Clinical evaluation of jaundice; a guideline of the Patient Care Committee of the American Gastroenterological Association

Article Abstract:

A guideline is presented for the evaluation of the medical symptom jaundice, prepared by the Patient Care Committee of the American Gastroenterological Association. Jaundice is the accumulation of yellow or yellow-green bile pigments in the skin and in the whites (sclera) of the eye. The condition can be caused by many different conditions and diseases that interfere with liver function and/or the secretion of bile, a fluid produced by the liver which helps digest the intestinal contents. The guideline presented is an algorithm for determining the cause of the jaundice using tests and procedures. The process begins with the physician examining and taking the medical history of the patient from which the physician arrives at a clinical evaluation and probable diagnosis. This is then evaluated by tests, beginning, if possible, with those which are not invasive (nonsurgical). The basic causes of jaundice are divided into major groups: liver tumors, or infiltration of tumors from elsewhere in the body, and blockages of bile flow caused by processes or causes outside of the liver. Implicit in the guideline is the willingness of the physician to proceed based on the initial clinical evaluation, and on each stage of successive test results and analysis. The study cautions that simple tests and bedside observations can often provide more useful data than newly developed high-technology diagnostic procedures, which are often extremely costly.

Standards, Diagnosis, Liver diseases, Jaundice, American Gastroenterological Association

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A Clinical Practice Guideline for Treating Tobacco Use and Dependence: A US Public Health Service Report

Article Abstract:

A panel of 18 scientists, doctors, and consumers has updated a clinical practice guideline on smoking that was first published in 1994. They created 50 meta-analyses of 6,000 articles published between 1975 and 1999. Their major conclusion is that every smoker should be identified and offered treatment. There are many effective treatments, including nicotine gum, nicotine inhaler, nicotine nasal spray, nicotine patches, and a drug called bupropion. Insurance companies should pay for these treatments, since they are as cost-effective as treatments for other common medical conditions.

Reports, Smoking cessation programs, Smoking cessation

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How conducting a clinical trial affects physicians' guideline adherence and drug preferences

Article Abstract:

An analysis is conducted to determine the effect of a company-sponsored clinical trial on physician's adherence to international treatment recommendations and their prescribing of the pharmaceutical company's drugs. Results reveal that conducting a pharmaceutical company sponsored trial had no significant impact on physician's adherence to international treatment recommendations but increased their use of the trial sponsor's drugs.

United States, Product development, Pharmaceutical industry, Practice, Physicians, Clinical trials

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