Module-4-EBNPG_2024_audio

Welcome to module four of the evidence analysis center orientation tutorial. In this module, you will learn how the Academy's evidence based Nutrition Practice guidelines are developed upon completion of module four, you will understand the importance of clinical guidelines. How the guidelines are developed components of a guideline and how to locate and navigate the guideline and the evidence analysis library, evidence-based Nutrition Practice guidelines are a series of guiding statements which are developed using a systematic process for identifying, analyzing and synthesizing scientific evidence and interpreting the evidence of clinical expertise. They are designed to assist practitioner and patient decisions about appropriate nutrition care for specific diseases or conditions in typical settings. Key elements include scope interventions and practices considered major recommendations and corresponding reading of evidence. Strength and rationale guidelines promote consistency, achievement of expected outcomes and assure quality care guideline. Support implementation of the nutrition care process and its terminology support reimbursement efforts and implementing guidelines encourage recognition and collaboration by and with other healthcare professionals guidelines are built from systematic reviews, the evidence summaries and conclusion statements from the systematic review report. What the evidence says the guideline recommendation is a course of action for the practitioner. Before the work of the guideline starts the project manager and the expert panel review, the systematic review evidence and the strength of the evidence. This information will guide the development of the guideline following the E A framework. The project manager and the expert panel ask, does this topic have multiple subtopics and require extensive guidelines and formal recommendations for practitioners. If the answer is yes, the guideline development phase begins, let's review the guideline development process. In previous modules, we covered the scoping review process and the systematic review process. The guideline process also has five major steps which include an evidence to decision framework, development recommendations and the rationale, the assignment of a grade in rating and a thorough internal and external review. And finally, the dissemination and implementation of the guideline recommendations are the key focus of evidence based guidelines. They are the unique components that distinguish practice guidelines from other clinical publications. Once the systematic review steps are completed, the expert panel applies moderating factors to formulate recommendations. The academy uses an evidence to decisions framework tool designed to develop a transparent and logical way to determine the need for recommendation. The tour guides, the expert panel to address a series of questions that will determine if a recommendation should be developed. A recommendation should be written using brief action statements. The first sentence should be the what of the recommendation. The second sentence should be the why a good recommendation will contain what to do and why do it and should be easily identifiable. The expert panel should use action words so that the recommendation is clear guideline components include recommendation, recommendation, rating, classification of conditional or imperative risk. In terms of implementing the recommendation conditions of application, potential costs associated with application recommendation, narrative recommendation, strength rationale minority opinions if needed and its supporting evidence. The rating for the recommendation is primarily based on the strength of the supporting evidence but also the balance between benefits or harms anticipated and clinical practice implications. Each recommendation is labeled conditional or imperative. An imperative label means that the recommendation is broadly applicable to the target population without restraints and pertinence. A conditional label means that the recommendation clearly defines a specific situation or a specific subpopulation within the larger guideline population. Here is the rating chart and the definitions for each rating category. This chart is available from the evidence analysis library under the policy and process section. For each form of treatment, recommended safety issues should be considered in terms of potential harm. The long term use in safety of specific dietary components or supplements is an important consideration in recommendations to treat a specific condition. The expert panel is any risk or harms in this section of the guideline. Any condition that may limit the application of the recommendation should be indicated under the heading title conditions of application. A recommendation with a conditional label will always have conditions specified. This section covers obvious cause that may be associated with the application of the recommendation. The cost can be afforded to patient, the facility or health care organization. Examples include a specialized staff equipment or laboratory test. The recommendation narrative is a summary of the supporting evidence for each recommendation within the guideline. It clearly explains the evidence that supports the recommendation. It includes the study designs and quality ratings of the included studies. When developing the rationale, the lead analysts begin by first stating the highest quality articles and the findings as they relate to the outcomes that were addressed as with the recommendation language. It is important to state only the facts and findings of the relevant articles and that include any opinion based language list, the evidence strain and methodological issues that determine the recommendation strength. The expert panel usually reaches a consensus and the recommendation and a rating so they will write none. However, if they cannot come to a consensus, then any minority opinions should be listed here. Since the majority of the recommendations are supported by the systematic review, the evidence analysis question is linked under this heading area. This is a review bibliography for each research question is linked under the section titled references, sources not analyzed during the systematic review process may be used to support and formulate a recommendation. References must be credible resources. For example, other guidelines or position papers recommendations based solely on these types of references are rated as consensus recommendations are largely based on the summarized evidence from an E A systematic review. However, sometimes the expert panel may determine that the eal may be straightened and broaden by using external guidelines. When developing the recommendations, external guidelines may be incorporated into the E A by serving as a reference for a consensus recommendation. The methodology is carefully vetted by the lead analyst to be considered for inclusion in the eal. External guidelines must meet specific methodological criteria. The academy uses the appraisal of guidelines and evaluation instrument or agreed to instrument guidelines that meet the criteria may be incorporated into the eal. They are rated by the expert panel using the academy's recommendation rating scale. Let's take a look at the guideline review process. An external review of the guideline ensures that the guideline has been developed using a systematic evidence analysis process. Guideline. Reviewers completely agreed to instrument evaluation form only guidelines that meet the rigorous methodology criteria may be published in the E A. The academy follows a rigorous review process. First, an interdisciplinary team of experts on the topic are solicited. Reviewers may include physicians, nurses, researchers for other discipline to work within the topic. Reviewers are blinded. The expert panel is not aware of who is selected to review the guideline. The reviewers used to agree to assess the quality of the guideline and the methodological rigor. The expert panel reviews the results of the guideline evaluation and determine agreement or disagreement with the external reviewers warranted edits are made. Finally, the council on research approves the guideline for publication and the E A now that the guideline has been published. Let's review how to access it on E A module. One explained how to access the E A content as a reminder, use your mouse to hover over the projects tab to view a listing of the topics in alphabetical order, select a topic guideline. Links are located in the left navigation bar with the most current information tab. Please note that not all e a systematic reviews result in the guideline. Here is a better view of the links to access the guideline. They include the executive summary guideline introduction, major recommendations, background information or appendices and references. The executive summary of a guideline is a list of the recommendations and ratings but without the supporting evidence, this is a great way to review the recommendations at a glance. The executive summary is available to the public. The guideline introduction includes the scope of the guideline statement of intent methods used to develop the guideline benefits and risks or harms of implementing the guideline. A thorough review of the guideline introduction will help the user understand the development of the recommendations to target audience and the guideline objective. Click on the recommendations tab to access the list of the recommendation links know the recommendations are organized by nutrition care process category. Click on the link to view the recommendation and supporting evidence. A detailed review of the methods for developing the guideline is outlined in this section. Additional guideline tabs include background and references which provide important information and the development of the guideline from the recommendations page. Click on the link to view the full recommendation rating risks in terms of implementing the recommendation conditions of application, narrative and rationale to view the content. Click on the title to expand each section, print the entire guideline from the guideline page, click on the title icon and select the PDF options. Academy guidelines are revisited every five years. A literature search and evidence mapping is conducted to identify new research published since the previous search. When the guideline is updated, a table is created comparing the new guideline and the older version of the guideline. The document will indicate which recommendation remain unchanged, updated, new or was not reviewed. The systematic review is now complete. The guideline has been developed. What's next? You have now learned how the research is synthesized and guidelines are developed. The next step is to apply the guideline into practice. Module five covers dissemination and implementation of the guideline. To learn more about the resources used by the academy to develop and review its guidelines. Please visit these sites. The links are also available in the policy and process section of the E A under the guideline development section. Please proceed to module five. Thank you.