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1.
Dtsch Med Wochenschr ; 144(14): 990-996, 2019 07.
Artigo em Alemão | MEDLINE | ID: mdl-31096279

RESUMO

The AWMF and its medical societies perceive an increasing dominance of economic targets in the hospital health care sector, leading to impairment of patient care. While resource use in health care should be appropriate, efficient and fairly allocated, "economization" creates a burdensome situation for physicians, nurses and other health care professionals.The AMWF and the medical societies studied causes and developed measures for a scientific, patient-centred and resource-conscious medical care. Disincentives due to the remuneration system, number and equipment of hospitals resp. specialist departments and their basic funding need to be overcome. Proposed actions relate to the patient-doctor-level, the management level of hospitals and the level of planning and financing hospitals including compensation of hospital care. To place patients and their health in the forefront again, joint efforts of all stakeholders in health care are needed.


Assuntos
Economia Hospitalar , Administração Hospitalar , Assistência Centrada no Paciente/economia , Sociedades Médicas/organização & administração , Humanos
2.
Geburtshilfe Frauenheilkd ; 78(11): 1056-1088, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30581198

RESUMO

Purpose The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer. Method The process of updating the S3 guideline published in 2012 was based on the adaptation of identified source guidelines. They were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and with the results of a systematic search of literature databases followed by the selection and evaluation of the identified literature. The interdisciplinary working groups took the identified materials as their starting point and used them to develop suggestions for recommendations and statements, which were then modified and graded in a structured consensus process procedure. Recommendations Part 2 of this short version of the guideline presents recommendations for the therapy of primary, recurrent and metastatic breast cancer. Loco-regional therapies are de-escalated in the current guideline. In addition to reducing the safety margins for surgical procedures, the guideline also recommends reducing the radicality of axillary surgery. The choice and extent of systemic therapy depends on the respective tumor biology. New substances are becoming available, particularly to treat metastatic breast cancer.

3.
Geburtshilfe Frauenheilkd ; 78(10): 927-948, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30369626

RESUMO

Purpose The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer. Methods The process of updating the S3 guideline dating from 2012 was based on the adaptation of identified source guidelines which were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and the results of a systematic search of literature databases and the selection and evaluation of the identified literature. The interdisciplinary working groups took the identified materials as their starting point to develop recommendations and statements which were modified and graded in a structured consensus procedure. Recommendations Part 1 of this short version of the guideline presents recommendations for the screening, diagnosis and follow-up care of breast cancer. The importance of mammography for screening is confirmed in this updated version of the guideline and forms the basis for all screening. In addition to the conventional methods used to diagnose breast cancer, computed tomography (CT) is recommended for staging in women with a higher risk of recurrence. The follow-up concept includes suggested intervals between physical, ultrasound and mammography examinations, additional high-tech diagnostic procedures, and the determination of tumor markers for the evaluation of metastatic disease.

4.
Orthopade ; 47(9): 757-769, 2018 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-30116852

RESUMO

The update of the German S3 guideline on atraumatic femoral head necrosis in adults aims to provide an overview of diagnosis and treatment. All clinical studies, systematic reviews, and meta-analyses published in German or English between 01.05.2013 and 30.04.2017 were included. Of 427 studies, 28 were suitable for analysis. Risk factors are corticosteroids, chemotherapy, kidney transplants, hemoglobinopathies, and alcoholism. Differential diagnoses are for example bone marrow edema, insufficiency fracture, and destructive arthropathy. Radiography should be performed upon clinical suspicion. In patients with normal radiography findings but persistent complaints, magnetic resonance imaging (ARCO classification) is the method of choice. Computed tomography (CT) can be used to confirm/exclude articular surface collapse. A subchondral sclerosis zone >30% in CT indicates a better prognosis. Left untreated, a subchondral fracture will develop within 2 years. The risk of disease development in the opposite side is high during the first 2 years, but unlikely thereafter. In conservative therapy, iloprost and alendronate can be used in a curative approach, the latter for small, primarily medial necrosis. Conservative therapy alone as well as other drug-based and physical approaches are not suitable for treatment. No particular joint-preserving surgery can currently be recommended. Core decompression should be performed in early stages with <30% necrosis. From ARCO stage IIIc or in stage IV, the indication for total hip arthroplasty should be checked. Results after total hip arthroplasty are comparable with those after coxarthrosis, although the revision rate is higher due to the relatively young age of patients. Statements on the effectiveness of cell-based therapies such as expanded stem cells or bone marrow aspirates cannot currently be made.


Assuntos
Artroplastia de Quadril , Necrose da Cabeça do Fêmur , Adulto , Descompressão Cirúrgica , Cabeça do Fêmur , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/cirurgia , Humanos , Radiografia
5.
Z Evid Fortbild Qual Gesundhwes ; 129: 3-11, 2017 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-29157559

RESUMO

The question of how to improve healthcare quality and the need for patient empowerment and shared decision-making has been the subject of political and scientific debate for years. In addition to various quality initiatives, "top lists" summarizing selected recommendations to increase awareness of overuse, spread by means of public campaigns, has become popular on the international level - known as the "Choosing Wisely" initiative. However, the trustworthiness of "top lists", their impact on patient-relevant outcomes, their role in and integration into the context of the various pre-existing approaches to improve healthcare quality and the effects of neglecting under- and misuse are not clear. On the other hand, "top lists" may provide new opportunities to improve awareness and dissemination of carefully selected recommendations based on high-quality guidelines. Therefore, the Association of Scientific Medical Societies in Germany (AWMF) has established an ad hoc commission to design a system-specific initiative. The commission has the task to clarify goals, methods of development and concepts for implementation and evaluation, to address concerns and to build upon specific existing resources - e. g., the established quality management system for guidelines in Germany. The key goals defined by the commission include the systematization of the dialogue between healthcare practitioners and patients and the promotion of ethically founded decision-making as an answer to an increasing economic orientation of the healthcare system. To ensure the methodological quality of specific recommendations, the commission has developed a manual. To the best of our knowledge, this manual is the first detailed method paper aiming to guide developers of "Choosing Wisely" recommendations. More than 20 German medical scientific societies have already addressed the subject of "top lists".


Assuntos
Assistência à Saúde/normas , Qualidade da Assistência à Saúde , Tomada de Decisões , Alemanha , Humanos , Sociedades Médicas , Sociedades Científicas
6.
Z Evid Fortbild Qual Gesundhwes ; 127-128: 3-10, 2017 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-29128430

RESUMO

The quality of reporting practice guidelines is often poor, and there is no widely accepted guidance or standards for such reporting in health care. The international RIGHT (Reporting Items for practice Guidelines in HealThcare) Working Group was established to address this gap. The group followed an existing framework for developing guidelines for health research reporting and the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network approach. A checklist and an explanation and elaboration statement were developed. The RIGHT checklist includes 22 items that are considered essential for good reporting of practice guidelines: basic information (items 1 to 4), background (items 5 to 9), evidence (items 10 to 12), recommendations (items 13 to 15), review and quality assurance (items 16 and 17), funding and declaration and management of interests (items 18 and 19), and other information (items 20 to 22). The RIGHT checklist can assist developers in reporting guidelines, support journal editors and peer reviewers when considering guideline reports, and help health care practitioners understand and implement a guideline.


Assuntos
Lista de Checagem , Guias de Prática Clínica como Assunto , Relatório de Pesquisa , Assistência à Saúde , Alemanha , Humanos
8.
JAMA Intern Med ; 177(7): 1020-1025, 2017 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-28505266

RESUMO

Importance: No guidelines exist currently for guideline panels and others considering changes to disease definitions. Panels frequently widen disease definitions, increasing the proportion of the population labeled as unwell and potentially causing harm to patients. We set out to develop a checklist of issues, with guidance, for panels to consider prior to modifying a disease definition. Observations: We assembled a multidisciplinary, multicontinent working group of 13 members, including members from the Guidelines International Network, Grading of Recommendations Assessment, Development and Evaluation working group, and the World Health Organisation. We used a 5-step process to develop the checklist: (1) a literature review of issues, (2) a draft outline document, (3) a Delphi process of feedback on the list of issues, (4) a 1-day face-to-face meeting, and (5) further refinement of the checklist. The literature review identified 12 potential issues. From these, the group developed an 8-item checklist that consisted of definition changes, number of people affected, trigger, prognostic ability, disease definition precision and accuracy, potential benefits, potential harms, and the balance between potential harms and benefits. The checklist is accompanied by an explanation of each item and the types of evidence to assess each one. We used a panel's recent consideration of a proposed change in the definition of gestational diabetes mellitus (GDM) to illustrate use of the checklist. Conclusions and Relevance: We propose that the checklist be piloted and validated by groups developing new guidelines. We anticipate that the use of the checklist will be a first step to guidance and better documentation of definition changes prior to introducing modified disease definitions.


Assuntos
Lista de Checagem , Doença , Guias como Assunto , Terminologia como Assunto , Medicina Clínica/métodos , Current Procedural Terminology , Gerenciamento Clínico , Humanos
9.
Dtsch Arztebl Int ; 114(7): 119, 2017 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-28302257
10.
Dtsch Arztebl Int ; 113(31-32): 532-8, 2016 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-27581506

RESUMO

BACKGROUND: Venous thromboembolism (VTE) is the third most common cardiovascular condition, after myocardial infarction and stroke. Prophylactic measures in accordance with current guidelines can significantly reduce the risk of VTE and the associated morbidity and mortality. Until now, the German interdisciplinary, evidence- and consensus-based (S3) clinical practice guideline on VTE prophylaxis was based on a complete review of all pertinent literature available in MEDLINE up to January 2008. More recent publications and drug approvals have made a thorough revision necessary. METHODS: A systematic search was carried out in the MEDLINE and Embase databases for publications that appeared from 1 January 2008 to 7 August 2013. Updates of 5 national and international reference guidelines and 2 new Health Technology Assessment (HTA) reports were considered as well. A structured consensus-finding process was carried out with delegates from 27 scientific medical societies and from the Union of Medical Specialist Associations. RESULTS: 46 randomized controlled trials (RCTs) were included for critical appraisal. New findings led to re-evaluation of the value of compression stockings in combination with pharmacological prophylaxis (open recommendation), and suggest equal value of non-vitamin K antagonist oral anticoagulants (NOACs) and low molecular weight heparins (LMWH) or fondaparinux in elective hip and knee replacement (strong recommendation). For patients undergoing hip fracture surgery, we recommend LMWH or fondaparinux. CONCLUSION: Further research is needed to assess the value of NOACs for pharmacological prophylaxis in orthopedic/trauma patients undergoing surgical procedures other than the ones mentioned above, and into the benefit and harm of new devices available for mechanical prophylaxis. The stringent implementation of basic measures such as early mobilization, movement exercises, and patient instruction is a key point to prevent venous thrombo - embolism.


Assuntos
Anticoagulantes/uso terapêutico , Cardiologia/normas , Fibrinolíticos/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Meias de Compressão/normas , Tromboembolia Venosa/prevenção & controle , Anticoagulantes/normas , Medicina Baseada em Evidências , Fibrinolíticos/normas , Alemanha , Complicações Pós-Operatórias/diagnóstico , Resultado do Tratamento , Tromboembolia Venosa/diagnóstico
12.
Artigo em Alemão | MEDLINE | ID: mdl-27480183

RESUMO

INTRODUCTION: Specific recommendations form the centerpiece of medical guidelines. The intended strength of a recommendation is usually expressed by the use of different wordings. Recent investigations showed that guideline users (recipients) interpret the binding character of wordings in different ways. The perception of different wording and their binding character of the strength of guideline recommendations among guideline developers (sender) have so far not been investigated in the German-speaking area. METHODS: German-speaking guideline developers were invited online and at specialist meetings to participate in a survey investigating 13 different terms used in guideline recommendations. The aim was to measure their perceived binding character on a visual analog scale (VAS: 0-100). Additional demographic and occupational data were collected. The results were compared with data from a previous survey among guideline users. RESULTS: Overall, 136 guideline developers with an average of 4.2 (median 3) guideline (co-) authorships participated in the survey. While guideline developers interpreted the two imperative recommendations "must" and "must not" with a similarly high level of obligation, the level of obligation was not rated homogenously for strong and weak recommendations like "shall" or "should". Two out of five negative formulations were perceived as more binding than their corresponding positive formulations. In comparisons with the ratings of the guideline users the terms "darf nicht" (must not), (-5.8 VAS, p≤0.0001) and "muss" (must), (-2.9 VAS, p≤0.0006) were perceived as less binding by the guideline developers, as was "sollte nicht"(should not) (-6.6 VAS, p≤0.0001) and "kann nicht empfohlen werden" (cannot be recommended) (-9.4 VAS, p≤0.0001). Only "soll" (shall) was perceived as more binding (+8.7 VAS, p≤0.0001). DISCUSSION: The current survey demonstrates that guideline developers perceive the binding character of terms used in guideline recommendations in a similar way as it was found for guideline users in a previous survey. Negative recommendations are more often rated as more binding by guideline developers as the corresponding positive terms. The discordant ratings by the guideline developers can be explained by their methodological knowledge regarding formulations of recommendations. It would be desirable that efforts be made to identify wordings in guidelines which better discriminate the intended level of obligation of guideline recommendations with regard to these results.


Assuntos
Guias de Prática Clínica como Assunto , Alemanha , Humanos , Inquéritos e Questionários
13.
BMC Med Res Methodol ; 16: 39, 2016 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-27039299

RESUMO

BACKGROUND: The use of comprehensive instruments for guideline appraisal is time-consuming and requires highly qualified personnel. Since practicing physicians are generally busy, the rapid-assessment Mini-Checklist (MiChe) tool was developed to help them evaluate the quality and utility of guidelines quickly. The aim of this study was to validate the MiChe in comparison to the AGREE II instrument and to determine its reliability as a tool for guideline appraisal. METHODS: Ten guidelines that are relevant to general practice and had been evaluated by 2 independent reviewers using AGREE II were assessed by 12 GPs using the MiChe. The strength of the correlation between average MiChe ratings and AGREE II total scores was estimated using Pearson's correlation coefficient. Inter-rater reliability for MiChe overall quality ratings and endorsements was determined using intra-class correlations (ICC) and Kendall's W for ordinal recommendations. To determine the GPs' satisfaction with the MiChe, mean scores for the ratings on five questions were computed using a six-point Likert scale. RESULTS: The study showed a high level of agreement between MiChe and AGREE II in the quality rating of guidelines (Pearson's r = 0.872; P < 0.001). Inter-rater-reliability for overall MiChe ratings (ICC = 0.755; P < 0.001) and endorsements (Kendall's W = 0.73; P < 0.001) were high. The mean time required for guideline assessment was less than 15 min und user satisfaction was generally high. CONCLUSIONS: The MiChe performed well in comparison to AGREE II and is suitable for the rapid evaluation of guideline quality and utility in practice. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00007480.


Assuntos
Medicina Geral/normas , Clínicos Gerais/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Guias de Prática Clínica como Assunto/normas , Adulto , Idoso , Lista de Checagem/métodos , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Padrões de Prática Médica , Inquéritos e Questionários
14.
Dtsch Med Wochenschr ; 141(7): 453-6, 2016 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-26934866

RESUMO

Any recommendations of the previous practice guidelines on prevention of venous thromboembolism have been put to the test and have been revised in the latest edition in case new evidence had become available. Recommendations which have proven themselves in clinical practice have remained unchanged such as algorithms for risk assessment, however there are now updates on the recommendations of novel oral anticoagulants for prevention of venous thromboembolism, on the use of mechanical prophylaxis, on heparin-induced thrombocytopenia and on prophylaxis in outpatients after surgical procedures.


Assuntos
Tromboembolia Venosa/prevenção & controle , Tromboembolia Venosa/terapia , Humanos , Guias de Prática Clínica como Assunto , Medição de Risco
16.
Implement Sci ; 11: 6, 2016 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-26772173

RESUMO

BACKGROUND: The Guidelines International Network (G-I-N) aims to promote high quality clinical guideline development and implementation. Guideline-based performance measures are a key implementation tool and are widely used internationally for quality improvement, quality assurance, and pay for performance in health care. There is, however, no international consensus on best methods for guideline-based performance measures. In order to address this issue, the G-I-N Performance Measures Working Group aimed to develop a set of consensus-based reporting standards for guideline-based performance measure development and re-evaluation. METHODS: Methodology publications on guideline-based performance measures were identified from a systematic literature review and analyzed. Core criteria for the development and evaluation process of guideline-based performance measures were determined and refined into draft standards with an associated rationale and description of the evidence base. In a two-round Delphi-process, the group members appraised and approved the draft standards. After the first round, the group met to discuss comments and revised the drafts accordingly. RESULTS: Twenty-one methodology publications were reviewed. The group reached strong consensus on nine reporting standards concerning: (1) selection of clinical guidelines, (2) extraction of clinical guideline recommendations, (3) description of the measure development process, (4) measure appraisal, (5) measure specification, (6) description of the intended use of the measure, (7) measure testing/validating, (8) measure review/re-evaluation, and (9) composition of the measure development panel. CONCLUSIONS: These proposed international reporting standards address core components of guideline-based performance measure development and re-evaluation. They are intended to contribute to international reporting harmonization and improvement of methods for performance measures. Further research is required regarding validity, acceptability, and practicality.


Assuntos
Assistência à Saúde/normas , Guias de Prática Clínica como Assunto , Competência Profissional/normas , Humanos
17.
Ann Intern Med ; 163(7): 548-53, 2015 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-26436619

RESUMO

Conflicts of interest (COIs) have been defined by the American Thoracic Society as "a divergence between an individual's private interests and his or her professional obligations such that an independent observer might reasonably question whether the individual's professional actions or decisions are motivated by personal gain, such as direct financial, academic advancement, clinical revenue streams, or community standing." In the context of guideline development, the concerns are not simply about identifying and disclosing direct financial or indirect COIs. Despite this recognition, the management of COIs in guidelines is often unsatisfactory. In response to requests from its international membership and informed by existing syntheses of the evidence and policies of international organizations, the Guidelines International Network Board of Trustees developed guidance on the disclosure of interests and management of COIs. Current approaches are relatively similar throughout the guideline development community, with an increasing recognition of the importance of disclosing and managing indirect COIs. Although there are differences in detail among the approaches, the similarities allow for the formulation of 9 core principles for managing COIs. In formulating these principles, the Guidelines International Network Board of Trustees recognizes that COIs cannot be totally avoided when panel members are being chosen for certain guidelines or in certain settings; thus, the important issue is the management of COIs in a fair, judicious, transparent manner.


Assuntos
Pesquisa Biomédica/ética , Conflito de Interesses , Revelação , Guias como Assunto , Humanos
18.
Dtsch Arztebl Int ; 112(27-28): 471-8, 2015 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-26214233

RESUMO

BACKGROUND: Guidelines of high methodological quality make an essential contribution to the quality assurance of medical knowledge. The detailed evaluation of guideline quality is a complex and time-consuming task. The answers to a few key questions generally suffice for an initial, rapid assessment of the quality and utility of a guideline. METHOD: We selectively searched the pertinent literature for guideline-assessing instruments and analyzed selected ones with respect to their target group, purpose, orientation, and comprehensiveness. We identified key questions from brief instruments that can be used to assess guideline quality rapidly. RESULTS: A comparison of ten instruments revealed that most were designed to provide a highly detailed assessment of guideline quality. Four recently developed instruments enable a rough and rapid assessment. They focus, in essence, on four key questions: Was the evidence analyzed systematically? Does the evidence support the recommendations? Is the goal of the guideline formulated, and are the authors named? Is the organization of the guideline easy to follow, and are the recommendations clearly signposted? CONCLUSION: Alongside the comprehensive instruments for assessing guidelines, such as DELBI and AGREE II, rapid-assessment instruments are a convenient tool for gaining a quick impression of the value of a guideline.


Assuntos
Lista de Checagem/normas , Medicina Baseada em Evidências/normas , Participação do Paciente/métodos , Guias de Prática Clínica como Assunto/normas , Garantia da Qualidade dos Cuidados de Saúde/normas
19.
Z Evid Fortbild Qual Gesundhwes ; 108(8-9): 470-80, 2014.
Artigo em Alemão | MEDLINE | ID: mdl-25523845

RESUMO

The German Guideline Programme in Oncology (GGPO) is a joint initiative between the German Cancer Society, the Association of the Scientific Medical Societies in Germany and German Cancer Aid. In accordance with the aims of the German National Cancer Plan, the GGPO supports the systematic development of high-quality guidelines. To enhance implementation and evaluation, the suggestion of performance measures (PMs) derived from guideline recommendations following a standardised methodology is obligatory within the GGPO. For this purpose, PM teams are convened representing the multidisciplinary guideline development groups including clinical experts, methodologists and patient representatives as well as those organisations that take an active part in and share responsibility for documentation and quality improvement, i.e., clinical cancer registries, certified cancer centres and, if appropriate, the institution responsible for external quality assurance according to the German Social Code (SGB). The primary selection criteria for PMs include strength of the underlying recommendation (strong, grade A), existing potential for improvement of care and measurability. The premises of data economy and standardised documentation are taken into account. Between May 2008 and July 2014, 12 guidelines with suggestions for 100 PMs have been published. The majority of the suggested performance measures is captured by the specific documentation requirements of the clinical cancer registries and certified cancer centres. This creates a solid basis for an active quality management and re-evaluation of the suggested PMs. In addition, the suspension of measures should be considered if improvement has been achieved on a broad scale and for a longer period in order to concentrate on a quality-oriented, economic documentation.


Assuntos
Fidelidade a Diretrizes/normas , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/normas , Pesquisa sobre Serviços de Saúde/organização & administração , Pesquisa sobre Serviços de Saúde/normas , Oncologia/organização & administração , Oncologia/normas , Guias de Prática Clínica como Assunto/normas , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde/normas , Comportamento Cooperativo , Alemanha , Órgãos Governamentais , Humanos , Comunicação Interdisciplinar , Sociedades Médicas
20.
Z Evid Fortbild Qual Gesundhwes ; 108(10): 550-9, 2014.
Artigo em Alemão | MEDLINE | ID: mdl-25499107

RESUMO

Following a recommendation of the National Advisory Council for the Concerted Action in Health Care, the Association of the Scientific Medical Societies (AWMF) have promoted, supported and coordinated the development of clinical practice guidelines in Germany since 1995. The allocation of the responsibility for guideline development in the scientific societies corresponded to the principle of subsidiarity, in contrast to other countries counting on government-organised guideline programmes. To fulfil internationally consented criteria of high-quality guidelines, a quality improvement system was established relying on frequent assessments of the current state. Today, high-quality clinical practice guidelines developed by the scientific societies organised under the umbrella of the AWMF are an indispensable tool for various initiatives to improve healthcare in the German healthcare system. The next challenging goal is to establish a theory-driven framework allowing for a systematic implementation and evaluation of guidelines in Germany on the basis of existing approaches. However, success in this endeavour will require further research and funding.


Assuntos
Avaliação do Impacto na Saúde/tendências , Programas Nacionais de Saúde/tendências , Guias de Prática Clínica como Assunto , Previsões , Alemanha , Humanos , Melhoria de Qualidade/tendências , Sociedades Médicas/tendências
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