1. The Evidence Analysis Process: Steps and Features

2. Presentation Objectives
Understand the Steps in the Academy of Nutrition and Dietetics’ Evidence Analysis Process
Identify topics and features in the Academy’s Evidence Analysis Library

3. FREE to Academy Members!
Evidence Analysis Library
FREE to Academy Members!
Online resource
with the best
available research
on important
dietetics topics in a
practitioner-friendly
format
One of the most important developments in nutrition and dietetics practice, today and for the future is the Academy of Nutrition and Dietetics’ evidence analysis Library. The creation of the EAL makes possible Evidence-Based Dietetics Practice. This will enable superior nutrition care, standardization in all areas of dietetic practice and consistency in measuring outcomes of the work of the registered dietitian. This will result in enhanced professionalism and an increased ability to achieve third party reimbursement for services.
This is the home page for the EAL®. The tabs on the top line indicate the broad categories of the EAL®. The second line of tabs indicates the sub-categories for the selected category on the top line.
There are parts of the EAL® that the public can view and other areas that are restricted to Academy members and subscribers. The Pediatric Weight Control and Childhood Overweight projects are available to the public because they were supported by a grant from the Academy Foundation.

4. “Evidence-Based Dietetics Practice”
Definition
“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.”
The definition of EBP was developed by A.N.D. Evidence-based Practice Committee with input from Research Committee, Quality Management Committee, and Scope of Dietetics Practice Task Force. It was approved by ADA House of Delegates Leadership Team and adopted association wide.
READ SLIDE
The important point to note here is the use of systematically reviewed scientific evidence - this is the research out there is reviewed according to set procedures. And that EBP integrates best available evidence with professional expertise and client values by the work of the expert Workgroups
We cannot prove our expertise and streamline practice what we learn in newspaper articles and popular fashion magazines, we need to focus on the evidence based approach to practice.
It:
Improve quality of healthcare
Decrease wide variations in practice
And
Reduce the gap between what is known from research…and what happens in real life
Definition developed by A.N.D. Evidence-based Practice Committee with input from Research Committee, Quality Management Committee, and Scope of Dietetics Practice Task Force. Approved by A.N.D. House of Delegates Leadership Team

5. Why Evidence-Based? Improve quality of healthcare
Decrease wide variations in practice
Reduce the gap between what is known from research…and what happens in real life
Take advantage of biomedical knowledge
We cannot prove our expertise and streamline practice with what we learn in newspaper articles and popular fashion magazines, we need to focus on the evidence based approach to practice.
It:
Improves quality of healthcare
Decrease wide variations in practice
And
Reduce the gap between what is known from research…and what happens in real life

6. Academy’s Evidence Analysis Process
A rigorous and systematic process for searching, analyzing and summarizing research on a specific nutrition topic.
As I share with you what resources are available through Academy that promoted evidence based practice, I think it is important that you understand how these resources were created and what makes them so credible.
Every EAL project, including those that develop into guidelines and toolkits go through the Academy’s Evidence Analysis process. This process is a rigorous and systematic process for searching, analyzing and summarizing research on a specific nutrition topic.

7. State-of-the-art method for evaluating food and nutrition questions.
EAL Process
State-of-the-art method for evaluating food and nutrition questions.
Conducted by a team consisting of content experts in the field and evidence analysts trained in research analysis
Meticulous methods and web-based templates are used throughout the process to ensure objectivity, transparency and reproducibility of the process
The methodology followed by the Academy is highly recognized. The Academy’s uses web-based templates to ensure objectivity and transparency of the process.

9. Members of the Team Workgroup Members Methodologist Workgroup Chair
Patient Advocate
Project
Manager
Lead
Analyst
Evidence Analysts
Methodologist
Oversight committee - read through the cycle
Medical Librarian

10. Scoping Review

11. Why do a scoping review?
To examine the extent, range and nature of available research on a topic or question
To determine the value of undertaking a full systematic review.
To summarize and disseminate research findings across a body of research evidence (e.g. that is heterogeneous and/or complex)
To identify research gaps in the literature to aid planning and commissioning of future research.
Think the main thing to stress is that we’re just looking to see what’s out there, but no results or quality analysis.
Arksey H, O’Malley L. Scoping studies: Towards a Methodological Framework. Int J Soc Res Methodol. 2005; 8(1):19–32.

12. Characteristics of different reviews
Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC medical research methodology. 2018;18(1):143.

13. Formulate the Question
Step 1:
Formulate the Question

14. Formulate the Question
We ask questions to…
Identify relevant research
Identify areas where knowledge for practice is needed
Connect scientific research knowledge to practice
Focus the Approach to the Research

15. Nutrition Care Process
Assessment
Nutrition
Diagnosis
Nutrition
Intervention
What do you do at each
step in the nutrition care process?
Evidence analysis should focus on answering questions related to these steps.
This represents the Nutrition Care Process which those of you who are in clinical practice have been doing.
Nutrition
Monitoring
And
Evaluation
Outcomes

16. Example Question
The workgroup is asked to formulate 10 questions (typically) for their project. Here is a sample question > we use a PICO format P_I_C_O_

17. Gather and Classify the Research
Step 2:
Gather and Classify the Research

18. Review titles and abstracts
The Search Strategy
Develop a search plan
Inclusion and exclusion criteria
Conduct search
Appropriate search and MeSH terms
Use multiple databases
Review titles and abstracts
Rationale for excluding articles documented
Sort list of articles is created
Reviewed by workgroup
Alteration in search strategy may occur
Search strategy is documented
Before beginning a literature search, the workgroup must develop a detailed search plan - the inclusion and exclusion criteria. A medical librarian, with systematic review experience, conducts the actual search using appropriate search and meSH terms and multiple data bases. The workgroup then reviews the search plan results. They decide which articles to include and which to exclude. Any article that is excluded must have a valid reason—all of which is documented and published on the EAL. The final list of included articles is called the sort list.

19. Steps in Identifying Research
All Research
Results of Electronic Database
Searches
Result of First Citation and
Abstract Review
Articles
Must be
Included
In Search
Plan &
Results
Result of Expert Work Group
Citation and Abstract Review
Conducting a thorough search of multiple databases is critical. This diagram shows that the initial search is always wide. Duplicate articles and articles that don’t meet the criteria are excluded. All of this is carefully documented.
Final List: Result of Work Group
Review of Articles

20. Search Plan & Results for Each Question
Reports
Inclusion
& Exclusion
Criteria
Date of Search
Inclusion Criteria:
-Age
-Setting (outpatient)
-Sample Size
-Acceptable dropout rate
-Year Range
-English Language
Databases Searched
Search Terms
List of Articles
This is done by the expert WG setting the inclusion – who should be included on the search - and exclusion criteria, As I mentioned before, the Academy has standard criteria for every project regarding peer-reviews, English language and human studies
Then the lead analyst takes this info to do a search on the research that is out there.
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21. Search Plan & Results
Included articles and Excluded articles (with reason)
List reason for exclusion
for each article not
included in the analysis;
e.g. Sample size too small
Youwill be able to look at the search plan and results which looks like this slide. It will show you which articles the workgroup did not include and will give you a reason why they didn’t do appraisal for that worksheet. This is in order to make sure that all work on the EAL is transparent and that if anyone did the same search, using the same inclusion criteria, would be able to come up with the same results.

22. Critically Appraise Each Article
Step 3:
Critically Appraise Each Article

23. Worksheet 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
Here is a sample worksheet – All worksheets are available to you on the EAL – you can actually search a topic and see all the research that has already been appraised for you – if you are looking for research on a topic
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24. Critical Appraisal of Each Article
Completed worksheet
Completed quality criteria checklist
Most detailed information on EAL
Work of analysts:
Reviewed by lead analyst
Approved by workgroup
Evidence Analysts critically appraise each article using a data extraction worksheet designed to capture specific outcomes. As a part of this step, a worksheet and quality criteria checklist (QCC) is created for each article. Once the evidence analysts completed the worksheet and QCC, it is reviewed by the lead analyst and approved by the workgroup.

25. Critical Appraisal of Each Article
Completed worksheet
Completed quality criteria checklist
Most detailed information on EAL
Work of analysts:
Reviewed by lead analyst
Approved by workgroup
Evidence Analysts critically appraise each article using a data extraction worksheet designed to capture specific outcomes. As a part of this step, a worksheet and quality criteria checklist (QCC) is created for each article. Once the evidence analysts completed the worksheet and QCC, it is reviewed by the lead analyst and approved by the workgroup.

26. Quality Criteria Checklist
Questions related to
relevance and validity
Determines if article
is rated as:
Positive Quality
Negative Quality
Neutral Quality
Here is the checklist that gives the article its quality rating – again important to prove the best research was found to answer a question for a topic on the EAL. Each article will receive a quality rating of positive, negative or neutral based on the answers to the quality criteria checklist. The quality of the articles will help determine the grade of the conclusion statement. The conclusion statement will have a better grade (i.e. grade I or II) with more positive quality articles supporting it. Over 3600 articles have been analyzed on the Evidence Analysis Library.
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27. Summarize the Evidence in an Overview table and Evidence Summary
Step 4:
Summarize the Evidence in an Overview table and Evidence Summary

28. Evidence Summary Summarize articles into Summary Table
Information synthesized from articles into narrative evidence summary
Responsibility of Analyst
Reviewed by Lead Analyst
Reviewed and Approved by Workgroup
The Lead Analyst reviews the worksheets and quality criteria checklists completed by the evidence analysts and drafts evidence summaries for each evidence analysis question. Evidence summaries are a synthesis of the evidence into a narrative format. Additionally, a summary table is created to provide information on the studies and outcomes at a glance.

29. Narrative Evidence Summary
Example: Summary of evidence for Oats and Gluten Intolerance question
Once the analysts have completed their worksheets and quality criteria checklist, the lead analyst drafts up an evidence summary and provides this to the expert workgroup to review and edit. The lead analyst takes ALL the information that was found out through the articles and pulls it in to an Evidence Summary

30. Evidence Summary - Bibliography
Citations linked to worksheets at the bottom of the Evidence Summary
If you recall, I showed you a sample worksheet, to see a worksheet, you can go to the very bottom of the evidence summary and see a link for each articles. If you click on them, you can see the worksheets for any article that was used for a particular question

31. Step 5:
Develop Conclusion Statement and Grade the Strength of the Supporting Evidence

32. Conclusion Statement
Bottom Line – Answer to question based on the science
Determined after research analyzed
Graded based on quality of supporting evidence
The Conclusion Statement is the answer to the evidence analysis question. This is why following the PICO format during the question develop process is so important. Conclusion Statements are drafted by the Lead Analyst and reviewed, approved, and graded by the workgroup.

33. Conclusion Statement
The WG makes a conclusion based on the evidence for our Question – it is graded----

34. Explanation of Grades % of Grade I questions on EAL
Here is the grade chart we use to tell you how strong the evidence was or was not. From the previous slide, the grade on low carbohydrate diets was a Grade II: Fair—which states that the evidence consists of results from studies of strong design answering the question addressed, but there is uncertainty attached to the conclusion because of inconsistencies among the results from different studies or because of doubts about generalizability, bias, research design flaws, or adequacy of sample size. Alternatively, the evidence consists solely of results from weaker designs for the questions addressed, but the results have been confirmed in separate studies and are consistent with minor exceptions at most.

35. Guideline Development

36. Evidence-Based Guidelines…
Evidence-Based Nutrition Practice Guidelines
Evidence-Based Guidelines…
A series of guiding statements and treatment algorithms
Developed using a systematic process
Assist the practitioner in decision making for appropriate nutrition care
Some projects on the EAL move on to become guidelines
Evidence-Based Nutrition Practice Guidelines are systematically developed statements based on scientific evidence to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.
Evidence-based Guidelines and Toolkits can help you:
Implement evidence-based practice
Implement NCP/SL
Promote consistency
Achieve expected outcomes
Assure quality care

37. What is an Evidence-Based Nutrition Practice Guideline?
Evidence-Based Nutrition Practice Guidelines (EBNPG) are a series of guiding statements which are developed using a systematic process for identifying, analyzing and synthesizing scientific evidence. They are designed to assist practitioner and patient decisions about appropriate nutrition care for specific disease states or conditions in typical settings.
Key elements include scope, interventions and practices considered, major recommendations and corresponding rating of evidence strength and areas of agreement and disagreement.
The Evidence-Based Nutrition Practice Guidelines are a series of guiding statements which are developed using a systematic process for identifying, analyzing and synthesizing scientific evidence. They are designed to assist practitioner and patient decisions about appropriate nutrition care for specific disease states or conditions in typical settings.  Key elements include scope, interventions and practices considered, major recommendations and corresponding rating of evidence strength and areas of agreement and disagreement.

38. Evidence-Based Research
Evidence Summaries & Conclusion Statements = what the evidence says
Guideline = course of action for the practitioner based on the evidence
What is the difference between the evidence-based research and the evidence-based recommendation? Basically, the systematic review evidence summaries and conclusion statements are what the evidence says. The guideline is a course of action for the practitioner based on the evidence

39. NutriGuides – EAL on the GO!
This mobile application is designed for the busy healthcare professional by providing easy access to all EAL recommendations right at your fingertips!
NutriGuides is available from the Apple iTunes store for the iPhone and iPad; and from GooglePlay for Android devices

40. Published on the EAL® Available free to All Academy Members
Research Question
Conclusion
Grade
Evidence Summary Narrative
Summary Table
Worksheets and Quality Checklists for each article
Search Plan & Results
Individual EAL Subscriptions are available from
For Institutional EAL subscriptions, contact
Finally after the WG approves the question and it’s CS – it is published on the EAL for you as a free member benefit!
After the evidence analysis is completed for a project, the information can be used to create a Guideline, Toolkit, or other resources for the dietetic practitioner. A project may also be used to support an Academy Position Paper. Guidelines and resources are published on the EAL and Position Papers are linked from the Academy website.

41. Evidence Analysis Library Projects
There are currently 40 plus evidence analysis projects with 18 evidence-based nutrition practice guidelines published on the EAL. The projects are listed in alphabetical order from the Projects tab on the EAL Home page. This allows the users to view all of the topics.

42. Summary
Academy’s Evidence Analysis Library can be found at:
Questions contact: