Guideline development Flashcards
What are accept statements
Australasian CREI consensus Expert Panel on trial evidence
What are ACCEPT guidelines (name and year)
Fibroids (2011)
Endometriosis (2012)
Diagnosis and detection of Ovarian Hyperstimulation syndrome (2015)
Treatment of Ovarian hyperstimulation syndrome (2015)
Elective Oocyte cryopreservation (2019)
How is an ACCEPT guideline developed
- Evidence reviewed – search of relevant databases performed
- Level of evidence assessed
- Uses NHMRC Evidence Hierarchy
- Recommendations/consensus statements generated
- Review of recommendations through consensus process
- Unanimous = alpha, unanimous with caveat = B, majority – gamma, no consensus = delta
- Guideline published and disseminated
Agree II - what is it?
Appraisal of guidelines for research and evaluation (II)
Agree II is a tool that assesses the methodological rigour and transparency in which a guideline is developed.
Agree II is used to :
Assess the quality of guidelines.
Provide a methodological strategy for the development of guidelines.
Inform what information and how information ought to be reported in guidelines.
Domains of Agree II tool
- Scope and purpose
a) overall objectives of the guideline are specifically described
b) health questions covered by the guideline are specifically described
c) the population to whom the guideline is meant to apply is specifically described - Stakeholder involvement
a) the guideline development group includes individuals from all relevant professional groups
b) the view and preferences of the target population have been sought.
c) the target users of the guideline are clearly defined. - Rigor and development
a) systematic methods were used to search for evidence
b) criteria for selecting the evidence are clearly described
c) strengths and limitations of the body of evidence clearly described
d) methods for formulating the recommendations are clearly described
e) health benefits, side effects, and risks have been considered in formualting the recommendations
f) there is an explicit link between the recommendations and the supporting evidence
g) the guideline has been externally reviewed by experts prior to its publication
h) a procedure for updating the guideline is provided - Clarify of presentation
a) the recommendations are specific and unambiguous
b) the different options for management of the condition or health issue are clearly presented.
c) key recommendations are easily identifiable - Applicability
a) the guideline describes the facilitators and barriers to its application
b) the guideline provides advice and/or tools on how the recommendations can be put into practice
c) the potential resource implications of applying the recommendations have been considered
d) the guideline presents monitoring and/or auditing criteria. - Editorial independence
a) views of the funding body have not influenced the content
Competing interestes of guideline development group members have been recorded and addressed. - Overall guideline assessment
Steps in developing a guideline
trustworthiness checklist for RCTs (TRACT)
GRADE
Grading of Recommendations, Assessment, Development, and Evaluation
- Transparent framework for developing and presenting summaries of evidence and provides a systematic approach for making clinical practice recommendations.
Considers the following and then puts into a grade (image)
- number and design of studies addressing the outcome
- quality of the studies and/or synthesised evidence such as risk of bias, inconsistency, indirectness, imprecision, publication bias and any other considerations that may influence the quality of evidence.
RCTs tend to start high level and observational studies low level.
Once quality of evidence grade is determined then assess for the strength of the recommendations (done variably across different guidelines as below)
Grade/strength of the recommendation - PCOS
- Conditional recommendation against the option
** Conditional recommendation for with the option or the comparison
*** Conditional recommendation for the option
** Strong recommendation for the option
Grade of the recommendation ESHRE
Strong recommendation (includes patient, clinician and policy makers)
Weak recommendation (includes patient, clinician and policy makers)
Good practice point - information of the advice of the GDG regarding a certain recommendation
Research only recommendation - the test or intervention should only be considered within the setting of a research trial for which appropriate approvals and safety precautions have been established.
Grade of recommendation RANZCOG
Evidence-based recommendation (with quality alongside)
Consensus-based (evidence sought but none identified)
WG opinion/good practice note - (outside scope of the evidence search and based on consensus from working group).
Grade of recommendation RCOG
Does not use grade framework
Grade of recommendations ASRM
Does not use grade framework
GRADE acronym stands for
Grading of recommendations assessment, development and evaluation
NHMRC standards for guidelines
Be relevant and useful for decision making
Be transparent
Be accessible
Be up to date
Be evidence informed
Be focussed on health and related outcomes
Make actionable recommendations
Identify and manage conflicts of interest
Be overseen by a guideline development group
three aspects to interpreting guideline recommendation
Category
Quality of evidence
Direction and strength of recommendations
reporting guidelines for main study types
CONSORT-IMPRINT checklist
