(1)This is an abbreviated version of the complete form: contact Eloise.Clark@cchmc.org for more information Copyright Cincinnati Children's Hospital Medical Center; all rights reserved

(1)

This is an abbreviated version of the complete form: contact Eloise.Clark@cchmc.org for more information

Form for Reporting Results of search/appraisal to answer a clinical question

TOOL 1

A. Date submitted ___________________

B. Topic and/or question as originally asked C. PICO (searchable clinical question)

P (population/problem) ____________________________________________________________

I (intervention) ____________________________________________________________

C (comparison) ____________________________________________________________

O (outcome) ____________________________________________________________

D. Individual, or Group/team members (include credentials, discipline and/or specialty) E. Search strategy (complete as fully as possible)

1.D^ATABASES

2.SEARCH TERMS(and Boolean combinations, if any). If possible, please attach a printout of the search strategy.

3.LIMITS AND FILTERS

F. References/citations and level/grade of evidence (may use a reference manager such as RefWorks or EndNote; see Table for definition of level/grade of evidence)

G. 1. Discussion/summary of evidence

2. Health Benefits, Side Effects and Risks of PICO intervention or test H. Recommendation(s) and grade

I. Known conflicts of interest (check if unknown) Remaining items are optional

J. Introductory/background information

K. Applicability issues (e.g. organizational barriers or costs to consider, measurable outcomes, implementation tools)

(2)

Division / Condition / Topic / BESt ###

Best Evidence Statement (BESt)

Date published/posted

Topic and/or question as originally asked Clinical Question

P (population/problem)

TOOL 2

I (intervention) C (comparison) O (outcome)

Target Population [inclusion/exclusion criteria]

Recommendation(s) (See Table of Recommendation Strength following references) [specific and unambiguous language]

1. It is recommended that…

Discussion/summary of evidence

Health Benefits, Side Effects and Risks

References/citations

Supporting information Introductory/background information (optional)

Group/team members (include credentials, discipline and/or specialty)

Group/Team Leader Other group/team members Support personnel

Search strategy

Known conflicts of interest (if any, delete this item if unknown) Applicability issues (optional)

Reviewed by:

(3)

Checklist for evaluating readiness for posting of BESt

Re: BESt Name and/or ###

TOOL 3

Date submitted is present PICO is adequately presented

Target population is specifically described

Recommendation(s) is/are adequately specific and unambiguous.

Recommendation(s) has/have been assigned a strength grade and grade table is present.

References/citations are present and the link to the recommendation(s) is explicit or transparent.

All citations have been assigned a quality level and level legend is present.

Health benefits, side-effects and risks have been appropriately considered in formulating recommendations.

Team member(s), including credentials, discipline and/or specialty is present Systematic search strategy is adequately described

I, the reviewer, was not involved with the development of this BESt

Meets all criteria (may be posted)

Does not meet all criteria (return to developer with suggested changes) Comments:

Reviewer’s name Date Reviewed