Efficiency of pragmatic search strategies to update clinical guidelines recommendations.

BACKGROUND: A major challenge in updating clinical guidelines is to efficiently identify new, relevant evidence. We evaluated the efficiency and feasibility of two new approaches: the development of restrictive search strategies using PubMed Clinical Queries for MEDLINE and the use of the PLUS (McMaster Premium Literature Service) database. METHODS: We evaluated a random sample of recommendations from a national guideline development program and identified the references that would potentially trigger an update (key references) using an exhaustive approach. We designed restrictive search strategies using the minimum number of Medical Subject Headings (MeSH) terms and text words required from the original exhaustive search strategies and applying broad and narrow filters. We developed PLUS search strategies, matching Medical Subject Headings (MeSH) and Systematized Nomenclature of Medicine (SNOMED) terms with guideline topics. We compared the number of key references retrieved by these approaches with those retrieved by the exhaustive approach. RESULTS: The restrictive approach retrieved 68.1 % fewer references than the exhaustive approach (12,486 versus 39,136), and identified 89.9 % (62/69) of key references and 88 % (22/25) of recommendation updates. The use of PLUS retrieved 88.5 % fewer references than the exhaustive approach (4,486 versus 39,136) and identified substantially fewer key references (18/69, 26.1 %) and fewer recommendation updates (10/25, 40 %). CONCLUSIONS: The proposed restrictive approach is a highly efficient and feasible method to identify new evidence that triggers a recommendation update. Searching only in the PLUS database proved to be a suboptimal approach and suggests the need for topic-specific tailoring.

[Quality assurance of prenatal care in a rural health center]. / Garantía de calidad de la vigilancia prenatal en un centro de salud rural.

OBJECTIVE: This study was carried out with the aim of evaluating the quality of Prenatal Care (PNC) and improving attention to the pregnant woman. DESIGN: This was a retrospective evaluation, with a later monitoring of two indicators: an early start to care and an evaluation of risk. Site. The study was undertaken in a rural Primary Care Centre. PATIENTS AND OTHERS PARTICIPANTS: For purposes of the evaluation all the pregnant women (222) looked after between 1988 and 1990 were studied; for the monitoring, all those between July 1990 and June 1991. MAIN MEASUREMENTS AND RESULTS: On the first evaluation, both the starting of PNC within the first 12 weeks (in 65% of cases) and the evaluation of obstetric risk at the first visit (29% compliance) were considered unacceptably low. With the help of corrective measures and simple practical monitoring, 100% compliance was reached in 12 months. The risk evaluation on subsequent visits (between 73 and 95% compliance) and the number of checks (90% compliance) were considered adequate, and no intervention was made. CONCLUSIONS: We concluded that the PNC programmes should include quality assurance activities, as these have a positive effect on the improvement of medical care.