clinical guidelines

Question 1

Basics to guidelines and aims guidelines

Answer 1

evidence meets practice

reduce variation, decrease costs and improve care by assisting clinical decision making

Question 2

Evidence based medicine (EBM) is what?

Answer 2

integration of best research evidence with clinical expertise and patient values

Question 3

problems with EBM

Answer 3

too much literature
quality variations
access issues
sometimes difficult to translate to practice

Question 4

EBM basic steps

Answer 4

question - evidence - critical appraisal - integrate - effectiveness

Question 5

EBM limitations

Answer 5

funding and patient recruitment
access to testing and follow up
logistics
power of trials

Question 6

systematic reviews

Answer 6

clear objectives and predefined criteria
reproducible methodology and systematic search and presentation
validity assessment

Question 7

meta analysis

Answer 7

statistical methods to summarise data
enhances power
increased precision for estimated treatment effect
avoids large confirmatory study costs

Question 8

PICO

Answer 8

population
intervention
comparison
outcomes

Question 9

meta analysis what can go wrong

Answer 9

poor defined question or methodology
publication, search, selection bias
study wrong outcome
applicability of results- newer game changing studies contradict

Question 10

evidence based medicine critics

Answer 10

lack of individual variation and emphasis on patient values
reduced input from clinical judgement
shouldn’t treat if no RCT?

Question 11

what is strong evidence

Answer 11

implies that evidence relates to important outcome and that the advantages outweigh disadvantages and evidence applies in setting in question
also that it is unlikely any future evidence will be contradictory

Question 12

what are clinical guidelines

Answer 12

systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances

Question 13

purpose of clinical guidelines

Answer 13

make explicit recommendations with a definite intent to influence what physicians do

Question 14

basics of good guidelines to benefit patients public and professionals and systems in healthcare

Answer 14

extensive, critical and well balanced information on benefits and limitations of various interventions
helps to judge individual cases

Question 15

some criteria for guidelines

Answer 15

valid and reliable
clinically applicable and flexible
cost effective and clear

Question 16

clarity for guidlines

Answer 16

explicit link between guidelines and scientific evidence

should never take over from expert judgement but be an aid instead

Question 17

patient and public benefits of guidelines

Answer 17

improved quality of care, outcomes, consistency, public policy
empowers informed choice and promotes health equality

Question 18

professional and system benefits of guidelines

Answer 18

time and cost efficient, identify gaps, reduces variation and waste

Question 19

guidelines limitations

Answer 19

incorrect recommendations or conflicting/ inflexible
abcence or bias evidence
other agendas
poor generalisability 
adverse effects on public policy

Question 20

AGREE tool

Answer 20

appraisal if guidelines for research and evaluation

Question 21

GRADE sytem

Answer 21

transparent and systematic- quality of evidence and strength of recommendation
levels of confidence in recommendations

Question 22

grades of recommendation

Answer 22

strength of evidence not the strength of clinical importance of the recommendation
recommendations can be unimportant, small benefit or based on low quality studies

Question 23

reducing certainty

Answer 23

bias or inconsistencies

imprecision and indirectness

Question 24

improve certainty

Answer 24

large magnitude of effect

effect present even with residual confounding

Question 25

medicolegal implications of guidelines

Answer 25

aids clinical judgement
not a standard of care
can be source of reference in legal proceeding if significant deviation from guidelines

Question 26

non compliance

Answer 26

complex or conflicting info
disagreements or wrong info 
not feasible 
accessibility to info
causes variation, poor outcomes, higher costs

Question 27

EBM in real world

Answer 27

marginal clinical benefits
ethical care priority
does guideline apply? is advise pragmatic? is it what patients want?