Evidence and guidelines COMEP
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This document discusses guidelines for evidence-based medicine. It describes the importance of using high-quality research evidence and expertise to inform clinical guidelines. Guidelines are developed through a rigorous process that involves forming a multidisciplinary group, conducting systematic reviews of the literature, critically appraising evidence, and linking recommendations directly to evidence through a grading system. The goals are to promote best practices, reduce unwarranted variation, and improve patient outcomes and health care delivery.
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Evidence and guidelines COMEP
- 1. EVIDENCE AND GUIDELINES Gordon Lowe Emeritus Professor of Vascular Medicine, University of Glasgow; Chair of Scottish Intercollegiate Guidelines Network (SIGN), 2002-7
- 7. Prove it
- 21. What is SIGN? S cottish I ntercollegiate G uidelines N etwork Established by Conference of Royal Colleges and Faculties in Scotland Social Work SIGN Allied Health Professionals Patients Nursing Chief Scientist Office Scottish Executive, NHS management Medical Royal Colleges Pharmacy Dentistry
- 24. How SIGN develops guidelines
- 37. Systematic review process Systematic reviews meta-analyses Randomised controlled trials Quality rating Quality rating Cohort, case control studies Non-experimental studies Expert opinion Quality rating Considered judgement Graded recommend-ations Evidence tables Collect the evidence Rate the evidence Summarise the evidence Consider the evidence Evidence based recommendation
- 43. Discard Review methodology Abstracts Exclude Include List of rejects Checklists
- 51. 1. Selection of guideline topics 2. Composition of the guideline development group 4. Formation and grading of recommendations 3. Systematic literature review 5. Consultation and peer review 6. Publication and dissemination 7. Imple mentation 8. Review
- 55. SIGN levels of evidence
- 57. The key question Volume of evidence (how many studies?) Applicability (how do the study settings (interventions / equipment) compare with what is available in your setting?) Generalisability (how does the study population compare with what the target population?) Consistency (how similar are the results of the studies in the evidence table?)
- 58. Clinical impact (is the potential benefit from application of the intervention, test etc. sufficiently great to justify a recommendation?) Evidence statements (Definitive statements summarising the evidence base taking into account clinical judgement including level of evidence ) Recommendation (Evidence-based recommendation including grade A-D)
- 59. SIGN grades of recommendation
- 62. 1. Selection of guideline topics 2. Composition of the guideline development group 5. Consultation and peer review 4. Formation and grading of recommendations 3. Systematic literature review 6. Publication and dissemination 7. Imple mentation 8. Review
- 67. Methodology is described in detail in SIGN’s handbook www.sign.ac.uk
- 68. SIGN guidelines are freely available to NHSScotland are downloadable from www.sign.ac.uk
Editor's Notes
- This slide gives a good clear statement on the purpose of guidelines.
- 1. overview of what SIGN is 2. The methodology we use 3. The roles of Programme Managers in supporting guideline development groups and the roles of guideline development group members themselves
- 5
- So what makes a good clinical guideline. How can we tell the good from the bad. This is one area where we definitely cant judge a book by its cover. Very poor quality guidelines from highly respected organisations. Fortunately a tool exists to allow us to evaluate the quality of clinical guidelines. The agree tool stands for appraisal of guidelines research and evaluation.
- These points probably sound obvious but if you were to examine the development process of the majority of guidelines produced to date you would probably not be able to demonstrate adhherence to these key principles
- SIGN Guidelines are just that guidelines so unlike e.g. NICE guideline that are mandatory, SIGN guidelines allow for clinical judgement
- Another aspect of group composition is that of skill mix. Ideally aim for a mix of these characteristics in our groups.
- At SIGN All reccs are directly linked to the evidence. If there is one thing you are going to take away Id like you to be clear about this.as there are a lot of misunderstanding s about this point. The grade of recc in a sign guideline are based on strength of evidence rather than degree of clinical effect.
- The peer review process starts with the National Open meeting which takes place about a year after the group starts work. The development group present their draft to an multidisciplinary audience of their peers who are actively involved in giving feedback concerns criticism and advice to the group either on the day or in written responses. The gl is also on the website for a limited period at this time – if interested in urinary incontinece please look at this and feed back comments please.
- After the national meeting the group refines the draft and the next stage of peer review starts. Copies of the draft are sent to around 30 experts world wide for input and all comments are addressed. An in house editorial team makes sure all reviewers comments have been adequately addressed and provides a quality control function prior to publication.