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Each of these measures should be taken into account. Some measures will be clinically defined and some will be socially defined and, again, both types should be included. Appendix D outlines generic outcome measures that can be applied to specific conditions and interventions.
3.5 Review the scientific evidence
If possible, a systematic literature review should be undertaken to establish the benefits and harms of the possible interventions.
Methods for reviewing and evaluating the literature range from highly formal, quantitative information syntheses (such as meta-analysis of randomised controlled trials) to subjective synopses of observational data. The more formal the review, the more credible and valid the resulting guidelines. The panel should select the most rigorous and systematic review methods practicable according to the approach outlined in Chapter 2 and the methods described in The Cochrane Collaboration Handbook (Sackett 1994).
The guidelines should clearly state the methods used to review the literature. There should be rigorous discussion of and debate about the literature, and any gaps in it should be identified.
3.6 Formulate the guidelines
The guidelines should be constructed on the basis of the best available scientific evidence of the probable outcomes associated with different clinical interventions. The panel should consider the following:
• the natural history of the disease or condition in question, if appropriate;
• the probable outcomes of each intervention, taking into account the strength of evidence associated with each, with preference given to empirical evidence over expert judgment;
• the balance of benefits against risks;
• a comparison between the outcomes for alternative interventions, including conservative or expectant management where appropriate, for the disease or condition in question; and
• an economic appraisal of the best investment for the best health outcomes (see Appendix E).
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