Guidelines should reflect all knowledge, not just clinical trials

Zuiderent‐Jerak, Teun; Forland, Frode; Macbeth, Fergus

doi:10.1136/bmj.e6702

Cited by 70 publications

(50 citation statements)

References 5 publications

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“…A wider debate about how guideline groups can create greater clarity about the reliability of evidence used is needed 26. Reducing the use of poorly evidenced recommendations has potential to create a shorter, more reliable and usable clinical support.…”

Section: Discussionmentioning

confidence: 99%

Guidelines: is bigger better? A review of SIGN guidelines

Baird

Lawrence

2014

BMJ Open

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ObjectivesTo quantify and analyse the quality of evidence that is presented in national guidelines.SettingLevels of evidence used in all the current valid recommendations in the Scottish Intercollegiate Guideline Network (SIGN) guidelines were reviewed and statistically analysed.Outcome measuresThe proportion of level D evidence used in each guideline and a statistical analysis.MethodData were collected from published guidelines available online to the public. SIGN methodology entails a professional group selected by a national organisation to develop each of these guidelines. Statistical analysis of the relationship between the number of guideline recommendations and the quality of evidence used in its recommendations was performed.ResultThe proportion of level D evidence increases with the number of recommendations made. This correlation is significant with Kendall's τ=0.22 (approximate 95% CI 0.008 to 0.45), p = 0.04; and Spearman ρ=0.22 (approximate 95% CI 0.02 to 0.57), p=0.04.ConclusionsPractice guidelines should be brief and based on scientific evidence. Paradoxically the longest guidelines have the highest proportion of recommendations based on the lowest level of evidence. Guideline developers should be more aware of the need for brevity and a stricter application of evidence-based principles could achieve this. The findings support calls for a review of how evidence is used and presented in guidelines.

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Section: Discussionmentioning

confidence: 99%

Guidelines: is bigger better? A review of SIGN guidelines

Baird

Lawrence

2014

BMJ Open

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“…1,38 Defined methods for incorporating qualitative studies and other types of knowledge, such as clinical audits and quality improvement projects, into clinical guidelines need to be developed. 39 …”

Section: Discussionmentioning

confidence: 99%

Clinical Practice Guidelines for Delirium Management: Potential Application in Palliative Care

Bush

Bruera

Lawlor

et al. 2014

Journal of Pain and Symptom Management

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Context Delirium occurs in patients across a wide array of health care settings. The extent to which formal management guidelines exist or are adaptable to palliative care is unclear. Objectives This review aims to 1) source published delirium management guidelines with potential relevance to palliative care settings, 2) discuss the process of guideline development, 3) appraise their clinical utility, and 4) outline the processes of their implementation and evaluation and make recommendations for future guideline development. Methods We searched PubMed (1990–2013), Scopus, U.S. National Guideline Clearinghouse, Google, and relevant reference lists to identify published guidelines for the management of delirium. This was supplemented with multidisciplinary input from delirium researchers and other relevant stakeholders at an international delirium study planning meeting. Results There is a paucity of high-level evidence for pharmacological and non-pharmacological interventions in the management of delirium in palliative care. However, multiple delirium guidelines for clinical practice have been developed, with recommendations derived from “expert opinion” for areas where research evidence is lacking. In addition to their potential benefits, limitations of clinical guidelines warrant consideration. Guidelines should be appraised and then adapted for use in a particular setting before implementation. Further research is needed on the evaluation of guidelines, as disseminated and implemented in a clinical setting, focusing on measurable outcomes in addition to their impact on quality of care. Conclusion Delirium clinical guidelines are available but the level of evidence is limited. More robust evidence is required for future guideline development.

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“…Therefore it is problematic to reduce the external evidence only to level 1 and 2 studies because a lot of knowledge is not taken into account. Internationally this condition is criticized consistently [20,30], as can best be shown by the graphic demonstration of the American Chiropractors Association. (Fig.3.…”

Section: Fig3 Detailed Illustration Of All 3 Areas Of the Ebm-triadmentioning

confidence: 99%

Evidence based medicine in physical medicine and rehabilitation (English version)

et al. 2014

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Evidence Based Medicine in Physical Medicine and RehabilitationIn the last twenty years the term "Evidence Based Medicine (EBM)" has spread into all areas of medicine and is often used for decision-making in the medical and public health sector. It is also used to verify the significance and/or the effectiveness of different therapies. The definition of EBM is to use the physician's individual expertise, the patient's needs and the best external evidence for each individual patient. Today, however, the term EBM is often wrongly used as a synonym for best "external evidence". This leads not only to a misuse of evidence based medicine but suggests a fundamental misunderstanding of the model which was created by Gordon Guyatt, David Sackett and Archibald Cochrane. This problem becomes even greater the more social insurance institutions, public healthcare providers and politicians use external evidence alone as a main guideline for financing therapies in physical medicine and general rehabilitation without taking into account the physician's expertise and the patient's needs.The wrong interpretation of EBM can lead to the following problems: well established clinical therapies are either questioned or not granted and are therefore withheld from patients (for example physical pain management). Absence of evidence for individual therapy methods does not prove their ineffectiveness! In this short statement the significance of EBM in physical medicine and general rehabilitation will be analysed and discussed.

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Guidelines should reflect all knowledge, not just clinical trials

Cited by 70 publications

References 5 publications

Guidelines: is bigger better? A review of SIGN guidelines

Guidelines: is bigger better? A review of SIGN guidelines

Clinical Practice Guidelines for Delirium Management: Potential Application in Palliative Care

Evidence based medicine in physical medicine and rehabilitation (English version)

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