The Disconnect Between Practice Guidelines and Clinical Practice—Stressed Out

Long-Term Follow-Up After Fractional Flow Reserve–Guided Treatment Strategy in Patients With an Isolated Proximal Left Anterior Descending Coronary Artery Stenosis

“…It is therefore generally accepted that the presence of a stenosis in the proximal LAD weighs more in the prognosis than any other coronary segment (15,26). The presence of a narrowing of more than 50% luminal reduction in the proximal segment of the left anterior coronary artery often triggers a revascularization procedure (18,27).…”

Patterns of care for early stage bladder cancer

“…Although these guidelines offer recommendations in how to approach patients with early stage bladder cancer, they fall short of defining the optimal care, necessarily leaving decision-making in the hands of the physician. Because of the limited evidence base, consensus guideline recommendations lack stringency and generally favor more intensive care, despite the economic implications and the possibility that such care has little added value for the patient 20. Bladder cancer already ranks among the most expensive cancers to treat from diagnosis to death,21 in part due to its chronic nature and the growing population with early stage disease.…”

“…Because of the limited evidence base, consensus guideline recommendations lack stringency and generally favor more intensive care, despite the economic implications and the possibility that such care has little added value for the patient. 20 Bladder cancer already ranks among the most expensive cancers to treat from diagnosis to death, 21 in part because of its chronic nature and the growing population with early stage disease. As the US population ages, the disease's prevalence will invariably increase and related health-care costs are sure to rise.…”

Applying evidence in practice: A qualitative case study of the factors affecting residents’ decisions

“…Possible solutions to effecting behavioral change have been proposed from informatics (clinical decision support), policy (pay for performance), education, and legislation. [32][33][34][35] In this study, we sought to understand the barriers and incentives to applying evidence-based guidelines by directly engaging a group of residents as they made decisions regarding adoption, adaptation or rejection of the officially sanctioned evidence-based guideline presented to them. The problems the residents faced and their ways of coping with them in the messy real world of clinical practice suggest that environmental and organizational factors may need to be considered when introducing guidelines that require behavioral changes, particularly those that are enhanced or supported by technology.…”