Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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Z Arztl Fortbild Qualitatssich · Jan 2007
[Evidence-based medicine: some misunderstandings put right].
Evidence-based Medicine (EbM) has been identified with the "Five Steps" of asking an answerable question, tracking down the evidence, appraising original articles, integrating the result into one's practice and evaluating the effect. However, the constraints of most health care settings allow the full cycle of this approach to a very limited number of problems only. Most problems have to be solved at the intuitive end of the cognitive spectrum. ⋯ Doctors achieve this in a variety of ways; Sackett's Five Steps is only one of them. We conclude that EbM has had a tremendous impact on practitioners in this country. Future training efforts have to be adapted to the cognitive structure of doctors' reasoning.
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Z Arztl Fortbild Qualitatssich · Jan 2006
Practice Guideline[The German Disease Management Guideline Asthma: methods and development process].
The German National Program for Disease Management Guidelines, which is being operated under the auspices of the German Medical Association (GMA), the Association of the Scientific Medical Societies (AWMF) and the National Association of Statutory Health Insurance Physicians (NASHIP), provides a conceptual basis for the disease management of prioritized healthcare aspects. The main objective of the program is to establish consensus of the medical professions on key recommendations covering all sectors of healthcare provision and facilitating the coordination of care for the individual patient through time and across interfaces. Within the scope of this program, the Scientific Medical Societies concerned with the prevention, diagnosis, treatment and rehabilitation of asthma in children, adolescents and adults have reached consensus on the core contents for a National Disease Management Guideline for Asthma. This consensus was reached by applying formal techniques and on the basis of the adaptation of recommendations from existing guidelines with high quality standards in methodology and reporting, and information from evidence reports.
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Z Arztl Fortbild Qualitatssich · Jan 2006
Practice Guideline[National Disease Management Guideline for Asthma: recommendations and evidence for "asthma prevention" issues].
The National Disease Management Program (NDM Program) represents the basic content of structured, cross-sectoral healthcare. In particular, the NDM Program is directed towards coordinating different disciplines and areas of healthcare. The recommendations are developed through interdisciplinary consensus of the scientific medical societies on the basis of the best available evidence. ⋯ With respect to secondary prevention, recommendations have been made for allergen avoidance, active/passive smoking and immunotherapy. Regarding tertiary prevention, position statements on vaccination and specific immunotherapy are developed. The present paper presents both the original texts of the recommendations and the evidence underlying them.