Guidelines Presentation - International Le.PPTVIP

Evidence-Based Guidelines for the Treatment of Epileptic Seizures with AEDs Elinor Ben-Menachem, MD, PhD Institution for Clinical NeuroscienceSahlgrenska Academy Sahlgrenska University Hospital G?teborg, Sweden Guideline Development Overview of activities Guideline Development Find the evidence Define inclusion/exclusion criteria Search clinical question + inclusion/exclusion criteria Potential sources to search electronic databases (MEDLINE, Current Contents) Cochrane library published literature/references unpublished data English/non-English studies Perform multiple searches Guideline Development – 2 Abstract, Analyze and Grade/Rate the evidence Specific relevant variables as measure of quality “Major” variables Randomization Control group Masked outcome assessment Adequate comparator (assay sensitivity) Adequate enrollment to detect difference Minimal detectable difference Guideline Development – 3 Abstract, Analyze and Grade/Rate the evidence “Minor” variables Primary outcome clearly defined Inclusion/Exclusion criteria clearly defined Equivalent treatment groups at baseline Adequate duration of assessment Drop out rate and how it is handled statistically Summarize abstraction/analysis into tabular form Evidence tables Guideline Development – 3 Abstract, Analyze and Grade/Rate the evidence Grading/rating scale based on relevant variables Usually four categories Top group – RCTs with best evidence, meet all criteria Next group – RCTs missing some “minor” criteria Third group – Trial missing some “major” criteria Last group – Low quality trials missing most or all “major” criteria OR only expert opinion Significant variability in grading/rating scales across guidelines Guideline Development Translate evidence and develop recommendations Usually 4 or 5 levels of recommendations Levels defined using output of grading/rating scale At least one recommendation per question Develop algorithm (if possible) Validate guideline Internal/External Peer rev