Recommendations & Guidelines Flashcards

1
Q

Types of treatment recommendations

A

Decision analysis tree
Clinical guidelines

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2
Q

Steps to produce a treatment guideline

A

Define the decision
Specify outcomes
Use available evidence to specify link between options and outcomes
Incorporate value judgements to decide on optimal course of action
Consider local circumstances such as resource availability and modify appropriately

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3
Q

What is decision analysis?

A

Provision of a formal structure to process of decision making

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4
Q

How is decision analysis represented?

A

Flowchart or tree where on the left side is the decision to be analysed

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5
Q

What are the branches in decision analysis tree?

A

Branches are the options

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6
Q

Where are clinical outcomes in decision analysis tree?

A

On the right

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7
Q

Describe structure of decision chart

A

Squares on the left are decision nodes
Circles on right are chance nodes

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8
Q

What needs to be done once decision analysis tree is made?

A

Generate quantitative estimates of likelihood or probability of events.
Then, utility value is placed on each outcome from 0 (death) - 1 (full health)
Finally, total value of each decision is calculated

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9
Q

How is total value of each decision calculated in decision analysis?

A

Cross product of utility and probability with summing of individual outcomes

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10
Q

Who generates practice guidelines?

A

Panel of stakeholders e.g. NICE

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11
Q

Why do guidelines based on same evidence base vary in recommendation?

A

Guidance is also value based and based on local availability of resources

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12
Q

Important step in generating guidelines?

A

Having a systematically reviewed bade of evidence on which recommendations can be built

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13
Q

What statement must be present in guidelines?

A

Explicit statement of values

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14
Q

What questions need to be asked to see if guidelines are valid?

A

Did all relevant patient groups, management options and outcomes get considered?
Is there a proper systematic review?
Is there an appropriate specification of values and preferences associated with outcomes?
Do the authors indicate the strength of the recommendations?

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15
Q

Questions to ask to determine usefulness of guidelines

A

Who developed them?
How were they disseminated?
How were they implemented?

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16
Q

Development of highly effective guidelines

A

Developed by those who will use them

17
Q

Development of above average guidelines

A

Intermediate - modified national or external guidelines

18
Q

Development of below average guidelines

A

External - nt by those who will use them - but local

19
Q

Development of very low effectiveness guidelines

A

External, national guidelines

20
Q

Dissemination of highly effective guidelines

A

Specific educational intervention

21
Q

Dissemination of above average guidelines

A

Continuing medical education e.g. lectures

22
Q

Dissemination of below average guidelines

A

Mailing target groups

23
Q

Dissemination of very low effectiveness guidelines

A

Publishing in a journal

24
Q

Implementation of highly effective guidelines

A

Patient-specific reminder during consultation e.g. filed in notes

25
Q

Implementation of above average guidelines

A

Patient specific feedback

26
Q

Implementation of below average guidelines

A

General feedback e.g. gross audit

27
Q

Implementation of very low effectiveness guidelines

A

General reminder