Evidence Sixteen Individual Studies, Reviews,

¶ … Evidence

Sixteen individual studies, reviews, and guidelines were identified and examined for the quality of their evidence and recommendations. Only three of these published items met all four of the identified evaluation criteria (consideration of all groups, options, and outcomes; review of evidence linking options to outcomes; specification of values; and an assessment of the strength of recommendations made). Over half (eleven) of the studies failed to meet the first criteria, and many also did not clearly evaluate the strength of the recommendations made in the article. All but four of the items examined in this process included some level of review that kinked evidence to options, although the extent of the review and the degree of detail and certainty in these reviews varied drastically from study to study.

Grading of Recommendations

A wide variety of recommendations on a diversity of subjects and practice areas are made in the publications reviewed, covering issues such as communication between doctors and nurses, knowledge level of patients, best practices for emergency room care, and many other areas. The degree to which these recommendations can be trusted and valued is significantly different in each study, and thus letter grades were assigned to each set of recommendations mad according to a modified version of the Grading tool presented by DiCenso, Guyatt, and Ciliska, and the Canadian Task Force on Preventive Health Services. Most of the recommendations made were quite clear, however not all of them were especially trustworthy.

Many of the reviews that were analyzed were able to derive very clear recommendations from a wide variety of sources consulted, and these results and recommendations also tended to receive higher grades than many of the other published materials assessed due to a broader scope and increased validity. By using a review technique, evidence from many different studies and types of research could be compared and analyzed, leading to the result of a higher grade. The few guidelines that were reviewed were the most clear in their recommendations, yet because the direct evidence that led to the formation of these guidelines was not fully provided the recommendations received a lower score. This is not to suggest that these guidelines, when produced by reputable organizations, are not worthy of implementation or consideration, but rather that further investigation into the guideline areas, such that primary research data is found that supports the recommendations in the guidelines published. Having this data directly available will enable the guidelines to be viewed with a higher score of validity and reliability.