Posted: April 30th, 2024

Clinical Practice Guidelines

Clinical Practice Guidelines

1. Discuss the importance of Clinical Practice Guidelines and how they are used for nurse practitioners, physician assistants, and medical doctors in clinical practice.

2. List at least 5 different governing bodies for Clinical Practice Guidelines, and for each Clinical Practice Guideline that you list, discuss a health condition that can be managed by the clinical practice guideline.

3. Elaborate on the details that are provided in Clinical Practice Guidelines for the management of patients.

4. Which clinical practice guideline(s) would you anticipate using in a Public Health Department for Sexually Transmitted Infection visits? Why? Discuss the details of the clinical practice guidelines to manage a patient that is presenting for Syphilis and Chlamydia.

5. Sometimes there are slightly different recommendations from different clinical practice guidelines. Discuss the differences between American College of Gynecology (ACOG), United States Prevention Services Task Force (USPSTF), and the American Cancer Society (ACS) for mammogram screening.

6. Clinical Scenario: A Nurse Practitioner Student is seeing a 31-Year-Old Male patient that presents with seasonal allergic rhinitis. The symptoms include post nasal drip, rhinorrhea, itchy nose, and itchy eyes, and the symptoms have not been controlled with diphenhydramine nor loratadine. Based on the clinical practice guidelines, discuss the treatment(s), including education and non-pharmacological recommendations for the patient. Be sure to cite the clinical practice guideline that you are discussing.

Clinical Practice Guidelines (CPGs) are essential tools that provide evidence-based recommendations for healthcare professionals, including nurse practitioners, physician assistants, and medical doctors, to deliver high-quality care. These guidelines are developed by reputable organizations and experts in various medical fields, aiming to standardize and optimize patient management. By adhering to CPGs, healthcare providers can ensure that their clinical decisions align with the latest scientific evidence, promoting best practices and improving patient outcomes.
Several governing bodies are responsible for developing and publishing Clinical Practice Guidelines, each focusing on specific health conditions or areas of medicine. Here are five examples:

The American Diabetes Association (ADA): This organization provides guidelines for the management of diabetes mellitus, including recommendations for screening, diagnosis, treatment, and lifestyle modifications (American Diabetes Association, 2023).
The American Heart Association (AHA) and the American College of Cardiology (ACC): These organizations collaborate to develop guidelines for the prevention, diagnosis, and treatment of cardiovascular diseases, such as hypertension, coronary artery disease, and heart failure (Arnett et al., 2019).
The National Comprehensive Cancer Network (NCCN): This alliance of leading cancer centers offers guidelines for the prevention, diagnosis, and treatment of various types of cancer, including breast, lung, and colorectal cancer (National Comprehensive Cancer Network, 2023).
The American College of Obstetricians and Gynecologists (ACOG): This organization provides guidelines related to women’s health, including prenatal care, labor and delivery, and the management of gynecological conditions like endometriosis and pelvic inflammatory disease (American College of Obstetricians and Gynecologists, 2022).
The Infectious Diseases Society of America (IDSA): This organization offers guidelines for the diagnosis, treatment, and prevention of infectious diseases, such as influenza, HIV/AIDS, and various bacterial and viral infections (Infectious Diseases Society of America, 2023).

Clinical Practice Guidelines typically provide detailed information to guide healthcare professionals in the management of patients. This includes recommendations for screening and diagnostic tests, treatment options (pharmacological and non-pharmacological), follow-up care, and patient education. The guidelines often consider factors such as patient age, comorbidities, and risk factors to tailor the recommendations accordingly.
In a Public Health Department for Sexually Transmitted Infection (STI) visits, healthcare professionals would likely refer to the guidelines published by the Centers for Disease Control and Prevention (CDC). The CDC’s “Sexually Transmitted Infections Treatment Guidelines” provide comprehensive recommendations for the diagnosis and management of various STIs, including syphilis and chlamydia (Centers for Disease Control and Prevention, 2021).
For a patient presenting with syphilis, the guidelines recommend conducting a thorough medical history, physical examination, and laboratory tests (e.g., non-treponemal and treponemal tests). Treatment typically involves intramuscular benzathine penicillin G, with dosage and duration depending on the stage of syphilis. Follow-up testing is recommended to ensure adequate treatment response (Centers for Disease Control and Prevention, 2021).
For chlamydia, the guidelines recommend nucleic acid amplification tests (NAATs) for diagnosis. Treatment typically involves azithromycin or doxycycline, with a test of cure recommended for pregnant women (Centers for Disease Control and Prevention, 2021). Appropriate partner management and prevention education are also emphasized.
While Clinical Practice Guidelines aim to provide consistent recommendations, there may be variations in specific aspects due to different interpretations of evidence or divergent expert opinions. For mammogram screening, the guidelines from the American College of Obstetricians and Gynecologists (ACOG), the United States Preventive Services Task Force (USPSTF), and the American Cancer Society (ACS) have slightly different recommendations.
ACOG recommends annual mammograms starting at age 40 for average-risk women (American College of Obstetricians and Gynecologists, 2022), while the USPSTF recommends biennial screening mammograms for women aged 50 to 74 years (U.S. Preventive Services Task Force, 2022). The ACS, on the other hand, recommends annual mammograms starting at age 45 for women at average risk (American Cancer Society, 2022).
These differences arise from varying interpretations of the benefits and potential harms of screening, as well as the emphasis placed on individual risk factors and shared decision-making.
In the clinical scenario involving a 31-year-old male patient presenting with seasonal allergic rhinitis, the relevant Clinical Practice Guideline would be the “Practice Parameter for the Diagnosis and Management of Allergic Rhinitis” published by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI), the American College of Allergy, Asthma & Immunology (ACAAI), and the Joint Council of Allergy, Asthma & Immunology (JCAAI) (Dykewicz et al., 2020).
According to this guideline, the recommended treatment for the patient’s uncontrolled symptoms includes intranasal corticosteroids (INCs) as first-line therapy. Specific recommendations include fluticasone propionate, mometasone furoate, or triamcinolone acetonide (Dykewicz et al., 2020). If INCs are ineffective or contraindicated, the guideline suggests considering intranasal antihistamines, leukotriene receptor antagonists, or a short course of oral corticosteroids.
Non-pharmacological recommendations include environmental control measures, such as avoiding allergen exposure, using air filtration systems, and practicing good hygiene (Dykewicz et al., 2020). Patient education should cover proper medication administration techniques, adherence to treatment, and trigger avoidance strategies.
References:
American Diabetes Association. (2023). Standards of Medical Care in Diabetes-2023. Diabetes Care, 46(Supplement 1), S1-S262. https://diabetesjournals.org/care/issue/46/Supplement_1
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., … & Ziaeian, B. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 74(10), e177-e232. https://doi.org/10.1016/j.jacc.2019.03.010
National Comprehensive Cancer Network. (2023). NCCN Clinical Practice Guidelines in Oncology. https://www.nccn.org/guidelines/category_1
American College of Obstetricians and Gynecologists. (2022). Practice Bulletins. https://www.acog.org/clinical/clinical-guidance/practice-bulletins
Infectious Diseases Society of America. (2023). Practice Guidelines. https://www.idsociety.org/practice-guideline/
Centers for Disease Control and Prevention. (2021). Sexually Transmitted Infections Treatment Guidelines, 2021. https://www.cdc.gov/std/treatment-guidelines/default.htm
American College of Obstetricians and Gynecologists. (2022). Breast Cancer Screening. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2022/05/breast-cancer-screening
U.S. Preventive Services Task Force. (2022). Breast Cancer Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening
American Cancer Society. (2022). American Cancer Society Recommendations for Breast Cancer Screening in Women at Average Risk. https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html
Dykewicz, M. S., Wallace, D. V., Amrol, D. J., Baroody, F. M., Becker, A., Cox, L., … & Oppenheimer, J. (2020). Rhinitis 2020: a practice parameter update. Annals of Allergy, Asthma & Immunology, 125(1), 10-21. https://doi.org/10.1016/j.anai.2020.04.028

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