EBM - Evaluating a Practice Guideline Study

MUSM Libraries: Evaluating a PRACTICE GUIDELINE article

Appraise | Key characteristics | Finding articles

Appraise

What did they do? (Methods)
1. Did the recommendations consider all relevant patient groups, management options, and possible outcomes?
2. Is there a systematic review of evidence linking options to outcomes for each relevant question?
3. Is each of its recommendations both tagged by the level of evidence upon which it is based and linked to a specific citation?
4. Do the authors indicate the strength of their recommendations?
What was the answer? (Results)
1. What are the key recommendations?
What did they say about the answer? (Conclusion)
1. Do the results of the study support the author/s conclusions?
2. Does the conclusion reflect the discussion?
3. Are there study limitations, and do these impact the conclusions?
4. Are potential discrepancies mentioned?
What do I do with this information?
1. Do the recommendations make sense in my practice setting?

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Key characteristics

Clinical Practice Guidelines are systematically developed statements designed to assist practitioners and patient decisions about appropriate health care for specific clinical circumstances.

Key Characteristics:

comprehensive review of evidence
expert opinion used ot make value judgements
official endorsement(s)
intention to influence your practice patterns

Values are the basis for personal preferences concerning different clinical outcomes.

Grades of Recommendations:
(JAMA 1995 274:1800-1804)

A1: RCTs, no heterogeneity, CIs clear threshold NNT
A2: RCTs, no heterogeneity, CIs cross threshold NNT
B1: RCTs, heterogeneity, CIs clear threshold NNT
B2: RCTs, no heterogeneity, CIs cross threshold NNT
C1: Observational studies, CIs clear threshold NNT
C2: Observational studies, CIs cross threshold NNT

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Finding articles about practice guidelines and finding practice guidelines

PubMed:

Select PubMed@Mercer, enter your search term/s AND practice guideline[pt]
Select PubMed@Mercer, select Customize under Article types, then select Practice Guideline. Enter your search term/s.

National Guideline Clearinghouse

Select National Guideline Clearinghouse, enter your search term/s

References:

JAMA 1995 274:570-574
JAMA 1995 274:1630-1632

From: Guyatt, G. Users' Guides to the Medical Literature: Essentials of Evidence-based Clinical Practice. AMA Press, 2002 and Straus. Evidence-Based Medicine. How to Practice and Teach EBM. Churchill-Livingstone, 3rd edition, 2005 (pocket cards).

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