From Clinical Practice Guidelines to Computer-interpretable Guidelines

2010 ◽  
Vol 49 (06) ◽  
pp. 550-570 ◽  
Author(s):  
H. Tange ◽  
H. J. van den Herik ◽  
A. Hasman ◽  
A. Latoszek-Berendsen
Keyword(s):  
Guideline Development ◽  
Dissemination And Implementation ◽  
High Quality ◽  
Safety Issues ◽  
Quality Guidelines ◽  
Guideline Dissemination ◽  
Critical Requirement ◽  
The Moment ◽  
The Many

Summary Background: Guidelines are among us for over 30 years. Initially they were used as algorithmic protocols by nurses and other ancillary personnel. Many physicians regarded the use of guidelines as cookbook medicine. However, quality and patient safety issues have changed the attitude towards guidelines. Implementing formalized guidelines in a decision support system with an interface to an electronic patient record (EPR) makes the application of guidelines more personal and therefore acceptable at the moment of care. Objective: To obtain, via a literature review, an insight into factors that influence the design and implementation of guidelines. Methods: An extensive search of the scientific literature in PubMed was carried out with a focus on guideline characteristics, guideline development and implementation, and guideline dissemination. Results: We present studies that enable us to explain the characteristics of high-quality guidelines, and new advanced methods for guideline formalization, computerization, and implementation. We show how the guidelines affect processes of care and the patient outcome. We discuss the reasons of low guideline adherence as presented in the literature and comment upon them. Conclusions: Developing high-quality guidelines requires a skilled team of people and sufficient budget. The guidelines should give personalized advice. Computer-interpretable guidelines (CIGs) that have access to the patient’s EPR are able to give personal advice. Because of the costs, sharing of CIGs is a critical requirement for guideline development, dissemination, and implementation. Until now this is hardly possible, because of the many models in use. However, some solutions have been proposed. For instance, a standardized terminology should be imposed so that the terms in guidelines can be matched with terms in an EPR. Also, a dissemination model for easy updating of guidelines should be established. The recommendations should be based on evidence instead of on consensus. To test the quality of the guideline, appraisal instruments should be used to assess the guideline as a whole, as well as checking the quality of the recommendations individually. Only in this way optimal guideline advice can be given on an individual basis at a reasonable cost.

scholarly journals STANDARDIZATION AS AN APPROACH TO IMPROVING THE QUALITY OF CLINICAL AND LABORATORY WORK

2019 ◽  
Vol 31 (4) ◽  
pp. 1143-1147
Author(s):  
Denitsa Trancheva
Keyword(s):  
Medical Care ◽  
Healthcare System ◽  
Clinical Laboratory ◽  
Healing Process ◽  
Optimal Level ◽  
Optimal Order ◽  
Dissemination And Implementation ◽  
Regulatory Document ◽  
High Quality

Standardization is defined as an activity that regulates the general and repetitive application of a system of prescriptions on different (including specific) issues in order to achieve optimal order in certain circumstances. It involves the creation, dissemination and implementation of standards aimed at improving the common properties (quality, suitability, etc.) of products, processes and services. Standards are documents that contain rules, norms, and requirements for a product or service, in order to achieve better efficiency and meet the expectations of consumers and customers. Standards are means of information, serving to improve quality, to support the economic development and contributing to the benefit of the whole Society. The term ‘Standard’ is at the core of the standardization process. Applied to the health system, the standard is a regulatory document developed on the basis of different consensus and validated by a relevant body. This regulatory document establishes a set of rules and requirements concerning different types of medical activities and the results of their implementation. An important objective of each healthcare system is to provide the population with accessible, quality and safe medical care. The introduction of a system of standards in healthcare and in medicine, in particular, is a powerful tool for its achievement. This ensures high quality of the medical assistance offered, a rational use of financial, material and personnel resources as well as an optimization of the diagnostic and healing process. Standards set a minimum/optimal level of Quality Assurance through mandatory requirements that are the basis of State guarantees for affordable medical care, range and types of health services, lists of specific technologies with proven effectiveness, as well as guidelines to further improve the level of quality by formulating further scientifically substantiated recommendations. Standards allow for aggregation of information, which leads to optimization of solutions at all levels in the healthcare system. Standardization is one of the main means of achieving and maintaining the necessary level and one of the main tools in Quality Management. In laboratory medicine, standardization is an approach for the optimization of clinical and laboratory activities. The provision of high quality services is the responsibility of every professional working in the respective diagnostic structure. The quality and standardization in the Specialization of “Clinical Laboratory” are focused not only on the accuracy of laboratory results, but also they step on a broader basis, including each stage of the clinical and laboratory analysis, in order to make important medical decisions subject to patient care.

scholarly journals Appraisal of the Current Guidelines for Management of Malignant Left-Sided Colonic Obstruction Using the Appraisal of Guidelines Research and Evaluation II Instrument

2021 ◽  
pp. 1-9
Author(s):  
Paschalis Gavriilidis ◽  
Alan Askari ◽  
Nicola de’Angelis ◽  
Efstratios P. Gavriilidis ◽  
James Wheeler ◽  
...  
Keyword(s):  
Guideline Development ◽  
Colonic Obstruction ◽  
High Quality ◽  
Agree Ii ◽  
Guideline Quality ◽  
Domain V ◽  
Domain I ◽  
Current Guidelines ◽  
Agree Ii Instrument

Introduction: Colorectal cancer (CRC) is the fourth leading cause of death with 1.4 million new cases occurring annually worldwide. High-quality clinical practice guidelines are needed to tailor high-quality individualized treatment. The aim of the present study was to evaluate the methodological quality of the current guidelines for the management of acute malignant left-sided colonic bowel obstruction. Methods: A systematic search of the literature was carried out using electronic databases. The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was used to assess the quality of each guideline. Results: Search results returned a total of 14 guidelines appropriate for assessment. Both domain I (scope and purpose) and domain VI (editorial independence) were assessed with the same median score of 83%. The lowest scoring domain was domain V (applicability), scoring only 43%. The 2 guidelines that had the highest score were the National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN), each scoring 100%. However, there were significant variations in terms of quality. The NICE and New Zealand guidelines were voted unanimously for use unchanged, whilst 8 other guidelines were voted for use with modifications. Conclusion: Variation in guideline quality in CRC is a concern despite some clearly excellent published guidelines. All guidelines score poorly when it comes to describing how the guidelines could be applied. Lack of patient participation in guideline development is also a shortcoming that requires urgent redress.

scholarly journals Canadian Thoracic Society: Presenting a New Process for Clinical Practice Guideline Production

2009 ◽  
Vol 16 (6) ◽  
pp. e62-e68 ◽  
Author(s):  
Samir Gupta ◽  
Onil K Bhattacharyya ◽  
Melissa C Brouwers ◽  
Elizabeth A Estey ◽  
Margaret B Harrison ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Evaluation System ◽  
Guideline Development ◽  
Local Context ◽  
Dissemination And Implementation ◽  
Evaluation Instrument ◽  
Assessment Development ◽  
New Process ◽  
Review Cycle

A key mandate of the Canadian Thoracic Society (CTS) is to promote evidence-based respiratory care through clinical practice guidelines (CPGs). To improve the quality and validity of the production, dissemination and implementation of its CPGs, the CTS has revised its guideline process and has created the Canadian Respiratory Guidelines Committee to oversee this process. The present document outlines the basic methodological tools and principles of the new CTS guideline production process. Important features include standard methods for choosing and formulating optimal questions and for finding, appraising, and summarizing the evidence; use of the Grading of Recommendations Assessment, Development and Evaluation system for rating the quality of evidence and strength of recommendations; use of the Appraisal of Guidelines for Research and Evaluation instrument for quality control during and after guideline development and for appraisal of other guidelines; use of the ADAPTE process for adaptation of existing guidelines to the local context; and use of the GuideLine Implementability Appraisal tool to augment implementability of guidelines. The CTS has also committed to develop guidelines in new areas, an annual guideline review cycle, and a new formal process for dissemination and implementation. Ultimately, it is anticipated that these changes will have a significant impact on the quality of care and clinical outcomes of individuals suffering from respiratory diseases across Canada.

scholarly journals A demonstration of using formal consensus methods within guideline development; a case study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
P. Carter ◽  
K. J. M. O’Donoghue ◽  
K. Dworzynski ◽  
L. O’Shea ◽  
V. Roberts ◽  
...  
Keyword(s):  
Decision Making ◽  
Parenteral Nutrition ◽  
Group Decision Making ◽  
Group Decision ◽  
Guideline Development ◽  
Consensus Methods ◽  
Limited Evidence ◽  
High Quality ◽  
Quality Guidelines

Abstract Background Recommendations within guidelines are developed by synthesising the best available evidence; when limited evidence is identified recommendations are generally based on informal consensus. However, there are potential biases in group decision making, and formal consensus methods may help reduce these. Methods We conducted a case study using formal consensus, to develop one set of recommendations within the Neonatal Parenteral Nutrition guideline being produced for the National Institute for Health and Care Excellence. Statements were generated through identification of published guidelines on several topics relating to neonatal parenteral nutrition. Ten high quality guidelines were included, and 28 statements were generated; these statements were rated by the committee via two rounds of voting. The statements which resulted in agreement were then used to develop the recommendations. Results The approach was systematic and provided transparency. Additionally, a number of lessons were learnt; including the value of selecting the appropriate topic, giving adequate time to the process, and ensuring methodologies are understood by the committee for their value and relevance. Conclusion Formal consensus is a valuable option for use within guideline development when specific criteria are met. The approach provides transparent methodology, ensuring clarity on how recommendations are developed.

Accuracy of French census population estimates

2021 ◽  
pp. 1-20
Author(s):  
Lionel Espinasse ◽  
Vincent Le Palud ◽  
Julie Prévot ◽  
Gwenna ël Solard ◽  
Lucile Vanotti
Keyword(s):  
Response Rate ◽  
Process Development ◽  
Real Life ◽  
Population Estimates ◽  
Population Census ◽  
High Quality ◽  
The Many ◽  
Extensive Involvement ◽  
Quality Of The Population

The French population census method evolved in the early 2000s. Few studies have been published on the quality of the population estimates produced by this new method, apart from a few observing sample variance resulting from the introduction of a survey in large municipalities. However, the French census is subject to numerous quality controls throughout the process: development of a housing register, preparation of the collection, the collection itself and the post-collection, adjustment and estimation operations. The extensive involvement of stakeholders (municipalities and INSEE) in the preparation and conduct of the census leads to a very good understanding of the process. The many checks carried out throughout the process guarantee that the estimates produced are of a high quality. In addition, the census benefits from a very low non-response rate (3.9% in 2019). However, some features are not yet well known. Although many instructions are included in questionnaires, the answers given by enumerated persons are imperfect due to misunderstandings, an inability to adapt questions to real-life situations, or deliberately incorrect answers.

PROTECTION OF THE INFANT DIET: GOVERNMENT AND INDUSTR

PEDIATRICS ◽  
1965 ◽  
Vol 36 (4) ◽  
pp. 648-657
Author(s):  
Charles U. Lowe ◽  
David B. Coursin ◽  
George N. Donnell ◽  
Felix P. Heald ◽  
Robert Kaye ◽  
...  
Keyword(s):  
Medical Profession ◽  
Federal State ◽  
Market Place ◽  
High Quality ◽  
Governmental Agencies ◽  
Spot Check ◽  
Food And Nutrition ◽  
Minimum Requirements ◽  
The Many

Only a very small percentage of American and Canadian families produce all their own food. Under the circumstances, over 200 million people and close to 5 milion infants are dependent, to a greater or lesser extent, upon codes, ordinances, and laws enacted to insure that produce in the market place is sound, wholesome, and free of noxious or toxic contaminants. In most instances, neither the consuming public nor the medical profession is aware of the complex and comprehensive nature of the regulatory network which controls the quality of the food supply. Various governmental agencies, federal, state, provincial in Canada, and municipal, provide minimum standards of quality for food and nutritional products and promulgate codes governing manufacturing procedures. Some codes have the force of law whereas others are prepared as guides, particularly for those industries manufacturing food which does not enter interstate commernce, and compliance may be voluntary unless local legislation exists to enforce these codes. Compliance with these standards is determined both by governmental agencies and manufacturers using selective sampling and assay of products at various stages prior to marketing. However, governmental agencies are able to spot check only a small number of the many lots of products and foods under their jurisdiction. The high quality of today's commodity foods and nutritional products has resulted in large part from widespread compliance, self-policing, and desire by industry to surpass the minimum requirements set by law and to provide the consumer with superior products. Through the full co-operation of industry with governmental agencies, a great number and variety of food and nutrition products of high quality and uniformity is available to the consumer, and especially to the infant.

Exploring Quality Assurances

2022 ◽  
pp. 26-42
Author(s):  
Vimbi Petrus Mahlangu ◽  
Mpipo Zipporah Sedio
Keyword(s):  
Higher Education ◽  
Quality Assurance ◽  
Literature Review ◽  
Higher Education Institutions ◽  
Qualitative Approach ◽  
High Quality ◽  
Education Standards ◽  
High Quality Education ◽  
Critical Requirement

The purpose of this chapter is to argue that higher education institutions (HEIs) in doing quality assurance (QA) must focus on the critical aspects of quality assurance, the need to look at the advantages, disadvantages, and challenges facing HEIs regarding quality assurance. It is assumed that institutions should carry out quality assurance and accreditation processes for stakeholders to have confidence in them. It also explains in detail what quality assurance and accreditation must entail in higher education institutions (HEIs). The need to maintain high-quality education standards becomes a critical requirement for HEIs to remain competitive in the education sector market. This chapter follows a qualitative approach in exploring quality assurance and accreditation in HEIs. Data will be collected through literature review. Quality assurance and accreditation in HEIs must aim to maintain and raise the quality of education and to guarantee the improvement of its standards.

scholarly journals Effectiveness and efficiency of guideline dissemination and implementation strategies

2005 ◽  
Vol 21 (1) ◽  
pp. 149-149 ◽  
Author(s):  
J. M. Grimshaw ◽  
R. E. Thomas ◽  
G. MacLennan ◽  
C. Fraser ◽  
C.R. Ramsay ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Guidelines ◽  
Guideline Development ◽  
Implementation Strategies ◽  
Dissemination And Implementation ◽  
Guideline Dissemination ◽  
Effectiveness And Efficiency

Objectives: A systematic review of the effectiveness and costs of different guideline development, dissemination, and implementation strategies wasundertaken. The resource implications of these strategies was estimated, and a framework for deciding when it is efficient to develop and introduce clinical guidelines was developed.

scholarly journals Impact of storage temperature and time on Moldavian dragonhead oil – spectroscopic and chemometric analysis

2019 ◽  
Vol 17 (1) ◽  
pp. 609-620
Author(s):  
Tomasz Oniszczuk ◽  
Arkadiusz Matwijczuk ◽  
Alicja Matwijczuk ◽  
Sławomir Kocira ◽  
Agnieszka Niemczynowicz ◽  
...  
Keyword(s):  
Storage Temperature ◽  
Chemometric Analysis ◽  
Ftir Spectra ◽  
High Quality ◽  
Long Term Storage ◽  
Innovative Methods ◽  
High Durability ◽  
The Moment

AbstractMoldavian dragonhead (Dracocephalum moldavica L.) is a plant endemic to Asia where it has been used for centuries for the production of essential oils. With the constantly growing demand for vegetable fats it is necessary to find new methods of ensuring their high quality from the moment of production until their eventual purchase by the consumer. Correct assessment of the quality of oleaginous products is therefore one of the intensively explored scientific problems that stimulates the development of innovative methods of analysing such substances. One of the newer and, most importantly, faster alternatives in the context of analysing the quality of oil and the changes it undergoes during storage is offered by FTIR spectroscopy (Fourier-Transform Infrared spectroscopy). By measuring the relevant FTIR spectra, we were able to observe clear discrepancies in the intensity of bands characteristic of the aging processes taking place in the oleaginous samples due to the oxidation of their fat fractions. The chemometric analysis of FTIR spectra confirmed the high quality of the analysed oils. It is noteworthy that the analysed samples of Moldavian dragonhead oil did not show particularly extensive changes in terms of their FTIR spectra during long-term storage. It confirms their high durability and usability in food production as an excellent product. This is valuable information in order to make progress in the use of Moldavian dragonhead oil in food products.

CHARACTERISTICS OF HIGH-QUALITY GUIDELINES

2003 ◽  
Vol 19 (1) ◽  
pp. 148-157 ◽  
Author(s):  
Jako S. Burgers ◽  
Françoise A. Cluzeau ◽  
Steven E. Hanna ◽  
Claire Hunt ◽  
Richard Grol
Keyword(s):  
Guideline Development ◽  
Quality Criteria ◽  
Professional Organizations ◽  
Publication Type ◽  
High Quality ◽  
Care Level ◽  
Governmental Agencies ◽  
Quality Guidelines ◽  
Treatment Type ◽  
Guideline Program

Objectives: To identify predictors of high-quality clinical practice guidelines.Methods: A total of 86 guidelines from 11 countries were assessed by four independent appraisers per guideline using the AGREE instrument (23 items). Six aspects of guideline development were considered to explain the variation in quality scores: care level (primary/secondary care), scope (diagnosis/treatment), type of guideline (new/update), year of publication, type of agency (governmental/professional), and whether the guideline was produced within a structured and coordinated program.Results: Guidelines produced within a guideline program and by governmental agencies had higher scores than their counterparts. Differences in the applicability of the guidelines could not be explained by the variables studied.Conclusions: To ensure high quality, clinical guidelines should be produced within a structured and coordinated program. Professional organizations or specialist societies that aim to develop guidelines may adopt quality criteria from leading guideline agencies.

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