American Dietetic Association Navigating the Evidence Analysis Library

1. American Dietetic AssociationNavigating the Evidence Analysis Library

2. “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

3. 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?

4. Online Resource with the best available research on important dietetics topics in a practitioner-friendly format ADA Evidence Analysis Librarywww.adaevidencelibrary.com

5. 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?

6. 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

7. Navigate through the library by selecting from tabs:

8. 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

9. Select from list of Diseases & Conditions Choose a Topic Disorders of Lipid Metabolism Macronutrients Trans-fatty acids Then, choose a sub-topic

10. Example: View EA Question What is the relationship between diets high in trans fatty acids and serum cholesterol levels? Bibliography for Topic

11. Example:EA Conclusion Statement/Grade “Mouse over” Question to see Conclusion & Grade

12. 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

13. Explanation of Grades

14. Narrative Summary Of the research available to answer question Example: Evidence Summary Evidence Summary

15. Example: Bibliography Bibliography for Question listed at end of Evidence Summary (and linked to worksheets)

16. 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

17. Example: Quality Criteria Checklist • Primary Research • or • Narrative Review • Determine Quality Rating of Article

18. 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

19. Criteria: Guideline Elements Model (GEM) AGREE Instrument National Guidelines Clearinghouse standards Classification: American Academy of Pediatrics Criteria and Classification for Guideline Development

20. 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

21. 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

22. 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

23. Evidence-Based Guidelines Homepage

24. Guideline List

25. Guideline List: Select Disorders of Lipid Metabolism

26. Disorders of Lipid MetabolismEvidence-Based Nutrition Practice GuidelineMain Menu Choose a Category

27. Disorders of Lipid MetabolismEvidence-Based Nutrition Practice Guideline Introduction • Guideline Overview • Scope of Guideline • Statement of Intent • Guideline Methods • Implementation • Benefits and Risks/harms

28. Select a Category within Introduction Disorders of Lipid MetabolismEvidence-Based Nutrition Practice Guideline Scope of guideline

29. Disorders of Lipid MetabolismEvidence-Based Nutrition Practice Guideline • Introduction • Scope • Disease/Condition • Guideline Category • Intended Users • Objectives • Target Population

30. Disorders of Lipid MetabolismEvidence-Based Nutrition Practice Guideline • Introduction • Guideline Methods • Method for Creating Guidelines • Inclusion and Exclusion Criteria

31. Main Menu: Major Recommendations

32. Disorders of Lipid MetabolismEvidence-Based Nutrition Practice Guideline Introduction • Select • Guideline • Methods

33. Disorders of Lipid MetabolismEvidence-Based Nutrition Practice Guideline • Introduction • Guideline Methods • Method for Creating Guidelines • Inclusion and Exclusion Criteria

34. Disorders of Lipid MetabolismEvidence-Based Nutrition Practice Guideline Choose a different category Return to Main Menu Select • Major Recommendations

35. 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

36. Disorders of Lipid MetabolismEvidence-Based Nutrition Practice Guideline • Major Recommendations • Trans-fatty Acid Intake and DLM RecommendationFeatures: • Recommendation • Rating • Risks/Harms • Strength • Rationale • Narrative

37. 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.

39. 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?

40. Disorders of Lipid MetabolismEAL Trans fatty acids question View Conclusion Statement and Grade Drill down to the Evidence Summary

41. Disorders of Lipid MetabolismEAL Trans fatty acids question Evidence Summary Scroll down for worksheets

42. Disorders of Lipid MetabolismEAL Trans fatty acids question Drill down to Quality rating And worksheets

43. Disorders of Lipid MetabolismEvidence-Based Nutrition Practice Guideline Main Menu: Algorithms

44. View Main Algorithm for Disorders of Lipid Metabolism • See recommendations organized within a treatment plan Nutrition Care Process Assessment Diagnosis Intervention Monitoring & Evaluation

45. Link to another level within the Algorithm Red = different level in algorithm Blue = recommendation Determine Meal Plan and Nutrition Recommendation Select

46. View second level algorithm • Link to Recommendation Select Recommend Intake of as Few Trans Fatty Acids as Possible

47. View Recommendation • Drill down as needed

48. 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

49. 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

50. 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)