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Aim Developing new clinical practice guidelines (CPGs) can be time-consuming and expensive. A more efficient approach could be to adopt, adapt or contextualise recommendations from existing good quality CPGs so that the resultant ...
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Aim Developing new clinical practice guidelines (CPGs) can be time-consuming and expensive. A more efficient approach could be to adopt, adapt or contextualise recommendations from existing good quality CPGs so that the resultant guidance is tailored to the local context. Results The first steps are to search for international CPGs that have a similar purpose, end-users and patients to your situation. The second step is to critically appraise the methodological quality of the CPGs to ensure that your guidance is based on credible evidence. Then the decisions begin. Can you simply ‘adopt’ this (parent) clinical practice guidelines, and implement the recommendations in their entirety, without any changes, in your setting? If so, then no further work is required. However this situation is rare. What is more likely, is that even if recommendations from the parent clinical practice guidelines can be adopted, how they are implemented needs to address local issues. Thus you may need to ‘ contextualise’ the guidance, by addressing implementation issues such as local workforce, training, health systems, equipment and/or access to services. Generally this means that additional information is required (Practice/Context Points) to support effective implementation of the clinical practice guidelines recommendations. In some cases, you may need to ‘adapt’ the guidance, where you will make changes to the recommendations so that care is relevant to your local environments. This may involve additional work to search for local research, or obtain local consensus, regarding how best to adapt recommendations. For example, adaptation might reflect substituting one drug for another (drugs have similar effects, but the alternative drug to the recommended one may be cheaper, more easily obtained or more culturally acceptable). There is lack of standardisation of clinical practice guidelines terminology, leading clinical practice guideline activities often being poorly conceptualised or reported. We provide an approach that would help improve efficiency and standardisation of clinical practice guidelines activities.
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During the last decade, studies have shown the benefits of using clinical guidelines in the practice of medicine. Although the importance of these guidelines is widely recognized, health care organizations typically pay more atten...
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During the last decade, studies have shown the benefits of using clinical guidelines in the practice of medicine. Although the importance of these guidelines is widely recognized, health care organizations typically pay more attention to guideline development than to guideline implementation for routine use in daily care. However, studies have shown that clinicians are often not familiar with written guidelines and do not apply them appropriately during the actual care process. Implementing guidelines in computer-based decision support systems promises to improve the acceptance and application of guidelines in daily practice because the actions and observations of health care workers are monitored and advice is generated whenever a guideline is not followed. Such implementations are increasingly applied in diverse areas such as policy development, utilization management, education, clinical trials, and workflow facilitation. Many parties are developing computer-based guidelines as well as decision support systems that incorporate these guidelines. This paper reviews generic approaches for developing and implementing computer-based guidelines that facilitate decision support. It addresses guideline representation, acquisition, verification and execution aspects. The paper describes five approaches (the Arden Syntax, GuideLine Interchange Format (GLIF), PROforma, Asbru and EON), after the approaches are compared and discussed.
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Dear Editor We would like to express our sincere thanks for beginning the process of formally improving reporting of clinical trials in veterinary medicine published in JVIM.1 Adopting the CONSORT2 and REFLECT3 guidelines for our ...
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Dear Editor We would like to express our sincere thanks for beginning the process of formally improving reporting of clinical trials in veterinary medicine published in JVIM.1 Adopting the CONSORT2 and REFLECT3 guidelines for our journal can only improve study transparency, quality, and relevance. As the article by Sargeant et al4 illustrated, studies that adhered to specific methodologic and completeness-of-reporting criteria were less likely to find positive outcomes, suggesting that current reporting practices might impart biases in result analysis.
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The goal of this article was to explore the structure and evaluation of guidelines and to discuss those features applicable to the librarian serving clinicians, thereby meeting the suggestions for guidelines that the Institute of ...
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The goal of this article was to explore the structure and evaluation of guidelines and to discuss those features applicable to the librarian serving clinicians, thereby meeting the suggestions for guidelines that the Institute of Medicine (IOM) initially suggested in 1990. A literature search of major biomedical databases was undertaken. In addition, organizations and textbooks were consulted. The search discovered components of guidelines in general, evaluation tools for those components, and a few evaluation tools for the guidelines themselves. A further exploration revealed attributes of guideline formation and development that serve to clarify both their value and limitations. It was determined that GRADE (Grading of Recommendations Assessment, Development, and Evaluation) most nearly meets the IOM's recommendations. Its widespread acceptance, incorporation of patient values and/or preferences, and its inclusion of studies other than randomized controlled trials make it uniquely suitable to clinical practice.
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Objectives: Health guidelines are a key knowledge translation tool produced and used by numerous stakeholders worldwide. Effective participation in guideline development groups or development groups is crucial for guideline succes...
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Objectives: Health guidelines are a key knowledge translation tool produced and used by numerous stakeholders worldwide. Effective participation in guideline development groups or development groups is crucial for guideline success, yet little guidance exists for members of these groups. In this study, we present the Guideline Participant Tool (GPT) to support effective participation in guideline groups, in particular those using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
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Objective: Transforming narrative guidelines into a computer-interpretable formalism is still a bottleneck in the development of decision-support systems. Our goal was to support this step by providing computer-interpretable templ...
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Objective: Transforming narrative guidelines into a computer-interpretable formalism is still a bottleneck in the development of decision-support systems. Our goal was to support this step by providing computer-interpretable templates for representing guideline knowledge using clinical abstractions that are appropriate for particular guideline sub-domains.
Methods and materials: We analyzed guidelines taken from the sub-domains of screening and immunization guidelines to find repeatable clinical abstractions and structured them as design templates to support encoding of these guidelines in a computer-interpretable format. To find guidelines for analysis and validation, we (1) searched the National Guideline Clearinghouse for screening guidelines in internal medicine, that have a clinical algorithm, and which were published during 2002-5 and (2) used adult and childhood immunization guidelines developed by Center of Disease Control and Prevention (CDC) and the Institute for Clinical Systems Improvement. Results: We developed two visual templates that structure screening guidelines as algorithms of guideline steps used for screening and data collection and used them to represent the guidelines collected. We validated the computability of the screening templates by executing a screening guideline in a workflow engine. We validated the computability of immunization templates by writing code that, based on represented knowledge, computes immunization due dates and by creating an algorithm that translates the knowledge into computer-interpretable guidelines. Conclusion: We have demonstrated that our templates could be effectively applied to screening and immunization guidelines to produce computer-interpretable representations using domain-level abstractions.
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Interest in the development and promotion of clinical practice guidelines (CPGs) continues to grow in many professions. However, the potential benefits associated with CPGs are dependent upon their quality. A number of studies hav...
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Interest in the development and promotion of clinical practice guidelines (CPGs) continues to grow in many professions. However, the potential benefits associated with CPGs are dependent upon their quality. A number of studies have shown that the quality of CPGs varies greatly. Furthermore, the quality of many of the CPGs used in health and social sciences has yet to be examined. In light of this, the aim of this study was to examine the quality of CPGs that focus on intervention and care management in mental health in Quebec. A search of Quebec regulatory bodies websites was conducted and six CPGs were included in this study. The CPGs were assessed by four trained raters using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Items scores and domains scores were considered to determine the quality of the six CPGs. Results show that many of the CPGs did not achieve minimum ratings for numerous quality checks. Notably, none of the CPGs were designed using a rigorous methodology, they lacked transparency throughout the development process and insufficient consideration was given to the applicability of the recommendations they included. Because these shortcomings may hinder the efficacy and utilization of CPGs, suggestions to improve the development of CPGs and to improve their quality are discussed.
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Guidelines support health care decision-making but continue to be underused, therefore more research is needed on how they can be better developed and implemented. The same is true of mental health care, for which there is recent ...
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Guidelines support health care decision-making but continue to be underused, therefore more research is needed on how they can be better developed and implemented. The same is true of mental health care, for which there is recent growing interest in improving care delivery and associated outcomes by optimizing the use of mental health care guidelines. This editorial describes the key concepts from accumulated research on guideline implementation to suggest a number of avenues for research on implementation of mental health care guidelines.
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摘要 :
Guidelines support health care decision-making but continue to be underused, therefore more research is needed on how they can be better developed and implemented. The same is true of mental health care, for which there is recent ...
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Guidelines support health care decision-making but continue to be underused, therefore more research is needed on how they can be better developed and implemented. The same is true of mental health care, for which there is recent growing interest in improving care delivery and associated outcomes by optimizing the use of mental health care guidelines. This editorial describes the key concepts from accumulated research on guideline implementation to suggest a number of avenues for research on implementation of mental health care guidelines.
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