Preparation of a Review Document

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All statements of evidence, including procedure-specific information, are presented to indicate whether or not they support the use of a particular intervention based on the evidence. Recommendations are presented with a brief explanation of the evidence on which they are based (including the balance of benefits and risks, where relevant). The strength of recommendations are graded based upon the agreement between the members of the subgroup. A strong recommendation will be offered when the desirable effects of an intervention clearly outweigh (intervention recommended) or clearly do not outweigh adverse effects (intervention not recommended). A weak recommendation will be offered if the overall effects are less certain—either because of low quality evidence or because evidence suggested that desirable and undesirable effects were closely balanced. The group  also develop clinical questions that need to be answered in the future. The final review document is circulated to each member of the PWG for review.
PWG members critically review the recommendations proposed by the subgroup prior to the face-to-face meeting. Individual comments on the evidence and draft recommendations are collated for presentation during the face-to-face meeting followed by round-table discussions; the Delphi method is used to achieve final consensus. The final document of consensus agreements is circulated to all PWG members for a final review and approval; any additional relevant comments are incorporated, if necessary.
A webcopy document, including a summary of the recommendations, details of the procedure-specific systematic literature review, the criteria for study inclusion as well as lists of included and excluded studies is drafted for uploading onto the website. The evidence and graded recommendations for perioperative interventions are contained within folders, in which procedure-specific evidence and recommendations are clearly separated. The web-based format offers a user-friendly way to present the large amount of information contained within each review, and encourages users to submit feedback to the PWG via the website.

Study quality assessments

Level of Evidence (LoE)

Grade of recommendation

(based on overall LoE, considering balance of clinical practice information and evidence)

Study type

Statistical analyses and patient follow-up assessment

Allocation concealment

Jadad scores

Additional assessment of overall study quality required to judge LoE

Systematic review with homogeneous results

N/A

N/A

N/A

N/A

1

A

Randomised controlled trial (RCT)

Statistics reported

and >80%

follow-up

AND

A

(15)

N/A

1

A

(based on two or more studies or a single large, well-designed study)

OR

B

(35)

N/A

OR

B

(1–2)

Yes

Randomised controlled trial (RCT)

Statistics not reported or questionable or <80% follow-up

AND/OR

B

(1–2)

Yes

2

B

(or extrapolation from one procedure-specific

LoE 1 study)

OR

C

(15)

N/A

OR

D

(15)

N/A

Non-systematic review, cohort study,

case study; (e.g. adverse effects)

N/A

N/A

3

C

Clinical practice information (expert opinion); inconsistent evidence

N/A

N/A

4

D