Application Of Clinical Practice Guidelines Research Articles

Deprescribing Opportunities for Frail Residents of Nursing Homes: A Multicenter Study in Australia, China, Japan, and Spain

ObjectiveDeprescribing opportunities may differ across health care systems, nursing home settings, and prescribing cultures. The objective of this study was to compare the prevalence of STOPPFrail medications according to frailty status among residents of nursing homes in Australia, China, Japan, and Spain. DesignSecondary cross-sectional analyses of data from 4 cohort studies. Setting and ParticipantsA total of 1142 residents in 31 nursing homes. MethodsMedication data were extracted from resident records. Frailty was assessed using the FRAIL-NH scale (non-frail 0–2; frail 3–6; most-frail 7–14). Chi-square tests and prevalence ratios (PRs) were used to compare STOPPFrail medication use across cohorts. ResultsIn total, 84.7% of non-frail, 95.6% of frail, and 90.6% of most-frail residents received ≥1 STOPPFrail medication. Overall, the most prevalent STOPPFrail medications were antihypertensives (53.0% in China to 73.3% in Australia, P < .001), vitamin D (nil in China to 52.7% in Australia, P < .001), lipid-lowering therapies (11.1% in Japan to 38.9% in Australia, P < .001), aspirin (13.5% in Japan to 26.2% in China, P < .001), proton pump inhibitors (2.1% in Japan to 32.0% in Australia, P < .001), and antidiabetic medications (12.3% in Japan to 23.5% in China, P = .010). Overall use of antihypertensives (PR, 1.15; 95% CI, 1.06–1.25), lipid-lowering therapies (PR, 1.78; 95% CI, 1.45–2.18), aspirin (PR, 1.31; 95% CI, 1.04–1.64), and antidiabetic medications (PR, 1.31; 95% CI, 1.00–1.72) were more prevalent among non-frail and frail residents compared with most-frail residents. Antihypertensive use was more prevalent with increasing frailty in China and Japan, but less prevalent with increasing frailty in Australia. Antidiabetic medication use was less prevalent with increasing frailty in China and Spain but was consistent across frailty groups in Australia and Japan. Conclusions and ImplicationsThere were overall and frailty-specific variations in prevalence of different STOPPFrail medications across cohorts. This may reflect differences in prescribing cultures, application of clinical practice guidelines in the nursing home setting, and clinician or resident attitudes toward deprescribing.

Bringing ‘Yotkom’ to northern Uganda: translating ‘health’ for those who need it most through a synthesis of clinical practice guidelines

In resource-poor settings, like northern Uganda, a shortage of trained medical staff and reduced access to evidence-based education or guidelines often leads to an inconsistent approach to medical practice and prescription, and consequent poor patient outcomes. Within this context the application of clinical practice guidelines developed in high-income countries has variable success. Due to the impractical resource and skill requirements of internationally developed guidelines, clinicians in resource-poor contexts are often left depending on traditional practices that are not evidence-based. In this practice paper, we describe the integrated knowledge translation-informed approach to developing a context-specific synthesis of clinical practice guidelines in a northern Ugandan hospital. Using the Knowledge Creation element of the Knowledge to Action cycle as a guide, and strategies from the Expert Recommendations for Implementing Change framework, we identified the most common conditions relevant to our health context and summarised the current best-practice guidelines for each. These recommendations were then further distilled through the context funnel of (1) health system resources, (2) clinician resources, (3) cultural implications, and (4) patient resources. This has resulted in a synthesis of clinical practice guidelines that are relevant to our context in terms of need and available resources and easy for clinicians to navigate during patient management. We wish to share this experience with clinicians and researchers working in similar resource-limited contexts, and provide a thinking framework for distilling best practice through the context funnel to develop pragmatic recommendations for low-middle income countries.

Using AGREE II reporting checklist to evaluate the quality of Tuina clinical practice guidelines.

The objective of this study is to evaluate the methodological quality of Tuina clinical practice guidelines (CPGs). Computer searches of China National Knowledge Infrastructure (CNKI), Chinese Technical Periodicals (VIP), Wanfang Data Knowledge Service Platform, PubMed, Cochrane Library, Embase, and other databases were conducted to search for published guidelines on Tuina, with a search time frame from database creation to March 2021. Four evaluators independently used the Appraisal of Guidelines for Research and Evaluation II instrument to evaluate the quality of the included guidelines. A total of eight guidelines related to Tuina were included in this study. The quality of reporting was low in all included guidelines. The highest quality report had a total score of 404 and was rated as "highly recommended." The worst guideline had a final score of 241 and was rated as "not recommended." Overall, 25% of the included guidelines were recommended for clinical use, 37.5% were recommended after revision, and 37.5% were not recommended. The number of existing Tuina clinical practice guidelines is limited. The methodological quality is low, far from the internationally accepted clinical practice guideline development and reporting norms. In the future, reporting specifications of guidelines and the methodology of guideline development, including the rigor of the guideline development process, the clarity, application, and independence of reporting, should be emphasized in the development of the Tuina guidelines. These initiatives could improve the quality and applicability of clinical practice guidelines to guide and standardize the clinical practice of Tuina.

Guidance on Which Calibrators in a Metrologically Traceable Calibration Hierarchy Must Be Commutable with Clinical Samples.

Equivalent results for the same measurand in clinical samples (CSs), measured using different end-user in-vitro diagnostic medical devices (IVD-MDs), are essential for the application of clinical practice guidelines for diagnosis, treatment, monitoring, or risk assessment. The International Organization for Standardization (ISO) document 17511:2020 specifies how to establish metrological traceability to the highest available reference system component to enable equivalent results among IVD-MDs. Commutability with CSs is an essential property of a reference material used as a calibrator in a calibration hierarchy. However, not all calibrators in a calibration hierarchy are required to be commutable; different calibration hierarchies have different requirements for which calibrators must be commutable with CSs. Because assessment of commutability is a substantial effort, it is therefore important to determine which calibrators need to be commutable when implementing a calibration hierarchy. We provide guidance on which calibrators must be commutable with CSs, when a correction for any noncommutability bias is appropriate, and when commutability of a calibrator with CSs is not required for various types of calibration hierarchies described in ISO 17511:2020.

[Development of a Ranking Tool for Scientificity, Transparency and Applicability of Clinical Practice Guidelines].

Objective: To address the limitations of existing methods and tools for evaluating clinical practice guidelines, we aimed to develop a comprehensive instrument focusing on the three main dimensions of guideline development: scientificity, transparency, applicability. We will use it to rank the guidelines according to the scores. We abbreviated it as STAR, and its reliability, validity and usability were also tested. Methods: A multidisciplinary expert working group was set up, including methodologists, statisticians, journal editors, medical professionals, and others. Scoping review, Delphi methods and hierarchical analysis were used to determine the final checklist of STAR. Results: The new instrument contained 11 domains and 39 items. Intrinsic reliability of each domain was indicated by Cronbach's α coefficient, with a average value of 0.646. The Cohen's kappa coefficients for methodological evaluators and clinical evaluators were 0.783 and 0.618. The overall content validity index was 0.905. The R2 for the criterion validity analysis was 0.76. The average score for usability of the items was 4.6, and the mean time spent to evaluate each guideline was 20 minutes. Conclusion: The instrument has good reliability, validity and evaluating efficiency, and can be used for evaluating and ranking guidelines more comprehensively.

Systems for grading the strength of recommendations in clinical practice guidelines in oncology

Introduction. In order to improve the applicability of clinical practice guidelines, their authors assign recommendations with grades denoting the degree of conviction regarding their practical application. Nevertheless even within one branch of medicine, significant differences between the grading systems arise. Material and methods. To identify these systems, websites of societies and institutions publishing oncology guidelines were searched. Only high-quality, regularly updated guidelines were included. Results. Five systems were analysed – all incorporate quality of evidence and strength of recommendation, but vary in the methods of their assessment and structure of the scales. Discussion. The described systems depend on the review of data, the quality of which supports the ascribed strength. Systems differ with regard to the methods of assessing the quality, quantity and consistency of evidence, potentially leading to assigning different grades of strength to recommendations based on the same studies. Conclusions. The introduction of unified grading systems across each branch of medicine could aid the development of unambiguous recommendations that are easy to introduce within the healthcare system.

Narrative Review of Clinical Practice Guidelines for Rehabilitation of People With Spinal Cord Injury: 2010-2020.

Clinical practice guidelines provide reliable, vetted, and critical information to bring research to practice. Some medical specialties (e.g., physical medicine and rehabilitation) provide multidomain treatment for various conditions. This presents challenges because physical medicine and rehabilitation is a small specialty, a diverse patient base in terms sociodemographics and diagnosis, treatments are difficult to standardize, and rehabilitation research is underfunded. We wished to identify quality and applicability of clinical practice guidelines and searched "Spinal Cord Injury AND Clinical Practice Guidelines AND Rehabilitation" and vetting process.Three hundred fifty-nine articles were identified of which 58 met all criteria for full-text review of which 13 were included in the final selection. Additional publications were accessed from a nondatabase search. Five articles addressed postacute care, community treatment. Nine articles had no recorded vetting process but addressed rehabilitation as an outcome and were included separately. Many of the clinical practice guidelines were developed without evidence from randomized controlled trials, one had input from stakeholders, and some are out of date and do not address important aspects of changes in demographics of the affected population and the use of newer technologies such as sensors and robotics and devices. Identification of these gaps may help stimulate treatment that is clinically relevant, accessible, and current.

2. Strategic Application of Clinical Practice Guideline for CKD Management

2. Strategic Application of Clinical Practice Guideline for CKD Management

A Validated Model for Sudden Cardiac Death Risk Prediction in Pediatric Hypertrophic Cardiomyopathy.

Hypertrophic cardiomyopathy is the leading cause of sudden cardiac death (SCD) in children and young adults. Our objective was to develop and validate a SCD risk prediction model in pediatric hypertrophic cardiomyopathy to guide SCD prevention strategies. In an international multicenter observational cohort study, phenotype-positive patients with isolated hypertrophic cardiomyopathy <18 years of age at diagnosis were eligible. The primary outcome variable was the time from diagnosis to a composite of SCD events at 5-year follow-up: SCD, resuscitated sudden cardiac arrest, and aborted SCD, that is, appropriate shock following primary prevention implantable cardioverter defibrillators. Competing risk models with cause-specific hazard regression were used to identify and quantify clinical and genetic factors associated with SCD. The cause-specific regression model was implemented using boosting, and tuned with 10 repeated 4-fold cross-validations. The final model was fitted using all data with the tuned hyperparameter value that maximizes the c-statistic, and its performance was characterized by using the c-statistic for competing risk models. The final model was validated in an independent external cohort (SHaRe [Sarcomeric Human Cardiomyopathy Registry], n=285). Overall, 572 patients met eligibility criteria with 2855 patient-years of follow-up. The 5-year cumulative proportion of SCD events was 9.1% (14 SCD, 25 resuscitated sudden cardiac arrests, and 14 aborted SCD). Risk predictors included age at diagnosis, documented nonsustained ventricular tachycardia, unexplained syncope, septal diameter z-score, left ventricular posterior wall diameter z score, left atrial diameter z score, peak left ventricular outflow tract gradient, and presence of a pathogenic variant. Unlike in adults, left ventricular outflow tract gradient had an inverse association, and family history of SCD had no association with SCD. Clinical and clinical/genetic models were developed to predict 5-year freedom from SCD. Both models adequately discriminated between patients with and without SCD events with a c-statistic of 0.75 and 0.76, respectively, and demonstrated good agreement between predicted and observed events in the primary and validation cohorts (validation c-statistic 0.71 and 0.72, respectively). Our study provides a validated SCD risk prediction model with >70% prediction accuracy and incorporates risk factors that are unique to pediatric hypertrophic cardiomyopathy. An individualized risk prediction model has the potential to improve the application of clinical practice guidelines and shared decision making for implantable cardioverter defibrillator insertion. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT0403679.

2. Strategic Application of Clinical Practice Guideline for CKD Management

2. Strategic Application of Clinical Practice Guideline for CKD Management

Treatment of hemorrhoids: A survey of surgical practice in Australia and New Zealand.

BACKGROUNDHemorrhoidal disease is the most common anorectal disorder. Hemorrhoids can be classified as external or internal, according to their relation to the dentate line. External hemorrhoids originate below the dentate line and are managed conservatively unless the patient cannot keep the perianal region clean, or they cause significant discomfort. Internal hemorrhoids originate above the dentate line and can be managed according to the graded degree of prolapse, as described by Goligher. Generally, low-grade internal hemorrhoids are effectively treated conservatively, by non-operative measures, while high-grade internal hemorrhoids warrant procedural intervention.AIMTo determine the application of clinical practice guidelines for the current management of hemorrhoids and colorectal surgeon consensus in Australia and New Zealand.METHODSAn online survey was distributed to 206 colorectal surgeons in Australia and New Zealand using 17 guideline-based hypothetical clinical scenarios.RESULTSThere were 82 respondents (40%) to 17 guideline-based scenarios. Nine (53%) reached consensus, of which only 1 (6%) disagreed with the guidelines. This was based on low quality evidence for the management of acutely thrombosed external hemorrhoids. There were 8 scenarios which showed community equipoise (47%) and they were equally divided for agreeing or disagreeing with the guidelines. These topics were based on low and moderate levels of evidence. They included the initial management of grade I internal hemorrhoids, grade III internal hemorrhoids when initial management had failed and the patient had recognised risks factors for septic complications; and finally, the decision-making when considering patient preferences, including a prompt return to work, or minimal post-operative pain.CONCLUSIONAlthough there are areas of consensus in the management of hemorrhoids, there are many areas of community equipoise which would benefit from further research.

[Series: Education and the dentist in 2025. Evidence-based clinical practice guidelines for an academic learning line 'quality and safety in oral care'].

Education in the field of quality and safety in oral care still needs further development, both for students and teachers. Based on the current development of clinical practice guidelines in the field of oral care in the Netherlands, this article describes a proposal for implementing this as a 'quality of oral care' learning line in the dental school curricula. Within clinical educational practice and scientific training, students should become familiar with the development, assessment and application of clinical practice guidelines. Some proposals for embedding this new learning line in the curriculum are given. In order to further shape the learning line, close cooperation between the three dental schools and the Kennisinstituut Mondzorg (Institute for Knowledge Translation in Oral Care) in the Netherlands is recommended.

Adherence to AUA Clinical Guidelines: Motivations and Barriers.

The AUA (American Urological Association) has been producing clinical practice guidelines to inform its members on standards of care since 1994. While adherence to these clinical practice guidelines varies, there are limited data on ways to improve adherence or reduce barriers to use. A survey was developed to query adherence to AUA clinical practice guidelines and identify barriers to use. Five specific clinical practice guidelines were queried from various areas of urological care. Reasons for lack of adherence or perceived barriers to clinical practice guideline implementation were elicited. The survey was sent to a random sample of AUA members in clinical practice in the United States. Of the 2,455 AUA members surveyed 260 (10.6%) responded, with 148 (6.0%) answering all questions concerning AUA guidelines. Overall adherence to AUA guidelines was 72.7%. The guideline with the most adherence was for microhematuria (90.68%) and the least followed guideline was on the timing of post-vasectomy semen analysis (53.33%). The mean self-reported rate of adherence to the 5 guidelines was 81.7% (range 71.3% to 95.03%). The top reason given for lack of adherence was not agreeing with the guideline. The most commonly reported barriers to following clinical practice guidelines included insurance coverage (29.08%) and disagreement with guidelines (21.92%). Overall there is an optimistic view of the quality and applicability of clinical practice guidelines. These survey data help identify areas for improvement. We recommend e-mail distribution of clinical practice guidelines, improvement in ease of use for the mobile app, incorporation of clinical practice guidelines into the electronic medical record, and addition of CliffsNotes® and flowchart format to future clinical practice guidelines.

[Clinical application evaluation of clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for uncomplicated lower urinary tract infection].

A questionnaire survey of 1 000 clinicians having experience in treating uncomplicated lower urinary tract infections from different levels of hospitals was conducted to mainly evaluate the applicability and effectiveness of clinical application of clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for uncomplicated lower urinary tract infection(hereinafter referred to as Guideline). The research was conducted with the three-level quality control strictly throughout the process, and the data was real and reliable. The survey's results showed that: most clinicians considered that the Guideline had good clinical applicability. The availability and price of the recommended medicine were moderate. Traditional Chinese medicine had obvious features and advantages in treating lower urinary tract infection for it could reduce the usage of antibiotics and shorten the course of antibiotic application. In the recommendation section, clinicians proposed increasing medication guidance, updating the Guideline timely, as well as increasing treating methods and techniques, strengthen propaganda and promotion, and improve the use of evidence-based methods. In the evaluation of effectiveness, the majority of clinicians agreed that the definition in both traditional Chinese medicine (TCM) and Western medicine and differential diagnosis in the Guideline were accurately described and the basic principle of treatment as well as the treating method of TCM were recommended appropriately. The TCM formulas and Chinese patent medicine had good effect. Some clinicians suggested refining the syndrome differentiation of stranguria. Some clinicians considered that the formulas and herbs recommended in Guideline didn't have obvious effect and some had doubts about the manipulation of fumigation and washing in the part of other methods recommended in Guideline. Moreover, specification and procedure of manipulation of fumigation and washing using herbs and the acupuncture included in characteristic TCM therapy treating uncomplicated lower urinary tract infection remained to be developed.

[Clinical application evaluation and revision suggestions of clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for pelvic inflammatory disease].

To evaluate the clinical application of clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for pelvic inflammatory disease and provide reference for the revision of the Guideline. Questionnaire research was conducted from applicability and application evaluation. A total of 1 311 copies of valid questionnaires were obtained, including 717 questionnaires on applicability evaluation and 594 questionnaires on application evaluation. There were 83 items from 4 aspects in the applicability questionnaire. In statistical agreement rates of those items to reflect the application status of the Guideline, the rates of 8 items were all more than 95% except for rates of "content integrity", "comparison with the diagnosis and treatment scheme of his/her unit (individual)" and "economy of clinical application", 94.70%, 93.86% and 93.17% respectively. In statistical agreement rates of those items to reflect the quality of the Guideline, the rates of 3 items were all more than 97%, except the rate of "whether syndrome classification is reasonable" item was 95.26%. Among the items that reflect the local purchase difficulty and price evaluation of Chinese patent medicine recommended in the Guideline, most clinicians thought the prices were modest. There were 56 items from 6 aspects in the application evaluation questionnaire. In statistical agreement rates of those items to reflect the application rationality of the Guideline, the rates of 3 items were all more than 96%, except rate of "whether syndrome classification is reasonable" item was 91.58%. In statistical agreement rates of those items to reflect the clinical application effect of the recommended regimen in the Guideline, the traditional application of traditional Chinese medicine decoction had generally better application effect, whereas Chinese patent medicines were less effective. In statistical agreement rates of those items to reflect the overall evaluation of clinical application, the rates of "overall effect" and "overall safety" were all more than 96%, except the rates of "overall economy" item was 92.42%. It indicates that the overall effect of this Guideline is relatively well. It is suggested to improve the classification of syndrome differentiation and increase the species of Chinese medicine decoction and Chinese patent medicines, and to standardize the duration and course of medication. The next revised work should not only uptake the experiences of prominent TCM doctors and all kinds of research achievements, but also regularly update and strengthen the publicity of the Guideline.

[Clinical application evaluation and revision suggestions of clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for sepsis].

To investigate the clinical application of clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for sepsis, in order to promote the follow-up revision and further promotion of the Guidelines. Copies of 500 application evaluation questionnaire and 500 copies of applicability evaluation questionnaire were given to the clinicians who had used this Guideline in China, both in a form of registered questionnaire, and a database was established by Excel 2016 for descriptive statistical analysis. Copies of 211 application evaluation questionnaire and 211 copies of applicability evaluation questionnaire were collected. We can conclude from the survey that we should adjust the whole content and structure on the basis of better evaluation of the present recommendation scheme, update the prescription selection and clinical evidence of the recommendation scheme, and put forward the improvement measures for the hindrance factors in the application of the Guideline. Furthermore, in order to promote the Guideline more clearly, we should strengthen the doctor-patient education, improve guidance quality and increase the publicity, providing basis for the implementation and promotion strategies of the Guideline.

Applicability of clinical practice guidelines for rehabilitation in traumatic brain injury in disaster settings: A critical appraisal

To provide an overview of recommendations and quality of existing clinical practice guidelines (CPGs) for management of traumatic brain injury (TBI) focusing on rehabilitation medicine; and synthesise recommendations from these for applicability in disaster settings. Comprehensive literature search including health databases, CPG clearinghouse/developer websites, and grey literature using Internet search engines to September 2017. All TBI CPGs published in the last decade were selected if their scope included: management of TBI, systematic methods for evidence search, clear defined recommendations and supporting evidence for rehabilitation interventions. Three authors independently critically appraised the quality of included CPGs using the Appraisal of Guidelines, Research and Evaluation (AGREE) Instrument. All recommendations were extracted, compared and categorized for applicability in disaster settings. Only 4 of the 14 potential identified CPGs met the inclusion criteria. Despite variation in scope, target population, size, and guideline development processes, all four CPGs were assessed as of good quality (AGREE Global score of 5–7 out of 7). The recommendations included: patient/carer education, general physical therapy, practice in daily living activities and safe equipment use, direct cognitive/behavioural feedback, basic compensatory memory/visual strategies, basic swallowing/communication and psychological input for TBI survivors in disaster settings. More advanced interventions are generally not applicable following disasters due to limited access to services, trained staff/resources, equipment, funding and operational issues. Although CPGs in this study were of high quality, many recommendations for TBI care are challenging to implement in disaster settings and need further research to identify and address barriers for implementation.

The effectiveness of interventions designed to increase the uptake of clinical practice guidelines and best practices among musculoskeletal professionals: a systematic review

BackgroundThe objective of this systematic review was to summarize and evaluate evidence about the effectiveness of knowledge translation (KT) interventions to improve the uptake and application of clinical practice guidelines and best practices for a wide range of musculoskeletal (MSK) disorders and health care professionals.MethodsA search for relevant randomized controlled trials (RCTs) published in English was conducted in MEDLINE (Ovid interface), EMBASE, CINAHL, and CENTRAL (Cochrane library). Two independent reviewers selected studies, assessed risk of bias, and extracted data. All MSK disorders were included except MSK injuries, fractures, trauma, or inflammatory disorders.ResultsA total of 7904 citations yielded 11 eligible RCTs. The targeted MSK disorders included: low back pain (n = 5), neck pain (n = 2), whiplash (1), spinal disorders (n = 1), and osteoarthritis of the hip and knee (n = 2). Studies primarily involved physiotherapists, chiropractors, and a mix of physiotherapists, chiropractors and osteopaths. Results were reported using effect sizes (Cohen’s d). Interactive educational meetings were the most commonly used KT strategy. For professional outcomes, 3 studies using single-component interventions had a small effect (d ranges from 0.14 to 0.28) and 7 studies used multifaceted interventions (3 were effective (d ranges from 0.824 to 2.27). For patient outcomes, 4 studies were ineffective (d ranges from 0.06 to 0.31). The majority of the included RCTs had moderate-to-high risk of bias. About half of the studies used theory-based interventions, but the elements of the interventions and theoretical frameworks were often poorly described. Furthermore, there were no comparable outcome measures to evaluate the impact of the interventions on a similar scale.ConclusionsThe findings suggested that multifaceted educational KT interventions appear to be effective for improving professional outcomes, although effects were inconsistent. The KT strategies were generally not effective on patient outcomes. In general, studies were of low quality, interventions were poorly described, and only half had theoretical underpinning. Researchers are encouraged to use validated professional and patient outcomes.

Colorectal surgeon consensus with diverticulitis clinical practice guidelines.

AIMTo determine the application of clinical practice guidelines for the current management of diverticulitis and colorectal surgeon specialist consensus in Australia and New Zealand.METHODSA survey was distributed to 205 colorectal surgeons in Australia and New Zealand, using 22 hypothetical clinical scenarios.RESULTSThe response rate was 102 (50%). For 19 guideline-based scenarios, only 11 (58%) reached consensus (defined as > 70% majority opinion) and agreed with guidelines; while 3 (16%) reached consensus and did not agree with guidelines. The remaining 5 (26%) scenarios showed community equipoise (defined as less than/equal to 70% majority opinion). These included diagnostic imaging where CT scan was contraindicated, management options in the failure of conservative therapy for complicated diverticulitis, surgical management of Hinchey grade 3, proximal extent of resection in sigmoid diverticulitis and use of oral mechanical bowel preparation and antibiotics for an elective colectomy. The consensus areas not agreeing with guidelines were management of simple diverticulitis, management following the failure of conservative therapy in uncomplicated diverticulitis and follow-up after an episode of complicated diverticulitis. Fifty-percent of rural/regional based surgeons would perform an urgent sigmoid colectomy in failed conservative therapy of diverticulitis compared to only 8% of surgeons city-based (Fisher’s exact test P = 0.016). In right-sided complicated diverticulitis, a greater number of those in practice for more than ten years would perform an ileocecal resection and ileocolic anastomosis (79% vs 41%, P < 0.0001).CONCLUSIONWhile there are areas of consensus in diverticulitis management, there are areas of community equipoise for future research, potentially in the form of RCTs.

Concise interpretation and application of clinical practice guidelines for general practitioners

临床实践指南的应用有利于规范诊疗行为，缩小不同医疗机构和临床医生间的诊疗水平差异，对降低患者就医成本和改善医疗保健质量具有重要意义。文章阐述了指南的定义与类型、我国指南制订的现状与质量、指南在基层医务人员中的使用现状以及基层医务人员如何正确解读和应用指南，并提出指南制订团队应该邀请基层医务人员参与到指南的制订与推广中来。