Pre-Appraised Evidence for Clinical Decision-Making – Description
Overview
Pre-appraised sources of evidence are growing both in the public and commercial sect ors. Governments, including that of the United States, have committed resources to provide practice guidelines and other open sources of freely available evidence online to the public. Commercial publishers are emerging that sell evidence sources through online licenses or memberships. However, just because these pre-appraised sources exist does not mean that they are high quality.
The AGREE Enterprise is an international group of guideline developers who have created criteria to judge the quality of guidelines. You can see the tool and discussion at www.agreetrust.org. The essential elements of the guideline appraisal tool are:
Clear statement of the purpose or objective/question of the information and patient group to whom the guideline applies is specified.
Stakeholders/professional groups relevant to the guideline, patient views—have been involved and the guideline piloted with the target group.
Systematic method of searching for evidence, criteria for selecting evidence, and methods of formulating recommendations are clear.
Health benefits, side effects, and risks have been considered in the recommendations.
There is an explicit link between the recommendations and the supporting evidence.
Experts have externally reviewed the guideline, and a procedure for updating is provided.
Recommendations are clear and unambiguous and easy to identify.
The guideline includes tools for application (audit criteria, algorithm, etc.).
Many hierarchies exist to level the strength of individual studies and synthesized sources. Generally, these hierarchies attempt to assign a rating to help users quickly assess the strength of evidence underpinning the recommendation or simply the urgency associated with a recommendation. Until a standardized approach exists, you must understand what the hierarchies mean. (Hopp et al., 2012)
Instructions
Create a Microsoft Word document and respond to the following questions using the learning resources presented in this module for guidance.
What is your PICO question?
What keywords will you use to search for a clinical practice guideline?
What two guidelines did you compare (their focus), and what organization produced the guideline?
Which guideline did you select?
What type of hierarchy did the guideline use (level of evidence, grade of recommendation, or something else)?
How easy or difficult was the guidelines.gov site to use?
If you were part of a group to determine what type of resource to use to help bring evidence to bedside decision-making, what would be the top three requirements of the source?
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