Clinical Practice Guidelines for Dementia in Australia: A step towards improving uptake of research findings in health and aged-care settings

This author accepted manuscript (post print) is made available following a 12 month embargo form date of publication (21 April 2016) in accordance with the publisher copyright policy

Clinical practice guidelines for the foot and ankle in rheumatoid arthritis: a critical appraisal

Background: Clinical practice guidelines are recommendations systematically developed to assist clinical decision-making and inform healthcare. In current rheumatoid arthritis (RA) guidelines, management of the foot and ankle is under-represented and the quality of recommendation is uncertain. This study aimed to identify and critically appraise clinical practice guidelines for foot and ankle management in RA. Methods: Guidelines were identified electronically and through hand searching. Search terms 'rheumatoid arthritis', 'clinical practice guidelines' and related synonyms were used. Critical appraisal and quality rating were conducted using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Results: Twenty-four guidelines were included. Five guidelines were high quality and recommended for use. Five high quality and seven low quality guidelines were recommended for use with modifications. Seven guidelines were low quality and not recommended for use. Five early and twelve established RA guidelines were recommended for use. Only two guidelines were foot and ankle specific. Five recommendation domains were identified in both early and established RA guidelines. These were multidisciplinary team care, foot healthcare access, foot health assessment/review, orthoses/insoles/splints, and therapeutic footwear. Established RA guidelines also had an 'other foot care treatments' domain. Conclusions: Foot and ankle management for RA features in many clinical practice guidelines recommended for use. Unfortunately, supporting evidence in the guidelines is low quality. Agreement levels are predominantly 'expert opinion' or 'good clinical practice'. More research investigating foot and ankle management for RA is needed prior to inclusion in clinical practice guidelines

Adapting clinical practice guidelines for diabetic retinopathy in Kenya: process and outputs.

BACKGROUND: The use of clinical practice guidelines envisages augmenting quality and best practice in clinical outcomes. Generic guidelines that are not adapted for local use often fail to produce these outcomes. Adaptation is a systematic and rigorous process that should maintain the quality and validity of the guideline, while making it more usable by the targeted users. Diverse skills are required for the task of adaptation. Although adapting a guideline is not a guarantee that it will be implemented, adaptation may improve acceptance and adherence to its recommendations. METHODS: We describe the process used to adapt clinical guidelines for diabetic retinopathy in Kenya, using validated tools and manuals. A technical working group consisting of volunteers provided leadership. RESULTS: The process was intensive and required more time than anticipated. Flexibility in the process and concurrent health system activities contributed to the success of the adaptation. The outputs from the adaptation include the guidelines in different formats, point of care instruments, as well as tools for training, monitoring, quality assurance and patient education. CONCLUSION: Guideline adaptation is applicable and feasible at the national level in Kenya. However, it is labor- and time -intensive. It presents a valuable opportunity to develop several additional outputs that are useful at the point of care

Traction for low back pain, the evidence is flawed : a thesis presented in partial fulfilment of the requirements for the Masters of Health Science (MHlthSci) in Environmental Health at Massey University Campus, Wellington, New Zealand

Research suggests the burden of low back pain is growing despite recent advances in investigative technology and the explosion in research. Evidence based practice is necessary within physiotherapy. However, the best evidence component must be clinically appropriate, accurate, and grounded within pertinent research. The selection of participants and the methodological designs of the studies must be appropriate to provide results valid to everyday clinical practice. Systematic reviews and meta-analyses consider primary research to critically analyse research questions, and formulate scientific conclusions on the efficacy of interventions. These research derived conclusions then inform clinical practice guidelines which are envisioned to improve clinical practice. These guidelines are also utilised by educational facilities to flavour their curriculum, and by insurance and governmental policy writers in accrediting specific interventions. Information from today will dictate the beliefs, attitudes, and practices of future graduates, and determine approved treatment options. The reported negative conclusions on the efficacy of traction as an intervention for low back pain have resulted in traction no longer being recommended within clinical practice guidelines, any remaining sporadic use questioned by professional colleagues and policy writers, and it no longer taught at undergraduate level. This is despite its long history, popularity amongst some practitioners, anecdotal evidence supporting its use in the clinical setting, and its demonstrable effects in scientific studies. This masters project argues that the cause of the disparity lies within incongruous study designs, which are not valid to clinical practice. Specifically, caused by the misappropriation of historical definitions and classifications vis-à-vis low back pain cohorts. This has resulted in substantial heterogeneity within study populations themselves, both between groups and between studies, which along with other methodological flaws and inappropriate reporting, has given rise to unwarranted conclusions. These fundamental errors have made the conclusions of scientific trials, systematic reviews, and clinical practice guidelines erroneous, and inapplicable to everyday clinical practice. The ‘evidence based’ recommendations of th

'How compliant do we want to be with the colonoscopy surveillance guidelines?'

Objective: To assess the referral practice for surveillance colonoscopy amongst clinicians and to measure whether practice was inline with the current Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG) guidelines. Method: A questionnaire was sent to members of the ACPGBI. Results: A total of 195 (49%) clinicians responded, providing information on their referral habits with comments on where they deviated from the guidelines. Conclusions: The BSG and ACPGBI guidelines are well established amongst clinicians and generally accepted as best practice however the majority of clinicians deviate from the guidelines for particular clinical scenarios. In fact only 18% of respondents followed all recommendations for surveillance colonoscopy for patients with polyps, previous cancers and a family history

A protocol for a systematic review of clinical guidelines and published systematic reviews on the early detection of oral cancer

Background: The predicted increase in incidence of oral cavity cancer (OCC) coupled with high mortality and poor prognosis – particularly when diagnosed at a late/advanced stage – highlights the need for prevention and early detection/screening to reverse these trends. Dental healthcare professionals in primary care settings have a pivotal role in this effort. Aim: The aim of this protocol is to detail the process for assessing the evidence for the best practice and methods of early detection/screening for OCC in primary care dental settings by undertaking a systematic review of global clinical guidelines and published systematic reviews. Method: Searches for clinical guidelines and systematic reviews will be conducted in the following databases: Cochrane library, Medical Literature Analysis and Retrieval System Online (Ovid), Excerpta Medical dataBASE, PubMed, Turning Research into Practice, SCOPUS and Web of Science Core Collection. Our search will extend to include Google Scholar and international professional organizations/associations websites. In addition, we will handsearch the bibliographies and undertake citation searches of the selected papers. Quality appraisal will be undertaken using the Appraisal of Guidelines for Research and Evaluation version II instrument for the clinical guidelines and both A MeaSurement Tool to Assess Systematic Reviews and Risk of Bias in Systematic Reviews tools for the systematic reviews. A narrative synthesis approach will be used to assess the evidence of extracted data, primarily taking account of quality appraisal and recency of publication. Discussion: The synthesis of evidence will determine best practice for OCC early detection/screening by primary care dental healthcare professionals and will evaluate the relationship between clinical guidelines and the evidence base available from systematic reviews in this area

Association between quality of clinical practice guidelines and citations given to their references

It has been suggested that bibliometric analysis of different document types may reveal new aspects of research performance. In medical research a number of study types play different roles in the research process and it has been shown, that the evidence-level of study types is associated with varying citation rates. This study focuses on clinical practice guidelines, which are supposed to gather the highest evidence on a given topic to give the best possible recommendation for practitioners. The quality of clinical practice guidelines, measured using the AGREE score, is compared to the citations given to the references used in these guidelines, as it is hypothesised, that better guidelines are based on higher cited references. AGREE scores are gathered from reviews of clinical practice guidelines on a number of diseases and treatments. Their references are collected from Web of Science and citation counts are normalised using the item-oriented z-score and the PPtop-10% indicators. A positive correlation between both citation indicators and the AGREE score of clinical practice guidelines is found. Some potential confounding factors are identified. While confounding cannot be excluded, results indicate low likelihood for the identified confounders. The results provide a new perspective to and application of citation analysis.Comment: Paper submitted to 14th International Society of Scientometrics and Informetrics Conferenc

Fuzzy Logic in Clinical Practice Decision Support Systems

Computerized clinical guidelines can provide significant benefits to health outcomes and costs, however, their effective implementation presents significant problems. Vagueness and ambiguity inherent in natural (textual) clinical guidelines is not readily amenable to formulating automated alerts or advice. Fuzzy logic allows us to formalize the treatment of vagueness in a decision support architecture. This paper discusses sources of fuzziness in clinical practice guidelines. We consider how fuzzy logic can be applied and give a set of heuristics for the clinical guideline knowledge engineer for addressing uncertainty in practice guidelines. We describe the specific applicability of fuzzy logic to the decision support behavior of Care Plan On-Line, an intranet-based chronic care planning system for General Practitioners

Professional Practice Guidelines for Occupationally Mandated Psychological Evaluations

Psychological evaluations are relied on by employers, professional licensing boards, and civil service commissions to make hiring and employment decisions affecting individuals, orga- nizations, and the public. To promote best practices, these professional practice guidelines were developed for use by psychologists who perform clinical evaluations of individuals for occupational purposes, regardless of whether the evaluation is intended to obtain employ- ment, to achieve licensure/certification, or to maintain either. These guidelines were created by the Committee on Professional Practice and Standards (COPPS) to educate and inform the practice of psychologists who conduct occupationally mandated psychological evaluations (OMPEs), as well as to stimulate debate and research in this important area