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Head & Neck Jun 2020The Coronavirus disease-2019 (COVID-19) pandemic is a global health crisis and otolaryngologists are at increased occupational risk of contracting COVID-19. There are... (Review)
Review
BACKGROUND
The Coronavirus disease-2019 (COVID-19) pandemic is a global health crisis and otolaryngologists are at increased occupational risk of contracting COVID-19. There are currently no uniform best-practice recommendations for otolaryngologic surgery in the setting of COVID-19.
METHODS
We reviewed relevant publications and position statements regarding the management of otolaryngology patients in the setting of COVID-19. Recommendations regarding clinical practice during the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) outbreaks were also reviewed.
RESULTS
Enhanced personal protective equipment (N95 respirator and face shield or powered air-purifying respirator, disposable cap and gown, gloves) is required for any otolaryngology patient with unknown, suspected, or positive COVID-19 status. Elective procedures should be postponed indefinitely, and clinical practice should be limited to patients with urgent or emergent needs.
CONCLUSION
We summarize current best-practice recommendations for otolaryngologists to ensure safety for themselves, their clinical staff, and their patients.
Topics: COVID-19; Cause of Death; Communicable Disease Control; Coronavirus Infections; Disease Transmission, Infectious; Female; Global Health; Humans; Male; Occupational Health; Otolaryngologists; Otorhinolaryngologic Surgical Procedures; Pandemics; Patient Safety; Personal Protective Equipment; Pneumonia, Viral; Practice Guidelines as Topic; Risk Assessment; Survival Analysis
PubMed: 32270565
DOI: 10.1002/hed.26162 -
La Clinica Terapeutica 2018The paper's authors aim to elaborate on the innovations brought by law n. 24/2017, issued by the Italian Parliament with a close focus on art. 5, which pertains to the... (Review)
Review
The paper's authors aim to elaborate on the innovations brought by law n. 24/2017, issued by the Italian Parliament with a close focus on art. 5, which pertains to the drafting of guidelines and the adoption of best practices. The guidelines constitute in fact an element of innovation brought by the above-mentioned law, and compliance with them can shield from possible liability those health care professionals who find themselves embroiled in professional accidents while in the fulfillment of their duties. Besides, there are several critical aspects within the law that need to be highlighted as well. As far as best practices are concerned, the lawmakers who drafted the legislation make no mention as to the standards of evidence needed in order to characterize any given professional behavior as "best practice". The reform appears unlikely to be effective in providing doctors with clear behavioral standards, thus reducing the margin for liability claims against them.
Topics: Delivery of Health Care; Humans; Italy; Liability, Legal; Medical Errors; Practice Guidelines as Topic
PubMed: 29595871
DOI: 10.7417/T.2018.2059 -
British Journal of Anaesthesia May 2013
Topics: Anesthesiology; Humans; Medical Errors; Patient Care Team; Practice Guidelines as Topic; Safety; Safety Management
PubMed: 23599509
DOI: 10.1093/bja/aet011 -
Circulation Mar 2016Randomized, clinical trials are commonly regarded as the highest level of evidence to support clinical decisions. Good Clinical Practice guidelines have been constructed... (Review)
Review
Randomized, clinical trials are commonly regarded as the highest level of evidence to support clinical decisions. Good Clinical Practice guidelines have been constructed to provide an ethical and scientific quality standard for trials that involve human subjects in a manner aligned with the Declaration of Helsinki. Originally designed to provide a unified standard of trial data to support submission to regulatory authorities, the principles may also be applied to other studies of human subjects. Although the application of Good Clinical Practice principles generally led to improvements in the quality and consistency of trial operations, these principles have also contributed to increasing trial complexity and costs. Alternatively, the growing availability of electronic health record data has facilitated the possibility for streamlined pragmatic clinical trials. The central tenets of Good Clinical Practice and pragmatic clinical trials represent potential tensions in trial design (stringent quality and highly efficient operations). In the present article, we highlight potential areas of discordance between Good Clinical Practice guidelines and the principles of pragmatic clinical trials and suggest strategies to streamline study conduct in an ethical manner to optimally perform clinical trials in the electronic age.
Topics: Clinical Trials as Topic; Humans; Practice Guidelines as Topic; Research Design
PubMed: 26927005
DOI: 10.1161/CIRCULATIONAHA.115.019902 -
The Journal of Clinical Psychiatry Jun 2017Herein we provide the 2015 update for the Florida Best Practice Psychotherapeutic Medication Guidelines (FPG) for major depressive disorder (MDD). The FPG represent... (Review)
Review
OBJECTIVE
Herein we provide the 2015 update for the Florida Best Practice Psychotherapeutic Medication Guidelines (FPG) for major depressive disorder (MDD). The FPG represent evidence-based decision support for practitioners providing care to adults with MDD.
PARTICIPANTS
The consensus meeting included representatives from the Florida Agency for Health Care Administration (FAHCA), advocacy members, academic experts in MDD, and multidisciplinary mental health clinicians, as well as health policy experts. The FAHCA provided funding support for the FPG.
EVIDENCE
Evidence was limited to results from adequately powered, randomized, double-blind, placebo-controlled trials; in addition, pooled-, meta-, and network-analyses were included. Recommendations were based on consensus arrived at by the multistakeholder Florida Expert Panel. Articles selected were identified on the electronic search engine PubMed with the dates 2010 to present. The search terms were major depressive disorder, psychopharmacology, antidepressants, psychotherapy, neuromodulation, complementary alternative medicines, pooled-analysis, meta-analysis, and network-analysis. Bibliographies of the identified articles were manually searched for additional citations not identified in the original search.
CONSENSUS PROCESS
A consensus meeting comprising all representatives took place on September 25-26, 2015, in Tampa, Florida. Guiding principles (eg, emphasis on the most rigorous evidence for efficacy, safety, and tolerability) were discussed, defined, and operationalized prior to review of extant data. As MDD often pursues a recurrent and chronic course, principles of practice, measurement-based care, and comprehensive assessment and management of overall physical and mental health were emphasized. Evidence supporting pretreatment major depressive episode specifiers (eg, mixed features, anxious distress) and the role of pharmacogenomics (and other biological-behavioral markers) in informing treatment selection were comprehensively discussed. Algorithmic priority was assigned to agents with relatively greater therapeutic index (ie, efficacy) and minimal propensity for safety and tolerability disadvantages.
CONCLUSIONS
The updated 2015 FPG provide concise, pragmatic, evidence-based decision support for treatment selection and sequencing for adults with MDD. Principles of practice include measurement-based care, priority to both psychiatric and medical comorbidity, identification of DSM-5-defined specifiers (eg, mixed features), suicide risk assessment, and evaluation of cognitive symptoms. The FPG have purposefully aimed to minimize emphasis on "expert opinion" and instead differentially emphasized extant evidence for pharmacologic treatments.
Topics: Adult; Antidepressive Agents; Consensus Development Conferences as Topic; Depressive Disorder, Major; Evidence-Based Medicine; Florida; Humans; Practice Guidelines as Topic
PubMed: 28682531
DOI: 10.4088/JCP.16cs10885 -
International Wound Journal Apr 2011This article describes the barriers, changes and achievements related to implementing one element of a wound care programme being best practice care. With the absence of... (Review)
Review
This article describes the barriers, changes and achievements related to implementing one element of a wound care programme being best practice care. With the absence of a coordinated approach to wound care, clinical practice within our Area Health Service (AHS) was diverse, inconsistent and sometimes outdated. This was costly and harmful, leading to overuse of unhelpful care, underuse of effective care and errors in execution. The major aim was to improve the outcomes and quality of life for patients with wound care problems within our community. A collaborative across ten sites/services developed, implemented and evaluated policies and guidelines based on evidence-based bundles of care. Key barriers were local resistance and lack of experience in implementing structural and cultural changes. This was addressed by appointing a wound care programme manager, commissioning of a strategic oversight committee and local wound care committees. The techniques of spread and adoption were used, with early adopters making changes observable and allowing local adaption of guidelines, where appropriate. Deployment and improvement results varied across the sites, ranging from activity but no changes in practice to modest improvement in practice. Evaluating implementation of the leg ulcer guideline as an exemplar, it was demonstrated that there was a statistically significant improvement in overall compliance from 26% to 84%. However, only 7ยท7% of patients received all interventions to which they were entitled. Compliance with the eight individual interventions of the bundle ranged from 26% to 84%. Generic performance was evaluated against the wound assessment, treatment and evaluation plan with an average compliance of 70%. Early results identified that 20% of wounds were healed within the target of 10 days. As more standardised process are implemented, clinical outcomes should continue to improve and costs decrease.
Topics: Evidence-Based Medicine; Humans; Practice Guidelines as Topic; Quality Assurance, Health Care; Wounds and Injuries
PubMed: 21272244
DOI: 10.1111/j.1742-481X.2010.00761.x -
Adicciones 2013Best practice is the best application of available evidence to current activities in the drugs field. The European Monitoring Centre for Drugs and Drug Addiction...
Best practice is the best application of available evidence to current activities in the drugs field. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) created a web-based tool aimed at bridging together scientific evidence and current practices in the drug addiction field. Beyond dissemination of evidence, the scope is to share best practice among the European countries. The synthesis of the evidence is based on the methods of the Cochrane collaboration (the Drugs and Alcohol Group) and the Grade working group. As of February 2013 the portal encompasses four modules on the effectiveness of demand reduction interventions, a collection of European projects on prevention, treatment, harm reduction and social reintegration and an inventory of European Guidelines and Standards including a bank of instruments to evaluate interventions (http://www.emcdda.europa.eu/bestpractice). The summaries of evidence are presented in a plain language format and include brief explanation of the measures of effect supporting the evidence, but do not provide specific recommendations. The main future challenge of EMCDDA's best practice promotion is to become a service for those willing to implement best practice. The Best Practice Portal should become a platform where to find all is needed for successful implementation (handbooks, training materials, guidelines for evaluation and contacts for mentoring).
Topics: Europe; Health Promotion; Humans; Internet; Practice Guidelines as Topic; Substance-Related Disorders
PubMed: 23487273
DOI: No ID Found -
Journal of Clinical Oncology : Official... Mar 2020Palliative care began in academic centers with specialty consultation services, and its value to patients, families, and health systems has been evident. The demand for... (Review)
Review
Palliative care began in academic centers with specialty consultation services, and its value to patients, families, and health systems has been evident. The demand for palliative care to be integrated throughout the cancer trajectory, combined with a limited palliative care workforce, means that new models of care are needed. This review discusses evidence regarding the need for integration of palliative care into routine oncology care and describes best practices recognized for dissemination of palliative care. The available evidence suggests that palliative care be widely adopted by clinicians in all oncology settings to benefit patients with cancer and their families. Efforts are needed to adapt and integrate palliative care into community practice. Limitations of these models are discussed, as are future directions to continue implementation efforts. The benefits of palliative care can only be realized through effective dissemination of these principles of care, with more primary palliative care delivered by oncology clinicians.
Topics: Delivery of Health Care, Integrated; Disease Management; Health Plan Implementation; Humans; Models, Organizational; Neoplasms; Palliative Care; Patient Care Planning; Practice Guidelines as Topic
PubMed: 32023151
DOI: 10.1200/JCO.18.01766 -
Molecular Biology of the Cell Nov 2017The San Francisco Declaration on Research Assessment (DORA) was penned 5 years ago to articulate best practices for how we communicate and judge our scientific...
The San Francisco Declaration on Research Assessment (DORA) was penned 5 years ago to articulate best practices for how we communicate and judge our scientific contributions. In particular, it adamantly declared that Journal Impact Factor (JIF) should never be used as a surrogate measure of the quality of individual research contributions, or for hiring, promotion, or funding decisions Since then, a heightened awareness of the damaging practice of using JIFs as a proxy for the quality of individual papers, and to assess an individual's or institution's accomplishments has led to changes in policy and the design and application of best practices to more accurately assess the quality and impact of our research. Herein I summarize the considerable progress made and remaining challenges that must be met to ensure a fair and meritocratic approach to research assessment and the advancement of research.
Topics: Biomedical Research; Humans; Journal Impact Factor; Practice Guidelines as Topic; Publishing
PubMed: 29084913
DOI: 10.1091/mbc.E17-08-0534 -
Journal of Medical Economics Jan 2018To review, summarize, and analyze both similarities and differences of pharmacoeconomic (PE) guidelines, to enable researchers to access their characteristics and the... (Comparative Study)
Comparative Study Review
OBJECTIVE
To review, summarize, and analyze both similarities and differences of pharmacoeconomic (PE) guidelines, to enable researchers to access their characteristics and the current state of PE guidelines; furthermore, to learn which methodological issues still remain contested and to promote the methodological development of PE guidelines.
MATERIALS AND METHODS
The authors performed a search for PE guidelines using PubMed, the Cochrane library database, and the websites of the International Society for Pharmacoeconomics and Outcomes Research. Information of each guideline was extracted using a pre-designed extraction template, which included 22 aspects; the guidelines were summarized in the forms of charts, and their characteristics have been described.
RESULTS
A total of 40 PE guidelines were studied. The most common methodological issues include the types of analysis, sources for effectiveness, use of quality-adjusted life-years (QALYs) to measure outcomes, and use of incremental cost effectiveness ratios to present results. The majority of the guidelines preferred a cost utility analysis with outcomes expressed in terms of QALYs. Most of the guidelines preferred meta-analysis or meta-analysis of the randomized controlled trials, and required a systematic review of all evidence. Issues that varied most in the guidelines were the choice of the comparator, recommended costs to be included, methods related to indirect cost calculations, methods of sensitivity analysis, and discounting rate.
CONCLUSION
A comparison of these guidelines revealed that a number of differences exist among them in several key aspects, and some critical methodological issues still exist, for which no best solution is available. Furthermore, efforts need to be made to develop harmonious methods for the PE, and to improve the transferability of the outcomes of PE evaluations.
Topics: Cost-Benefit Analysis; Economics, Pharmaceutical; Female; Global Health; Humans; Internationality; Male; Practice Guidelines as Topic
PubMed: 28959910
DOI: 10.1080/13696998.2017.1387118