Medical Standard

Advances in medical, biomedical and health services research have reduced the level of uncertainty in clinical practice. Clinical practice guidelines (CPGs) complement this progress by establishing standards of care backed by strong scientific evidence. CPGs are statements that include recommendations intended to optimize patient care. These statements are informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options. Clinical Practice Guidelines We Can Trust examines the current state of clinical practice guidelines and how they can be improved to enhance healthcare quality and patient outcomes. Clinical practice guidelines now are ubiquitous in our healthcare system. The Guidelines International Network (GIN) database currently lists more than 3,700 guidelines from 39 countries. Developing guidelines presents a number of challenges including lack of transparent methodological practices, difficulty reconciling conflicting guidelines, and conflicts of interest. Clinical Practice Guidelines We Can Trust explores questions surrounding the quality of CPG development processes and the establishment of standards. It proposes eight standards for developing trustworthy clinical practice guidelines emphasizing transparency; management of conflict of interest ; systematic review-guideline development intersection; establishing evidence foundations for and rating strength of guideline recommendations; articulation of recommendations; external review; and updating. Clinical Practice Guidelines We Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care. This book contains information directly related to the work of the Agency for Healthcare Research and Quality (AHRQ), as well as various Congressional staff and policymakers. It is a vital resource for medical specialty societies, disease advocacy groups, health professionals, private and international organizations that develop or use clinical practice guidelines, consumers, clinicians, and payers.

Healthcare decision makers in search of reliable information that compares health interventions increasingly turn to systematic reviews for the best summary of the evidence. Systematic reviews identify, select, assess, and synthesize the findings of similar but separate studies, and can help clarify what is known and not known about the potential benefits and harms of drugs, devices, and other healthcare services. Systematic reviews can be helpful for clinicians who want to integrate research findings into their daily practices, for patients to make well-informed choices about their own care, for professional medical societies and other organizations that develop clinical practice guidelines. Too often systematic reviews are of uncertain or poor quality. There are no universally accepted standards for developing systematic reviews leading to variability in how conflicts of interest and biases are handled, how evidence is appraised, and the overall scientific rigor of the process. In Finding What Works in Health Care the Institute of Medicine (IOM) recommends 21 standards for developing high-quality systematic reviews of comparative effectiveness research. The standards address the entire systematic review process from the initial steps of formulating the topic and building the review team to producing a detailed final report that synthesizes what the evidence shows and where knowledge gaps remain. Finding What Works in Health Care also proposes a framework for improving the quality of the science underpinning systematic reviews. This book will serve as a vital resource for both sponsors and producers of systematic reviews of comparative effectiveness research.

Medical Devices and Regulations: Standards and Practices will shed light on the importance of regulations and standards among all stakeholders, bioengineering designers, biomaterial scientists and researchers to enable development of future medical devices. Based on the authors’ practical experience, this book provides a concise, practical guide on key issues and processes in developing new medical devices to meet international regulatory requirements and standards. Provides readers with a global perspective on medical device regulations Concise and comprehensive information on how to design medical devices to ensure they meet regulations and standards Includes a useful case study demonstrating the design and approval process

CONTENTS: 1. U.S. ARMY AEROMEDICAL EVACUATION CRITICAL CARE FLIGHT PARAMEDIC STANDARD MEDICAL OPERATING GUIDELINES - CY23 Version Published January 2023, 318 pages 2. TCCC Guidelines for Medical Personnel - 15 December 2021, 19 pages 3. JTS Clinical Practice Guidelines, 2,260 total pages - current as of 19 September 2023: INTRODUCTION The SMOG continues to go through significant improvements with each release as a result of the collaboration of Emergency Medicine professionals, experienced Flight Medics, Aeromedical Physician Assistants, Critical Care Nurses, and Flight Surgeons. There has been close coordination in the development of these guidelines by the Joint Trauma System, and the Defense Committees on Trauma. Our shared goal is to ensure the highest quality en route care possible and to standardize care across all evacuation and emergency medical pre-hospital units. It is our vision that all of these enhancements and improvements will advance en route care across the services and the Department of Defense. Unit medical trainers and medical directors should evaluate Critical Care Flight Paramedics (CCFP) ability to follow and execute the medical instructions herein. These medical guidelines are intended to guide CCFPs and prehospital professionals in the response and management of emergencies and the care and treatment of patients in both garrison and combat theater environments. Unit medical providers are not expected to employ these guidelines blindly. Unit medical providers are expected to manipulate and adjust these guidelines to their unit’s mission and medical air crew training / experience. Medical directors or designated supervising physicians should endorse these guidelines as a baseline, appropriately adjust components as needed, and responsibly manage individual unit medical missions within the scope of practice of their Critical Care Flight Paramedics, Enroute Critical Care Nurses, and advanced practice aeromedical providers. The medication section of this manual is provided for information purposes only. CCFPs may administer medications only as listed in the guidelines unless their medical director and/or supervising physician orders a deviation. Other medications may be added, so long as the unit supervising physician and/or medical director approves them. This manual also serves as a reference for physicians providing medical direction and clinical oversight to the CCFP. Treatment direction, which is more appropriate to the patient’s condition than the guideline, should be provided by the physician as long as the CCFP scope of practice is not exceeded. Any medical guideline that is out of date or has been found to cause further harm will be updated or deleted immediately. The Medical Evacuation Concepts and Capabilities Division (MECCD) serves as the managing editor of the SMOG and are responsible for content updates, managing the formal review process, and identifying review committee members for the annual review. The Standard Medical Operating Guidelines are intended to provide medical procedural guidance and is in compliment to other Department of Defense and Department of the Army policies, regulatory and doctrinal guidance. Nothing herein overrides or supersedes laws, rules, regulation or policies of the United States, DoD or DA.