Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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Z Arztl Fortbild Qualitatssich · Jan 2006
[Health services research and guidelines--from the Association of the Scientific Medical Societies' (AWMF) perspective].
The Association of the Scientific Medical Societies (AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften) is an umbrella organization. It currently represents 151 scientific societies and thus the majority of medical researchers in Germany. Through the coordination and support of the scientific medical societies, the AWMF significantly contributes to health services research by establishing guidelines that ensure a high quality of healthcare. ⋯ Together with the Agency for Quality in Medicine [AQuMed; Arztliches Zentrum für Qualität in der Medizin (AZQ)], AWMF published a 'German Instrument for Methodological Guideline Appraisal' ('Deutsches Instrument zur methodischen Leitlinien-Bewertung', DELBI) in order to assure the quality of the guideline development process. A close cooperation has also developed between AWMF and the German Medical Association within the scope of their program for promoting health services research and with the Board of the German Network for Health Services Research (Deutsches Netzwerk for Versorgungsforschung, DNVF). Furthermore, AMWF has acknowledged a special need for improving the financial and conceptual promotion of a systematic evaluation of guideline development and the implementation and application of guidelines in everyday clinical practice.
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Despite the increasing burden of disease and known deficiencies of actual stroke care there is a lack of evidence-based stroke guidelines in Germany. For future guideline development and implementation in Germany, critically appraising internationally available guidelines might be useful. ⋯ None of the 13 appraised guidelines covered all key methodological quality criteria. The analysis shows, however, that it should be possible to compile a methodologically sound stroke guideline by using those parts of the different appraised guidelines that fitted the quality criteria best.
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Z Arztl Fortbild Qualitatssich · Jan 2006
[Oversized patient arms: a problem with blood pressure measurements].
The increase in the worldwide prevalence of obesity systematically leads to a higher number of individuals who may be wrongly diagnosed as hypertensive because their arms are too large for standard blood pressure cuffs, which are ordinarily appropriate in patients with normal sized arms. The aim was to gain real data of upper arm and wrist circumferences in 327 elected subjects with larger arms (upper arm circumference >32.5 cm) from two Bavarian general practices. ⋯ Availability of one large cuff and one wrist blood measurement device (either used at the upper arm or at the wrist depending on patient dimensions) seems to be sufficient. This should allow for true blood pressure readings to be obtained in at least 96% of all patients with arms of more than normal circumference.
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Z Arztl Fortbild Qualitatssich · Feb 2005
[Clinical practice guidelines in Germany, 1994 to 2004. From guideline methodology towards guideline implementation].
The role of clinical practice guidelines (CPG) as a tool for continuous medical education (CME), and quality management in health care is now widely accepted in Germany. Since the 90ies, the physicians' professional associations as well as health care authorities and parliament have been introducing several incentives and regulations in order to promote the use of evidence based CPG. ⋯ Future CPG activities should address much more other key factors for the success of CPGs, such as medical relevance, practicability, effective dissemination, and implementation. The article describes the process of guideline adaptation by regional physician audit groups as a tool for CPG implementation.