Medical Practice Guidelines: Current Activities and Future Directions

Audet, Anne-Marie J.; Greenfield, Sheldon; Field, Marilyn J.

doi:10.7326/0003-4819-113-9-709

Cited by 300 publications

(93 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As diretrizes clínicas, uma vez corretamente implementadas, são consideradas importantes ferramentas para a melhoria da qualidade do cuidado ao AVCi, diminuindo a inadequada variação de prática e acelerando a incorporação de avanços na prática diária 14,15 . Uma extensa literatura, em vários países, tem tentado compreender quais os fatores que limitam a adesão dos médicos às diretrizes 16,17,18 , apontando barreiras organizacionais, de fatores relacionados a pacientes, ao processo de implementação da diretriz e suas características.…”

Section: Introductionunclassified

Análise das barreiras à utilização de trombolíticos em casos de acidente vascular cerebral isquêmico em um hospital privado do Rio de Janeiro, Brasil

et al. 2013

View full text Add to dashboard Cite

O acidente vascular cerebral isquêmico (AVCi) é uma importante causa de sequela e morte. A correta utilização do trombolítico enfrenta várias barreiras. O objetivo foi discutir as barreiras à terapia trombolítica em pacientes que chegam, com sintomas de AVCi agudo, à emergência de um hospital privado do Rio de Janeiro, Brasil. Coorte retrospectiva de pacientes entre 2009 e 2011. Foram admitidos 257 pacientes com suspeita de AVCi. Dos pacientes com diagnóstico confirmado (156), 11,5% (18) foram trombolisados. Dos 30 pacientes com diagnóstico de AVCi, dentro da janela terapêutica e com NIHSS na faixa para trombólise, 20 não foram trombolisados, 9 por barreiras administrativas (45%). Neste trabalho o percentual de trombólise foi superior ao observado nos Estados Unidos, mas barreiras impediram o tratamento de 45% dos pacientes com indicação à trombólise. Imagina-se que na rede pública brasileira a situação seja ainda mais desfavorável.

show abstract

Section: Introductionunclassified

Análise das barreiras à utilização de trombolíticos em casos de acidente vascular cerebral isquêmico em um hospital privado do Rio de Janeiro, Brasil

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Treatment guidelines have been developed for a wide variety of diseases, including breast cancer (Audet et al, 1990; Committee to Advise the Public Health Service on Clinical Practice Guidelines, 1990;Glick et al, 1993). Although the traditional objective of treatment guidelines has been to improve disease-related outcomes such as time to recurrence and survival, more recently treatment guidelines have been recommended because of their potential to influence other aspects of care (Kanouse et al, 1988;Kelly et al, 1992;Shapiro et al, 1993).…”

mentioning

confidence: 99%

The association between population-based treatment guidelines and adjuvant therapy for node-negative breast cancer

Sawka

Olivotto²,

Coldman³

et al. 1997

Br J Cancer

View full text Add to dashboard Cite

C Sawka1 2, 3,4, I Olivotto5,6, A Coldman6,7, V GoeJ3,4,8 Summary This study evaluated the impact of province-wide treatment guidelines on consistency of adjuvant therapy for node-negative breast cancer. A retrospective population-based cohort study was conducted in the Canadian provinces of British Columbia, which has provincewide guidelines, and Ontario, which does not. All eligible 1991 incident cases of node-negative breast cancer in British Columbia (n = 942) and a similar number of randomly selected 1991 incident cases in Ontario (n = 938) were reviewed. Consistency of adjuvant therapy received was evaluated by stratifying cases into discrete diagnostic groups using several grouping systems, and by then comparing the distribution of treatments received within each diagnostic group in the two provinces. Recursive partitioning was also performed. We observed that patterns of pathology reporting were consistent with awareness of the factors used in the British Columbia guidelines to define indications for adjuvant therapy. Consistency of care was greater in British Columbia than in Ontario by all diagnostic grouping systems and by recursive partitioning (P < 0.001), and the observed patterns in British Columbia corresponded to the British Columbia guidelines. We conclude that populationbased treatment guidelines can play a role in promoting consistent patterns of adjuvant therapy for women with node-negative breast cancer.

show abstract

“…1 Guidelines are devoted to helping clinicians with clinical decision making. 2 An important part of guidelines, which are based on a detailed review of the relevant literature about a given subject, are the published reports of randomized controlled trials (RCTs), widely accepted as the criterion standard of rigorous research design for clinical studies.…”

Section: Introductionmentioning

confidence: 99%

Randomized Controlled Trials: Do They Have External Validity for Patients With Multiple Comorbidities?

Fortin

Dionne²,

Pinho³

et al. 2006

The Annals of Family Medicine

271

205

View full text Add to dashboard Cite

PURPOSE Many randomized controlled trials (RCTs) exclude patients who have multiple comorbidities. The aim of this study was to illustrate the prevalence of comorbidities among patients followed up in primary care who would have met the inclusion criteria of selected RCTs focusing on treatment of a particular condition. We used hypertension as an example of a particular chronic condition. METHODSWe used an existing database of 980 patients (660 women) that was representative of a population consulting primary care family doctors and that contained information about all chronic conditions. We randomly selected 5 RCTs that focused on patients with hypertension. The inclusion and exclusion criteria used in each of the 5 RCTs were applied (1 study at a time) to the patients in our database. The patients from our data set who met the inclusion criteria of a given RCT were considered eligible for that RCT. RESULTSOf the patients from our data set who were eligible for each of the RCTs, 89% to 100% had multiple chronic conditions. The mean number of chronic conditions of patients eligible for each RCT ranged from 5.5 ± 3.3 to 11.7 ± 5.3. CONCLUSIONSResults from this study suggest that RCTs targeting a chronic medical condition such as hypertension could fi nd that, in a sample taken from family practice, most eligible patients have comorbid conditions. Whether these patients are sampled or excluded should be reported. Research results intended to be applied in medical practice should take the complex reality of effective treatment of these patients into consideration.

show abstract

Medical Practice Guidelines: Current Activities and Future Directions

Cited by 300 publications

References 9 publications

Análise das barreiras à utilização de trombolíticos em casos de acidente vascular cerebral isquêmico em um hospital privado do Rio de Janeiro, Brasil

Análise das barreiras à utilização de trombolíticos em casos de acidente vascular cerebral isquêmico em um hospital privado do Rio de Janeiro, Brasil

The association between population-based treatment guidelines and adjuvant therapy for node-negative breast cancer

Randomized Controlled Trials: Do They Have External Validity for Patients With Multiple Comorbidities?

Contact Info

Product

Resources

About