wk 10- clinical practice

Question 1

describe what clinical practice guidelines are, their uses and their limitations

Answer 1

Clinical guidelines are systematically developed statements that help translate evidence into actionable recommendations for health professionals

Guidelines aim to
1. reduce unwarranted variations in care,
2. encourage best practice, and
3. facilitate more informed and meaningful involvement of patients in making decisions about their health care.

They do not take the place of informed clinical judgment and patient choice in determining care, but provide a summary of evidence and expert judgment about care that can be used to inform discussions with patients.

Question 2

what are the major online resources for locating clinical practice guidelines 3

Answer 2

online resources such as
1. guideline-specific databases,
2. bibliographic databases,
3. and the websites of disease-specific organisations and professional associations, can be used to locate guidelines.

Question 3

how are guidelines developed ? 8 step process

Answer 3

1. Identifying the scope of a guideline—providing an outline of the aspects of care within the designated topic area that the guideline will cover.
2. Forming a guideline development group—usually made up of health professionals from a range of disciplines with expertise in the clinical area, representatives of patients and carers and people who have technical expertise in guideline development methods and in systematic literature reviewing.
3. Gaining agreement about the specific clinical questions or problems that will be addressed by the guideline and that will guide the types of evidence used and the search for evidence.
4. Searching systematically for evidence and appraising its quality.
5. Discussing and agreeing the implications of the evidence for clinical practice.
6. Formulating draft recommendations.
7. Obtaining external review and feedback on the guideline. Sometimes this may include a public consultation process.
8. Ongoing review and update of the guideline to ensure it remains based on the most current best available evidence—a timeframe of 3 years is often used.

Question 4

what appraisal intrusment do you use for clinical guidelines?

Answer 4

the AGREE II instrument

Question 5

limitations 5

Answer 5

1. large amount of time, money expertise and effort
2. evidence may be out of date
3. duplication and overlap
   4.little consideration of comorbidities
4. issues of conflict of interest

Question 6

grading quality of evidence and strength of recommendations

Answer 6

quality of evidnece- extent to which one can be confident that an estimate of effect is adequate to support a particular recommendation

strength of recommendation- extent to which one can be confident that adherence to the recommendation will do more good than harm

Question 7

issues to consider in pico framework

Answer 7

-is population similar to patients?
-health care setting
-cost, resources, skills
-values

Question 8

legal considerations

Answer 8

vary between countries

use of guidelines are not mandatory

in court of law, historical reliance of expert witness

they provide judges with benchmark of clinical conduct even though not mandatory