Rapid Responses

The primary purpose of Rapid Responses is to provide a venue for readers to comment on and discuss scientific content published in CJA Online.

Please note that Rapid Response comments must be made in one of Canada's official languages, English or French, to solicit response.

General comments or concerns should be sent to the communications{at}cas.ca.

Electronic Letters to:

Reports of Original Investigations: Tasnim Sinuff, Kevin W. Eva, Maureen Meade, Peter Dodek, Daren Heyland, and Deborah Cook Clinical practice guidelines in the intensive care unit: a survey of Canadian clinicians’ attitudes: [Guide de pratique clinique dans les unités de soins intensifs : un sondage sur les attitudes des cliniciens canadiens] Can J Anesth 2007; 54: 728-736 [Abstract] [Full text] [PDF]

eLetters: Submit a response to this article

Electronic letters published:

guidelines' implementation : intergrate the peers to increase anaesthetists' adherence

Pascal Vignally, Roland Sambuc, Stephanie Gentile   (18 September 2007)

guidelines' implementation : intergrate the peers to increase anaesthetists' adherence 18 September 2007
Pascal Vignally, epidemiologist Italian National Institute of Health, Roland Sambuc, Stephanie Gentile Send letter to journal: Re: guidelines' implementation : intergrate the peers to increase anaesthetists' adherence pascal.vignally{at}iss.it Pascal Vignally, et al.	Sinuff et al(1) illustrated the main issue of knowledge and adherence in daily practice to guidelines, demonstrating the importance of planning implementation strategies according to clinician preferences. In a study carried out in 2005, we showed how anaesthetists would judge and adhere to guidelines based on who promoted them. Using a multiple- choice questionnaire, we asked a random sample of 100 anaesthetists to evaluate their knowledge of guidelines and promoters. The way they became aware of guidelines was also investigated. The overall response rate was 77%. The level of confidence with guidelines was not related to the scientific evidence (consensus conferences were evaluated more reliable compared to clinical practice guidelines 94,3% vs 76,8% p<0,001). But the level of confidence was significantly linked to the promoter: French society of anaesthesia and reanimation was considered a more reliable promoter than national health agencies and pharmaceutical industries (respectively 67,4% vs 11,6% and 3,8%, p<0,001). Anaesthetists became aware of guidelines mainly through their specialty society (62%)but also congresses (31%), hospital colleagues (23%) and publications (14%). The main resources used for finding guidelines were specialty societies internet sites. According to these results, peers and in particular specialty societies appeared to be more important source of information on guidelines for anaesthetists. When studies showed that the quality of some guidelines developed by specialty societies might be unsatisfactory, these studies didn't critize the specialty societes' influence for supporting guidelines (2,3): only the lack of explicit methodological criteria for production of guidelines was confirmed. Grol recommends targeting each specific type of public for a best integration of the guidelines and a real impact in clinical practices (4). In order to achieve a better appreciation and a higher application of their guidelines, national health agencies have to rely on specialty societies. 1 Sinuff T, Eva KW, Meade M, Dodek P, Heyland D, Cook D. Clinical practice guidelines in the intensive care unit: a survey of Canadian clinicians' attitudes.Can J Anaesth. 2007 Sep;54(9):728-36 2 Grilli R, Magrini N, Penna A et al. Practice guidelines developed by specialty societies: the need for a critical appraisal.Lancet. 2000 Jan 8;355(9198):103-6 3 Wright JM. Practice guidelines by specialist societies are surprisingly deficient. Int J Clin Pract. 2007 Jul;61(7):1076-7 4 Grol. Development of guidelines for general practice care. Br J Gen Pract. 1993 Apr;43(369):146-51