Clinical guidelines, protocols and systematic reviews: what occupy?

Sergio Uribe
Universidad de Valparaíso - Universidad Austral de Chile Chile

Protocols
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Instructions on operational management of health problems identified. comprehens
ive review of the literature on a clearly defined question, which is done using
a systematic and explicit methods to identify, select and critically evaluate re
levant research. set of recommendations designed to support decision making of h
ealth professionals or patients

Systematic review
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Clinical Practice Guideline

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Em PubMed indexed publications
350 300
250
200 Pro to colos Gu scl tn ic ed as if ones if Re vi ste m to 150 as you c
100
50
0 8 0s 90s 60s 70s 2000s
Clinical protocols

series of procedures using a center any evidence, but generally are based on exp
ert opinion may be mandatory administrative part

Clinical protocols

CF Sumner et al. Operating room protocol. Bull Contra Costa Dent Soc 1967 Jun; 1
2 (4) :19-24. Turco M et al. Treatment of Severe temporomandibular joint bilater
al ankylosis in adults: our protocol. Minerva Stomatol. 2007 Apr; 56 (4) :181-90
.

Clinical Protocol
Systematic reviews
solve a specific problem using a specific type of evidence can be found that the
research results by themselves do not detect professionals involved

Systematic reviews

Tulloch JF et al. Methods Used to Evaluate Growth modification in Class II maloc

clusion. Am J Orthod Dentofacial Orthop. 1990 Oct; 98 (4) :340-7. Lopez R et al.
Selection bias in case-control studies on periodontitis: a systematic review. E
ur J Oral Sci 2007 Oct; 115 (5) :339-43.

Clinical guidelines

solve general problems using all available evidence used to support the particip
ating decision-making professionals, patients and agencies
Clinical guidelines

Infection control guidelines Tomasi NJ from Ohio State Dental Board. Cincinnati
Dent Soc Bull. 1986 Sep; 55 (7): 21, 23-4. Flores MT et al. Guidelines for the m
anagement of traumatic dental injuries. III. Primary teeth. Dent Traumatol. 2007
Aug; 23 (4) :196-202.

Clinical guidelines
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Clinical guidelines

Levels of evidence
- - - - - -
Ia Evidence obtained from a meta-analysis of controlled trials (RCT) Ib Evidence
obtained from at least one RCT IIa Evidence obtained from at least one well-des
igned study without randomization IIb Evidence obtained from at least one well-d
esigned quasi-experimental evidence III obtained from at least one well-designed
non-experimental studies IV Evidence obtained from expert opinion or consensus
reports
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Clinical guidelines

Grades of recommendation
- -
- -
A Requires at least one RCT and all the literature agrees quality B requires at
least one non-randomized clinical trial or well designed observational studies,
there may be conflicting evidence C requires the consensus of experts. It's easy
to find differences of opinion GPP Recommended Best Practice
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Authors SIGN Pages patient groups Dating Period Objective review from 1996 to 20
03 115 42 30 If you define effective strategies for prevention and management of
dental caries in children between 6-16 years 2 5 pages No Yes Yes Yes
MINSAL 38 No 47 1993-2005 32 maintain and restore oral health of children (a) 6
years
Pages Pages dedicated to restoring patients involved in clinical Sheet Quick Ref
erence Guide Recommendations for implementing recommendations for audit
No Yes No No No
What is most useful?

Clinical Guidelines Evidence Based Systematic Reviews Clinical Protocols

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Where to find information?
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Clinical Guides
www.guidelines.gov www.sign.ac.uk
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Systematic reviews
www.pubmed.com www.cochrane.org
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How do I know how good it is?

Systematic Review> QUORUM Clinical Guide> AGREE Protocol>?

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www.nature.com / ebd
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