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Objective: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and three additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. Methods: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and two general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, three rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. Principal Conclusions: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates. ; open

Setting Priorities for Clinical Practice Guidelines -- Copyright -- Acknowledgments -- Contents -- Summary -- STUDY APPROACH -- FINDINGS AND RECOMMENDATIONS: PRIORITY SETTING -- Criteria and Their Application -- Procedure Modifications -- Topic Definition -- FUTURE ROLES FOR AHCPR -- National and Local Guidelines -- Clearinghouse, Assessment, and Other Activities -- 1 Introduction -- BACKGROUND -- COMMITTEE APPROACH -- Composition and Activities -- Definitions -- Principles -- PRIORITY SETTING IN OTHER ORGANIZATIONS -- American College of Physicians -- Intermountain Health Care -- Kaiser Permanente, Northern California Region -- State of Minnesota -- Office of Medical Applications and Research, National Institutes of Health -- U.S. Preventive Services Task Force -- OVERVIEW OF REPORT -- 2 Criteria for Topic Selection -- CURRENT CRITERIA FOR GUIDELINES TOPICS -- CURRENT CRITERIA FOR TECHNOLOGY ASSESSMENT -- DIFFERENCES IN CRITERIA FOR GUIDELINES AND TECHNOLOGY ASSESSMENT -- TOWARD COMMON CRITERIA? -- General Criteria -- Potential for Guidelines to Change Health Outcomes or Costs -- Social, Ethical, and Legal Considerations -- Availability of Evidence -- ADDITIONAL CRITERIA -- Criterion Measurement -- THE RELATIVE IMPORTANCE OF INDIVIDUAL CRITERIA -- Criteria Weights -- Measurement Scales -- Availability of Data -- PROCEDURES FOR APPLYING CRITERIA -- Simultaneous Application of Criteria -- Sequential Application of Criteria -- Single-Versus Multiple-Track Processes -- REASSESSMENT OF EXISTING GUIDELINES -- 3 Procedures for Priority Setting -- FORUM AND OHTA PRIORITY-SETTING PROCEDURES -- The Forum's Procedures for Topic Selection -- OHTA'S Procedures for Priority Setting -- Comparing Procedures -- Other Organizations -- TOWARD COMMON PROCEDURES? -- PROCESS MODIFICATIONS: IMPROVING THE USE OF EXPERT JUDGMENT -- Systematizing Consensus Development.

Guidelines for clinical practice have proliferated in recent years. Numerous studies indicate that guidelines can increase empirically based practice and improve clients' outcomes. Guidelines for social work practice would also promote more informed client decision making, improve clinical training in schools of social work, encourage more cost-effective and accountable practice, and help codify current knowledge in controversial practice areas. The National Association of Social Workers should institute a guidelines development program and ensure that guidelines reflect traditional social work values and the best in available scientific evidence and practice experience.

The author affirms the need for social work practice guidelines but poses some cautions and challenges regarding their development. Guidelines represent an important tool to support both the practice and the advocacy missions of the profession. The content of these guidelines must be flexible, reflect interdisciplinary practice, and address the multiple roles that social workers play with clients and their families. The guideline development process will need to confront the practical challenges that have the potential for derailing this type of endeavor. Those challenges include resistance to change, inadequate financing, and struggle about auspice.

General practitioners' (GPs') use of clinical practice guidelines (CPGs) may be influenced by various contextual and attitudinal factors. This study examines general attitudes toward CPGs to establish profiles according to these attitudes and to determine if these profiles are associated with awareness and with use of CPGs in daily practice. The authors conducted a cross-sectional telephone survey of 1,759 French GPs and measured (a) their general attitudes toward CPGs and (b) their awareness and use in daily practice of CPGs for six specific health problems. A bivariate probit model was used with sample selection to analyze the links between GPs' general attitudes and CPG awareness/use. The authors found three GP profiles according to their opinions toward CPGs and a positive association between these profiles and CPG awareness but not use. It is important to build awareness of CPGs before GPs develop negative attitudes toward them.

Introduction: There is scientific evidence that the health of women before pregnancy contributes to the maternal and infant outcomes of pregnancy. There is also scientific evidence that the health of women of reproductive age may be improved through the provision of Preconception Care (PCC). Preconception care includes interventions to assess, identify, address, and modify a woman's health conditions and risks to ensure that these health conditions and risks do not negatively affect the outcome of her pregnancy. Many of the medical conditions, environmental exposures, personal behaviors, and psychosocial risks associated with negative pregnancy outcomes have been identified and there are recommendations for including these conditions in PCC services. Objective: Our purpose is to present a tool for clinical care providers involved in delivering PCC services. We try to answer the following questions: what do providers actually do when a woman of reproductive age arrives at their offices? What questions to ask? What examinations to conduct? What laboratory tests to perform? And, what education and counselling to offer? Methods: We reviewed published and un-published literature related to the scientific evidence for the effectiveness of PCC in improving pregnancy outcomes. We searched PubMed for published articles, and we searched the internet for unpublished reports prepared by international organizations such as the World Health Organization and reports from governmental agencies. We summarized the information and presented a comprehensive overview of actions that providers should take to address various risk behaviors, exposures and health conditions. Results: Several scientists, countries, and international organizations have proposed answers to the above questions. However, there has been no consistency and there is not a single publication that includes a comprehensive compilation of the proposed actions. We summarized the recommended actions that clinical care providers should take in addressing various health conditions, risk behaviors, and exposures. Conclusion: It is recommended that all providers screen all women for their intentions to become pregnant and to provide them with appropriate services. Women should be referred to specialized care when risk behaviors and medical conditions that go beyond the skills and abilities of the primary care provider are identified.

In Brazil, governmental and non-governmental organisations develop practice guidelines (PGs) in order to optimise patient care. Although important improvements have been made over the past years, many of these documents still lack transparency and methodological rigour. In order to conduct a critical analysis and define future steps in PG development in Brazil, we carried out a structured assessment of strengths, weaknesses, opportunities and threats (SWOT analysis) for the development of a national guideline programme. Participants consisted of academia, methodologists, medical societies and healthcare system representatives. In summary, the PG development process has improved in Brazil and current investments in methodological research and capacity-building are ongoing. Despite the centralised processes for public PGs, standardised procedures for their development are not well established and human resources are insufficient in number and capacity to develop the amount of trustworthy documents needed. Brazil's capacity could be strengthened and initial efforts have been made such as the adoption of standards proposed by world-renowned institutions in PG development and enhancement of the involvement of key stakeholders. Further steps involve the alignment between health technology assessment and PG processes for synergy and the development of a national network to promote the interaction between groups involved in the development of PGs. The lessons learned from this paper could be used to foster debate on guideline development, especially for countries facing similar threats on this topic.

Thai Dermatological Society publicized a clinical practice guideline (CPG) for Thaipsoriasis patients in 2010. However, as differences between patients and healthcare providersexist across the country. This study aims to survey healthcare data of psoriasis patients inPhitsanulok to develop a clinical practice guideline to be appropriate for the region. Analysis ofresponses to a questionnaire mailed to psoriasis patients who had been treated in public hospitals in Phitsanulok in aspect of demographic and healthcare data. Most Phitsanulokpsoriasis patients received government health care service support - only 5% self-financed theirpsoriasis treatment in public hospitals; 96% lived more than 5 km2 from hospital attended; about40% visited the hospital more than four times per year. One third of patients had no knowledgeabout their own disease, and only 7% of those who self-assessed were well-informed about it.Healthcare data from Phitsanulok Psoriasis patients, such as number of annual visits, distance from home to hospital and patients' knowledge about the disease is very useful. Problemsidentified can be addressed in training physicians and healthcare workers in both hospitals andhealth stations. ; สมาคมแพทย์ผิวหนังแห่งประเทศไทยเผยแพร่แนวทางการดูแลผู้ป่วยสะเก็ดเงินใน ประเทศไทยในปี พ.ศ. 2010 อย่างไรก็ดี ในแต่ละท้องถิ่นมีความแตกต่างกันในแง่ผู้ป่วยและบุคลากรสาธารณสุขงานวิจัย นี้จัดทำขึ้นเพื่อสำรวจข้อมูลด้านสาธารณสุขของผู้ป่วยสะเก็ดเงินจังหวัด พิษณุโลก สำหรับการพัฒนาแนวทางในการดูแลผู้ป่วยในจังหวัด โดยประยุกต์จากแนวทางการดูแลผู้ป่วยของสมาคมแพทย์ผิวหนังแห่งประเทศไทย โดยการส่งแบบสอบถามทางไปรษณีย์ตามข้อมูลในเวชระเบียนของผ้ปูป่วยสะเก็ดเงิน ที่มี ข้อมูลที่อยู่สมบูรณ์ทั่วทั้งจังหวัด และทำการวิเคราะห์ข้อทั่วไปและข้อมูลด้านการเข้ารับบริการในสถานพยาบาล ผู้ป่วยสะเก็ดเงินจังหวัดพิษณุโลกส่วนใหญ่ได้รับการดูแลด้านค่าใช้จ่ายจาก รัฐบาล มีเพียงร้อยละ 5 เท่านั้น ที่ต้องชำระค่ารักษาพยาบาลเอง ผู้ป่วยร้อยละ 96 ต้องเดินทางจากที่พักมายังสถานพยาบาลเป็นระยะทางมากกว่า 5 กิโลเมตร และผู้ป่วยร้อยละ 40 ต้องมาสถานพยาบาลเพื่อรักษาโรคสะเก็ดเงินมากกว่า 4 ครั้งต่อปี นอกจากนี้ หนึ่งในสามของผู้ป่วย ไม่มีความรู้เกี่ยวกับโรคสะเก็ดเงินเลย ในขณะที่มีเพียงร้อยละ 7 เท่านั้น ที่ประเมินตนเองว่ามีความรู้ดี การให้ความรู้ทั้งต่อแพทย์และเจ้าหน้าที่สถานีอนามัย เพื่อให้สามารถดูแลผู้ป่วยอย่างถูกต้อง การจัดทำแนวทางการดูแลและการส่งต่อโดยสถานพยาบาลขนาดเล็ก น่าจะเป็นแนวทางเพิ่มเติมเพื่อแก้ปัญหาการเดินทางไกล ไม่พอใจคุณภาพผู้รักษา และเสียเวลาของผู้ป่วย

Cover -- Title Page -- Copyright Page -- Contents -- Forewords -- About the editors -- About the contributors -- Introduction -- Chapter 1 The potential benefits, limitations and harms of clinical practice guidelines -- Chapter 2 Developing guidelines -- Chapter 3 Health economics and clinical practice guidelines -- Chapter 4 The legal status of clinical practice guidelines -- Chapter 5 Using clinical practice guidelines -- Chapter 6 The Mental Health Technology Appraisal and Clinical Guidelines Programmes of the National Institute for Clinical Excellence for England and Wales -- Chapter 7 Mental health guidelines development in Scotland -- Chapter 8 The National Collaborating Centre for Mental Health -- Chapter 9 Using mental health guidelines in the NHS: views from a specialist mental health trust -- Chapter 10 Using mental health guidelines in primary care: the example of depression management -- Postscript -- Appendix: Completed NICE mental health technology appraisals and guidelines: summaries as available from the NICE website -- Index

Clinical Practice Guidelines -- Copyright -- Acknowledgments -- Contents -- Summary -- CONTEXT -- OVERVIEW OF PRACTICE GUIDELINES INITIATIVES -- Public Initiatives -- Private Initiatives -- INSTITUTE OF MEDICINE COMMITTEE AND PROJECT -- FINDINGS AND CONCLUSIONS -- State of the Art -- Ahcpr and the Forum -- Roles of Public and Private Sectors -- RECOMMENDATIONS: DEFINITIONS -- RECOMMENDATIONS: ATTRIBUTES OF GOOD GUIDELINES -- RECOMMENDATIONS: IMPLEMENTATION AND EVALUATION -- DIVERSITY IN CLINICAL PRACTICES AND GUIDELINES -- EXPECTATIONS FOR PRACTICE GUIDELINES -- NEXT STEPS FOR THE INSTITUTE OF MEDICINE -- FINAL COMMENT -- 1 Introduction and Background -- CONTEXT -- OVERVIEW OF PRACTICE GUIDELINES INITIATIVES -- Public Initiatives -- Private Initiatives -- SPECIFIC RESPONSIBILITIES OF AHCPR -- Deadlines and Priorities -- Development Procedures and Requirements -- Dissemination -- Use of Guidelines -- Evaluation and Further Research -- THE INSTITUTE OF MEDICINE COMMITTEE AND PROJECT -- OVERVIEW OF THE REPORT -- CONCLUSIONS AND CAUTIONARY NOTES -- REFERENCES -- 2 Definitions of Key Terms -- THE COMMITTEE'S APPROACH -- PRACTICE GUIDELINES -- Common Usage: The Dictionary -- Professional and Technical Usage -- The Committee's Definition: Practice Guideline -- Guidelines and the Strength of Evidence -- Relation of Guidelines to Review Criteria and Other Evaluation Tools -- Definition of Appropriate Care -- Guidelines and Costs -- EVALUATION INSTRUMENTS -- MEDICAL REVIEW CRITERIA -- Common Usage: The Dictionary -- Professional and Technical Usage -- The Committee's Definition: Medical Review Criteria -- STANDARDS OF QUALITY -- Common Usage: The Dictionary -- Professional and Technical Usage -- The Committee's Definition: Standards of Quality -- PERFORMANCE MEASURES -- Common Usage: The Dictionary -- Professional and Technical Usage.