RATIONALE: In 2008, the Philippine College of Surgeons in collaboration with the Philippine Society of General Surgeons and the Philippine Academy of Head and Neck Surgeons, Inc. had published Evidence-based Clinical Practice Guidelines (CPG) on the Diagnosis and Management of Thyroid Nodules. This was followed by an update in 2013 with a focus on important diagnostic and therapeutic management issues concerning thyroid malignancy. The objective of this study was to assess knowledge gaps and behavioral patterns among users with respect to these CPGs. METHODS: A validated 30 item survey assessing knowledge of, attitudes towards, and adherence to the recommendations of different Evidence based Clinical Practice Guidelines was administered to general surgery residents, PSGS fellows, and otorhinolaryngology residents and consultants performing thyroidectomies. RESULTS: There were 343 assessable forms. Of the respondents, 276 (80.47%) were general surgeons, 33 (9.62%) were otorhinolaryngologists. There were 66 (19.24%) consultants, and 277 (80.76%) residents. Otorhinolaryngologists were less aware of the local CPGs than their GS counterparts. GS Residents, compared to their consultants, were more aware of the American Thyroid Association guidelines than the local guidelines. Among all respondents, the local guidelines had about equal preference for usage as the American Thyroid Association guidelines. There were no statistically significant differences on the level of knowledge and attitudes among the respondents. CONCLUSION The level of awareness about the PCS Thyroid Guidelines needs to be improved. The dissemination process needs to be reviewed and ensure that all stakeholders will be reached.
thyroids ; clinical practice guidelines

BACKGROUND: Guidelines and protocols have gained support as vehicles for promulgating the best practices in clinical medicine, and many researchers have proposed frameworks for modeling them in a computer-interpretable format. However, for guidelines to be most useful for decision support, they need to be integrated into the patient care process and to be patient-specific. OBJECTIVE: To achieve this, as a part of the development of interoperable and sharable clinical decision support system in the context of electronic health records, we identified the system requirements on the CDS for integrating hypertension management into workflow of a health center. We also introduced our approach to the acquisition of medical knowledge. METHODS: A method combining the top-down and bottom-up approaches was used. For the top-down, the service scope and target group of patients were defined, and the knowledge sources, including JNC 7 and other guidelines from which decision logic was extracted, were identified. For the bottom-up approach, scenario-use cases were applied and an analysis of care data and a survey of the care providers were conducted. RESULTS: This bidirectional method revealed the opportunities of our approach and the means by which improvements can be suggested in practice. The content and functions expected by users were also identified. These results will be used for further encoding knowledge at the computable level and application development at the implemental level.
Clinical Medicine ; Electronic Health Records ; Humans ; Hypertension* ; Logic ; Patient Care ; Practice Guidelines as Topic

OBJECTIVETo obtain the knowledge status on recommended heart failure (HF) guidelines among Chinese physicians.

METHODSQuestionnaire on heart failure including 20 multiple choice questions and 10 fill in the blank questions was designed based on the Chinese guidelines for the diagnosis and treatment of chronic heart failure in 2007 and the Chinese guidelines for the diagnosis and treatment of acute heart failure in 2010. The rate of correct answer for each item was calculated and compared among physicians specialized for cardiovascular diseases and not.

RESULTSThe Questionnaire was completed in 400 physicians, including 208 physician specialized for cardiovascular disease and 192 physicians not specialized in cardiovascular disease. The rate of correct answer for 20 multiple choice questions was lower than 60% in 8 questions, 60%-80% in 8 questions, higher than 80% in 4 questions. The rate of correct answers for 10 fill in the blank questions focusing on the aimed dosage of 10 ACEI/ARB/β-blockers was 49%. The 8 multiple choice questions with correct answer rate <60% are detailed items of myocardial remodeling, symptoms suggestive of HF, diagnosis tools for patients with suspected HF, the AHA stages of heart failure, the Forrester's hemodynamic classes of acute heart failure, the goals of ACEI/ARBs treatment in patients with HF, names of heart diseases which might benefit from ACEI/ARBs treatment defined by evidenced based medicine, and detailed application methods of ACEI/ARBs and β-blockers for HF patients. In general, the rate of correct answer was significantly higher in physicians specialized for cardiovascular disease compared physicians not specialized for cardiovascular disease.

CONCLUSIONThere is a considerable knowledge gap on the Chinese guidelines for the diagnosis and treatment of chronic heart failure and the Chinese guidelines for the diagnosis and treatment of acute heart failure among Chinese physicians. Efforts must be made to educate physicians to improve their knowledge and improve HF patient care.

Adult ; Clinical Competence ; Female ; Heart Failure ; Humans ; Male ; Middle Aged ; Physicians ; Practice Guidelines as Topic ; Surveys and Questionnaires

China ; Clinical Competence ; Educational Measurement ; Employment ; Guidelines as Topic ; Humans ; Licensure, Dental ; Oral Medicine ; standards ; Professional Practice

China ; Clinical Competence ; Educational Measurement ; Employment ; Guidelines as Topic ; Humans ; Licensure, Dental ; Preventive Dentistry ; standards ; Professional Practice

The aim of this report was to discuss the development and content of a guide on clinical performance and basic clinical skills for medical students. We published the first edition of this guide in 2010 and will publish the second edition in 2016. Initially, we took a survey on important clinical presentations and fundamental clinical and technical skills in 41 medical schools in Korea. Ultimately, we chose 80 core clinical presentations and 56 clinical skills. In the guide to basic clinical skills, we described the physical examination and technical skills according to the preprocedural preparation, procedure, and postprocedural process. In the guide on clinical performance, we reviewed patient encounters-from history taking and the physical examination to patient education. We included communication skills, principles of patient safety, and clinical reasoning schemes into the guides. In total, 43 academic faculty members helped develop the basic clinical skills guide, 75 participated in establishing the clinical performance guide, and 16 advisors from 14 medical specialty societies contributed to the guide. These guides can help medical students approach patients holistically and safely.
Clinical Competence/*standards ; Educational Measurement/*methods ; Humans ; *Practice Guidelines as Topic ; Republic of Korea ; *Students, Medical

Refering to the oversea evidence-based guidelines for migraine, the authors analyze the compilation characteristics of Guideline for Clinical Practice of Acupuncture in the Treatment of Migraine (WHO WPR) (herein after referred to as "Guideline"), and briefly explain the range of application, clinical value and attentions of the Guideline. The methodological characteristics of the Guideline are stated from four aspects: general conditions of the included literature, evaluation standard for literature quality, classification standard for evidence level, and classification standard of recommendation. The characteristics of recommended protocol of the Guideline are stated from three aspects: universality, classification method and content.
Acupuncture Therapy ; standards ; Clinical Trials as Topic ; Evidence-Based Medicine ; Humans ; Migraine Disorders ; therapy ; Practice Guidelines as Topic

The digital clinical guidelines could greatly improve the safety and quality of clinical diagnosis and treatment. However, most of such guidelines were written in engineering language, which was difficult for clinicians to understand in practice. To tackle this problem, we adoped the flowchart as the visual representation method of digital clinical guidelines. The corresponding criterions expressed by the flowchart were easily understood by clinicians. Then we set the digital clinical guidelines written in Arden syntax as an example, the interconversion between flowcharts and digital clinical guidelines was realized. The result of using the visual representation method proposed in this paper shows that the clinical diagnosis logic becomes clear and intuitive. So this is an effective method for clinicians to understand and edit the digital clinical guidelines.
Decision Support Systems, Clinical ; Humans ; Libraries, Digital ; Practice Guidelines as Topic ; Software

China ; Clinical Competence ; Educational Measurement ; Employment ; Guidelines as Topic ; Humans ; Licensure, Dental ; Periodontal Diseases ; Professional Practice

China ; Clinical Competence ; Educational Measurement ; Employment ; Guidelines as Topic ; Humans ; Licensure, Dental ; Professional Practice ; Surgery, Oral ; standards