggests making healthcare delivery against national standards a local responsibility and quality of care the driving force for decision making at every level of the service to ensure excellence for patients no matter where the care is provided. A number of controversial issues surround the use of guidelines. Some argue that they are a fetter on clinical discretion, clinical freedom and can lead to the practice of 'cookbook medicine'. Others maintain that they are an essential aid to providing safe and appropriate medical and nursing care.

Benchmarking↗
PubMed2001

Evaluating and applying clinical practice guidelines.

Clinical practice guidelines (CPG) hold great potential for providing a summary of large volumes of clinical evidence and a related set of practical recommendations. Nurse practitioners should become aware of the range of available CPGs and methods by which they can be evaluated for use. Appropriate evaluation of CPGs should include their overall reliability and validity, as well as their applicability in specific situations. This article provides an overview of an appropriate evaluation method and serves as an introduction to future columns presenting individual CPGs.

Evidence-Based Medicine↗
PubMed2000

Clinical practice guidelines vs actual clinical practice : the asthma paradigm.

In recent years, a multitude of practice guidelines, statements, position papers, and "best practices" have been promulgated for a number of disease entities by a variety of medical societies and managed care organizations. In the case of asthma, for example, the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) initially published guidelines for the diagnosis and management of asthma in 1991; these recommendations were updated in 1997. However, health-care providers have not widely and consistently adhered to these guidelines. Several recent publications suggest that this underutilization of the NIH asthma guidelines may in part be related to a lack of understanding. This lack of understanding appears to span the spectrum of physicians in private practice, physicians working in health maintenance organizations, as well as university-affiliated physicians. Moreover, both primary-care physicians and "asthma specialists" share deficits in their knowledge base. To compound the problem, patients with asthma also demonstrate poor adherence to the guidelines. This poor adherence is evident irrespective of the patient's socioeconomic status. These types of data clearly indicate a need for further educational programs directed to both physicians and patients. However, as with the development and promulgation of any practice guideline, physicians need to be convinced that there exists compelling evidence from well-controlled clinical trials, for example, or from evidence-based medicine, to substantiate implementation of these guidelines.

Adult↗
PubMed2006

The new KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and CKD.

BACKGROUND/AIMS: The National Kidney Foundation (NKF) recently published new guidelines and clinical practice recommendations for the diagnosis and management of patients with diabetes and chronic kidney disease (CKD). METHODS: Guidelines were developed using an evidence-based approach. When sufficient evidence was lacking, recommendations were developed that reflect expert opinion. RESULTS: Guidelines describe the process for screening and diagnosis of kidney disease in the setting of diabetes and the management of hyperglycemia, hypertension, dyslipidemia, and nutrition. Recommendations describe the management of albuminuria in the normotensive diabetic patient and the potential value of albuminuria as a marker of treatment efficacy; the impact of diabetes and CKD in special populations; the importance of behavioral self-management; and the value of intensive multifaceted intervention in these high risk patients. CONCLUSIONS: The new guidelines and recommendations update and extend the scope of the NKF's Kidney Disease Outcomes Quality Initiative (KDOQI(TM)).

Diabetes Complications↗
PubMed2006

Knowledge and practices relating to the 2004 acute otitis media clinical practice guideline: a survey of practicing physicians.

OBJECTIVE: To identify primary care physicians' familiarity with the 2004 acute otitis media (AOM) clinical practice guideline and to compare their practices with its recommendations. DESIGN: Mail survey October through December 2004 to all active physician members of the Slone Center Office-based Research Network, a national, practice-based, pediatric research network. RESULTS: The response rate was 276 of 469 (58.8%). Overall, 90.5% had read the guideline or summaries of it. Pneumatic otoscopy was always used by 16.2%, used half the time or more by 23.1%, used less than half the time by 34.6% and never used by 26.2%. Observation is considered a reasonable option for some AOM cases by 88.0% and, over the previous 3 months, these physicians used observation a median of 10% of the time (25th and 75th percentiles, 5% and 25%, respectively). In terms of concern that the observation option may increase AOM complications, 75.6% were not at all or only slightly concerned; 24.4% were moderately or very concerned. In general, these physicians have altered their antibiotic prescribing practices for AOM towards the guideline's recommendations since its publication. However, antibiotic choices deviated most widely from the guideline in cases of AOM with severe illness, where only 17.9% follow the recommendation for high-dose amoxicillin-clavulanate, and in cases of children who fail treatment with amoxicillin-clavulanate, where only 27.7% favor the recommended intramuscular ceftriaxone. CONCLUSIONS: Most physicians in this survey are familiar with the AOM guideline, but many do not follow its diagnostic and antibiotic recommendations. Observation for selected cases is acceptable to most of these physicians and is currently used in a small proportion of cases.

Acute Disease↗
PubMed2000

The development of evidence-based clinical practice guidelines. Integrating medical science and practice.

Practice guidelines are rapidly becoming preferred decision-making resources in medicine, as advances in technology and pharmaceutics continue to expand. An evidence-based approach to the development of practice guidelines serves to anchor healthcare policy to scientific documentation, and in conjunction with practitioner opinion can provide a powerful and practical clinical tool. Three sources of information are essential to an evidence-based approach: a) an exhaustive literature synthesis; b) meta-analysis; and c) consensus opinion. The systematic merging of evidence from these sources offers healthcare providers a scientifically supportable document that is flexible enough to deal with clinically complex problems. Evidence-based practice guidelines, in conjunction with practice standards and practice advisories, are invaluable resources for clinical decision making. The judicious use of these documents by practitioners will serve to improve the efficiency and safety of health care well.

Anesthesiology↗