John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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French recommendations for the treatment of constipation : an additional therapeutic decision support (1st part) Volume 24, issue 4, Avril 2017

Figures

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Authors
1 CHU de Rennes, Hôpital Pontchaillou, services d’explorations fonctionnelles digestives, services des maladies de l’appareil digestif, proctologie, Rennes, France
2 CHU de Lyon, Hôpital E. Herriot, service d’explorations fonctionnelles digestives, Lyon, France
3 CHU Nord, Hôpital Nord, service d’hépato-gastroentérologie, Chemin des Bourrely, 13015 Marseille, France
4 CHU de Nantes, Hôtel-Dieu, clinique de chirurgie digestive et endocrinienne, Nantes, France
5 Hôpital Bagatelle, service de proctologie, 203 route de Toulouse, Talence, France
6 Hôpital Saint-Joseph, Institut de proctologie Léopold Bellan, Paris, France
7 CHU de Bordeaux, Hôpital Saint-André, service hépato-gastroentérologie et oncologie digestive, Bordeaux, France
8 CHU d’Angers, service de chirurgie viscérale, Angers, France
9 CHU de Nancy, service d’hépato-gastroentérologie, Vandoeuvre-Les-Nancy, France
* Tirés à part

Recommendations for clinical practice in health is usually based on a cumbersome methodology. It involves the creation of a steering group and one or more working groups. It also involves both editors and a reading group to try to answer questions deemed relevant in terms of care and treatment. The project requires a systematic analysis of the literature and the drafting of recommendations whose level of proof must be graded. A short and a long text are usually submitted to be validated by the reading group and then to an audience involved in the management of the disease. This is a long-term process: a two-year period usually separates the implementation of the project from the first communication. Under the aegis of the SNFCP and in partnership with the SNFGE and the GFNG, recommendations for the treatment of constipation now rest on the work of analyzing the literature and drafting of 33 courageous partners who are here thanked. A rapid speculation would suggest that the process is over. It remains two important steps : the first is the diffusion of recommendations and the second is its dissemination. Recommendations for clinical practice are usually targeted to the greatest number of practitioners. Classically the short text is readily available with a willingness to disseminate it to general practitioners and nursing staff: it is available on the sites of the three partner societies. The long text develops a detailed argument that often falls within the domain of expertise and specialty.

The communication of the ranks of recommendations during congress or publication remains unfortunately often an insufficient stage in their dissemination. The text is difficult to read and it is not often of great help in daily practice. This observation led several societies to abandon these large works at limited impact.

We chose this time the elaboration of argued algorithms, representing an aid to the therapeutic decision in the most common situations. These algorithms have been developed independently of the drafting of the short text of the recommendations but they are based on the same methodology. The different steps of each algorithm are documented by a short text, grades of recommendations and essential references. Their main objective is to improve the penetration of available scientific data into practice.