Posted: May 1st, 2025

Health & Medical Question

Essay 3: Analyzing a Healthcare Guideline:

How Evidence-Based Knowledge is Created

After reading through this assignment sheet,

watch this video!

Rationale/ Objectives

Published professional guidelines

are an increasingly important source of expert guidance for patients, providers, healthcare administrators, and government officials. From clinical practice to healthcare management, guidelines play a key role in arguing for particular treatments, policies, and public health interventions.

While clinical guidelines help set standards, clinicians and policymakers who become overly reliant on them risk overlooking the patient’s unique physiology and context. As a matter of clinical judgment, it is t

here

fore important to understand how guidelines function as argumentative texts. Such understanding increases your ability to critically evaluate the evidence guideline authors use to form their claims.

This assignment has two objectives:

to help you understand the anatomy of clinical practice guidelines as forms of argument and the ways in which their recommendations are formed, and

to teach you how to critically evaluate an area of clinical research for gaps in clinical knowledge/ understanding.

Your Task

1. As we will see from the 2020 ACS guideline update on cervical cancer screening, different groups may create and propose their own guidelines for treatment, prevention, and diagnosis of health problems.
2. Because of the variety of guidelines proposed by different groups (with their own priorities and interests), we should learn to question these guidelines, or at least not accept them blindly.

Your Job

Imagine you and

your group

work in a hospital or clinical setting and have been asked to check on a specific guideline that the hospital or clinic is considering adopting to guide clinicians.

Your job is to look at the sources used as evidence for the guideline, find 4 of those sources (or 3, if you work alone), and check to see how well they support the guideline you are reading. It can be that the ‘evidence’ was well used and really does support the guidelines that the authors created. But perhaps the ‘evidence’ for giving a medication to both adults and children was a study done only on 10 adult men? Or the ‘evidence’ was from a very outdated study? Your job will be to report back on this guideline and give your opinion as to whether this guideline should be adopted or not.

You can choose to work as part of a team (that I have assigned) or work independently. You cannot choose to work independently after your group has turned in the first component on Thursday, April 11th.

PURPOSE: The overall purpose of this assignment is to examine four research studies to make a claim (thesis statement) about the extent to which the four studies support one of the evidence-based recommendations from a professional practice guideline published by a reputable national organization.

LENGTH and FORMAT: 5-7 pages, double-spaced, Times New Roman font, 1-inch margins, APA style. A title page, abstract, and appendices (tables) are required but are not included in the page count. You may use first-person in this analysis, referring to your group as “we.” Doing so will help you avoid using passive voice unnecessarily, as APA style recommends. View the template here.

AUDIENCES: Imagine that the audience for this report includes a group of hospital or other healthcare administrators who have to decide what guidelines to recommend to their staff.  Remember to keep your audience in mind when you are writing your report.

Your instructor and class members are your secondary audience. We want to better understand the relationship between individual research studies and healthcare practice recommendations based on the professional practice guideline that you choose to analyze.

RUBRICS: You will receive two rubrics for this assignment. The

“product rubric”

shows how each element of the paper will be weighted in your grade. It can also guide you in understating what must be included in a successful final product. You are expected to put all of

the 7Cs

into practice in this report.. Each group receives one grade for the paper. A separate “process rubric” will help you evaluate your group members’ contributions, evaluations that will be part of your participation grades.

Below are steps for working through this assignment with your group.

Understand the genre: Familiarize yourself with Clinical practice guidelines through the examples posted on BB.

Choose a Clinical Practice Guideline: With

your team

, decide on one set of published evidence-based, professional guidelines on a topic in health and medicine of your choice. Do not use the examples posted. Instead, find a guideline based on the shared interests of your group. You can use

the Library Guide

to help you find a guideline.

Here’s a video

explaining how I found a CPG on the TRIP Database through the VU library.

Evaluate the source: Read and analyze your chosen guideline. Pay close attention to the article’s headings to see how the information is organized. Identify the recommendations and references that correspond with research studies.

Identify a recommendation to focus on: The recommendation that your group chooses may reflect one or more of the following: (1) a “gray area” in the guidelines (an area where the guidelines offer expert opinions or recommendations that are not definitive), (2) an area of particular interest to you, (3) or area that has generated controversy or uncertainty.

Find supporting sources: With your group, select four peer-reviewed articles from the guideline’s References. Each one of these four studies must tie to one of the guideline’s recommendations–especially the one you chose to highlight (see step 4).

Read and summarize source: Each person in the group read the four articles analytically. Then represent your findings in a

summary table

that is similar to the sample tables provided (see professional example on BB and student papers). These tables should appear in one or more Appendices in your final paper. It is wise to complete these tables before drafting the paper because they will help you organize your thoughts and understand the studies that are the focus of your group’s guideline analysis paper. All group members should participate in reviewing and understanding the four tables because they are the basis for the paper.

Plan, draft, and write together: Use a group composing process that combines individual and group drafting, revision, review, editing, and proofreading. Expect to do at least three or four complete drafts of the paper before the final version is complete. You will have opportunities for instructor and peer review. Think about the best tools to use for working together, such as a Google Doc, MS track changes, Google Meet Group discussions, and the like. Note that part of your final exam will ask you to reflect upon your group’s writing process, the role of each group member in it, and the quality of the final result.

Fine-tune and Edit: Model your paper’s organization after the examples provided, although you can and should seek ways to improve upon the examples. Use APA style for your writing, format, and citation.

Completing a draft: Submit a copy of your articles and guidelines with each of your drafts and include citations for all in your References page.

[Page 1: APA Cover page]
[Sample Title]Surviving Cancer and Beyond: Studies Supporting Recommendations for
Cancer Survivors
Name of Writer
Department Name, University Name
Course name
Professor Name
Date
[Body of paper: 5-7 pages]
Repeat title
Introduction
Introduce and summarize your chosen guideline, including the following information:
1. Title
2. Authors
3. Publication date
4. Publication venue (Where was it published?)
5. Purpose
6. Any context necessary to understand the guideline and its significance
7. Organizing statement
8. Thesis
Summary of Treatment Recommendation
Choose 1 of the guideline’s treatment recommendations and explain it. Be sure to discuss
how “strong” the recommendation is.
Overview of your position
Share that you are looking at four sources on the same topic as your chosen guideline.
Connect the guideline with the four articles you are about to introduce. Include a thesis
statement that guides the reader toward a conclusion about whether or not they should
adopt this CPG in their healthcare setting.
Summaries of sources
You should have four high-level academic articles related to your topic. Summarize these
articles used to support the recommendation. Include the following information:
1. Title
2. Authors
3. Publication date
4. Publication venue
5. Purpose/ study questions
6. Participants
7. Methods
8. Results
9. Conclusions
10. Relevance to treatment recommendation
Discussion/Relationship Between Guideline and Articles
Use subheadings to highlight key findings and commonalities among the four sources.
Conduct a “discussion” that evaluates the findings and concludes whether or not your
group recommends adopting this guideline in a clinical context. Give your critique. What
is the guideline missing and what does it do well? How can this clinical guideline be
expanded to encompass more factors, treatments, or suggestions from the four articles?
Conclusion
Wrap up your paper by summarizing your main points and restating your thesis
statement.
[References: excluded from page count]
References
Include all citations in APA format. Use alphabetical order by the first author’s last name.
Include a citation for the guideline and any additional sources that you use.
[Appendices: excluded from page count]
Include your summary tables for each source.
Topic: Colon Cancer
Selected Guideline: Pain Control – “A multimodal, opioid-sparing, pain management plan should be implemented before the induction of anesthesia. Grade of
recommendation: strong recommendation based on moderate-quality evidence, 1B.” (https://fascrs.org/ascrs/media/files/Education/2023-Enhanced-Recovery-CPG.pdf)
***Is this document meant to have the exact info from our four sources or summarized info in our own words? If it is supposed to be our summary of the info, how long
is it meant to be?
1
Source
Participants
Focus
Methods
Results
Conclusion
Aryaie, A. H., Lalezari,
S., Sergent, W. K.,
Puckett, Y., Juergens,
C., Ratermann, C., &
Ogg, C. (2018).
Decreased opioid
consumption and
enhance recovery with
the addition of IV
Acetaminophen in
colorectal patients: a
prospective, multiinstitutional,
randomized, doubleblinded, placebocontrolled study
(DOCIVA study).
Surgical endoscopy,
32(8), 3432–3438.
https://doi.org/10.1007/s
00464-018-6062-y
105 patients were
enrolled and 97
remained in the study
after exclusion (control
group n = 50; study
group n = 47).
They hypothesized that
administration of IV
acetaminophen alone
would reduce the opioid
consumption in postoperative colorectal
surgery and reduce the
side effects of narcotics.
Patients were
randomized to receive
either IV
acetaminophen or
placebo in addition to
opioid PCA. Primary
endpoints evaluated
were opioid
consumption and pain
visual analogue scale
score (PVASS) during
first 48 h postoperatively. Secondary
endpoints evaluated
were time of return of
GI function (ROGIF),
time to diet ordered
(TTDO), length of
hospital stay (LOHS),
and occurrence of ileus.
105 patients were
IV acetaminophen helps
to reduce opioid
consumption for patients
undergoing colorectal
surgery. Additionally,
there appears to be a
shortened length of
hospital stay, better pain
control, reduced time to
return of bowel function,
and lower rate of postoperative ileus in
patients receiving IV
acetaminophen.
enrolled and 97
remained in the
study after exclusion
(control group n =
50; study group n =
47). Mean ± SEs of
opioid consumption
in the study group
was 21.5 ± 1.8 mg
of morphine
equivalent (ME) and
35.0 ± 3.3 mg ME
at 24 and 48 h,
respectively, versus
36.4 ± 4.1 mg ME
and 59.7 ± 6.7 mg
ME in the control
group (p = 0.002
and 0.002). PVASS
levels were lower in
the study group at
all intervals at 3, 8,
24, and 48 h (p =
0.02, 0.006, < 0.01,
and 0.02). ROGIF,
TTDO, and LOHS
were also found to
be lower in the
study group (p ≤
0.01, < 0.01, and
0.002). The rate of
ileus was reduced
by using IV
acetaminophen
(22% vs 2.1%; p =
0.004).
2
Thiele, R. H., Sarosiek,
B. M., Modesitt, S. C.,
McMurry, T. L.,
Tiouririne, M., Martin,
L. W., Blank, R. S.,
Shilling, A., Browne, J.
A., Bogdonoff, D. L.,
Bauer, T. W., &
There were 7774
patients among 9
distinct surgical
populations including
2155 patients in the preER cohort and 5619
patients in the post-ER
cohort.
Enhanced Recovery
(ER) is a change
management framework
in which a
multidisciplinary team
of stakeholders utilizes
evidence-based
medicine to protocolize
Following the
establishment of a
formal institutional ER
program, ER was
adopted in 9 distinct
surgical subspecialties
over 5 years at an
academic medical
There were 7774
patients among 9
distinct surgical
populations including
2155 patients in the
pre-ER cohort and
5619 patients in the
post-ER cohort. The
Institution-wide efforts
to adopt ER can generate
significant
improvements in patient
care, opioid
consumption, hospital
capacity, and
profitability within a
Hedrick, T. L. (2021).
Development and
Impact of an
Institutional Enhanced
Recovery Program on
Opioid Use, Length of
Stay, and Hospital Costs
Within an Academic
Medical Center: A
Cohort Analysis of 7774
Patients. Anesthesia and
analgesia, 132(2), 442–
455.
https://doi.org/10.1213/
ANE.000000000000518
2
3
Verret, M., Lauzier, F.,
Zarychanski, R., Perron,
C., Savard, X., Pinard,
A. M., Leblanc, G.,
Cossi, M. J., Neveu, X.,
Turgeon, A. F., &
Canadian Perioperative
Anesthesia Clinical
Trials (PACT) Group
(2020). Perioperative
Use of Gabapentinoids
In total, 281 trials (N =
24,682 participants)
were included in this
meta-analysis.
all aspects of a surgical
care to allow more rapid
return of function.
While service-specific
reports of ER adoption
are common,
institutional-wide
adoption is complex,
and reports of
institution-wide ER
adoption are lacking in
the United States. We
hypothesized that ER
principles were
generalizable across an
institution and could be
implemented across a
multitude of surgical
disciplines with
improvements in length
of stay, opioid
consumption, and cost
of care.
center. We compared
length of stay, opioid
consumption, and total
cost of care in all
surgical subspecialties
as a function of time
using a segmented
regression/interrupted
time series statistical
model.
introduction of an ER
protocol was
associated with several
significant changes: a
reduction in length of
stay in 5 of 9
specialties; reduction
in opioid consumption
in 8 specialties; no
change or reduction in
maximum patientreported pain scores;
and reduction or no
change in hospital
costs in all specialties.
The ER program was
associated with an
aggregate increase in
profit over the study
period.
large academic medical
center.
Widely used for acute
pain management, the
clinical benefit from
perioperative use of
gabapentinoids is
uncertain. The aim of
this systematic review
was to assess the
analgesic effect and
adverse events with the
perioperative use of
Randomized controlled
trials studying the use
of gabapentinoids in
adult patients
undergoing surgery
were included. The
primary outcome was
the intensity of
postoperative acute
pain. Secondary
outcomes included the
In total, 281 trials (N =
24,682 participants)
were included in this
meta-analysis.
Compared with
controls,
gabapentinoids were
associated with a lower
postoperative pain
intensity (100-point
scale) at 6 h (mean
No clinically significant
analgesic effect for the
perioperative use of
gabapentinoids was
observed. There was
also no effect on the
prevention of
postoperative chronic
pain and a greater risk of
adverse events. These
results do not support
for the Management of
Postoperative Acute
Pain: A Systematic
Review and Metaanalysis.
Anesthesiology, 133(2),
265–279.
https://doi.org/10.1097/
ALN.000000000000342
8
4
Brinck, E. C., Tiippana,
E., Heesen, M., Bell, R.
F., Straube, S., Moore,
R. A., & Kontinen, V.
(2018). Perioperative
We analyzed 130
studies with 8341
participants, with
ketamine given to 4588
participants and 3753
gabapentinoids in adult
patients.
intensity of
postoperative subacute
pain, incidence of
postoperative chronic
pain, cumulative opioid
use, persistent opioid
use, lengths of stay, and
adverse events. The
clinical significance of
the summary estimates
was assessed based on
established thresholds
for minimally important
differences.
difference, -10; 95%
CI, -12 to -9), 12 h
(mean difference, -9;
95% CI, -10 to -7), 24
h (mean difference, -7;
95% CI, -8 to -6), and
48 h (mean difference,
-3; 95% CI, -5 to -1).
This effect was not
clinically significant
ranging below the
minimally important
difference (10 points
out of 100) for each
time point. These
results were consistent
regardless of the type
of drug (gabapentin or
pregabalin). No effect
was observed on pain
intensity at 72 h,
subacute and chronic
pain. The use of
gabapentinoids was
associated with a lower
risk of postoperative
nausea and vomiting
but with more
dizziness and visual
disturbance.
the routine use of
pregabalin or gabapentin
for the management of
postoperative pain in
adult patients.
Inadequate pain
management after
surgery increases the
risk of postoperative
complications and may
We searched
CENTRAL, MEDLINE
and Embase to July
2018 and three trials
registers (metaRegister
We analyzed 130
studies with 8341
participants, with
ketamine given to 4588
participants and 3753
Perioperative
intravenous ketamine
probably reduces
postoperative analgesic
consumption and pain
intravenous ketamine
for acute postoperative
pain in adults. The
Cochrane database of
systematic reviews,
12(12), CD012033.
https://doi.org/10.1002/
14651858.CD012033.p
ub4
serving as controls
across various
surgeries.
predispose for chronic
postsurgical pain.
Perioperative ketamine
may enhance
conventional analgesics
in the acute
postoperative setting.
To evaluate the efficacy
and safety of
perioperative
intravenous ketamine in
adult patients when
used for the treatment
or prevention of acute
pain following general
anaesthesia.
of controlled trials,
ClinicalTrials.gov and
the World Health
Organization (WHO)
International Clinical
Trials Registry Platform
(ICTRP)) together with
reference checking,
citation searching and
contact with study
authors to identify
additional studies.
serving as controls
across various
surgeries. Racemic
ketamine was
primarily used, with
doses ranging from
0.25 mg to 1 mg for
bolus and 2 to 5
µg/kg/minute for
infusions; some studies
used S-ketamine or Rketamine exclusively.
Perioperative ketamine
reduced postoperative
opioid consumption by
8 mg morphine
equivalents over 24
hours and by 13 mg
over 48 hours, with
reductions in pain at
rest and during
movement at 24 and 48
hours. Ketamine also
extended the time to
first analgesic request
by 54 minutes and
decreased
postoperative
hyperalgesia area. CNS
adverse events were
reported in 52 studies,
with 5% of ketamine
recipients experiencing
adverse events
compared to 4% in the
control group.
intensity. Results were
consistent in different
operation types or timing
of ketamine
administration, with
larger and smaller
studies, and by higher
and lower pain intensity.
CNS adverse events
were little different with
ketamine or control.
Perioperative
intravenous ketamine
probably reduces
postoperative nausea and
vomiting by a small
extent, of arguable
clinical relevance.
Ketamine also reduced
postoperative nausea
and vomiting. Overall,
ketamine showed
efficacy in pain
management with
manageable adverse
effects.