The Shortcomings of Clinical Practice Guidelines

Abstract

Accumulation of medical knowledge related to diagnosis and management over the last 5-6 decades has altered the course of diseases, improved clinical outcomes and increased survival. Thus, it has become difficult for the practicing physician to evaluate the long-term effects of a particular therapy on survival of an individual patient. Further, the approach by each physician to an individual patient with the same disease is not always uniform. In an attempt to assist physicians in applying newly acquired knowledge to patients, clinical practice guidelines were introduced by various scientific societies. Guidelines assist in facilitating the translation of new research discoveries into clinical practice; however, despite the improvements over the years, there are still several issues related to guidelines that often appear ‘lost in translation'. Guidelines are based on the results of randomized clinical trials, other nonrandomized studies, and expert opinion (i.e. the opinion of most members of the guideline committees). The merits and limitations of randomized clinical trials, guideline committees, and presentation of guidelines will be discussed. In addition, proposals to improve guidelines will be presented.

Heart Rate, Life Expectancy and the Cardiovascular System: Therapeutic Considerations

“…Nonetheless, the addition of other bradycardic drugs to patients treated with β-blockers requires careful consideration from a physician who understands the physiology and pathophysiology of the coronary circulation, the effects of heart rate on the cardiovascular system, drug-drug interactions, and the medical problems of the individual patient for whom they are responsible. No clinical practice guidelines can fully address these issues [75]. …”

Management of rectal cancer in Canada: an evidence-based comparison of clinical practice guidelines

“…11,12 They have the ability to improve the quality and consistency of care provided by bridging the gap between clinicians' knowledge/practices and what is supported in the literature. 12,13 Ideally, CPGs should analyze and distil the best evidence to provide direction to health care providers. However, guidelines may contain flawed or inaccurate content, may be presented in a suboptimal fashion, or may be poorly generalizable to individual patients.…”

“…However, guidelines may contain flawed or inaccurate content, may be presented in a suboptimal fashion, or may be poorly generalizable to individual patients. 12,13 Other barriers to implementation include clinician factors such as lack of agreement with published guidelines or limited time and resources, or patient factors such as specific preferences and expectations. 14 The Appraisal of Guidelines for Research & Evaluation II instrument (AGREE-II) is a standardized and validated tool used to evaluate the quality and methodology of CPGs.…”

Aortic Size and Aortic Dissection: Does One Size Fit All?

“…Since antiquity, physicians have had to make important decisions about the well-being of their patients, often based on incomplete information and under conditions of uncertainty [30]. The father of medicine, Hippocrates (460-370 B.C.…”