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magnitude and reliability of the treatment effect seen in clinical studies: strong effects are more likely to be real and more likely to be clinically important. Ideally, recommendations would be based on the highest level of evidence, but this may be difficult to achieve in public health and social science interventions.
3. The method used to synthesise the available evidence should be the strongest applicable. Taking the evidence—of whatever level, quality, relevance or strength—and turning it into a clinically useful recommendation depends on the judgment, experience and good sense of the group developing the guidelines. The fact of having evidence from a high-level study does not automatically result in a good clinical recommendation.
4. The process of guideline development should be multidisciplinary and should include consumers. If guidelines are to be relevant, those who are expected to use them or to benefit from their use should play a part in their conception and development. Involving a range of generalist and specialist clinicians, allied health professionals, experts in methodology, and consumers will improve the quality and continuity of care and will make it more likely that the guidelines will be adopted.
5. Guidelines should be flexible and adaptable to varying local conditions. They should include evidence relevant to different target populations and geographic and clinical settings, take into account costs and constraints, and make provision for accommodating the different values and preferences of patients.
6. Guidelines should be developed with resource constraints in mind. They should incorporate an economic appraisal, which may be helpful for choosing between treatment options.
7. Guidelines are developed to be disseminated and implemented taking into account their target audiences. They should also be disseminated in such a way that practitioners and consumers become aware of them and use them.
8. The implementation and impact of guidelines should be evaluated.
9. Guidelines should be revised regularly.
Guideline development
When selecting guideline topics, there must be a clear problem or concern that would be redressed if guidelines were developed. A multidisciplinary panel consisting of representatives of all relevant groups should be convened. It should clarify the purpose of the guidelines—such as specifying what conditions and clinical problems they will cover—and identify the desired health outcomes. Rigorous and systematic review of the scientific evidence is essential.
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