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American dietetic association navigating the evidence analysis library l.jpg
American Dietetic AssociationNavigating the Evidence Analysis Library


Ada definition description l.jpg

Evidence-Based Dietetics Practice is the use of systematically reviewed scientific evidence in making food and nutrition practice decisions by integrating best available evidence with professional expertise and client values to improve outcomes.”

Revised and approved by EBP Committee January 2006

ADA Definition/Description


Why evidence based practice l.jpg

To improve Patient outcomes

To improve safety, quality, efficiency

To take advantage of “exploding” biomedical knowledge (thousands of new research studies appear every month)

Why Evidence-based Practice?


Ada evidence analysis library www adaevidencelibrary com l.jpg

Online

Resource

with the best

available research

on important

dietetics topics in a

practitioner-friendly

format

ADA Evidence Analysis Librarywww.adaevidencelibrary.com


What are the steps in ada s evidence analysis process l.jpg

Select Topic & Appoint Expert Working Group

Define Questions & Analytical Framework/ Determine Inclusion/Exclusion Criteria

Conduct Literature Review for each question

Analyze articles

Complete Evidence Summaries & Tables

Draft proposed Conclusion Statements

Reach Consensus on Conclusion Statements/Grades

PUBLISH to ONLINE LIBRARY (EAL)

What are the steps in ADA’s Evidence Analysis Process?


Current list of ada eal projects l.jpg

Diseases & Conditions

Adult Diabetes 1 & 2 (revision)

Adult weight management

Determinants of Pediatric Overweight (FNPA)

Chronic Kidney Disease (revision)

Chronic Obstructive Pulmonary Disease (COPD)

Critical Illness

Disorders of Lipid Metabolism (Hyperlipidemia revision)

Gestational Diabetes (revision)

Gluten Intolerance/ Celiac

Heart Failure

HIV/AIDS

Diseases & Conditions (continued)

Hydration

Hypertension

Nutrition in Athletic Performance

Nutrition Care in Bariatric Surgery

Oncology

Pediatric Weight Management

Spinal Cord Injury & Nutrition

Unintended weight loss

Assessment

Estimating Energy Expenditure/Indirect Calorimetry

Foods

Non-nutritive sweetener

Current List of ADA EAL Projects



Slide8 l.jpg

Drill down to the amount of information you desire on EAL

Question

Conclusion Statement/Grade of the strength and quality of the evidence

Evidence Summary

Bibliography/Worksheets on each article

Quality Checklists

EAL


Slide9 l.jpg

Select from list of Diseases & Conditions

Choose a Topic

Disorders of

Lipid Metabolism

Macronutrients

Trans-fatty acids

Then, choose a sub-topic


Example view ea question l.jpg
Example: View EA Question

What is the relationship between diets high in trans fatty acids and serum cholesterol levels?

Bibliography for Topic


Example ea conclusion statement grade l.jpg
Example:EA Conclusion Statement/Grade

“Mouse over” Question to see Conclusion & Grade


Conclusion statement l.jpg
Conclusion Statement

Trans-fatty acids raise total cholesterol and LDL-C. Unlike saturated fatty acids, trans-fatty acids do not increase and may decrease HDL-C. Trans-fatty acids increase the TC/HDL-C ratio in a dose dependent manner. GRADE I



Example evidence summary l.jpg

Narrative

Summary

Of the

research

available

to answer

question

Example: Evidence Summary

Evidence Summary


Example bibliography l.jpg
Example: Bibliography

Bibliography for Question listed at end of Evidence Summary (and linked to worksheets)


Example worksheet for each article l.jpg
Example: Worksheet for each article

  • Citation / PubMed ID

  • Date

  • Study Design

  • Class

  • Rating (+/0/-)

  • Research Purpose

  • Inclusion Criteria

  • Exclusion Criteria

  • Description of Study Protocol

  • Data Collection Summary

  • Description of Actual Data Sample

  • Summary of Results

  • Author Conclusion

  • Reviewer Comments


Example quality criteria checklist l.jpg
Example: Quality Criteria Checklist

  • Primary Research

  • or

  • Narrative Review

  • Determine Quality Rating of Article


Ada s evidence based guidelines l.jpg

Use best available evidence in making clinical decisions

Use a systematic process for identifying, assessing, analyzing and synthesizing evidence as a basis for development

Promote use of professional expertise where evidence is weak or lacking

ADA’s Evidence-Based Guidelines


Criteria and classification for guideline development l.jpg

Criteria:

Guideline Elements Model (GEM)

AGREE Instrument

National Guidelines Clearinghouse standards

Classification:

American Academy of Pediatrics

Criteria and Classification for Guideline Development


Transition from evidence to guideline l.jpg

Review of conclusion statements, evidence summaries and supporting evidence.

Formulation of:

Recommendations: a series of guiding statements that propose a course of action for practitioners

Clinical Algorithms: step-by-step flowchart for treatment of the specific disease/condition

Introduction: scope, intent, methods, benefits/harms

Appendices: food tables, etc.

Glossary

External review

Publish on EAL

Transition from evidence to Guideline


Features of guideline introduction l.jpg

Scope: disease/condition, objective, intended users, target population

Statement of Intent

Guideline Methods: process of guideline development, inclusion/exclusion criteria

Implementation of Guideline: how

Benefits and Potential Risks/Harms of Implementing

Features of Guideline Introduction


Features of guideline recommendations l.jpg

Written for the practitioner, as a course of action population

Describe “what” the practitioner should do and “why” it should be done

Display rating using ADA scale

Strong, Fair, Weak, Consensus, Insufficient Evidence

List potential risks/harms for implementing

Provide a brief narrative illustrating the supporting evidence

Provide rationale for the recommendation rating

List any minority opinions

Link to supporting evidence

Features of Guideline Recommendations



Slide24 l.jpg

Guideline List population


Slide25 l.jpg

Guideline List: population

Select Disorders of Lipid Metabolism


Disorders of lipid metabolism evidence based nutrition practice guideline main menu l.jpg
Disorders of Lipid Metabolism populationEvidence-Based Nutrition Practice GuidelineMain Menu

Choose a Category


Disorders of lipid metabolism evidence based nutrition practice guideline l.jpg
Disorders of Lipid Metabolism populationEvidence-Based Nutrition Practice Guideline

Introduction

  • Guideline Overview

  • Scope of Guideline

  • Statement of Intent

  • Guideline Methods

  • Implementation

  • Benefits and Risks/harms


Disorders of lipid metabolism evidence based nutrition practice guideline28 l.jpg

Select a Category within Introduction population

Disorders of Lipid MetabolismEvidence-Based Nutrition Practice Guideline

Scope of

guideline


Disorders of lipid metabolism evidence based nutrition practice guideline29 l.jpg
Disorders of Lipid Metabolism populationEvidence-Based Nutrition Practice Guideline

  • Introduction

    • Scope

  • Disease/Condition

  • Guideline Category

  • Intended Users

  • Objectives

  • Target Population


Disorders of lipid metabolism evidence based nutrition practice guideline30 l.jpg
Disorders of Lipid Metabolism populationEvidence-Based Nutrition Practice Guideline

  • Introduction

    • Guideline Methods

  • Method for Creating Guidelines

  • Inclusion and Exclusion

    Criteria


Slide31 l.jpg

Main Menu: population

Major Recommendations


Disorders of lipid metabolism evidence based nutrition practice guideline32 l.jpg
Disorders of Lipid Metabolism populationEvidence-Based Nutrition Practice Guideline

Introduction

  • Select

  • Guideline

  • Methods


Disorders of lipid metabolism evidence based nutrition practice guideline33 l.jpg
Disorders of Lipid Metabolism populationEvidence-Based Nutrition Practice Guideline

  • Introduction

    • Guideline Methods

  • Method for Creating Guidelines

  • Inclusion and Exclusion

    Criteria


Slide34 l.jpg

Disorders of Lipid Metabolism populationEvidence-Based Nutrition Practice Guideline

Choose a different category

Return to Main Menu

Select

  • Major

    Recommendations


Slide35 l.jpg

Disorders of Lipid Metabolism populationEvidence-Based Nutrition Practice Guideline

  • Major

    Recommendations

    (listed by topics)

    • Macronutrients: Fat (Topic)

  • Trans-fatty Acid Intake

  • and Disorders of

  • Lipid Metabolism

Select a Recommendation


Slide36 l.jpg

Disorders of Lipid Metabolism populationEvidence-Based Nutrition Practice Guideline

  • Major

    Recommendations

  • Trans-fatty Acid Intake and DLM

RecommendationFeatures:

  • Recommendation

  • Rating

  • Risks/Harms

  • Strength

  • Rationale

  • Narrative


Slide37 l.jpg

Disorders of Lipid Metabolism populationEvidence-Based Nutrition Practice Guideline

  • Major

    Recommendations

  • Trans-fatty Acid Intake and DLM

    • Recommendation

Trans-fatty acids consumption should be as low as

possible. A cardioprotective dietary pattern should

contain less than 7% of calories from saturated fat

and trans-fatty acids. Trans-fatty acids raise total

cholesterol and LDL-C and may decrease HDL-C,

thereby increasing the TC/HDL-C and

LDL-C/HDL-C ratios. Increasing trans-fatty acid

intake increases risk of CHD events.


Slide39 l.jpg

Disorders of Lipid Metabolism populationEvidence-Based Nutrition Practice Guideline

Link to the supporting evidence on the EAL

What is the relationship between diets

high in trans fatty acids and risk for CHD?


Slide40 l.jpg

Disorders of Lipid Metabolism populationEAL Trans fatty acids question

View Conclusion Statement and Grade

Drill down to the Evidence Summary


Slide41 l.jpg

Disorders of Lipid Metabolism populationEAL Trans fatty acids question

Evidence Summary

Scroll down for worksheets


Slide42 l.jpg

Disorders of Lipid Metabolism populationEAL Trans fatty acids question

Drill down to

Quality rating

And

worksheets


Slide43 l.jpg

Disorders of Lipid Metabolism populationEvidence-Based Nutrition Practice Guideline

Main Menu:

Algorithms


Slide44 l.jpg

Nutrition Care Process

Assessment

Diagnosis

Intervention

Monitoring &

Evaluation


Slide45 l.jpg

Link to another level within the Algorithm population

Red = different level in algorithm

Blue = recommendation

Determine Meal Plan

and Nutrition

Recommendation

Select


Slide46 l.jpg

Select

Recommend Intake of as Few Trans Fatty Acids as Possible


Slide47 l.jpg


Evidence based guideline projects l.jpg

Current [Published Online] population

Disorders of Lipid Metabolism

2006

Adult Weight Management (May)

Critical Illness

2007

Pediatric Weight Management

Oncology

Hypertension

Heart Failure

Spinal Cord Injury

Evidence-Based Guideline Projects


Next steps l.jpg

Develop companion documents for the Toolkit for application of guidelines

Documentation forms for medical record

Forms to monitor outcomes

Case studies

Client education resources

Pilot test Toolkits

Next Steps


Slide50 l.jpg

Other EAL Features of guidelines

Robust Search

Help and FAQs

Contributors

(lists workgroup members, analysts, and sponsors for each project)

Evidence Analysis Process

(describes methods in detail)


Summary l.jpg

ADA’s Evidence Analysis Library can be found at of guidelineswww.adaevidencelibrary.com

For questions contact:

[email protected]

Summary


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