HTHSCI 3C04 Lecture Notes - Lecture 10: Medline, Pubmed, Rigour
28 Apr 2018
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UNIT X: Best Practice Guidelines and Using Evidence in Clinical Practice
- Clinical practice guidelines: statements that include recommendations intended to optimize patient care that are
informed by a systematic review of evidence and assessment of the benefits and harms of alternative care options
Practice Guidelines Evaluation and Adaptation Cycle: framework for organizing and making decisions about which high quality
guidelines to adopt
Sources
- National Guideline Clearinghouse
- Guidelines international network (G.I.N.) membership required
- Guideline developers (i.e. RNAO)
- National Library of Medicine search (MEDLINE, PubMed, etc.)
- Directly via internet (Google)
AGREE II Instrument (Appraisal of Guidelines for Research and Evaluation)
- Developers: to develop guideline protocols, procedures and reporting templates
- Clinicians: to evaluate the quality of guidelines that are candidates for use in clinical practice
- Policy-makers: to set policies requiring use of guidelines in certain contexts
- Journal editors: to determine reporting requirements for guidelines submitted for publication
Consists of 23 key items organized in 6 domains and evaluated using a 7-point response scale
1. Scope and purpose (3 items)
o Overall objectives are specifically described
o Clinical question covered by the guideline is specifically described
o Patients whom the guideline is meant to apply are specifically described
2. Stakeholder involvement (4 items)
o Who was involved in developing the guidelines; level of expertise
o Target preferences and populations – did the target population have an opportunity to review and provide
feedback
o Target users are clearly defined and guideline has been piloted among users
o Who was involved, how they were involved and when they were involved
3. Rigour of development (7 items)
o Databases used; procedure for updating the guideline is provided
o Selection criteria clearly described
o Strengths and limitations evaluation
o Designs and methods used and included
o Health benefits, side effects and risks have been considered in formulating recommendations
o How they formed recommendations – who was involved (external review is key)
o Explicit link between recommendations and evidence
4. Clarity and presentation (3 items)
o Clear and easily understandable
o Recommendations are specific and unambiguous
o Different options for management of the condition are clearly presented
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