Guideline development processes influence the quality of clinical guidelines. The aim of this study was to use the AGREE II instrument to evaluate the variability of the quality of selected guidelines, to determine a baseline for the quality of current guidelines and determine whether guidelines demonstrated good standard practice during their development. The AGREE II instrument was used to assess a selection of guidelines published between January 2012 and June 2013. Eleven guidelines were selected for review. Overall, guidelines scored highest in domain 1 (Scope and purpose) and 4 (Clarity of presentation); and lowest in domain 3 (Rigour of development) and 6 (Editorial independence) with the overall assessment score of three out of seven. The study demonstrated that the quality of guidelines was variable and that there are deficiencies in the guideline development process. The results from this study provide a baseline to measure the quality of future guidelines. / Dissertation (MSc)--University of Pretoria, 2014. / tm2015 / School of Health Systems and Public Health (SHSPH) / MSc / Unrestricted

This thesis explores the Rapid Recommendations process, a new responsive way of creating clinical practice guidelines. / Healthcare workers rely on clinical practice guidelines to inform their practice. However, most guidelines are not trustworthy when judged by accepted standards and they typically take several years to produce. Guideline trustworthiness is undermined by panel members who often have conflicts of interest, by including representation from only a subset of stakeholders, by failing to examine the entirety of the evidence systematically, and by rapid obsolescence. Further, they are often difficult for users to understand in limited time. Rather than updating guidance on a fixed schedule, the Rapid Recommendations approach involves continuous monitoring of the literature and produces guidelines in response to new potentially practice-changing evidence. A collaborative network of clinicians, methodologists, and patients respond by rapidly producing trustworthy evidence syntheses and guidance. We have identified efficiencies at every step of the guideline development process. The guideline panel does not include anyone with a financial conflict of interest and there are strict limits professional and intellectual conflicts. Systematic reviews are produced on the relative effects of each option, on prognosis, and on patient values and preferences with the explicit intent to inform the question at hand. The panel also considers practical issues. Rapid Recommendations are published in a concise multilayered user-friendly format headed by an interactive infographic that contains all of the necessary information for users need to make informed decisions at the point of care. The guideline is published simultaneously in print and electronically, including decision aids that can be used at the point of care and integrated into electronic medical records. In this thesis, you will find a selection of exemplary publications relevant to the Rapid Recommendations process. We show that a responsive approach to rapid and trustworthy guideline creation is possible. It represents a way forward from the current limitations that plague most current clinical practice guidelines. / Thesis / Candidate in Philosophy / Healthcare workers often decide what to do in practice based on the advice of experts through clinical practice guidelines. However, most clinical practice guidelines are not completely trustworthy. Guideline authors often have conflicts of interest, do not include patients or patient views, and are created so slowly that they rapidly fall into obsolescence. This thesis explores a new way of developing clinical practice guidelines that we call Rapid Recommendations. Instead of creating them on a fixed schedule (i.e., every few years), they are created in response to new studies that might change practice. The scope is limited, and timelines are shorter, meaning that the guidelines are published sooner. The guideline authors include all stakeholders, including patients. None of the authors have any financial interests in the topic, and other conflicts are minimized. The guidelines are published on an expedited basis and in an accessible online multilayered format with infographics. This thesis includes a selection of exemplary publications relevant to the Rapid Recommendations process.

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<p>Swedish studies have shown that more people than expected have problems with leg ulcers and that the yearly cost for treatment per patient is approximately 26 500kr. </p><p>Since the elderly population is on the rise, there is a need to highlight this growing problem, to make sure that proper assessment tools are used and to improve the standard of care given to patients with leg ulcers. The aim was to show what a difference the nurse can make to patients with leg ulcers. With all types of wounds it is imperative to establish if there is any underlying reasons since certain illnesses can cause more wounds or delay the healing process. The doctor is responsible for making the diagnosis and to prescribe the correct treatment whereas the nurse’s responsibility is for the nursing care and its documentation. The patient’s lifestyle, his next of kin and his environment all play an important part in this healing process. A holistic approach is therefore necessary to be able to give good standard of nursing care. The nurse can by being careful and precise when changing the dressing, using assessment tools and document, give encouragment for compliance, inform and educate patients, help a great deal in the patient’s healing process. Further research is needed to see how the nurses’ compliance can be improved, and how new knowledge can be implemented. </p><p>Nurse students need to learn more about wounds and wound treatments in their basic education, and evidencebased guidelines have to be used in the caring for leg ulcer patients.</p>

Swedish studies have shown that more people than expected have problems with leg ulcers and that the yearly cost for treatment per patient is approximately 26 500kr. Since the elderly population is on the rise, there is a need to highlight this growing problem, to make sure that proper assessment tools are used and to improve the standard of care given to patients with leg ulcers. The aim was to show what a difference the nurse can make to patients with leg ulcers. With all types of wounds it is imperative to establish if there is any underlying reasons since certain illnesses can cause more wounds or delay the healing process. The doctor is responsible for making the diagnosis and to prescribe the correct treatment whereas the nurse’s responsibility is for the nursing care and its documentation. The patient’s lifestyle, his next of kin and his environment all play an important part in this healing process. A holistic approach is therefore necessary to be able to give good standard of nursing care. The nurse can by being careful and precise when changing the dressing, using assessment tools and document, give encouragment for compliance, inform and educate patients, help a great deal in the patient’s healing process. Further research is needed to see how the nurses’ compliance can be improved, and how new knowledge can be implemented. Nurse students need to learn more about wounds and wound treatments in their basic education, and evidencebased guidelines have to be used in the caring for leg ulcer patients.

No description available.

Purpose: With the obesity epidemic ever increasing, the purpose of this quality improvement project is to assess if Veteran’s Administration (VA) primary care providers have knowledge of and/or application barriers of the Veteran’s Administration/Department of Defense Clinical Practice Guideline for Screening and Management of Overweight and Obesity (SMOOG) in the VA primary care clinic in southern Arizona. Background: The prevalence of obesity seen in adults in the U.S. escalated from 15% to 34%, which is more than double from 1980 to 2008. Active military and Veterans obesity rates rose in similar fashion. The implementation of practice guidelines is critical to effective treatment to counteract the rising rates of overweight and obesity. Adherence to clinical practice guidelines often remains low causing an omission of therapies recommended in the guidelines. Methods: This quality improvement project used a descriptive methodology. Initially, SMOOG was evaluated using the AGREE II instrument. Next, a survey was administered to primary care providers to identify provider knowledge of and barriers to utilization of the SMOOG guidelines. Inclusion criteria for this study are: VA employed primary care provider and practicing primary care for at least 1 year. The 20-question survey measured providers’ knowledge and perceptions of their use of the VA/DoD SMOOG. Results: Evaluation using the AGREE II tool revealed the lowest possible quality scores observed in the Applicability domain. Based upon the results of the evaluation SMOOG is recommended for use with modifications specifically improving its applicability. Fifteen primary care providers participated in the survey. The results revealed that few primary care providers use SMOOG in clinical practice and barriers exist to implementation of SMOOG. Conclusions: Assessing providers’ knowledge, perceptions, and barriers to SMOOG provides insight towards the next steps in addressing the rising prevalence of obesity among U.S. Veterans. An appraisal of SMOOG revealed that the guideline was developed with a high quality in the areas of evidence and clear presentation, but is clearly deficient in its applicability of implementation of the recommendations. The data obtained serves as an initial step to inform future research into synthesizing and guiding an implementation strategy.

Effective patient care requires interprofessional collaboration and decisions based on clinical guidelines. The goal of this study was to determine how interprofessional collaboration influences the introduction of nursing Best Practice Guidelines. This study was a secondary qualitative analysis of data obtained from interviews and reports from two selected sites (long term care and community health care) that demonstrated interprofessional collaboration during the introduction of nursing Best Practice Guidelines. Findings emphasized the importance of communication, the role of an interprofessional team, and the understanding of the roles of all involved in the introduction of discipline specific clinical guidelines. In addition, unregulated staff members were involved in leadership roles and their work was important in providing effective interprofessional collaborative care during the introduction of guidelines. Therefore, it is essential to appropriately involve all members of the interprofessional team, regardless of discipline or educational level, during the introduction of clinical guidelines.

This paper addresses the nature of Social Work supervision in the Directorate of Developmental Welfare Services. It contains five chapters namely Research Orientation, Literature Review, Social Structure in Namibia, Empirical Study and the last chapter is the Conclusions and Recommendations. The Research Orientation deals with motivating factors explaining the need for this research as well as pointing out the goal and objectives of the research. The goal of the research is to explore and describe Social Work supervision in the Directorate of Developmental Welfare Services in Namibia. The Literature Review gives comprehensive explanations of the importance of Social Work supervision in delivering social services. It provides opinions of different authors and their views on the nature of supervision, the supervisory needs of supervisees, and the functions and roles of supervisors. The Research Methodology chapter looks at how the research was done, how the researcher gathered information and the tools that were used. The research data was examined using the quantitative data analysis approach. Data analysis and interpretation breaks down the data obtained from the questionnaires, which are the instruments that the researcher used to obtain the information. The result consists of graphs and tables that clearly present the data. This chapter also covers the social structure of Namibia, a brief description of the regions in Namibia in order to help the reader understand the distances between offices. The Conclusions are a summary of the findings obtained from the respondents on the nature of supervision in the directorate. Possible solutions to improve supervision in the directorate are addressed in the recommendations. One of the recommendations is that the directorate should develop standardised supervisory guidelines. / Dissertation (MA (Social Work))--University of Pretoria, 2008. / Social Work and Criminology / unrestricted

None / Clinicians in general value the use of the best evidence in decision-making and consider that can improve patient care. However, a successful evidence based practice is hard to achieve in real life. In recent years, with the consolidation of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, the development of improved standards to judge the trustworthiness of guideline recommendations and the adoption of more strict policies to limit the influence of conflict of interests, trustworthy guidelines have become an attractive alternative for an evidence-based clinical practice. In this thesis we offer an explicit and easy-to-use guidance to clinicians regarding how to use guideline recommendations in the context of a real life practice. We also provide an in-depth explanation of the judgments involved in determining the direction and strength of recommendations. Finally, we expand the knowledge about how to manage conflict of interests in guideline developers. Through two studies evaluating the conflict of interest policy implemented at the American College of Chest Physicians 9th edition of the Antithrombotic Guidelines, we show what aspects of the policy were successful and what aspects need to be reformulated. / Thesis / Doctor of Philosophy (PhD) / None