Users' Guides to the Medical Literature
Evidence-Based Medicine Working Group
Are the Results Valid?
Were all important options and outcomes specified?
Was an explicit and sensible process used to identify, select and combine the evidence?
Was an explicit and sensible process used to consider the relative value of different outcomes?
Were important recent developments included?
Has the guidelines had peer review and testing?
What Are the Recommendations?
Are practical, important recommendations made?
How strong are the recommendations?
Could the uncertainty in the evidence or values change the guideline's recommendations?
Will the Results Help Me in My Patient Care?
Is the objective of the guideline consistent with mine?
Are the recommendations applicable to my patients?
JAMA 1995: 274: 570-574
JAMA 1995; 274: 1630-1632
Clinical Practice Guidelines are systematically developed statements designed to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.
Key Characteristics: comprehensive review of evidence expert opinions used to make value judgments official endorsement(s) intention to influence your practice patterns
Values are the basis for personal preferences concerning different clinical outcomes
Patient Preferences refer to the degrees of subjective satisfaction, distress, or desirability that patients associate with a particular health state
Grades of Recommendations: (JAMA 1995: 274:1800-1804)
A1: RCTs, no heterogeneity, Cls clear threshold NNT
A2: RCTs, no heterogeneity, Cls cross threshold NNT
B1: RCTs, heterogeneity, Cls clear threshold NNT
B2: RCTs, heterogeneity, Cls cross threshold NNT
C1: Observational studies, Cls clear threshold NNT
C2: Observational studies, Cls cross threshold NNT
Finding Clinical Practice Guidelines
practice guideline (pt)