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We used a controlled pre-/post-intervention design to compare IMS Health dispensing data for 15 cancer drugs (2007 2012) in England vs Wales, stratified by pre-CDF NICE drug approval status (rejected, mixed recommendations, recommended, not appraised).
How should the quality of guidelines or recommendations be appraised?
The quality of evidence and grading of recommendations was appraised using the AGREE II tool.
In this paper we address the following questions related to evaluation of guidelines and their implementation: How should the quality of guidelines or recommendations be appraised?
In the absence of systematic reviews, meta-analyses, guidelines and treatment recommendations were appraised, but only when based on a thorough and well-defined search strategy.
An expert system may display the sequence of rules through which it arrived at its conclusion; tracing this flow helps the user to appraise the credibility of its recommendation and is useful as a learning tool for students.
The quality of evidence for each outcome was appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Study validity was appraised in keeping with ongoing recommendations distinguishing several sources of bias typical of randomized trials [ 23].
For each cited meta-analysis, we looked for evidence within the guideline that it had been critically appraised and whether specific practice recommendations had been based on the findings of the meta-analysis.
A multidisciplinary panel of 14 experts appraised and prioritized 40 key recommendations from within the Dutch national guideline on antimicrobial use for adult hospitalized patients with sepsis (http://www.swab.nl/guidelines).swab.nl/guidelines
This became a more prominent factor when the panel was required to appraise individual studies and provide individual recommendations for each intervention as part of the modified GRADE approach.
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