Set Of Clinical Practice Guidelines Research Articles

Knee pain and mobility impairments: meniscal and articular cartilage lesions.

The Orthopaedic Section of the American Physical Therapy Association presents this fifth set of clinical practice guidelines on knee pain and mobility impairments, linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) interventions provided by physical therapists, (3) and assessment of outcome for common musculoskeletal disorders.

New guidelines on nondrug treatment in RA

A new set of clinical practice guidelines on the nonpharmacological treatment of rheumatoid arthritis is likely to improve patient accessibility to appropriate and coordinated therapy. The recommendations are classified according to therapeutic objectives and indications, and include a set of quality criteria for self-assessment and practice improvement.

Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain

The Orthopaedic Section of the American Physical Therapy Association presents this fourth set of clinical practice guidelines on knee ligament sprain, linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) interventions provided by physical therapists, (3) and assessment of outcome for common musculoskeletal disorders. J Orthop Sports Phys Ther 2010;40(4):A1–A37. doi:10.2519/jospt.2010.0303

The effect of provider- and workflow-focused strategies for guideline implementation on provider acceptance.

BackgroundThe effective implementation of clinical practice guidelines (CPGs) depends critically on the extent to which the strategies that are deployed for implementing the guidelines promote provider acceptance of CPGs. Such implementation strategies can be classified into two types based on whether they primarily target providers (e.g., academic detailing, grand rounds presentations) or the work context (e.g., computer reminders, modifications to forms). This study investigated the independent and joint effects of these two types of implementation strategies on provider acceptance of CPGs.MethodsSurveys were mailed to a national sample of providers (primary care physicians, physician assistants, nurses, and nurse practitioners) and quality managers selected from Veterans Affairs Medical Centers (VAMCs). A total of 2,438 providers and 242 quality managers from 123 VAMCs participated. Survey items measured implementation strategies and provider acceptance (e.g., guideline-related knowledge, attitudes, and adherence) for three sets of CPGs--chronic obstructive pulmonary disease, chronic heart failure, and major depressive disorder. The relationships between implementation strategy types and provider acceptance were tested using multi-level analytic models.ResultsFor all three CPGs, provider acceptance increased with the number of implementation strategies of either type. Moreover, the number of workflow-focused strategies compensated (contributing more strongly to provider acceptance) when few provider-focused strategies were used.ConclusionProvider acceptance of CPGs depends on the type of implementation strategies used. Implementation effectiveness can be improved by using both workflow-focused as well as provider-focused strategies.

Clinical Practice Recommendations

D uring the past 2 years, Clinical Diabetes has published “Diabetes Foundation,” an eight-part series intended to explain and review facets of diabetes care for general physicians and physicians in training. The goal of the series has been to improve diabetes care for patients treated by such physicians because only a very small percentage of patients with diabetes have access to an endocrinologist. Although previous articles have focused on individual topics related to diabetes care and have reviewed available scientific data, this final article will focus on summarizing recommendations from the American Diabetes Association (ADA) and integrating them as a set of clinical practice guidelines. Information supporting the recommendations has appeared in the previous installments of “Diabetes Foundation” and from the ADA.1 Although there are always exceptions, it is likely that the majority of patients with diabetes or glucose abnormalities would benefit from implementation of many of these guidelines for prevention of diabetes itself and of the complications of diabetes and diabetes treatments. Patients who are experiencing symptoms of diabetes such as polyuria, polydipsia, or unexplained weight loss should be screened for diabetes, especially if they are obese or overweight (BMI > 25 kg/m2). Asymptomatic adult patients should be tested at any age if they are overweight or obese and have an additional risk factor for diabetes. Children who are overweight (BMI greater than the 85th percentile or weight > 120% of ideal for height) should be screened for type 2 diabetes if they have a family history of type 2 diabetes, are of an ethnic background predisposed to diabetes, have signs of insulin resistance such as acanthosis nigricans on physical examination, have a maternal history of diabetes or gestational diabetes mellitus (GDM), or have other conditions typically associated with type 2 diabetes. Such testing in children should …

American Association Of Clinical Endocrinologists And American Association Of Endocrine Surgeons Medical Guidelines For The Management Of Adrenal Incidentalomas

American Association Of Clinical Endocrinologists And American Association Of Endocrine Surgeons Medical Guidelines For The Management Of Adrenal Incidentalomas

Hip Pain and Mobility Deficits — Hip Osteoarthritis: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Healthfrom the Orthopaedic Section of the American Physical Therapy Association

The Orthopaedic Section of the American Physical Therapy Association presents this third set of clinical practice guidelines on hip osteoarthritis, linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) prognosis, (3) interventions provided by physical therapists, and (4) assessment of outcome for common musculoskeletal disorders. J Orthop Sports Phys Ther 2009;39(4):A1-A25. doi:10.2519/jospt.2009.0301

Physiotherapists and Use of Low Back Pain Guidelines: A Qualitative Study of the Barriers and Facilitators

A new set of clinical practice guidelines (CPGs) for the management of low back pain (LBP) and prevention of persistent disability entitled "Clinic on Low back pain in Interdisciplinary Practice" (CLIP) was developed in the province of Quebec, Canada. The literature shows that simply disseminating CPGs does not necessarily lead to their adoption by clinicians. To improve adherence to CPGs among healthcare professionals, the literature suggests that there is a need to identify and address the factors impeding or facilitating their use. The aim of this study was therefore to identify the barriers to and facilitators of CLIP CPG use, as perceived by physiotherapists (PTs). A descriptive study using a qualitative method was conducted with a sample of 16 PTs from a variety of professional backgrounds. Each participant used the CPGs over a 6-week period with two patients suffering from LBP, and then participated in a semi-structured interview in which he or she was asked to identify the barriers and facilitators experienced. The participating PTs identified many barriers and facilitators pertaining to the guidelines themselves, the users and the environment. Four key nodes emerged from these barriers and facilitators during data analysis. It appears that the clinicians' understanding of the CPGs, the level of compatibility between their practices and the CLIP CPG recommendations, the level of CPG relevance as perceived by the clinicians, and their level of agreement with the CPGs, all affected their use of the guidelines. In order to increase CLIP CPG use, the implementation strategy to be developed should take into account the barriers and facilitators that were identified in this study.

Neck Pain

The Orthopaedic Section of the American Physical Therapy Association presents this second set of clinical practice guidelines on neck pain, linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) prognosis, (3) interventions provided by physical therapists, and (4) assessment of outcome for common musculoskeletal disorders.

Roles of specialists in psychogeriatrics

Roles of specialists in psychogeriatrics

Two different treatment regimens in women with preterm contractions who were admitted to a hospital due to a presumptive diagnosis of preterm labor: An observational study

To determine the effect of adherence to a set of clinical practice guidelines (CPG) for the management of preterm contractions on health-care resource consumption and pregnancy outcomes. This prospective observational study was conducted in a tertiary care university hospital from January 2003 to December 2004. Comparisons were made between the cases receiving treatment according to the CPG (CPG group) and those receiving treatment deviating from the CPG (non-CPG group). There were 203 patients with preterm contractions. Compared with the CPG group, the non-CPG group had a higher rate of both tocolytic and steroid use, a longer maternal hospital stay, and a lower neonatal birthweight. Adherence to CPG in patients with preterm contractions at 28(+0)-36(+6) weeks' gestation consumes fewer health-care resources without compromising pregnancy outcomes.

The role of new therapies for severe community-acquired pneumonia

Community-acquired pneumonia (CAP) is associated with significant morbidity and mortality and is the most common cause of death from infectious diseases. CAP patients requiring intensive care unit (ICU) admission carry the highest mortality rates. This paper aims to review the current literature regarding epidemiology, risk factors, severity criteria and reasons for admitting the hospitalized patient to the ICU, and the empiric and specific antibiotic therapeutic regimens employed. Multiple sets of clinical practice guidelines have been published in the past few years addressing the treatment of CAP. The guidelines all agree that CAP patients admitted to the hospital represent a major concern, and appropriate empiric therapy should be instituted to improve clinical outcomes. The cost, morbidity and mortality of CAP patients requiring ICU admission remain unacceptably high. These are heterogeneous groups of patients, so it is important to use risk-stratification based on clinical parameters and prediction tools. Appropriate antibiotic therapy is an important component in the management of both groups of patients. In particular, it is essential to administer an appropriate antimicrobial agent from the initiation of therapy, so that the risks of treatment failure and the morbidity of CAP may be minimized.

Methodological Approach: American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac Surgery

Atrial fibrillation remains a common and challenging problem following cardiac surgery. The American College of Chest Physicians, through the Health and Science Policy Committee, established a panel to develop a set of clinical practice guidelines for the management or prophylaxis of atrial fibrillation or flutter in patients undergoing coronary artery bypass surgery. The panel based its guidelines on a systematic review of the literature that included a computerized search of PubMed and CENTRAL, the Cochrane Collaboration database, as well as a search of selected journals and references in key articles. Studies were eligible for review if they were controlled trials. Paired reviewers assessed the quality of each eligible study and extracted relevant data. The resulting data were assembled into evidence tables organized by key management questions. The panel derived recommendations that were based on this review of evidence and were formulated according to the ACCP protocol for grading evidence and strength of recommendations.

Reconstituting populations through evidence-based medicine: an ethnographic account of recommending procedures for diagnosing type 2 diabetes in clinical practice guidelines

This ethnographic investigation responds to calls for more social science research on -- versus for or against -- evidence-based medicine (EBM). It centers on the recommendations endorsed, in a set of clinical practice guidelines, by Canadian specialists in the late 1990s for diagnosing diabetes. Empirically, the article mainly relies on public presentations and discussion at the Canadian Diabetes Association Professional Conferences (1997-2001), supplemented by findings from documentary sources, direct observation, participant-observation and interviews. It confirms the importance of clinical reason and clinical epidemiology as preconditions for EBM, the textually mediated character of EBM and patients' bodies as sites for producing knowledge crucial to EBM. Most significantly, it also demonstrates the importance of non-patients' bodies as sites for producing knowledge that is crucial to EBM and its politics. EBM politics encompass the discursive, socio-technical and visceral reconstitution of populations.

A new set of clinical practice guidelines for the treatment of patients with prostate cancer have been developed by the American Society of Clinical Oncology

A new set of clinical practice guidelines for the treatment of patients with prostate cancer have been developed by the American Society of Clinical Oncology

Foreword

Foreword

The RAND/AMA/AMCC Clinical Appropriateness Initiative: Insights for Multi-site Appropriateness Studies Derived from the Abdominal Aortic Aneurysm Surgery Project

This paper describes a collaborative effort among several organizations in the United States (the RAND/American Medical Association (AMA/Academic Medical Center Consortium (AMCC) Clinical Appropriateness Initiative) and presents, as an illustrative example, one of the four projects of this initiative, the abdominal aortic aneurysm surgery project that was directed by the author. The Clinical Appropriateness Initiative was conceived as a long-term program to develop and maintain a current set of clinical practice guidelines that would play an integral role in enhancing the quality of care delivered in the USA. However, several problems were encountered in its inception that ultimately resulted in early termination of the project. The primary reason for the demise of the abdominal aortic aneurysm surgery project and the other components of the Clinical Appropriateness Initiative was failure to enlist the support of AMCC clinical leaders prior to initiating the project. Numerous opportunities to optimize the generation and implementation of the practice guidelines for the intention of improving health care quality were identified during the conduct of the Clinical Appropriateness Initiative. Health care quality improvement initiatives throughout Europe may benefit from the RAND/AMA/AMCC experience and have the ability to address many of the scientific and policy issues raised by the Clinical Appropriateness Initiative.

On the AHCPR Depression in Primary Care guidelines: Further considerations for practitioners.

The majority of cases of clinical depression go unrecognized and untreated, despite the fact that depression is an eminently treatable disorder. The Agency for Health Care Policy and Research (AHCPR) recently published a set of clinical practice guidelines focused on depression in primary care settings. The review of the literature on which the guidelines are based is thorough and appropriate and should enhance the detection of depression and the quality of pharmacotherapy for depression. However, the guidelines encourage primary care physicians to provide pharmacotherapy to their depressed patients as the first line of treatment. The wisdom of this recommendation is questioned and revisions to the guidelines are suggested. Specifically, patients should be informed of the broad array of treatment options available and provided with a more balanced presentation of the potential benefits of psychotherapy for depression. Patients should decide which treatment alternative they wish to undergo.

Six sets of clinical practice guidelines for 1992.

Six sets of clinical practice guidelines for 1992.