ICU · Statistics & evidence-based medicine
Guidelines, Evidence-Based Medicine & Quality-Improvement Methodology
Also known as Evidence-based medicine · GRADE · GRADE Evidence to Decision · Clinical guidelines · Guideline development · Quality improvement · PDSA cycle · AGREE II · PICO · Care bundles · Evidence hierarchy · Systematic review · Critical appraisal · CASP · CONSORT · PRISMA · STROBE · Bias · Implementation science · Knowledge translation · CFIR · PARIHS
Guidelines, EBM and quality improvement for the ICU First Part: evidence-based medicine as the integration of best evidence, clinical expertise and patient values; the PICO question and the evidence hierarchy; the GRADE approach to evidence quality (high/moderate/low/very low), recommendation strength (strong/weak), downgrading and upgrading domains, and the Evidence to Decision framework; the guideline-development pipeline from PICO to systematic review to evidence profile to graded recommendation; guideline appraisal (AGREE II); critical appraisal tools (CASP checklists) and reporting guidelines (CONSORT, PRISMA, STROBE); implementation science (knowledge-to-action, CFIR, PARIHS); and QI methodology - PDSA cycles, care bundles, audit and feedback, and the structure-process-outcome framework.
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Meet the patient — the guideline you are asked to trust
You are the ICU representative on the hospital antimicrobial stewardship committee. A new national guideline recommends procalcitonin-guided antibiotic discontinuation as a weak recommendation, moderate-quality evidence. The committee chair asks: should we adopt this? Before you can answer, you need to know what those words mean, how the guideline was built, and whether you can trust it.[1][2]
Evidence-based medicine is the integration of the best research evidence with clinical expertise and patient values. It is not cookbook medicine — your judgment and the patient in front of you are explicit, weighted components. The pipeline runs from asking the right question (PICO), through finding and grading the evidence (GRADE), to appraising the guideline (AGREE II), to closing the gap between guidance and practice (PDSA, care bundles, audit). The whole chain is examinable end to end.[1][2]
References23ShowHide
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- [13]Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, Fervers B, Graham ID, Grimshaw J, Hanna SE, Littlejohns P, Makarski J, Zitzelsberger L; AGREE Next Steps Consortium AGREE II: advancing guideline development, reporting and evaluation in health care CMAJ, 2010.PMID 20603348
- [14]Schulz KF, Altman DG, Moher D; CONSORT Group CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials BMJ, 2010.PMID 20332509
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- [17]von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies PLoS Med, 2007.PMID 17941714
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