29 Oct For this assignment, you will appraise a clinical practice guideline on a topic chosen by your faculty member. Ground yourself in the topic (again).? Read/ Review the clinic
For this assignment, you will appraise a clinical practice guideline on a topic chosen by your faculty member.
- Ground yourself in the topic (again).
- Read/ Review the clinical practice guideline provided to you by your course faculty.
- The article you will appraise is available as a PDF in the Course Readings. The reference is here:
- US Preventive Services Task Force, Owens, D. K., Davidson, K. W., Krist, A. H., Barry, M. J., Cabana, M., Caughey, A. B., Curry, S. J., Donahue, K., Doubeni, C. A., Epling, J. W., Kubik, M., Ogedegbe, G., Pbert, L., Silverstein, M., Simon, M. A., Tseng, C.-W., & Wong, J. B. (2020). Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA, 323(16), 1590. https://doi.org/10.1001/jama.2020.4679
Criteria
(1) This criterion is linked to a Learning OutcomePICO Question
The PICO question at the top of the worksheet is complete and reflective of the Faculty-provided PICO question.
(2) Validity
The 5 questions related to guideline validity are answered clearly and succinctly with evidence from the guideline. The student demonstrates graduate-level critical thinking in responses. Guideline page numbers are included where applicable.
(3) This criterion is linked to a Learning OutcomeResults
The 3 questions related to the guideline results are answered clearly and succinctly with evidence from the guideline itself. The student demonstrates graduate-level critical thinking in responses. Guideline page numbers are included where applicable.
(4) Results Application
The 3 questions related to the application of the results "Will the results help me in caring for my patient?" are answered clearly and succinctly with evidence from the guideline itself. The student demonstrates graduate-level critical thinking in responses. Guideline page numbers are included where applicable.
(5) This criterion is linked to a Learning OutcomeSpelling/ Grammar/ APA
The student demonstrates graduate level spelling, grammar, and APA formatting of citations within the answers. Page numbers ought to be included when direct quotes are provided. The CPG reference at the top of worksheet is in correct APA format.
(6) Overall Appraisal
Overall Appraisal: In one succinct paragraph, give a narrative overall appraisal that includes a summary of the strengths and weaknesses of the guideline, as well as its use for the identified PICO question. Use APA format for citations and scholarly graduate level writing.
Guide to the Critical Appraisal of Clinical Practice Guidelines (CPG)
Student Name:
Faculty name:
Reference of CPG:
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1. WHAT QUESTION ARE YOU TRYING TO ANSWER? |
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Patients |
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Intervention |
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Comparison |
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Outcome(s) |
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2. ARE THE RESULTS OF THE GUIDELINES VALID? |
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Questions that need asking |
What is this, and where do I find this information? |
Details from Assigned CPG Include page number as applicable |
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Is the group, committee, or organization that developed the guidelines clearly identified? |
Yes / No |
This information is usually located either right at the front of the guidelines, or in the back of the document in an appendix. For some guideline groups, this information is located on their website at point of download of the guideline itself. |
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Did authors declare conflicts of interest among all parties involved in guideline preparation and consensus? |
Yes / No Can’t tell |
Conflict of interest is essential to locate within a clinical practice guideline (CPG) to ensure validity. Sometimes the writers of CPGs have financial or expert relationships with pharmaceutical companies or are extensively involved in other research studies that might negatively bias the development of objective CPGs. Conflict of interest should ideally be stated up front within the guideline, but may also be included in a paragraph at the very back of a document. |
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Is there proof of a systematic literature search and strategic selection of articles for review? ( Was it a SYSTEMATIC PROCESS?) |
Yes / No Can’t tell |
All CPGs need to describe the literature review (and the timeline; example 2000-2009) whereby evidence was located. Specific databases where the search occurred should be cited (e.g., Medline, PubMed, Embase, Cochrane). Again, this should be noted within the first few pages of the CPG. |
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Have evidence ratings or indicators of value been indicated for each guideline? |
Yes / No Can’t tell |
CPGs should be developed by consensus. In doing so, there should be a specific scale to rate the quality and strength of evidence and also the consensus result. This might look like “Grade 1a,” which might suggest a highly rated recommendation and a highly rated consensus among the CPG committee. This should be noted for each and every guideline within the CPG and be noted throughout the document. |
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To what extent has expert opinion been identified for particular guidelines – is it extensive? |
Yes / No Can’t tell |
Sometimes, background research is just not available to help inform CPGs on particular topics. In these instances, guideline groups or committees sometimes choose to create a statement or guideline that is based solely on expert opinion or experience of experts. While a few statements of this nature are usually accepted within guidelines, a high percentage of statements within a CPG may be inappropriate. Further, clinicians using these guidelines must consider the risks and value of using expert opinion-based guidelines to make clinical decisions. |
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3. WHAT ARE THE RESULTS? |
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Questions that need asking |
What is this, and where do I find this information? |
Details from Assigned CPG Include page number as applicable |
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Is there a clear message on the clinical importance and practical value for use of these guidelines? |
Yes / No Can’t tell |
All CPGs must be written in practical and implementable statements. They must not be vague or generic; they are intended to be actionable and easy to understand without risk of misinterpretation. |
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Is there discussion of benefits, harm, risks, and cost impacts? |
Yes / No Can’t tell |
High-quality CPGs provide specific information within the guidelines about patient-specific benefits, harms/risks, and also cost of implementation of the guidelines in clinical settings. This is essential to note because it informs the prospective user of the CPG of what implementation aspects might warrant further review. |
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Are these guidelines of recent age? Do the results include reference to currently available treatments or interventions? |
Yes / No Can’t tell |
Most clinical practices note changes every 5 years or so. As such, a CPG that is older than this timeframe may not be appropriate, particularly if there is mention of older and less-used medications particular to your clinical practice setting. |
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4. WILL THE RESULTS HELP ME IN CARING FOR MY PATIENT? |
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Questions that need asking |
Response |
What is this? |
Details from Assigned CPG Include page number as applicable |
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Are the guidelines presented in a user-friendly and easy-to-follow format? |
Yes / No Can’t tell |
Guidelines that are difficult to understand or hard to follow can be prone to misinterpretation. There is also greater likelihood that the CPG will not be embraced and used consistently in clinical settings if it is hard to interpret. |
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Do the guidelines offer next steps for practical implementation; recognition of implementation barriers? |
Yes / No Can’t tell |
Most good CPGs include suggestions for next steps including a standardized documentation, standing-orders form, or audit assessment sheet, for example. This may also include a sample patient or family education pamphlet, posters for health care professionals, electronic flags for charts, or other resources. It is a good sign that some suggestions and tools are provided for implementation by guideline developers. |
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Is there discussion of clinical flexibility for application in multiple or diverse clinical settings? |
Yes / No Can’t tell |
Remember that CPGs created exclusively for implementation in large tertiary facilities may not be directly applicable in smaller or community-based health care settings. A strong CPG should identify some general recommendations of special implementation for different settings. As an example, a CPG intended for use in hospitals may not necessarily be effective for implementation in rural clinic settings. |
Overall Appraisal: In one succinct paragraph, give a narrative overall appraisal that includes a summary of the strengths and weaknesses of the guideline, as well as its use for the identified PICO question.
Guide to the Critical Appraisal of Clinical Practice Guidelines Page 1 of 2
Guide to the Critical Appraisal of Clinical Practice Guidelines Page 3 of 3
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Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents US Preventive Services Task Force Recommendation Statement US Preventive Services Task Force
Summary of Recommendations
The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents. B
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care–feasible interventions for the cessation of tobacco use among school-aged children and adolescents.
I
See the Figure for a more detailed summary of the recommendation for clinicians. See the Practice Considerations section for more information on effective interventions to prevent initiation of tobacco use and for suggestions for practice regarding the I statement. USPSTF indicates US Preventive Services Task Force.
IMPORTANCE Tobacco use is the leading cause of preventable death in the US. An estimated annual 480 000 deaths are attributable to tobacco use in adults, including from secondhand smoke. It is estimated that every day about 1600 youth aged 12 to 17 years smoke their first cigarette and that about 5.6 million adolescents alive today will die prematurely from a smoking-related illness. Although conventional cigarette use has gradually declined among children in the US since the late 1990s, tobacco use via electronic cigarettes (e-cigarettes) is quickly rising and is now more common among youth than cigarette smoking. e-Cigarette products usually contain nicotine, which is addictive, raising concerns about e-cigarette use and nicotine addiction in children. Exposure to nicotine during adolescence can harm the developing brain, which may affect brain function and cognition, attention, and mood; thus, minimizing nicotine exposure from any tobacco product in youth is important.
OBJECTIVE To update its 2013 recommendation, the USPSTF commissioned a review of the evidence on the benefits and harms of primary care interventions for tobacco use prevention and cessation in children and adolescents. The current systematic review newly included e-cigarettes as a tobacco product.
POPULATION This recommendation applies to school-aged children and adolescents younger than 18 years.
EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that primary care–feasible behavioral interventions, including education or brief counseling, to prevent tobacco use in school-aged children and adolescents have a moderate net benefit. The USPSTF concludes that there is insufficient evidence to determine the balance of benefits and harms of primary care interventions for tobacco cessation among school-aged children and adolescents who already smoke, because of a lack of adequately powered studies on behavioral counseling interventions and a lack of studies on medications.
RECOMMENDATION The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care–feasible interventions for the cessation of tobacco use among school-aged children and adolescents. (I statement)
JAMA. 2020;323(16):1590-1598. doi:10.1001/jama.2020.4679
Editorial page 1563
Related article page 1599 and JAMA Patient Page page 1626
Audio and Supplemental content
CME Quiz at jamacmelookup.com
Group Information: The US Preventive Services Task Force (USPSTF) members are listed at the end of this article.
Corresponding Author: Douglas K. Owens, MD, MS, Stanford University, 615 Crothers Way, Encina Commons, Mail Code 6019, Stanford, CA 94305-6006 ([email protected]).
Clinical Review & Education
JAMA | US Preventive Services Task Force | RECOMMENDATION STATEMENT
1590 JAMA April 28, 2020 Volume 323, Number 16 (Reprinted) jama.com
© 2020 American Medical Association. All rights reserved.
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T obacco use is the leading cause of preventable death in the US.1 An estimated annual 480 000 deaths are attrib- utable to tobacco use in adults, including secondhand
smoke.1 It is estimated that every day about 1600 youth aged 12 to 17 years smoke their first cigarette2 and that about 5.6 million ado- lescents alive today will die prematurely of a smoking-related illness.1,3 Although conventional cigarette use has gradually declined among children in the US since the late 1990s,4 tobacco use via electronic cigarettes (e-cigarettes) is quickly rising and is now more common among youth than cigarette smoking. e-Cigarette sales in the US market have risen rapidly since 2007,5
and e-cigarette use by youth has been tracked in the National Youth Tobacco Survey since 2011.1 From 2011 to 2019, current e-cigarette use increased from 1.5% to 27.5% among high school students6,7 (from an estimated 220 000 to 4.11 million students); in 2019, 5.8% of high school students (an estimated 860 000 stu- dents) used conventional cigarettes.7
e-Cigarette products usually contain nicotine,8 which is addic- tive, raising concerns about e-cigarette use and nicotine addiction in children.5 Evidence suggests an association between e-cigarette use in nonsmoking adolescents and subsequent cigarette smoking in young adults. Ever use of e-cigarettes is associated with increased risk of ever use of combustible tobacco products.9 In addition, as the degree of e-cigarette use increases, frequency and intensity of smoking cigarettes also increases.9 Exposure to nico- tine during adolescence can harm the developing brain, which may affect brain function and cognition, attention, and mood1,5,10,11; thus, minimizing nicotine exposure from any tobacco product in youth is important. In 2019, an outbreak of e-cigarette, or vaping, product use–associated lung injury (EVALI) occurred in the US; approximately 15% of patients hospitalized with EVALI were younger than 18 years.12 Vitamin E acetate, an additive to some tetrahydrocannabinol-containing e-cigarettes, was found to be strongly linked to the outbreak.12 Other tobacco products high school students report using include cigars, cigarillos, and little cigars (7.6%); smokeless tobacco (4.8%); hookahs (3.4%); and pipe tobacco (1.1%).7 In 2019, cigar use (including cigarillos and little cigars) surpassed cigarette use in high school students.7 See the Definitions section for more information on tobacco products and terminology used in this US Preventive Services Task Force (USPSTF) recommendation.
USPSTF Assessment of Magnitude of Net Benefit Available evidence on interventions to prevent and help youth quit tobacco use almost exclusively focus on cigarette smoking. For this recommendation, the US Preventive Services Task Force (USPSTF) found this evidence to be most applicable to smoking combustible products (including cigarettes, cigars, cigarillos, and little cigars) and use of e-cigarettes (“vaping”).
See the Figure and Table 1 for more information on the USPSTF recommendation rationale and assessment. For more details on the methods the USPSTF uses to determine the net benefit, see the USPSTF Procedure Manual.13 For a summary of the evidence that served as the basis for the recommendations, see the review of the evidence on the benefits and harms of primary care interventions for tobacco use prevention and cessation in children and adolescents.14,15
Prevention The USPSTF concludes with moderate certainty that primary care– feasible behavioral interventions, including education or brief coun- seling, to prevent tobacco use in school-aged children and adoles- cents have a moderate net benefit. The USPSTF found adequate evidence that behavioral counseling interventions, such as face-to- face or telephone interaction with a health care clinician, print ma- terials, and computer applications, can have a moderate effect in pre- venting initiation of tobacco use in school-aged children and adolescents. The USPSTF sought but found no evidence on the harms of behavioral counseling interventions for the prevention or cessation of tobacco use; however, the USPSTF bounds the magni- tude of potential harms of behavioral counseling interventions as no greater than small, based on the absence of reported harms in the literature and the noninvasive nature of the interventions (Table 1).
Cessation The USPSTF concludes that there is insufficient evidence to de- termine the balance of benefits and harms of primary care interven- tions for tobacco cessation among school-aged children and ado- lescents who already smoke, because of a lack of adequately powered studies on behavioral counseling interventions and a lack of studies on medications.
The USPSTF found inadequate evidence on the benefit of be- havioral counseling interventions for tobacco cessation in school- aged children and adolescents because many studies had small sample sizes and may not have been adequately powered to de- tect a benefit, making it unclear whether the observed lack of ef- fect of interventions was the result of intervention failure or lack of statistical power. Although the USPSTF found no evidence on the harms of behavioral counseling interventions, it bounds the mag- nitude of potential harms of behavioral counseling interventions as no greater than small, based on the absence of reported harms in the literature and the noninvasive nature of the interventions.
The USPSTF found inadequate evidence on the benefits and harms of medications for tobacco cessation in children and adoles- cents, primarily because of an inadequate number of studies that have evaluated tobacco cessation medications in this population. Potential harms depend on the specific medication (Table 1).
Practice Considerations Patient Population Under Consideration This recommendation applies to school-aged children and adoles- cents younger than 18 years. The USPSTF has issued a separate rec- ommendation statement on interventions for tobacco use cessa- tion in adults 18 years and older, including pregnant persons.16
Definitions “Tobacco use” refers to use of any tobacco product. As defined by the US Food and Drug Administration (FDA), tobacco products in- clude any product made or derived from tobacco intended for hu- man consumption (except products that meet the definition of drugs), including, but not limited to, cigarettes, cigars (including ciga- rillos and little cigars), dissolvable tobacco, hookah tobacco, nico- tine gels, pipe tobacco, roll-your-own tobacco, smokeless tobacco
USPSTF Recommendation: Tobacco Use Prevention and Cessation in Children and Adolescents US Preventive Services Task Force Clinical Review & Education
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© 2020 American Medical Association. All rights reserved.
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