Evidence Incorporation into Guidelines of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition
Bibliographic record
Abstract
Purpose: We systematically reviewed how guidelines of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) reported the evidence base for their recommendations. Methods: Two independent reviewers performed a comprehensive, cross-sectional review of the clinical guidelines published by NASPGHAN and available on its website on Sept. 25, 2010. Only publications directly relevant to clinical practice were included. We included “position statements” and “reports.” We did not review the primary study reports referenced by the guidelines. Data extraction addressed guidelines' evidence-classification schemes, guidelines' literature review methodologies, and guideline recommendations' quality of supporting evidence. We classified the supporting evidence for recommendations by study design, as follows: randomized controlled trial(s), observational, undefined, and expertise alone (i.e., without explicit reference to primary data). Results: Of the 15 NASPGHAN guidelines, we excluded three guidelines that did not address clinical practice. Of the 12 included guidelines, four were labelled Clinical Guidelines (33%), five were Position Statements (42%), and three were Reports (25%). Altogether, they included 201 recommendations: 109 diagnostic, and 92 treatment-related. Eight of the twelve guidelines applied formal evidence-grading systems; in all, they used five different evidencegrading systems. Most guidelines reported some information on the literature review process (Table 1). Table 2 describes the type of evidence that supported the diagnostic and treatment recommendations. Overall, a slight majority of recommendations (51%) did not cite primary data directly and thus referenced only expertise.Table 1: Literature search and data collectionTable 2: Types of supporting evidence for guideline recommendationsConclusion: There was significant heterogeneity in clinical guideline methods and reporting. Most recommendations were limited by the quality of supporting evidence. There is a great need for more high-quality research in pediatric gastroenterology, hepatology and nutrition. Greater standardization of guideline reporting could also facilitate the communication of evidence for guideline recommendations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.130 | 0.375 |
| Meta-epidemiology (narrow) | 0.003 | 0.003 |
| Meta-epidemiology (broad) | 0.005 | 0.008 |
| Bibliometrics | 0.031 | 0.021 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.007 | 0.006 |
| Open science | 0.009 | 0.006 |
| Research integrity | 0.008 | 0.007 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".