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    Review of evidence based clinical practice guidelines developed in Latin America and Caribbean during the last decade: an analysis of the methods for grading quality of evidence and topic prioritization

    In the last decade, efforts have been made in Latin America and the Caribbean to advance in the methodological development of evidence based clinical practice guidelines, among other strategies to improve the health provision of services and indicators. To build an evidence map to show the regional GRADE impact in developing clinical practice guidelines and contrast the results with current needs. A systematic literature search was conducted in databases, developer’s websites, health ministries, repositories and grey literature. Documents were included when they were evidence based clinical practice guidelines developed in Latin American and Caribbean countries in the last decade. Data from the Global Burden of Disease was used to highlight relevant health conditions. Nine thousand seven hundred seventy-six documents were retrieved. 98 guidelines, with specific mention of the use of GRADE methodology were identified. 81% of the guidelines were developed within the last 4 years. 68% are from Colombia, 13% from Peru, 9% from Chile, 3% from Argentina and Costa Rica and Brazil, Honduras and Dominican Republic account 1%. 67% were developed for non-communicable diseases, 10% for communicable diseases, 9% for neonatal pathologies and 5% for maternal problems, 1% injuries and 7% other topics (nutrition, oral health). Our findings show a slow and increasing incorporation of the GRADE methodology in the region. GRADE guidelines have been adopted mainly by Colombia and slowly by other countries. Topics for guidelines continue to be comparable to the high-income countries and they don’t address communicable diseases or other relevant health issues in the region, such as violence or malnutrition; thus, the evidence based guidelines for clinical practice are only a tool within a complex multimodal strategy to tackle the challenges of the health determinants. A prioritizing strategy for relevant regional health topics and the use of robust methodological approaches must be in the political agenda in the region. GRADE methods could help to improve the quality and validity of recommendations not only for chronic pathologies but also for ancient and challenging maladies prevalent in the region, as part of a multimodalintersectoral strategy.

    Research Open Access

    Published: 19 February 2019

    Review of evidence based clinical practice guidelines developed in Latin America and Caribbean during the last decade: an analysis of the methods for grading quality of evidence and topic prioritization

    Paula Andrea Cabrera & Rodrigo Pardo

    volume

    15, Article number: 14 (2019) Cite this article

    4692 Accesses 9 Citations 9 Altmetric Metrics details

    Abstract

    Background

    In the last decade, efforts have been made in Latin America and the Caribbean to advance in the methodological development of evidence based clinical practice guidelines, among other strategies to improve the health provision of services and indicators.

    Objectives

    To build an evidence map to show the regional GRADE impact in developing clinical practice guidelines and contrast the results with current needs.

    Methods

    A systematic literature search was conducted in databases, developer’s websites, health ministries, repositories and grey literature. Documents were included when they were evidence based clinical practice guidelines developed in Latin American and Caribbean countries in the last decade. Data from the was used to highlight relevant health conditions.

    Results

    Nine thousand seven hundred seventy-six documents were retrieved. 98 guidelines, with specific mention of the use of GRADE methodology were identified. 81% of the guidelines were developed within the last 4 years. 68% are from Colombia, 13% from Peru, 9% from Chile, 3% from Argentina and Costa Rica and Brazil, Honduras and Dominican Republic account 1%. 67% were developed for non-communicable diseases, 10% for communicable diseases, 9% for neonatal pathologies and 5% for maternal problems, 1% injuries and 7% other topics (nutrition, oral health).

    Discussion

    Our findings show a slow and increasing incorporation of the GRADE methodology in the region. GRADE guidelines have been adopted mainly by Colombia and slowly by other countries. Topics for guidelines continue to be comparable to the high-income countries and they don’t address communicable diseases or other relevant health issues in the region, such as violence or malnutrition; thus, the evidence based guidelines for clinical practice are only a tool within a complex multimodal strategy to tackle the challenges of the health determinants.

    Conclusions

    A prioritizing strategy for relevant regional health topics and the use of robust methodological approaches must be in the political agenda in the region. GRADE methods could help to improve the quality and validity of recommendations not only for chronic pathologies but also for ancient and challenging maladies prevalent in the region, as part of a multimodalintersectoral strategy.

    Background

    Evidence based clinical practice guidelines (CPG) are an efficient strategy to optimize health care through the implementation of valid recommendations for specific conditions. They guide health professionals and decision makers in areas of clinical uncertainty [1,2,3,4] through evidence-based recommendations that assess the benefits-risk balance and critically appraise old and new technologies.

    CPG are documents developed with methodological rigour by multidisciplinary panels that incorporate, not only valid results of ongoing research, but also the opinion and experience of clinicians, patient’s preferences and values, priorities and needs within the community, available resources and costs, legal frameworks, cultural heterogeneity and health system organization [1, 5,6,7]. CPG must be valid and replicable, multidisciplinary and collaborative, easily applicable, accessible, unambiguous, having the aim to increase their reliability, acceptance, use and implementation. They are the result of an active and planned process that takes into consideration the barriers and facilitators to implement the recommendations in the daily clinical scenarios for the local, regional or national contexts they are designed for [4, 5, 7].

    Leading countries have a solid infrastructure dedicated to the production of high-quality CPG from the best available evidence, which become national and international benchmarks. In Latin America and the Caribbean, efforts have been made to further the methodological constructions of these documents [1, 5].

    National programs have been created in the region to support the systematic development of guidelines. Initiatives such as the ones from National Academy of Medicine of Argentina (2006), the Brazilian Medical Association, the Brazilian Ministry of Health (2004), the AUGE initiative (Chile 2005), the Ministry of Health and Social Protection from Colombia (2009), the IHCAI Foundation of Costa Rica (2004), or the National Center for Technological Excellence in Health of the Mexican government (2007) are worth mentioning, among new emerging ones.

    This ongoing process has been made possible thanks to the commitment of relevant partners from Spain (Guiasalud, Enebro Foundation and the Universidad de Sevilla), Portugal (Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina da Universidade de Lisboa), the Pan American Health Organization (PAHO) and from the Guidelines International Network (GIN) that harmonize and systematize the development of CPG around the world.

    To our knowledge, no systematic evaluation has been done during the last decade to assess the development of CPG and the incorporation of new methodologies in the Latin American and Caribbean region.

    Source : globalizationandhealth.biomedcentral.com

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    research exam #3 questions Flashcards

    Study with Quizlet and memorize flashcards terms like which statement best describes how evidence based clinical practice guidelines are mainly most often used?, which statement is true of the scope of evidence based guidelines?, which of the follow is an important feature of all evidence based clinical guidelines? and more.

    research exam #3 questions

    which statement best describes how evidence based clinical practice guidelines are mainly most often used?

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    guide agency developing protocols specific to their setting

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    which statement is true of the scope of evidence based guidelines?

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    broad guidelines and focus guidelines can both be useful

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    Terms in this set (37)

    which statement best describes how evidence based clinical practice guidelines are mainly most often used?

    guide agency developing protocols specific to their setting

    which statement is true of the scope of evidence based guidelines?

    broad guidelines and focus guidelines can both be useful

    which of the follow is an important feature of all evidence based clinical guidelines?

    they should explicitly indicate the amount, level and quality supporting each recommendation

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

    evidence of each recommendation is summarized and referenced

    In the exemplar of the vitamin and supplements--which best describes its recommendations?

    It made 2 no recommendations possible due to inadequate evidence

    In the exemplar evidence based guideline of cardiovascular disease in cancer, what can be said about the methods used

    Information about methodology is available via link cited in the article

    From the follow possible methodological steps producing evidence practice

    -They are carried out by numbers of the affected disciplinary groups

    -A SR is identified or conducted prior to development of recommendations

    -Recommendation are explicitly linked to supporting evidence

    Which of the following is the best reason for a project team that is updating a clinical protocol that starts by looking to a clinical based guideline instead of individual studies

    Could save time and effort

    The quality of evidence is in supporting of a recommendation depends on which of the following?

    The scientific soundness, number and type of supporting studies and consistency of supporting findings

    Which of the following panel profiles has what it takes to produce a clinical based guideline

    A panel comprised of members with clinical expertise, prior knowledge, and knowledge on sound methods to produce a guideline

    Which if the following is not a trigger for an evidence based practice project

    Family disagreement about health of a elderly parent

    The PICOT format is best used for which practice guideline

    question about Intervention effectiveness

    What is a sound evaluation of the following question that served as a project guide:

    They include all essential elements for a focused project

    Assume you work on a medical unit and read an article about an effective way for diabetics to figure out new ways to manage low blood sugar

    Discuss the method with the nurse leader, CNS or nurse manager

    Which statement best describes appraisal of research evidence

    Appraisal is a set of judgement using an objective set of criteria regarding the credibility, clinical significance and applicability of recommendation, conclusions of SR and study findings

    Which of the follow statements is true about the credibility of a study finding

    Credibility of a founding rests on the methodical soundness of the study that produced it

    Which of the following statement of using a study finding is the best guide

    A credible and clinically significant finding can be used as a base of care after deliberation about its applicability

    When appraising a piece of research evidence a clinical nurse should use which of the following resources?

    Structured appraisal questions appropriate to the type of evidence

    Which one of the following considerations is relevant to appraisal of the clinical significance of the findings a experimental study

    Size of treatment and outcomes of different groups

    Which of the following issues is not part of appraisal in applicable findings

    settings ability to replicate the study

    All of the following statements are true about appraising the findings of a clinical significance of findings of a study except which one

    Clinical significance of the study is always addressed

    Which of the following decisions is not apart of appraising the recommendations clinical practice guideline

    Determining if the guideline is needed by clinicians

    Which of the following characteristics of a recommendation is the most important determinant of its credibility

    The linkage between the recommendation and evidence supporting it

    What should you consider evaluating the clinical significance of a clinical practice guideline recommendation

    Likelihood that implementation of the recommendation will produce good patient outcome

    Your project team reads a guideline that makes recommendation and provides references, but provides no information about how the recommendations were produced, which statement describes the degree of confidence

    -Guideline should be judged on questionable credibility

    Which of the following factors plays a major role in figuring out that a clinical guideline is credible?

    Source : quizlet.com

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