Valvojat: Borrelioosiyhdistys, Bb, Jatta1001, Bb, Jatta1001, Borrelioosiyhdistys, Jatta1001, Borrelioosiyhdistys, Bb, Jatta1001, Borrelioosiyhdistys, Bb

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Viestit: 1820
Liittynyt: Ma Tammi 26, 2009 23:13


Viesti Kirjoittaja Bb » Su Helmi 15, 2009 14:14

Lähettäjä: Soijuv Lähetetty: 10.2.2008 9:53

Urologi Richard Amerlingin mukaan etukäteen laadituista, kirjallisista hoitosuosituksista on ollut enemmän haittaa kuin hyötyä. Vaarana on, että kaikille samoja oireita sairastaville annetaan samaa hoitoa. Yksi ja sama hoitomuoto ei kuitenkaan sovi kaikille. Hoitosuositusten laadinta on keinotekoista ja työlästä ja monet niistä ovat vanhentuneita jo julkaisuhetkellä. Lääketeollisuus tukee hoitosuositusten laadintaa ja siksi niillä on useinkin suuri vaikutus suositusten laadinnassa.

http://content.karger.com/ProdukteDB/pr ... tNr=223997

Vol. 26, No. 1, 2008

Guidelines Have Done More Harm than Good

Richard Amerlinga, James F. Winchestera, Claudio Roncob

aDivision of Nephrology and Hypertension, Beth Israel Medical Center, New York, N.Y., USA;
bDepartment of Nephrology and Intensive Care, St. Bortolo Hospital, Vicenza, Italy

Address of Corresponding Author

Blood Purif 2008;26:73-76 (DOI: 10.1159/000110569)


Practice guidelines have proliferated in medicine but their impact on actual practice and outcomes is difficult, if not impossible, to quantify.

Though guidelines are based largely on observational data and expert opinion, it is widely believed that adherence to them leads to improved outcomes. Data to support this belief simply does not exist.

If guidelines are universally ignored, their impact on treatment and outcomes is minimal. The incorporation of guidelines into treatment protocols and performance measures, as is now common practice in nephrology, increases greatly the likelihood that guidelines will influence practice and hence, outcomes.

Practice patterns set up this way may be resistant to change, should new evidence emerge that contradicts certain recommendations. Even if guidelines are entirely appropriate, a 'one-size-fits-all' approach is likely to benefit some, but not all.

Certain patients may be harmed by adherence to specific guidelines. Guidelines certainly do not encourage clinicians to consider and treat each patient as an individual. They are unlikely to stimulate original research.

They are created by a process that is artificial, laborious and cumbersome. This all but guarantees many guidelines are obsolete by the time they are published. Guidelines are produced with industry support and recommendations often have a major impact on sales of industry products.

Copyright © 2008 S. Karger AG, Basel

Author Contacts

Richard Amerling, MD
Division of Nephrology and Hypertension, Beth Israel Medical Center
Baird Hall, 18th floor, 350 East 17th Street
New York, NY 10003 (USA)
Tel. +1 212 420 4070, E-Mail ramerling@bethisraelny.org

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