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NDT Advance Access originally published online on August 25, 2007
Nephrology Dialysis Transplantation 2007 22(11):3110-3114; doi:10.1093/ndt/gfm516
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org


Intention and outcome in guideline-based nephrological practice: a suitable space for ‘clinical technology’

Eric Will

Department of Renal Medicine, St James's University Hospital, Leeds, UK

Correspondence and offprint requests to: E. J. Will, Honorary Renal Physician, Department of Renal Medicine, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK. Email: eric.will@leedsth.nhs.uk; wilesroyd@aol.com

Keywords: chronic renal disease; clinical practice guidelines;outcome measure; quality of care

The first 150 words of the full text of this article appear below.



   Introduction
 
Common sense tells us that our intended actions are a powerful means of producing desirable outcomes in nephrology, as well as in life in general. Unfortunately, the evidence suggests that intention alone is a rather weak determinant of any outcome [1]. Indeed, sometimes we are even aware of a disbenefit from the best motivation, if we act without effective mechanisms and attention to detail [2]. Where effective means are available, the energy of intention may be considered the crucial factor [3], and that leads to the blame of clinicians for not responding to guideline advice. While the motivation and response of clinicians may well be deficient, other more systematic factors have a role to play. There are very few validated methods available in nephrology that would produce predictable results from clinical intervention, whatever the intention of the physician. The potential weakness of intention is . . . [Full Text of this Article]



   A need to reconcile individual with unit results
 


   Categorical and continuous variables—the dispersion of clinical data
 


   The conversion of desirable limits into practical instructions
 


   A principle of systematic over-aspiration
 


   A principle of pre-emptive intervention
 


   The framing of guideline statements
 


   Conclusion
 

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