MEDECIELO MELO - Chapter 8 Summary

Name: Melo L.
Medecielo
Chapter Title: EvidenceBased Clinical Practice Guidelines
Definition of Terms: Summary
1. Clinical practice - to assist The finest patient care is provided through

practitioners and patient decisions clinical practice, which also serves as a guide
about appropriate health care for the best interventions and treatments. The
2. Methodology - used to identify, and goal of clinical practice is to increase patient
analyze information about a topic. safety while lowering costs and enhancing
3. Guidelines - contains treatment quality. Guidelines can increase
recommendations for clinical practice patient safety by lowering medical errors. In
or health policy. order to make decisions regarding a patient's
4. Utilization - making practical and treatment, evidence-based medicine (EBM)
effective use of something. uses the most recent best practices. Health
5. External Barrier - examining the care professionals who have a part in the
barriers and the potential resources creation and application of recommendations
for addressing each of the problem include pharmacists, therapists, nurses, and
6. Evidence based practice - process others who are specialist physicians who
used to review and translate the latest treat patients. Health care professionals
scientific evidence. should check the recommendations to see if
7. Explicit - stated clearly, leaving no the questions were well described and should
room for conclusion or doubt. take into account if they would be helpful in
8. Rigorous - extremely thorough or practice.
accurate.
9. Conflict of interest - refers to the Before deciding to put a recommendation into
situation in which financial or other action, healthcare professionals weigh the
personal consideration may advantages and risks of a therapy or
compromise. intervention. The grading system determined
10. Morbidity and mortality - morbidity is the intensity of the suggestions and the
the state of being unhealthy of a degree of assurance in the accuracy of the
disease, while Mortality is the number effect assessment.
of death occur in a population.
The GRADE working group employs a
uniform grading system to assess the
reliability of the available data and the
efficacy of clinical treatment. Moreover, this
system takes results relating to risks
associated with treatment. Clinical
recommendations include all essential
components of standard therapy for the
majority of patients with a certain ailment.
Consideration of the unique patient features
that would justify deviating from the
recommended course of action should be
prompted by guidelines. Clinical practice
guidelines are used in the healthcare industry
to make it easier to apply evidence to clinical
practice, increase patient safety and care
quality, and reduce costs.
Self-Assessment questions
Copy + Paste the Self-Assessment questions. Provide your answer and rationale with
citations. Follow the sample given below.
Answer:
Choice: A
Rationale:
1. Which groups or organization types are commonly involved in guideline development?

a. Federal and state governments
b. Professional societies and associations
c. Managed care organizations
d. Third-Party payers
e. All of the above
Answer: All of the above

Choice: E
Rationale: Governments, professional associations third party payers and utilization review
groups develop guidelines.
Reference: Abrons, J., & Kukreja, P. (2023). Drug Information: A Guide for Pharmacists. 5
2. Which characteristic is common between guideline development and drug information

practices?
a. Decision-making and recommendations based on individual experience
b. Assurance of cost savings
c. A clear specific definition of clinical questions
d. Lack of interdisciplinary participation
Answer: assurance of cost savings

Choice : B
Rationale: National academies of science, engineering, and medicine reports explicitly dealt
with standard clinical practice guidelines, systematic reviews of comparative effectiveness
research and providing care at lower cost.
3. Clinical practice guidelines are essential to getting research findings into practice
because:
a. Wellstudied new treatments proven effective are substantially underutilized.
b. Interventions found to be ineffective or harmful continue to be provided.
c. Research information is not readily available for implementation into practice.
d. a and b only are essential.
e. b and c only are important.
Answer: a and b are essential

Choice : D
Rationale: Delay in the sharing of knowledge of well studied, efficacious treatment has
resulted underutilization of appropriate interventions and continued used of interventions
proven to be ineffective.
4. Recommendations for optimizing patient care that are developed by systematically

reviewing the evidence and assessing the benefits and harms of
health care interventions is the definition for:
a. Strengths of recommendations
b. Evidencebased medicine
c. Clinical practice guidelines
d. Systematic reviews
Answer: Clinical practice guidelines

Choice: C
Rationale: Clinical practice guidelines are recommendations for providing optimal patient
care. Ideally based on systematic review. And expert knowledge to assess the benefits and
harms of interventions for topic or disease states.
5. Which of the following is among the five core competencies for health professionals as
recommended in a landmark Institute of Medicine report?
a. Deliver patientcentered care.
b. Participate in interdisciplinary teams.
c. Utilize informatics.
d. All of the above.
Answer: All of the above

Choice: D
Rationale: The central concept of these reports relate to the use of the best available
evidence, the use of decision support and including patient in healthcare decisions.
6. The first step in the Institute of Medicine’s proposed standards for developing
evidencebased clinical practice guidelines is:
a. Conduct a systematic review for qualifying evidence.
b. Establish an interdisciplinary guideline development group.
c. Establish transparency.
d. Manage conflict of interest.
Answer: Establishing transparency

Choice: C
Rationale: The first step of the major steps in proposed standards is establishing
transparency.
7. Development of a clinical practice guideline should:

a. Include a hospital administrator
b. Be an interdisciplinary process
c. Be made up of panel members without any conflicts of interest
d. Have a pharmacist leading the effort
Answer: Be a made up of panel members without any conflict of interest

Choice: C
Rationale: Individuals considered membership should declare interest and activities
potentially resulting in managing of conflict.
8. Which of the following characteristics associated with a disease would suggest that it
would be a good topic for the development and
implementation of a practice guideline?
a. Evidence that current practice is optimal
b. Evidence of little variation in current practice
c. Availability of highquality evidence for the efficacy of treatments that reduce morbidity or
mortality
d. Low frequency and/or severity of morbidity or mortality
Answer: Availability of high quality evidence for the efficacy of treatments that reduce
morbidity or mortality
Choice: C
Rationale: Characteristics of disease states with the maximum potential to benefit from
guidelines includes availability of high qualityfor the efficacy of treatments that reduce morb.
And mortality.
9. In the PICO model for framing clinical questions, the C represents:

a. Collaboration
b. Comparison
c. Clinical
d. Control
Answer: comparison
Choice: B
Rationale: comparison means what other interventions or treatments were compared with
the interventions considered.
10. When using the GRADE system, which of the following information should be
incorporated with guideline recommendations?
a. Quality of evidence across studies for each critical outcome
b. Strength of the recommendations
c. The balance between benefits and harms
d. a and b only
Answer: A and B only

Choice: D
Rationale: The GRADE working group first published a standardized grading method for
determining the quality of evidence and the strength of clinical practice recommendations in
2004.
11. When using the GRADE system, all of the following are reasons for lowering the level of
confidence rating except:
a. Publication bias
b. Imprecision
c. Indirectness
d. Consistency
Answer: consistency
Choice: D
Rationale: the rating are increased or decreased based on five reasons which are risk of
bias, inconsistency , indirectness, imprecision and publication bias.
12. When using the GRADE system, which of the following is a reason for rating the level of
confidence higher?
a. Doseresponse relationship
b. Large effect size
c. b and c only
d. a, b, and c
Answer: A, B and C
Choice: D
Rationale: the level of confidence similarly can be increased based on three reasons; large
effect size, dose response and all plausible confounding.
13. All of the following are true regarding the AGREE II instrument for guideline evaluation
except:
a. Created by an international group of researchers and policymakers
b. Provides a framework to assess the quality of guidelines
c. Assesses the quality of the clinical content
d. Provides a methodological strategy for the development of guidelines
Answer: created by an international group of research and policymakers

Choice : A
Rationale: AGREE II was develop to assist in evaluating guideline quality, provide a
methodological strategy for guideline develop, and inform practitioners about what
information should be reported.
14. External barriers to clinical practice guideline implementation include all of the following
except:
a. Cost to patient
b. Increased malpractice liability
c. Insufficient staff, consultant support, or other resources
d. Lack of reimbursement
Answer: NOTA
Choice: None
Rationale: All of the following are part of the External Barriers
15. All of the following statements about clinical practice guidelines are true except:
a. Clinical practice guidelines should contain all necessary elements of routine care for
most individuals with a specific condition.
b. Clinical practice guidelines should not prompt consideration of the specific characteristics
of an individual patient that might warrant departures from the guideline.
c. Clinical practice guidelines represent an application of decision support systems to
facilitate providing quality clinical care.
d. Clinical practice guidelines should be part of the continuous improvement of systems of
care.
Answer: Clinical practice guidelines should be part of the continuous improvement of

system care.
Choice: D
Rationale: Guidelines are already in practice of improving the quality and outcomes of care.
References (APA 7th ed)

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Name: Melo L.

Definition of Terms: Summary

1. Clinical practice - to assist The finest patient care is provided through

1. Which groups or organization types are commonly involved in guideline development?

Answer: All of the above

2. Which characteristic is common between guideline development and drug information

Answer: assurance of cost savings

Answer: a and b are essential

4. Recommendations for optimizing patient care that are developed by systematically

Answer: Clinical practice guidelines

Answer: All of the above

Answer: Establishing transparency

7. Development of a clinical practice guideline should:

Answer: Be a made up of panel members without any conflict of interest

9. In the PICO model for framing clinical questions, the C represents:

Answer: A and B only

Answer: created by an international group of research and policymakers

Answer: Clinical practice guidelines should be part of the continuous improvement of

References (APA 7th ed)

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