Journal of evaluation in clinical practice
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Clinical practice guidelines (CPGs) have become a common feature in the health and social care fields, as they promote evidence-based practice and aim to improve quality of care and patient outcome. However, the benefits of the recommendations reported in CPGs are only as good as the quality of the CPGs themselves. Indeed, rigorous development and strategies for reporting are significant precursors to successful implementation of the recommendations that are proposed. Unfortunately, research has demonstrated that there is much variability in their level of quality. Furthermore, the quality of many CPGs has yet to be examined. The aim of the present study was to assess the quality of seven CPGs from four Quebec professional regulatory bodies pertaining to clinical evaluations in the fields of medicine, psychoeducation, psychotherapy, and social work. ⋯ Our findings highlight that there is still a lot to be done in order to improve the rigour and transparency with which scientific evidence is assessed and applied when developing CPGs. Impacts regarding the implementation of these CPGs are discussed in light of their use in clinical practice.
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Healthcare systems worldwide devote significant resources towards collecting data to support care quality assurance and improvement. In the United Kingdom, National Clinical Audits are intended to contribute to these objectives by providing public reports of data on healthcare treatment and outcomes, but their potential for quality improvement in particular is not realized fully among healthcare providers. Here, we aim to explore this outcome from the perspective of hospital boards and their quality committees: an under-studied area, given the emphasis in previous research on the audits' use by clinical teams. ⋯ Measures to enhance the audits' perceived legitimacy could help address these limitations. These include audit suppliers moving from an emphasis on cumulative, retrospective reports to real-time reporting, clearly presenting the "headline" outcomes important to institutional bodies and staff. Measures may also include further negotiation between hospitals, suppliers and their commissioners about the nature and volume of data the latter are expected to collect; wider use by hospitals of routine clinical data to populate audit data fields; and further development of interactive digital technologies to help staff explore and report audit data in meaningful ways.
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Clinical practice guidelines (CPGs) for knee osteoarthritis (OA) guide the provision of high-quality healthcare for people with knee OA, which may improve outcomes. Our aim was to evaluate the quality of and content within recently published CPGs for people with knee OA. ⋯ Several CPGs have been developed or recently updated since 2014. Over half of the ten CPGs we appraised were deemed to be high-quality. Exercise, education, and weight-management advice are interventions that were most commonly recommended by CPGs.
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The human body is regulated by intrinsic factors which follow a 24-hour biological clock. Implications of a circadian rhythm in the out-of-hospital cardiac arrest (OHCA) are studied but the literature is not consistent. The main objective of our study was to identify temporal cluster of high or low incidence of OHCA occurrence during a day. ⋯ We observed a three-hour morning high incidence peak of OHCA. This high incidence could be explained by different physiological changes in the morning. These changes are well known and the evidence of a morning peak of cardiovascular disease should enable medical teams to adapt care strategy and hospital organization.
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Expanded financial coverage is critical to fight against poverty through public health reforms in developing countries. This study explores inequity in public health financing reforms in Turkey between 2003 and 2015. ⋯ Study results provide a deep understanding of the effects of poverty on public health financing reforms on households in Turkey. To reduce out-of-pocket health spending inequities and to protect vulnerable groups from increasing the level of health expenditures, we suggest that the government enlarges health insurance coverage for the poor.