NCCN Guidelines for Survivorship Expanded to Address Two Common Conditions

2014 ◽  
Vol 12 (5S) ◽  
pp. 825-827 ◽  
Author(s):  
Elizabeth Kvale ◽  
Susan G. Urba
Keyword(s):  
Clinical Trials ◽  
Cognitive Impairment ◽  
Clinical Practice ◽  
Peripheral Neuropathy ◽  
Cancer Pain ◽  
Practice Guidelines ◽  
Strong Evidence ◽  
Evidence Based ◽  
Nccn Guidelines

The NCCN Clinical Practice Guidelines in Oncology for Survivorship include a new section on cancer-associated cognitive impairment and an expanded section on adult cancer pain that more completely addresses chemotherapy-induced peripheral neuropathy. These additions to the guidelines are the result of increasing awareness that long-term cancer survivors struggle with many late effects. Both the assessment and the management of cognitive impairment still lack a strong evidence-based foundation. The management of peripheral neuropathy, including the use of anti-depressants and opioids, often in combination, is backed by data primarily derived from clinical trials performed for various types of peripheral neuropathy.

A Commentary on the Complexity of Tinnitus Management

2011 ◽  
Vol 34 (4) ◽  
pp. 421-428 ◽  
Author(s):  
Grant Searchfield
Keyword(s):  
Clinical Practice ◽  
Practice Guidelines ◽  
Strong Evidence ◽  
Clinical Guidelines ◽  
Evidence Based ◽  
Current State ◽  
High Level

There is a desire among many tinnitus researchers and clinicians for greater standardization in the assessment and management of tinnitus. In their commentary on the complexity of tinnitus, Hoare et al. have highlighted the need for strong evidence-based protocols. The authors make many valid and important conclusions as to the current state of clinical guidelines; they identify clear gaps in evidence and limited consensus as to clinical practice. While I agree with the bulk of their commentary there are a few areas where I will offer a counter view. In particular I will address their view that only high-level evidence has a place in forming practice guidelines for tinnitus.

scholarly journals The Shortcomings of Clinical Practice Guidelines

Cardiology ◽  
2015 ◽  
Vol 130 (3) ◽  
pp. 187-200 ◽  
Author(s):  
Konstantinos Dean Boudoulas ◽  
Carl V. Leier ◽  
Paraschos Geleris ◽  
Harisios Boudoulas
Keyword(s):  
Clinical Trials ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Randomized Clinical Trials ◽  
Medical Knowledge ◽  
Long Term Effects ◽  
New Research ◽  
Lost In Translation

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.

Symptoms and clinical relevance: A dilemma for clinical trials on prevention of venous thromboembolism

2013 ◽  
Vol 109 (04) ◽  
pp. 585-588 ◽  
Author(s):  
Giancarlo Agnelli ◽  
Henri Bounameaux
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Trials ◽  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Relevance ◽  
Evidence Based ◽  
Fatal Pulmonary Embolism ◽  
Surrogate Outcome

SummaryThe outcomes of thromboprophylactic trials have been debated for decades. Recently, the 9th edition of the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines based their strong recommendations only on patient-important outcomes. Practically, symptoms were considered the crucial element. Consequently, studies that primarily aimed at reducing venographic thrombi were considered less pertinent than studies that focused on symptomatic thrombosis. In the present viewpoint, we challenge the argument that “symptomatic” and “clinically relevant” are interchangeable. In particular, the case is made that asymptomatic events may be clinically relevant and that asymptomatic venographically detected thrombosis is a clinically relevant surrogate outcome for fatal pulmonary embolism.

scholarly journals National Comprehensive Cancer Network: Global Utilization of Clinical Oncology Guidelines

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 89s-89s
Author(s):  
R. Carlson ◽  
C. Donnelly ◽  
K. Winckworth-Prejsnar ◽  
J. Bacigalupo ◽  
J. McClure
Keyword(s):  
Clinical Practice ◽  
Clinical Oncology ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Medical Oncology ◽  
Evidence Based ◽  
Nccn Guidelines ◽  
The Us ◽  
Strongly Agree ◽  
Cancer Network

Background: The global influence and demand for clinical oncology guidelines is increasing. National Comprehensive Cancer Network (NCCN), American Society of Clinical Oncology (ASCO), European Society of Medical Oncology (ESMO), and various other organizations develop clinical oncology guidelines, which are used across regions to provide evidence-based recommendations for the management of cancer.1 Aim: To identify and analyze utilization trends of clinical oncology guidelines outside the US. Methods: In 2017, NCCN distributed an electronic survey to 212,423 registered users of the NCCN Web site outside the US through a third party software. Participants were prompted to respond to the following statement “I consult the following guidelines regularly: (Select all that apply).” Options included several clinical oncology guidelines, as well as the option “I do not regularly consult clinical oncology guidelines.” The survey also included the following query: “In my opinion, the NCCN Guidelines are: (select one per row).” The survey then listed several descriptors and the respondents were asked to select strongly agree, agree, no opinion, disagree, or strongly disagree for each one. Results: NCCN received 1698 responses to the survey from oncology professionals outside of the US. Of this pool, 82% of respondents identified as physicians and 18% were other oncology professionals. Of respondents to the first query (n=1190), 89% selected the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines), 55% ESMO Clinical Practice Guidelines, 50% ASCO Guidelines, 20% National Institute for Health and Care Excellence (NICE) guidelines, 15% local, national, or other oncology guidelines, 11% Sociedad Española de Oncología Médica (SEOM), 8% Cancer Care Ontario Guidelines, 7% Multinational Association of Supportive Care in Cancer (MASCC), 6% Japanese Society of Medical Oncology Clinical Guidelines, and 6% do not regularly consult clinical oncology guidelines. In response to the second query (n=1392), more than 90% of respondents outside of the US “strongly agree” or “agree” that the NCCN Guidelines are useful in patient care decision-making, a reliable reference, up-to-date, objective and balanced, evidence-based, and helpful in clinical teaching. Conclusion: Based on data presented, NCCN Guidelines are consulted more frequently than any other clinical oncology guideline outside the US. Previous research indicates similar utilization trends. We believe, in part, healthcare professionals outside the US consult the NCCN Guidelines frequently due to the descriptors listed in the survey results. Additional research is needed to identify the synergies between the relevance of international clinical oncology guidelines and local utilization trends to better serve the needs of patients globally.

scholarly journals European evidence-based recommendations for clinical assessment of upper limb in neurorehabilitation (CAULIN): data synthesis from systematic reviews, clinical practice guidelines and expert consensus

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Gerdienke B. Prange-Lasonder ◽  
Margit Alt Murphy ◽  
Ilse Lamers ◽  
Ann-Marie Hughes ◽  
Jaap H. Buurke ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Upper Limb ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Assessment ◽  
Strong Evidence ◽  
Expert Consensus ◽  
Evidence Based ◽  
Core Set ◽  
Assessment Procedures

Abstract Background Technology-supported rehabilitation can help alleviate the increasing need for cost-effective rehabilitation of neurological conditions, but use in clinical practice remains limited. Agreement on a core set of reliable, valid and accessible outcome measures to assess rehabilitation outcomes is needed to generate strong evidence about effectiveness of rehabilitation approaches, including technologies. This paper collates and synthesizes a core set from multiple sources; combining existing evidence, clinical practice guidelines and expert consensus into European recommendations for Clinical Assessment of Upper Limb In Neurorehabilitation (CAULIN). Methods Data from systematic reviews, clinical practice guidelines and expert consensus (Delphi methodology) were systematically extracted and synthesized using strength of evidence rating criteria, in addition to recommendations on assessment procedures. Three sets were defined: a core set: strong evidence for validity, reliability, responsiveness and clinical utility AND recommended by at least two sources; an extended set: strong evidence OR recommended by at least two sources and a supplementary set: some evidence OR recommended by at least one of the sources. Results In total, 12 measures (with primary focus on stroke) were included, encompassing body function and activity level of the International Classification of Functioning and Health. The core set recommended for clinical practice and research: Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT); the extended set recommended for clinical practice and/or clinical research: kinematic measures, Box and Block Test (BBT), Chedoke Arm Hand Activity Inventory (CAHAI), Wolf Motor Function Test (WMFT), Nine Hole Peg Test (NHPT) and ABILHAND; the supplementary set recommended for research or specific occasions: Motricity Index (MI); Chedoke-McMaster Stroke Assessment (CMSA), Stroke Rehabilitation Assessment Movement (STREAM), Frenchay Arm Test (FAT), Motor Assessment Scale (MAS) and body-worn movement sensors. Assessments should be conducted at pre-defined regular intervals by trained personnel. Global measures should be applied within 24 h of hospital admission and upper limb specific measures within 1 week. Conclusions The CAULIN recommendations for outcome measures and assessment procedures provide a clear, simple, evidence-based three-level structure for upper limb assessment in neurological rehabilitation. Widespread adoption and sustained use will improve quality of clinical practice and facilitate meta-analysis, critical for the advancement of technology-supported neurorehabilitation.

scholarly journals Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

2019 ◽  
Vol 17 (8) ◽  
pp. 977-1007 ◽  
Author(s):  
Robert A. Swarm ◽  
Judith A. Paice ◽  
Doralina L. Anghelescu ◽  
Madhuri Are ◽  
Justine Yang Bruce ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cancer Pain ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Opioid Analgesics ◽  
Nccn Guidelines ◽  
Pain Syndromes ◽  
Nonopioid Analgesics ◽  
Pain Crisis

In recent years, the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Adult Cancer Pain have undergone substantial revisions focusing on the appropriate and safe prescription of opioid analgesics, optimization of nonopioid analgesics and adjuvant medications, and integration of nonpharmacologic methods of cancer pain management. This selection highlights some of these changes, covering topics on management of adult cancer pain including pharmacologic interventions, nonpharmacologic interventions, and treatment of specific cancer pain syndromes. The complete version of the NCCN Guidelines for Adult Cancer Pain addresses additional aspects of this topic, including pathophysiologic classification of cancer pain syndromes, comprehensive pain assessment, management of pain crisis, ongoing care for cancer pain, pain in cancer survivors, and specialty consultations.

Limitations in the evidence for safe and effective medications for older people

2017 ◽  
pp. 189-194
Author(s):  
Antonio Cherubini ◽  
Graziano Onder
Keyword(s):  
Clinical Trials ◽  
Cognitive Impairment ◽  
Clinical Practice ◽  
Older Patients ◽  
Best Practice ◽  
Randomized Clinical Trials ◽  
Evidence Based ◽  
Geriatric Syndromes ◽  
Published Evidence ◽  
Based Medicine

In the last decades, evidence-based medicine has emerged as the approach to promote the best clinical practice for health problems. It collates the best published evidence, preferentially based on randomized clinical trials, to guide clinical practice. However, the growing older population challenges the evidence underpinning ‘best practice’. Many older patients are characterized by multimorbidity and polypharmacotherapy, present various degrees of functional and cognitive impairment, and are at risk of developing geriatric syndromes. For these reasons they have been almost systematically excluded from clinical trials. In addition, the results of clinical trials are difficult to apply to patients with these characteristics, given the high risk of drug–drug and drug–disease interactions. An effort to promote a greater involvement of older patients in clinical research is needed, using specific measures to facilitate the participation of complex older patients, who are representative of those treated in clinical practice.

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