Obstetrical Ultrasound During Pregnancy

No relevant evidence was identified comparing the safety of frequent obstetrical ultrasounds compared to the routine use of obstetrical ultrasound during pregnancy. This review identified 10 evidence-based guidelines that provided recommendations regarding various indications for obstetrical ultrasound, as well as the frequency of obstetrical ultrasound; however, the methodological rigour of these guidelines is limited and recommendations should be interpreted with caution. One guideline recommended against obstetrical ultrasound for non-medical purposes and recommended that ultrasound exposure be as low as reasonably possible during pregnancy. These recommendations were based on moderate-quality evidence and expert opinion, and should be interpreted with caution. The guidelines made recommendations for specific patient populations for whom more frequent obstetrical ultrasound examinations may be required. These populations included pregnancies affected by certain congenital infections, people pregnant with twins, pregnant adolescents, and pregnant people at high risk for fetal anomalies or for whom mid-trimester transabdominal ultrasound would be challenging.

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Organizing and delivering treatment for ADHD

10.1093/med/9780198739258.003.0045 ◽

2018 ◽

Author(s):

David Coghill ◽

Marina Danckaerts

Keyword(s):

Treatment Initiation ◽

Careful Consideration ◽

Routine Clinical Practice ◽

Evidence Based ◽

High Quality ◽

Children With Adhd ◽

High Quality Evidence ◽

Ongoing Care ◽

Evidence Based Guidelines ◽

Quality Evidence

Following diagnosis, all children with ADHD will require some form of intervention, and most will require treatment over a relatively prolonged period of time. Whilst there are now several high-quality evidence-based guidelines for the management of ADHD, these are often difficult to operationalize into routine clinical practice and as a consequence studies report considerable variations in care at local, national, and international levels. We describe a structured, but flexible, approach to the organization and delivery of ADHD treatments that aims to optimize care and reduce variation in practice. This pathway pays particular attention to optimizing care through careful consideration of the initial targets for treatment and choice of first treatment, initiation and titration of medication treatments, monitoring ongoing care and identifying adverse events, and the adjustment and switching of treatments when outcomes are not optimal.

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The Impact of Health Information Technology on the Quality of Medical and Health Care: A Systematic Review

Health Information Management Journal ◽

10.1177/183335830903800305 ◽

2009 ◽

Vol 38 (3) ◽

pp. 26-37 ◽

Cited By ~ 90

Author(s):

Aziz Jamal ◽

Kirsten McKenzie ◽

Michele Clark

Keyword(s):

Health Care ◽

Information Technology ◽

Health Information Technology ◽

Health Information ◽

Patient Outcomes ◽

Evidence Based ◽

Specific Patient ◽

Evidence Based Guidelines ◽

The Impact

The aim of this study was to systematically review the published evidence of the impact of health information technology (HIT) or health information systems (HIS) on the quality of healthcare, focusing on clinicians' adherence to evidence-based guidelines and the corresponding impact this had on patient clinical outcomes. The review covered the use of health information technologies and systems in both medical care (i.e. clinical and surgical) and other areas such as allied health and preventive services. Studies were included in the review if they examined the impact of Electronic Health Record (EHR), Computerised Provider Order-Entry (CPOE), or Decision Support System (DS); and if the primary outcomes of the studies were focused on the level of compliance with evidence-based guidelines among clinicians. Measurements considered relevant to the review were either of changes in clinical processes resulting from a change of the providers' behaviour, or of specific patient outcomes that demonstrated the effectiveness of a particular treatment given by providers. Of 23 studies included in the current review, 17 assessed the impact of HIT/HIS on health care practitioners' performance. A positive improvement, in relation to their compliance with evidence-based guidelines, was seen in 14 studies. Studies that included an assessment of patient outcomes, however, showed insufficient evidence of either clinically or statistically important improvements. Although the number of studies reviewed was relatively small, the findings demonstrated consistency with similar previous reviews of this nature in that wide scale use of HIT has been shown to increase clinician's adherence to guidelines.

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Discordant and inappropriate discordant recommendations in consensus and evidence based guidelines: empirical analysis

BMJ ◽

10.1136/bmj-2021-066045 ◽

2021 ◽

pp. e066045 ◽

Cited By ~ 3

Author(s):

Liang Yao ◽

Muhammad Muneeb Ahmed ◽

Gordon H Guyatt ◽

Peijing Yan ◽

Xu Hui ◽

...

Keyword(s):

Empirical Analysis ◽

Data Extraction ◽

Evaluation Criteria ◽

Heart Association ◽

Evidence Based ◽

Quality Of Evidence ◽

Assessment Development ◽

Evidence Based Guidelines ◽

Quality Evidence

Abstract Objective To investigate whether alignment of strength of recommendations with quality of evidence differs in consensus based versus evidence based guidelines. Design Empirical analysis. Data source Guidelines developed by the American College of Cardiology and the American Heart Association (ACC/AHA) and the American Society of Clinical Oncology (ASCO) up to 27 March 2021. Study selection Recommendations were clearly categorised as consensus or evidence based, were separated from the remainder of the text, and included both the quality of evidence and the strength of the recommendations. Data extraction Paired authors independently extracted the recommendation characteristics, including type of recommendation (consensus or evidence based), grading system used for developing recommendations, strength of the recommendation, and quality of evidence. The study team also calculated the number of discordant recommendations (strong recommendations with low quality evidence) and inappropriate discordant recommendations (those that did not meet grading of recommendations assessment, development, and evaluation criteria of appropriateness). Results The study included 12 ACC/AHA guidelines that generated 1434 recommendations and 69 ASCO guidelines that generated 1094 recommendations. Of the 504 ACC/AHA recommendations based on low quality evidence, 200 (40%) proved to be consensus based versus 304 (60%) evidence based; of the 404 ASCO recommendations based on low quality evidence, 292 (72%) were consensus based versus 112 (28%) that were evidence based. In both ACC/AHA and ASCO guidelines, the consensus approach yielded more discordant recommendations (ACC/AHA: odds ratio 2.1, 95% confidence interval 1.5 to 3.1; ASCO: 2.9, 1.1 to 7.8) and inappropriate discordant recommendations (ACC/AHA: 2.6, 1.7 to 3.7; ASCO: 5.1, 1.6 to 16.0) than the evidence based approach. Conclusion Consensus based guidelines produce more recommendations violating the evidence based medicine principles than evidence based guidelines. Ensuring appropriate alignment of quality of evidence with the strength of recommendations is key to the development of “trustworthy” guidelines.

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LO24: Is prehospital care supported by evidence-based guidelines? An environmental scan and quality appraisal using AGREE II

CJEM ◽

10.1017/cem.2017.86 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S35-S36

Author(s):

S. Turner ◽

E. Lang ◽

K. Brown ◽

C. Leyton ◽

E. Bulger ◽

...

Keyword(s):

Life Support ◽

Guideline Development ◽

Prehospital Care ◽

Evidence Based ◽

High Quality ◽

Agree Ii ◽

Level Of Evidence ◽

High Quality Evidence ◽

Evidence Based Guidelines ◽

Quality Evidence

Introduction: The Institute of Medicine (IOM) has recommended that high-quality, evidence-based guidelines be developed for emergency medical services (EMS). The National Association of EMS Physicians (NAEMSP) has outlined a strategy that will see this task fulfilled, consisting of multiple working groups focused on all aspects of guideline development and implementation. A first step, and our objective, was a cataloguing and appraisal of the current guidelines targeting EMS providers. Methods: A systematic search of the literature was conducted in MEDLINE (1175), EMBASE (519), PubMed (14), Trip (416), and guidelines.gov (64) through May 1, 2016. Two independent reviewers screened titles for relevance to prehospital care, and then abstracts for essential guideline features, including a systematic review, a grading system, and an association between level of evidence and strength of recommendation. All disagreements were moderated by a third party. Citations meeting inclusion criteria were appraised with the AGREE II tool, which looks at six different domains of guideline quality, containing a total of 23 items rated from 1 to 7. Each guideline was appraised by three separate reviewers, and composite scores were calculated by averaging the scaled domain totals. Results: After primary (kappa 97%) and secondary (kappa 93%) screening, 49 guidelines were retained for full review. Only three guidelines obtained a score of >90%, the topics of which included aeromedical transport, analgesia in trauma, and resuscitation of avalanche victims. Only two guidelines scored between 80% and 90%, the topics of which included stroke and pediatric seizure management. One guideline, splinting in an austere environment, scored between 70% and 80%. Nine guidelines scored between 60% and 70%, the topics of which included ischemic stroke, cardiovascular life support, hemorrhage control, intubation, triage, hypothermia, and fibrinolytic use. Of the remaining guidelines, 14 scored between 50% and 60%, and 20 obtained a score of <50%. Conclusion: There are few high-quality, evidence-based guidelines in EMS. Of those that are published, the majority fail to meet established quality measures. Although a lack of randomized controlled trials (RCTs) conducted in the prehospital field continues to limit guideline development, suboptimal methodology is also commonplace within the existing literature.

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