Evidence Based Guidelines Development Project Research Articles

Diagnostic laparoscopy: indications and benefits.

The increased availability of treatment options for gastrointestinal cancer, necessitates precise preoperative staging. Laparoscopy can be useful for establishing the diagnosis and staging of cancer. However, there is an ongoing discussion as to whether staging laparoscopy provides additional results despite newly developed imaging tools. A systematic review of relevant literature was undertaken. The strength of evidence was classified according to the North of England Evidence Based Guidelines Development Project. Medline and manual searches were carried out to identify all published manuscripts of clinical trials that dealt with staging laparoscopy. Systematic quality review of those publications was used to verify staging accuracy, complications and trocar metastases. Only one randomized trial was performed in gynaecological cancer. In cervical cancer, as a result of this study, staging laparoscopy remains unproven. In gastrointestinal cancer (oesophageal, gastric, pancreatic, liver and colorectal cancers) only prospective and retrospective observational studies are available with an evidence-based level of grade B. As a result of these trials, staging laparoscopy, in a well-defined group of patients with locally advanced cancer, is recommended. The effects of surgical staging in gynaecological cancer must be kept in mind but cannot be transferred to gastrointestinal cancer in general. Further studies are required to answer those questions.

North of England evidence based guidelines development project: summary version of evidence based guideline for the primary care management of stable angina

The aim of this guideline is to provide recommendations to aid primary health care professionals in their management of patients with chronic stable angina due to coronary artery disease (not aortic stenosis or hypertrophic obstructive cardiomyopathy). It does not deal with unstable angina or myocardial infarction. It is a summary version of the full guideline,1 to which reference should be made for clarification or further information. The development group assumes that health care professionals will use general medical knowledge and clinical judgment in applying the general principles and specific recommendations in this document to the management of individual patients. Recommendations may not be appropriate for use in all circumstances. Decisions to adopt any particular recommendation must be made by the practitioner in the light of available resources and circumstances presented by individual patients. Throughout this guideline categories of evidence (cited as I, II, and III) and the strength of recommendations (A, B, or C) are as described in the paper in the previous issue (23 March, p 760). Aspects covered by this guideline are investigation, risk factor identification and management, drug treatment, and referral. All recommendations are for primary health care professionals and apply to adult patients attending general practice with angina. Comment—Assessment will be based on a clinical history and relevant examination. This guideline requires that the following should be known: precipitants of anginal attacks; smoking history; occupation; amount of exercise taken; drug history; weight; blood pressure. Comment—The group thought that a chronological age limit for investigation or referral was not appropriate. Functional status was thought to be more appropriate. ### Precipitating factors RECOMMENDATION ### Investigation of angina RECOMMENDATION Patients being investigated for angina should have the following investigations:

North of England evidence based guidelines development project: methods of guideline development

There is increasing interest in clinical guidelines in Britain. With this interest has come increasing awareness of the methodological issues in the development of valid guidelines.1 2 3 Practice guidelines are considered valid if “when followed, they lead to the health gains and costs predicted for them.”1 When appropriately disseminated and implemented, valid guidelines can lead to changes in clinical practice and improvements in patient outcome.4 5 6 7 Conversely, the dissemination and implementation of invalid guidelines may lead to wasteful use of resources on ineffective interventions or, worse, deterioration in patients' health. Validity has been related to three principal factors in guideline development—namely, the composition of the guideline development panel and its processes; the identification and synthesis of evidence; and the method of guideline construction.5 Though these factors have been discussed at theoretical5 and more practical levels,8 there have been few attempts to put them into practice in Britain. In this series of three papers we describe the methods used to develop evidence based guidelines for the primary care management of two common chronic conditions—namely, asthma in adults and stable angina—and summary versions of the two guidelines that resulted.9 10 The guideline development groups were composed of relevant health care professionals and patients; a specialist resource (a consultant chest physician for asthma and a consultant cardiologist for stable angina) and an experienced small group leader; and members of the research team. All group members …

North of England evidence based guidelines development project: summary version of evidence based guideline for the primary care management of asthma in adults

North of England evidence based guidelines development project: summary version of evidence based guideline for the primary care management of asthma in adults

Developing valid guidelines: methodological and procedural issues from the North of England Evidence Based Guideline Development Project.

Thereisincreasing interest inclinical guidelines within theUnitedKingdom. Withthis interest hascomeanincreasing awareness of themethodological issues involved inguideline development, although reports arelimited.' Woolfdescribed threemainmethodsof guideline development: informal consensus, formal consensus, andevidence linked.2 In guidelines developed through informal consensus, themethodusedmostofteninthe UnitedKingdom,theguideline panelhas poorly defined, oftenimplicit, criteria for decision making. Development by formal consensus, usedby many consensusdevelopment conferences andDelphi groups, provides greater structure totheanalytical process butstill fails toprovide anexplicit