7 Evidence Appraisal: Nonresearch 151Attention has also been paid to assessing equity in clinical practice guidelines.
Equity concerns arise in groups potentially vulnerable to inequity because of resi-
dence, race, occupation, gender, religion, education, socioeconomic status, social
network, and capital (Dans et al., 2007). When appropriate, an EBP team must
consider the sociopolitical dimensions of applying CPGs to disadvantaged patient
populations.
The age of the patient population is equally as important. Consider the anatomic,
physiologic, and developmental differences between children and adults before
applying published guidelines. Also, if possible, find a guideline specifically de-
veloped for children. For example, Black, Flynn, Smith, Thomas, and Wilkinson
(2015) developed a pediatric airway-management guideline because only an
adult guideline was available.
EBP teams also need to note that although groups of experts create these guide-
lines, which frequently carry a professional society’s seal of approval, opinions
that convert data to recommendations require subjective judgments that, in turn,
leave room for error and bias (Mims, 2015). Potential conflicts of interest can be
generated by financial interests, job descriptions, personal research interests, and
previous experience. The IOM panel recommended that, whenever possible, indi-
viduals who create the guidelines should be free from conflicts of interest; if that
is not possible, however, those individuals with conflicts of interest should make
up a minority of the panel and should not serve as chairs or co-chairs (IOM,
2011).
Key elements to note when appraising Level IV evidence and rating evidence
quality are identified in Table 7.2 and in the JHNEBP Nonresearch Evidence Ap-
praisal Tool (see Appendix F).