Clinical guidelines development and usage: a critical insight and literature review: thyroid disease diagnostic algorithms

Murgić, Jure and Salopek, Daniela and Prpić, Marin and Jukić, Tomislav and Kusić, Zvonko (2008) Clinical guidelines development and usage: a critical insight and literature review: thyroid disease diagnostic algorithms. Collegium Antropologicum, 32 (4). pp. 1283-1290. ISSN 0350-6134

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Abstract

Clinical guidelines have been increasingly used in medicine. They represent a system of recommendations for the conduction of specific procedures used in fields from public health to different diagnostic and therapeutic procedures in clinical medicine. Guidelines are designed to facilitate to medical practitioners the adoption, evaluation and application of an increasing body of evidence and arising number of expert opinions regarding the presently best treatment and to help in delivering proper decision for the management of a patient or condition. Clinical guidelines represent a part of complementar activity by which research is implemented into praxis, standards are defined and clinical excelence is promoted in all health care fields. There are specific conditions which quality guidelines should meet. First of all, they need to be founded on comprehensive literature review, apart from clinical studies and trials in the target field. Also, there are more systems for analyzing and grading the strenght of clinical evidence and the level of recommendation emerging from it. Algorithms are used to organize and summarize guidelines. The algorithm itself has a form of an informatic record and a logical flow. Algorithms, especially in case of clinical uncertainty, must be used for the improvement of health care, increasing it’s availability and integration of the newest scientific knowledge. They should have an important role in the health care rationalisation, fight against non-rational diagnostics manifested as diagnostic procedures with no clinical indications, it’s unnecesary repetition and wrong sequence. Several diagnostic algorithms used in the field of thyroid diseases are presented, since they have been prooved to be of great use.

Abstract in Croatian

Kliničke smjernice imaju sve veću upotrebu u kliničkoj medicini. One podrazumijevaju sustav preporuka za provođenje secifičnih postupaka kako u javnom zdravstvu tako i u dijagnostičkim i terapijskim procedurama u kliničkoj medicini. Smjernice su osmišljene kako bi olakšale praktičarima usvajanje, procjenu i primjenu sve veće količine dokaza i stručnih mišljenja o trenutno najboljem načinu liječenja određenog stanja i time pomogle u donošenju odgovarajuće odluke o načinu postupanja s pacijentom. Kliničke smjernice su dio komplementarnih aktivnosti kojima se istraživanja prevode u praksu, određuju standardi i promovira klinička izvrsnost u bilo kojoj grani zdravstvene djelatnosti. Postoje specifični uvjeti koje kvalitetne smjernice moraju zadovoljiti, prije svega moraju se temeljiti na sveobuhvatnoj reviziji literature, uz pregled kliničkih studija u ciljnom području. Postoji više sustava za analizu jačine kliničkog dokaza te stupnja preporuke koji iz toga proizlazi. Algoritmi pak služe kako bi organizirali i saželi te smjernice. Sam algoritam ima oblik informatičkog zapisa logičkog tijeka. Algoritmi, osobito u slučaju kliničke nesigurnosti, moraju služiti poboljšanju zdravstvene skrbi, dostupnosti i objedinjenju najnovijih znanstvenih spoznaja. Trebali bi imati ulogu u racionalizaciji zdravstvene zaštite (gospodarski učinak), tj. u borbi protiv neracionalne dijagnostike koja se očituje u dijagnostičkim postupcima bez kliničkih indikacija, nepotrebnom ponavljanju i pogrešnom slijedu dijagnostičkih postupaka. Prezentirano je nekoliko dijagnostičkih algoritama iz područja bolesti štitnjače, u kojima vlada potreba za uporabom algoritama te koje su zbog niza osobina zahvalno područje za uporabu algoritama.

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