Understanding Evidence-Based Clinical Practice Guidelines

Evidence-Based Clinical Practice Guidelines
Student’s Name
Institutional Affiliation
Evidence-Based Clinical Practice Guidelines
Guideline developers.
The guideline in question addresses the management of pain among the elderly. Many authors played a part in the development of the guideline. Among them include Aza Abdulla, Margaret Bone, Jean Gaffin, Nicolas Adams, Alison Elliott, Roger Knaggs, Derek Jones, Liz Sampson, Denis Martin, and Pat Schofield (Abdulla et al., 2013).
Were the developers of the guideline representative of key stakeholders in this specialty?
These authors played as representatives for the British Geriatric Society and the British Pain Society. Through collaboration, the two societies and the highlighted authors produced a detailed pain management guideline (Abdulla et al., 2013).
Who funded the guideline development?
The research bringing out the guideline did not receive any grants from funding organizations in the commercial, non-profit making institutions, and neither from those in public (Abdulla et al., 2013).
Were any of the guideline developers funded researchers of the reviewed studies?
No.
Did the team have a valid development strategy?
Yes. The team aimed at providing a review concerning pain management among the elderly to provide recommendations for health professionals looking after them in hospital settings. In particular, their strategy emphasized the importance of multimodal approaches in pain management among the elderly persons (Abdulla et al.

, 2013).
Was an explicit (how decisions were made), sensible, and impartial process used to identify, select, and combine evidence?
Yes, the decisions were made in a sensible. Also, the impartial process used in identifying and selecting the evidence was explicit. An approximate 5000 records were determined to be of use in the initial research. Abstracts from each of these documents were reviewed by selected members, and the full papers retrieved for analysis (Abdulla et al., 2013). Quality scores were assigned for each of these sources and reviewed independently from different members. Relevant articles in alignment with the purpose of the guideline were then incorporated into matrices and encompassed in the commentary within the sections.
Did its developers carry out comprehensive, reproducible literature review within the last 12 months of its publication/revision?
No. The developers spent most of their time fining the original sources of information. As indicated in the guideline, detailed summaries of the research on the document were provided. In addition, quality scores for each document used in the research was conducted to ensure that the authors did not revisit the same after publication.
Were all important options and outcomes considered?
Yes. Options for management of elderly patients have been highlighted. One of them is the pharmacological approach, which is the use analgesic drugs to treat the elderly patients. However, the authors have suggested that use of combinational therapy works best with the use of pharmacological approaches. The second one is the use of interventional therapies in pain management and entails the use of minimally invasive procedures and neural blocks. The third method is psychological therapies, which involve addressing how patients respond and cope with pain. The fourth and fifth include physiotherapy and occupational therapy, and complementary therapy. The former entails the use of programs that address strength, flexibility, and endurance aimed at increasing physical activity, reduction of pain, and enhancement of body functions (Abdulla et al., 2013). On the other hand, the latter entails practices such as massage, transcutaneous electrical stimulation, and reflexology.
Is each recommendation tagged by the level/strength of evidence upon which it is based and linked to the scientific evidence?
Yes. The recommendations given in the article are sourced from CINAHL and PubMed. The publications were done between the year 1997 and 2010. Also concerning the use of pharmacological approach, scientific evidence is shown by the manner in which the medicine is prescribed (Abdulla et al., 2013). For example, Paracetamol is recommended as analgesia, best known to relieve musculoskeletal pain. Also, the article has suggested that short-term opioids are best in relieving cancer and non-cancer illnesses (Cassileth, B. R., & World Scientific (Firm), 2011).
Do the guidelines make explicit recommendations (reflecting value judgments about outcomes)?
Yes. The recommendations made in the guideline are explicit. The authors are honest concerning the expected outcomes. For example, concerning the pharmacological approach, the authors have suggested that such method of treatment should be highly individualized. Moreover, the patients have to be monitored for both tolerability and efficacy (Abdulla et al., 2013). The reason behind this is that there is high variance in the manner in how each patient respond to the drugs. Also, the authors have also highlighted possible side effects such as vomiting and nausea. Moreover, the authors have also recommended the use of a combinational therapy since they avail greater chances of pain relief and with few or no side effects.
Concerning psychological therapies, the authors have suggested that behavioral therapy is one proven method of relieving chronic pain among adults. Moreover, the approach is also used enhancing mood and other disabilities (Cox, 2009). However, it has also been indicated that the use of this method among adults have not been proven as small sample size was used in making the recommendations. Lastly, complementary therapies were partially recommended because of limited evidence concerning the use of the approach (Lindquist, 2013). That is, according to the guideline, evidence concerning the use of complementary therapies is based on small-scale studies thereby rendering the method weak.
Has the guideline been subjected to peer review and testing?
Yes. The original guideline was published by Age and Ageing but is now under Sage publications. This is an indication that the article is peer reviewed and tested (Abdulla et al., 2013). Also, the article is less than five years old, a shred of evidence it is peer-reviewed.
Is the intent of use provided (i.e., national, regional, local)?
Yes. The article states that the guideline is reviewed for purposes of determining recommendations for pain management among the older people. Also, the authors have suggested the intent of use, not only national but also on an international scope. The article’s purpose as indicated by the authors is to provide recommendations for the management of pain by all health professionals, thereby used globally and not limited to a specific region (Abdulla et al., 2013). Also, the practice recommendations are not limited to particular care settings, but rather encompasses any that aims to serve the elderly patients.
Are the recommendations clinically relevant?
Yes. The recommendations are clinically relevant for many reasons. The first one is that the developers are representatives of the British Pain Society. They have worked together to review pain management among elderly patients and giving recommendations for its treatment. Moreover, PubMed and Scopus among other health related organizations were used to enhance the validity of the guideline (Abdulla et al., 2013).
Will the recommendations help me in caring for my patients?
Yes. The recommendations provided in the guideline can be used to care for the patients. For example, concerning the pharmacological approach, the authors have recommended certain drugs for specific people. For example, Paracetamol have been recommended for patients suffering from musculoskeletal pain (Abdulla et al., 2013). In addition, Opioids have been recommended for cancer and non-cancer pains.
Are the recommendations practical/feasible? Are the resources (people and equipment) available?
Yes, the recommendations in the article are feasible. Moreover, the resources for achieving these recommendations are available. The approaches of pain management in the article are practical, and this is attributed to the fact that the resources, people, and healthcare settings foreseeing the implementation of these methods are available. For example, there are many pharmaceutical companies providing opioids for the case of pharmacological approach. Also, the authors have indicated places where they do not have complete trust in the methods, either due to inadequate research.
Are the recommendations a major variation from current practice? Can the outcomes be measured through standard care?
No. The recommendations do not show a major variation from the current practice. Also, the outcomes of these suggestions can be measured through standard care. Concerning variance with current practice, the recommendations suggested in the guideline are up-to-date. Moreover, the article is peer-reviewed, updated, and its research detailed. It has been noted that the authors selected sources of data were refined using the PsycINFO, Scopus, and Amed (Abdulla et al., 2013). The guideline was removed from PubMed database.

References
Abdulla, A., Adams, N., Bone, M., Elliott, A., Gaffin, J., Jones, D. … & Schofield, P. (2013). Evidence-based clinical practice guidelines on the management of pain in older people: executive summary. British journal of pain, 7(3), 152-154.
Cassileth, B. R., & World Scientific (Firm). (2011). The complete guide to complementary therapies in cancer care: Essential information for patients, survivors and health professionals. Singapore: World Scientific Pub. Co.
Cox, F. (2009). Perioperative Pain Management. Chichester: John Wiley & Sons.
Lindquist, R. (2013). Complementary & alternative therapies in nursing. Springer Publishing Company Inc.