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Lancet (London, England) Oct 2003Major difficulties arise when introducing evidence and clinical guidelines into routine daily practice. Data show that many patients do not receive appropriate care, or... (Review)
Review
Major difficulties arise when introducing evidence and clinical guidelines into routine daily practice. Data show that many patients do not receive appropriate care, or receive unnecessary or harmful care. Many approaches claim to offer solutions to this problem; which ones are as yet the most effective and efficient is unclear. We aim to provide an overview of present knowledge about initiatives to changing medical practice. Substantial evidence suggests that to change behaviour is possible, but this change generally requires comprehensive approaches at different levels (doctor, team practice, hospital, wider environment), tailored to specific settings and target groups. Plans for change should be based on characteristics of the evidence or guideline itself and barriers and facilitators to change. In general, evidence shows that none of the approaches for transferring evidence to practice is superior to all changes in all situations.
Topics: Evidence-Based Medicine; Guideline Adherence; Humans; Patient Care; Practice Guidelines as Topic; Professional Practice; Quality Assurance, Health Care; Quality of Health Care
PubMed: 14568747
DOI: 10.1016/S0140-6736(03)14546-1 -
Anaesthesia Jan 2019It is widely recognised that prolonged fasting for elective surgery in both children and adults serves no purpose, adversely affects patient well-being and can be... (Review)
Review
It is widely recognised that prolonged fasting for elective surgery in both children and adults serves no purpose, adversely affects patient well-being and can be detrimental. Although advised fasting times for solids remain unchanged, there is good evidence to support a 1-h fast for children, with no increase in risk of pulmonary aspiration. In adults, a major focus has been the introduction of carbohydrate loading before anaesthesia, so that patients arrive for surgery not only hydrated but also in a more normal metabolic state. The latter attenuates some of the physiological responses to surgery, such as insulin resistance. As in children, there is no increase in risk of pulmonary aspiration. Further data are required to guide best practice in patients with diabetes.
Topics: Adult; Child; Elective Surgical Procedures; Fasting; Guidelines as Topic; Humans; Practice Guidelines as Topic; Preoperative Care; Preoperative Period
PubMed: 30500064
DOI: 10.1111/anae.14500 -
Epidemiology and Infection Jul 2018During emerging disease outbreaks, public health, emergency management officials and decision-makers increasingly rely on epidemiological models to forecast outbreak... (Review)
Review
During emerging disease outbreaks, public health, emergency management officials and decision-makers increasingly rely on epidemiological models to forecast outbreak progression and determine the best response to health crisis needs. Outbreak response strategies derived from such modelling may include pharmaceutical distribution, immunisation campaigns, social distancing, prophylactic pharmaceuticals, medical care, bed surge, security and other requirements. Infectious disease modelling estimates are unavoidably subject to multiple interpretations, and full understanding of a model's limitations may be lost when provided from the disease modeller to public health practitioner to government policymaker. We review epidemiological models created for diseases which are of greatest concern for public health protection. Such diseases, whether transmitted from person-to-person (Ebola, influenza, smallpox), via direct exposure (anthrax), or food and waterborne exposure (cholera, typhoid) may cause severe illness and death in a large population. We examine disease-specific models to determine best practices characterising infectious disease outbreaks and facilitating emergency response and implementation of public health policy and disease control measures.
Topics: Anthrax; Cholera; Coinfection; Disease Outbreaks; Forecasting; Hemorrhagic Fever, Ebola; Humans; Influenza, Human; Malaria; Models, Theoretical; Practice Guidelines as Topic; Smallpox; Typhoid Fever
PubMed: 29734964
DOI: 10.1017/S095026881800119X -
British Journal of Community Nursing Dec 2016
Review
Topics: Compression Bandages; Humans; Leg; Lymphedema; Practice Guidelines as Topic; Ultrasonography, Doppler
PubMed: 27922775
DOI: 10.12968/bjcn.2016.21.12.612 -
Cleveland Clinic Journal of Medicine Jan 2020Sepsis is a life-threatening organ dysfunction that results from the body's response to infection. It requires prompt recognition, appropriate antibiotics, careful... (Review)
Review
Sepsis is a life-threatening organ dysfunction that results from the body's response to infection. It requires prompt recognition, appropriate antibiotics, careful hemodynamic support, and control of the source of infection. With the trend in management moving away from protocolized care in favor of appropriate usual care, an understanding of sepsis physiology and best practice guidelines is critical.
Topics: Anti-Bacterial Agents; Disease Management; Humans; Practice Guidelines as Topic; Sepsis; Shock, Septic
PubMed: 31990655
DOI: 10.3949/ccjm.87a.18143 -
The European Journal of Contraception &... Aug 2019Our aim was to provide a consensus of best practice in intrauterine contraception (IUC) for French practitioners. A meeting of 38 gynaecologists was held to establish... (Review)
Review
Our aim was to provide a consensus of best practice in intrauterine contraception (IUC) for French practitioners. A meeting of 38 gynaecologists was held to establish a consensus of best practice in IUC, using the validated nominal group (NG) method to reach consensus. Seventy questions were posed covering insertion, monitoring and removal of IUC devices. Two working groups were formed and all proposals were voted on, discussed and approved by the NG. Of the 70 questions asked, answers to only four failed to reach NG consensus. While, in general, the IUC practices of French gynaecologists are in line with international guidelines, some notable differences were identified: for example, when to use the levonorgestrel-releasing intrauterine system versus the copper intrauterine device; practice recommendations in the event of upper genital tract infections; and immediate postpartum insertion. Clinicians are encouraged to inform women about IUC, irrespective of their age or parity. In general, the wishes and characteristics of the woman must be the main criteria informing the choice of IUC, once all potential contraindications have been excluded and information about IUC shared. This consensus paper is intended to update and standardise knowledge about IUC for health care professionals, to address any reticence about use of this contraceptive method.
Topics: Consensus; Female; France; Health Knowledge, Attitudes, Practice; Humans; Intrauterine Devices; Midwifery; Physicians; Practice Guidelines as Topic
PubMed: 31204843
DOI: 10.1080/13625187.2019.1625325 -
Clinical Gastroenterology and... Feb 2019The purpose of this clinical practice update review is to describe key principles in the diagnosis and management of functional gastrointestinal (GI) symptoms in... (Review)
Review
DESCRIPTION
The purpose of this clinical practice update review is to describe key principles in the diagnosis and management of functional gastrointestinal (GI) symptoms in patients with inflammatory bowel disease (IBD).
METHODS
The evidence and best practices summarized in this manuscript are based on relevant scientific publications, systematic reviews, and expert opinion where applicable. Best practice advice 1: A stepwise approach to rule-out ongoing inflammatory activity should be followed in IBD patients with persistent GI symptoms (measurement of fecal calprotectin, endoscopy with biopsy, cross-sectional imaging). Best practice advice 2: In those patients with indeterminate fecal calprotectin levels and mild symptoms, clinicians may consider serial calprotectin monitoring to facilitate anticipatory management. Best practice advice 3: Anatomic abnormalities or structural complications should be considered in patients with obstructive symptoms including abdominal distention, pain, nausea and vomiting, obstipation or constipation. Best practice advice 4: Alternative pathophysiologic mechanisms should be considered and evaluated (small intestinal bacterial overgrowth, bile acid diarrhea, carbohydrate intolerance, chronic pancreatitis) based on predominant symptom patterns. Best practice advice 5: A low FODMAP diet may be offered for management of functional GI symptoms in IBD with careful attention to nutritional adequacy. Best practice advice 6: Psychological therapies (cognitive behavioural therapy, hypnotherapy, mindfulness therapy) should be considered in IBD patients with functional symptoms. Best practice advice 7: Osmotic and stimulant laxative should be offered to IBD patients with chronic constipation. Best practice advice 8: Hypomotility agents or bile-acid sequestrants may be used for chronic diarrhea in quiescent IBD. Best practice advice 9: Antispasmodics, neuropathic-directed agents, and anti-depressants should be used for functional pain in IBD while use of opiates should be avoided. Best practice advice 10: Probiotics may be considered for treatment of functional symptoms in IBD. Best practice advice 11: Pelvic floor therapy should be offered to IBD patients with evidence of an underlying defecatory disorder. Best practice advice 12: Until further evidence is available, fecal microbiota transplant should not be offered for treatment of functional GI symptoms in IBD. Best practice advice 13: Physical exercise should be encourage in IBD patients with functional GI symptoms. Best practice advice 14: Until further evidence is available, complementary and alternative therapies should not be routinely offered for functional symptoms in IBD. This Clinical Practice Update was produced by the AGA Institute.
Topics: Disease Management; Gastrointestinal Diseases; Humans; Inflammatory Bowel Diseases; Practice Guidelines as Topic
PubMed: 30099108
DOI: 10.1016/j.cgh.2018.08.001 -
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 7·7% 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 -
The Laryngoscope Jun 2020
Review
Topics: Humans; Laryngeal Diseases; Leukoplakia; Otolaryngology; Patient Selection; Practice Guidelines as Topic; Vocal Cords
PubMed: 32034947
DOI: 10.1002/lary.28527 -
Updates in Surgery Dec 2017Within traditional clinical care, the postoperative recovery after pelvic/rectal surgery has been slow with high morbidity and long hospital stay. The enhanced recovery... (Review)
Review
Within traditional clinical care, the postoperative recovery after pelvic/rectal surgery has been slow with high morbidity and long hospital stay. The enhanced recovery after surgery program is a multimodal approach to perioperative care designed to accelerate recovery and safely reduce hospital stay. This review will briefly summarize optimal perioperative care, before, during and after surgery in this group of patients and issues related to implementation and audit.
Topics: Elective Surgical Procedures; Humans; Length of Stay; Pelvis; Perioperative Care; Practice Guidelines as Topic; Rectum
PubMed: 29067634
DOI: 10.1007/s13304-017-0492-2