scholarly journals A Patient Decision Aid for Psoriasis Based on Current Clinical Practice Guidelines

2012 ◽  
Vol 148 (6) ◽  
Author(s):  
Jerry Tan ◽  
Barat Wolfe
2020 ◽  
pp. 106002802095934 ◽  
Author(s):  
Brian L. Erstad

Objectives The purpose of this critical narrative review is to discuss common indications for ordering serum albumin levels in adult critically ill patients, evaluate the literature supporting these indications, and provide recommendations for the appropriate ordering of serum albumin levels. Data Sources PubMed (1966 to August 2020), Cochrane Library, and current clinical practice guidelines were used, and bibliographies of retrieved articles were searched for additional articles. Study Selection and Data Extraction Current clinical practice guidelines were the preferred source of recommendations regarding serum albumin levels for guiding albumin administration and for nutritional monitoring. When current comprehensive reviews were available, they served as a baseline information with supplementation by subsequent studies. Data Synthesis Serum albumin is a general marker of severity of illness, and hypoalbuminemia is associated with poor patient outcome, but albumin is an acute phase protein, so levels vacillate in critically ill patients in conjunction with illness fluctuations. The most common reasons for ordering serum albumin levels in intensive care unit (ICU) settings are to guide albumin administration, to estimate free phenytoin or calcium levels, for nutritional monitoring, and for severity-of-illness assessment. Relevance to Patient Care and Clinical Practice Because hypoalbuminemia is common in the ICU setting, inappropriate ordering of serum albumin levels may lead to unnecessary albumin administration or excessive macronutrient administration in nutritional regimens, leading to possible adverse effects and added costs. Conclusions With the exception of the need to order serum albumin levels as a component of selected severity-of-illness scoring systems, there is little evidence or justification for routinely ordering levels in critically ill patients.


2016 ◽  
Vol 25 (1) ◽  
pp. 221-228 ◽  
Author(s):  
Jessica E Morgan ◽  
Hadeel Hassan ◽  
Julia V Cockle ◽  
Christopher Lethaby ◽  
Beki James ◽  
...  

Author(s):  
Annalisa Casarin

This chapter will focus on guidelines for clinical practice that mention a range of Complementary and Alternative Medicine (CAM) techniques. After exploring the definition and grading of clinical practice guidelines as a decision-making tool, the CAM methods included in the review will be described. A definition of chronic diseases will be provided and an overview of the current clinical practice guidelines on a number of prevalent conditions will be presented. Guidelines released by several international regulatory organisations will be compared in order to detect which CAM techniques have been or not been recommended for chronic illnesses in different countries. The challenges in implementing and appraising guidelines will be finally discussed.


2021 ◽  
Author(s):  
Martyna TOMCZYK ◽  
Cécile JAQUES ◽  
Ralf J. JOX

Abstract Introduction: This study aims to identify the full spectrum of ethical challenges of all forms of palliative sedation for adults as presented in current clinical practice guidelines (CPGs), and to determine whether CPGs specify ethical challenges of this therapy for cancer and non-cancer patients and, if so, how exactly they do this. To the best of our knowledge, no studies have yet investigated this topic. The purpose is purely descriptive; our aim is not to make any kind of normative judgements on these challenges. Nor is our aim to assess the quality of the CPGs. Methods and analysis : We will perform a systematic review of CPGs on palliative sedation for adults via five electronic databases, grey literature search tools, citation tracking, and contact with palliative care experts. Current CPGs validated by an international, national, or regional authority, published in English, German, French, Italian, or Polish, from 2000 to the date of the search, will be subjected to content analysis at the textual, linguistic, and thematic levels. This study protocol is reported in accordance with the PRISMA-P criteria and registered on PROSPERO. Discussion The results of our systematic review can help raise awareness and understanding of the complexity of ethical problems, rigorously guide reflection in this field, and be useful in elaborating ethical guidelines in an interdisciplinary approach, in order to have a positive impact on the quality of patient care, education and training, and research in respect of this complex and challenging practice.


2017 ◽  
Vol 25 (11) ◽  
pp. 3289-3290
Author(s):  
Christopher C Blyth ◽  
Gabrielle M Haeusler ◽  
Brendan J McMullan ◽  
Rishi S Kotecha ◽  
Monica A Slavin ◽  
...  

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Caitlin Dmitriew ◽  
Robert Ohle

Abstract Background Acute aortic syndrome (AAS) is an uncommon, life-threatening emergency that is frequently misdiagnosed. The 2020 Canadian clinical practice guidelines for the diagnosis of AAS incorporate all available evidence into four key recommendations. In order to facilitate the implementation of these recommendations, a clinical decision aid was created. The objective of this study was to identify barriers and facilitators among physicians prior to implementation of the guideline recommendations in a multicentre step wedge cluster randomized control trial. Methods We conducted semi-structured interviews with nine emergency room physicians working at five sites distributed between urban academic and rural settings. We used purposive sampling, contacting physicians until data saturation was reached. Interview questions were designed to understand potential barriers and facilitators to guideline recommendation uptake and use. Responses were analysed according to the Theoretical Domains Framework, and overarching themes describing these barriers and facilitators were identified. Results Two themes and six subthemes encompassing 13 theoretical domains were identified. These included clinical decision-making support, awareness of the evidence, social factors, expected consequences, ability of physicians to acquire the necessary data and ease of use. A majority of interviewees anticipated that the guideline recommendations would support clinical decision making and more effectively risk-stratify patients. Other facilitators included endorsement of the guidelines by professional organizations and peers. Barriers to implementation include the fact that laboratory testing and knowledge of the rationale for its use in the investigation of AAS were not widespread. The complexity of the clinical decision aid and concerns about test specificity were also identified as potential barriers to use. Conclusion Physicians were amenable to using the AAS guideline recommendations to support clinical decision-making and to reduce resource use. A structured intervention should be developed to address the identified barriers and leverage the facilitators in order to ensure successful implementation. Our findings may have implications for the implementation of other guidelines used in emergency departments.


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