Practice guidelines do improve patient outcomes: association or causation?

Blood Purif. 2008;26(1):67-72

Authors: Levin A

Guidelines have been developed in nephrology and medicine developed to assist practitioners and patients in making decisions about healthcare for specific clinical circumstances. There has been a proliferation of guidelines over the last decade in all areas of medicine, including nephrology. Many of the nephrology guidelines are based on a less robust evidentiary base than guidelines in cardiology or diabetes. There continues to be a debate in medicine as to whether guidelines and their development process actually impact patient outcomes. This article describes the ways in which guidelines may impact patient outcomes in nephrology and emphasizes the role of guidelines in education, research and health policy development such that there is an indirect benefit on medical practice and thus patient outcomes. Our failure to be able to directly attribute any specific guideline to a change in patient outcomes speaks to the complexity of CKD patients, and the difficult in measuring hard outcomes versus process outcomes. Examples of the activities stimulated by guidelines in key areas of nephrology are given. Guidelines are an important component of the application of medical knowledge to medical practice, and need to be contextualized as such. Rigorous evaluation of current implementation techniques and resultant impacts should be undertaken.

PMID: 18182800 [PubMed - in process]

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Clinical guidelines: Involvement of peers increases physician adherence.

World J Gastroenterol. 2008 Jan 14;14(2):322-3

Authors: Vignally P, Grimaud JC, Sambuc R, Gentile S

The literature illustrates the important issue of physician adherence to guidelines in their daily practice. In a quantitative study, we asked a random sample of 100 hospital gastroenterologists to evaluate their knowledge of guidelines and awareness of promoters. The degree to which guidelines were considered reliable was not related to the scientific evidence but was significantly associated with the promoter. The French Society of Gastroenterology was considered to be a more reliable promoter than national health agencies and pharmaceutical industries. Gastroenterologists become aware of guidelines mainly through their specialty society (62%). Specialty societies appear to be a more important source of information on guidelines for physicians. National health agencies should involve the specialty societies in the guideline development process to achieve changes in clinical practice.

PMID: 18186576 [PubMed - in process]

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The impact of new European Organisation for Research and Treatment of Cancer guidelines on the use of granulocyte colony-stimulating factor on the management of breast cancer patients.

Eur J Cancer. 2008 Feb;44(3):353-65

Authors: Zielinski CC, Awada A, Cameron DA, Cufer T, Martin M, Aapro M

Febrile neutropenia (FN) is a severe consequence of myelosuppressive therapy. The European Organisation for Research and Treatment of Cancer recently published guidelines on the use of granulocyte colony-stimulating factor (G-CSF) to prevent FN in patients with malignant disease. In this review, the impact of these guidelines on breast cancer treatment is discussed. A brief summary of FN in breast cancer is given, and patient-related and treatment schedule-related risk factors for FN are reviewed for the adjuvant/neoadjuvant and metastatic disease settings. Primary G-CSF support is recommended if the overall FN risk is 20%, or if a reduction in dose-intensity is associated with a poorer outcome. Any formulation of G-CSF is recommended. The utility of G-CSF in reducing the incidence of FN and enabling treatment regimens is discussed.

PMID: 18191396 [PubMed - in process]

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Evidence-based interventions to improve the palliative care of pain, dyspnea, and depression at the end of life: a clinical practice guideline from the American College of Physicians.

Ann Intern Med. 2008 Jan 15;148(2):141-6

Authors: Qaseem A, Snow V, Shekelle P, Casey DE, Cross JT, Owens DK, , Dallas P, Dolan NC, Forciea MA, Halasyamani L, Hopkins RH, Shekelle P

RECOMMENDATION 1: In patients with serious illness at the end of life, clinicians should regularly assess patients for pain, dyspnea, and depression. (Grade: strong recommendation, moderate quality of evidence.) RECOMMENDATION 2: In patients with serious illness at the end of life, clinicians should use therapies of proven effectiveness to manage pain. For patients with cancer, this includes nonsteroidal anti-inflammatory drugs, opioids, and bisphosphonates. (Grade: strong recommendation, moderate quality of evidence.) RECOMMENDATION 3: In patients with serious illness at the end of life, clinicians should use therapies of proven effectiveness to manage dyspnea, which include opioids in patients with unrelieved dyspnea and oxygen for short-term relief of hypoxemia. (Grade: strong recommendation, moderate quality of evidence.) RECOMMENDATION 4: In patients with serious illness at the end of life, clinicians should use therapies of proven effectiveness to manage depression. For patients with cancer, this includes tricyclic antidepressants, selective serotonin reuptake inhibitors, or psychosocial intervention. (Grade: strong recommendation, moderate quality of evidence.) RECOMMENDATION 5: Clinicians should ensure that advance care planning, including completion of advance directives, occurs for all patients with serious illness. (Grade: strong recommendation, low quality of evidence.).

PMID: 18195338 [PubMed - indexed for MEDLINE]

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Prophylaxis for adults with severe haemophilia: a compelling need for evidence-based guidelines.

Haemophilia. 2008 Jan 14;

Authors: Walsh CE,

PMID: 18201188 [PubMed - as supplied by publisher]

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Evidence-based Guidelines: Definitely Fit for Purpose.

Clin Oncol (R Coll Radiol). 2008 Jan 15;

Authors: Macbeth F, Melder A, Cleves A

PMID: 18201883 [PubMed - as supplied by publisher]

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AIUM Practice Guideline for the Performance of the Focused Assessment With Sonography for Trauma (FAST) Examination.

J Ultrasound Med. 2008 Feb;27(2):313-8

Authors:

PMID: 18204028 [PubMed - in process]

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Asthma guidelines: are they implemented on discharge?

Arch Dis Child. 2008 Feb;93(2):183

Authors: Bird D, Bhojani S, D’Costa S

PMID: 18209000 [PubMed - indexed for MEDLINE]

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[German guidelines for the assessment of BPH : What's new in 2007?]

Urologe A. 2008 Jan 12;

Authors: Oelke M, Michel MC, Höfner K

The new version of the German guidelines for assessing benign prostatic hyperplasia (BPH) was written in 2006 and 2007 by experts of the BPH working group on behalf of the German Association of Urology and Federation of German Urologists. The full version is expected to be published in 2008. Recommendations for assessing BPH were modified and updated and include patient history, symptom questionnaires, physical examination, urine analysis, prostate-specific antigen, uroflowmetry, ultrasound examination of the urinary bladder (including postvoid residual urine), and ultrasound examination of the upper urinary tract or creatinine measurement. Optional tests are voiding diary, pressure-flow studies, ultrasound measurement of detrusor wall thickness, urethrocystography, and urethrocystoscopy. For the first time, tests for the differential diagnosis of bladder symptoms and BPH are described. Furthermore, the latest knowledge was added on disease progression, indications for urodynamic assessment, and ultrasound measurement of detrusor wall thickness for evaluating bladder outlet obstruction. International quality standards were applied in order to increase the guidelines’ value; all tests were judged using the levels of evidence and grades of recommendation of the U.S. Department of Health and Human Services classification.

PMID: 18210073 [PubMed - as supplied by publisher]

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Specific information about the WHO guidelines for gestational diabetes screening improves clinical practices.

J Eval Clin Pract. 2008 Feb;14(1):36-42

Authors: Gayet-Ageron A, Poncet B, Guerre P, Rocher L, Dureau-Drevard E, Colin C, Orgiazzi J, Berland M, Touzet S

Rationale, aims and objective To evaluate the impact of specific information on World Health Organization (WHO) guidelines for gestational diabetes mellitus (GDM) screening on clinical practices and to estimate its acceptance by women. Methods A non-randomized interventional study, comparing two periods, that is, before (period I) and after (period II) the implementation of the WHO guidelines during year 2000 in three obstetrical units, using reminders, meetings and pre-printed prescription sheets. Women were interviewed on GDM screening acceptance. Results A total of 333 pregnant women were included in period I and 345 in period II. The proportion of women who were screened significantly increased between period I and period II (0.9% in period I, 59.1% in period II, P

PMID: 18211641 [PubMed - in process]

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