Misguided guidelines.

The proposed guidelines (see record 2001-17060-009) would require detailed, probing inquiry into motivation for choosing assisted suicide. This is an appropriate requirement in principle. In practice, it will be virtually impossible to carry out this inquiry within likely statutory time limits. Evaluators most likely will either reject the guidelines as impractical or give them merely perfunctory observance. There is, moreover, an inherent tension in the evaluator's relationship with the patient between empathy and impersonal distancing that the guidelines do not adequately acknowledge; this tension necessarily compromises the evaluator's ability to apply the guidelines in the probing, detailed manner they envision. The guidelines provide false comfort that physician-assisted suicide can be carried out with adequately sensitive monitoring of voluntariness and mental competence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Record keeping guidelines.

Provides ethical and procedural guidelines for the maintenance and use of client records, developed by the American Psychological Association's Committee on Professional Practice and Standards. Issues discussed include the underlying principles of record keeping; content, construction and control, and retention of records; outdated records; and the disclosure of record-keeping procedures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributes of clinical guidelines that influence use of guidelines in general practice: observational study

OBJECTIVE: To determine which attributes of clinical practice guidelines influence the use of guidelines in decision making in clinical practice. DESIGN: Observational study relating the use of 47 different recommendations from 10 national clinical guidelines to 12 different attributes of clinical guidelines-for example, evidence based, controversial, concrete. SETTING: General practice in the Netherlands. SUBJECTS: 61 general practitioners who made 12 880 decisions in their contacts with patients. MAIN OUTCOME MEASURES: Compliance of decisions with clinical guidelines according to the attribute of the guideline. RESULTS: Recommendations were followed in, on average, 61% (7915/12 880) of the decisions. Controversial recommendations were followed in 35% (886/2497) of decisions and non-controversial recommendations in 68% (7029/10 383) of decisions. Vague and non-specific recommendations were followed in 36% (826/2280) of decisions and clear recommendations in 67% (7089/10 600) of decisions. Recommendations that demanded a change in existing practice routines were followed in 44% (1278/2912) of decisions and those that did not in 67% (6637/9968) of decisions. Evidence based recommendations were used more than recommendations for practice that were not based on research evidence (71% (2745/3841) v 57% (5170/9039)). CONCLUSIONS: People and organisations setting evidence based clinical practice guidelines should take into account some of the other important attributes of effective recommendations for clinical practice.     

A summary of cancer screening guidelines

Guidelines and programs for the early detection of cancer or cancer screening are based on the premise that outcomes are improved if the cancer is diagnosed and treated at the early stages of disease. However, there are also disadvantages to the early detection of cancer that must be considered when evaluating and establishing guidelines and programs. The Cancer Bureau of the Laboratory Centre for Disease Control at Health Canada has compiled a summary of existing guidelines for the early detection of various cancers. Recommendations have been provided by governmental organizations, non-governmental organizations, health agencies and professional associations. Many organizations base their guidelines on current evidence and periodically update them as new evidence becomes available. Therefore, it is our intention to revise this compilation in the future to reflect any updates. Guidelines for the early detection of cancer are listed in the tables that follow for 12 different cancer sites: breast, cervical, prostate, colorectal, ovarian, skin, testicular, gastric, lung, pancreatic, bladder and oral cancers.     

Falling short of Pap test guidelines

OBJECTIVES: This article examines the associations between women's characteristics and getting or not getting a Pap test. DATA SOURCE: The data are from the 1994/95 National Population Health Survey (NPHS) conducted by Statistics Canada. ANALYTICAL TECHNIQUES: Multivariate logistic regressions were used to determine the odds of women not complying with Pap test guidelines, that is, of never having had a Pap test, and among women who had had one, of not having done so in the last three years. MAIN RESULTS: One in four women aged 18 to 69 had either never had a Pap test or had not had one in the three years before the NPHS. Notably, older women--who are at the greatest risk for cervical cancer--are less compliant with screening guidelines than younger women. Other characteristics of women with high odds of never having had a Pap test are: being single, being a resident of Quebec, having immigrated to Canada, having less than a secondary school education, not being in the highest income group and having had no sex partners in the previous year.