A guideline is a statement by which to determine a course of action. A guideline aims to streamline particular processes according to a set routine or sound practice. By definition, following a guideline is never mandatory. Guidelines are not binding and are not enforced.
Definition: The plan for a course of medical treatment or for a scientific experiment
I think guidelines in stroke rehab are totally fucking worthless, in fact counterproductive. Because they are preventing the creation of stroke rehab protocols. Changing the status quo of failures of stroke rehab guidelines, (Only 10% successful) is going to be difficult. Leaders will accept that challenge. Do we have ANY LEADERS IN STROKE?
Another reason to endorse and spread guidelines
European Heart Journal, Volume 40, Issue 2, 7 January 2019, Pages 82–83, https://doi.org/10.1093/eurheartj/ehy818
Published:
07 January 2019
In considering all the different medical subspecialties, cardiology is certainly one of the most profoundly devoted to the evidence-based (EB) approach. Guidelines could certainly be considered the cornerstone of the EB approach; scientific production and attention on this topic is growing every year (Figure1).
Figure 1
PubMed indexed articles with the word guidelines in their title during the last 10 years.
Focusing on the European side of the Atlantic, a large representation of Task Forces members of ESC Guidelines comes from Italy. This significant effort made by the Italian medical community in building and broadening guidelines reflects the scientific and legal value that such documents already have in Italy.
But, why are guidelines gaining importance in Italy?
In the era of expanding medical costs, facing the need for a sustainable healthcare system and trying to mitigate the growing trend towards defensive medical practice, the Italian Parliament enacted a new legislation (n. 24, 8th March 2017) that enhances the importance of treatment safety and regulates civil liability of healthcare professionals and providers. This new legislation was aimed at restoring the balance in the relationships between physicians and patients, reducing liability claims, which have adversely affected the healthcare system. The cardinal principle in the law is patients’ safety: healthcare professionals are asked to contribute to risk prevention while administering any kind of care.
Of seminal importance in the text of the legislation is article five stating that healthcare professionals, in their practice, should act following guidelines, published by technical associations and scientific societies in the national system of guidelines [Sistema Nazionale Linee Guida (SNLG)].
This feature has much to do with the content of art. Five hundred and ninety-sexies of the Italian Penal Code that considers a doctor causing damage or death to a patient not punishable, when he or she complies with published guidelines, introducing a strong legal value to such a document.
Under these circumstances we can speculate that in the near future Italian societies of every medical subspecialty, not only cardiology, will reinforce their work on guideline publication and accreditation to the Italian SNLG. In fact, during the last few months, after the constitution of the board of this observatory at the Ministry of Health in February 2018, the process of national guidelines document publication has entered its final phase.
This, however, may lead to a redundancy of guideline documents with possible inconsistency across different recommendations.
As stated in each guideline document published by the ESC, ‘National Societies are encouraged to endorse, translate, and implement the ESC Guidelines […] because it has been shown that the outcome of disease may be favourably influenced by the thorough application of clinical recommendations’.
In line with this statement, a formal endorsement of ESC Guidelines appears to be the best option to streamline the SNLG process rather than favouring the proliferation of local documents.
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