Evidence-Based Decision-Making 4: Development and Limitations of Clinical Practice Guidelines

2015 ◽  
pp. 443-453 ◽  
Author(s):  
Bruce Culleton
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Evidence Based ◽  
Evidence Based Decision Making

Pediatric Clinical Practice Guidelines & Policies

2017 ◽  
Author(s):  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Evidence Based ◽  
Child Health Care ◽  
American Academy Of Pediatrics ◽  
Policy Information ◽  
Policy Statements ◽  
Reference Tools ◽  
Evidence Based Decision Making

Evidence-based clinical practice guidelines and policy statements from the AAP! Clinical practice guidelines have long provided physicians with an evidence-based decision-making tool for managing common pediatric conditions. Policies issued and endorsed by the American Academy of Pediatrics (AAP) represent the AAP position on child health care issues. More than 40 clinical practice guidelines and more than 500 policy statements, clinical reports, and technical reports have been combined into this 17th edition, giving you even easier access to the important clinical and policy information you need. Now includes eBook access! Updated and expanded for 2017 * Printed text and eBook access of all AAP clinical practice guidelines and full text of 2016 AAP policy statements * Complete 2016 AAP policy statements, clinical reports, and technical reports * Quick reference tools including coding tips and patient education handouts

Evidence-Based Practice Among Speech-Language Pathologists

2005 ◽  
Vol 14 (3) ◽  
pp. 208-220 ◽  
Author(s):  
Richard P. Zipoli ◽  
Marianne Kennedy
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Evidence Based Practice ◽  
Graduate Training ◽  
Perceived Barriers ◽  
Evidence Based ◽  
Speech Language Pathologists ◽  
Positive Attitudes

A total of 240 speech-language pathologists responded to a questionnaire examining attitudes toward and use of research and evidence-based practice (EBP). Perceived barriers to EBP were also explored. Positive attitudes toward research and EBP were reported. Attitudes were predicted by exposure to research and EBP practice during graduate training and the clinical fellowship year (CFY). Clinical experience and opinions of colleagues were used to guide decision making more frequently than research studies or clinical practice guidelines. Only exposure to research and EBP during the CFY predicted use of evidence-based resources. Respondents reported a decline in exposure to research and EBP as they moved from graduate training into the CFY. A lack of time was perceived as a barrier to EBP.

scholarly journals Effect of Education on Shared Decision-making using Clinical Practice Guidelines: A Randomized Controlled trial.

2020 ◽  
Author(s):  
Shuhei Fujimoto ◽  
Tatsuya Ogawa ◽  
Kanako Komukai ◽  
Takeo Nakayama
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Shared Decision Making ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Evidence Based Practice ◽  
Occupational Therapists ◽  
Evidence Based ◽  
Shared Decision ◽  
Randomized Controlled

Abstract Background: To investigate the influence of the evidence–practice gap on physiotherapists and occupational therapists through shared decision making (SDM) using clinical practice guidelines (CPGs).Methods: The study was designed as a blocked, randomized controlled multicenter trial. Participants included 126 therapists with 42 continuous samplings from three institutions. Being a permanent employee from any of these institutions was a necessary inclusion criterion. However, participants with disorders (visual, auditory, attentional disorder) were excluded. An allocator was assigned to mask the participation’s attribution until the allocation was completed. The evaluator and analyzer were also masked. For the intervention group, a workshop was conducted on SDM using CPGs. Lecture on the knowledge of CPGs (CPG group) and lecture on the knowledge of SDM (SDM group) were the control groups. The primary outcomes were “education, attitudes and beliefs, and interest and perceived role in evidence-based practice (EPIC scale).” The secondary outcome included evidence-based practice (EBP) knowledge. To review the intervention effect of education on SDM using CPGs, two-factor variance analysis (mixed model) was adopted to conduct Holm’s method.Results: In each group, 42 participants were randomized and analyzed. The EPIC scale showed significant difference between the CPG with SDM and CPG groups (CPG with SDM group [mean ± standard deviation, pre/post]：2.4±0.9/4.4±1.7; CPG group： 3.0±1.5/3.5±2.0; SDM group： 2.6±1.2/ 3.3±1.8）. The question on EBP “I learned the foundations for EBP as a part of my academic preparation” showed significant differences between the CPG with SDM and CPG groups （CPG with SDM group： 1.8±0.8/2.2±1.0; CPG group： 2.3±1.1/ 2.0±1.0）.Conclusion: SDM education using CPGs for physical and occupational therapists improves EBP self-efficacy.

scholarly journals Usefulness of Cochrane Reviews in Clinical Guideline Development—A Survey of 585 Recommendations

2022 ◽  
Vol 19 (2) ◽  
pp. 685
Author(s):  
Christoffer Bruun Korfitsen ◽  
Marie-Louise Kirkegaard Mikkelsen ◽  
Anja Ussing ◽  
Karen Christina Walker ◽  
Jeanett Friis Rohde ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Health Authority ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
Cochrane Reviews ◽  
Danish Health

The Danish Health Authority develops clinical practice guidelines to support clinical decision-making based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and prioritizes using Cochrane reviews. The objective of this study was to explore the usefulness of Cochrane reviews as a source of evidence in the development of clinical recommendations. Evidence-based recommendations in guidelines published by the Danish Health Authority between 2014 and 2021 were reviewed. For each recommendation, it was noted if and how Cochrane reviews were utilized. In total, 374 evidence-based recommendations and 211 expert consensus recommendations were published between 2014 and 2021. Of the 374 evidence-based recommendations, 106 included evidence from Cochrane reviews. In 28 recommendations, all critical and important outcomes included evidence from Cochrane reviews. In 36 recommendations, a minimum of all critical outcomes included evidence from Cochrane reviews, but not all important outcomes. In 33 recommendations, some but not all critical outcomes included evidence from Cochrane reviews. Finally, in nine recommendations, some of the important outcomes included evidence from Cochrane reviews. In almost one-third of the evidence-based recommendations, Cochrane reviews were used to inform clinical recommendations. This evaluation should inform future evaluations of Cochrane review uptake in clinical practice guidelines concerning outcomes important for clinical decision-making.

scholarly journals The Effect of Education on Clinical Practice Guidelines with Shared Decision Making: A Randomized Controlled trial

2020 ◽  
Author(s):  
Shuhei Fujimoto ◽  
Tatsuya Ogawa ◽  
Kanako Komukai ◽  
Takeo Nakayama
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Shared Decision Making ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Evidence Based Practice ◽  
Occupational Therapists ◽  
Secondary Outcome ◽  
Evidence Based ◽  
Shared Decision

Abstract Background: To investigate the influence of the evidence-practice gap on physiotherapists and occupational therapists through shared decision making (SDM) education using clinical practice guidelines (CPGs).Methods: The study design was a multicenter, blocked, randomized control trial. Participants included 126 therapists with 42 continuous samplings from the three institutions. Inclusion criteria were being a permanent employee from the institutions. Exclusion criteria were participants with disorders that may cause intervention (visual, auditory, attentional disorder). An allocator assigned masked the participation’s attribution until the allocation was completed. The evaluator and analyzer were masked. For the intervention group, workshop on SDM using the CPGs were conducted. The control group was lecture on the knowledge of CPGs (CPG group) and lecture on the knowledge of SDM (SDM group). The primary outcomes were education, attitudes and beliefs, and interest and perceived role in evidence-based practice (EPIC scale). The secondary outcome was the Evidence based practice (EBP) knowledge. To review the intervention effect of the education on SDM using CPGs, two-factor variance analysis (mixed model) was adopted to conduct Holm’s method in comparison to a post-hoc test.Results: Participants randomized and analysed in each group were 42. The EPIC scale showed significant difference between CPGs with SDM group and the CPG group (CPG with SDM group (mean ± standard deviation, pre/post）：2.4±0.9/4.4±1.7; CPG group：3.0±1.5/3.5±2.0; SDM group ：2.6±1.2/ 3.3±1.8）. The question item on EBP “I learned the foundations for EBP as part of my academic preparation” had significant differences between CPGs with SDM group and CPGs group（CPG with SDM group：1.8±0.8/2.2±1.0; CPG group：2.3±1.1/ 2.0±1.0）.Conclusions: EBP education on the SDM using CPGs increased confidence in using EBP for physiotherapists and occupational therapists.

scholarly journals Text Classification in Clinical Practice Guidelines Using Machine-Learning Assisted Pattern-Based Approach

2021 ◽  
Vol 11 (8) ◽  
pp. 3296
Author(s):  
Musarrat Hussain ◽  
Jamil Hussain ◽  
Taqdir Ali ◽  
Syed Imran Ali ◽  
Hafiz Syed Muhammad Bilal ◽  
...  
Keyword(s):  
Machine Learning ◽  
Decision Making ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Machine Learning Algorithms ◽  
Nominal Group ◽  
Specific Information ◽  
Matching Techniques ◽  
Disease Specific

Clinical Practice Guidelines (CPGs) aim to optimize patient care by assisting physicians during the decision-making process. However, guideline adherence is highly affected by its unstructured format and aggregation of background information with disease-specific information. The objective of our study is to extract disease-specific information from CPG for enhancing its adherence ratio. In this research, we propose a semi-automatic mechanism for extracting disease-specific information from CPGs using pattern-matching techniques. We apply supervised and unsupervised machine-learning algorithms on CPG to extract a list of salient terms contributing to distinguishing recommendation sentences (RS) from non-recommendation sentences (NRS). Simultaneously, a group of experts also analyzes the same CPG and extract the initial patterns “Heuristic Patterns” using a group decision-making method, nominal group technique (NGT). We provide the list of salient terms to the experts and ask them to refine their extracted patterns. The experts refine patterns considering the provided salient terms. The extracted heuristic patterns depend on specific terms and suffer from the specialization problem due to synonymy and polysemy. Therefore, we generalize the heuristic patterns to part-of-speech (POS) patterns and unified medical language system (UMLS) patterns, which make the proposed method generalize for all types of CPGs. We evaluated the initial extracted patterns on asthma, rhinosinusitis, and hypertension guidelines with the accuracy of 76.92%, 84.63%, and 89.16%, respectively. The accuracy increased to 78.89%, 85.32%, and 92.07% with refined machine-learning assistive patterns, respectively. Our system assists physicians by locating disease-specific information in the CPGs, which enhances the physicians’ performance and reduces CPG processing time. Additionally, it is beneficial in CPGs content annotation.

Clinical practice guidelines for comprehensive patient assessment in emergency care: A quality evaluation study

2021 ◽  
pp. 205715852110069
Author(s):  
Åsa Falchenberg ◽  
Ulf Andersson ◽  
Birgitta Wireklint Sundström ◽  
Anders Bremer ◽  
Henrik Andersson
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Emergency Care ◽  
Quality Evaluation ◽  
Evaluation Study ◽  
Evidence Based ◽  
Patient Assessment ◽  
Care Needs ◽  
Home Based

Emergency care nurses (ECNs) face several challenges when they assess patients with different symptoms, signs, and conditions to determine patients’ care needs. Patients’ care needs do not always originate from physical or biomedical dysfunctions. To provide effective patient-centred care, ECNs must be sensitive to patients’ unique medical, physical, psychological, social, and existential needs. Clinical practice guidelines (CPGs) provide guidance for ECNs in such assessments. The aim of this study was to evaluate the quality of CPGs for comprehensive patient assessments in emergency care. A quality evaluation study was conducted in Sweden in 2017. Managers from 97 organizations (25 emergency medical services and 72 emergency departments) were contacted, covering all 20 Swedish county councils. Fifteen guidelines were appraised using the validated Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. The results revealed that various CPGs are used in emergency care, but none of the CPGs support ECNs in performing a comprehensive patient assessment; rather, the CPGs address parts of the assessment primarily related to biomedical needs. The results also demonstrate that the foundation for evidence-based CPGs is weak and cannot confirm that an ECN has the prerequisites to assess patients and refer them to treatment, such as home-based self-care. This may indicate that Swedish emergency care services utilize non-evidence-based guidelines. This implies that ECN managers and educators should actively seek more effective ways of highlighting and safeguarding patients’ various care needs using more comprehensive guidelines.

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