From their experience, GPs expressed a need to rely on their 'common sense' a source of 'knowledge' that may complement the limitations of guideline application in multimorbidity.
Common limitations of guideline documents for diagnosis and management of tinnitus are the lack of a clear link between the outcomes of the diagnostic test battery and the recommended treatment, as well as guidelines being too general and lacking reference to the appropriate assessment tools (i.e., recommended questionnaires), which leads to variability in clinical practice.
A component of this limitation of guidelines was the issue of 'prevention'prevention
Guidelines can be helpful in these situations, but a limitation of guidelines is that they usually are compendiums of expert opinion and provide little quantitative guidance.
A major limitation of guidelines is their poor fit to complex clinical problems, particularly in the presence of multi-morbidity, being more suited to relatively straightforward clinical decisions, [ 20].
Four (7 %) guidelines elaborated the research gap and 21 (35 %) presented the limitations of reporting guidelines.
The reasons for this are manifold, but limitations of treatment guidelines in terms of content, implementation and relevance to everyday clinical life, including insufficient patient education, access to health care and cost of medication as well as poor inhaler technique are likely to contribute.
Staff members were also given the opportunity to comment on strengths and limitations of the guidelines.
Box 1 Staff perceptions of strengths and limitations of sedation guidelines Strengths The bedside nurse 'knows' the patient and their requirements, can initiate changes, use objective data on the screen, see changes and ask for a review if needed It is a clinical tool to justify an increase or decrease in sedation.
Physical therapists are free to compile a patient-centred program at one's professional discretion, within the limitations of the guideline.
Among the limitations of the guideline is the fact that it attempts to include nearly every aspect of critical care potentially related to sepsis, perhaps losing focus in the process.
