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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2009 September;75(9):504-8


language: English

How to develop guidelines for clinical practice

Jaeschke R., Jankowski M., Brozek J., Antonelli M.

1 Department of Medicine, McMaster University, Hamilton, ON, Canada; 2 Polish Institute for Evidence-Based Medicine, Kraków, Poland; 3 Department of Medicine, Jagiellonian University School of Medicine, Kraków, Poland; 4 Regina Elena Italian National Cancer Institute, Rome, Italy; 5 Institute of Anesthesia and Intensive Care, Sacro Cuore Catholic University, Rome, Italy


Recent decades have seen an explosion of clinical practice guidelines – documents developed to inform clinicians about the best options for managing treatment, with the explicit intent to influence behaviour. As our exposure to guidelines has increased it has become clear that the process of guideline development should follow specific rules in order to avoid disagreement, misunderstanding, misleading recommendations, and confusion. In this article, we review the approach to developing clinical practice guidelines suggested by an international Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) workgroup. This approach suggests several steps for guideline development: 1. determine the purpose, scope, and intended audience; 2. select the panel of guideline authors; 3. specify the main focused clinical questions that the recommendations will address; 4. decide on the relative importance of outcomes; 5. find and summarize the evidence supporting each recommendation; 6. determine the quality of the available evidence; 7. evaluate the balance of desirable and undesirable consequences for a particular course of action; 8. formulate recommendations, including their strenght; and 9. consider a system for subsequent guideline implementation and evaluation. We aim to help the readers of practice guidelines asses those guidelines’ quality and validity, as well as to assist the authors of future guidelines in systematically generating clinical recommendations. (Minerva Anestesiol 2009;75:504-8)

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