• also a type of journal article, published alongside

• Briefly explain your search strategy.? Utilized various internet, textbook and journals searches. I ensured to only access and refer to peer reviewed, reputable sources and none greater than 5 years in circulation.• Who developed the guideline?? The guideline, The Diagnosis and Management of Otitis Media, was developed by the American Academy of Pediatrics and endorsed by the American Academy of Family Physicians (APA, 2013). (It applies to otherwise healthy children 6 months through 12 years of age)• Is this a revision of a previous guideline or an original? What is the date of publication?? Original guideline written November 2003 and endorsed by APA in July 2013• Explain the concept of “systematic review of current best evidence.

“? A systematic review is a summary of the medical literature that uses explicit and reproducible methods to systematically search, critically appraise, and synthesize on a specific issue. Researchers conducting systematic reviews use explicit methods aimed at minimizing bias, in order to produce more reliable findings that can be used to inform decision making (Neinstein, et. Al., 2016). Systematic reviews are also a type of journal article, published alongside primary research articles in scholarly journals.

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• How was conflict of interest managed in the development of these guidelines?? Professional expectations dictate that clinical practice guidelines are based on credible scientific evidence, critical computation of said evidence, and un-biased clinical judgment that relates the evidence to the needs of practitioners and patients (IOM, 2009). Arguably, the most compelling issue in the development of clinical practice guidelines is the lack of research that can be used to guide the evolution of comprehensive recommendations applied to clinical practice. Through professional collaboration and respect for one another’s idealism and expertise, any conflict of interest issue can be resolved. • How is quality of evidence defined?? In 2014 the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group presented its initial proposal for patient management.  GRADE provides a specific definition for the quality of evidence in the context of making recommendations. The quality of evidence reflects the extent to which confidence in an estimate of the effect is adequate to support a particular recommendation (Atkins, et. al., 2014).

 • Explain differences among strong recommendation, recommendation, and option.Grade of Recommendation Clarity of risk/benefit Quality of supporting evidence ImplicationsStrong recommendation, high quality evidence(Coco, Vernacchio, Horst, Anderson, 2013) Benefits clearly outweigh risk and burdens, or vice versa. Consistent evidence from well performed randomized, controlled trials or overwhelming evidence of some other form. Further research is unlikely to change our confidence in the estimate of benefit and risk. Strong recommendations, can apply to most patients in most circumstances without reservation. Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present.

Strong recommendation, moderate quality evidence(Coco, Vernacchio, Horst, Anderson, 2013) Benefits clearly outweigh risk and burdens, or vice versa. Evidence from randomized, controlled trials with important limitations (inconsistent results, methodologic flaws, indirect or imprecise), or very strong evidence of some other research design. Further research (if performed) is likely to have an impact on our confidence in the estimate of benefit and risk and may change the estimate.

Strong recommendation and applies to most patients. Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present.Strong recommendation, low quality evidence(Coco, Vernacchio, Horst, Anderson, 2013) Benefits appear to outweigh risk and burdens, or vice versa. Evidence from observational studies, unsystematic clinical experience, or from randomized, controlled trials with serious flaws. Any estimate of effect is uncertain. Strong recommendation, and applies to most patients. Some of the evidence base supporting the recommendation is, however, of low quality.

Weak recommendation, high quality evidence(Coco, Vernacchio, Horst, Anderson, 2013) Benefits closely balanced with risks and burdens. Consistent evidence from well performed randomized, controlled trials or overwhelming evidence of some other form. Further research is unlikely to change our confidence in the estimate of benefit and risk. Weak recommendation, best action may differ depending on circumstances or patients or societal values.Weak recommendation, moderate quality evidence(Coco, Vernacchio, Horst, Anderson, 2013) Benefits closely balanced with risks and burdens, some uncertainly in the estimates of benefits, risks and burdens. Evidence from randomized, controlled trials with important limitations (inconsistent results, methodologic flaws, indirect or imprecise), or very strong evidence of some other research design. Further research (if performed) is likely to have an impact on our confidence in the estimate of benefit and risk and may change the estimate. Weak recommendation, alternative approaches likely to be better for some patients under some circumstances.

Weak recommendation, low quality evidence(Coco, Vernacchio, Horst, Anderson, 2013) Uncertainty in the estimates of benefits, risks, and burdens; benefits may be closely balanced with risks and burdens. Evidence from observational studies, unsystematic clinical experience, or from randomized, controlled trials with serious flaws. Any estimate of effect is uncertain. Very weak recommendation; other alternatives may be equally reasonable• What are “key Action statements?”? Key action statements are a component of the development process, which allows moving from conception to completion in a designated timeframe, emphasizes a logical sequence of key actions supported by an amplifying text, profiles evidence, and makes recommendation grades that link action to evidence (IOM, 2009). Key action statements should be clear and precise to avoid inconsistent interpretation and prevent inappropriate practice variation. Having drafted a list of key statements, the group should review the list for ambiguous or vague actions.

• For this particular child, what are the specific treatment recommendations including any diagnostics, medications (include exact dosage, frequency, length of treatment), follow-up, referral, prevention, and pain control (APA, 2013).? Amoxicillin 80-90 mg/kg/day PO (maximum 3 g/24h) divided BID for 5-7d; 10d may be required if illness is severe (Amoxicillin-clavulanate has a broader spectrum than amoxicillin and may be a better initial antibiotic. However, because of cost and adverse effects, the subcommittee has chosen amoxicillin as first-line AOM treatment) (APA, 2013, Burns, et.

al., 2017).? Acetaminophen 15mg/kg every 6 hours as needed for pain/fever (alternate with ibuprofen) (APA, 2013).? Ibuprofen 10mg/kg every 6 hours as needed for pain/fever (alternate with acetaminophen) (APA, 2013).? No referral required at this, will consider ENT is AOM develops reoccurring pattern? Follow up in 2 weeks; sooner of needed