L2 CPG Flashcards
Purpose of systemic review
secondary research study to summarize the evidence on a specific topic
can review interventions, diagnostic tests, outcome measures, or prognostic factors
should be done apriori
Types of reviews
narrative
systemic
metanalysis
Purpose of CPGs
systemically developed statements designed to facilitate evidence-based decision-making for the management of specific health conditions
includes explicit recommendations for decisions
can be broader than SR, address multiple aspects of care, associated with health condition
General info about SR
- Summarize existing research evidence
- Results in meta, quantitative, qualitative analysis
- shorter length
- peer-reviewed
- rarely grant funded
CPG general info
- summarize evidence and make recommendations for best clinical practice
- experts interpret the research and provide when research evidence is lacking
- can be very large documents
- peer-reviewed AND feedback from stakeholders
- funded by government or professionals
What is a CDR?
prediction tool, uses an explicit set of criteria about pt to direct treatment choice, combines effects of treatment effect modifiers, represented as classification tree
Steps for Appraising Systematic Reviews
- Determine the applicability
- Determine the quality
- Interpret the results
- Summarize the clinical bottom line
Vote-counting analysis
descriptive statistics
can be used for qualitative or quantitative studies
methods to report SR
Mean difference
also called effect size
difference between treatment and control groups
Standardized mean difference
used if units of measurements are different
Forest plots
visual representation of a meta-analysis
What is the objective of using a CPG as a PT?
enable PTs and PTAs to understand the state of evidence in an effort to decrease unwarranted variations in practice, minimize gap from evidence to practice, optimize movement
What are the qualities of an OPTIMAL CPG?
Applicability
Quality
Clinical Utility
Methodology for CPG
Literature search
Screen Abstract
Screen full text
Appraisal and extraction
Results in master spreadsheet
Create Evidence Table
Synthesize/write recommendation
“should be provided”
weight of the evidence supports substantial benefit as compared to other or conventional strategies
benefit outweighs harm
“may be considered”
evidence to support intervention vs other strategies is unclear or evidence supports intervention as compared to no intervention
benefit and harm would be equal
“should not be provided”
weight of the evidence does not indicate a substantial benefit above other strategies
harm outweighs benefit
Meta-analysis
statistical technique that combines quantitative outcomes across multiple primary studies
Narrative reviews
overview of literature
description of content of articles
helps provide general info about topic and express a perspective
subject to bias
Appraise the quality of a SR
Cochrane Review
Literature search was comprehensive
Was an objective, reproducible and reliable method used to judge the quality of studies?
Standardized method used to extract data?
Clinical heterogeneity for meta-analysis?
Clinical heterogenity
measures if the study population, interventions, and outcome measures were similar amongst studies
What methods were used to report the SR?
Vote counting analysis
Meta-analysis
What characteristics should you consider when looking over CPGs?
age of study
sponsoring organization
topic
clarity of info
depth
availability of full text
Process of writing CPG
comprehensive search of numerous databases
PICO question
Appraisal of articles
Extraction of data
grading levels of evidence
inclusion and exclusion criteria
includes clinical expertise, pt perspective
Appraising the quality of CPG
stakeholder involvement
Rigor of development (SR should be written for each question)
Stakeholder involvement in CPG
risk of bias depending on authors and topic
ensure authors are from a broad range of interest groups
pts views and target users of CPG should be clearly defined
Master spreadsheet
all appraisals and extraction data entered
one master sheet per intervention
Evidence table
summary of available data per intervention
discussion to minimize bias, achieve consensus
Applying CPG
CPG development is an evidence-based method of systematically searching, selecting, appraising, and summarizing evidence
it is ok if patient doesn’t match every criteria, but focus on what is safe & applicable for your patient
