Journal Club - 2007-10-23

Reading and assessing practice guidelines

Summary

For reading guidelines, if they are hard to read, look for synopses elsewhere

• Early: FirstWatch (free), JournalWatch, editorials
• Later: UpToDate, PIER, NGC, Inforetriever

For assessing guidelines, look in their publication, or their republication at NGC, for evidence of

• transparent, accountable process. Systematic review
• broad representation of stake holders

Difficult guidelines to use

Preoperative cardiac. Oct, 2007 (too dense)

• The statement
  • At Circulation
    • Executive summary (27 page pdf) (handout is an extract)
    • Full text (1.5 meg, 83 page pdf)
• Synopses
  • Journal Watch (easy)
  • NGC - not yet available
  • PIER - not yet available
  • UpToDate - not yet updated

Endocarditis. April, 2007 (too dense)

• The statement
  • At Circulation
    • Definition of high risk
• Synopses
  • Journal Watch
    • General
    • Cardiology
    • Dermatology
    • GI
    • Pediatrics
    • Women's health
  • NGC - not yet available
  • PIER - (easy)
  • UpToDate - (easy)

CDC Adult Immunization Schedule. Oct, 2007 (sparse)

• The statement
  • At the CDC (handout)
  • At the Annals
  • MMWR
• Synopses
  • Annals editorial
  • Journal Watch
  • NGC - NA

Example:

• Varicella: "routine vaccination of all healthy persons aged >13 years without evidence of immunity"
  • Methods (scroll down to methods)
• So should we be screening for varicella by querying prior varicella illnesses, then checking serology if history is negative?

ACP and USPSTF (much easier to use)

These are all written in the inverse pyramid structure

Glycemic Control and Type 2 Diabetes Mellitus: The Optimal Hemoglobin A1c Targets. A Guidance Statement from the American College of Physicians. Annals, 2007 (handout)

Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Annals, 2007

Counseling about Proper Use of Motor Vehicle Occupant Restraints and Avoidance of Alcohol Use while Driving: U.S. Preventive Services Task Force Recommendation Statement. Annals, 2007

Assessing practice guidelines

Formal methods are:

• AGREE Collaboration - 23 item form
• GRADE Working Group - 5 item form

Quick and dirty is to use:

1. National Guidelines Clearinghouse (NGC) guidelines.gov or simply ngc.gov. However, you must wait a few months.

• look at the Guideline's complete summary
  • Prostate cancer - American Cancer Society
  • Prostate cancer - USPSTF
• you can compare guidelines with their "My Collection"
  • Example with prostate cancer

2. UpToDate and PIER