Clinical Practice Guidelines
By Jguest
Clinical Practice Guidelines
Clinical practice guidelines are guided by systemic evidence review and assessing benefits and harms of alternative options all intended to optimize patient care. Clinical practice guidelines are designed to screen, diagnose and treat ailments which are relevant to internal medicine and its subspecialties. Clinical guidelines with the strongest supporting evidence should be prioritized. Systemic reviews critically assess and evaluate all research that pertains to a specific clinical issue. The research conducted should display effective implementation and impact of using such guidelines as measures of quality.
Recommendation for screening breast cancer: all women aged 40 and above should perform a clinical breast examination every year. Every one to two years, mammography is recommended for all women between 50 and 75, unless pathology is detected. In instances where women have a high risk of breast cancer, mammography may commence at an earlier age (US Preventative Services Task Force). There is inadequate evidence to make changes in the current breast self-examination practice, although teaching breast self-examination is not specifically recommended.
As the most common type of cancer in women, screening breast cancer is aimed at reducing morbidity and mortality. Screening tests for breast cancer include clinical breast examination and breast imaging through mammography, ultrasonography, magnetic resonance imaging and digital breast tomosynthesis. Studies show that women who routinely undergo mammograms have a 10% to 25% less chance to die compared to women who do not have mammogram tests. Mammograms are not perfect and false-positive results lead to more testing which causes anxiety as well as time wastage (Pace et al, 2014). Overdiagnosis is expensive and cause physical and psychological effects. The benefits of screening breast cancer are dissimilar for various women. Since age is a crucial factor, it is prudent to start breast screening while younger (American Cancer Society).
Recommendation for treating Insomnia: Adult patients for insomnia should receive cognitive behavioral therapy as initial treatment for a chronic insomnia disorder. Clinicians must discuss harms, benefits and cost of using medication with patients whom therapy was unsuccessful, before deciding whether to add pharmacological therapy. Treating insomnia is aimed at improving sleep and alleviating dysfunction and distress it causes, using or combining both psychological therapy with pharmacological therapy.
Insomniacs are dissatisfied with the quantity and quality of sleep, experiencing difficulty trying to initiate or maintain sleep, and unable to return to sleep once they wake up. People with insomnia are fatigued, have poor cognitive functions, experience disturbed moods, and distress. Symptoms must be present three nights a week for three months and must not be associated with other medical or mental disorders (Morin & Benca, 2012). Drugs approved by the U.S Food and Drug Administration for pharmacological therapy includes benzodiazepines, nonbenzodiazepine, doxepin and melatonin. Insomnia has also been treated using complementary and alternative approaches such as herbal medicine and acupuncture. Once treated, patients experience improvements in the quality of life, while clinicians can effectively treat other cnditions such as cognitive impairment, chronic pain and fatigue.
References
US Preventive Services Task Force
Pace, L. E., & Keating, N. L. (2014). A systematic assessment of benefits and risks to guide breast cancer screening decisions. Jama, 311(13), 1327-1335.
American Cancer Society
Morin, C. M., & Benca, R. (2012). Chronic insomnia. The Lancet, 379(9821), 1129-1141.
