Welcome to PAPERS!
An evidence-based reference guide for clinical practice
ABOUT: In this section, Otolaryngology-relevant Cochrane Reviews and the Clinical Practice Guidelines developed by the American Academy of Otolaryngology-Head and Neck Surgery Foundation have been compiled for ease of reference so they may be used to guide clinical decision-making. The latest publications in all of the major Otolaryngology journals can be found in the Hot Off The Press subsection. In the future we will update Papers to include Landmark Papers for each subspecialty and High-Yield Review articles.
Clinical Practice Guidelines
Clinical Practice Guidelines (CPG), according to the Institute of Medicine, are “statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.” The CPGs included on Headmirror were developed by the American Academy of Otolaryngology-Head and Neck Surgery Foundation and are published open access in Otolaryngology-Head and Neck Surgery.
PURPOSE
The purpose of these guidelines is to promote evidence-based medical practice, provide a framework to guide clinical decision-making, and establish benchmarks for measuring performance. Each CPG makes explicit and actionable recommendations that serve as a guide to best practices, provide guidance to reduce un-indicated diagnostic tests, and highlights areas of quality improvement.
COMPONENTS OF THE GUIDELINES
The full “Published Guideline” explores each key action statement in depth and presents the state of the literature that was used to justify the committee’s ultimate decision regarding each individual statement. The strength of each recommendation is based on the quality of the existing evidence (tables below). By comprehensively reviewing the literature, gaps in knowledge are identified that simultaneously establish future research needs.
Supporting materials contained in each CPG have been developed to assist in guideline implementation. A table containing the Summary of Key Action Statements and a Management Algorithm figure are published with each CPG and are included here on Headmirror. These resources can be used as quick references to provide decision support to clinicians choosing among different diagnostic pathways and treatment options. The “Executive Summary” captures the key take-home points and includes all of the useful tables also published in the full guideline. The “Plain Language Summary” contains useful patient education materials that are essential for shared decision-making and enhanced patient compliance.
A CAUTIONARY NOTE: “ABSENCE OF EVIDENCE IS NOT EVIDENCE OF ABSENCE”
Clinical practice guidelines are regarded as a guide for physician and patient decision-making, and should not be used blindly to replace clinical judgement. Many CPGs suffer from limitations in the scientific evidence base. Small retrospective clinical studies, for example, do not provide high-quality scientific evidence to make strong recommendations. Likewise, large, prospective randomized trials are often difficult or impossible to conduct for a variety of ethical, logistical, or financial reasons. It is important to emphasize, therefore, that the absence of a “strong recommendation” or “recommendation” for a given action statement should not be interpreted as that statement “lacking significance.” Rather, it may simply imply that the existing literature is not robust enough to provide a recommendation (“for” or “against”). Understanding these methodological nuances may shed light on why certain action statements are weighted more strongly while others are optional.
Cochrane ReviewS
Cochrane Reviews are rigorously performed, systematic reviews of the literature on a wide variety of topics. They are considered to be among the most methodologically robust evidence-based reference resources to guide clinical decision-making. The methodology is described in detail in the Cochrane Handbook for Systematic Reviews of Interventions. To reduce the impact of bias, the sources included in each review must meet strict inclusion criteria:
A thorough search to identify studies from several sources and databases
Assessment of validity using predefined criteria and an investigation of heterogeneity to select studies for inclusion
Systematic collection of data
Accurate synthesis and interpretation of data