. Publish, Disseminate, and Revisit Clinical practice guidelines must reach the relevant stakeholders in as wide and rapid a fashion as possible. There are many avenues to achieve this, the most common being a peer-reviewed journal. To aid in wide dissemination, the Agency for Healthcare Research and Quality, a branch of the U.S. Department of Health and Human Services, initiated the National Guideline Clearinghouse ( www.guideline.gov ), the goal of which is to provide timely internet access to a broad range of CPGs. (This site is an excellent resource for the most up
Shobhan Vachhrajani, Abhaya V. Kulkarni and John R. W. Kestle
Mark N. Hadley
Medical evidence-based guidelines, including clinical practice guidelines (CPGs) as discussed in this issue of the Journal of Neurosurgery: Pediatrics , are important, necessary, and valuable additions to clinicians' knowledge base. The specialty of surgery, and particularly the subspecialty of neurosurgery, has been late to embrace this concept. Properly developed, medical evidence–based guidelines represent a contemporary compilation of acceptable assessment, examination, and treatment strategies in the management of specific diseases. Such guidelines
Peter C. Gerszten
Clinical practice guidelines may be defined as systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical conditions. The practice guideline is a management plan that enables healthcare providers to make sequential decisions about testing or therapy in a given clinical situation. Given the heterogeneity of disease presentations and the complexity of making therapeutic decisions, the development of guidelines in neurosurgery presents unique problems and challenges. Clinical practice guidelines were developed in part as a method for the assessment of quality of medical care processes. Practice guidelines serve as a tool for comparisons to be made within and between healthcare delivery systems. The implementation of guidelines also allows for the acquisition of clinical and financial data that provide for outcomes analysis and other types of information. The characterization of patterns of care in different institutions and the relationship between patterns of care and outcomes will in the future allow for quality improvement, enable physicians to offer predictability and accountability to third-party interests, and contribute to an understanding of how to offer the best care to neurosurgical patients.
The author provides an overview of clinical practice guidelines and illustrates their role in the assessment of quality of patient care, demonstrates how they fit into the methodology of quality assessments, and underscores the importances of practice quidelines for the development of disease management systems.
Edward R. Smith and R. Michael Scott
Moyamoya is a progressive arteriopathy of unknown origin affecting the branches of the internal carotid artery (ICA). The arteriopathy can present as an isolated medical condition, affecting both sides of the brain (“moyamoya disease”) or can be unilateral or found in association with systemic disorders (“moyamoya syndrome”). The ischemia resulting from luminal narrowing predisposes children to transient ischemic attacks and stroke—the primary presentations of affected patients. Although it is rare—affecting 1 in 1 million children in the US—moyamoya is implicated in 6% of all childhood strokes. Diagnosis is defined by characteristic findings on arteriograms, including stenosis of the branches of the ICA and a pathognomonic spray of small collateral vessels in this region, descriptively likened to a “puff of smoke” (“moyamoya” in Japanese). Treatment is predicated on restoration of cerebral blood flow by surgical revascularization. The rarity of this disorder has limited research and the development of evidence-based clinical management. While acknowledging these limitations, in this article the authors aim to summarize current studies of pediatric moyamoya, with the objective of providing a framework for construction of evidence-based guidelines for treatment. The compilation of current data in these guidelines should serve as a resource to aid pediatric neurosurgeons in their role as advocates for providing appropriate care to affected children.
Rachel Lazarus, Katherine Helmick, Saafan Malik, Emma Gregory, Yll Agimi and Donald Marion
Deployed Setting (CPG ID:68) . Fort Sam Houston, TX : Department of Defense Center of Excellence for Trauma , 2018 ( http://jts.amedd.army.mil/assets/docs/cpgs/JTS_Clinical_Practice_Guidelines_(CPGs)/Emergency_Cranial_Procedures_by_Non-Neurosurgeons_Deployed_Setting_23_Apr_2018_ID68.pdf ) [Accessed October 15, 2018] 2 Bell R , McCafferty R , Shackelford S , Tomlin J , Dirks M , Neal C , : Joint Trauma System Clinical Practice Guideline: Neurosurgery and Severe Head Injury (CPG ID:30) . Fort Sam Houston, TX : Department of Defense Center of
Jonathan A. Forbes, Ian Laughlin, Shane Newberry, Michael Ryhn, Jason Pasley and Travis Newberry
WU , Fisher RS : Medicolegal Investigation of Death Springfield, IL , Charles C Thomas , 1993 . 311 – 381 10 Swan KG , Swan RC : Wound ballistics for the civilian surgeon . Surg Annu 17 : 163 – 187 , 1985 11 Swift B , Rutty GN : The exploding bullet . J Clin Pathol 57 : 108 , 2004 12 Unexploded Ordnance Management : Joint Theater Trauma System Clinical Practice Guidelines United States Army Institute of Surgical Research , ( http://usaisr.amedd.army.mil/cpgs/Unexploded_Ordnance_Management_7_Mar_12.pdf ) [Accessed September 9
Michael G. Kaiser, Jason C. Eck, Michael W. Groff, William C. Watters III, Andrew T. Dailey, Daniel K. Resnick, Tanvir F. Choudhri, Alok Sharan, Jeffrey C. Wang, Praveen V. Mummaneni, Sanjay S. Dhall and Zoher Ghogawala
review, clinical practice guidelines are evolving documents that require periodic updating as new information and knowledge accumulates. The purpose of the current series, “Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine,” is to incorporate the more recent medical evidence that has been published since the original publication and establish new recommendations. In 2009, an expert panel of neurosurgical and orthopedic spine surgeons was convened, many having participated in the original guidelines effort. All
Ann Marie Flannery and Laura Mitchell
, 3 the methods that were used will be described separately. In brief, a forest plot was created and a meta-analysis was conducted to determine the overall effect of the intervention, such as preoperative antibiotics, after the sources had been selected using evidencebased criteria, as described above. Revision Plans In accordance with the Institute of Medicine's standards for developing clinical practice guidelines and criteria specified by the National Guideline Clearinghouse, following the release of this document the Task Force will monitor related
Jeffrey L. Nadel, D. Andrew Wilkinson, Hugh J. L. Garton, Karin M. Muraszko and Cormac O. Maher
relatively rare disease entity and that primary care pediatricians may be less familiar with all of the screening regimens these children are recommended to receive. Encouragingly, when examining temporal trends of screening, the issuance of the 2005 recommendations did appear to increase the proportion of children who were screened: only 32.9% of those born from 2001 to 2007 were screened, whereas 60.3% of those born from 2008 to 2014 were screened. This substantial increase supports the continued expansion of practice guidelines for screening and surveillance of
International Stereotactic Radiosurgery Society practice guidelines
Zain A. Husain, Arjun Sahgal, Antonio De Salles, Melissa Funaro, Janis Glover, Motohiro Hayashi, Masahiro Hiraoka, Marc Levivier, Lijun Ma, Roberto Martínez-Alvarez, J. Ian Paddick, Jean Régis, Ben J. Slotman and Samuel Ryu
radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient . J Neurosurg Spine 14 : 151 – 166 , 2011 21184635 10.3171/2010.9.SPINE091005 23 Sahgal A , Roberge D , Schellenberg D , Purdie TG , Swaminath A , Pantarotto J , : The Canadian Association of Radiation Oncology scope of practice guidelines for lung, liver and spine stereotactic body radiotherapy . Clin Oncol (R Coll Radiol) 24 : 629 – 639 , 2012 10.1016/j.clon.2012.04.006 22633542 24 Sellin JN , Reichardt W , Bishop AJ , Suki