Download Guideline Newsletter - NHS Greater Glasgow and Clyde

NHS Greater Glasgow and Clyde
- Clinical Librarian -
NHSGG Partnerships Guidelines Newsletter
July 2006
Welcome to the Partnerships Guidelines Newsletter. The newsletter is intended as an information tool to help you
keep up to date with developments in your area of clinical expertise and interest. It is not in any way an
expression of organisational policy. The inclusion of a guideline in this newsletter does not imply that it is used, or
should be implemented, within NHS Greater Glasgow and Clyde. Any views expressed in guidelines quoted in
the newsletter will have to be subjected to the scrutiny of your own clinical judgement. You are, however,
welcome to use the guideline newsletter to inform your practice or service development.
This newsletter covers national and international guidelines that have either been published or added to specialist
databases (such as Medline or CINAHL) in the previous month. It is divided into three sections: one for clinical
guidelines from the UK, one for clinical guidelines from international bodies and one for publications on guideline
implementation. Within the two clinical sections, there are sub-categories to make it easier for you to find the
guidelines that might be relevant to your practice.
Where available, the newsletter includes abstracts and links to online full-text versions or executive summaries of
the guidelines.
Contents
A. UK Guidelines …………………………………………………………………………………………………….
p.2
Primary Care
………………………………………………………………………………………….
Cancer Care/Palliative Care
……………………………………………………………………………….
Mental Health and Learning Disabilities …………………………………………………………………….
Dentistry
………………………………………………………………………………………….
Sexual Health, BBV and related Topics …………………………………………………………………….
Child Health
………………………………………………………………………………………….
p. 2
p. 3
p. 3
p. 3
p. 3
p. 3
B. International Guidelines ………………………………………………………………………………………….
p. 4
1.
2.
3.
4.
5.
6.
1.
2.
3.
4.
5.
6.
Primary Care
………………………………………………………………………………………….
Cancer Care/Palliative Care
…………………………………………………………………….
Mental Health and Learning Disabilities …………………………………………………………………….
Dentistry
………………………………………………………………………………………….
Sexual Health, BBV and related Topics …………………………………………………………………….
Child Health
………………………………………………………………………………………….
C. Guidelines Implementation ……………………………………………………………………………………….
p. 4
p. 8
p. 9
p. 11
p. 11
p. 12
p. 14
If you would like to obtain full text versions of any of the guidelines listed in the newsletter, please refer to the
NHSScotland e-Library where you will find most of the guidelines in full text. The e-Library is accessible to all
NHSScotland staff at http://www.elib.scot.nhs.uk. Full text access requires an ATHENS password, which can be
obtained online from the e-Library website. For those guidelines that are not available online, please fill in and
sign the document request form that is included with the newsletter and send it to the Maria Henderson Library,
Gartnavel Royal Hospital. Phone: 0141-211 3913.
1
Carsten Mandt, Clinical Librarian, NHSGG, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
A. UK Guidelines
Primary Care
Gemmell CG, Edwards DI, Fraise AP, Gould FK, Ridgway GL, Warren RE, et al. Guidelines for the
prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in
the UK. Journal of Antimicrobial Chemotherapy 57(4) 2006: 589-608.
These evidence-based guidelines have been produced after a literature review of the treatment and
prophylaxis of methicillin-resistant Staphylococcus aureus (MRSA) infection. The guidelines were further
informed by antibiotic susceptibility data on MRSA from the UK. Recommendations are given for the
treatment of common infections caused by MRSA, elimination of MRSA from carriage sites and
prophylaxis of surgical site infection. There are several antibiotics currently available that are suitable for
use in the management of this problem and potentially useful new agents are continuing to emerge.
National Institute for Clinical and Healthcare Excellence (NICE). Hypertension: management of
hypertension
in
adults
in
primary
care.
London:
NICE,
2006.
URL:
http://www.nice.org.uk/page.aspx?o=CG34 [last accessed: 04.07.2006].
National Institute for Clinical and Healthcare Excellence (NICE). The management of atrial
fibrillation. London: NICE, 2006. URL: http://www.nice.org.uk/page.aspx?o=cg36 [last accessed:
04.07.2006].
Wood D. The Joint British Societies' guidelines on prevention of cardiovascular disease. Br J
Cardiac Nursing 1(1) 2006: 12-7.
Back to the Contents page
Cancer Care/Palliative Care
National Institute for Clinical and Healthcare Excellence (NICE). Improving outcomes for people
with
brain
and
other
CNS
tumours.
London:
NICE,
2006.
URL:
http://www.nice.org.uk/page.aspx?o=csgbraincns [last accessed: 04.07.2006].
Scottish Intercollegiate Guidelines Network (SIGN). Management of oesophageal and gastric
cancer. Edinburgh: SIGN, 2006. URL: http://www.sign.ac.uk/pdf/sign87.pdf [last accessed:
05.07.2006].
If you have any comments on the above Guidelines, or would like a copy of any SIGN Guidelines, please contact
Grace Watson at Clinical Audit on 0141 211 3916 or email [email protected].
Back to the Contents page
2
Carsten Mandt, Clinical Librarian, NHSGG, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
Mental Health and Learning Disabilities
National Institute for Clinical and Healthcare Excellence (NICE). Parkinson's disease: diagnosis
and management in primary and secondary care. London: NICE, 2006. URL:
http://www.nice.org.uk/page.aspx?o=CG035 [last accessed: 04.07.2006].
Back to the Contents page
Dentistry
No relevant new guidance was published this month.
Back to the Contents page
Sexual Health, BBV and related Topics
Back to the Contents page
Child Health
No relevant new guidance was published this month.
Back to the Contents page
3
Carsten Mandt, Clinical Librarian, NHSGG, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
B. International Guidelines
Primary Care
Arnau JM, Vallano A, Lopez A, Pellise F, Delgado MJ, Prat N. A critical review of guidelines for low
back pain treatment. European Spine Journal 15(5) 2006: 543-553.
Main problem: Little is known about the methodological quality of guidelines for low back pain treatment.
We evaluated the methods used by the developers according to established standards. Methods:
PubMed, guideline databases, and the World Wide Web were used to identify guidelines. Seventeen
guidelines met the inclusion criteria: interventions for low back pain stated, recommendations based on
or explicitly linked to evidence, and English version available. Guidelines were evaluated independently
by two appraisers using a practical tool for this purpose, Users ' Guides to the Medical Literature, and the
Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Results: Thirteen guidelines
(76%) specified the most important therapies applied, but only nine (53%) included a complete
description of the target population. Explicit processes to identify, select, and combine evidence were
described in only six guidelines (35%). Few guidelines (3; 18%) explicitly considered all main outcomes
when formulating therapeutic recommendations, and none contained a process to determine the relative
value of different outcomes. Methodological criteria for grading the strength of the recommendations
varied, and were often insufficiently specified. None of the guidelines assessed the impact of uncertainty
associated with the evidence and values used. According to AGREE the quality score was highest for
the scope and purpose, and clarity and presentation domains, and lowest for editorial independence and
applicability. With regard to the recommendations, there was consensus for some of the interventions for
acute pain (analgesics and NSAIDs, maintaining physical activity, and avoiding excessive bed rest), but
explicit recommendations were lacking or ambiguous for 41% of the interventions. Most of the guidelines
did not contemplate specific recommendations for chronic pain. Conclusions: A small number of the
available guidelines for low back pain treatment achieved acceptable results for specific quality criteria.
In general, the methods to develop the guidelines' therapeutic recommendations need to be more
rigorous, more explicit and better explained. In addition, greater importance should be placed on the
recommendations for chronic pain.
Bellamy D, Bouchard J, Henrichsen S, Johansson G, Langhammer A, Reid J, et al. International
Primary Care Respiratory Group (IPCRG) Guidelines: management of chronic obstructive
pulmonary disease (COPD). Primary Care Respiratory Journal 15(1) 2006: 48-57.
COPD is a common and under-diagnosed disease which is increasing in prevalence worldwide. A more
aggressive and optimistic approach must be adopted towards its management in primary care. This
IPCRG Guideline on the management of COPD in primary care is fully consistent with GOLD guidelines.
It highlights the goals of COPD treatment and the need for spirometric testing to make the diagnosis. It
covers the classification of the disease according to disease severity, non-pharmacologic therapy
including smoking cessation, avoidance of risk factors, patient education, pharmacologic therapy
including the use of oxygen treatment, the management of exacerbations, the role of pulmonary
rehabilitation, and the need for monitoring and ongoing care for COPD patients.
Bellido D. The overweight patient: Practical guide of intervention in primary health care. Revista
Espanola de Obesidad 4(1) 2006: 33-44.
In Spain, 54.7% of the population are overweight (39.2% excess body weight, 15.5% obesity); the
prevalence of overweight/obesity is continuously increasing. A debate and consensus forum (Foro
ACTUA), in which expert endocrinologists, psychologists and primary health care physicians
participated, has defined a practical guide of intervention aimed at primary Health Care. These
guidelines go from the definition of excess body fat and its assessment, over the aims and goals to be
set and patient motivation, to the therapeutic resources for weight reduction and their reinforcement.
Carusone SC, Loeb M, Lohfeld L. A Clinical Pathway for Treating Pneumonia in the Nursing
Home: Part II: The Administrators' Perspective and How It Differs From Nurses' Views. Journal
of the American Medical Directors Association 7(5) 2006: 279-286.
4
Carsten Mandt, Clinical Librarian, NHSGG, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
Objectives: This paper examines the utility and sustainability of a clinical pathway for treating nursing
home residents with pneumonia from the perspective of nursing administrators and medical directors in
Ontario, Canada. The discussion includes a comparison of the perspectives of the administrators and
the nursing staff (reported in part I of this article). Design: A qualitative case study design was used.
Setting: Data were collected from 6 nursing homes in Southern Ontario that were drawn from a larger
randomized controlled trial of a clinical pathway to help identify, diagnose, and manage cases of nursing
home-acquired pneumonia. Participants: Six interviews were conducted with nursing administrators and
2 with medical directors (1 per facility). Key themes were identified in the interview data using the
template style of analysis described by Miller and Crabtree. Findings: Administrators were in favor of
using a clinical pathway for identifying and treating pneumonia in nursing home residents. Participants
thought that during the study residents with pneumonia received better and more timely care, and that
nurses' clinical skills, knowledge, and confidence had improved. In comparison with views expressed by
nurses and medical directors in the same facilities, nursing administrators tended to report less clinical
training and staff support were required to successfully implement the pathway. Conclusions: Even
though nurses and administrators strongly support the use of a pneumonia clinical pathway in nursing
homes, implementation plans should be tailored to individual facilities and be informed by the
perspectives of both administrators and staff.
Carusone SC, Loeb M, Lohfeld L. A Clinical Pathway for Treating Pneumonia in the Nursing
Home: Part I: The Nursing Perspective. Journal of the American Medical Directors Association 7(5)
2006: 271-278.
Objectives: This paper examines nursing staff's perspectives on the utility and sustainability of a clinical
pathway for treating nursing home residents with pneumonia. Design: A qualitative (case study) design
was used. Setting: Data were collected from 6 nursing homes in Southern Ontario (5 from metro regions
and 1 from a nonmetro region). Nursing homes were drawn from a larger randomized controlled trial of a
clinical pathway for nursing home-acquired pneumonia conducted between 2001 and 2005. The clinical
pathway was designed to assist in the identification, diagnosis, and management of pneumonia,
including a decision tool for determining the appropriate location of treatment (hospital versus nursing
home). Participants: A total of 7 focus groups and 1 one-on-one interview were conducted between
February 2003 and May 2004. Interview data were analyzed using the template style, described by Miller
and Crabtree, to identify key themes. Findings: Nurses strongly supported the idea of the clinical
pathway and believed that providing pneumonia care in the nursing home was better for the resident. As
a result of using the clinical pathway, nurses felt that pneumonia was being identified, diagnosed, and
treated earlier, resulting in fewer hospitalizations. In addition to the benefits to resident care, the nurses
felt that their skills and knowledge also improved. Nurses generally supported the implementation of the
pathway although some concern was expressed about the additional responsibility and resources that
would entail. Conclusions: The implementation of a clinical pathway for treating pneumonia in nursing
homes and quick access to a backup clinician are desired by nurses who also believe it will result in
better care and fewer hospitalizations of residents.
Halbert RJ, Isonaka S. International Primary Care Respiratory Group (IPCRG) Guidelines:
integrating diagnostic guidelines for managing chronic respiratory diseases in primary care.
Primary Care Respiratory Journal 15(1) 2006: 13-9.
This is the first of the IPCRG Guideline papers. The IPCRG took on the task of producing an integrated
guideline for the management of chronic respiratory diseases in primary care. This included some
original work aimed at developing questionnaires suitable for improving the diagnosis and recognition of
respiratory diseases in the primary care setting. This paper provides the background evidence and
rationale for the integrated diagnostic section of the IPCRG Guideline. It focuses on identifying the
unique challenges in respiratory disease diagnosis in primary care, the use of epidemiology to build a coordinated diagnostic framework, and the development of tools to support guideline implementation.
Hertzer NR, Block PC. PAD guidelines: ACC/AHA guidelines for the management of patients
with peripheral arterial disease (lower extremity, renal mesenteric, and abdominal aortic). Acc
Cardiosource Review Journal 15(5) 2006: 14-17.
Peripheral arterial disease (PAD) encompasses a range of non-coronary arterial syndromes affecting the
arteries supplying the brain, visceral organs, and limbs. Numerous pathophysiologic processes can
contribute to the creation of stenoses or aneurysms of the noncoronary arterial circulation, but
atherosclerosis remains the most common disease process affecting the aorta and its branch arteries.
5
Carsten Mandt, Clinical Librarian, NHSGG, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
The American College of Cardiology (ACC) and a number of other organizations have released a set of
clinical guidelines addressing the diagnosis and management of atherosclerotic, aneurysmal, and
thromboembolic PAD. The document was developed by a Writing Committee whose membership
derived from the ACC, the American Heart Association, Society for Vascular Surgery, Society of
Interventional Radiology, Society for Vascular Medicine and Biology, and the Society for Cardiovascular
Angiography and Interventions. Given that the burden of PAD is widespread, the new guidelines are
intended to assist all clinicians who might provide care for such patients, including primary care
clinicians, vascular and cardiovascular specialists, and trainees in the primary care and vascular
specialties, as well as nurses, physical therapists, and rehabilitative personnel who seek clinical tools
that can improve the proper evaluation and management of patients with PAD and associated
thromboembolic disease. This is the third and last in a series of featured interviews on the new
guidelines. This one concentrates on aneurysms of the abdominal aorta, its branch vessels, and the
lower extremities.
Home P. Global Guideline for Type 2 Diabetes: Recommendations
comprehensive, and minimal care. Diabetic Medicine 23(6) 2006: 579-593.
for
standard,
The Clinical Guidelines Task Force of the International Diabetes Federation has created an evidencebased Global Guideline for the care of people with Type 2 diabetes around the world. The
recommendations developed for three levels of care (standard, comprehensive, and minimal), which can
be applied in settings with different resources, are presented here. The source document is published
elsewhere.
Inzitari D, Carlucci G. Italian Stroke Guidelines (SPREAD): Evidence and clinical practice.
Neurological Sciences 27(SUPPL. 3) 2006: S225-S227.
Evidence-based medicine's aims are to retrieve, screen and compound the best external evidence with
the experience of the physician, and to best respond to the specific medical need of each individual
patient. Clinical questions are better answered when good systematic reviews of randomised trials or
good randomised clinical trials are available. On the other hand, in a clinical scenario, difficulties in
applying the evidence may be amplified due to variability of disease conditions, feasibility of intervention
and patient's preferences. Guidelines are recommendations, based as much as possible on evidence,
aimed at supporting clinical judgement/diagnostic skills/treatment decisions in everyday practice.
Guidelines may improve the quality of care received by the patient and may contribute towards better
consistency of care in a definite geographical area. However, guidelines risk reducing physician skills to
critically appraising the evidence. In a clinical scenario, guidelines do not always provide substantial
help, especially when no conclusive evidence supports them. The Italian Stroke Guidelines (SPREAD)
have contributed towards more evidence-based and better harmonised stroke care in Italy. However, the
number of high grade recommendations in SPREAD is still limited. Professionals should not forget that
clinical decisions often reflect several issues, not only scientific ones, including personal experience,
applicability of intervention and patient's preferences.
Kressig RW, Beauchet O, Anders J, Feipel V, Freiberger E, Fruehwald T, et al. Guidelines for
clinical applications of spatio-temporal gait analysis in older adults. Aging Clinical &
Experimental Research 18(2) 2006: 174-176.
Quantifying spatio-temporal gait parameters in stationary and ambulatory geriatric settings may aid the
early identification of potential fallers, as well as the documentation of illness-specific gait disorders and
intervention-related changes in rehabilitative medicine. Bringing gait analysis out of the laboratory and
into a clinical setting is the goal of the European GAITRite network group, initiated in 2003 in Geneva. To
enhance reproducibility of gait measures and for better comparability of outcomes in clinical
environments, a consensus on data collection was formulated and presented at the 2nd European
GAITRite Meeting in Marseilles. The guidelines presented here are intended to facilitate network
collaborations and to provide guidance to clinicians who wish to implement spatio-temporal gait analysis
in clinical settings.
Larson LW, Gerbert DA, Herman LM, Leger M, McNellis R, O'Donoghue DL, et al. ACC/AHA 2005
guideline update: chronic heart failure in the adult. JAAPA/Journal of the American Academy of
Physician Assistants. 19(4) 2006: 53-6. (2 ref).
Levy ML, Fletcher M, Price DB, Hausen T, Halbert RJ, Yawn BP. International Primary Care
6
Carsten Mandt, Clinical Librarian, NHSGG, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
Respiratory Group (IPCRG) Guidelines: diagnosis of respiratory diseases in primary care.
Primary Care Respiratory Journal 15(1) 2006: 20-34.
This Diagnosis paper constitutes the second of the IPCRG Guideline papers on the management of
chronic respiratory diseases in primary care. Primary care health professionals are usually the first point
of contact for patients who can present a wide range of initial symptoms which may or may not constitute
their first presentation of a chronic disease such as asthma, COPD, or rhinitis. This paper is focussed
upon the early identification and diagnosis of chronic respiratory diseases in primary care. It uses a
symptom-based approach, and includes original questionnaires and diagnostic guides to help the
primary care clinician proceed systematically through the diagnostic process.
Lichtenstein GR, Abreu MT, Cohen R, Tremaine W. American Gastroenterological Association
Institute medical position statement on corticosteroids, immunomodulators, and infliximab in
inflammatory
bowel
disease.
Gastroenterology
130(3)
2006:
935-9.
URL:
http://www.gastrojournal.org/article/PIIS0016508506000734/fulltext [last accessed: 05.07.2006].
Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Shalet SM, Vance ML, et al. Evaluation and
treatment of adult growth hormone deficiency: an Endocrine Society Clinical Practice
Guideline. Journal of Clinical Endocrinology & Metabolism 91(5) 2006: 1621-34.
OBJECTIVE: The objective is to provide guidelines for the evaluation and treatment of adults with GH
deficiency (GHD). PARTICIPANTS: The chair of the Task Force was selected by the Clinical Guidelines
Subcommittee of The Endocrine Society (TES). The chair selected five other endocrinologists and a
medical writer, who were approved by the Council. One closed meeting of the group was held. There
was no corporate funding, and members of the group received no remuneration. EVIDENCE: Only fully
published, peer-reviewed literature was reviewed. The Grades of Evidence used are outlined in the
Appendix. CONSENSUS PROCESS: Consensus was achieved through one group meeting and emailing of drafts that were written by the group with grammatical/style help from the medical writer.
Drafts were reviewed successively by the Clinical Guidelines Subcommittee, the Clinical Affairs
Committee, and TES Council, and a version was placed on the TES web site for comments. At each
level, the writing group incorporated needed changes. CONCLUSIONS: GHD can persist from childhood
or be newly acquired. Confirmation through stimulation testing is usually required unless there is a
proven genetic/structural lesion persistent from childhood. GH therapy offers benefits in body
composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit
those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens
should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment
with a careful evaluation of the benefits and risks specific to the individual. [References: 166]
O'Byrne PM. Asthma Management Guidelines: the issue of implementation. Primary Care
Respiratory Journal 15(1) 2006: 5-6.
Tomlins R. International Primary Care Respiratory Group (IPCRG) Guidelines: dissemination
and implementation--a proposed course of action. Primary Care Respiratory Journal 15(1) 2006:
71-4.
There is growing evidence that good implementation of evidence-based guidelines can result in
improvement in health outcomes. This paper on Dissemination and Implementation constitutes the final
paper of the IPCRG Guidelines on the management of chronic respiratory diseases in primary care. It
highlights the historical development of these guidelines following the formation of the International
Primary Care Airways Group (IPAG) in 2001 together with its dissemination and implementation
subgroup, and the subsequent transfer of this dissemination and implementation role to the IPCRG. It
covers the main factors within the IPCRG workplan, including the issues of governance, launch,
dissemination, implementation, and evaluation.
Back to the Contents page
7
Carsten Mandt, Clinical Librarian, NHSGG, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
Cancer Care/Palliative Care
Arends J, Bodoky G, Bozzetti F, Fearon K, Muscaritoli M, Selga G, et al. ESPEN Guidelines on
Enteral Nutrition: Non-surgical oncology. Clinical Nutrition 25(2) 2006: 245-259.
Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the
possibility of increasing or ensuring nutrient intake in cases where normal food intake is inadequate.
These guidelines are intended to give evidence-based recommendations for the use of ONS and TF in
cancer patients. They were developed by an interdisciplinary expert group in accordance with officially
accepted standards, are based on all relevant publications since 1985 and were discussed and accepted
in a consensus conference. Undernutrition and cachexia occur frequently in cancer patients and are
indicators of poor prognosis. EN should be started if undernutrition already exists or if food intake is
markedly reduced for more than 7-10 days. Standard formulae are recommended for EN. Nutritional
needs generally are comparable to non-cancer subjects. In cachectic patients metabolic modulators
such as progestins, steroids and possibly eicosapentaenoic acid may help to improve nutritional status.
EN is indicated preoperatively for 5-7 days in cancer patients undergoing major abdominal surgery.
During radiotherapy of head/neck and gastrointestinal regions dietary counselling and ONS prevent
weight loss and interruption of radiotherapy. Routine EN is not indicated during (high-dose)
chemotherapy. The full version of this article is available at www.espen.org.
Aus G, Abbou CC, Bolla M, Heidenreich A, Schmid HP, van Poppel H, et al. EAU guidelines on
prostate cancer. European Urology 48(4) 2005: 546-51.
OBJECTIVES: The first summary of the European Association of Urology (EAU) guidelines on prostate
cancer was published in 2001. These guidelines have been continuously updated since many important
changes affecting the clinical management of patients with prostate cancer have occurred over the past
years. The aim of this paper is to present a summary of the 2005 update of the EAU guidelines on
prostate cancer. METHODS: A literature review of the new data has been performed by the working
panel. The guidelines have been updated and level of evidence/grade of recommendation added to the
text. This enables readers to better understand the quality of the data forming the basis of the
recommendations. RESULTS: A full version is available at the EAU Office or at . Systemic prostate
biopsies under ultrasound guidance is the preferred diagnostic method and the use of periprostatic
injection of a local anaesthetic can significantly reduce pain/discomfort associated with the procedure.
Active treatment (surgery or radiation) is mostly recommended for patients with localized disease and a
long life expectancy with radical prostatectomy being the only treatment evaluated in a randomized
controlled trial. Follow-up is at large based on prostate specific antigen (PSA) and a disease-specific
history with imaging only indicated when symptoms occur. Cytotoxic therapy has become an option for
selected patients with hormone refractory prostate cancer. CONCLUSION: The knowledge in the field of
prostate cancer is rapidly changing. These EAU guidelines on prostate cancer summarize the most
recent findings and put them into clinical practice.
Cancer Care Ontario (CCO). Screening for Skin Cancer: A Clinical Practice Guideline. Toronto:
CCO, 2006.URL: http://www.cancercare.on.ca/pdf/pebc15-1s.pdf [last accessed: 05.07.2006].
Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Management guidelines
for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16(2) 2006: 109-42.
Glicksman AS, Colorectal Cancer Care Task Force. Colorectal algorithm guidelines for screening.
Medicine & Health, Rhode Island 89(4) 2006.
Materstvedt L. The EAPC Ethics Task Force on Palliative Care and Euthanasia. European J
Palliative Care 13(2) 2006: 69-71.
Negrier S, Saiag P, Guillot B, Verola O, Avril MF, Bailly C, et al. Clinical practice guideline: 2005
Update of recommendations for the management of patients with cutaneous melanoma without
distant metastases (summary report). Bulletin du Cancer 93(4) 2006: 371-384.
Context: The National French federation of comprehensive cancer centres (FNCLCC) and the French
society of dermatology (SFD) initiated together the update of clinical practice guideline fur the
8
Carsten Mandt, Clinical Librarian, NHSGG, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
management of patients with cutaneous melanoma in collaboration with the French national cancer
institute and with specialists from French public universities, general hospitals and private clinics. This
work is based on the methodology developped in the 'Standards, Options and Recommendations' (SOR)
project. Objectives: To update SOR guidelines for the management of patients with cutaneous
melanome previously validated in 1998 and French melanoma consensus conference published by SFD
and ANAES in 1995. Methods: The methodology is based on a literature review and critical appraisal by
a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards,
Options and Recommendations project. Once the guidelines have been developed, they are reviewed by
independent reviewers. Results: This article is a summary version of the updated clinical practice
guidelines with algorithms. The main questions addressed by the expert group in this update concerned
(1) The new AJCC-UICC classification (2) Excision margins (3) Sentinel node biopsy (4) Adjuvant
treatments (5) Initial staging and follow up of operated patients.
Back to the Contents page
Mental Health and Learning Disabilities
Freyberger HJ, Stieglitz RD. Guidelines for diagnosis in psychiatry and psychotherapy. Zeitschrift
fur Psychiatrie, Psychologie und Psychotherapie 54(1) 2006: 23-32.
The guidelines, which have been published by different international as well as national psychiatric
associations concern primarily to specific mental disorders and secondary to treatment strategies.
Diagnostic guidelines have been introduced only as a part of the disorder-related publications.
Nevertheless the operational diagnostic systems include principles, which could be understood as
guidelines-related issues, e.g. the principle of comorbidity and the multiaxial classificatory approach.
Moreover a comprehensive diagnostic evaluation should cover dimensional approaches to describe
course-related processes and change. In this context, quality assurance approaches were described and
discussed.
Meierkord H, Boon P, Engelsen B, Gocke K, Shorvon S, Tinuper P, et al. EFNS guideline on the
management of status epilepticus. European Journal of Neurology 13(5) 2006: 445-450.
The objective of the current paper was to review the literature and discuss the degree of evidence for
various treatment strategies for status epilepticus (SE) in adults. We searched MEDLINE and EMBASE
for relevant literature from 1966 to January 2005. Furthermore, the Cochrane Central Register of
Controlled Trials (CENTRAL) was sought. Recommendations are based on this literature and on our
judgement of the relevance of the references to the subject. Recommendations were reached by
informative consensus approach. Where there was a lack of evidence but consensus was clear we have
stated our opinion as good practice points. The preferred treatment pathway for generalised convulsive
status epilepticus (GCSE) is intravenous (i.v.) administration of 4 mg of lorazepam or 10 mg of diazepam
directly followed by 15-18 mg/kg of phenytoin or equivalent fosphenytoin. If seizures continue for more
than 10 min after first injection another 4 mg of lorazepam or 10 mg of diazepam is recommended.
Refractory GCSE is treated by anaesthetic doses of midazolam, propofol or barbiturates; the
anaesthetics are titrated against an electroencephalogram burst suppression pattern for at least 24 h.
The initial therapy of non-convulsive SE depends on the type and the cause. In most cases of absence
SE, a small i.v. dose of lorazepam or diazepam will terminate the attack. Complex partial SE is initially
treated such as GCSE, however, when refractory further non-anaesthetising substances should be given
instead of anaesthetics. In subtle SE i.v. anaesthesia is required. copyright 2006 EFNS.
Menke R, Wobrock T, Weinmann S, Janssen B, Falkai P, Gaebel W. Practice guidelines in
psychiatry and psychotherapy. Zeitschrift fur Psychiatrie, Psychologie und Psychotherapie 54(1)
2006: 3-12.
Greater adherence to available guidelines in physician's diagnostic-therapeutical decision-making can
decisively contribute to opening up potentials for optimisation in psychiatry and psychotherapy. However,
studies find an often still lacking adherence to guidelines, and as well variations in quality. Against this
background, concept and methodology of guideline development by a professional association is
presented using the DGPPN as an example. From a series of projects of the German Research
Networks for Depression and Schizophrenia as well, current findings on successful strategies for
9
Carsten Mandt, Clinical Librarian, NHSGG, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
dissemination and implementation of guidelines are discussed. Available first positive results of
evaluation from these projects underline the impact with respect to quality of process and outcome in
treatment which can be expected from improving guideline adherence even under routine conditions.
Rief W. Psychological aspects in medical conditions - Guidelines of behavioural medicine.
Zeitschrift fur Psychiatrie, Psychologie und Psychotherapie 54(1) 2006: 13-22.
Course and outcome of chronic physical diseases are highly depending on behaviour and attitudes of
the patient. This is the topic of behavioural medicine, which investigates the interaction of psychological,
biological, and social factors in physical diseases/complaints. Typical examples are cardiovascular
diseases, diabetes mellitus II, chronic pain, or cancer. Interventions to modify behaviour and attitudes of
patients with these disorders have shown to improve the course and/or quality of life. Recently
developed guidelines how to manage and treat these disorders are presented. Special emphasis should
be given to a high-quality implementation of psychological strategies. Finally typical characteristics of
behaviour medicine approaches are described, such as motivational analysis, subjective illness beliefs,
illness behaviour, adherence, emotional coping, analysis of resources, stress management and
biofeedback.
Sabaawi M, Singh NN, de Leon J. Guidelines for the use of clozapine in individuals with
developmental disabilities. Research in Developmental Disabilities 27(3) 2006: 309-336.
Clozapine is the most effective antipsychotic medication currently in use, but there has been a paucity of
well-controlled research on its efficacy with people with developmental disabilities. We present a set of
guidelines to ensure proper utilization of clozapine in individuals with developmental disabilities, because
it can offer them therapeutic advantages similar to those observed in people with schizophrenia. We
provide recommendations regarding the use of clozapine that are based on three main sources:
literature and published professional practice guidelines regarding the use of clozapine in individuals
who do not have developmental disabilities, the limited literature on the use of clozapine in individuals
who have developmental disabilities, and our own clinical experience. The first part of the guidelines
contains an overview of necessary practical knowledge regarding side effects, dose and blood level
considerations, and interactions with other medications, diet and tobacco smoking. In the second part,
we offer procedures for selecting individuals for clozapine therapy based on proper indications and
contraindications for treatment. We also include requirements regarding informed consent, dosage and
special laboratory and clinical monitoring.
Schatzberg AF, Blier P, Delgado PL, Fava M, Haddad PM, Shelton RC. Antidepressant
discontinuation syndrome: Consensus panel recommendations for clinical management and
additional research. Journal of Clinical Psychiatry 67(SUPPL. 4) 2006: 27-30.
Objective: Currently, no evidence-based guidelines exist for the management of serotonin reuptake
inhibitor (SRI) discontinuation syndrome. This article summarizes recommendations with respect to
future research as well as clinical management recommendations for SRI discontinuation syndrome.
Participants: In April 2004, a panel of physicians convened in New York City to discuss
recommendations for clinical management of and additional research on SRI discontinuation syndrome.
Evidence: Previous guidance for management of SRI discontinuation syndrome was proposed in 1997 in
a consensus meeting also chaired by Alan F. Schatzberg. A literature search of the PubMed database
was conducted to identify articles on SRI discontinuation syndrome that have been published since
1997. Consensus Process: The 2004 panel reviewed important preclinical and clinical studies, discussed
prospective investigation of this syndrome in clinical trials, and suggested the establishment of a
research network to collect data in naturalistic settings. The panel also reviewed the management
recommendations published in 1997 and subsequently updated the recommendations, taking into
account the latest clinical data as well as the personal experience of its members with patients.
Conclusions: Additional preclinical and clinical studies are necessary to further elucidate the underlying
biological mechanisms of SRI discontinuation syndrome and to identify the patient populations and
agents that are most affected by this phenomenon. Management strategies include gradual tapering of
doses and should emphasize clinical monitoring and patient education.
Schulz H, Buscher C, Koch U, Watzke B. Guidelines for the rehabilitative care of patients with
mental disorders. Zeitschrift fur Psychiatrie, Psychologie und Psychotherapie 54(1) 2006: 53-64.
Mental disorders are often characterized by a chronic course, with severe impairments, activity
10
Carsten Mandt, Clinical Librarian, NHSGG, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
limitations or participation restrictions. Therefore rehabilitative elements are of special importance in the
treatment of mental disorders. We have analysed current guidelines for five highly prevalent mental
disorders (depression, panic disorder, somatoform disorders, posttraumatic stress disorder and
borderline personality disorder) concerning generic and specific rehabilitative elements. The analyses
demonstrate that important and specific rehabilitative elements are only marginally mentioned in
guidelines up to now. Hence a considerable need for research exists for a further specification of
rehabilitative elements and consecutively for a systematic review of their effectiveness, thus fostering the
development of guidelines, which are more suitable for the rehabilitation of patients with mental
disorders.
Tettenborn B. Management of epilepsy in women
recommendations. CNS Drugs 20(5) 2006: 373-387.
of
childbearing
age:
Practical
Women with epilepsy should not be discouraged from becoming pregnant as the likelihood of having a
healthy baby is very high. However, in such women, early and individualised counselling about
pregnancy and contraception is essential. Ideally, pregnancies should be planned, folic acid (5 mg/day)
given and antiepileptic drug (AED) treatment optimised well before conception to ensure that the lowest
dosage that controls seizures is administered. When initiating AEDs in a woman of childbearing age, the
most appropriate drug for the seizure type and syndrome should be chosen, although it is preferable to
avoid valproate, because of a possible elevated risk of fetal malformations, when equi-effective agents
are available for a given syndrome. In women who become pregnant while taking AEDs, fetal monitoring
should include high-resolution ultrasonography before week 20 and measurement of serum a-fetoprotein
levels. Amniocentesis is not routinely indicated. The measurement of blood concentrations of AEDs can
be useful to ensure that the lowest possible maintenance dosage is being used, especially for those
drugs whose pharmacokinetics are likely to change during pregnancy. Breastfeeding should be
encouraged whatever the treatment administered.
Wambaugh JL, Duffy JR, McNeil MR, Robin DA, Rogers MA. Treatment guidelines for acquired
apraxia of speech: Treatment descriptions and recommendations. Journal of Medical Speech
Language Pathology 14(2) 2006.
This article is the second of two reports from the Academy of Neurologic Communication Disorders and
Sciences (ANCDS) Writing Committee of Treatment Guidelines for AOS. The first report provided a
review and evaluation of the AOS treatment evidence (Wambaugh, Duffy, McNeil, Robin, & Rogers,
2006a). The current report is focused on the aspects of guidelines development that followed the review
of the evidence. The major categories of AOS treatments are described in terms of treatment
techniques, targets, outcomes, candidacy, and evidence quality. In addition, this report provides the
committee's treatment recommendations and suggestions for future research.
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Dentistry
No relevant new guidance was published this month.
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Sexual Health, BBV and related Topics
ACOG Committee on Practice Bulletins - Gynecology. ACOG Practice Bulletin. Clinical
management guidelines for obstetrician-gynecologists, Number 72, May 2006: Vaginitis.
Obstetrics & Gynecology 107(5) 2006: 1195-1206.
Vaginal symptoms are common in the general population and are one of the most frequent reasons for
patient visits to obstetrician-gynecologists. Vaginitis may have important consequences in terms of
discomfort and pain, days lost from school or work, and sexual functioning and self image. Vaginitis is
associated with sexually transmitted diseases and other infections of the female genital tract, including
human immunodeficiency virus (HIV), as well as adverse reproductive outcomes in pregnant and
11
Carsten Mandt, Clinical Librarian, NHSGG, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
nonpregnant women. Treatment usually is directed to the specific cause of vaginal symptoms, which
most commonly include bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. The purpose
of this document is to provide information about the diagnosis and treatment of vaginitis.
BC Centre for Excellence in HIV/AIDS. Management of Accidental Exposure to HIV. BC Centre for
Excellence in HIV/AIDS, 2006.URL: http://www.cfenet.ubc.ca/webuploads/files/AEguidelines_0406.pdf
[last accessed: 05.07.2006].
Ivezic S, Mimica N. Diagnostic guidelines for sexual dysfunctions. Medicina 41(4) 2005: 323-328.
Sexual response is result of interaction between the CNS and periphery physiological processes. In
order to diagnose the sexual dysfunction we need to have sufficient information on basis which we are
able to asses the fulfillments of diagnostic criteria for specific sexual dysfunction. In order to achieve this
following information are needed: sexual response and sexual behavior, somatic and mental disorder
and current medication. Sexual dysfunction will not be diagnose when is related to stress, inadequate
environment conditions, drug and alcohol abuse, medication, age, somatic and mental disorder.
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Child Health
Anonymous. Healthy Eating and Activity Together (HEAT) Clinical Practice Guideline:
Identifying and Preventing Overweight in Childhood. Journal of Pediatric Health Care. 20(2) 2006:
Supplement: S1-63.
Calonge N. Screening for speech and language delay in preschool children: Recommendation
statement. American Family Physician 73(9) 2006: 1605-1610.
Konno M, Kobayashi A, Tomomasa T, Kaneko H, Toyoda S, Nakazato Y, et al. Guidelines for the
treatment of Crohn's disease in children. Pediatrics International 48(3) 2006: 349-352.
This paper shows guidelines for the treatment of Crohn's disease in children by the Working Group of the
Japanese Society for Pediatric Gastroenterology, Hepatology and Nutrition (Chair: Yuichiro Yamashiro)
and the Japanese Society for Pediatric Inflammatory Bowel Disease (Chair: Akio Kobayashi). The points
in which these guidelines differ from those for adult patients are as follows. (i) Total enteral nutrition in
the form of an elemental formula is indicated as primary therapy for children with Crohn's disease at
onset as well as the active stage. Oral mesalazine is used together. (ii) Total parenteral nutrition (TPN)
with oral mesalazine is required for children with serious illness. The use of a corticosteroid should be
withheld for at least 1 week after TPN has been started. (iii) When TPN is not considered to be effective,
additional corticosteroid is used. Full doses of corticosteroid should be used for at least 2 weeks after
clinical improvement has been achieved, and then the dose of the corticosteroid should be tapered
carefully. (iv) When surgery is indicated in pediatric patients with stricture or fistula formation and
complicated by persistent growth failure despite medical therapy, the optimum time for surgery is thought
to be before epiphyseal plates have been closed.
Plourde G. Preventing and managing pediatric obesity: Recommendations for family
physicians. Canadian Family Physician 52(MAR) 2006: 322-328.
Objective: To review the evidence on prevention and management of childhood obesity and to offer
suggestions for family physicians. Quality of evidence: Articles were obtained from a PubMed search.
Most studies on pediatric obesity provide level II evidence. There are some level I studies on
management. Main message: Pediatric obesity is under diagnosed and undertreated. Prevention should
be initiated as early as pregnancy. Prevention and treatment approaches should include patient and
family interventions focusing on nutrition, physical activity, reduced television viewing, and behaviour
modification. The effectiveness of such interventions by primary care physicians has not been totally
demonstrated, but incorporating them into clinical practice routines is likely to be beneficial. Conclusion:
12
Carsten Mandt, Clinical Librarian, NHSGG, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
Family physicians have a role in promoting preventive measures and identifying and treating obesityrelated comorbidity. Pediatric obesity is not an individual child's problem, but a problem that involves the
whole family and the community. Recommending a healthy diet and increased physical activity and
counseling families on behaviour change is the best approach to preventing and managing childhood
obesity.
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13
Carsten Mandt, Clinical Librarian, NHSGG, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
C. Guidelines Implementation
Barosi G. Strategies for dissemination and implementation of guidelines. Neurological Sciences
27(SUPPL. 3) 2006: S231-S234.
Interventions designed to effectively implement and disseminate clinical practice guidelines (CPG) fall
into different categories. A systematic review of the effectiveness and costs of different guideline
development, dissemination and implementation strategies was recently undertaken by the Health
Technology Assessment (HTA) Programme in UK. Overall, the majority of comparisons reporting
dichotomous process data observed improvement in care. However, there was considerable variation in
the observed effects both within and across interventions. Evaluation studies provided evidence that
adherence of physicians to CPG is a strong predictor of the stroke outcome. Cochrane Collaboration
performed a systematic review including studies published up to 2004 that compared integrated clinical
pathways (ICP) for stroke care with standard medical care. They found no significant difference between
ICP and control groups in terms of death or discharge destination. Patients managed with a care
pathway were more dependent at discharge, less likely to suffer a urinary tract infection, less likely to be
readmitted and more likely to have neuroimaging. A positive effect was reported from a validation study
of a multifaceted strategy for stroke care ICP implementation in Italy.
Cricelli I. Use of personal digital assistant devices in order to access, consult and apply a
corpus of clinical guidelines and decision-based support documentation like the Italian
SPREAD Guidelines on stroke disease. Neurological Sciences 27(SUPPL. 3) 2006: S238-S239.
During the past few years, personal digital assistants (PDAs) have become widespread commodities,
like computers and mobile phones. Many health-care providers, particularly physicians, routinely use
PDAs in their everyday work. Accessing guidelines and clinical decision-based support tools, such as the
downloadable version of the Italian SPREAD Guidelines represents one of the most important and
common clinical applications. The current experience suggests that the need for best evidence models
at the time of decision making is strong and that portable accessibility is critical: including just-in-time
information systems that allow physicians to retrieve the best evidence at the point of care, and a
standardized electronic health record (EHR) easily integrating into daily practice and is affordable to
most family physicians.
Doherty SR, Jones PD. Use of an 'evidence-based implementation' strategy to implement
evidence-based care of asthma into rural district hospital emergency departments. Rural and
Remote Health. 6(1) 2006: 1-11.
Introduction: To determine if an evidence-based implementation (EBI) could lead to the successful
implementation of evidence based care for adult asthma in small rural district hospitals., Methods: A
controlled trial involving eight small rural hospitals (four each in the study and control groups) was
conducted. Retrospective pre-intervention audits were conducted at all eight hospitals for 7 months (1
January 2004 to 31 July 2004) and evidence-practice gaps identified. An EBI was then used to
implement established guidelines for the management of asthma in the study hospitals. Post-intervention
audits were then performed over a period of 7 months (1 October 2004 to 31 April 2005)., Results: There
were 52 presentations of asthma in the study hospitals in the pre-implementation phase and 47 postimplementation. The corresponding numbers for the control hospitals were 46 and 42 respectively. There
were no statistically significant differences in the severity between the groups. Following the EBI there
were significant improvements at the study hospitals for the documentation of severity (8% to 62%, p
<0.001), use of spirometry (12% to 62%, p <0.001) and the use of written short-term asthma plans (9%
to 26%, p = 0.05). There was a decrease in use of ipratropium in mild asthma (44% to 30%, p = 0.228),
an increase in the use of systemic steroids (61% to 72%, p = 0.255) and no change in prescribing
antibiotics for afebrile patients with asthma (21% to 21% p = 0.956). There was no significant change in
practice at the control hospitals except for a decrease in the use of systemic steroids (48% to 21%, p =
0.011). For the six clinical indicators aggregate there was a significant increase in compliance with
guidelines at the study hospitals (36% to 62%, p < 0.001) but no change at the control hospitals (31% to
31%, p = 0.970)., Conclusion: The pre-intervention audits demonstrated low levels of compliance with
asthma guidelines across six clinical indicators. An EBI significantly improved compliance across these
six indicators, and no improvement was noted in the control hospitals. This study demonstrates that an
EBI can alter clinical practice in small rural district hospitals.
14
Carsten Mandt, Clinical Librarian, NHSGG, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].
Panzarasa S, Stefanelli M. Workflow management systems for guideline implementation.
Neurological Sciences 27(SUPPL. 3) 2006: S245-S249.
The activities of care providers need to be coordinated within a process properly designed on the basis
of available best practice medical knowledge. It requires a rethinking of the management of care
processes within health-care organisations. The current workflow technology seems to offer the most
convenient solution to build such cooperative systems. However, some of its present weaknesses still
require an intense research effort to find solutions allowing its exploitation in real medical practice. This
paper presents an approach to design and build evidence- based workflow management systems
(WfMS). They can be viewed as components of a knowledge management infrastructure each health
care organisation should be provided with, to increase its performance in delivering high-quality care, by
efficiently exploiting the available knowledge resources. On the basis of a general methodology, we
describe a WfMS implementation in the area of Stroke management; such a system, after intensive
testing in our research laboratory, is now in the process of being transferred in a real working setting (a
stroke unit) and integrated with an existing electronic patient record.
Price M. Can hand-held computers improve adherence to guidelines? A (Palm) Pilot study of
family doctors in British Columbia. Canadian Family Physician 51 2005.
Ricci S, Celani MG, Righetti E. Development of clinical guidelines: Methodological and practical
issues. Neurological Sciences 27(SUPPL. 3) 2006: S228-S230.
The key elements for developing a clinical guideline are (a) guidelines are developed by multidisciplinary
groups, (b) they are based on a systematic review of the scientific evidence, and (c) recommendations
are explicitly linked to the supporting evidence and graded according to the strength of that evidence.
Besides reporting the statistical strength of the randomised controlled trial results, it is necessary to
consider the strength of the evidence, the methodological quality of the studies and the external validity
by applying a 'considered judgement' to the whole amount of the data. The Scottish Intercollegiate
Guidelines Network (SIGN) process for developing guidelines is based on 4 steps: (a) methodological
evaluation, (b) synthesis of evidence, (c) considered judgement and (d) grading system. The judgement
on grading of recommendations is made on the basis of an (objective) assessment of the study design
and quality, and a (perhaps more subjective) judgement of the consistency, clinical relevance and
external validity of the evidence. The SPREAD group decided to adopt this methodology starting from
the 3rd edition (2003); however, it was agreed to integrate the principles of the SIGN [4] with the
statistical considerations on alpha and beta error size suggested by the Centre for Evidence-Based
Medicine methodology [6], to give a more comprehensive evaluation of the available evidence. By being
the product of a multidisciplinary approach, being explicit and providing information on the way
agreement has been reached or on the reasons of disagreement, the SPREAD guidelines seem to fulfil
the needs for shared guidelines, and to avoid the concerns related to pitfalls in the transparency of the
process and in the reaching of a consensus.
Schulman I, Lundquist M. Designing and implementing clinical practice guidelines for CIA
management tailored to the individual therapeutic needs of the patient. Oncology Nursing Forum.
33(2) 2006: 437.
van der Sanden WJ, Mettes DG, Plasschaert AJ, Grol RPT, Mulder J, Verdonschot EH. Effectiveness
of clinical practice guideline implementation on lower third molar management in improving
clinical decision-making: a randomized controlled trial. European Journal of Oral Sciences. 113(5)
2005: 349-54. (25 ref).
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15
Carsten Mandt, Clinical Librarian, NHSGG, West House, Audit Office, Gartnavel Royal Hospital, 1055 Great Western
Road, Glasgow, G12 0XH. Phone: 0141-211 0633. E-mail: [email protected].