About us
I am a Consultant in General Medicine and Infectious Diseases practising at Mater Dei Hospital, Malta. I have trained in my country, Malta, and in the United Kingdom. Here I learnt the value of using CPGs and developed a healthy interest in guideline development.
I have been Main Coordinator of CPG development at St. Luke's Hospital Malta, since 2003, and since 2007 at Mater Dei Hospital. The process is standardised with the appointment of a Guideline Development Group (GDG) which is headed by a Guideline Coordinator. The CPG is written by a Guideline Developer, with advise from the GDG. A final Peer review process is followed before publication.
A detailed process of guideline development is very well described in the Scottish Intercollegiate Guideline Network's Guideline Developer's Handbook.
Dr Tonio Piscopo MD, MRCP(UK), DTM&H(Lond.)
The CPG Team:
Infectious Diseases Special Advisors:
Dr Charles Mallia Azzopardi, Consultant in General Medicine and Infectious Diseases, Mater Dei Hospital, is also Special Advisor to Guideline Management.
Dr Chantal Galea, Specialist in Infectious Diseases, Mater Dei Hospital, Malta.
Gastroenterology Special Advisor:
Dr Pierre Ellul, Resident Specialist in Gastroenterology, Mater Dei Hospital, Malta..
Respiratory Medicine Special Advisor:
Dr Josef Micallef, Resident Specialist in Respiratory Medicine, Mater Dei Hospital, Malta.
Neurology Special Advisor
Dr Malcolm Vella, Higher Specialist Trainee in Neurology, Mater Dei Hospital, Malta.
About Clinical Practice Guidelines
Clinical Practice Guidelines (CPGs) are being developed and implemented as an integral part of medical care in the developed world. Evidence shows that there are significant improvements in care and outcomes after introduction of CPGs 1,2.
CPGs are “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances” 3. The aims of CPGs are to achieve improvements in quality and appropriateness of care and to maintain cost-effectiveness. They should also act as educational tools helping practitioners to implement the ever-increasing amount of evidence and opinion on best current practice.
CPGs may be evidence-based or consensus-based. Most CPGs would have an element of both, with levels of recommendations attached to specific statements depending on the level of evidence.
It is important to note that Guidelines are different from Protocols in that Protocols would be a more rigid set of rules which one has to follow very closely leaving little space for clinical discretion. An example of a protocol would be the Cardiopulmonary resuscitation (CPR) algorithms. The terminology ‘protocol’ has thus limited place, and the term ‘guideline’ has largely replaced it. This is because no clinical scenario can ever be exactly the same as another and thus no guideline can ever be specific enough to be applied to all situations. Consequently, CPGs should be regarded as advisory, not mandatory in nature. Characteristics of good CPGs: 1. As described above, it is essential that CPGs should not replace clinical judgement and they should leave space for clinical discretion. Inflexibile CPGs leave no room to tailor care and apart from discouraging their use, will decrease the popularity of that CPG. 2. CPGs need to be specific where evidence-based medicine permits. Sections on Quality of evidence and Strengths of recommendations should feature in the CPG to express the level of evidence in favour of each recommendation. The clinician would then be guided as to the extent of clinical discretion he can use. 3. CPGs have always to be taken in a local context. They cannot always create standards of care mainly because local resources vary in different countries. Thus limited resources in a particular area might dictate the choice of a less desirable alternative in terms of a specific management strategy. 4. Clarity of communication is paramount for effective guidelines. We all know that most clinicians are hard pressed for time, and will not waste time to try to comprehend an unnecesserily cumbersome, lengthy and tortuous text, peppered with references. Thus for example, Algorithms are used to facilitate movement of the clinician along the CPG recommendations. In the absence of adequate clarity, the guideline will not be used by the people who are meant to use it. 5. Any explanatory notes which are long should be appended to a second part of the CPG. This will ensure that the first part of the CPG will remain simple and clear and that any further clarification is accessible as well. The reference base of each guideline needs to be included also in this second part. This imparts credibility and reproducibility to the guideline and will be valuable when the guideline is revised and updated. 6. Finally, CPGs should be easily available and accessible, ideally at the bedside or immediate vicinity. Without this, the best CPGs will not reach their full potential. The aim of this website is to facilitate this aspect of CPG use. References: 1. Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice:a sytematic review of rigorous evaluations: Lancet 1993; 342:1317-22 2. Effective Health Care Bulletin. Implementing clinical practice guidelines. York:University of York, 1994. 3. Field MJ, Lohr KN. Institute of Medicine Committee to advise the Public Health Service on Clinical Practice Guidelines. Clinical Practice Guidelines: directions for a new program. Washington DC: National Academy Press; 1990