WEBVTT 1 00:00:01.590 --> 00:00:07.079 Welcome to module four of the evidence analysis center orientation tutorial. In 2 00:00:07.489 --> 00:00:08.800 this module, 3 00:00:08.810 --> 00:00:10.380 you will learn how the Academy's 4 00:00:10.390 --> 00:00:13.810 evidence based Nutrition Practice guidelines are developed 5 00:00:17.100 --> 00:00:19.079 upon completion of module four, 6 00:00:19.440 --> 00:00:22.680 you will understand the importance of clinical guidelines. 7 00:00:23.360 --> 00:00:25.159 How the guidelines are developed 8 00:00:25.629 --> 00:00:27.370 components of a guideline 9 00:00:27.700 --> 00:00:31.739 and how to locate and navigate the guideline and the evidence analysis library, 10 00:00:34.130 --> 00:00:39.330 evidence-based Nutrition Practice guidelines are a series of guiding statements 11 00:00:39.669 --> 00:00:40.979 which are developed 12 00:00:41.279 --> 00:00:44.630 using a systematic process for identifying, 13 00:00:44.919 --> 00:00:45.830 analyzing 14 00:00:46.069 --> 00:00:48.720 and synthesizing scientific evidence 15 00:00:48.990 --> 00:00:51.669 and interpreting the evidence of clinical expertise. 16 00:00:52.479 --> 00:00:57.259 They are designed to assist practitioner and patient decisions about appropriate 17 00:00:57.270 --> 00:01:01.810 nutrition care for specific diseases or conditions in typical settings. 18 00:01:02.560 --> 00:01:04.339 Key elements include scope 19 00:01:04.529 --> 00:01:06.699 interventions and practices considered 20 00:01:07.029 --> 00:01:10.559 major recommendations and corresponding reading of evidence. 21 00:01:10.569 --> 00:01:12.099 Strength and rationale 22 00:01:15.260 --> 00:01:17.029 guidelines promote consistency, 23 00:01:17.650 --> 00:01:19.500 achievement of expected outcomes 24 00:01:20.160 --> 00:01:21.580 and assure quality care 25 00:01:22.470 --> 00:01:23.000 guideline. 26 00:01:23.010 --> 00:01:27.050 Support implementation of the nutrition care process and its terminology 27 00:01:27.690 --> 00:01:29.610 support reimbursement efforts 28 00:01:29.989 --> 00:01:33.910 and implementing guidelines encourage recognition and collaboration 29 00:01:34.080 --> 00:01:37.059 by and with other healthcare professionals 30 00:01:40.779 --> 00:01:43.209 guidelines are built from systematic reviews, 31 00:01:43.860 --> 00:01:46.529 the evidence summaries and conclusion statements 32 00:01:46.540 --> 00:01:49.000 from the systematic review report. 33 00:01:49.010 --> 00:01:50.279 What the evidence says 34 00:01:51.050 --> 00:01:55.190 the guideline recommendation is a course of action for the practitioner. 35 00:01:57.879 --> 00:01:59.959 Before the work of the guideline starts 36 00:02:00.370 --> 00:02:03.769 the project manager and the expert panel review, 37 00:02:03.779 --> 00:02:07.019 the systematic review evidence and the strength of the evidence. 38 00:02:07.650 --> 00:02:10.610 This information will guide the development of the guideline 39 00:02:13.720 --> 00:02:15.850 following the E A framework. 40 00:02:16.300 --> 00:02:19.300 The project manager and the expert panel ask, 41 00:02:19.360 --> 00:02:22.919 does this topic have multiple subtopics and require 42 00:02:22.929 --> 00:02:26.770 extensive guidelines and formal recommendations for practitioners. 43 00:02:27.429 --> 00:02:28.850 If the answer is yes, 44 00:02:29.009 --> 00:02:31.119 the guideline development phase begins, 45 00:02:35.419 --> 00:02:38.039 let's review the guideline development process. 46 00:02:40.740 --> 00:02:42.110 In previous modules, 47 00:02:42.570 --> 00:02:44.789 we covered the scoping review process 48 00:02:45.289 --> 00:02:46.970 and the systematic review process. 49 00:02:47.570 --> 00:02:51.630 The guideline process also has five major steps which include 50 00:02:51.830 --> 00:02:53.869 an evidence to decision framework, 51 00:02:54.380 --> 00:02:56.779 development recommendations and the rationale, 52 00:02:57.460 --> 00:02:59.429 the assignment of a grade in rating 53 00:03:00.000 --> 00:03:02.889 and a thorough internal and external review. 54 00:03:03.240 --> 00:03:06.789 And finally, the dissemination and implementation of the guideline 55 00:03:10.029 --> 00:03:13.940 recommendations are the key focus of evidence based guidelines. 56 00:03:14.639 --> 00:03:17.380 They are the unique components that distinguish 57 00:03:17.389 --> 00:03:20.690 practice guidelines from other clinical publications. 58 00:03:21.570 --> 00:03:24.169 Once the systematic review steps are completed, 59 00:03:24.389 --> 00:03:29.470 the expert panel applies moderating factors to formulate recommendations. 60 00:03:31.720 --> 00:03:35.720 The academy uses an evidence to decisions framework tool 61 00:03:35.830 --> 00:03:38.779 designed to develop a transparent and logical 62 00:03:38.789 --> 00:03:41.500 way to determine the need for recommendation. 63 00:03:42.210 --> 00:03:45.940 The tour guides, the expert panel to address a series of questions 64 00:03:46.199 --> 00:03:49.460 that will determine if a recommendation should be developed. 65 00:03:51.850 --> 00:03:55.970 A recommendation should be written using brief action statements. 66 00:03:56.470 --> 00:03:58.770 The first sentence should be the what 67 00:03:58.880 --> 00:04:00.199 of the recommendation. 68 00:04:00.479 --> 00:04:02.669 The second sentence should be the why 69 00:04:03.669 --> 00:04:06.649 a good recommendation will contain what to do 70 00:04:06.899 --> 00:04:07.929 and why do it 71 00:04:08.050 --> 00:04:10.089 and should be easily identifiable. 72 00:04:10.770 --> 00:04:15.429 The expert panel should use action words so that the recommendation is clear 73 00:04:19.190 --> 00:04:20.869 guideline components include 74 00:04:21.808 --> 00:04:22.669 recommendation, 75 00:04:23.489 --> 00:04:24.750 recommendation, rating, 76 00:04:25.570 --> 00:04:28.190 classification of conditional or imperative 77 00:04:28.970 --> 00:04:31.470 risk. In terms of implementing the recommendation 78 00:04:32.380 --> 00:04:33.839 conditions of application, 79 00:04:34.549 --> 00:04:36.929 potential costs associated with application 80 00:04:37.609 --> 00:04:38.980 recommendation, narrative 81 00:04:39.730 --> 00:04:41.459 recommendation, strength rationale 82 00:04:42.420 --> 00:04:44.040 minority opinions if needed 83 00:04:44.829 --> 00:04:46.450 and its supporting evidence. 84 00:04:49.299 --> 00:04:51.200 The rating for the recommendation 85 00:04:51.399 --> 00:04:55.000 is primarily based on the strength of the supporting evidence 86 00:04:55.269 --> 00:04:59.540 but also the balance between benefits or harms anticipated 87 00:04:59.690 --> 00:05:01.829 and clinical practice implications. 88 00:05:04.309 --> 00:05:07.109 Each recommendation is labeled conditional 89 00:05:07.239 --> 00:05:08.290 or imperative. 90 00:05:08.760 --> 00:05:11.369 An imperative label means that the recommendation 91 00:05:11.380 --> 00:05:14.529 is broadly applicable to the target population 92 00:05:14.660 --> 00:05:16.730 without restraints and pertinence. 93 00:05:17.359 --> 00:05:19.179 A conditional label means that the 94 00:05:19.190 --> 00:05:22.970 recommendation clearly defines a specific situation 95 00:05:23.119 --> 00:05:27.380 or a specific subpopulation within the larger guideline population. 96 00:05:30.769 --> 00:05:34.720 Here is the rating chart and the definitions for each rating category. 97 00:05:35.380 --> 00:05:37.899 This chart is available from the evidence analysis 98 00:05:37.910 --> 00:05:41.000 library under the policy and process section. 99 00:05:44.220 --> 00:05:46.500 For each form of treatment, recommended 100 00:05:46.829 --> 00:05:48.720 safety issues should be considered 101 00:05:49.320 --> 00:05:50.859 in terms of potential harm. 102 00:05:50.899 --> 00:05:55.910 The long term use in safety of specific dietary components or supplements 103 00:05:56.070 --> 00:05:59.420 is an important consideration in recommendations to treat a 104 00:05:59.570 --> 00:06:00.839 specific condition. 105 00:06:01.660 --> 00:06:05.880 The expert panel is any risk or harms in this section of the guideline. 106 00:06:08.640 --> 00:06:12.040 Any condition that may limit the application of the recommendation 107 00:06:12.260 --> 00:06:16.540 should be indicated under the heading title conditions of application. 108 00:06:17.160 --> 00:06:22.059 A recommendation with a conditional label will always have conditions specified. 109 00:06:25.239 --> 00:06:27.750 This section covers obvious cause that may be 110 00:06:27.760 --> 00:06:30.589 associated with the application of the recommendation. 111 00:06:31.350 --> 00:06:36.049 The cost can be afforded to patient, the facility or health care organization. 112 00:06:36.540 --> 00:06:39.010 Examples include a specialized staff 113 00:06:39.230 --> 00:06:40.010 equipment 114 00:06:40.230 --> 00:06:41.529 or laboratory test. 115 00:06:43.959 --> 00:06:45.660 The recommendation narrative 116 00:06:46.089 --> 00:06:48.579 is a summary of the supporting evidence 117 00:06:48.589 --> 00:06:51.160 for each recommendation within the guideline. 118 00:06:51.640 --> 00:06:55.119 It clearly explains the evidence that supports the recommendation. 119 00:06:55.679 --> 00:07:00.019 It includes the study designs and quality ratings of the included studies. 120 00:07:02.619 --> 00:07:04.459 When developing the rationale, 121 00:07:04.600 --> 00:07:08.730 the lead analysts begin by first stating the highest quality articles 122 00:07:08.980 --> 00:07:12.440 and the findings as they relate to the outcomes that were addressed 123 00:07:13.290 --> 00:07:15.070 as with the recommendation language. 124 00:07:15.079 --> 00:07:19.760 It is important to state only the facts and findings of the relevant articles 125 00:07:19.950 --> 00:07:22.350 and that include any opinion based language 126 00:07:22.920 --> 00:07:23.290 list, 127 00:07:23.299 --> 00:07:25.899 the evidence strain and methodological issues 128 00:07:25.910 --> 00:07:28.029 that determine the recommendation strength. 129 00:07:31.470 --> 00:07:36.410 The expert panel usually reaches a consensus and the recommendation and a rating 130 00:07:36.709 --> 00:07:38.119 so they will write none. 131 00:07:38.320 --> 00:07:40.850 However, if they cannot come to a consensus, 132 00:07:40.859 --> 00:07:43.690 then any minority opinions should be listed here. 133 00:07:46.470 --> 00:07:51.320 Since the majority of the recommendations are supported by the systematic review, 134 00:07:51.619 --> 00:07:55.500 the evidence analysis question is linked under this heading area. 135 00:07:58.329 --> 00:07:58.859 This is 136 00:07:59.049 --> 00:08:02.420 a review bibliography for each research question 137 00:08:02.429 --> 00:08:05.380 is linked under the section titled references, 138 00:08:07.630 --> 00:08:11.160 sources not analyzed during the systematic review process 139 00:08:11.350 --> 00:08:14.690 may be used to support and formulate a recommendation. 140 00:08:15.149 --> 00:08:17.649 References must be credible resources. 141 00:08:17.660 --> 00:08:21.029 For example, other guidelines or position papers 142 00:08:21.399 --> 00:08:26.450 recommendations based solely on these types of references are rated as consensus 143 00:08:29.109 --> 00:08:31.510 recommendations are largely based 144 00:08:31.720 --> 00:08:33.729 on the summarized evidence from an E 145 00:08:33.989 --> 00:08:35.330 A systematic review. 146 00:08:35.880 --> 00:08:39.659 However, sometimes the expert panel may determine that the eal 147 00:08:40.000 --> 00:08:41.640 may be straightened and broaden 148 00:08:41.830 --> 00:08:45.809 by using external guidelines. When developing the recommendations, 149 00:08:46.510 --> 00:08:49.609 external guidelines may be incorporated into the E 150 00:08:49.760 --> 00:08:49.890 A 151 00:08:50.299 --> 00:08:53.650 by serving as a reference for a consensus recommendation. 152 00:08:54.280 --> 00:08:57.900 The methodology is carefully vetted by the lead analyst 153 00:09:01.919 --> 00:09:04.219 to be considered for inclusion in the 154 00:09:04.479 --> 00:09:09.119 eal. External guidelines must meet specific methodological criteria. 155 00:09:09.669 --> 00:09:13.659 The academy uses the appraisal of guidelines and evaluation instrument 156 00:09:13.890 --> 00:09:15.700 or agreed to instrument 157 00:09:16.400 --> 00:09:20.349 guidelines that meet the criteria may be incorporated into the eal. 158 00:09:20.619 --> 00:09:22.460 They are rated by the expert panel 159 00:09:22.469 --> 00:09:25.260 using the academy's recommendation rating scale. 160 00:09:28.159 --> 00:09:31.140 Let's take a look at the guideline review process. 161 00:09:34.150 --> 00:09:38.840 An external review of the guideline ensures that the guideline has been developed 162 00:09:39.030 --> 00:09:42.090 using a systematic evidence analysis process. 163 00:09:43.169 --> 00:09:47.219 Guideline. Reviewers completely agreed to instrument evaluation form 164 00:09:47.640 --> 00:09:49.570 only guidelines that meet the rigorous 165 00:09:49.580 --> 00:09:52.580 methodology criteria may be published in the 166 00:09:52.799 --> 00:09:52.859 E A. 167 00:09:55.940 --> 00:09:59.299 The academy follows a rigorous review process. 168 00:09:59.650 --> 00:10:04.140 First, an interdisciplinary team of experts on the topic are solicited. 169 00:10:04.450 --> 00:10:07.840 Reviewers may include physicians, nurses, researchers 170 00:10:08.049 --> 00:10:10.440 for other discipline to work within the topic. 171 00:10:11.190 --> 00:10:12.530 Reviewers are blinded. 172 00:10:12.539 --> 00:10:16.289 The expert panel is not aware of who is selected to review the guideline. 173 00:10:17.320 --> 00:10:21.299 The reviewers used to agree to assess the quality of the guideline 174 00:10:21.469 --> 00:10:23.020 and the methodological rigor. 175 00:10:24.239 --> 00:10:27.580 The expert panel reviews the results of the guideline evaluation 176 00:10:27.820 --> 00:10:31.500 and determine agreement or disagreement with the external reviewers 177 00:10:32.479 --> 00:10:33.950 warranted edits are made. 178 00:10:34.830 --> 00:10:38.849 Finally, the council on research approves the guideline for publication and the E 179 00:10:39.000 --> 00:10:39.099 A 180 00:10:42.059 --> 00:10:44.429 now that the guideline has been published. 181 00:10:44.599 --> 00:10:46.989 Let's review how to access it on E 182 00:10:47.179 --> 00:10:47.299 A 183 00:10:50.359 --> 00:10:52.840 module. One explained how to access the E 184 00:10:53.020 --> 00:10:53.059 A 185 00:10:53.190 --> 00:10:53.799 content 186 00:10:54.570 --> 00:10:55.679 as a reminder, 187 00:10:55.760 --> 00:10:58.820 use your mouse to hover over the projects tab to 188 00:10:58.830 --> 00:11:01.530 view a listing of the topics in alphabetical order, 189 00:11:01.929 --> 00:11:03.280 select a topic 190 00:11:03.489 --> 00:11:04.039 guideline. 191 00:11:04.049 --> 00:11:08.239 Links are located in the left navigation bar with the most current information tab. 192 00:11:08.250 --> 00:11:10.419 Please note that not all e 193 00:11:10.530 --> 00:11:10.570 a 194 00:11:10.750 --> 00:11:13.229 systematic reviews result in the guideline. 195 00:11:16.510 --> 00:11:19.630 Here is a better view of the links to access the guideline. 196 00:11:20.260 --> 00:11:22.340 They include the executive summary 197 00:11:22.599 --> 00:11:25.919 guideline introduction, major recommendations, 198 00:11:25.929 --> 00:11:29.000 background information or appendices and references. 199 00:11:31.909 --> 00:11:34.159 The executive summary of a guideline 200 00:11:34.299 --> 00:11:37.080 is a list of the recommendations and ratings 201 00:11:37.270 --> 00:11:39.090 but without the supporting evidence, 202 00:11:39.809 --> 00:11:43.150 this is a great way to review the recommendations at a glance. 203 00:11:43.549 --> 00:11:46.510 The executive summary is available to the public. 204 00:11:49.469 --> 00:11:51.130 The guideline introduction 205 00:11:51.260 --> 00:11:53.150 includes the scope of the guideline 206 00:11:53.280 --> 00:11:54.599 statement of intent 207 00:11:55.270 --> 00:11:57.179 methods used to develop the guideline 208 00:11:57.549 --> 00:12:00.489 benefits and risks or harms of implementing the guideline. 209 00:12:01.130 --> 00:12:03.520 A thorough review of the guideline introduction 210 00:12:03.640 --> 00:12:07.250 will help the user understand the development of the recommendations 211 00:12:07.450 --> 00:12:08.909 to target audience 212 00:12:09.039 --> 00:12:10.450 and the guideline objective. 213 00:12:13.280 --> 00:12:15.090 Click on the recommendations tab 214 00:12:15.340 --> 00:12:18.010 to access the list of the recommendation links 215 00:12:18.400 --> 00:12:22.619 know the recommendations are organized by nutrition care process category. 216 00:12:23.340 --> 00:12:26.880 Click on the link to view the recommendation and supporting evidence. 217 00:12:30.590 --> 00:12:33.210 A detailed review of the methods for developing 218 00:12:33.219 --> 00:12:35.609 the guideline is outlined in this section. 219 00:12:39.659 --> 00:12:44.280 Additional guideline tabs include background and references which 220 00:12:44.289 --> 00:12:47.880 provide important information and the development of the guideline 221 00:12:50.739 --> 00:12:52.500 from the recommendations page. 222 00:12:52.510 --> 00:12:54.440 Click on the link to view the full 223 00:12:54.450 --> 00:12:59.539 recommendation rating risks in terms of implementing the recommendation 224 00:12:59.690 --> 00:13:01.500 conditions of application, 225 00:13:01.609 --> 00:13:03.280 narrative and rationale 226 00:13:03.890 --> 00:13:07.309 to view the content. Click on the title to expand each section, 227 00:13:10.520 --> 00:13:13.460 print the entire guideline from the guideline page, 228 00:13:13.940 --> 00:13:17.419 click on the title icon and select the PDF options. 229 00:13:20.380 --> 00:13:23.210 Academy guidelines are revisited every five years. 230 00:13:23.890 --> 00:13:27.549 A literature search and evidence mapping is conducted to 231 00:13:27.559 --> 00:13:30.700 identify new research published since the previous search. 232 00:13:31.760 --> 00:13:33.539 When the guideline is updated, 233 00:13:33.710 --> 00:13:36.700 a table is created comparing the new guideline 234 00:13:36.710 --> 00:13:38.419 and the older version of the guideline. 235 00:13:39.109 --> 00:13:42.789 The document will indicate which recommendation remain unchanged, 236 00:13:42.929 --> 00:13:45.890 updated, new or was not reviewed. 237 00:13:48.940 --> 00:13:51.200 The systematic review is now complete. 238 00:13:51.460 --> 00:13:53.000 The guideline has been developed. 239 00:13:53.109 --> 00:13:54.080 What's next? 240 00:13:56.619 --> 00:14:00.690 You have now learned how the research is synthesized and guidelines are developed. 241 00:14:01.380 --> 00:14:04.400 The next step is to apply the guideline into practice. 242 00:14:05.200 --> 00:14:09.419 Module five covers dissemination and implementation of the guideline. 243 00:14:12.309 --> 00:14:16.150 To learn more about the resources used by the academy to develop 244 00:14:16.320 --> 00:14:18.030 and review its guidelines. 245 00:14:18.140 --> 00:14:19.750 Please visit these sites. 246 00:14:20.179 --> 00:14:24.049 The links are also available in the policy and process section of the 247 00:14:24.270 --> 00:14:24.320 E A 248 00:14:24.950 --> 00:14:27.090 under the guideline development section. 249 00:14:30.770 --> 00:14:33.150 Please proceed to module five. Thank you.