Regarding the URL for the workshop syllabus, it is on a US Navy Website that
seems to have a firewall blocking many people from visiting the site.
Being inside the system, I have never encountered this difficulty so I am
sorry for the inconvenience. I will check with the Webmaster at the site to
see if there is a way to facilitate more public access.
Very Respectfully, Chip Taylor, MD
-----Original Message-----
From: Peg Allen [mailto:[log in to unmask]]
Sent: Thursday, January 20, 2000 12:50 PM
To: evidence-based-health
Subject: Re: Guideline Adaptation?
First, I'd like to commend you for developing this practice and sharing your
workshop on the web. Unfortunately, the URL given does not work for me. Is
there an error?
Second, I'd like to make some recommendations:
1. Expand the databases searched to include CINAHL (nursing & allied
health) and others as relevant to the guideline question. Why?
* A primary source of systematic reviews for nursing, The Online Journal
of Knowledge Synthesis for Nursing, is not in indexed in MEDLINE. This is
also the case for the interdisciplinary Online Journal of Clinical
Innovations, focused on integrative reviews of key patient care issues.
* There are many high-quality nursing & allied health journals
publishing significant research that are not indexed in MEDLINE.
* CINAHL has publication types "Systematic Review" and "Research" which
aid in identifying relevant literature.
* CINAHL indexes the Cochrane Library, so one search there will find
both Cochrane reviews as well as others.
* Because indexing is an art, not a science, CINAHL searches may find
relevant articles missed in a MEDLINE search.
Note: depending on the topic, you should also search EMBASE, PsycINFO, and
other related databases. MEDLINE indexes just 4,000+ of the estimated
13,000 - 14,000 biomedical journals published today. Also, you need to
consider databases that index non journal formats - books, dissertations,
others.
2. Add current awareness sources (your librarian can help with this) to
identify studies not yet in the citation/abstract databases - there are
several free/low-cost options. Focused web searching can help with this
step, as well as searches of two databases that monitor and index
newspapers, adding citations to the actual journal articles where the
research is published:
Health and Medicine in the News
http://www.biomed.lib.umn.edu/hmed/index.html - see links to other sources
at the bottom of the page.
3. Since I can't view the syllabus, I'm not sure if this is a problem. You
should be working with interdisciplinary teams for best results. Include
health sciences librarian(s) on your project teams, as they have the skills
to conduct the thorough literature reviews required, which offers a more
cost-effective use of staff time. Clinicians need to spend their time
reviewing the reviews and studies, not finding them.
I find it appalling that the following Cochrane review did not include a
CINAHL search:
Interventions to promote collaboration between nurses and doctors
(Zwarenstein
M. Bryant W. Bailie R. Sibthorpe B.) The Cochrane Library (Oxford) **
1999
The MEDLINE search in 1997 identified 100 studies for review. A CINAHL
search today on just one appropriate subject heading, nurse-physician
relations, identified 226 studies. I'm sure there are other reviews which
would be improved by additional database searches.
Hope this helps - Peg
Margaret (Peg) Allen, MLS-AHIP mailto:[log in to unmask]
Library/Information Consultant
Resource Librarian Consultant for Cinahl Information Systems, Inc.
http://www.cinahl.com/
Library Consultant, Northern and Southwest Wisconsin Area Health Education
Centers, http://home.dwave.net/~nahec/ and
http://www.medsch.wisc.edu/ahec/swahec/
PO Box 2, 308 Kann, Stratford, WI 54484-0002
(715)687-4976 Fax:(715)687-4976
----- Original Message -----
From: Taylor, Harry A. CDR <[log in to unmask]>
To: evidence-based-health <[log in to unmask]>
Sent: Thursday, January 20, 2000 8:47 AM
Subject: Guideline Adaptation?
> After criticizing our organization's well established evidence-informed,
> consensus-based process of adapting clinical practice guidelines, I have
> been tasked to make recommendations on how to make the adaptation of
> existing clinical practice guidelines (primarily consensus-based) more
> explicitly evidence-based. In my first attempt at this effort, I
presented
> the SIGN methodology (SIGN publication #39) as a model and was informed
that
> our charter was to adapt guidelines, not to create guidelines. I've been
> searching for an appropriate model for adaptation since that time.
>
> My colleagues and I, at Naval Hospital Jacksonville, developed an EBHC
> skills seminar around dissection of the NHLBI Asthma guidelines.
> Knowledgeable clinicians reviewed the guideline and developed a series of
> key clinical questions (in this case as a teaching tool designed to
> demonstrate that (1) some of the guideline recommendations were clearly
> supported by good evidence, (2) other strong recommendations were
supported
> by weak evidence and (3) some strongly worded recommendations went against
> the evidence for effectiveness). We then used the Clinical Queries
feature
> of PubMed and the Catnipper software to take the participants through the
> process of searching the primary source literature online, evaluating the
> abstracts for relevance, the articles for validity and documenting their
> findings as a CAT. The final session took the participants through the
same
> process using the TRIP search engine to identify Cochrane reviews and
other
> high quality evidence-based reviews. The "ah ha" experience for these
> healthcare administrators was that they could access high quality
> information relatively easily. The syllabus for our course was placed on
a
> CD-Rom which can be viewed at http://nhso/code03/ebhc.htm for anyone who
> might be interested.
>
> My questions to the group -
>
> (1) Does anyone have a model for adapting consensus-based guidelines of
> varying quality using an evidence-based approach?
>
> (2) Does the approach that we used for teaching EBHC skills seem like a
> reasonable model for adaptation of existing guidelines? Please make
> recommendations.
>
> The outline of my proposed model is:
>
> * Seed guideline (varying quality) is reviewed and key clinical
> questions are developed.
> * Key clinical questions are searched in an iterative process similar
> to that described in SIGN publication 39 searching the Cochrane Library on
> disk first, then using the TRIP search engine and finally the Clinical
> Queries feature of PubMed to efficiently identify high quality reviews
> and/or appropriate high quality studies.
> * Use of the Catmaker(R) software to appraise and catalog the evidence
> relating to the key questions.
> * Creation of evidence summaries from this catalog of evidence.
> * Grading the evidence.
> * Development of graded recommendations from the evidence summaries.
> * Development of an adapted guideline, decision support tools and
> metrics based on the graded recommendations.
>
> I greatly appreciate any and all input from the group.
>
> Very Respectfully, Chip Taylor, MD
>
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