Practice Guidelines Belief, Criticism, and Probability

Archives of internal medicine (Impact Factor: 17.33). 01/2011; 171(1):15-7. DOI: 10.1001/archinternmed.2010.453
Source: PubMed
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    ABSTRACT: Evidence-practice gaps, adverse medication-related incidents and unplanned medical admissions to hospital are common in elderly Australians. Many prescribing indicator tools designed to address some of these problems have been reported in the literature, the most common of which is the Beers list of inappropriate medications in the elderly. However, many of these tools are not appropriate for the Australian healthcare environment without modification and validation, and there appears to be a need for a tool based on Australian data. To develop a list of prescribing indicators for elderly (aged >65 years) Australians based on the most frequent medications prescribed to Australians, and the most frequent medical conditions for which elderly Australians consult medical practitioners. The most common reasons for elderly Australians to seek or receive healthcare were cross-referenced with the 50 highest-volume Pharmaceutical Benefits Scheme medications prescribed to Australians in 2006 to develop prescribing indicators in the elderly using Australian medication and medical condition information resources. Forty-eight prescribing indicators were identified, consisting mainly of optimum as well as inappropriate medication choices for a large number of common medical conditions in the elderly. A prescribing indicators tool was developed. This tool is envisaged as forming an important part of the medication review process, which is aimed at addressing the common problem of adverse medication-related events in elderly Australians.
    Drugs & Aging 01/2008; 25(9):777-93. DOI:10.2165/00002512-200825090-00004 · 2.84 Impact Factor
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    ABSTRACT: NCCN has developed NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for the treatment of cancer, management of complications, and screening. The NCCN Guidelines, regularly updated, are a fusion of scientific data and expert opinion from panels composed of oncology professionals from NCCN member institutions. Over time, these guidelines have become more and more accepted by the oncology community in the United States. They are also extensively used internationally. As reported by William T. McGivney, PhD, Chief Executive Officer of NCCN, the NCCN Guidelines also "have been requested by cancer care professionals in more than 115 countries." Furthermore, the 2009 NCCN Annual Report notes that 44% of all registered users are outside the United States. In 2009, NCCN approved adapted China editions of 10 different Guidelines for the management of common cancers, and the translation of NCCN Guidelines into Japanese is currently in progress. In 2009, NCCN Guidelines programs were held in Korea, United Arab Emirates, Japan (in 2 cities), and China (in 3 cities). Thus, NCCN Guidelines are obviously filling a need internationally. The volume of data, wealth of new information, and deluge of new therapeutic agents is daunting. The fear, felt years ago, that a small group of cancer centers would dictate how cancer treatment should be managed has been replaced by acceptance of the need for a systematic way of approaching a diverse group of related diseases. Challenges in Translation Still, it is not likely that a single group of guidelines, however carefully prepared or regularly...
    Journal of the National Comprehensive Cancer Network: JNCCN 02/2011; 9(2):133-4. · 4.18 Impact Factor
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    ABSTRACT: Clinical guidelines are an important source of guidance for clinicians. Few studies have examined the quality of scientific data underlying evidence-based guidelines. We examined the quality of evidence that underlies the recommendations made by the American College of Obstetricians and Gynecologists (the College). The current practice bulletins of the College were examined. Each bulletin makes multiple recommendations. Each recommendation is categorized based on the quality and quantity of evidence that underlies the recommendation into one of three levels of evidence: A (good and consistent evidence), B (limited or inconsistent evidence), or C (consensus and opinion). We analyzed the distribution of levels of evidence for obstetrics and gynecology recommendations. A total of 84 practice bulletins that offered 717 individual recommendations were identified. Forty-eight (57.1%) of the guidelines were obstetric and 36 (42.9%) were gynecologic. When all recommendations were considered, 215 (30.0%) provided level A evidence, 270 (37.7%) level B, and 232 (32.3%) level C. Among obstetric recommendations, 93 (25.5%) were level A, 145 (39.7%) level B, and 117 (34.8%) level C. For the gynecologic recommendations, 122 (34.7%) were level A, 125 (35.5%) level B, and 105 (29.8%) level C. The gynecology recommendations were more likely to be of level A evidence than the obstetrics recommendations (P=.049). One third of the recommendations put forth by the College in its practice bulletins are based on good and consistent scientific evidence.
    Obstetrics and Gynecology 09/2011; 118(3):505-12. DOI:10.1097/AOG.0b013e3182267f43 · 5.18 Impact Factor
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