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Study: Most Guideline Recommendations Based on Less-Than-Ideal Quality of Evidence

Authors question transparency (January 15)

A study published in the January issue of the Mayo Clinic Proceedings indicates that most clinical practice guidelines for interventional procedures, such as bronchoscopy and angioplasty, are based on lower-quality medical evidence and fail to disclose authors’ conflicts of interest.

“Guidelines are meant to create a succinct roadmap for the diagnosis and treatment of medical conditions by analyzing and summarizing the increasingly abundant medical research,” writes Joseph Feuerstein, MD, and his colleagues at the Beth Israel Deaconess Medical Center. “Guidelines are used as a means to establish a standard of care… However, a guideline’s validity is rooted in its development process.”

In an accompanying editorial, Jayant Talwalkar, MD, says that the study further illustrates that existing guidelines are highly variable with respect to evidence quality and transparency.

“Most of the current practice guidelines in circulation do not meet criteria that represent trustworthiness, as defined by the Institute of Medicine,” Talwalkar says.

Talwalkar also points out that more attention needs to be paid to potential conflicts of interest among guideline authors and guideline-development panels.

According to Talwalkar, up to 80% of recommendations from most guidelines are supported by evidence from nonrandomized studies or from expert consensus opinion, making conflict of interest disclosure crucial.

Talwalkar says that, in the future, the guideline-writing process must evolve to include more concise and up-to-date recommendations as well as more transparency about the management of potential conflicts of interest.

Source: Mayo Clinic; January 15, 2014.

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