THE SIGNIFICANCE OF CLINICAL PROTOCOLS IN SURGICAL DISCIPLINES
DOI:
https://doi.org/10.24297/jssr.v6i1.6639Abstract
In the current article we aim to describe and show the significance of evidence-based medicine (EBM) in surgical disciplines, as this is expressed through the application of clinical protocols and clinical indicators of quality and outcome. We also probe the questions of clinical protocols assisting in hospital management, and moreover of the political and political-ethical issues for the implementation of clinical protocols in the pursuit of better hospital management. Clinical protocols are guidelines with broader scientific acceptance, helping physicians, surgeons and health staff in general, to perform a procedure or combination of procedures with the best possible results at the lowest possible cost. Clinical indicators are implemented in order to assess the achieved results; such indicators are in-hospital mortality, frequency of adverse events such as stroke or venous thromboembolism, duration of hospitalization, incidence of reoperation, incidence of re-admittance etc. The article also includes, for reasons of better understanding, two examples of clinical protocols (coronary artery surgery and total hip arthroplasty).
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References
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46. Migita K, Bito S, Nakamura M, Miyata S, Saito M, Kakizaki H et al. Venous thromboembolism after total joint arthroplasty: results from a Japanese multicenter cohort study. Arthritis Res Ther. 2014.2014 Jul 21;16(4):R154
47. Ishi SV, Lakshmi M, Kakde ST, Sabnis KC, Jagannati M, Girish TS et al. Randomised controlled trial for efficacy of unfractionated heparin (UFH) versus low molecular weight heparin (LMWH) in thrombo-prophylaxis. J Assoc Physicians India. 2013 Dec;61(12):882-6
48. Laport S, Chapelle C, Bertoletti L, Lega JC, Cucherat M, Zufferey PJ et al. Indirect comparison meta-analysis of two enoxaparin regimens in patients undergoing major orthopaedic surgery. Impact on the interpretation of thromboprophylactic effects of new anticoagulant drugs. Thromb Haemost. 2014 Sep 2;112(3):503-10
49. Lussana F, Squizzato A, Permunian ET, Cattaneo M. A systematic review on the effect of aspirin in the prevention of post-operative arterial thrombosis in patients undergoing total hip and total knee arthroplasty. Thromb Res. 2014 Sep;134(3):599-603.
50. Dervenis C, Kastanioti C, Polyzos N. Restructuring the finances of the greek health care system in the era of economic crisis. World J Surg. 2013 Mar;37(3):707-9
2. Eddy DM (1988). "The Quality of Medical Evidence: Implications for Quality of Care". Health Affairs 7: 19–32.
3. Greenhalgh, Trisha. How To Read a Paper: The Basics of Evidence-Based Medicine. Wiley-Blackwell, fourth edition, 2010, p. 1.
4. Eddy D. Clinical decision making: From theory to practice. Practice policies – guidelines for methods. JAMA 1990, 263:1839–1841
5. Cook D, Guyatt G, Laupacis A, Sackett D, Goldberg R. Clinical recommendations using levels of evidence for antithrombotic agents
6. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. Jan 13, 1996; 312(7023): 71–72.
7. Wilson W, Taubert KA, Gewitz M, et al. “Prevention of infective endocarditis: guidelines from the American Heart Association. Circulation. 116 (15): 1736–54.
8. Kariotis P. Health Services Management and Biomedical Technology, Euroclinica, Athens, 1992 (in gr)
9. Kasimatis K. Social Planning and Evaluation. 2003, Gutenberg, Athens (in gr)
10. Koutouzis Μ. Management of an Organization, Organization, Management of Human Resources, the Procedure of Decision-making, Communication within an Organization, Leadership-Guidance, Control Procedures in: Dikaios K and others: “Basic Principles of Administration and Management of Health Services, Greek Open University, 1999. (in gr)
11. Stathopoulos A: “Indroduction in Enteprises‟ Economics and Management 1986, Athens. (in gr)
12. Bourandas D., Management, Benos Ed., Athens 2002 (in gr)
13. Fanariotis P., Public Services and Organisations Administration, Stamoulis Ed., Athens 1999 (in gr)
14. Stathopoulos P., Organisational Structure and Administration of Social Services, Papazisis ed, Athens 2012. (in gr)
15. Iatridis D. (2000): “Social Policy Planning†Gutenberg, Αθήνα. (in gr)
16. Chatzikokolaki M, Lionis C and Liaropoulos L (2003): «Effectiveness Measurement of Health Services with the Method of Best Practice During the Production Process†in: Niakas: «Issues of Administration and Management of Health Services» MediForce, Athens. (in gr)
17. Leftakis A (2004): « Doctors Perceptions Regarding the Economics of Intensive Care Unitsâ€. in Niakas D, Health Services, Management and Technology, MediForce, Athens (in gr)
18. Bakalarou Î. (2004): “The Application of the EFQM Excellence Model in Hospitals†in. Niakas D. Health Services, Management and Technology, Mediforce, Athens (in gr)
19. Anagnostou G an Oikonomopoulos C, “The Introduction of the Institution of Manager in Greek Public Hospitals. A first critical evaluation of the institutionâ€. Administrative Bulletin, Issue 27, Nov 2003, p. 69-77 (in gr)
20. WHO (1946) Constitution available at http://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf, date of visit 16/03/2011
21. World Health Organization 2000: The World Health Report
22. Üstün & Jakob (2005), Üstün & Jakob (2005) Re-defining heath, available at http://www.who.int/bulletin/bulletin_board/83/ustun11051/en/, date of visit 16/03/2011.
23. Biron Laura, Rumbold Benedict, & Faden Ruth (2012): “Social value judgments in healthcare critiqueâ€, Journal of Health Organization and Management, Vol. 26 Iss: 3 pp 317-330. Quotations from 324 and 323.
24. George, Vic (2010): „Major Thinkers in Welfare: contemporary issues in historical perspective‟ Policy Press Bristol 2010
25. Mill J. S.(1910/1926) : “Utilitarianism†and “On Liberty†Everyman‟s Library London, quotations from pp 6 and 4 respectively.
26. Aristotle: Politics, http://classics.mit.edu/Aristotle/politics.1.one.html, date of visit 18/03/2011
27. Rousseau, Jean Jacques: „The Social Contract‟ Translated by G. D. H. Cole. at http://www.constitution.org/jjr/socon.htm, visited 23/3/2011.
28. Burgers JS, Grol R, Klazinga NS, Mäkelä M, Zaat J, for the AGREE Collaboration. Towards evidence-based clinical practice: an international survey of 18 clinical guideline programs. Int J Qual Health Care 2003;15:31-45
29. The AGREE Collaboration. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Qual Saf Health Care. 2003;12:18-23
30. Skalkidis I, Nastos K, Zavitsanos X. Clinical protocols and clinical guidelines-Issues of their implementation in everyday clinical practice. Archives of Hellenic Medicine. 2010, 27(2): 264-273
31. Institute of Medicine (edt.) Clinical practice guidelines we can trust. Washington DC, 2011
32. Reames BN, Krell RW, Ponto SN, Wong SL (2013). Critical evaluation of oncology clinical practice guidelines. J Clin Oncol 31 (20): 2563–8.
33. Mulley A. Learning from differences within the NHS. Clinical indicators should be used to learn, not to judge. Br Med J 1999, 319:528–530
34. Reid CM, Solterbeck A, Buxton BF, Skillngton PD, Shardey GC, Smith JA, Rosenfeldt FL. Developing performance indicators for cardiac surgery: a demonstration project in Victoria. Hear Lung Circ. 2001;10(1 Suppl):S29-33
35. Sonnad SS, Matuszewski K. Control mechanisms for guideline implementation. Qual Manag Health Care 2006, 15:15–26
36. Fetter RB, Shin Y, Freeman JL, Averill RF, Thompson JD (1980) Case mix definition by diagnosis related groups. Medical Care 1980; 18(2):1–53
37. Fetter RB, Freeman JL. (1986) Diagnosis related groups: product line management within hospitals. Academy of Management Review 1986; 11(1):41–54
38. Polyzos N, Karanikas H, Thireos E, Kastanioti C, Kontodimopoulos N. Reforming reimbursement of public hospitals in Greece during the economic crisis: Implementation of a DRG system. Health Policy 109(2013):14-22
39. Ghaffari S, Donan S, Aisbett C, Jackson T. Investigating DRG cost weights for hospitals in middle income countries. Journal of Health Policy and Management. 2009;24:251-64
40. International Classification of Diseases, ICD-10, World Health Organisation, 2010
41. Ma X, Ma C, Yun Y, Zhang Q, Zheng X. Safety and efficacy outcomes of preoperative aspirin in patients undergoing coronary artery bypass grafting: a systematic review and meta-analysis. J Cardiovas Pharmacolo Ther. 2014 Jan;19(1):97-113.
42. Ferraris VA, Ferraris Sp, Joseph O, Wehner P, Mentzer RM Aspirin and Postoperative Bleeding After Coronary Artery Bypass Grafting. Ann Surg. Jun 2002;235(6):820-7
43. Kremke M, Tang M, Bak M, Kristensesn KL, Hindshol K, Andreasen JJ et al. Antiplatelet therapy at the time of coronary artery bypass grafting: a multicentre cohort study. Eur J Cardiothorac Surg. 2013 Aug;44(2):e133-40
44. Sun JC, Teoh KH, Lamy A, Sheth T, Ellins ML, Jung H et al. Randomized trial of aspirin and clopidogrel versus aspirin alone for the prevention of coronary artery bypass graft occlusion: the Preoperative Aspirin and Postoperative Antiplatelets in Coronary Artery Bypass Grafting study. Am Heart J. 2010 Dec;160(6):1178-84.
45. deLeon N, Jackevicius CA. Use of aspirin and clopidogrel after coronary artery bypass graft surgery. Ann Pharmacother. 2012 May;46(5):678-87
46. Migita K, Bito S, Nakamura M, Miyata S, Saito M, Kakizaki H et al. Venous thromboembolism after total joint arthroplasty: results from a Japanese multicenter cohort study. Arthritis Res Ther. 2014.2014 Jul 21;16(4):R154
47. Ishi SV, Lakshmi M, Kakde ST, Sabnis KC, Jagannati M, Girish TS et al. Randomised controlled trial for efficacy of unfractionated heparin (UFH) versus low molecular weight heparin (LMWH) in thrombo-prophylaxis. J Assoc Physicians India. 2013 Dec;61(12):882-6
48. Laport S, Chapelle C, Bertoletti L, Lega JC, Cucherat M, Zufferey PJ et al. Indirect comparison meta-analysis of two enoxaparin regimens in patients undergoing major orthopaedic surgery. Impact on the interpretation of thromboprophylactic effects of new anticoagulant drugs. Thromb Haemost. 2014 Sep 2;112(3):503-10
49. Lussana F, Squizzato A, Permunian ET, Cattaneo M. A systematic review on the effect of aspirin in the prevention of post-operative arterial thrombosis in patients undergoing total hip and total knee arthroplasty. Thromb Res. 2014 Sep;134(3):599-603.
50. Dervenis C, Kastanioti C, Polyzos N. Restructuring the finances of the greek health care system in the era of economic crisis. World J Surg. 2013 Mar;37(3):707-9
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Published
2014-12-08
How to Cite
Tagarakis, G. I., Dikeos, C., Tsolaki, F., Daskalopoulos, M., Bougioukakis, P., Tsilimingas, N., & Polyzos, N. (2014). THE SIGNIFICANCE OF CLINICAL PROTOCOLS IN SURGICAL DISCIPLINES. JOURNAL OF SOCIAL SCIENCE RESEARCH, 6(1), 927–933. https://doi.org/10.24297/jssr.v6i1.6639
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