GUIDELINES IN CLINICAL PRACTICE: A DICTUM OR A DAMN..?!

Abstract

Clinical practice guidelines are systematically developed statements that assist practitioners to provide appropriate evidence-based care. They are often created by statutory bodies, expert associational advisory committees, government and regional offices and even individual hospital policy groups. The objectives of clinical guidelines are to standardize medical care, to raise the quality of care and to reduce several kinds of risks to the patient and health care provider. Implementation of clinical practice guidelines is a complex process and protocols with good quality, with clinical importance and prioritization of topics, and a user-friendly format are usually successful. In day to day clinical practice guidelines are not strictly followed. The merits and demerits of guideline based practice patterns have been analyzed here. There could be many reasons for the non adherence to protocol based medical practice which has to be addressed. A historical perspective of guidelines and a breach in standardized practice is also mentioned. As there can be fallacies in protocols; a clinical practice that is not strictly adhering with guidelines, should not be considered as a wrongful treatment strategy.

Keywords

Guidelines - protocol - clinical practice - adherence

Publikationsverlauf

Artikel online veröffentlicht:
22. April 2020

• References

• 1 Kattan MW, Eastham JA, Wheeler TM, Maru N, Scardino PT, Erbersdoblar A, Graefen M, Huland H, Koh H, Shariat S, Slawin KM, Ohori M: Counseling men with prostate cancer: A nomogram for predicting the presence of small moderately differentiated, confined tumors. The Journal of Urology, Vol. 170, 1792-1797, November 2003.
• 2 Steyerberg EW, Roobol MJ, Kattan MW, van der Kwast TH, de Koning HJ, Schroder FH: Prediction of indolent prostate cancer: validation and updating of a prognostic nomogram. J Urol 2007 Jan; 177(1): 107 -12.
• 3 Di Blasio CJ, Rhee AC, Cho D, Scardino PT, Kattan NM: Predicting clinical end points: treatment nomograms in prostate cancer. Seminars in Oncology volume 30, Issue 5, Pages 567-586, October 2003.
• 4 Bechis SK, Carroll PR, Cooperberg MR: Impact of age at diagnosis on prostate cancer treatment and survival. J Clin Oncol. 2011 Jan 10; 29(2): 235-41.
• 5 May M, Gunia S, Helke C: How far is the preoperative Kattan nomogram applicable for the predication of recurrence after prostatectomy in patients presenting with PSA levels of more than 20 ng/ml? A validation study. Urol Int. 2006; 77(3):222-6.
• 6 Greene KL, Meng MV, Pasta DJ, Kattan MW: Validation of the Kattan preoperative nomogram for prostate cancer recurrence using a community based cohort: results from cancer of the prostate strategic urological research endeavor (capsure). J. Urol. 2004 Jun; 171 (6 Pt 1): 2255-9
• 7 Eskicorapci SY, Turkeri L, Karabulut E, Cal C, Akpinar H: Validation of two preoperative Kattan nomograms predicting recurrence after Radical Prostatectomy for localized Prostate Cancer in Turkey: a multicenter study of the Uro-oncology Society, Urology, Volume 74, Issue 6, December 2009, Pages 1289-1295.
• 8 Stone H H, Haney B B, Kolb LD, Geheber CE, Hooper CA: Prophylactic and preventive Antibiotic Therapy: timing, duration and economics. Ann Surg. 1979 June; 189(6): 691-699.
• 9 Pearle MS, Roehrborn CG: Antimicrobial prophylaxis prior to shock wave lithotripsy in patients with sterile urine before treatment; A meta-analysis and cost-effectiveness analysis. Urology Volume 49, Issue 5, May 1997, Pages 679-686.
• 10 John Ferguson: Antibiotic prescribing: how can emergence of antibiotic resistance be delayed? Aust Prescr 2004, 27:39-42.
• 11 Martinez JA, Mensa J, Marco F: Risk factors for oxacillin/methicillin resistance in coagulase-negative staphylococci: Journal of Hospital Infection. Volume 35, Issue 4, April 1997, Pages 295-299.
• 12 “The Hippocratic Oath”. Translated by Michael North, National Library of Medicine. National Institutes of Health, 2002.
• 13 The code of Hammurabi, translated by L.W. King. The Eleventh Edition of the Encyclopaedia Britannica. 1910-1911 by the Rev. Claude Hermann Walter Johns, M.A Litt.D.
• 14 L. W. King: “the code of Hammurabi: Translated by L.W. King”. Yale University Retrieved September 14,2007.
• 15 Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE: Ureteral stones Clinical Guidelines Panel summary report on the management of ureteral calculi. The American Urological Association. J. Urol. 1997 Nov 158(5)1915-21.
• 16 Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M: 2007 guideline for the management of ureteral calculi. J. Urol. 2007 Dec.178(6),2418-2434.
• 17 Matlaga BR: Contemporary surgical management of upper urinary tract calculi. J. Urol, 181(5),2152-2156(2009).
• 18 Lingeman JE, McAteer JA, Gnessin E, Evan AP: Shock wave lithotripsy: advances in technology and technique, Nat Rev Urol. 2009Dec; 6(12) 660-670.
• 19 Wang C, Nieschlag E, Swerdloff R, Behre HM: Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA, and ASA Recommendations. Eur. Urol. 55(1),121-130(2009).
• 20 Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM: Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 2010 Jun: 95(6),2536-59
• 21 Petak SM, Nankin HR, Spark RF, Swerdloff RS, Rodriguez-Rigau LJ. American Association of Clinical Endocrinologists: AACE Medical Guideline for Clinical Practice for Evaluation and Treatment of Hypogonadism in Adult Male patients-2002 update. Endocr pract. 8. 440-456(2002).
• 22 Corona G, Maggi M: The role of testosterone in erectile dysfunction. Nat Rev Urol, 2010 Jan 7(1) 46-56.