EBM and Guidelines

Question 1

What influences medical decisions?

Answer 1

Clinical experience
Patient desires
Clinical evidence
Patient circumstances

Question 2

does clinical experience = clinical evidence

Answer 2

NO

Question 3

clinical experience

Answer 3

own drug knowledge
outcomes seen firsthand

Question 4

clinical evidence

Answer 4

retrieved from drug info resources
primary, secondary, tertiary

Question 5

benefits of systematic approach

Answer 5

right info to answer questions
improves efficiency
prevents ‘cherry-picking’
provides a stop to search

Question 6

the five A’s

Answer 6

Ask
Acquire
Appraise
Apply
Assess

Question 7

Clinical practice guidelines

Answer 7

decision making tools that provide treatment algorithms
influence decisions such as formulary approval and insurance coverage

Question 8

Clinical practice guidelines developed via

Answer 8

systematic review of available evidence
KOL knowledge
assessment of benefits/harms of interventions

Question 9

Clinical practice guidelines published by

Answer 9

federal/state govt
professional associations
quality assurance organizations

Question 10

CPGs inform but do not ____ clinical judgement

Answer 10

replace

Question 11

are guidelines systematic literature reviews?

Answer 11

NO

Question 12

phase 1 of guideline development

Answer 12

determine topic/scope
identify audience
select members

Question 13

phase 2 of guideline development

Answer 13

focused question
conduct literature search
evaluate evidence

Question 14

phase 3 of guideline development

Answer 14

develop recommendations
categorize levels of evidence
draft summary

Question 15

phase 4 of guideline development

Answer 15

update and implement

Question 16

IOM 8 Standards

Answer 16

establish transparency
manage conflict of interest
guideline development group composition
clinical practice guideline systematic review intersection
establish foundations + rating strength
articulate recommendations
external review
update guidelines

Question 17

Guideline sections

Answer 17

preamble
intro/background
methods
executive summary
full recommendations

Question 18

Formal Consensus Panel

Answer 18

similar to informal panels
formal decision making process

Question 19

evidence-based guidelines

Answer 19

most rigorous
extensive methodology

Question 20

Informal Consensus Panel

Answer 20

meeting of experts
group discussions

Question 21

Executive summary vs CPG

Answer 21

executive = condensed cpg, brief intro, figures/tables only
CPG = expanded intro, methodology

Question 22

CPG is influenced by

Answer 22

setting
incentives
regulations

Question 23

GRADE

Answer 23

determining strength of recommendations
quality (level) of evidence
class (strength) of recommendation

Question 24

Quality (Level) of Evidence

Answer 24

quality of scientific evidence supporting recommendation

Question 25

Class (Strength) of Recommendation

Answer 25

benefit vs risk of intervention

Question 26

Factors that modify level of evidence

Answer 26

randomization, target population, results, bias, cofounders, dosing, administration

Question 27

AGREE

Answer 27

tool for assessing quality of CPG
assess 6 domains
rated on 7 point scale

Question 28

6 domains of AGREE

Answer 28

scope/purpose
stakeholder involvement
rigor of development
clarity
applicability
editorial independence

Question 29

steps to identify relevant guidelines

Answer 29

1. start w tertiary
2. keywords
3. review available webpage
4. follow reference/link