Amit,
Thanks for this reference. I think there are a number of reviews of the
EBness of guidelines, and they never do well - its why we need to
critically appraise a guideline before considering using it. Another
reference is:
Arch Intern Med 2001 Jan 8;161(1):69-74 Related Articles, Books, LinkOut
Critical appraisal of clinical practice guidelines targeting chronic
obstructive pulmonary disease.
Lacasse Y, Ferreira I, Brooks D, Newman T, Goldstein RS.
Centre de Pneumologie L'Hopital Laval, 2725 Chemin Ste-Foy, Ste-Foy,
Quebec, Canada G1V 4G5. [log in to unmask]
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is so prevalent
that the endorsement of management strategies by professional organizations
issuing clinical practice guidelines (CPGs) will likely influence the
clinical and financial resources allocated to this condition. OBJECTIVES:
To examine the content of and to critically appraise the CPGs targeting
COPD. METHODS: We identified, through a MEDLINE search (from January 1990
to May 1999) and contacts with experts and professional organizations, the
CPGs for the overall management of COPD. We assessed the guidelines
according to an index of quality measuring 3 dimensions: the rigor of
development, the context and content, and the extent to which the
dissemination and implementation have been addressed. The recommendations
were also examined and compared. RESULTS: Of the 15 CPGs we included, none
was based on a systematic review of the literature. Two were independently
reviewed before their release, 1 included strategies for dissemination and
implementation, and 1 estimated the economic implications associated with
its recommendations. The recommendations were often difficult to interpret
(reviewers' agreement: kappa median, 0.41). When unanimity existed
regarding the benefits of a given management modality (such as respiratory
rehabilitation), discrepancies were often identified in the application of
the recommendation. CONCLUSIONS: The methodological quality of CPGs
targeting COPD is limited, and there are disparities among many of their
recommendations. Despite there being several CPGs worldwide, there is a
need for an evidence-based summary of the literature to serve as a resource
for those who provide health care to individuals with COPD.
Paul Glasziou
At 26/02/2004, Ghosh, Amit K.,
M.D. wrote:
>Dear Prof. Djulbegovic,
>
>Thank you for your interest. I share your views on uncertainty and have
>enjoyed reading your work.
>Here is the reference.It is available full text online:
>
> Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines following
> guidelines? JAMA. 1999;281:1900-1905.
>
>I will read your article
>
>Amit K. Ghosh, MD, FACP
>Associate Program Director, General Internal Medicine Research Fellowship
>Consultant
>Division of General Internal Medicine
>Assistant Professor of Medicine
>Mayo Clinic College of Medicine
>200 1st Street, SW
>Rochester, MN, 55905
>Phone: 507-538-1128
>Fax: 507-284-4959
>[log in to unmask]
Paul Glasziou
Department of Primary Health Care &
Director, Centre for Evidence-Based Practice, Oxford
ph: 44-1865-227055 www.cebm.net
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