5- The role of clinical guidelines Flashcards
what are clinical guidelines?
Systematically developed recommendations on how healthcare and other professionals should care for people with specific conditions
what are national institute for health and care excellence (NICE) clinical guidelines?
- Systematically developed recommendations on how healthcare and other professionals should care for people with specific conditions
- Based on the best available evidence
what are Scottish intercollegiate guidelines network (SIGN) guidelines?
- Derived from a systematic review of the scientific literature
- Aimed to accelerate the translation of new knowledge into action
- Aim to reduce variations in practice
- Improve patient-important outcomes
Name 3 organisations that produce guidelines.
- British Dental Journal
- European Commission
- General Dental Council (GDC)
How do we rate the quality of a guideline?
- the potential benefits of practice guidelines are only as good as the quality of the guidelines themselves
- it is important to assess the methods used to develop practice guidelines in order to be confident of the resulting recommendations
What should high quality guidelines be?
- based on the best available evidence
- have a clear scope and purpose
- demonstrate methodological rigour
- be free from bias
what is a systemic review?
A replicable, scientific, and transparent process
what do a systemic review do?
A systematic review summarises the results of available carefully designed healthcare studies (controlled trials) and provides a high level of evidence on the effectiveness of healthcare interventions. Judgments may be made about the evidence and inform recommendations for healthcare
What is a benefit of a systemic review?
It reduces researcher bias and demands the researcher is comprehensive in their approach
what are other benefits of a systematic review?
- Can end confusion
- Yield new insights by combining findings from different studies
- Highlights where there is not enough evidence
- When there is enough evidence can reduce the influence of flawed single studies
Name the features of a good systemic review.
- Based on scientifically rigorous methods
- Answers a defined research question
- Searches all relevant sources of peer reviewed published studies and checks for unpublished studies
- Includes and reports pre-established quality control guidelines for studies
- Transparency and replicability of methods
what is the transparency of a systemic review?
- What search terms were used?
- What data sources were searched?
- What studies were excluded and why?
- What period was covered?
- Any conflict of interests?
True or false -A meta -analysis combine the results of individual studies in a systemic review to produce an overall statistic?
True or false - check with someone
what is a meta-analysis?
A meta-analysis combines results of individual studies in a systematic review to produce an overall statistic i.e. the ‘average result’.
what is the aim of meta-analysis?
- Provide a more precise estimate of the effects of an intervention
- to reduce uncertainty
what diagram can results of a meta-analysis be put on?
Forest plot
what does the solid vertical line in the centre of a first plot represent?
the line of no effect
what are the limitations of systemic reviews and meta-analyses?
- In a ‘hot’ subject may soon become outdated
- May be poorly conducted or reported
- May only have weak or biased Randomised Control Trials (RCTs) included
- May be Anglo-centric
- May ignore/under-represent grey literature
- May be weakened by ‘heterogeneity’ of RCTs
How good is the review?
-The Grading of Recommendations Assessment, Development
and Evaluation (GRADE) is a system for rating quality of evidence and
strength of recommendations
- Critical Appraisal Skills Program (CASP)
a methodological checklist which provides key criteria
relevant to systematic reviews
True or false- clinical guidelines are an essential part of evidence based practice?
True
what are the components of evidence based dentistry?
- Dentists expertise
- Scientific evidence
- Patient needs and preferences
What if there are no (high quality) Systematic Reviews?
- Guideline recommendations can be based on expert opinion…..
- Are recommendations based on expert opinion as good as those based on evidence from one or more high quality systematic reviews?
- Do guidelines differentiate between recommendations based on ‘high quality’ evidence and those based on ‘low quality’ evidence?
What should high quality clinical guidelines include?
- Have clear scope and purpose
- Be evidence- based (best available evidence that has been quality appraised)
- Include end-users and patients in the development
- Developed by a group of qualified individuals
- Communicate the strength of recommendations (GRADE)
- Presented in clear, unambiguous language
- Be free from bias
- Subject to public consultation
What did a review by the NHS centre for reviews and dissemination conclude?
There appears to be little justification for the removal of pathology-free impacted third molars
