Clinical Practice Guidelines and Recommendations
Can Changes in Guidelines on the Use of Antibiotic Prophylaxis Before Invasive Dental Procedures Tell Us Whether Antibiotic Prophylaxis Is Effective in Preventing Infective Endocarditis?
This issue of Mayo Clinic Proceedings contains an important report by DeSimone et al1 that investigates the effect of the 2007 American Heart Association (AHA) guidelines on the prescribing of antibiotic prophylaxis (AP) by dentists to protect patients at risk for infective endocarditis (IE) from developing the disease after invasive dental procedures. Infective endocarditis affects the endocardial lining of the heart, particularly the valve leaflets, and has a yearly incidence of 3 to 10 per 100,000 in most parts of the world.Call for Papers on Clinical Practice Guidelines
Clinical practice guidelines provide physicians with information that can be used to improve the quality of clinical decisions. Because Mayo Clinic Proceedings has the third largest print circulation of all indexed biomedical journals, it provides an ideal platform for dissemination of guidelines to a broad audience of generalist and specialist physicians who are active in clinical practice. Based on this resource, we invite clinical practice guideline development groups to consider submitting their guidelines for publication in the Proceedings.Clinical Practice Guidelines and Recommendations: Room for Dissent?
In this issue of Mayo Clinic Proceedings, an article by Musher asks “Should committees that write guidelines and recommendations publish dissenting opinions?”1 Although he raises important concerns—using examples from both the development of practice guidelines in general and the more specific guidelines for pneumococcal vaccination—I disagree with his conclusion that it is important for committees to publish dissenting opinions alongside new or updated guidelines and recommendations.Contemporary Evidence-Based Guidelines: Practice Based on the Strongest Evidence
In this issue of Mayo Clinic Proceedings, 2 articles written by 2 different (but overlapping) groups of Mayo Clinic experts (Kullo et al1 and Lopez-Jimenez et al2) provide critiques of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Risk in Adults3 and the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk.4 These 2 guidelines are hereafter referred to as the 2013 ACC/AHA cholesterol guideline and the 2013 ACC/AHA risk assessment guideline, respectively.Improving the Transparency and Trustworthiness of Subspecialty-Based Clinical Practice Guidelines
The growth of clinical practice guideline development programs worldwide has resulted in what appears to be an uncontrolled proliferation of recommendations on providing medical care to patients with acute and chronic illnesses. In turn, there has been substantial interest and scrutiny regarding the quality and transparency of the processes used to craft these important documents. Recent discussions and guidances issued by the Institute of Medicine (IOM) on what practices and procedures should be used to make clinical practice guidelines trustworthy underscore this observation.2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation: Physiologic and Educational Rationale for Changes
The 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care and the European Resuscitation Council Guidelines for Resuscitation 2005 have prompted a heightened discussion of cardiopulmonary resuscitation (CPR) and emergency cardiovascular care among health care professionals.1,2 Compared to the 2000 guidelines, the new guidelines have changed recommendations in many areas primarily because of advances in the science of cardiac resuscitation.Inhaled Corticosteroids: Why Do Physicians and Patients Fail to Comply With Guidelines for Managing Asthma?
During the past 30 years, both the prevalence and the mortality associated with asthma have increased.1 All the various reasons for this increase are still unclear. Some reasons are increased outdoor air pollution, particularly ozone and diesel exhaust particles; more time spent indoors in tight, inadequately ventilated buildings; and physicians becoming more likely to use the diagnosis of “asthma.”The New Hypertension Guidelines From JNC 7: Is the Devil in the Details?
High blood pressure is a common condition, afflicting 29% of the adult population of the United States.1 It is a major risk factor for myocardial infarction, heart failure, stroke, dementia, kidney disease, and progressive atherosclerosis. In May 2003, the National High Blood Pressure Education Program (NHBPEP) Coordinating Committee published an “express” version of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7).Pneumonia Management Guidelines—Why, How, and Where to Start
Clinical practice guidelines (CPGs) are proliferating. Their ultimate purpose is to improve quality of medical care while reducing costs and utilization of resources. Increasingly, they are being used to assess and compare provision of health-care services across different settings.Critique of the Early Cancer Detection Guidelines of the US Preventive Services Task Force and of the National Cancer Institute
In 1984, the Department of Health and Human Services established the US Preventive Services Task Force (USPSTF). This task force was given the charge of evaluating the evidence for preventive services and encouraging those of proven efficacy (McGinnis JM: Personal communication). The findings of the USPSTF were published in October 1989 in the Guide to Clinical Preventive Services.1
