title: Do guidelines influence medical practice? Changes in management of acute pancreatitis 7 years after the publication of the French guidelines.
abstract: OBJECTIVE
  The elaboration and publication of guidelines should help homogenizing the management of frequent diseases with high mortality and morbidity rates, such as acute pancreatitis.
  
  
  OBJECTIVE
  To evaluate the implementation of French guidelines on the management of acute pancreatitis (AP), and to correlate changes with a received medical training course.
  
  
  METHODS
  In 2001 (before the Consensus Conference) and 2008, the same questionnaire dealing with recommendations for AP management was sent to the French gastroenterology Units. Responses in 2001 and 2008 were compared.
  
  
  RESULTS
  One hundred and seventy-six questionnaires were analyzed (public hospitals: 62%, academic hospitals: 20%, private institutions: 18%). In 2008 (vs. 2001), lipase levels were measured for establishing AP diagnosis by 99% (vs. 83%). To evaluate AP severity, a computed tomography (CT) scan was performed at 48 h by 69% (vs. 29%, P ≤ 0.001). The most used severity index was the CT Balthazar score 76% (vs. 55%, P ≤ 0.001). Antibiotic prophylaxis and artificial nutrition by enteral route were proposed by 20% (vs. 57%) and 58% (vs. 25%) for necrotizing pancreatitis. Practices were more frequently in agreement with the guidelines in public nonacademic and academic hospitals. Training course on AP management was associated with a more appropriate use of CT scan for the evaluation of AP severity and of antibiotics.
  
  
  CONCLUSIONS
  Major changes were noticed since the publication of the French guidelines. Although establishing guidelines is an expensive process, it does increase compliance with best evidence-based practice.
authors: Pôle des Maladies de l'Appareil Digestif, Pancreatology Unit, Beaujon Hospital, Denis Diderot-Paris VII University, AP-HP, Clichy, France. vinciane.rebours@bjn.aphp.fr
authors: Vinciane
authors: V
authors: Rebours
authors: Philippe
authors: P
authors: Lévy
authors: Jean-François
authors: JF
authors: Bretagne
authors: Gilles
authors: G
authors: Bommelaer
authors: Pascal
authors: P
authors: Hammel
authors: Philippe
authors: P
authors: Ruszniewski
mesh_terms: D000208:Acute Disease; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data / Q000639:trends; D015415:Biomarkers / Q000097:blood; D004502:Education, Medical, Continuing; D004750:Enteral Nutrition / Q000706:statistics & numerical data / Q000639:trends; D005602:France; D005762:Gastroenterology / Q000193:education; D019983:Guideline Adherence / Q000706:statistics & numerical data* / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008049:Lipase / Q000097:blood; D010195:Pancreatitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D017410:Practice Guidelines as Topic; D011364:Professional Practice / Q000639:trends*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data
chemical_list: D015415:Biomarkers; D008049:Lipase