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    Evaluation and adaptation of clinical practice guidelines

    Clinical practice guidelines are “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.”1 They are intended to offer concise instructions on how to provide healthcare services.2 The most important benefit of clinical practice guidelines is their potential to improve both the quality or process of care and patient outcomes.3 Increasingly, clinicians and clinical managers must choose from numerous, sometimes differing, and occasionally contradictory, guidelines.4 This situation is further complicated by concerns about the quality of available guidelines.5,6,7,8,9,10,11 Indeed, adoption of guidelines of questionable validity can lead to the use of ineffective interventions, inefficient use of scarce resources, and perhaps most importantly, harm to patients.12,13 Determining which guidelines are quality products worthy of adoption can be daunting. Every effort should be made to identify existing guidelines that have been rigorously developed and to adopt or adapt them for local use.12 However, organisations and clinicians should scrutinise the methods by which the guidelines were developed, as well as the content and utility of the recommendations. Even guidelines developed by prominent professional groups or government bodies should not be exempt from this scrutiny as it has been shown that these guidelines may be of substandard quality.10 The Practice Guidelines Evaluation and Adaptation Cycle14,15 is a framework for organising and making decisions about which high quality guidelines to adopt (figure). Although the cycle was originally intended for use by organisations and groups wanting to implement best practice, most steps of the process are also helpful in guiding evaluation of guidelines by individual clinicians. This Users’ guide will describe strategies for identifying, critically appraising, and adopting or adapting guidelines for local use.

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    Evaluation and adaptation of clinical practice guidelines FREE

    Ian D Graham, PhD1, Margaret B Harrison, RN, PhD2

    http://dx.doi.org/10.1136/ebn.8.3.68

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    Clinical practice guidelines are “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.”1 They are intended to offer concise instructions on how to provide healthcare services.2 The most important benefit of clinical practice guidelines is their potential to improve both the quality or process of care and patient outcomes.3 Increasingly, clinicians and clinical managers must choose from numerous, sometimes differing, and occasionally contradictory, guidelines.4 This situation is further complicated by concerns about the quality of available guidelines.5,6,7,8,9,10,11 Indeed, adoption of guidelines of questionable validity can lead to the use of ineffective interventions, inefficient use of scarce resources, and perhaps most importantly, harm to patients.12,13

    Determining which guidelines are quality products worthy of adoption can be daunting. Every effort should be made to identify existing guidelines that have been rigorously developed and to adopt or adapt them for local use.12 However, organisations and clinicians should scrutinise the methods by which the guidelines were developed, as well as the content and utility of the recommendations. Even guidelines developed by prominent professional groups or government bodies should not be exempt from this scrutiny as it has been shown that these guidelines may be of substandard quality.10

    The Practice Guidelines Evaluation and Adaptation Cycle14,15 is a framework for organising and making decisions about which high quality guidelines to adopt (figure). Although the cycle was originally intended for use by organisations and groups wanting to implement best practice, most steps of the process are also helpful in guiding evaluation of guidelines by individual clinicians. This Users’ guide will describe strategies for identifying, critically appraising, and adopting or adapting guidelines for local use.

    Practice guidelines evaluation and adaptation cycle

    Adapted from Graham DI, MB Harrison, Brouwers M. Evaluating and adapting practice guidelines for local use: a conceptual framework. In: Pickering S, Thompson J, editors. Clinical governance in practice. London: Harcourt, 2003:213–29.

    1. IDENTIFY A CLINICAL AREA TO PROMOTE BEST PRACTICE

    The first step is to select an area in which to promote best practice. Reasons for selecting a particular area can include the prevalence of the condition or its associated burden, concerns about large variations in practice or care gaps, costs associated with different practice options, the likelihood that a guideline will be effective in influencing practice, a desire to keep practice up to date or evidence-based, or awareness of the existence of relevant evidence-based guidelines.

    2. ESTABLISH AN INTERDISCIPLINARY GUIDELINE EVALUATION GROUP AND 3. ESTABLISH A GUIDELINE APPRAISAL PROCESS

    When an organisation or group is interested in providing best practice, a local interdisciplinary guideline evaluation group should be established comprising key stakeholders who will be affected by the selection of guideline recommendations, including patients or individuals from the community.14 The advantages of using a group to evaluate guidelines include sharing of work among group members, reduced potential for bias in the evaluation process, and increased awareness of guidelines and opportunities for group members to develop ownership of the resulting decisions.

    It is important to select an appraisal process. Guideline appraisal instruments are intended to be used to systematically assess and compare guidelines using the same criteria. They typically consist of a several quality criteria or items that assess the extent to which each guideline meets these criteria. To date, many appraisal instruments have been developed.16 The Appraisal of Guidelines Research and Evaluation (AGREE) Instrument (http://www.agreecollaboration.org)17 is rapidly becoming accepted as the gold standard for guideline appraisal. The AGREE instrument has been tested in 11 countries on >100 guidelines and >200 appraisers.17 It is endorsed by the World Health Organization, the Council of Europe, and the Guidelines International Network (http://www.g-i-n.net).

    The AGREE instrument was designed to assess the process of guideline development and the extent to which the process is reported. It consists of 23 Likert scale items organised into 6 domains. Each domain is intended to capture a separate dimension of guideline quality (see box). Each guideline assessed is assigned standardised dimension scores ranging from 0–100. It also includes a question to provide a global assessment of the overall quality of the guideline, ie, whether one would “strongly recommend this guideline for use in practice without modifications,” “recommend this guideline for use in practice on condition of some alterations or with provisos,” or “not recommend this guideline (not suitable for use in practice).” Complete information about the instrument can be found at www.agreecollaboration.org.

    Source : ebn.bmj.com

    Evidence Based Clinical Practice Guidelines Quiz 9 Flashcards

    Study with Quizlet and memorize flashcards terms like Which statement best describes how evidence-based clinical practice guidelines are mainly and most often used? A) To inform patients of the care they should expect B )To guide agencies in developing protocols specific to their setting C) As a standard for nurse performance appraisal D) As an educational tool for nurses and other providers, From the following possible methodological steps for producing evidence-based clinical practice guidelines, which combination includes widely accepted core principles? 1. They are carried out by members of the affected disciplinary groups 2. A systematic review identified or conducted prior to development of recommendations 3. Only studies with a sample size greater than 100 are considered 4. Recommendations are explicitly linked with supporting evidence 5. Recommendations are set forth only for those issues for which there are two or more randomized controlled trials A) 1, 2, 4 B) 1, 3, 5 C) 2, 4, 5 D) 1, 3, 4, Which of the following is the best reason for a project team that is updating a clinical protocol to start by looking for an evidence-based clinical practice guideline rather than individual studies? A) It is required for Medicare reimbursement B) It is the route to a clinical protocol preferred by accrediting organizations C) It could save time and effort D) An evidence-based clinical practice guideline can be used as is - without adaptation. and more.

    Evidence Based Clinical Practice Guidelines Quiz 9

    5.0 1 Review

    Which statement best describes how evidence-based clinical practice guidelines are mainly and most often used?

    A) To inform patients of the care they should expect

    B )To guide agencies in developing protocols specific to their setting

    C) As a standard for nurse performance appraisal

    D) As an educational tool for nurses and other providers

    Click card to see definition 👆

    B )To guide agencies in developing protocols specific to their setting

    Click again to see term 👆

    From the following possible methodological steps for producing evidence-based clinical practice guidelines, which combination includes widely accepted core principles?

    1. They are carried out by members of the affected disciplinary groups

    2. A systematic review identified or conducted prior to development of recommendations

    3. Only studies with a sample size greater than 100 are considered

    4. Recommendations are explicitly linked with supporting evidence

    5. Recommendations are set forth only for those issues for which there are two or more randomized controlled trials

    A) 1, 2, 4 B) 1, 3, 5 C) 2, 4, 5 D) 1, 3, 4

    Click card to see definition 👆

    A) 1, 2, 4

    Click again to see term 👆

    1/10 Created by kayla_maslauskas

    Terms in this set (10)

    Which statement best describes how evidence-based clinical practice guidelines are mainly and most often used?

    A) To inform patients of the care they should expect

    B )To guide agencies in developing protocols specific to their setting

    C) As a standard for nurse performance appraisal

    D) As an educational tool for nurses and other providers

    B )To guide agencies in developing protocols specific to their setting

    From the following possible methodological steps for producing evidence-based clinical practice guidelines, which combination includes widely accepted core principles?

    1. They are carried out by members of the affected disciplinary groups

    2. A systematic review identified or conducted prior to development of recommendations

    3. Only studies with a sample size greater than 100 are considered

    4. Recommendations are explicitly linked with supporting evidence

    5. Recommendations are set forth only for those issues for which there are two or more randomized controlled trials

    A) 1, 2, 4 B) 1, 3, 5 C) 2, 4, 5 D) 1, 3, 4 A) 1, 2, 4

    Which of the following is the best reason for a project team that is updating a clinical protocol to start by looking for an evidence-based clinical practice guideline rather than individual studies?

    A) It is required for Medicare reimbursement

    B) It is the route to a clinical protocol preferred by accrediting organizations

    C) It could save time and effort

    D) An evidence-based clinical practice guideline can be used as is - without adaptation.

    C) It could save time and effort

    An example of a false negative is:

    A) A healthy person correctly identified as healthy

    B) A healthy person incorrectly identified as diseased

    C) A diseased person incorrectly identified as healthy

    D) A diseased person correctly diagnosed as diseased

    C) A diseased person incorrectly identified as healthy

    If a test has a sensitivity of 100%, it means that:

    A) It should not be as a screening test because it may have some false positives

    B) The test identifies everyone with the disease and it never flags any healthy people as having the disease

    C) The test identifies everyone with the disease but it may mistakenly flag some healthy people as having the disease

    D) It sometimes yields false negatives

    C) The test identifies everyone with the disease but it may mistakenly flag some healthy people as having the disease

    An example of a true positive is:

    A) A healthy person incorrectly identified as diseased

    B) A diseased person incorrectly identified as healthy

    C) A disease person correctly identified as having the disease

    D) A healthy person correctly identified as healthy

    C) A disease person correctly identified as having the disease

    Which of the following characteristics of a clinical practice guideline is the best indicator that the recommendations are truly evidence-based?

    A) A computerized database search was conducted before the recommendations were developed.

    B) The producers used a levels of evidence hierarchy to characterize the types of supporting evidence

    C)The producers of the guideline will say so and a reference list is provided.

    D) The evidence for each recommendation is summarized and referenced.

    D) The evidence for each recommendation is summarized and referenced.

    Which of the following is an important feature of all evidence-based clinical practice guidelines?

    A) They should be base on conclusions from meta-analysis

    B) They should explicitly indicate the amount, level, and quality of evidence supporting each recommendation

    C) They should link pathophysiology to clinical actions

    D) They should be based on randomized clinical trials

    B) They should explicitly indicate the amount, level, and quality of evidence supporting each recommendation

    Which of the following panel profiles best portrays a panel that has what it takes to produce an evidence-based clinical practices guidelines?

    Source : quizlet.com

    Nurs 3600 Flashcards

    Study Nurs 3600 flashcards. Create flashcards for FREE and quiz yourself with an interactive flipper.

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    Nurs 3600

    78cards Bailey T. Nursing Research In Nursing

    What is the main goal of clinical protocols?

    Set standards of care

    TermWhich of the following is not a form of nursing protocol?

    Diagnostic criteria map

    Evidence-based clinical protocols should be used in combination with:

    Clinical judgment and patient preference

    The most basic form of research evidence is a finding from a(n):

    Individual study

    Which statement best describes the concept of "nursing phenomenon"?

    A reality in the field of nursing

    The researcher's decision to use either a qualitative or quantitative method is determined by the:

    Nature of the question

    Which of the following is a goal of qualitative research?

    Understanding

    Which statement is true regarding the findings of a single, original study? They:

    Sould be integrated with findings from other studies of the same issue.

    When considering making a change in practice, which of the following should the project group do first?

    Look for an evidence-based guideline about the issue.

    Quantitative research uses ___________________________while qualitative research uses___________________.

    Numerical measurements; verbal descriptions

    Research variables are:

    Properties of person, situations, or things that change or vary

    What type of research variable is gender?

    Categorical

    What is meant by "control of extraneous variables"?

    Elimination or holding steady of variables that could influence a study's results.

    Which statement best describes the difficulty caused by low response rates to surveys? Low response rates:

    Yield data from a sample that may not be representative of the population.

    In studies that use more than one data collector, how is the consistency of the data evaluated?

    Inter-rater reliability

    Which of the following is the most important characteristic of a sample?

    Representativeness

    Which of the following describes a convenience sample in a research study?

    The sample was selected from residents of eight nursing homes in Arkansas and consisted of cognitively impaired individuals with no phytsical impairments or other psychiatric illnesses.

    Reliability in a research study is:

    The degree to which a data collection instrument consistently obtains the same or similar measurement values.

    Which of the following best describes the purpose of a descriptive study? To:

    Measure and describe the features or elements of a situation

    What is the advantage of random samples compared to convenience samples?

    The sample better represents the population

    Which of the following statements is an accurate interpretation of the statistical result Pearson r = 0.70?

    49% of variability in one variable is explained by the variability in the other variable and vice versa.

    In a correlation study, the p value of a Pearson r statistic is 0.005. What does this mean?

    There is a very small probability that the relationship between the due variables is due to chance.

    In correlational research when two variables have a very strong relationship, the Pearson r value will be near:

    1

    Which situation or factor in a report of a study using a correlational design would cause a nurse to question the validity of the study?

    The researchers conclude that a causal relationship exists between the variables.

    Why would a nurse researcher choose to use a correlational study of multiple variables?

    To examine relationships between or among variables

    A researcher concludes that a negative correlation exists between two variables. What does this mean?

    Individuals with high values on one variable tended to have low values on the other variable.

    In quantitative descriptive research, data are obtained from participants under ____________________ conditions.

    Natural

    Which type of variable generally is most difficult to capture with a quantitative measurement?

    Psychosocial

    The results of descriptive research studies most often are reported as: SELECT ALL THAT APPLY.

    Means Medians Percentages Ranges

    A nurse is reviewing results of a study measuring the correlation between pain and patients' activity level. The Pearson r of the association between the two variables is .66. What conclusions can the nurse make about the study results?

    There is a high level of assocation between the two variables.

    Which of the following is not a key feature of experimental studies?

    Flexibility in data collection and analysis

    TermWhich of the following results from a sample size that is too small?

    Low power to detect a difference in outcomes of the two groups

    Training the staff or research assistants who will deliver the interventions assures which one of the following goals of an experimental study?

    Consistent delivery of the interventions

    How is sample size ideally determined in an experimental study?

    With a power analysis

    TermWhen is a study categorized as quasi-experimental as opposed to being categorized as experimental?

    Random assignment to groups was not done.

    What is the relationship between clinical significance and statistical significance?

    Their relationship can take various forms.

    Source : www.chegg.com

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