Clinical practice guidelines [Neurosurgery Wiki]

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====== Clinical practice guidelines ======
 

Clinical practice [[guidelines]] are systematically developed statements to assist practitioner and patient decisions about appropriate Healthcare for specific clinical circumstances.” (Institute of Medicine, 1990)

These guidelines define the [[role]] of specific diagnostic and [[treatment]] modalities in the [[diagnosis]] and [[management]] of patients. The statements contain [[recommendation]]s that are based on [[evidence]] from a rigorous [[systematic review]] and synthesis of the published medical [[literature]].

These guidelines are not fixed [[protocol]]s that must be followed, but are intended for Healthcare professionals and providers to consider. While they identify and describe generally recommended courses of intervention, they are not presented as a substitute for the advice of a physician or other knowledgeable Healthcare professional or provider. 
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Clinicians' trust [[level of evidence 1]] [[recommendation]]s, issued on preponderantly solid [[randomized clinical trial]]s (RCTs), to guide best practice [[decision-making]]. However, sometimes physicians following one CPG find themselves in a situation in which they do not follow another, issued on the same strong evidence base. 
The aim of Volovici et al. is to reflect on the [[consistency]] of [[recommendation]]s in different [[guideline]]s (between-guideline consistency). They also consider within-guideline consistency (or durability), defined as the number of recommendations carried over from one edition to another in consecutive editions of the same CPG. For illustration purposes, they use two examples: hypertension guidelines and traumatic brain injury (TBI) guidelines. They conclude that just like research, CPGs also need to have between-guideline and within-guideline consistency (akin to the [[reproducibility]] of studies). Clinicians and researchers should take into account the lower [[consistency]] of guidelines that are not based on at least one strong RCT
((Volovici V, Steyerberg EW. Lost in translation between [[evidence]] and [[recommendation]]s: Expert opinion is needed to define "level I". World Neurosurg. 2021 Mar 25:S1878-8750(21)00465-4. doi: 10.1016/j.wneu.2021.03.095. Epub ahead of print. PMID: 33775869.)).