NICE Guidelines

This project will employ a Population-Intervention-Comparative-Outcome (PICO) fromat for development of the research question to be investigated:

Evidence-based practice is an approach used by health care professionals to continually use current best evidence-based research to make ethical and reliable decisions regarding patient care. “Research to promote evidence-based practice is becoming more and more a part of the regular work of health care leaders” (Grand Canyon University, 2015, p. 1). However, it is important to determine the difference between solid research and flawed research that provides unreliable inferences. Evidence-based research includes focusing on a clinical question; and includes the review and incorporation of several studies to strengthen the results of the new study (Grand Canyon University, 2015). Roddy et al. and Ganz et al. articles will be assessed to determine if the recommended changes were backed by solid research that warrants changes in a hospital.

The National Guideline Clearinghouse provides information on clinical practice guidelines and the US Preventive Task Force provides recommendations for screenings and counseling based on the patient’s gender, age, race, etc. Both supply information for disease prevention and evidence based clinical practices that providers can use daily while caring for their patient. The recommendations and guidelines that are provided on the AHRQ website are ever evolving as new information becomes available thus allowing providers to keep up with current practice. The days of providing care based on “this is how it has always been done” are gone. The AHRQ guidelines and recommendations is the go-to website for medical providers looking to provide best care for their patients by following evidence based

The first section in the methods section describes the protocol to be followed. In order to find appropriate studies for the meta-analysis, Taylor and Swerdfeger, examined articles from Medline, Pubmed, Embase, and Google Scholar using the guidelines outlined by the Preferred Reporting Items for Systematic Review and Analysis (PRISMA) and independently assessed the risk of bias using the Newcastle-Ottawa Scale (NOS). Eslick then reviewed the articles. Following this, Taylor manually extracted the study design, the country of completion, sample sizes, interventions, outcome measures, and measures of effect from the articles. All literature had to be published and there was no language restriction on the studies,

The four accepted articles were analyzed and summarized. Article validity, reliability, and bias are included in the discussion. An overview of the articles are included in Table 2, indicating evidence level, design, population characteristics, intervention specifics, outcome measures, and PICO question relevance.

The big idea of “How to Read a Paper: The Basics of Evidence-Based Medicine” is that it describes the different types of clinical research reporting, and explains how to critically appraise the publications. The book provides the tools to find and evaluate the literature, and implement the findings in an evidence-based, patient-centered way. It is written for anyone in the health care professions who has little or no knowledge of evidence-based medicine; it provides a clear understanding of the concepts and how to put them into practice at the basic, clinical level.

Additionally, 17 relevant studies from the earlier report were included and reviewed. A second investigator verified the data abstraction, and two researchers using industry recognized standardized tools performed quality ratings independently. Guideline recommendations were made based on a systematic evaluation of the of evidence quality and recommendation strength. Expert consensus was used when conclusive data was unavailable. Prior to publication, a draft of the CPG was reviewed by additional AAP committees, designated outside organizations recognized experts in pertinent fields, and Subcommittee members were urged to disseminate the draft to stakeholders in their practices for additional review. (CITE

“Statements that include recommendations, intended to optimise patient care, that are informed by a systematic review of evidence and an assessment of the benefits and harm of alternative care options”(5,6)

In order to perform a critical appraisal of the selected articles, I would utilize the Critical Appraisal Guide, such as the one provided in the article Evidence-based Practice Step by Step: Critical Appraisal of the Evidence: Part 1, (2010). First by looking

Clinical Practice Guidelines (CPG’s) are systematically developed statements developed to assist healthcare professionals with decisions about appropriate health care for specific clinical circumstances and are promulgated to encourage high quality care and ideally are not promulgated as a means of establishing the identity of a particular professional group. These statements contain recommendations that are based on evidence from systematic review of published medical litature (National Heart, Lung, and Blood Institute, n.d.). Clinical practice guidelines are not used to exclude certain persons from practicing in an area and are not fixed protocols that must be followed. CPG’s shall not substitute for the advice of knowledgeable health care professionals (National Center for Complementary and Integrative Health, 2015). The National Guideline Clearinghouse (NGCH) has developed a database where thousands of guidelines can be obtained.

Reliability evidence evaluated; strength of reliability results (justified critical analysis): 80% agreement between raters. The response segments had a good rang of relaibilty

The Appraisal of Guidelines for Research & Evaluation (AGREE) Instrument is a tool that was developed to assess the rigor of development and transparency of clinical practice guidelines (AGREE, n.d.). Use of the AGREE tool, now improved to AGREE II, allows guideline users to have confidence in a guideline’s recommendations. The AGREE II instrument is categorized into 6 quality domains followed by an overall assessment and whether the appraiser would recommend the guideline.

A clinical practice guideline may include any level of hierarchy depending upon the level of research supporting the guideline. The authors obtained 72 references to develop this clinical practice guideline. Most of the articles are rated Level VA with a few systematic reviews that rated a Level I.

Studies 1 and 2 used the standardised critical appraisal tool from the Joanna Briggs Institute. This is a searching and selection process that identifies the specific objectives, study methods, populations and outcome from the chosen studies. Data from study 3 was critically appraised using the Downs and Black tool.

To identify the type of study, the algorithm for classifying quantitative experimental and observational study designs developed by NICE was used (Appendix B). An important part of conducting a systematic literature review is the critical appraisal stage of the methodology. Due to the ease of publication in this technological age, there are numerous research papers that lack quality in choice and use of methodology and so their results and conclusions are considered less valid. When conducting a systematic literature review, one of the aims is to review papers and critically appraise them of their quality, so that in which the methods that are applied to generate and summarise data are reviewed to assess in methodologic quality, the risk of bias in results, and the robustness of the conclusions. Critical appraisal is the process of carefully and systematically examining research to judge its trustworthiness and its value and relevance in a particular context. It is an essential part of evidence-based medicine because in which allow researchers and clinicians find and use research evidence reliably, efficiently and