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Published in: World Journal of Urology 3/2011

01-06-2011 | Topic Paper

Clinical practice guidelines to inform evidence-based clinical practice

Authors: J. Stuart Wolf Jr, Heddy Hubbard, Martha M. Faraday, John B. Forrest

Published in: World Journal of Urology | Issue 3/2011

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Abstract

Background

With the volume of medical research currently published, any one practitioner cannot independently review the literature to determine best evidence-based medical care. Additionally, non-specialists usually do not have the experience to know best practice for all of the frequent clinical circumstances for which there is no good evidence. Clinical practice guidelines (CPGs) help clinicians to address these problems because they are systematically created documents that summarize knowledge and provide guidance to assist in delivering high-quality medicine. They aim to improve health care by identifying evidence that supports the best clinical care and making clear which practices appear to be ineffective.

Methods

Non-structured literature review.

Results

CPGs combine evidence-based medicine (on topics for which evidence exists) with expert opinion (on topics for which there is no evidence). The optimal CPG applies structured and transparent judgments, from an unbiased and diverse panel which includes both clinical experts and non-physicians, to a systematic evidence review. It includes decisions in areas in which clinical data are both available and unavailable. The resulting guideline statements should be clearly linked to the quality of the available evidence and the target patient(s) should be clearly defined, so that the reader can assess strength and applicability of the statements to an individual patient.

Conclusions

The application of high-quality CPGs improves patient care, but all too often CPGs are not used to the greatest advantage because of inadequate dissemination and incorporation into practice. This article provides an overview of CPGs, focusing on their justification, creation, improvement, and use.
Literature
1.
go back to reference Institute of Medicine (IOM) (2008) Knowing what works in health care: a roadmap for the nation. National Academies Pres, Washington Institute of Medicine (IOM) (2008) Knowing what works in health care: a roadmap for the nation. National Academies Pres, Washington
3.
go back to reference Stulberg JJ, Delaney CP, Neuhauser DV, Aron DC, Fu P, Koroukian SM (2010) Adherence to surgical care improvement project measures and the association with postoperative infections. JAMA 303(24):2479–2485. doi:10.1001/jama.2010.841 PubMedCrossRef Stulberg JJ, Delaney CP, Neuhauser DV, Aron DC, Fu P, Koroukian SM (2010) Adherence to surgical care improvement project measures and the association with postoperative infections. JAMA 303(24):2479–2485. doi:10.​1001/​jama.​2010.​841 PubMedCrossRef
4.
go back to reference Berenguer CM, Ochsner MG, Lord SA, Senkowski CK (2010) Improving surgical site infections: using national surgical quality improvement program data to institute surgical care improvement project protocols in improving surgical outcomes. J Am Coll Surg 210(5):737–741PubMedCrossRef Berenguer CM, Ochsner MG, Lord SA, Senkowski CK (2010) Improving surgical site infections: using national surgical quality improvement program data to institute surgical care improvement project protocols in improving surgical outcomes. J Am Coll Surg 210(5):737–741PubMedCrossRef
6.
go back to reference Lesho EP, Myers CP, Ott M, Winslow C, Brown JE (2005) Do clinical practice guidelines improve processes or outcomes in primary care? Mil Med 170(3):243–246PubMed Lesho EP, Myers CP, Ott M, Winslow C, Brown JE (2005) Do clinical practice guidelines improve processes or outcomes in primary care? Mil Med 170(3):243–246PubMed
7.
go back to reference Weinberger M (2009) Seventeen years of asthma guidelines: why hasn’t the outcome improved for children? J Pediatr 154(6):786–788PubMedCrossRef Weinberger M (2009) Seventeen years of asthma guidelines: why hasn’t the outcome improved for children? J Pediatr 154(6):786–788PubMedCrossRef
8.
go back to reference Ellen M, Brown A, Cockerill R (2009) Do clinical practice guidelines influence length of stay in Ontario acute care hospitals? Healthc Q 12(4):64–71PubMed Ellen M, Brown A, Cockerill R (2009) Do clinical practice guidelines influence length of stay in Ontario acute care hospitals? Healthc Q 12(4):64–71PubMed
10.
go back to reference Woolf SH (1992) Practice guidelines, a new reality in medicine. II. Methods of developing guidelines. Arch Intern Med 152:946–952PubMedCrossRef Woolf SH (1992) Practice guidelines, a new reality in medicine. II. Methods of developing guidelines. Arch Intern Med 152:946–952PubMedCrossRef
11.
go back to reference Weber KL (2009) The AAOS clinical practice guidelines. J Am Acad Orthop Surg 17(6):335–336PubMed Weber KL (2009) The AAOS clinical practice guidelines. J Am Acad Orthop Surg 17(6):335–336PubMed
12.
go back to reference Buie WD (2010) Clinical practice guidelines: appraising the evidence. Dis Colon Rectum 53(8):1107–1109PubMedCrossRef Buie WD (2010) Clinical practice guidelines: appraising the evidence. Dis Colon Rectum 53(8):1107–1109PubMedCrossRef
13.
go back to reference Qaseem A, Snow V, Owens DK, Shekelle P, The Clinical Guidelines Committee of the American College of Physicians (2010) The development of clinical practice guidelines and guidance statements of the American College of Physicians: summary of methods. Ann Intern Med 153(3):194–199. doi:10.1059/0003-4819-153-3-201008030-00010 PubMed Qaseem A, Snow V, Owens DK, Shekelle P, The Clinical Guidelines Committee of the American College of Physicians (2010) The development of clinical practice guidelines and guidance statements of the American College of Physicians: summary of methods. Ann Intern Med 153(3):194–199. doi:10.​1059/​0003-4819-153-3-201008030-00010 PubMed
14.
go back to reference Mechanick JI, Camacho PM, Cobin RH, Garber AJ, Garber JR, Gharib H, Petak SM, Rodbard HW, Trence DL (2010) American Association of Clinical Endocrinologists. American Association of Clinical Endocrinologists protocol for standardized production of clinical practice guidelines–2010 update. Endocr Pract 16(2):270–283PubMed Mechanick JI, Camacho PM, Cobin RH, Garber AJ, Garber JR, Gharib H, Petak SM, Rodbard HW, Trence DL (2010) American Association of Clinical Endocrinologists. American Association of Clinical Endocrinologists protocol for standardized production of clinical practice guidelines–2010 update. Endocr Pract 16(2):270–283PubMed
16.
17.
go back to reference Sinuff T, Patel RV, Adhikari NKJ, Meade MO, Schünemann HJ, Cook DJ (2008) Quality of professional society guidelines and consensus conference statements in critical care. Crit Care Med 36:1049–1058PubMedCrossRef Sinuff T, Patel RV, Adhikari NKJ, Meade MO, Schünemann HJ, Cook DJ (2008) Quality of professional society guidelines and consensus conference statements in critical care. Crit Care Med 36:1049–1058PubMedCrossRef
19.
go back to reference Lopez-Olivo MA, Kallen MA, Ortiz Z, Skidmore B, Suarez-Almazor ME (2008) Quality appraisal of clinical practice guidelines and consensus statements on the use of biologic agents in rheumatoid arthritis: a systematic review. Arthritis Care Res 59(11):1625–1638. doi:10.1002/art.24207 CrossRef Lopez-Olivo MA, Kallen MA, Ortiz Z, Skidmore B, Suarez-Almazor ME (2008) Quality appraisal of clinical practice guidelines and consensus statements on the use of biologic agents in rheumatoid arthritis: a systematic review. Arthritis Care Res 59(11):1625–1638. doi:10.​1002/​art.​24207 CrossRef
20.
go back to reference Dahm P, Yeung LL, Chang SS, Cookson MS (2008) A critical review of clinical practice guidelines for the management of clinically localized prostate cancer. J Urol 180(2):451–460PubMedCrossRef Dahm P, Yeung LL, Chang SS, Cookson MS (2008) A critical review of clinical practice guidelines for the management of clinically localized prostate cancer. J Urol 180(2):451–460PubMedCrossRef
23.
go back to reference Cosgrove L, Bursztajn HJ, Krimsky S, Anaya M, Walker J (2009) Conflicts of interest and disclosure in the American Psychiatric Association’s clinical practice guidelines. Psychother Psychosom 78(4):228–232PubMedCrossRef Cosgrove L, Bursztajn HJ, Krimsky S, Anaya M, Walker J (2009) Conflicts of interest and disclosure in the American Psychiatric Association’s clinical practice guidelines. Psychother Psychosom 78(4):228–232PubMedCrossRef
26.
go back to reference Hirsh J, Guyatt G (2009) Clinical experts or methodologists to write clinical guidelines? Lancet 374:273–275PubMedCrossRef Hirsh J, Guyatt G (2009) Clinical experts or methodologists to write clinical guidelines? Lancet 374:273–275PubMedCrossRef
27.
go back to reference Freeman MD (2010) Clinical practice guidelines versus systematic reviews; which serve as the best basis for evidence-based spine medicine? Spine J 10:512–513PubMedCrossRef Freeman MD (2010) Clinical practice guidelines versus systematic reviews; which serve as the best basis for evidence-based spine medicine? Spine J 10:512–513PubMedCrossRef
28.
go back to reference Dahm P, Yeung LL, Gallucci M, Simone G, Schünemann HJ (2009) How to use a clinical practice guideline. J Urol 181(2):472–479PubMedCrossRef Dahm P, Yeung LL, Gallucci M, Simone G, Schünemann HJ (2009) How to use a clinical practice guideline. J Urol 181(2):472–479PubMedCrossRef
29.
go back to reference Torrijos RM, Glantz SA (2006) The US Public Heath Service “treating tobacco use and dependence clinical practice guidelines” as a legal standard of care. Tob Control 15:447–451PubMedCrossRef Torrijos RM, Glantz SA (2006) The US Public Heath Service “treating tobacco use and dependence clinical practice guidelines” as a legal standard of care. Tob Control 15:447–451PubMedCrossRef
30.
go back to reference Moses RE, Feld AD (2008) Legal risks of clinical practice guidelines. Am J Gastroenterol 103:7–11PubMed Moses RE, Feld AD (2008) Legal risks of clinical practice guidelines. Am J Gastroenterol 103:7–11PubMed
31.
go back to reference Recupero PR (2008) Clinical practice guidelines as learned treatises: understanding their use as evidence in the courtroom. J Am Acad Psychiatry Law 36(3):290–301PubMed Recupero PR (2008) Clinical practice guidelines as learned treatises: understanding their use as evidence in the courtroom. J Am Acad Psychiatry Law 36(3):290–301PubMed
33.
go back to reference Guyatt G, Baumann M, Pauker S, Halperin J, Maurer J, Owens DK, Tosteson ANA, Carlin B, Gutterman D, Prins M, Lewis SZ, Schünemann H (2006) Addressing resource allocation issues in recommendations from clinical practice guideline panels. Chest 129(1):182–187. doi:10.1378/chest.129.1.182 PubMedCrossRef Guyatt G, Baumann M, Pauker S, Halperin J, Maurer J, Owens DK, Tosteson ANA, Carlin B, Gutterman D, Prins M, Lewis SZ, Schünemann H (2006) Addressing resource allocation issues in recommendations from clinical practice guideline panels. Chest 129(1):182–187. doi:10.​1378/​chest.​129.​1.​182 PubMedCrossRef
34.
go back to reference Carlsen B, Glenton C, Pope C (2007) Thou shalt versus thou shalt not: a meta-synthesis of GPs’ attitudes to clinical practice guidelines. Br J Gen Pract 57:971–978PubMedCrossRef Carlsen B, Glenton C, Pope C (2007) Thou shalt versus thou shalt not: a meta-synthesis of GPs’ attitudes to clinical practice guidelines. Br J Gen Pract 57:971–978PubMedCrossRef
35.
go back to reference Nuckols T, Lim Y-W, Wynn B, Mattke S, MacLean C, Harber P, Brook R, Wallace P, Garland R, Asch S (2008) Rigorous development does not ensure that guidelines are acceptable to a panel of knowledgeable providers. J Gen Intern Med 23(1):37–44. doi:10.1007/s11606-007-0440-9 PubMedCrossRef Nuckols T, Lim Y-W, Wynn B, Mattke S, MacLean C, Harber P, Brook R, Wallace P, Garland R, Asch S (2008) Rigorous development does not ensure that guidelines are acceptable to a panel of knowledgeable providers. J Gen Intern Med 23(1):37–44. doi:10.​1007/​s11606-007-0440-9 PubMedCrossRef
36.
go back to reference Lamy J-B, Ebrahiminia V, Riou C, Seroussi B, Bouaud J, Simon C, Dubois S, Butti A, Simon G, Favre M, Falcoff H, Venot A (2010) How to translate therapeutic recommendations in clinical practice guidelines into rules for critiquing physician prescriptions? Methods and application to five guidelines. BMC Med Inform Decis Mak 10(1):31PubMedCrossRef Lamy J-B, Ebrahiminia V, Riou C, Seroussi B, Bouaud J, Simon C, Dubois S, Butti A, Simon G, Favre M, Falcoff H, Venot A (2010) How to translate therapeutic recommendations in clinical practice guidelines into rules for critiquing physician prescriptions? Methods and application to five guidelines. BMC Med Inform Decis Mak 10(1):31PubMedCrossRef
37.
go back to reference Connor SJ, Lienert AR, Brown LA, Bagshaw PF (2008) Closing the audit loop is necessary to achieve compliance with evidence-based guidelines in the management of acute pancreatitis. N Z Med J 121:19–25PubMed Connor SJ, Lienert AR, Brown LA, Bagshaw PF (2008) Closing the audit loop is necessary to achieve compliance with evidence-based guidelines in the management of acute pancreatitis. N Z Med J 121:19–25PubMed
38.
go back to reference Harrison MB, Legare F, Graham ID, Fervers B (2010) Adapting clinical practice guidelines to local context and assessing barriers to their use. CMAJ 182(2):E78–E84. doi:10.1503/cmaj.081232 PubMed Harrison MB, Legare F, Graham ID, Fervers B (2010) Adapting clinical practice guidelines to local context and assessing barriers to their use. CMAJ 182(2):E78–E84. doi:10.​1503/​cmaj.​081232 PubMed
39.
40.
go back to reference Kerfoot BP, Kearney MC, Connelly D, Ritchey ML (2009) Interactive spaced education to assess and improve knowledge of clinical practice guidelines: a randomized controlled trial. Ann Surg 249(5):744–749PubMedCrossRef Kerfoot BP, Kearney MC, Connelly D, Ritchey ML (2009) Interactive spaced education to assess and improve knowledge of clinical practice guidelines: a randomized controlled trial. Ann Surg 249(5):744–749PubMedCrossRef
Metadata
Title
Clinical practice guidelines to inform evidence-based clinical practice
Authors
J. Stuart Wolf Jr
Heddy Hubbard
Martha M. Faraday
John B. Forrest
Publication date
01-06-2011
Publisher
Springer-Verlag
Published in
World Journal of Urology / Issue 3/2011
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-011-0656-5

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