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Health systems should function in such a way that the amount of inappropriate care is minimized, while at the same time stinting as little as possible on appropriate and necessary care. The ability to determine and identify which care is overused and which is underused is essential to this functioning. To this end, the "RAND/UCLA Appropriateness Method" was developed in the 1980s. It has been further developed and refined in North America and, increasingly, in Europe. The rationale behind the method is that randomized clinical trials--the "gold standard" for evidence-based medicine--are generally either not available or cannot provide evidence at a level of detail sufficient to apply to the wide range of patients seen in everyday clinical practice. Although robust scientific evidence about the benefits of many procedures is lacking, physicians must nonetheless make decisions every day about when to use them. Consequently, a method was developed that combined the best available scientific evidence with the collective judgment of experts to yield a statement regarding the appropriateness of performing a procedure at the level of patient-specific symptoms, medical history, and test results. This manual presents step-by-step guidelines for conceptualising, designing, and carrying out a study of the appropriateness of medical or surgical procedures (for either diagnosis or treatment) using the RAND/UCLA Appropriateness Method. The manual distills the experience of many researchers in North America and Europe and presents current (as of the year 2000) thinking on the subject. Although the manual is self-contained and complete, the authors do not recommend that those unfamiliar with the RAND/UCLA Appropriateness Method independently conduct an appropriateness study; instead, they suggest "seeing one" before "doing one." To this end, contact information is provided to assist potential users of the method.
Advances in medical, biomedical and health services research have reduced the level of uncertainty in clinical practice. Clinical practice guidelines (CPGs) complement this progress by establishing standards of care backed by strong scientific evidence. CPGs are statements that include recommendations intended to optimize patient care. These statements are informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options. Clinical Practice Guidelines We Can Trust examines the current state of clinical practice guidelines and how they can be improved to enhance healthcare quality and patient outcomes. Clinical practice guidelines now are ubiquitous in our healthcare system. The Guidelines International Network (GIN) database currently lists more than 3,700 guidelines from 39 countries. Developing guidelines presents a number of challenges including lack of transparent methodological practices, difficulty reconciling conflicting guidelines, and conflicts of interest. Clinical Practice Guidelines We Can Trust explores questions surrounding the quality of CPG development processes and the establishment of standards. It proposes eight standards for developing trustworthy clinical practice guidelines emphasizing transparency; management of conflict of interest ; systematic review-guideline development intersection; establishing evidence foundations for and rating strength of guideline recommendations; articulation of recommendations; external review; and updating. Clinical Practice Guidelines We Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care. This book contains information directly related to the work of the Agency for Healthcare Research and Quality (AHRQ), as well as various Congressional staff and policymakers. It is a vital resource for medical specialty societies, disease advocacy groups, health professionals, private and international organizations that develop or use clinical practice guidelines, consumers, clinicians, and payers.
The global burden of disease: 2004 update is a comprehensive assessment of the health of the world's population. It provides detailed global and regional estimates of premature mortality, disability and loss of health for 135 causes by age and sex, drawing on extensive WHO databases and on information provided by Member States.--Publisher description.
Emphasising the multi-disciplinary nature of palliative care the fourth edition of this text also looks at the individual professional roles that contribute to the best-quality palliative care.
The authors of the first edition worked together again to revise data for the second edition of this popular volume. Based at three of the world's leading centers for the study and treatment of headache, these experts share their insights on every aspect of this common and irritating condition. In particular, the sections on migraine, cluster headache and vascular disease have been updated. Based on the classification system developed by the International Headache Society, Headache in Clinical Practice provides those interested in headache with an up-to-date compendium of current opinion, from epidemiology, pathophysiology and investigation, through options for intervention and management.
Bringing together treatment and referral advice from existing guidelines, this text aims to improve access to services and recognition of common mental health disorders in adults and provide advice on the principles that need to be adopted to develop appropriate referral and local care pathways.
Fully updated and revised by authors T. Heather Herdman, PhD, RN, FNI, and Shigemi Kamitsuru, PhD, RN, FNI, Nursing Diagnoses: Definitions and Classification 2018-2020, Eleventh Edition is the definitive guide to nursing diagnoses, as reviewed and approved by NANDA International (NANDA-I). In this new edition of a seminal text, the authors have written all introductory chapters at an undergraduate nursing level, providing the critical information needed for nurses to understand assessment, its link to diagnosis and clinical reasoning, and the purpose and use of taxonomic structure for the nurse at the bedside. Other changes include: 18 new nursing diagnoses and 72 revised diagnoses Updates to 11 nursing diagnosis labels, ensuring they are consistent with current literature and reflect a human response Modifications to the vast majority of the nursing diagnosis definitions, including especially Risk Diagnoses Standardization of diagnostic indicator terms (defining characteristics, related factors, risk factors, associated conditions, and at-risk populations) to further aid clarity for readers and clinicians Coding of all diagnostic indicator terms for those using electronic versions of the terminology Web-based resources include chapter and reference lists for new diagnoses Rigorously updated and revised, Nursing Diagnoses: Definitions and Classification 2018-2020, Eleventh Edition is a must-have resource for all nursing students, professional nurses, nurse educators, nurse informaticists, and nurse administrators.