Clinical Practice Guidelines We Can Trust (2011) / Chapter Skim
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3 Trustworthy Clinical Practice Guidelines: Challenges and Potential
3 Trustworthy Clinical Practice Guidelines: Challenges and Potential
Pages 53-74
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From page 53... ...
These challenges include limitations in the scientific evidence on which CPGs are based, lack of trans parency of development groups' methodologies, questions about how to reconcile conflicting guidelines, and conflicts of interests among guideline development group members and funders. The committee explored the literature devoted to empirical assessments of guideline development methodologies, and an array of guideline quality appraisal instruments.
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However, many CPG experts and practicing clinicians increasingly regard the scientific evidence base with suspicion for a variety of reasons, including gaps in evidence, poor-quality research and systematic reviews, biased guideline developers, and the dominance of industry-funded research and guideline develop ment. A 2005 study found that industry sponsored approximately 75 percent of clinical trials published in The Lancet, New England Journal of Medicine, and Journal of the American Medical Association (The House of Commons Health Committee, 2005)
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. Guideline developers and users emphasize that guideline recommendations should be based on only the most methodologically rigorous evidence, whether in the form of randomized controlled trials (RCTs)
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is illustrative. Although commentaries have described this case as a "politicization of professional practice guidelines" (Kraemer and Gostin, 2009, p.
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. Although the guideline does not describe processes for committee selection and guideline development, the document did grade both the strength of its recommendations and evidence quality using a standard scale.
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. The USPSTF methods were predefined, rigorous, and quantitative and they separated the systematic review process from that of guideline development (Imperiale and Ransohoff, 2010)
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. Such sentiments have been echoed in multiple commen taries relating to clinical practice guidelines, with authors recognizing that bias extends beyond financial interests to include intellectual and emotional interests as well (Lederer, 2007)
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Public forum testimony BOX 3-3 National Kidney Foundation's Kidney Disease and Outcomes Quality Initiative Anemia Management Guidelines (2006) As one of Medicare's largest pharmaceutical expenses -- costing $1.8 billion in 2007 (USRDS, 2009)
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8) emphasized the "scientific and methodological rigor" of the guideline development, including standardization of evidentiary review, an intensive internal and public two-stage review process, and full conflict of-interest disclosure and formal restrictions on members' contacts with sponsors during guideline development.
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Certain developers advocate restricting guideline development and recommendations to clinical domains associated with 1 Personal communication, M
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. EMPIRICAL ASSESSMENT OF GUIDELINE DEVELOPMENT METHODOLOGY A literature devoted to assessing methodological quality of CPG development reveals uneven progress over the past 25 years.
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. The authors concluded that despite evidence of moderate progress, the quality of practice guidelines developed by specialty societies remained unsatisfactory (Grilli et al., 2000)
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. STANDARDIZING GUIDELINE DEVELOPMENT QUALITY APPRAISAL Some studies have demonstrated that clinical practice guidelines can improve care processes and patient outcomes (Fervers et al., 2005; Ray-Coquard et al., 1997; Smith and Hillner, 2001)
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From page 66... ...
. Moreover, a number of taxonomies have been devised for the purposes of guideline methodology quality appraisal and/or improved reporting of guideline development processes (AGREE, 2003; Brouwers et al., 2010; Cluzeau et al., 1999; IOM, 1992; Shaneyfelt et al., 1999; Shiffman et al., 2003)
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The majority of CPG appraisal tools have been published in peer-reviewed journals (Vlayen et al., 2005)
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is not intended to dictate a particular guideline development methodology .
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In Methodologies and policies from ACCF/AHA Taskforce on Practice Guidelines.
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Paper presented at the IOM Committee on Standards for Developing Trustworthy Clinical Practice Guidelines meeting, January 11, 2010, Washington, DC. Burgers, J., R
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Presented at the IOM Committee on Standards for Developing Trustworthy Clinical Practice Guidelines meeting, January 11, 2010, Washington, DC. Goldberg, P
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Paper presented at the IOM Committee on Standards for Developing Trustworthy Clinical Practice Guidelines meeting, http://www.idsociety.org/ Content.aspx? id=16556January 11, 2010, Washington, DC.
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2006. KDOQI clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease.
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2006. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America.
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