scholarly journals Improving Prioritisation Processes for Clinical Practice Guidelines: New Methods and an Evaluation From the National Heart Foundation of Australia.

2021 ◽  
Author(s):  
Brooke Atkins ◽  
Tom Briffa ◽  
Cia Connell ◽  
Amanda Buttery ◽  
Garry Jennings
Keyword(s):  
Heart Disease ◽  
Priority Setting ◽  
Clinical Guidelines ◽  
Clinical Guideline ◽  
Guideline Development ◽  
Heart Diseases ◽  
International Classification ◽  
Public Consultation ◽  
Nominal Group ◽  
Expert Committee

Abstract BackgroundReleasing timely and relevant clinical guidelines is challenging for organisations globally. Priority setting is crucial as guideline development is resource intensive. Our aim, as a national organisation responsible for developing cardiovascular clinical guidelines, was to develop a method of generating and prioritising topics for future clinical guideline development in areas where guidance was most needed.MethodsSeveral novel processes were developed, adopted and evaluated including: 1) initial public consultation for health professionals and the general public to generate topics; 2) thematic and qualitative analysis, according to the International Classification of Diseases (ICD-11), to aggregate topics; 3) adapting a criteria-based matrix tool to prioritise topics; 4) achieving consensus through modified-nominal group technique and voting on priorities; and 5) process evaluation via survey of end-users. The latter was comprised of the organisation’s Expert Committee of 12 members with expertise across cardiology and public health, including two citizen representatives.ResultsTopics (n=405; reduced to n=278 when duplicates removed) were identified from public consultation responses (n=107 respondents). Thematic analysis synthesised 127 topics that were then categorised into 37 themes using ICD-11 codes. Exclusion criteria were applied (n=32 themes omitted), resulting in 5 short-listed topics: 1) congenital heart disease; 2) valvular heart disease; 3) hypercholesterolaemia, 4) hypertension and 5) ischaemic heart diseases and diseases of the coronary artery. The Expert Committee applied the prioritisation matrix to all five short-listed topics during a consensus meeting and voted to prioritise topics. Unanimous consensus was reached for the topic voted the highest priority: ischaemic heart disease and diseases of the coronary arteries, resulting in the decision to update the organisation’s 2016 clinical guidelines for acute coronary syndromes. Evaluation indicated that initial public consultation was highly valued by the Expert Committee, the matrix tool was easy to use and improved transparency in priority setting.ConclusionDeveloping a multistage, systematic process, incorporating public consultation, and an international classification system led to improved transparency in our clinical guideline priority setting processes and that topics chosen would have the greatest impact on health outcomes These methods are potentially applicable to other national and international organisations responsible for developing clinical guidelines.

Clinical Guideline Development for Otitis Media: A Report on Methodology

1993 ◽  
Vol 109 (3) ◽  
pp. 478-481 ◽  
Author(s):  
Anthony E. Magit ◽  
Sylvan E. Stool
Keyword(s):  
Otitis Media ◽  
Clinical Guidelines ◽  
Clinical Guideline ◽  
Otitis Media With Effusion ◽  
Guideline Development ◽  
Clinical Settings ◽  
Multiple Factors ◽  
Contemporary Practice ◽  
Major Emphasis ◽  
Head Neck

Clinical guideline development is a major emphasis of recent health policy efforts. Interest in clinical guidelines is the result of multiple factors, including economic pressures and the desire to achieve a baseline level of practice in clinical settings. Guidelines have always been of fundamental importance in medicine. This article will discuss the place clinical guidelines have in contemporary practice and the difficulties encountered in the process of developing a meaningful guideline for managing otitis media with effusion. (OTOLARYNGOL HEAD NECK SURG 1993;109:478-81.)

scholarly journals Practical Advice for Nurses in Implementing Nursing Clinical Guideline – Risk Estimation and Prevention of Cardiovascular Diseases

2020 ◽  
Vol 4 (39) ◽  
pp. 40-48
Author(s):  
Merja Merasto ◽  
◽  
Zaure Baygozhina ◽  
Ayagoz Umbetzhanova ◽  
Eveliina Kivinen ◽  
...  
Keyword(s):  
Cardiovascular Diseases ◽  
Clinical Guidelines ◽  
Development Process ◽  
Clinical Guideline ◽  
Guideline Development ◽  
Risk Estimation ◽  
Nursing Intervention ◽  
The Republic ◽  
Nursing Professionals ◽  
Nursing Clinical

The aim of the study: The evidence-based nursing clinical guidelines transform the best research evidence into recommendations for clinical practice. Majority of patients can be managed according to nursing clinical guidelines. In nursing clinical guideline implementation the nurse uses his/her own knowledge base and jurisdiction in the care of the patient. The nurse makes observations of the status of the patient and chooses the best nursing intervention included in the nursing clinical guideline to promote the condition of the patient. Methods. In the Republic of Kazakhstan, adaptation was chosen as a method how to develop nursing clinical guidelines. The Kazakhstani nursing clinical guideline “Risk estimation and prevention of cardiovascular diseases” contains recommendations for nursing professionals involved in screening risk factors and caring for patients with cardiovascular diseases. The guideline was originally developed by the Scottish Intercollegiate Guidelines Network. Results. Nurses need to make decisions concerning the care of cardiovascular patients: advice on treatment, patient information and education. The article contains evidence-based information of cardiovascular nursing care and recommendations for nursing professionals involved in screening risk factors and caring for patients with cardiovascular diseases. The main nursing intervention is motivational interview technique to establish a trustworthy relationship with the patient and trough controversial dialogue to support the patient towards healthier lifestyle and commitment to planned care. Conclusion. In addition, the article covers a short overview of nursing clinical guideline development process in the Republic of Kazakhstan, to ensure the common understanding of nursing clinical guideline development process and the role of nursing clinical guidelines in everyday nursing practice.

scholarly journals Processes for updating guidelines: protocol for a systematic review

2021 ◽  
Vol 4 ◽  
pp. 116
Author(s):  
Karen Cardwell ◽  
Joan Quigley ◽  
Barbara Clyne ◽  
Barrie Tyner ◽  
Marie Carrigan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Guidelines ◽  
Iterative Process ◽  
Clinical Guideline ◽  
Guideline Development ◽  
Grey Literature ◽  
Service Users ◽  
Narrative Synthesis ◽  
Literature Searching ◽  
Development Methodology

Background: National Clinical Guidelines are systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioner and service users’ decisions. Clinical guidelines require updating to ensure validly of the recommendations contained within. The purpose of this systematic review is to describe the most recent guideline update processes, including prioritisation methods, used by international or national groups who provide methods guidance for developing and updating clinical guidelines. Methods: A combination of searching a pre-defined list of international and national organisations that provide methods guidance for developing and updating clinical guidelines, together with grey literature searching, will be undertaken to identify relevant handbooks. This will be supplemented by a systematic literature search of Medline (EBSCO), Embase (OVID) and The Cochrane Methodology Register. As guideline development methodology has evolved considerably, the overall search span for this systematic review will be the last 10-years (2011-2021). Publications eligible for inclusion are methodological handbooks that provide updating guidance, including prioritisation methods, for clinical practice guidelines and peer-reviewed articles that describe or have implemented updating guidance, including prioritisation methods. Using Covidence, two reviewers will independently review titles/abstracts and full texts. Where disagreements occur, discussions will be held to reach consensus and where necessary, a third reviewer will be involved. Methodological handbooks will be quality assessed (using the GIN-McMaster Guideline Development Checklist) independently by two reviewers and any disagreements will be resolved by deliberation, or if necessary, a third reviewer. Data will be extracted by one reviewer and checked for inaccuracies/omissions by a second. A narrative synthesis will be undertaken. Conclusions: Updating clinical guidelines is an iterative process that is both resource intensive and time-consuming. The findings of this systematic review will support clinical guideline developers to ensure appropriate investment of resources.

Burden of Care Among Mothers Having Children with Congenital Heart Diseases

2020 ◽  
Vol 40 (2) ◽  
pp. 72-77
Author(s):  
Nita Sharma ◽  
Pratima Sharma ◽  
Tulashi Adhikari Mishra
Keyword(s):  
Heart Disease ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Sampling Technique ◽  
Structured Interview ◽  
Health Condition ◽  
P Value ◽  
Burden Of Care ◽  
Cross Sectional ◽  
Significance Level

Introduction: Congenital Heart Disease (CHD) is a problem with structure and function of the heart that is present at birth.  Children with CHD require special care, treatment and follow up for a number of common conditions which may be quite straining to the care givers. The objective of the study was to find out the burden of care among mothers having children with CHD. Methods: This descriptive cross-sectional study was carried out in a cardiac centre of Nepal. A total of 95 mothers having children with CHD attending outpatient department of our institute were selected as the sample for the study using non-probability purposive sampling technique. A semi structured interview questionnaire consisting of the Modified Caregiver Strain Index was used to assess the burden of care among mothers having children with CHD. Frequency and percent were used to describe the variables and chi- square test at 0.05 significance level was used to analyse associations. Results: Most (77.9%) of the mothers were regularly strained to find that their children’s health condition was deteriorating due to CHD. Nearly half (44.2%) of the mothers always had financial constrain while giving care to the child, nearly half (40%) of the mothers had done emotional adjustments to take care of their children with CHD, another two-fifths (28.4%) of the mothers sometimes had disturbed sleep and almost half (46.3%) of the mothers were always upset due to some behaviour of their child with CHD. Half (50.5%) of the mothers had high level of burden of care. Statistically significant association were found between age of the mother and level of burden of care (p value = 0.05). Similarly, the type of family (p value = 0.005), age of the children (p value = 0.000) and type of CHD (p value = 0.002) were significantly associated with the level of burden of care among the mothers. Conclusion: The study concluded that mothers tend to feel less burden of care as the child grows older, mothers having children with cyanotic heart disease tend to experience more burden of care. Mothers of less than thirty years of age and living in a joint family also experience more burden of care.  

scholarly journals Personalized Genetic Diagnosis of Congenital Heart Defects in Newborns

2021 ◽  
Vol 11 (6) ◽  
pp. 562
Author(s):  
Olga María Diz ◽  
Rocio Toro ◽  
Sergi Cesar ◽  
Olga Gomez ◽  
Georgia Sarquella-Brugada ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart Defects ◽  
Congenital Malformations ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Heart Defects ◽  
Genetic Diagnosis ◽  
Single Nucleotide Variants ◽  
Personalized Approach

Congenital heart disease is a group of pathologies characterized by structural malformations of the heart or great vessels. These alterations occur during the embryonic period and are the most frequently observed severe congenital malformations, the main cause of neonatal mortality due to malformation, and the second most frequent congenital malformations overall after malformations of the central nervous system. The severity of different types of congenital heart disease varies depending on the combination of associated anatomical defects. The causes of these malformations are usually considered multifactorial, but genetic variants play a key role. Currently, use of high-throughput genetic technologies allows identification of pathogenic aneuploidies, deletions/duplications of large segments, as well as rare single nucleotide variants. The high incidence of congenital heart disease as well as the associated complications makes it necessary to establish a diagnosis as early as possible to adopt the most appropriate measures in a personalized approach. In this review, we provide an exhaustive update of the genetic bases of the most frequent congenital heart diseases as well as other syndromes associated with congenital heart defects, and how genetic data can be translated to clinical practice in a personalized approach.

scholarly journals Natural history of the electrical axis during the first four weeks of life

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Paerregaard ◽  
J Kock ◽  
C Pihl ◽  
A Pietersen ◽  
K.K Iversen ◽  
...  
Keyword(s):  
Heart Disease ◽  
Heart Diseases ◽  
Structural Heart Disease ◽  
Funding Source ◽  
Axis Deviation ◽  
General Population Study ◽  
Gestation Age ◽  
History Of ◽  
The Right ◽  
Heart Foundation

Abstract Background The QRS axis represents the sum of the amplitudes and orientation of the ventricular depolarization. In newborns, the QRS axis is generally directed downward and to the right and left axis deviation (LAD) may be associated with heart disease. Accurate interpretation of abnormalities in the QRS axis may facilitate early diagnosis of heart diseases in newborns. Purpose To describe the evolution of the QRS axis during the first four weeks of life and provide updated, digitalized, normal values from healthy newborns. Methods Electrocardiograms from 12,317 newborns (age 0–28 days) included in a regional, prospective, general population study from 2016–2018 were analyzed. Electrocardiograms were obtained and analyzed with a computerized algorithm with manual validation. The algorithm calculated the QRS mean axis using the net amplitudes of three leads I, II, and III. The four main QRS axis classifications were: “adult normal” axis (+1° to +90°), left axis deviation (LAD, 0° to −90°), right axis deviation (RAD, +91° to +180°), and extreme axis deviation (EAD, +181° to +270°). Echocardiograms were performed according to standard guidelines. Only newborns with an echocardiography excluding structural heart disease were included. Results Electrocardiograms from 12,317 newborns with a median age at examination of 12 days (52% boys) were included. The median QRS axis was 119° at the ages 0–7 days and shifted leftwards to 102° at the ages 22–28 days (p<0.001). We found that girls had significant less pronounced right axis deviation than boys (111° vs 117°, p<0.001) and that increasing gestational age was associated with more pronounced right axis deviation (104° vs 116°, p<0.05). Infant size did not affect the axis (p>0.05). Only 0.5% had LAD (0° to −90°) and 1.1% had an axis within the interval +240° to +30° indicating that a QRS axis in this expanded interval is unusual in healthy newborns. Conclusion The QRS axis showed a gradual leftward-shift during the first four weeks of life and was affected by sex and gestation age but unaffected by infant size. LAD occurred in only 0.5% of the newborns. Our data serve as updated reference values, which may facilitate clinical handling of newborns. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): This work was supported by the Danish Children Heart Foundation, Snedkermester Sophus Jacobsen and wife Astrid Jacobsen's foundation (Grant 19-R112-A5248-26048), the Research Council at Herlev-Gentofte Hospital and Toyota-Fonden, Denmark.

scholarly journals Appropriate use criteria for cardiovascular magnetic resonance imaging (CMR): SIC—SIRM position paper part 1 (ischemic and congenital heart diseases, cardio-oncology, cardiac masses and heart transplant)

2021 ◽  
Vol 126 (3) ◽  
pp. 365-379
Author(s):  
Gianluca Pontone ◽  
Ernesto Di Cesare ◽  
Silvia Castelletti ◽  
Francesco De Cobelli ◽  
Manuel De Lazzari ◽  
...  
Keyword(s):  
Heart Disease ◽  
Magnetic Resonance ◽  
Heart Transplant ◽  
Congenital Heart ◽  
Clinical Decision Making ◽  
Heart Diseases ◽  
Integrated Approach ◽  
Clinical Decision ◽  
Italian Society ◽  
Cardiac Masses

AbstractCardiac magnetic resonance (CMR) has emerged as new mainstream technique for the evaluation of patients with cardiac diseases, providing unique information to support clinical decision-making. This document has been developed by a joined group of experts of the Italian Society of Cardiology and Italian society of Radiology and aims to produce an updated consensus statement about the current state of technology and clinical applications of CMR. The writing committee consisted of members and experts of both societies who worked jointly to develop a more integrated approach in the field of cardiac radiology. Part 1 of the document will cover ischemic heart disease, congenital heart disease, cardio-oncology, cardiac masses and heart transplant.

scholarly journals Development of clinical guidelines for service provision of functional electrical stimulation to support walking: mixed method exploration of stakeholder views

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
C Bulley ◽  
C Meagher ◽  
T Street ◽  
A Adonis ◽  
C Peace ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Clinical Guidelines ◽  
Service Provision ◽  
Clinical Guideline ◽  
Service Providers ◽  
Delphi Consensus ◽  
Stakeholder Views ◽  
Key Stakeholders ◽  
The Uk

Abstract Background Over the past 20 years Functional Electrical Stimulation (FES) has grown in clinical use to support walking in people with lower limb weakness or paralysis due to upper motor neuron lesions. Despite growing consensus regarding its benefits, provision across the UK and internationally is variable. This study aimed to explore stakeholder views relating to the value of a clinical guideline focusing on service provision of FES to support walking, how people might use it and what should be included. Methods A mixed methods exploration sought the views of key stakeholders. A pragmatic online survey (n = 223) focusing on the study aim was developed and distributed to the email distribution list of the UK Association for Chartered Physiotherapists Interested in Neurology (ACPIN). In parallel, a qualitative service evaluation and patient public involvement consultation was conducted. Two group, and seven individual interviews were conducted with: FES-users (n = 6), their family and carers (n = 3), physiotherapists (n = 4), service providers/developers (n = 2), researchers (n = 1) and distributors of FES (n = 1). Descriptive analysis of quantitative data and framework analysis of qualitative data were conducted. Results Support for clinical guideline development was clear in the qualitative interviews and the survey results. Survey respondents most strongly endorsed possible uses of the clinical guideline as ensuring best practice and supporting people seeking access to a FES service. Data analysis and synthesis provided clear areas for inclusion in the clinical guidelines, including current research evidence and consensus relating to who is most likely to benefit and optimal service provision as well as pathways to access this. Specific areas for further investigation were summarised for inclusion in the first stage of a Delphi consensus study. Conclusions Key stakeholders believe in the value of a clinical guideline that focuses on the different stages of service provision for FES to support walking. A Delphi consensus study is being planned based on the findings.

scholarly journals Analysis of Sociodemographic and Clinical Factors Associated with Hospitalized Stroke Patients of Bangladesh

1970 ◽  
Vol 6 (1) ◽  
pp. 19-23 ◽  
Author(s):  
AM Hossain ◽  
NU Ahmed ◽  
M Rahman ◽  
MR Islam ◽  
G Sadhya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Low Income ◽  
Heart Diseases ◽  
Previous History ◽  
Stroke Patients ◽  
College Hospital ◽  
Cross Sectional ◽  
History Of

A hospital based cross sectional study was carried out to analyze prevalence of risk factors for stroke in hospitalized patient in a medical college hospital. 100 patients were chosen using purposive sampling technique. Highest incidence of stroke was between the 6th and 7th decade. Patients came from both urban (54%) and rural (46%) areas and most of them belong to the low-income group (47%). In occupational category; service holder (28%) and retired person (21%) were the highest groups. Most of the study subjects were literate (63%). CT scan study revealed that the incidence of ischaemic stroke was 61% and haemorrhagic stroke 39%. Analysis indicated hypertension as major risk factor for stroke (63%) and major portion of the patients (42.85%) were on irregular or no treatment. Twenty four percent of the patients had heart diseases and out of 24 patients 45.83% were suffering from ischaemic heart disease. The present study detected diabetes in 21% patients. Fifty three percent of the study subjects were smoker, 39% patients had habit of betelnut chewing. Out of 26 female patients, only 23% had history of using oral contraceptives. Majority of the patients were sedentary workers (46%). Thirty seven percent of the stroke patients were obese. Among the stroke patients 9% had previous history of stroke and 3% had TIA respectively. Most of the patients (21%) were awake while they suffered from stroke and the time of occurrence was mostly in the afternoon (46%). This study found that hypertension, cigarette smoking, ischaemic heart disease and diabetes mellitus are the major risk factors prevalent in our community while other risk factors demand further study. Key words: stroke; risk factors; hospitalized patients; Bangladesh. DOI: 10.3329/fmcj.v6i1.7405 Faridpur Med. Coll. J. 2011;6(1): 19-23

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