 |
|
Users' Guides to the Medical Literature
XVI. How to Use a Treatment Recommendation
Gordon H. Guyatt, MD, MSc;
Jack Sinclair, MD;
Deborah J. Cook, MD, MSc;
Paul Glasziou, MB, BS, PhD;
for the Evidence-Based Medicine Working Group and the Cochrane Applicability Methods Working Group
JAMA. 1999;281:1836-1843.
Clinicians can often find treatment recommendations in traditional narrative reviews and the discussion sections of original articles and meta-analyses. Making a treatment recommendation involves framing a question, identifying management options and outcomes, collecting and summarizing evidence, and applying value judgments or preferences to arrive at an optimal course of action. Each step in this process can be conducted systematically (thus protecting against bias) or unsystematically (leaving the process open to bias). Clinicians faced with a plethora of recommendations may wish to attend to those that are less likely to be biased. Therefore, we propose a hierarchy of rigor of recommendations to guide clinicians when judging the usefulness of particular recommendations. Recommendations with the highest rigor consider all relevant options and outcomes, include a comprehensive collection of the methodologically highest quality data with an explicit strategy for summarizing the data (that is, a systematic review), and make an explicit statement of the values or preferences involved in moving from evidence to action. High rigor recommendations come from systematically developed, evidence-based practice guidelines or rigorously conducted decision analyses. Systematic reviews, which typically do not consider all relevant options and outcomes or make the preferences underlying recommendations explicit, offer intermediate rigor recommendations. Traditional approaches in which the collection and assessment of evidence remains unsystematic, all relevant options and outcomes may not be considered, and values remain implicit, provide recommendations of weak rigor. In an era in which clinicians are barraged by recommendations as to how to manage their patients, this hierarchy provides a potentially useful set of guides.
Author Affiliations: Departments of Clinical Epidemiology and Biostatistics (Drs Guyatt, Sinclair, and Cook), Medicine (Drs Guyatt and Cook), and Pediatrics (Dr Sinclair), McMaster University, Hamilton, Ontario; and Department of Social and Preventive Medicine, University of Queensland Medical School, Herston QLD, Australia (Dr Glasziou).
RELATED ARTICLE
May 19, 1999
JAMA. 1999;281(19):1863-1864.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Accreditation Council for Graduate Medical Education Competencies: Practice-Based Learning and Systems-Based Practice
Moskowitz and Nash
American Journal of Medical Quality 2007;22:351-382.
The Pylorus: Take It or Leave It? Systematic Review and Meta-Analysis of Pylorus-Preserving versus Standard Whipple Pancreaticoduodenectomy for Pancreatic or Periampullary Cancer
Karanicolas et al.
Ann. Surg. Oncol. 2007;14:1825-1834.
ABSTRACT
| FULL TEXT
A systematic review of conservative treatment of carpal tunnel syndrome
Piazzini et al.
Clin Rehabil 2007;21:299-314.
ABSTRACT
Eligibility Criteria of Randomized Controlled Trials Published in High-Impact General Medical Journals: A Systematic Sampling Review
Van Spall et al.
JAMA 2007;297:1233-1240.
ABSTRACT
| FULL TEXT
Bias in Clinical Intervention Research
Gluud
Am J Epidemiol 2006;163:493-501.
ABSTRACT
| FULL TEXT
A systematic review of prevalence and risk factors associated with playing-related musculoskeletal disorders in pianists
Bragge et al.
Occup Med (Lond) 2006;56:28-38.
ABSTRACT
| FULL TEXT
Evidence based prescribing
Maxwell
BMJ 2005;331:247-248.
FULL TEXT
Searching for Evidence-Based Medicine in the Literature Part 3: Assessment
Bartkowiak
Clin Med Res 2005;3:113-115.
FULL TEXT
Implementing Clinical Practice Changes: A Practical Approach
Wysocki and Bookbinder
Home Health Care Management Practice 2005;17:164-174.
ABSTRACT
Thrombosis Prophylaxis in Patient Populations With a Central Venous Catheter: A Systematic Review
Klerk et al.
Arch Intern Med 2003;163:1913-1921.
ABSTRACT
| FULL TEXT
Internal Fixation Compared with Arthroplasty for Displaced Fractures of the Femoral Neck: A Meta-Analysis
Bhandari et al.
JBJS 2003;85:1673-1681.
ABSTRACT
| FULL TEXT
Defining Benefits and Risks for SERMs in Clinical Trials and Clinical Practice
JOHNSON et al.
Ann. N. Y. Acad. Sci. 2001;949:304-314.
ABSTRACT
| FULL TEXT
Applying the results of trials and systematic reviews to our individual patients
Straus and McAlister
Evid. Based Ment. Health 2001;4:6-7.
FULL TEXT
Erythropoietin: A Paradigm for the Development of Practice Guidelines
Rizzo et al.
ASH Education Book 2001;2001:10-30.
ABSTRACT
| FULL TEXT
Grades of Recommendation for Antithrombotic Agents
Guyatt et al.
Chest 2001;119:3S-7S.
FULL TEXT
Evidence-based medicine: a commentary on common criticisms
Straus and McAlister
CMAJ 2000;163:837-841.
ABSTRACT
| FULL TEXT
Users' Guides to the Medical Literature: XXV. Evidence-Based Medicine: Principles for Applying the Users' Guides to Patient Care
Guyatt et al.
JAMA 2000;284:1290-1296.
ABSTRACT
| FULL TEXT
Users' Guides to the Medical Literature: XX. Integrating Research Evidence With the Care of the Individual Patient
McAlister et al.
JAMA 2000;283:2829-2836.
ABSTRACT
| FULL TEXT
|
