Evaluation of an educational program for nurses providing cancer symptom management: The pan-Canadian Oncology Symptom Triage and Remote Support Online Tutorial.

Purpose: To evaluate the acceptability of the pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) open-access online tutorial and its impact on nurses' knowledge and perceived confidence in symptom management. Methods: Retrospective pre-/post-test evaluation of nurses who completed the tutorial knowledge test and/or acceptability survey. The tutorial was modeled after the previously evaluated in-person workshop to prepare nurses providing cancer symptom management using COSTaRS practice guides. Results: From 2017-2021, 743 nurses completed the knowledge test, and 749 nurses evaluated the tutorial. Mean knowledge score was 4.4/6 and 83% of participants achieved passing scores. Compared to pre-tutorial, nurses improved their perceived confidence in assessing, triaging, guiding patients in self-care (p<0.001), and ability to use the COSTaRS guides (p<0.001). Nurses rated the tutorial as easy to understand (95%), just the right amount of information (92%), providing new information (75%), overall good to excellent (89%), and would recommend it to others (83%). Conclusions: More than 700 nurses accessed the tutorial. After completion, nurses demonstrated good knowledge and improved perceived confidence in cancer symptom management.

Compliance with the clinical guidelines for managing asthma by primary care physicians: An ambispective observational study. / Seguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo.

OBJECTIVE: To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. MATERIAL AND METHODS: We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. RESULTS: Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3-30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4-33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13-0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12-0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40-2.06). CONCLUSIONS: Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines.

Improving recognition of potential tissue donors: a quality improvement project by a hospitalist in training in The Hague, The Netherlands.

The number of tissue donations decreased in The Netherlands over recent years. The aim of this project was to determine the number of missed tissue donors in the Haaglanden Medical Centre and to develop a strategy to improve the number of tissue donors. We retrospectively analyzed patient files of all deceased patients in 2014 for their potential as tissue donors. Our objectives were to determine the number of missed tissue donors and the percentage of correctly identified tissue donors among all physicians and hospitalists in training. In addition, a clinical audit and three focus group interviews were used to determine the level of knowledge about and adherence to local and national protocols. The findings enabled us to suggest national and local improvements to reduce the percentage of missed tissue donors. The number of missed tissue donors was 94 (17.2%) of 548 deceased patients in 2014. The percentage of correctly identified tissue donors was 65.7% among all physicians (Cohen's Kappa coefficient 0.557, p ≤ 0.001) and 57.1% among hospitalists in training (Cohen's Kappa coefficient 0.492, p ≤ 0.001). In 31 patients (32.4%), the reported contra-indication by physicians was not a contra-indication for tissue donation in The Netherlands. There was no statistical difference in correct identification between physicians and hospitalists in training (p = 0.321, Mann-Whitney). The most effective actions to increase the number of tissue donations include to better inform physicians about contra-indications and help them in the recognition of a tissue donor.

Mapping South African allied health primary care clinical guideline activity: establishing a stakeholder reference sample.

BACKGROUND: Little is known about allied health (AH) clinical practice guideline (CPG) activity in South Africa, and particularly in relation to primary health care (PHC). This paper reports on a scoping study undertaken to establish a reference framework, from which a comprehensive maximum variation sample could be selected. This was required to underpin robust sampling for a qualitative study aimed at understanding South African primary care AH therapy CPG activities. This paper builds on findings from the South African Guidelines Evaluation (Project SAGE) Flagship grant. METHODS: South African government websites were searched for structures of departments and portfolios, and available CPGs. Professional AH association websites were searched for CPGs, purposively-identified key informants were interviewed, and CPGs previously identified for priority South African primary care conditions were critiqued for AH therapy involvement. RESULTS: Key informants described potentially complex relationships between players who may be engaged in South African AH CPGs, in both public and private sectors. There were disability/rehabilitation portfolios at national and provincial governments, but no uniformity in provincial government organisation of, or support for, PHC AH services. There were no AH primary care therapy CPGs on government websites, although there was 'clinical guidance' in various forms on professional association websites. Only two CPGs of priority South African PHC conditions included mention of any AH therapy (physiotherapy for adult asthma and chronic obstructive pulmonary disease). CONCLUSION: A comprehensive and wide-reaching stakeholder reference framework would be required in order to capture the heterogeneity of AH primary care CPG activity in South Africa. This should involve the voices of national and purposively-selected provincial governments, academic institutions, consultants, public sector managers and clinicians, private practitioners, professional associations, and private sector insurers. Provincial governments should be selected to reflect heterogeneity in local economics, population demographics and availability of university AH training programs. This investigation should aim to determine the areas of PHC in which AH are engaged.

Improving access to cancer guidelines: feedback from health care professionals.

PURPOSE: We examined access to locally developed and other available clinical practice guidelines (cpgs) for the management of cancer and evaluated how to improve uptake. METHODS: A 12-question online survey was administered to 772 members of 12 multidisciplinary tumour teams in a Canadian provincial oncology program. The teams are composed of physicians, surgeons, nurses, allied health professionals, and researchers involved in the provision of cancer care across the province. Many of these individuals construct or provide input into the provincial cpgs. The questionnaires were administered online and were completed voluntarily. RESULTS: Responses were received from 232 individuals, a response rate of 30.1%. Most respondents (75.1%) indicated they actively referenced cpgs for cancer treatment. Of the 177 respondents who identified barriers to cpg access, 24.9% said that the cause was being too busy; 24.3% and 22.6% cited the user-unfriendliness of the Web site and a lack of awareness about the cpgs. When asked about innovative changes that could be made to improve access, the creation of cpg summary documents was identified as the most effective change (46.3%). The creation of summary documents was ranked highest by physicians, surgeons, and nurses. CONCLUSIONS: Clinical practice guidelines are important tools for standardizing treatment protocols and improving outcomes in health care systems, but support for their use is variable among health care professionals. We have identified barriers to-and potential mitigating strategies for-more widespread access to cpgs by the various health professions involved in cancer care. Local creation of succinct and easily accessible cpgs was identified as the single most effective way to enhance access by health care professionals.

Nurses' adoption of diabetes clinical practice guidelines in primary care and the impacts on patient outcomes and safety: An integrative review.

BACKGROUND: Complications related to diabetes mellitus impose substantial health and economic burdens to individuals and society. While clinical practice guidelines improve diabetes management in primary care settings, the variability in adherence to these guidelines persist. Hence, there is a need to comprehensively review existing evidence regarding factors influencing nurses' adherence to implementation of clinical practice guidelines to improve clinical care and patient safety. OBJECTIVE: This integrative review seeks to investigate nurses' adherence to clinical guidelines for diabetes management in primary healthcare settings and to explore factors influencing effective implementation, focusing on the role of nurses and impacts on patient outcomes. METHODS: A comprehensive search was conducted in March 2023 across six electronic databases. The search targeted studies that examined the use of Type 2 diabetes mellitus guidelines by nurses in primary healthcare settings with a focus on clinical management outcomes related to diabetes care or patient safety. Included studies were classified using the Effective Practice and Organisation of Care taxonomy, synthesised narratively and presented thematically. Reporting of the review adhered to PRISMA guidelines. (PROSPERO ID CRD42023394311). RESULTS: The review included ten studies conducted between 2000 and 2020, and the results were categorised into three themes. These were: (i) Implementation strategies to promote clinical practice guidelines adherence, including health professional development, reminders for clinicians, patient-mediated interventions, health information systems, role expansion, and comprehensive package-of-care. A multifaceted educational approach emerged as the most effective strategy. (ii) Impact of guidelines adherence: These strategies consistently improved clinical management, lowering HbA1c levels, improving blood pressure and lipid profiles, and enhancing patient self-care engagement, along with increased nurses' adherence to diabetes clinical guidelines. (iii) The role of nurses in guideline implementation, enabling independent practice within multidisciplinary teams. Their roles encompassed patient education, collaborative practice with fellow healthcare professionals, program planning and execution, and comprehensive documentation review. Nurse-led interventions were effective in improving patient outcomes, underscoring the necessity of empowering nurses with greater autonomy in providing primary diabetes care. CONCLUSION: Implementing a diverse range of strategies, focusing on comprehensive education for healthcare providers, is paramount for enhancing guideline adherence in diabetes care, to improve clinical management towards optimal patient health outcomes. Tailoring these strategies to meet local needs adds relevance to the guidelines. Empowering nurses to take a leading role in primary care not only enhances patient safety but also promotes quality of care, resulting in improved overall outcomes. TWEETABLE ABSTRACT: In primary care, empowering nurses with diabetes guideline education and tailoring strategies to local needs enhance guideline adherence and improve patient outcomes.

Guidelines on Gestational and Congenital Syphilis: insights of health professionals in Bolívar (Colombia) / Guía de Sífilis Gestacional y Congénita: perspectivas de profesionales de la salud en Bolívar (Colombia)

Objectives: To describe the knowledge, appropriateness and practices regarding the evidence-based "Clinical Practice Guidelines (CPG) for the comprehensive management of gestational syphilis (GS) and congenital syphilis (CS)". Material and methods: A descriptive, cross-sectional study including general practitioners, specialists and nurses working at 52 healthcare institutions in the Bolivar Department (Colombia) who provided prenatal control or neonatal care in 2020. Convenience sampling was used. A digital questionnaire was administered to collect sociodemographic information, assessed knowledge, appropriateness and practices in terms of the evidenced-based "Clinical Practice Guidelines (CPG)" mentioned in the objectives. A descriptive analysis followed. Results: A total of 101 workers were included. There are deficiencies associated with the correct use of the inverse algorithm of diagnosis (48 %) and GS followup (77 %), management of the patient with a history of systemic manifestation allergies (31 %) and treatment of GS (61 %) and CS (10 %). The recommendation of not using the penicillin test in patients with no history of systemic allergies is considered of little benefit (60 %). 23 % of the workers do not use rapid tests and 44 % of the specialists administer syphilis treatment to the sexual partner. Conclusions: It is important to intensify the training strategies for health personnel with emphasis on nurses and, as a matter of urgency, empower them in syphilis control activities. New and continuous national and regional evaluations of the implementation of these guidelines are needed to assess the indicators associated with the strategy for the elimination of this disease.

Objetivos: describir los conocimientos, la idoneidad y las prácticas respecto a la "Guía de práctica clínica (GPC) basada en la evidencia para la atención integral de la sífilis gestacional (SG) y congénita (SC)". Materiales y métodos: estudio descriptivo de corte transversal. Incluyó médicos generales, especialistas y enfermeras que laboraban en 52 instituciones de salud en el departamento de Bolívar (Colombia) y realizan el control prenatal o la atención al neonato en el 2020. Muestreo por conveniencia. Se aplicó cuestionario digital que recolectó información sociodemográfica; evaluó conocimientos, idoneidad y prácticas sobre la "Guía de práctica clínica (GPC)" mencionada en los objetivos. Se hace análisis descriptivo. Resultados: se incluyeron 101 trabajadores. Hay deficiencias relacionadas con la aplicación correcta del algoritmo inverso de diagnóstico (48 %) y seguimiento de SG (77 %), manejo de la paciente con antecedentes de alergias de manifestaciones sistémicas (31 %) y tratamiento de la SG (61 %) y SC (10 %). La recomendación de no aplicar prueba de penicilina en pacientes sin antecedentes de alergias sistémicas se considera poco útil (60 %). El 23 % de los trabajadores no emplea las pruebas rápidas y el 44 % de los especialistas da tratamiento para sífilis al compañero sexual. Conclusiones: es importante intensificar las estrategias de capacitación en el personal de salud con énfasis en el personal de enfermería y, de manera urgente, empoderar a este personal en las actividades relacionadas con el control de la sífilis. Se requiere hacer nuevas y continúas evaluaciones a nivel nacional y regional de la implementación de esta guía que permitan evaluar los indicadores que contiene la estrategia de eliminación de esta enfermedad.

Methods for living guidelines: early guidance based on practical experience. Paper 2: consumer engagement in living guidelines.

OBJECTIVES: To describe and reflect on the consumer engagement approaches used in five living guidelines from the perspectives of consumers (i.e., patients, carers, the public, and their representatives) and guideline developers. STUDY DESIGN AND SETTING: In a descriptive report, we used a template to capture engagement approaches and the experiences of consumers and guideline developers in living guidelines in Australia and the United Kingdom. Responses were summarized using descriptive synthesis. RESULTS: One guideline used a Consumer Panel, three included two to three consumers in the guideline development group, and one did both. Much of our experience was common to all guidelines (e.g., consumers felt welcomed but that their role initially lacked clarity). We identified six challenges and opportunities specific to living guidelines: managing the flow of work; managing engagement in online environments; managing membership of the panel; facilitating more flexibility, variety and depth in engagement; recruiting for specific skills-although these can be built over time; developing living processes to improve; and adapting consumer engagement together. CONCLUSION: Consumer engagement in living guidelines should follow established principles of consumer engagement in guidelines. Conceiving the engagement as living, underpinned by a living process evaluation, allows the approach to be developed with consumers over time.

Development and implementation of clinical practice guidelines: current status in Korea.

Documentation of unexplained geographic variations in medical practices and use of inappropriate interventions has led to the proliferation of clinical practice guidelines. With increased enthusiasm for guidelines, evidence exists that clinical practice guidelines often influence clinical practices or health outcomes. Their successful implementation may improve the quality of care by decreasing in appropriate variation and expediting the application of effective advances to healthcare practices. In Korea, physicians and healthcare professionals have begun to take interests in clinical practice guidelines. Currently, over 50 practice guidelines have been developed through professional academic organizations or via other routes; however, the quality of the guidelines is unsatisfactory, implementation in clinical settings is incomplete, and there is insufficient infrastructure to develop clinical practice guidelines. Korea must develop policies and invest resources to enhance the development and implementation of clinical practice guidelines.

Sustainability of healthcare professionals' adherence to clinical practice guidelines in primary care.

BACKGROUND: Sustainability of adherence to clinical practice guidelines (CPGs) represents an important indicator of the successful implementation in the primary care setting. AIM: To explore the sustainability of primary care providers' adherence to CPGs after receiving planned guideline implementation strategies, activities, or programmes. METHODS: Cochrane Central Register of Controlled Trials (CENTRAL); Cumulative Index to Nursing and Allied Health Literature (CINAHL); EMBase; Joanna Briggs Institute; Journals@Ovid; Medline; PsycoINFO; PubMed, and Web of Science were searched from January 2000 through May 2021 to identify relevant studies. Studies evaluating the sustainability of primary care providers' (PCPs') adherence to CPGs in primary care after any planned guideline implementation strategies, activities, or programmes were included. Two reviewers extracted data from the included studies and assessed methodological quality independently. Narrative synthesis of the findings was conducted. RESULTS: Eleven studies were included. These studies evaluated the sustainability of adherence to CPGs related to drug prescribing, disease management, cancer screening, and hand hygiene in primary care. Educational outreach visits, teaching sessions, reminders, audit and feedback, and printed materials were utilized in the included studies as guideline implementation strategies. None of the included studies utilized purpose-designed measurements to evaluate the extent of sustainability. Three studies showed positive sustainability results, three studies showed mixed sustainability results, and four studies reported no significant changes in the sustainability of adherence to CPGs. Overall, it was difficult to quantify the extent to which CPG-based healthcare behaviours were fully sustained based on the variety of results reported in the included studies. CONCLUSION: Current guideline implementation strategies may potentially improve the sustainability of PCPs' adherence to CPGs. However, the literature reveals a limited body of evidence for any given guideline implementation strategy. Further research, including the development of a validated purpose-designed sustainability tool, is required to address this important clinical issue. TRIAL REGISTRATION: The study protocol has been registered at PROSPERO (No. CRD42021259748 ).

Physician Use of Multiple Criteria to Diagnose Periprosthetic Joint Infection May Be Less Accurate Than the Use of an Individual Test.

Introduction Multiple-criterion scoring systems for periprosthetic joint infection (PJI) can be algorithmically implemented in research, diagnostically outperforming individual tests. This improved performance may be lost in the practice setting, where clinicians rarely utilize strict algorithms. The ability of physicians to interpret multiple criteria for PJI and confront the complexity of combining them into a final diagnosis has never been studied. This study assessed the diagnostic characteristics of physicians using multiple criteria to diagnose PJI and compared the physicians' diagnostic accuracy to that of individual tests. Methods A total of 12 physicians, including academic arthroplasty surgeons (N=4), community arthroplasty surgeons (N=4), and infectious disease (ID) specialists (N=4) were asked to use their routine clinical diagnostic practice to assign a diagnosis to 277 clinical vignettes using multiple preoperative laboratory criteria for PJI. The undecided rate, interobserver agreement, and accuracy of physicians were characterized relative to the 2013 Musculoskeletal Infection Society (MSIS) gold standard and compared to the accuracy of each individual laboratory test for PJI. Results Physicians interpreting multiple criteria for PJI demonstrated high undecided diagnosis rates (mean=23.5%), poor interobserver agreement (kappa range=0.49-0.63), and mean accuracy of 90.8% (range:85.8%-97.4%) compared to the 2013 MSIS gold standard. The group of academic arthroplasty surgeons had a lower rate of undecided diagnoses than community arthroplasty surgeons (16.2% vs. 29.1%; p<0.0001) or ID specialists (16.2% vs. 25.1%; p<0.0001). Academic arthroplasty surgeons also exhibited a higher interobserver agreement than community arthroplasty surgeons (kappa = 0.63 (95%CI:0.59-0.68) vs. 0.49 (95%CI:0.44-0.54)). Mean physician accuracy (90.8%) was inferior to the alpha-defensin laboratory test (96.0%;p=0.0034) and the alpha-defensin lateral-flow test (94.6%;p=0.036), comparable to synovial fluid white blood cells (SF-WBC) (93.3%;p=0.17) and synovial fluid polymorphonuclear cell % (SF-PMN%) (94.0%;p=0.11), and superior to the erythrocyte sedimentation rate (ESR) (86.2%;p<0.0001) and C-reactive protein (CRP) (84.6%;p<0.0001). Only two academic arthroplasty surgeons in this study were able to outperform every individual test for PJI by combining multiple criteria to make a diagnosis. Conclusion Although multiple-criterion scoring systems may outperform individual tests for diagnosing PJI in the research setting, it appears that the complexity of using multiple tests to diagnose PJI causes indecision and variability among physicians. Physician use of multiple preoperative criteria to diagnose PJI is less accurate than the strict algorithmic calculation of the diagnosis as achieved in research. In fact, most physicians in this study would have improved their diagnostic accuracy for PJI by simply utilizing a single good test to make the diagnosis, instead of trying to combine multiple tests into a decision. We propose that less complex diagnostic criteria should be explored for routine clinical utilization.

Palliative Care Nursing in Australia and the Role of the Registered Nurse in Palliative Care.

The registered nurse has crucial preventative, therapeutic, sociocultural, and advocacy roles in promoting quality holistic patient-centred palliative care. This paper examines, describes, and analyses this multifaceted role from an antipodean perspective. We conducted systematic searches using PubMed, Google Scholar, government guidelines, authoritative body regulations, quality control guidelines, and government portals pertaining to palliative care nursing in Australia. This paper relies upon the information garnered from publications, reports, and guidelines resulting from these searches and analyses. The fundamental principles and guiding values of palliative care (and nursing) and the raison d'etre for palliative care as a discipline are underscored and expanded on. Australian Clinical Practice Guidelines (CPGs) pertaining to palliative end-of-life (EOL) nursing care and associated services are discussed. The relevant NMBA nursing standards that RNs need to have to administer opioids/narcotics in palliative care are summarised. The identification of patients who need EOL care, holistic person-centred care planning for them, and consultative multidisciplinary palliative clinical decision making are discussed in the palliative care context. Several components of advance care planning apropos health deterioration and conflicts are discussed. Several aspects of EOL care, especially palliative nursing care, are analysed using research evidence, established nursing and palliative care standards, and the Australian EOL CPGs.

Barriers to Clinical Practice Guideline Implementation Among Physicians: A Physician Survey.

INTRODUCTION: Clinical practice guidelines can help physicians provide evidence-based, standardized clinical decisions. We aimed to assess physician attitudes toward and barriers to guideline adherence. METHODS: We conducted a single center, cross-sectional, survey-based study. Physicians from many specialties participated in the study. All outcomes were measured using a validated survey tool. The primary outcome of interest was barriers to guideline adherence. Secondary outcomes included general attitudes toward guidelines and factors that could improve adherence to guidelines. Outcomes were measured by the survey tool. All outcomes were reported on a 5-point Likert scale. RESULTS: The email survey was received by 1819 physicians with 400 responders (22% response rate). About 50% (n=200) were in practice for >5 years, while 27% (n=107) were still in training. Trainees were less likely to understand the process of guideline development (RR= 0.76 [0.65-0.88], p=0.0017), to have input in guideline development (RR= 0.52 [0.41-0.65], p<0.0001), and to report up-to-date knowledge in practice guidelines (RR=0.53 [0.30-0.73], p=0.0002). Three factors were identified as major barriers to guideline adherence: complexity of guideline documents (61%, n=240), high number of weak or conditional recommendations (62%, n=245), and time constraints due to clinical responsibilities (65%, n=255). Factors that would improve guideline adherence included access to relevant guidelines at the point of care (87%), improved focus on guidelines during training (82%), and transparency on physician commercial affiliation (62%). CONCLUSION: Improved focus on guidelines during training and access to relevant guidelines at the point of care may be important to improve adherence to guidelines.

Care of frail and older adults: A content analysis of paramedic operational clinical practice guidelines.

INTRODUCTION: Frailty rates are increasing with population ageing. In paramedicine, Clinical Practice Guidelines (CPGs) are essential documents that support decision making, yet little evidence exists regarding the support CPGs provide paramedics in the care of frail and older adults. AIM: To investigate how CPGs support paramedics' care of frail and older adults. METHODS: CPGs from nine Australasian paramedic services were collected in 2019. Content analysis was used to explore two hundred and thirty-seven individual CPGs for decision support information regarding frail and older adults. RESULTS: Evidence-based content relating to older adults was sparse compared to paediatric content. Two overarching decision support domains were identified, patient assessment and management. Inconsistent age descriptors were widespread, particularly in pharmacological guidelines. Five service providers' CPGs contained validated assessment instruments for use with older adults. CONCLUSION: Decision support documentation regarding frail and older adults varies across Australasian paramedic services. Frailty and older adult specific CPGs, and validated assessment instruments suitable to the paramedicine environment could improve paramedic decision making and minimise patient risk. A collaborative approach encompassing service providers and educational institutions is crucial to develop consistent, evidence-based CPGs relevant to older adults.

Family physicians/GP and Internist opinions, familiarity and practice behaviour regarding clinical practice guidelines (CPGs) of common medical conditions in Nigeria.

BACKGROUND: Few studies exist on physicians' opinions, attitudes, familiarity and practice behaviour regarding clinical practice guidelines in sub-Saharan Africa. OBJECTIVES: To determine the opinions, familiarity, and practice behaviour regarding clinical practice guidelines (CPGs) and factors associated with their use among internists and family physicians/GP in Nigeria. METHODS: A semi-structured questionnaire regarding guidelines of five common medical conditions: hypertension, diabetes mellitus, tuberculosis, asthma and hepatitis B encountered in everyday medical practice were self-administered by 183 doctors across the country. RESULTS: Over 90% of respondents believed that guidelines were evidence-based, improved management outcomes, and quality of care, nevertheless, 57.4% were against using them in litigations against doctors. The majority (>70%) of the respondents were familiar with the guidelines except that of hepatitis B. Overall, guidelines were used regularly by 45.9%, used in part by 23.5% and 30.6% never used it. Approximately 50% of physicians had immediate accessibility to them at the point of care. The proportions of respondents reporting a change in practice behaviour ranged from 37.7-57.9% depending on the guideline. The factors associated with guideline-related behaviour change were familiarity with its contents, postgraduate educational training, increased helpfulness score, and practiced >5 years. CONCLUSIONS: The present study shows that most physicians have favourable opinions and are familiar with these guidelines, however, the proportions reporting changes in their patient management because of the guidelines are not satisfactory. It is important to ensure guidelines accessibility and promotes factors that encourage their implementation in medical practice.

Comparison of a Cancer Family History Collection and Risk Assessment Tool - ItRunsInMyFamily - with Risk Assessment by Health-Care Professionals.

INTRODUCTION: Primary care providers (PCPs) and oncologists lack time and training to appropriately identify patients at increased risk for hereditary cancer using family health history (FHx) and clinical practice guideline (CPG) criteria. We built a tool, "ItRunsInMyFamily" (ItRuns) that automates FHx collection and risk assessment using CPGs. The purpose of this study was to evaluate ItRuns by measuring the level of concordance in referral patterns for genetic counseling/testing (GC/GT) between the CPGs as applied by the tool and genetic counselors (GCs), in comparison to oncologists and PCPs. The extent to which non-GCs are discordant with CPGs is a gap that health information technology, such as ItRuns, can help close to facilitate the identification of individuals at risk for hereditary cancer. METHODS: We curated 18 FHx cases and surveyed GCs and non-GCs (oncologists and PCPs) to assess concordance with ItRuns CPG criteria for referring patients for GC/GT. Percent agreement was used to describe concordance, and logistic regression to compare providers and the tool's concordance with CPG criteria. RESULTS: GCs had the best overall concordance with the CPGs used in ItRuns at 82.2%, followed by oncologists with 66.0% and PCPs with 60.6%. GCs were significantly more likely to concur with CPGs (OR = 4.04, 95% CI = 3.35-4.89) than non-GCs. All providers had higher concordance with CPGs for FHx cases that met the criteria for genetic counseling/testing than for cases that did not. DISCUSSION/CONCLUSION: The risk assessment provided by ItRuns was highly concordant with that of GC's, particularly for at-risk individuals. The use of such technology-based tools improves efficiency and can lead to greater numbers of at-risk individuals accessing genetic counseling, testing, and mutation-based interventions to improve health.

Optimizing practice guidelines through incorporating patient and family values and preferences.

Neonatal care largely follows clinical practice guidelines and position statements developed locally by respective institutions as well as by national and international organizations. One might expect that adoption of clinical guidelines based on best available research evidence would make neonatal care practices mostly uniform. However, wide variation in clinical practice is still noted in neonatal care. Neonatal clinical guidelines are developed almost exclusively by healthcare professionals, with little or no input from families of the infants being cared for. Therefore, such variation in practice may stem not only from how the evidence is interpreted but also how caregivers and families value different outcomes that are affected by particular interventions. Acknowledging and incorporating the variability in patient and family values and preferences in clinical guidelines is an important step towards allowing shared decision making while reducing unwarranted practice variation, and thereby helping clinicians practice family-centered evidence-based medicine.

Is great information good enough? Evidence from physicians as patients.

We place an upper bound on the degree to which policies aimed at improving the information deficiencies of patients may lead to greater adherence to clinical guidelines and recommended practices. To do so, we compare the degree of adherence attained by a group of patients that should have the best possible information on health care practices-i.e., physicians as patients-with that attained by a comparable group of non-physician patients, taking various steps to account for unobservable differences between the two groups. Our results suggest that physicians, at best, do only slightly better in adhering to both low- and high-value care guidelines than non-physicians.

Knowledge acquired from Clinical Guidelines on the Diagnosis and Treatment of Acute Pancreatitis by attending physicians and residents in hospitals in Veracruz. / Conocimiento de las Guías Clínicas de Diagnóstico y Tratamiento de la Pancreatitis Aguda en médicos adscritos y residentes de los hospitales de Veracruz.

INTRODUCTION: Clinical practice guidelines on the diagnosis and treatment of acute pancreatitis (CPGDTAP) have been designed in an effort to reduce the morbidity and mortality of that severe disease. AIM: To identify the knowledge acquired from CPGDTAP in hospitals in Veracruz. MATERIALS AND METHODS: A descriptive, observational, multicenter study was conducted at four hospitals in Veracruz, through the application of a survey to evaluate the knowledge of attending physicians and residents that treat patients with acute pancreatitis. Descriptive statistics were employed to analyze the results. RESULTS: A total of 74 physicians were surveyed: 55.41% of whom were attending physicians and 44.59% of whom were resident physicians. The majority of physicians (67.57%) were familiar with CPGDTAP from the Asociación Mexicana de Gastroenterología (AMG), followed by those of the General Health Council of the Mexican Department of Health (CENETEC, the Spanish acronym) (54.05%) and the American College of Gastroenterology (ACG) (48.65%). A total of 97.30% of the physicians routinely use a nasogastric tube, 79.73% considered early enteral nutrition to be very important, as did 98.65% regarding generous fluid replacement, 85.14% did not routinely use antimicrobials, 63.51% ordered a CAT scan at 72h or later, and 87.84% answered that infected necrosis was the indication for surgery, preferably after the third week. DISCUSSION AND CONCLUSIONS: In our hospital environment, the CPGDTAP issued by the AMG and CENETEC were the most well-known, but their recommended measures were given importance by under 85% of the physicians surveyed. Therefore, the diffusion of the knowledge they contain is advisable to guarantee optimal results in acute pancreatitis management.

Examination of physicians' adherence to the 2013 ACC/AHA statin/cholesterol guidelines using a framework of awareness to adherence: A cross-sectional study.

BACKGROUND: Currently, limited data exists regarding primary care physicians' awareness and implementation of the 2013 cholesterol guidelines. OBJECTIVES: To evaluate primary care physicians' adherence to the 2013 ACC/AHA cholesterol management guidelines using the framework of the awareness-to-adherence model. METHODS: The study was a cross-sectional pre-post survey design based on the constructs of the awareness-to-adherence model to capture physicians' awareness of, agreement with, adoption of, and adherence to the 2013 ACC/AHA guidelines for cholesterol treatment and statin and cholesterol management software applications. Physicians with a Medicare Advantage organization in Texas were surveyed before and after educational interventions. RESULTS: A total of 170 responses were considered usable (post-survey). A significant difference was observed when physicians were divided into 2 groups (any intervention vs no intervention) (P = .027). Physicians with a higher level of agreement were 4.8 times more likely to be adherent to the guidelines (P = .011), compared with those with a lower level of agreement. Also, physicians practicing in the Rio Grande Valley area were 4.7 times more likely to be adherent to the guidelines (P = .001) compared with those from the Greater Houston area. CONCLUSION: A high level of awareness, but a lower level of adherence to the guidelines was reported among responding physicians. The awareness-to-adherence model was useful in examining physicians' level of adherence to the cholesterol guidelines and the utilization of statin and cholesterol management cellular apps and online websites. Future studies are required to examine physicians' adoption and adherence of new guidelines.