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ada definition description
“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
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
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
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
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
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

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
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
Example:EA Conclusion Statement/Grade

“Mouse over” Question to see Conclusion & Grade

conclusion statement
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
Narrative

Summary

Of the

research

available

to answer

question

Example: Evidence Summary

Evidence Summary

example bibliography
Example: Bibliography

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

example worksheet for each article
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
Example: Quality Criteria Checklist
  • Primary Research
  • or
  • Narrative Review
  • Determine Quality Rating of Article
ada s evidence based guidelines
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
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
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
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
Written for the practitioner, as a course of action

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
slide25

Guideline List:

Select Disorders of Lipid Metabolism

disorders of lipid metabolism evidence based nutrition practice guideline main menu
Disorders of Lipid MetabolismEvidence-Based Nutrition Practice GuidelineMain Menu

Choose a Category

disorders of lipid metabolism evidence based nutrition practice guideline
Disorders of Lipid MetabolismEvidence-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 guideline29
Disorders of Lipid MetabolismEvidence-Based Nutrition Practice Guideline
  • Introduction
    • Scope
  • Disease/Condition
  • Guideline Category
  • Intended Users
  • Objectives
  • Target Population
disorders of lipid metabolism evidence based nutrition practice guideline30
Disorders of Lipid MetabolismEvidence-Based Nutrition Practice Guideline
  • Introduction
    • Guideline Methods
  • Method for Creating Guidelines
  • Inclusion and Exclusion

Criteria

slide31

Main Menu:

Major Recommendations

disorders of lipid metabolism evidence based nutrition practice guideline32
Disorders of Lipid MetabolismEvidence-Based Nutrition Practice Guideline

Introduction

  • Select
  • Guideline
  • Methods
disorders of lipid metabolism evidence based nutrition practice guideline33
Disorders of Lipid MetabolismEvidence-Based Nutrition Practice Guideline
  • Introduction
    • Guideline Methods
  • Method for Creating Guidelines
  • Inclusion and Exclusion

Criteria

slide34

Disorders of Lipid MetabolismEvidence-Based Nutrition Practice Guideline

Choose a different category

Return to Main Menu

Select

  • Major

Recommendations

slide35

Disorders of Lipid MetabolismEvidence-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

Disorders of Lipid MetabolismEvidence-Based Nutrition Practice Guideline

  • Major

Recommendations

  • Trans-fatty Acid Intake and DLM

RecommendationFeatures:

  • Recommendation
  • Rating
  • Risks/Harms
  • Strength
  • Rationale
  • Narrative
slide37

Disorders of Lipid MetabolismEvidence-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

Disorders of Lipid MetabolismEvidence-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

Disorders of Lipid MetabolismEAL Trans fatty acids question

View Conclusion Statement and Grade

Drill down to the Evidence Summary

slide41

Disorders of Lipid MetabolismEAL Trans fatty acids question

Evidence Summary

Scroll down for worksheets

slide42

Disorders of Lipid MetabolismEAL Trans fatty acids question

Drill down to

Quality rating

And

worksheets

slide43

Disorders of Lipid MetabolismEvidence-Based Nutrition Practice Guideline

Main Menu:

Algorithms

slide44

View Main Algorithm for Disorders of Lipid Metabolism

  • See recommendations organized within a treatment plan

Nutrition Care Process

Assessment

Diagnosis

Intervention

Monitoring &

Evaluation

slide45

Link to another level within the Algorithm

Red = different level in algorithm

Blue = recommendation

Determine Meal Plan

and Nutrition

Recommendation

Select

slide46

View second level algorithm

  • Link to Recommendation

Select

Recommend Intake of as Few Trans Fatty Acids as Possible

slide47

View Recommendation

  • Drill down as needed
evidence based guideline projects
Current [Published Online]

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
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

Other EAL Features

Robust Search

Help and FAQs

Contributors

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

Evidence Analysis Process

(describes methods in detail)

summary
ADA’s Evidence Analysis Library can be found at www.adaevidencelibrary.com

For questions contact:

eal@adaevidencelibrary.com

Summary