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Athyros VG, Gossios TD, Katsiki N, Karagiannis A, Mikhailidis DP. The clinical benefit of implementing guidelines in cardiovascular disease prevention in real world settings. Arch Med Sci 2012; 8:6-10. [PMID: 22457666 PMCID: PMC3309428 DOI: 10.5114/aoms.2012.27272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 02/04/2012] [Accepted: 02/04/2012] [Indexed: 01/13/2023] Open
Affiliation(s)
- Vasilios G. Athyros
- 2 Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Thomas D. Gossios
- 1 Cardiology Clinic, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Niki Katsiki
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinic) and Department of Surgery, Royal Free Campus, University College London Medical School, University College London (UCL), London, United Kingdom
| | - Asterios Karagiannis
- 2 Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinic) and Department of Surgery, Royal Free Campus, University College London Medical School, University College London (UCL), London, United Kingdom
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Tomasik T, Jozwiak J, Windak A, Rygiel K, Mastej M, Smithson WH, Mathers N, Tomaszewski M, Kaess BM, Tykarski A, Konduracka E, Grzeszczak W, Lukas W. Prevention of coronary heart disease in primary medical care in Poland: results from the LIPIDOGRAM study. ACTA ACUST UNITED AC 2011; 18:287-96. [DOI: 10.1177/1741826710389366] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Tomasz Tomasik
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Jozwiak
- Department of Public Health, University of Technology, Czestochowa, Poland
- Silesian Analytical Laboratories, Katowice, Poland
| | - Adam Windak
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Rygiel
- Department of Public Health, University of Technology, Czestochowa, Poland
| | | | - W Henry Smithson
- Academic Group of Primary Medical Care, University of Sheffield, Sheffield, UK
| | - Nigel Mathers
- Academic Group of Primary Medical Care, University of Sheffield, Sheffield, UK
| | - Maciej Tomaszewski
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Bernhard M Kaess
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Internal Medicine II, University of Regensburg, Regensburg, Germany
| | - Andrzej Tykarski
- Department of Hypertension, Vascular Diseases, and Internal Diseases, University of Medical Sciences, Poznan, Poland
| | - Ewa Konduracka
- Department of Coronary Disease, Jagiellonian University Medical College, Krakow, Poland
| | - Wladyslaw Grzeszczak
- Department of Internal Diseases, Diabetology and Nephrology, Medical University of Silesia, Katowice, Poland
| | - Witold Lukas
- Department of Public Health, University of Technology, Czestochowa, Poland
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Porzsolt F, Kirner A, Kaplan RM. Predictors of successful cancer prevention programs. Recent Results Cancer Res 2008; 181:19-31. [PMID: 19213553 DOI: 10.1007/978-3-540-69297-3_2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Finding the optimal use of health-care resources requires the reliable estimation of costs and consequences. Acquiring these estimates may not be difficult for some common treatments. More difficult is the optimization of resources in the area of diagnostics. Only a few attempts have been made to optimize the use of resources in the area of prevention. Several aspects have to be considered when optimizing the resources for prevention: (1) participation rates in structured prevention programs are low, (2), acquiring data on follow-up and outcomes is difficult, (3) there are concerns about the quality of information available to public, and (4), the public is often unaware of scientific assessments of prevention programs. As prevention programs are costly long-term projects, a strategy to select these programs according to possible predictors of success might be useful. The few analyses of cancer prevention in the literature have been directed towards the most common malignant diseases (as assessed by incidence) such as cancer of the breast, colon, lung and prostate. We argue that incidence is a poor marker for selecting secondary prevention programs. Incidence may be a misleading indicator for two reasons: incidence of disease does not predict efficiency of management or good health outcomes, and incidence does not separate clinically significant from non-significant disease. The traditional strategy is based on the assumption that more screening increases the chance of cure. We propose an alternative outcomes model that suggests better disease management justifies new prevention programs. Indicators for better disease management are effective and efficient treatments as well as high-quality screening (sensitivity and specificity) techniques and possibly "side-effects of prevention programs," which provide early signs of success to motivate the patient's participation, to keep up with the program and finally to succeed.
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Abstract
Clinical guidelines are developed by most specialist societies but the available data suggest that their impact on physician behavior is limited. National guidelines may need modification at the local level to account for local conditions and need regular updates to ensure that they continue to be based on the best available evidence. Measures to involve community practitioners in guideline development may enhance their uptake in the community.
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