Clinical Practice Guidelines Flashcards
documents used by clinicians that provide guides in clinical decision-making and criteria regarding diagnosis, management, and treatment in specific areas of healthcare
practice guidelines
practice guidelines are documents used by clinicians to provide guides in __________________ and criteria regarding ________________, ______________, and _________________ in specific areas of healthcare
clinical decision-making; diagnosis, management, and treatment
Practice guidelines are ____________________________ from clinical researchers and professional expertise of clinicians from different fields
commonly compiled evidences
T/F: Practice guidelines are commonly compiled evidences from clinical researchers and professional expertise of clinicians from the same field
F: from different fields
research has shown that _________________ of development, a practice guideline may be outdated and must be updated
within 2 years of development
Types of practice guidelines
- evidence-based
- formal consensus-based
- mixture of EBM and consensus-based
utilize a rigorous systematic process involving review and critical evaluation of the medical literature to develop final recommendations
evidence-based
evidence-based practice guidelines utilize a _____________________________ involving review and critical evaluation of the medical literature to develop final recommendations
rigorous systematic process
presence of existing data
evidence-based
utilize the experience of experts in their practice area to draw conclusions and develop recommendations
formal consensus-based
formal consensus-based practice guidelines are useful for those instances where the evidence:
- does not exist
- is not complete
- is not conclusive enough to allow the development of a final recommendation
practice guidelines based on experience only
formal consensus-based
uses evidence to construct the guideline and supplements those steps without evidence with experience of the experts in that field
mixture of EBM and consensus-based
mixture of EBM and consensus-based is useful especially in areas of practice where: ____________________________________________ to be the standard of practice
there is no established evidence or proof is available
what are practice guidelines created primarily for?
- facilitating clinical decision making
- improving the quality of health care
- providing consistent treatment across environments
- decreasing costs
- diminishing professional liability
- identifying individualized alternative treatment
GRADE stands for
Grading of Recommendations, Assessment, Development and Evaluations
a transparent framework for developing and presenting summaries of evidence and provides a systematic approach for making clinical practice recommendations
GRADE
GRADE is a transparent framework for __________________________________ and provides a ____________________ for making clinical practice recommendations
developing and presenting summaries of evidence and provides a systematic approach
how does GRADE work?
- authors make a clinical question
- PIOM
- get systematic review
PIOM stands for
Population/Problem/Purpose, Intervention, Outcome, Methods
best estimate of the effect size for each outcome in absolute terms
systematic review
T/F: authors rate quality of evidence applied to each outcome
T
can be applied to a body of evidence across outcomes, usually by taking the lowest quality of evidence from all of the outcomes that are critical to decision making
overall GRADE
overall GRADE quality rating can be applied to a ________________________ , usually by taking the lowest quality of evidence from all the outcomes that are critical to decision making
body of evidence across outcomes
language bias is most common among
Eastern Asian Countries
what is the meta-analysis identifier?
randomized clinical trials or clinical trials
what are the GRADE certainty ratings
- very low
- low
- moderate
- high
true effect is probably markedly different from the estimated effect
very low
true effect might be markedly different from the estimated effect
low
authors believe that the true effect is probably close to the estimated effect
moderate
authors have a lot of confidence that the true effect is similar to the estimated effect
high
modified version of GRADE process
critical appraisal of evidence
evidence from 2 or more “high” quality studies with consistent findings for recommending for or against the intervention
strong (high quality) evidence
evidence from 2 or more “moderate” quality studies with consistent findings, or evidence from a single “high” quality study for recommending for or against the intervention
moderate quality evidence
evidence from one or more “low” quality studies with consistent findings or evidence from a single “moderate” quality study recommending for or against the intervention
low quality evidence
evidence from one or more “very low” quality studies with consistent findings or evidence from a single “low” quality study recommendation for or against the intervention
very low quality evidence
level of evidence and strength of recommendation that are considered options according to benefits and harms balanced
- strong (high quality) evidence
- moderate quality evidence
- low quality evidence
- very low quality evidence
a particular action is favored because anticipated benefits clearly exceed harms (or vice versa), and quality of evidence is excellent (moderate or strong) or unobtainable
strong recommendation
a particular action is favored because anticipated benefits clearly exceed harms (or vice versa), and the quality of evidence is good but not excellent (or is unobtainable)
moderate recommendation
a particular action is favored because anticipated benefits clearly exceed harms (or vice versa), but the quality of evidence is low or very low
weak recommendation
an option is provided when the aggregated data show evidence of both benefit and harm that appear similar in magnitude for any available courses of action
option
recommendation wherein clinicians should follow unless a clear and compelling rationale for an alternative approach is present
strong recommendation
recommendation that clinicians would be prudent to follow but should remain alert to new information and sensitive to patient preferences
moderate and weak recommendation
recommendation wherein clinicians should consider in their decision-making, but patient preference may have a substantial role
option
“An understanding of strengths and limitations inherent with each design is essential to________________________________ produced. Those trial designs with a high level of quality provide the most reliable evidence and that translates into the strongest recommendation/clinical decision.”
determine the overall quality of the
evidence
