The Infectious Diseases Society of America Lyme guidelines: a cautionary tale about the development of clinical practice guidelines

Flawed clinical practice guidelines may compromise patient care. Commercial conflicts of interest on panels that write treatment guidelines are particularly problematic, because panelists may have conflicting agendas that influence guideline recommendations. Historically, there has been no legal remedy for conflicts of interest on guidelines panels. However, in May 2008, the Attorney General of Connecticut concluded a ground-breaking antitrust investigation into the development of Lyme disease treatment guidelines by one of the largest medical societies in the United States, the Infectious Diseases Society of America (IDSA). Although the investigation found significant flaws in the IDSA guidelines development process, the subsequent review of the guidelines mandated by the settlement was compromised by a lack of impartiality at various stages of the IDSA review process. This article will examine the interplay between the recent calls for guidelines reform, the ethical canons of medicine, and due process considerations under antitrust laws as they apply to the formulation of the IDSA Lyme disease treatment guidelines. The article will also discuss pitfalls in the implementation of the IDSA antitrust settlement that should be avoided in the future.     

不同高血压治疗指南的比较与分析

为了更好的控制高血压的发病率和死亡率,达到对高血压患者的最佳和规范化治疗,各国家和地区的医疗机构均制定了相应的治疗指南,并及时进行更新和修正。由于这些指南之间存在着不同程度的差异,导致医疗工作者在学习和实践中产生了一定的困惑,通过运用哲学的思维和方法论对四种主要的高血压治疗指南的异同点进行比较和分析,有利于我国临床医师更好地将其运用于临床,从而更好地控制高血压患者的病情。     

ISSUES AND IMPLICATIONS OF ESTABLISHING GUIDELINES FOR THE USE OF BEHAVIORAL TECHNIQUES

Several guidelines surrounding the use of behavioral procedures have recently appeared, the best of which is that of the National Association of Retarded Citizens (NARC). Some issues and implications of the establishment of guidelines are briefly reviewed in the context of the NARC guidelines. Issues include the factual versus opinion bases for guidelines and the need to continue the development of explicit behavioral criteria for assessing staff competence. Implications for programs include the impact of guidelines on professional boundaries, administrative decision-making, and budgeting, together with the dangers of expanding the regulatory bureaucracy. Several miscellaneous impacts are noted, including a potential for curbing innovative behavioral technology.     

Guidelines with Strategies for Enhancement of Resilience and Psycho-Social Well-Being in Professional Nurses

There are currently no guidelines available for enhancement of resilience in professional nurses. This study aims to provide broad guidelines with specific strategies that may enhance resilience and psycho-social well-being in professional nurses. These guidelines are based findings from previous qualitative research on resilience in professional nurses in the public and private sector in South Africa. We used Kumpfer's (1999) theoretical model of resilience to frame the guidelines. Resilience among professional nurses appears to vary in manifestation across settings of practice.     

The American psychological Association's practice guidelines for men and boys: Are they hurting rather than helping male mental wellness?

Introduced in 2018, the American Psychological Association's (APA) Practice Guidelines for Men and Boys was intended to provide helpful direction for practitioners when seeing male patients. This followed in the tradition of other practice and clinical guidelines for clinical work with specific identity populations. However, the practice guidelines for men and boys quickly became controversial given concerns that the guidelines were disparaging of men and boys, particularly those with traditional values and sought to impose progressive or feminist gender norms and ideologies rather than remaining focused on clinical wellness and empathy. This review finds that, though the guidelines were offered in good faith, many of the critiques are likely valid. Specifically, the guidelines failed to acknowledge significant evidence for biological influences on gender (e.g., hormonal, and hypothalamic influences on gender identity and gendered behavior), were unintentionally disparaging of traditional men and families, and were too closely wedded to specific sociocultural narratives and incurious of data not supporting those narratives. It is concluded that there are reasonable concerns that the current guidelines may do more harm than good by dissuading traditional men and families from seeking counseling.     

Design and Development of the ITC Guidelines on Computer-Based and Internet-Delivered Testing

This article describes the design and development of the International Test Commission's (ITC, this issue) Guidelines for Computer-Based and Internet-Delivered Testing. It examines some of the reasons why the ITC Council decided to invest in a program of research, consultation, and conferences designed to develop internationally agreed-on guidelines specifically aimed at computer- and Internet-based testing and describes the methodology involved in developing and disseminating the guidelines. Through a process of reviewing relevant literature and organizing conferences and wide consultations, a set of internationally recognized guidelines that highlighted good practice issues in computer/Internet testing were developed. The guidelines will raise awareness among all stakeholders in the testing process of what constitutes good practice in computer/Internet testing and can be used as a benchmark to set local standards and guidelines. Further issues are raised from the research, not least the need to ensure that with advances in technology and science comes the updating of training in tests and testing to keep up with such advances.     

Application of multiple baseline designs in behavior analytic research: Evidence for the influence of new guidelines

The multiple baseline (MBL) design is a single‐case experimental design that has both research and applied utility. Although the concurrent and nonconcurrent MBL variants are valid designs, each rules out different threats to internal validity. To help clarify these differences, studies have provided guidelines for graphically depicting and distinguishing between concurrent and nonconcurrent MBLs. This study assessed the extent to which data‐presentation guidelines have been adopted by examining single‐case experimental design studies published in 3 behavior‐analytic journals from 2000 to 2015. Results suggest that data‐depiction guidelines have increased correct identification of concurrent multiple baseline designs but also indicate that these guidelines have not been universally adopted.     

Psychological management intervention guidelines for rape survivors with post-traumatic stress disorder (PTSD): A brief exploratory systematic literature review

This exploratory systematic literature review aimed to characterise the current evidence on psychological management intervention guidelines for use with rape survivors with post-traumatic stress disorder (PTSD) symptoms. For the data searches we accessed the following electronic databases: Google Scholar, Science Direct, EBSCOhost, and PsychInfo. We utilised search terms with variations of the following key words: psychological management guidelines of PTSD*, rape survivors*. Inclusion criteria were guidelines for rape survivors with PTSD that consider referral, treatment, and preventive and health promotion in an international setting. We excluded guidelines that did not address PTSD resulting from rape in an international setting. We employed a narrative synthesis data analysis approach to integrate the evidence from across studies. Findings suggest prevalent guidelines for rape survivors with PTSD focus on cognitive behavioural therapy and other psychological management interventions in highly specialised areas and Primary Health Care (PHC) settings in international countries, but not in other countries such as South Africa. Emerging guidelines are needed for PTSD psychological management interventions in rape care clinics situated in South Africa.     

Laboratory Safety and Nanotechnology Workers: an Analysis of Current Guidelines in the USA

Although some regulatory frameworks for the occupational health and safety of nanotechnology workers have been developed, worker safety and health issues in these laboratory environments have received less attention than many other areas of nanotechnology regulation. In addition, workers in nanotechnology labs are likely to face unknown risks and hazards because few of the guidelines and rules for worker safety are mandatory. In this article, we provide an overview of the current health and safety guidelines for nanotechnology laboratory workers by exploring guidelines from different organizations, including the Department of Energy Nanoscale Science Research Centers (DOE-NSRC), Massachusetts Institute of Technology (MIT), the National Institutes of Health (NIH), the National Institute for Occupational Safety and Health (NIOSH), the Occupational Safety and Health Administration (OSHA), Texas A&M University (TAMU), and University of Massachusetts-Lowell (UML). After discussing these current guidelines, we apply an ethical framework to each set of guidelines to explore any gaps that might exist in them. By conducting this gap analysis, we are able to highlight some of the weaknesses that might be important for future policy development in this area. We conclude by outlining how future guidelines might address some of these gaps, specifically the issue of workers’ participation in the process of establishing safety measures and the development and enforcement of more unified (and mandatory) guidelines.     

Ethical Issues and Guidelines for Conducting Data Analysis in Psychological Research

Psychologists are directed by ethical guidelines in most areas of their practice. However, there are very few guidelines for conducting data analysis in research. The aim of this article is to address the need for more extensive ethical guidelines for researchers who are post–data collection and beginning their data analyses. Improper data analysis is an ethical issue because it can result in publishing false or misleading conclusions. This article includes a review of ethical implications of improper data analysis and potential causes of unethical practices. In addition, current guidelines in psychology and other areas (e.g., American Psychological Association and American Statistical Association Ethics Codes) were used to inspire a list of recommendations for ethical conduct in data analysis that is appropriate for researchers in psychology.     

Effectiveness of research guidelines in prevention of scientific misconduct

In response to a series of allegations of scientific misconduct in the 1980’s, a number of scientific societies, national agencies, and academic institutions, including Harvard Medical School, devised guidelines to increase awareness of optimal scientific practices and to attempt to prevent as many episodes of misconduct as possible. The chief argument for adopting guidelines is to promote good science. There is no evidence that well-crafted guidelines have had any detrimental effect on creativity since they focus on design of research studies, documentation of research findings, assignment of credit through authorship, data management and supervision of trainees, not on the origin and evolution of ideas. This paper addresses a spectrum of causes of scientific misconduct or unacceptable scientific behavior and couples these with estimates of the potential for prevention if guidelines for scientific investigation are adopted. The conclusion is that clear and understandable guidelines should help to reduce the chance that flawed research will escape from our institutions. However, they cannot be relied upon alone to prevent all instances of scientific misconduct and should be regarded rather as one means of bolstering the integrity of the entire scientific enterprise.     

Guidelines and Ethical Considerations for Assessment Center Operations1

This document is an update of several prior editions of guidelines and ethical considerations for assessment center operations dating back to 1975. Each set of guidelines was developed and endorsed by specialists in the research, development, and implementation of assessment centers. The guidelines are a statement of the considerations believed to be most important for all users of the assessment center method. For instance, the use of job‐related simulations is a core concept when using the method. Job simulation exercises allow individuals to demonstrate their abilities in situations that are important on the job. As stressed in these guidelines, a procedure should not be represented as an assessment center unless it includes at least one, and usually several, job‐related simulations that require the assessee to demonstrate a constructed behavioral response. Other important areas include assessor selection and training, using ‘competencies’ as dimensions to be assessed, validation, participants' rights, and the incorporation of technology into assessment center programs. The current guidelines discuss a number of considerations in developing and using assessment centers in diverse cultural settings.     

Guidelines for planning and evaluating school psychology service delivery systems

Contemporary standards of professional practice (e.g., American Psychological Association, 1977) and recent educational compliance legislation (e.g., PL 94–142) emphasize the delivery of appropriate school psychological services geared to a range of school-age children with special needs. Thus, school psychologists must pay increased attention to the development of school psychology service delivery systems. Toward this end, guidelines are presented for planning and evaluating school psychology service delivery systems. The guidelines are set forth in order that school psychologists might consider them and adapt them to local circumstances. The eight principles which comprise the guidelines have been used by the author in planning and evaluating school psychology service delivery systems in several public school districts. One particular school district will serve to illustrate the utilization of the guidelines.     

Psychotherapierichtlinien: seit 40 Jahren Bewährung in der Praxis

Looking back at 40 years application of psychotherapy guidelines, a positive balance can be drawn. Benchmarks of the guidelines are the biopsychosocial conception of psychic disturbances requiring treatment and the congruent expertise procedure. The latter is considered by many psychotherapists as unreasonable and by the health insurances as not effective enough because of a rejection quota of only 5%. Nevertheless, it proved to be useful in historical, therapeutic and textual aspects. The biopsychosocial conception of psychic disturbances according to the psychotherapy guidelines is an important counterbalance to the objectifying view and evaluation of psychic processes. This concept implies also a complementary view of the ill compared to somatic medicine which allows a better comprehension and understanding of the individual suffering. The most important modification in the psychotherapy guidelines was the inclusion of behavior therapy as the guideline therapy. It succeeded in surpassing the hallmark of (higher) effectivity by offering shorter therapies and objectifiable verification, as an important complementary object-view into psychic processes. Meanwhile, however, this object-view threatens to displace the ?subject-view“ of the psychotherapy guidelines, especially supported by new developments in evidence-based medicine.     

THE STATISTICAL DEFINITION OF FAIRNESS IN THE FEDERAL SELECTION GUIDELINES AND ITS IMPLICATIONS FOR MINORITY EMPLOYMENT

The definition of fairness in the guidelines is the same as Cleary's regression model of test bias, which results in a lower proportion of new hires that is minority than the proportion of qualified applicants that is minority. This article explains the disparity, reviews alternative definitions that reduce the disadvantage, and discusses legal arguments. Apparently the guidelines definition is widely disregarded in practice–a color-blind model seems to be the definition generally used by employers. That definition puts minorities at less of a disadvantage than the federal guidelines definition does.     

Guidelines for Writing Letters to Patients

Patient letters provide a permanent record of the genetic counseling that was provided and are unique in medical care; rarely do other health care providers send summaries written specifically to their patients and families. We surveyed genetic counseling training program directors and found that while the acquisition of patient letter-writing skills was considered important, there were no specific guidelines made available to students. To develop letter-writing guidelines, we evaluated patient letters, reviewed references on professional correspondence, surveyed the medical literature, and worked with a writing consultant. The guidelines we subsequently developed and present here include a format for writing patient letters, suggestions on presenting medical information in understandable terms, and wording considerations. These patient letter-writing guidelines are intended to serve as a guide for teaching students this important skill and as a resource for practicing health care professionals.     

Telemedicine and adherence to national guidelines for ADHD evaluation: A case study

The pilot project evaluated a telemedicine clinic's adherence to American Academy of Pediatrics (AAP) guidelines for attention-deficit/hyperactivity disorder (ADHD) evaluation. Real-time videoconferencing linked the patients, the families, and the specialty mental health team. The ADHD Telemedicine Clinic adherence to AAP guidelines was tracked using chart data. The study included 22 patients (Mean age = 9.3 years, SD = 2.3 years) participating in 69 telemedicine visits across 13 different school-related sites. The ADHD Telemedicine Clinic reached extremely high adherence rates across the AAP evaluation guidelines for ADHD, ranging from 95-100% across the six guidelines. No factor inherent to the telemedicine service delivery mechanism impeded adherence to national guidelines for ADHD evaluation. Telemedicine-based outreach had the greatest impact on AAP Guideline #4, stating that information should be obtained from the child's academic setting. The school-based telemedicine clinic allowed increased communication across the school and specialty mental health systems and facilitated greater input across child, parent, school personnel, and mental health professionals. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Avoiding Twisted Pixels: Ethical Guidelines for the Appropriate Use and Manipulation of Scientific Digital Images

Digital imaging has provided scientists with new opportunities to acquire and manipulate data using techniques that were difficult or impossible to employ in the past. Because digital images are easier to manipulate than film images, new problems have emerged. One growing concern in the scientific community is that digital images are not being handled with sufficient care. The problem is twofold: (1) the very small, yet troubling, number of intentional falsifications that have been identified, and (2) the more common unintentional, inappropriate manipulation of images for publication. Journals and professional societies have begun to address the issue with specific digital imaging guidelines. Unfortunately, the guidelines provided often do not come with instructions to explain their importance. Thus they deal with what should or should not be done, but not the associated ‘why’ that is required for understanding the rules. This article proposes 12 guidelines for scientific digital image manipulation and discusses the technical reasons behind these guidelines. These guidelines can be incorporated into lab meetings and graduate student training in order to provoke discussion and begin to bring an end to the culture of “data beautification”.     

Writing About Clients: Developing Composite Case Material and Its Rationale

Ethical guidelines of the 4 major professional associations representing counselors and psychotherapists are reviewed. To help clarify thinking about writing up clinical cases, 3 kinds of cases are described. The author concludes that the current guidelines for clinician‐authors in writing about clients for publication or presentation are contradictory and conflicting. The use of composite clinical case material is discussed as having a number of advantages over disguise or consent when writing about clients. Presented are guidelines for developing composite clinical cases and an example of how to use them effectively.     

Prayer in psychotherapy: a model for its use, ethical considerations, and guidelines for practice

Although few guidelines exist, many therapists use prayer as a part of psychotherapy. The immense variance inherent in prayer behaviors and the paucity of literature on its use beckons the profession to develop a model for its use in therapy, examine the ethical implications for such use, and prepare guidelines for practice. A tripartite model for the conceptualization and localization of prayer in therapy is presented, ethical issues of therapist bias and competence and clients' right to autonomous decision making are considered, and guidelines for employing prayer in psychotherapy are developed.