OBJECTIVE: To provide consensus guidelines for the management of women with histologically confirmed cervical intraepithelial neoplasia (CIN), which can act as a precursor to invasive cervical cancer and represents one of the most common significant gynecologic diseases of women of reproductive age. PARTICIPANTS: An independent panel of 121 experts in ...

OBJECTIVE: The study was undertaken to provide consensus guidelines for the management of women with histologically confirmed cervical intraepithelial neoplasia (CIN) that can act as a precursor to invasive cervical cancer and represents one of the most common significant gynecologic diseases of women of reproductive age. PARTICIPANTS: An independent panel ...

OBJECTIVE: To evaluate the quality of Recommended Clinical Protocols and Guidelines for the Practice of Chiropractic (ICA guidelines) published by the International Chiropractors Association (ICA), August, 2000. METHODS: The Appraisal Instrument for Clinical Guidelines (Cluzeau instrument) was applied to the ICA guidelines by 10 independent experienced evaluators. An independent, global ...

The Royal College of Obstetricians and Gynaecologists Guidelines for the management of infertility in secondary care (1998) states that stimulated intrauterine insemination (IUI) has Grade A evidence to confirm its effective use in unexplained infertility. This paper challenges that assertion after closer assessment of the papers upon which it was ...

Management of columnar lined oesophagus (CLO; Barrett s oesophagus) is controversial. We prospectively audited surveillance practices in Scotland and prospectively assessed the impact of introducing local guidelines for Barrett s surveillance in Edinburgh. Most respondents were gastroenterologists. The majority take random, not four quadrant, biopsies from the CLO. In Edinburgh ...

Guidelines for medical management are now part of medical life. A fool--loosely defined as someone who does not know much about a particular area of medicine--will do well to follow guidelines when treating patients, but a wise man (again, loosely defined as someone who does know about the disease in ...

BACKGROUND: Important efforts have been invested in the past few years in the development of quality clinical guidelines. However, the means for the effective dissemination of guidelines to practicing physicians have not been determined. Several studies have examined the possibilities offered by the World Wide Web (the Web), but studies ...

This paper presents the results of postal survey of protocols for induction of labour. The drug regimes used for the induction of labour in NHS hospitals in England and Wales have been compared to both RCOG guidelines and to the drug manufacturer's recommendations. A wide variation in practice was found, ...

The publication of comprehensive evidence-based guidelines for the management of non-ST-segment elevation acute coronary syndrome by the American College of Cardiology and the American Heart Association in September 2000 marked a sentinel event in the evolution of managing this challenging patient population. Many of the recommendations included in the guidelines ...

A review of the management of COPD is presented, with particular emphasis on the effect on the approach to management of new information which has become available in the 5 years since the BTS guidelines on COPD were published. A major problem is the effective implementation of what is already ...

Major opportunity exists to better align clinical science and clinical practice. To do so will require efforts not only to develop clinical practice guidelines, but to facilitate their application in practice. The American College of Cardiology operates a program to develop and assess the effectiveness of tools that facilitate the ...

These guidelines for management of onychomycosis have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and ...

As the number of clinical practice guidelines relevant to clinical practice continues to grow, nurse practitioners may find it confusing to choose from two or more guidelines on the same or similar topics. The National Guideline Clearinghouse provides two resources to assist clinicians in comparing multiple guidelines on similar topics: ...

PURPOSE: Although the American Society of Clinical Onoclogy's (ASCO) Health Services Research (HSR) committee activities have primarily focused on clinical guideline development, little is known about the value placed on these guidelines by the desired end users. ASCO members and Health Maintenance Organizations (HMOs) were surveyed on the value and ...

Evidence on the use of clinical practice guidelines to aid in the legal determination of negligence is increasing, specifically where they affect determinations of the standard of care and causation. So too is evidence that some clinical practice guidelines are of poor quality. An action alleging the negligent failure to ...

Computer-interpretable clinical guidelines (CIGs) aim to eliminate clinician errors, reduce practice variation, and promote best medical practices by delivering patient-specific advice during patient encounters. Clinical guidelines are being regularly updated and revised to handle expanding clinical knowledge. When revising CIGs, much effort can be saved by specifying changes among versions ...

The aim of this work is to develop an XML-based application for the automated generation of decision rules from a textual guideline encoded using the Guideline Elements Model (GEM). A formalization of guideline-based chronological steps of treatment has been proposed to resolve the semantic ambiguities of the original document. The ...

In the late 1970s concern in Melbourne teaching hospitals over the increasing incidence of antibiotic-resistant microorganisms and inappropriate antibiotic prescribing, led to the establishment of a working party to produce guidelines on appropriate antimicrobial therapy. Therapeutic Guidelines: Antibiotic is now produced, marketed and sold by Therapeutic Guidelines Limited, an independent, ...

Guidelines are becoming increasingly important as potential tools in improving clinical decision making. Because oncology practice encompasses a large number of tumors and their variants and because each tumor is characterized by heterogeneous presentations and clinical evolutions, an oncology guidelines program must be large in scope. Oncology practice is slowly ...

To establish a guideline for the use of teleconsultation, which is one of the most important applications in telemedicine beeing perfomed very frequently in daily medical practice in almost any field of medicine. EVIDENCE: The recommendations are based on expert knowledge, because of the lack of evidence based data in ...

Within the past 5 years, no fewer than 6 guidelines for the management of acute pancreatitis have appeared in the literature, including the current submission from the International Association of Pancreatology. When these collected guidelines are subjected to comparison, however, marked similarities emerge between the proposals, and significant differences are ...

Clinical practice guidelines can potentially lead to reductions in healthcare costs and improved patient outcomes if adopted by physicians into their clinical practice. This research study provides data that gives healthcare administrators a basic understanding of how physicians perceive clinical practice guidelines (CPGs) and gives practical suggestions to obtain physician ...

BACKGROUND: Morning Report is a long-standing tradition for internal medicine residency programs, but format and content vary greatly and have not been compared to any accepted curriculum standards. The Federated Council for Internal Medicine (FCIM) Task Force on the Internal Medicine Residency Curriculum has published curriculum guidelines for residency programs. ...

OBJECTIVE: To systematically evaluate the quality of the development of guidelines for the management of chronic obstructive pulmonary disease (COPD). METHODOLOGY: MEDLINE and Excerpta Medica search for published guidelines, followed by independent evaluation by two reviewers, according to previously reported guideline development quality criteria, on a three-point scale. RESULTS: Five ...

Development and use of practice guidelines is one strategy to assist health professionals in translating research into practice. There has been a significant growth in the number of practice guidelines developed, with the increased focus on justifying health care costs and demonstrating outcomes. Quality and influence on established practice, however, ...

With increasing numbers of clinical practice guidelines (CPGs) becoming available to guide physicians, it is important to understand how guidelines are developed. Of importance, is evaluation of the scientific evidence on which guidelines are based, indeed whether the guideline is evidence based or based on expert opinion alone. This report ...

Neurological sequelae and multiple birth defects have been observed in children conceived by IVF and ICSI. Multiple pregnancy is the most important risk factor. These health problems challenge the responsible practice of medicine. The core values of medicine and the deontology of the profession have been reviewed to define the ...

OBJECTIVE: To systematically review surveys of clinicians' attitudes to clinical practice guidelines. DATA SOURCES: MEDLINE, HealthStar, Embase and CINAHL were searched electronically for English-only surveys published from 1990 to 2000. STUDY SELECTION: We included surveys with responses to one or more of seven propositions (see below). Studies were excluded if ...

Community acquired pneumonia is a common illness with significant morbidity and mortality and a high cost to society. Guidelines for management in the UK issued by the British Thoracic Society have been in existence since 1993 (Br J Hosp Med 1993; 49: 346-350). These have been updated in 2001 (Thorax ...

OBJECTIVE: To examine the awareness of and attitudes toward clinical practice guidelines (CPGs) produced by the American College of Obstetricians and Gynecologists (ACOG) among its fellows and to identify factors that would enhance the perceived value of the CPGs. STUDY DESIGN: A questionnaire survey on clinical practice guidelines sent to ...

AIM: To confirm or refute the impression that diagnostic radiology was often not represented on guideline writing committees, despite the fact that guidelines often made statements with implications for radiological practice. MATERIALS AND METHODS: We took two approaches. Firstly we examined all published Scottish Intercollegiate Guidelines Network (SIGN) guidelines and ...

These guidelines for the management of lichen sclerosus have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, ...

Clinical practice guidelines offer recommendations for optimizing health care. Guideline panels can rely on several methods for gathering information about current practice and synthesizing evidence that addresses specific questions. Clinical practice guidelines, including many that address thyroid disease, often rely on conventional narrative literature reviews and expert opinion rather than ...

This paper examines practical and regulatory implications, including both costs and benefits, resulting from implementation of EPPO's new resistance risk analysis guideline. Crop-protection companies operating in Europe are preparing risk analyses and management strategies, and are monitoring for resistance. However, this is a complex and expensive process involving technical, commercial ...

Since the first version saw the light of day in 1991 the Guidelines have occupied a central position in the Norwegian practice of anesthesia. This document comprises part of the quality management documents held in the departments of anesthesia in Norwegian hospitals. If departments of anesthesia are unable to adhere ...

BACKGROUND: Numerous agencies have developed clinical practice guidelines for the management of postmenopausal osteoporosis. The study objective was to conduct a systematic assessment of the quality of osteoporosis guidelines produced since 1998. METHODS: Guidelines were identified by searching MEDLINE (1998+), the world wide web, known guideline developer websites, bibliographies of ...

RATIONALE, AIMS AND OBJECTIVES: To explore the responses of primary health care professionals to guidelines in general, and to the UK national guidelines on the management and referral of women with breast conditions in particular. METHODS: Qualitative study using practice-based, semistructured group discussions with primary health care professionals. All practices ...

The development of a draft guideline on confirming placement of nasogastric tubes laid the basis for a senior nurse to use the principles of clinical governance to lead an improvement in practice. Key factors included risk management, dissemination of draft guidelines reflecting current evidence and changing practice. Good communication was ...

Chronic obstructive pulmonary disease (COPD) is a respiratory condition characterized by progressive decline in lung function. It imposes a considerable burden on patients, healthcare services and society that is likely to increase in the future. It is, therefore, important to ensure that this disease is managed as effectively as possible. ...

The Commission of European Affairs of the International League Against Epilepsy published 'Appropriate Standards for Epilepsy Care Across Europe' which contained recommendations for the use of electroencephalography (EEG) in the diagnosis of epilepsy (Brodie et al. Epilepsia 1997; 38:1245). The need for a more specific basic document of EEG methodology ...

This is one of a series of statements discussing the practice of gastrointestinal endoscopy in common clinical situations. It is intended to aid endoscopists in determining the appropriate use of endoscopic procedures in conjunction with anticoagulation and/or antiplatelet therapy. Guidelines for the appropriate practice of endoscopy are based on critical ...

The computerization of clinical practice guidelines is a significant scientific challenge for the medical informatics community. One frequently reported factor hindering this objective is the existence of deficiencies within guideline knowledge. In this paper, we focus on the detection of flaws within temporal scheduling constraints. Temporal scheduling constraints are important ...

Scottish Intercollegiate Guidelines Network (SIGN) guidelines on the indication for tonsillectomy in the management of sore throat were published in January 1999. To determine adherence to these guidelines in our unit, clinical records were examined on admission for tonsillectomy. Three cohorts were analysed. The first listed prior to SIGN, the ...

Guideline statements may be supported by evidence obtained from various study designs, but randomized trials are usually considered most important for making recommendations about therapeutic and preventive interventions. This study evaluated the extent to which randomized trials are cited in guidelines published in major journals. The references of 191 guidelines ...

There is an epidemic of guidelines but very little evidence-based information has been assembled to tell us exactly how guidelines are best implemented. Guidelines, although very valuable, are essentially a reductionistic attempt to simplify the complexities of medicine. Clinicians may appreciate that each guideline should be prefaced by a statement ...

A 14-yr-old boy was first found to have tracheal stenosis when anaesthesia was induced for extensive scoliosis surgery in the prone position. There are no guidelines for airway management under these conditions. We describe how we managed the problem and suggest some useful modifications.

BACKGROUND AND STUDY AIMS: Guidelines for antibiotic prophylaxis of infective endocarditis associated with gastrointestinal endoscopy are not uniform. Though based on weak scientific evidence, they do represent an attempt to unify the management of antibiotic prophylaxis. We investigated whether physicians who profess to adhere to these guidelines actually do apply ...

The American Heart Association has been the recognized source for Advanced Cardiac Life Support (ACLS) education for the past three decades. Since the first ACLS course, numerous revisions have been made to the management algorithms based on evolving scientific evidence. The last revisions made in August 2000 were the first ...

Case management guidelines are an integration of information obtained from research, observations, clinical experience, and judgments of expert clinicians, scientists, and clients. This guideline integrates information from multiple practice guidelines in order to guide the case manager in managing clients with Alzheimer disease and other dementias. The guideline provides direction ...

Traditionally, neonates in Australia received specialised care in hospitals for about a week, by which time any developing jaundice would have been detected and managed. However, with the introduction and popularity of early maternal discharge about 48 hours after delivery (in Australia and elsewhere), the duty of diagnosing neonatal jaundice ...