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A COMPARISON OF CLINICAL PRACTICE GUIDELINE APPRAISAL INSTRUMENTS
- Ian D. Graham, Lisa A. Calder, Paul C. Hébert, Anne O. Carter, Jacqueline M. Tetroe
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 16 / Issue 04 / October 2000
- Published online by Cambridge University Press:
- 25 May 2001, pp. 1024-1038
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- Article
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Objective: To identify and compare clinical practice guideline appraisal instruments.
Methods: Appraisal instruments, defined as instruments intended to be used for guideline evaluation, were identified by searching MEDLINE (1966–99) using the Medical Subject Heading (MeSH) practice guidelines, reviewing bibliographies of the retrieved articles, and contacting authors of guideline appraisal instruments. Two reviewers independently examined the questions/statements from all the instruments and thematically grouped them. The 44 groupings were collapsed into 10 guideline attributes. Using the items, two reviewers independently undertook a content analysis of the instruments.
Results: Fifteen instruments were identified, and two were excluded because they were not focused on evaluation. All instruments were developed after 1992 and contained 8 to 142 questions/statements. Of the 44 items used for the content analysis, the number of items covered by each instrument ranged from 6 to 34. Only the instrument by Cluzeau and colleagues included at least one item for each of the 10 attributes, and it addressed 28 of the 44 items. This instrument and that of Shaneyfelt et al. are the only instruments that have so far been validated.
Conclusions: A comprehensive, concise, and valid instrument could help users systematically judge the quality and utility of clinical practice guidelines. The current instruments vary widely in length and comprehensiveness. There is insufficient evidence to support the exclusive use of any one instrument, although the Cluzeau instrument has received the greatest evaluation. More research is required on the reliability and validity of existing guideline appraisal instruments before any one instrument can become widely adopted.
2 - The Epidemiology of ARDS
- Edited by James A. Russell, St. Paul's Hospital, Vancouver, Keith R. Walley, St. Paul's Hospital, Vancouver
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- Book:
- Acute Respiratory Distress Syndrome
- Published online:
- 05 October 2010
- Print publication:
- 28 May 1999, pp 28-47
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- Chapter
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Summary
Introduction
More than 25 years ago, Ashbaugh and colleagues described a series of patients whose striking but uniform clinical, physiologic, roentgenographic, and pathologic abnormalities distinguished them from other patients who developed respiratory failure. This syndrome has since become known as adult or acute respiratory distress syndrome (ARDS). Despite extensive research and literature devoted to ARDS, overall mortality rates have remained in excess of 40%. The inability to find new therapeutic modalities that decrease mortality rates from this syndrome has been a source of disappointment in this field. Consequently, prevention or early intervention appears to be an important and necessary approach in the management of ARDS. The high mortality rate and lack of success of new interventions have also led to a reevaluation of our basic understanding of ARDS. Thus, revisiting the epidemiology of this syndrome is of paramount importance. By determining the incidence and establishing risk factors for ARDS, invaluable information required to develop preventative strategies or targeted early therapy may surface, offering the hope for improved outcomes in patients afflicted with this syndrome.
In this chapter, we begin by describing possible study designs used in determining epidemiologic features of any disease, including ARDS, in order to better appreciate the strengths and weaknesses of the existing literature. We then describe the major studies estimating the incidence, risk factors, and case-fatality rate of ARDS. We also briefly discuss the long-term outcomes of this illness. In order to provide the reader with the most reliable epidemiologic inferences from the literature, we have primarily based our comments on a systematic search, selection, and appraisal of the published literature.