This week in BMC Medicine: healthcare guidance for doctors, patients and parents

Clinical guidelines are widely used by physicians to advise on appropriate patient care, and smart phone apps are increasingly being adopted by the general public to provide guidance on self-management for long-term conditions. It is therefore important that such tools provide clear, safe and correct recommendations. Research articles published in BMC Medicine this week have assessed the quality of hereditary breast cancer screening guidelines for physicians and asthma self-management apps for patients.

Stefania Boccia and colleagues from Università Cattolica del Sacro Cuore carried out an evaluation of hereditary breast screening guidelines using the AGREE instrument. Around 1 in 20 women carry a gene conferring increased susceptibility to breast cancer, and can undergo screening to ensure early detection and treatment. Guidelines are used by physicians to decide whether or not a patient should undergo genetic testing, taking into account ethical and cost issues. Boccia and colleagues’ assessment indicated potential limitations of the guidelines, and the authors highlight that they should be improved in order to make clear and evidence-based recommendations.

Apps for asthma self-management were systematically assessed by Josip Car and colleagues from Imperial College London, finding that none combine reliable information with appropriate supportive tools. These results indicate that physicians recommending healthcare apps should apply caution as some may be unsafe.

Quality guidance is also important for parents caring for children with mental health and behavioral  problems. The Triple P positive parenting program, an evidence-based guide that promotes positive parenting strategies, was developed by Matthew Sanders at the University of Queensland and is widely adopted across many countries. A systematic review and meta-analysis by Philip Wilson and colleagues published recently in BMC Medicine showed that long-term effectiveness of the Triple P program has not been adequately assessed, concluding that a review of the system is needed. In response to this study, Matthew Sanders and colleagues responded with a commentary on the potential limitations of the meta-analysis, emphasizing the evidence upon which the program has been built. These articles highlight the importance of assessing the long-term impact of guidance programs such as Triple P.

Also published in BMC Medicine this week, a debate article by David George and colleagues from the National Institute on Alcohol Abuse and Alcoholism explored the role of physicians in managing explosive rage. While rage episodes can have a devastating effect on people’s lives, there are no formal guidelines for treatment. The authors recommend that physicians have a unique opportunity to diagnose and treat patients suffering from rage, and that astute clinicians should look out for the signs.

Together, these research and debate articles emphasize the need for the development of quality healthcare guidance in the form of physician guidelines, patient self-management apps and parenting programs. Future studies assessing the efficacy and  credibility of such strategies should aid in the development of more effective and safe recommendations.

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