Guidelines Flashcards
How are guidelines developed?
1)define specific clinical questions
2)select relevant outcome variables
3) retrieve and synthesize associated evidence
4) rate the confidence in the effect size estimates
5) translate evidence into recommendations
What is a guideline?
-A group of systematically
developed statements to
optimize health care in
specific circumstances
-supports clinician in decision making
goal of a guidline
-to make explicit actionable recommendations
What is required to formulate recommendations?
expertise of clinical experts, statisticians,
librarians, writers, editors, epidemiologists,
economists, patients
elements of a guideline
-group composition
-conflict of interest
-process of preparing guideline
-methods
-present the recommendations
-references
How to read a guideline
-executive summary
-construction methods
-synthesis methods
-recommendations and supporting evidence
true or false: many guidelines are updated yearly
false. many are outdated
Guideline development process methods
-panel composition
-disclosure of conflict on intrest
-search strategy
-risk of bias
review
-results
PICO(S)
-process for synthesizing consice questions
-P-population
I-intervention
C-comparison
O-outcome
(S)-setting
What is GRADE?
-Grading of Recommendations Assessment, Development and Evaluation
-evaluates the quality of the evidence
Limitations of randomized trials
-lack of allocation concealment
-lack of blinding
-incomplete accounting of patients and outcome events
-selective outcome reporting bias
-other limitations: stopping early, carry over effects, reqruitment bias
Limitations of observational studies
-failure to develop and apply appropriate eligibility criteria
-flawed measurement of exposure and outcome
-failure to adequately control confounding
-incomplete follow up
Balance between desirable
and undesirable effects: GRADE evidence ranking
The larger the difference between the desirable and undesirable effects, the higher the likelihood that a strong recommendation is warranted. The
narrower the gradient, the higher the likelihood that a weak
recommendation is warranted
Quality of evidence: GRADE evidence ranking
-higher quality of evidence=higher change of strong recommendation
Values and preferences: GRADE
The more values and preferences vary, or the greater the uncertainty in values and preferences, the higher the likelihood that a weak
recommendation is warranted
Costs (resource allocation): GRADE evidence
higher cost=lower reccomendations
Rating quality and strength using GRADE
-establish initial level of confidence
-consider lowering or raising level of confidence
-final level confidence rating: high, moderate, low, very low
True or false: Failure to consider quality of evidence can lead to misguided recommendation
true
AGREE
system to rate the quality of evidence
EtD
system to rate the quality of evidence
