Shared care – current aspects
Peter Edwards, Stephen Jones, Dennis Shale, Mark Thursz in Shared Care, 2018
As implied already, guidelines may be unpopular for a variety of reasons. Their development and implementation can lead to considerable sensitivity on the part of the medical profession. A useful definition is ‘clinical guidelines are systematically developed statements which assist in decision making about appropriate health care for specific clinical conditions. It is recommended that the term “clinical guideline” should apply to the general statement of principle and that the word “protocol” should cover the more detailed development of these broad principles for local application’.44 However difficult the issues of development are, those of implementation are even greater.41 The professional barriers range from ‘lack of time’, through ‘lack of ownership’, to ‘loss of clinical freedom’. Other fundamental criticisms include: guidelines are intellectually suspect and reflect expert opinion, which may formalize unsound practiceby reducing medical practice variation they may standardize to an average rather than to the bestthey inhibit innovation and prevent individual cases from being dealt with discretelymedical legal issues are important as they may be taken to indicate standards expected of a competent colleague.
Evidence-Based Medicine
Anthony R. Mundy, John M. Fitzpatrick, David E. Neal, Nicholas J. R. George in The Scientific Basis of Urology, 2010
Modern clinical guidelines identify, summarize, and evaluate the best evidence and most current data about prevention, diagnosis, prognosis, therapy, risk benefit, and cost-effectiveness. They should define the most important questions related to clinical practice and identify all possible decision options and their outcomes (Fig. 8). Some guidelines contain decision or computation algorithms to be followed. Thus, they integrate the identified decision points and respective courses of action to the clinical judgment and experience of practitioners. Many guidelines place the treatment alternatives into classes to help providers in deciding which treatment to use. Additional objectives of clinical guidelines are to standardize medical care, to raise quality of care, to reduce several kinds of risk (to the patient, to the health care provider, to medical insurers, and health plans), and to achieve the best balance between cost and effectiveness. It has been demonstrated repeatedly that the use of guidelines by health care providers such as hospitals is an effective way of improving patient care.
Research in the clinical setting
Robert Jones, Fiona Jenkins in Managing and Leading in the Allied Health Professions, 2021
Clinical guidelines are a growing and integral part of evidence-based practice. Guidelines consist of a set of systematically developed statements aimed at assisting the practitioner and the patient in making appropriate decisions about individual healthcare. The key features of guideline developments include the rigorous and systematic searching, reading and appraisal of the evidence and taking into account the hierarchy of evidence. Also integral to guideline development is the consideration of what the implications of the evidence are for clinical practice, i.e. is the evidence relevant for a local population or specific circumstances? It also involves weighing up the strength of the evidence and assessing the benefits, risks, costs and possible harm of implementing the evidence into practice. Clinical guidelines should provide a tool containing a description of the best available evidence and recommendations for practice and a resource for patients providing the basis for patient/clinician shared decision making. Guidelines should be used and interpreted locally in order to improve patient care. For a detailed explanation of evidence-based practice, the reader is referred to Herbert et al., 2005.19
Capacity Building for Health Care Workers and Support Staff in Pediatric Emergency Triage Assessment and Treatment (ETAT) at Primary Health Care Level in Resource Limited Settings: Experiences from Malawi
Published in Comprehensive Child and Adolescent Nursing, 2022
Maureen Daisy Majamanda, Mtisunge Joshua Gondwe, Thomasena O’Byrne, Martha Makwero, Alfred Chalira, Norman Lufesi, Queen Dube, Nicola Desmond
Effective delivery of any training requires a guideline to ensure all relevant content is covered. Clinical guidelines are a vital tool for health practitioners in improving the quality of health care delivery across various clinical situations (Farquhar et al., 2002; Reddy et al., 2015). The process of reviewing and developing the training manuals involved experts from the field of pediatrics and child health from different sectors. These experts formed a working group as they represented all those that would implement the guidelines (Maher & Ford, 2017). The training manual acts as a reference guide in how content should be organized and delivered to a group of participants. McLachlan et al. (2020) assert that clinical guidelines standardize care and enable delivery of evidence-based practice. When successfully implemented, clinical guidelines decrease variation within the everyday clinical practice and, as a result, optimize the health of the patients and communities in which the guidelines have been adopted (Reddy et al., 2015).
Adherence of physical therapy with clinical practice guidelines for the rehabilitation of stroke in an active inpatient setting
Published in Disability and Rehabilitation, 2019
Ajimsha M. S., Smithesh Kooven, Noora Al-Mudahka
Clinical guidelines are systematically developed statements designed to help practitioners and patients to make decisions about appropriate health care. This audit provides an overall picture of the current adherence of physical therapy assessment and management with the physical therapy after acute stroke (PAAS) guideline at a tertiary rehabilitation hospital in the state of Qatar. Given the evidence that implementation of clinical guidelines leads to better quality of care and improved outcomes for patients with Stroke, it is important to improve the adherence of physical therapists involved in stroke rehabilitation towards recommended guidelines. An evaluation of the guideline adherence and practice variations helps to fine tune the Physical therapy care to a highest possible standard of practice. Proper assessments of the relationship between the process of physical therapy care and outcomes with a comprehensive set of process indicators are highly suggested. Despite the fact that the overall adherence of the guideline-based physical therapy practice was respectable, some key areas might be further stepped forward, especially in regions in which the adherence have been least however the evidence are robust.
A synthesis and appraisal of clinical practice guidelines, consensus statements and Cochrane systematic reviews for the management of focal spasticity in adults and children
Published in Disability and Rehabilitation, 2022
Gavin Williams, Barby J. Singer, Stephen Ashford, Brian Hoare, Tandy Hastings-Ison, Klemens Fheodoroff, Steffen Berwick, Edwina Sutherland, Bridget Hill
The purpose of clinical guidelines, recommendations and reviews is to inform and assist clinicians towards delivering best practice. However, in reality, the existence of multiple guidelines may be confusing and impede translation of evidence into clinical practice. As Table 5 demonstrates, the quality of the guidelines included in this review varied considerably. Furthermore, some guidelines contradict each other. This raises two challenges: firstly, some guidelines recommend against aspects of focal spasticity management that others endorse (Table 3), such as use of the MAS or Barthel Index. Secondly, recommendations in specific spasticity guidelines are not necessarily aligned with other condition-specific guidelines. This first challenge can be addressed by the generation of a summary of the most common guideline recommendations as outlined in this review.
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