bluuebunny/crossref_metadata_2025 huggingface dataset:
P107 Developing A Customised Web-Based Data Extraction Tool Using An Existing Customer Relationship Service: Thinking Outside The Box
Authors: Nagler E , Liébaut V , Haller M , van der Veer S , Bolignano D , Nistor I , Van Biesen W
Published: August 2013

Background

Standardised duplicate data extraction and tabulation can be challenging for organisations that develop multiple guidelines involving multiple and remote systematic review teams simultaneously.

Objectives

To develop a web-based tool for facilitating duplicate data extraction and efficient discrepancy resolution.

Methods

Based on previous experiences with word-processing and spreadsheet tools, European Renal Best Practice listed their system requirements and collaborated with a consultancy company to identify appropriate customisable software.

Results

We wanted the system to: be web-based, guide reviewers through a standardised data extraction form, be easy-to-use and manage, allow enough flexibility to accommodate different guideline topics, be free-of-charge and easily accessible from different locations without the need for downloading software. We identified a customer relationship management service, Salesforce, that allowed us to build a data extraction module using their backbone structure. It incorporates centralised management of multiple systematic reviews simultaneously, batch allocation of studies to individual reviewers, guided customised point-and-click data extraction, generation of tables to assist discrepancy resolution with easy export to a cvs-file extension format.

Discussion

This project represents a continuous effort to facilitate efficient and high-quality systematic reviewing with participation of our guideline development groups throughout the systematic reviewing process. A first version of the system is currently being evaluated.

Implications for Guideline Developers/Users

Customising existing software for guideline development purposes might be an attractive and inexpensive alternative to developing new tools for data extraction when full participation of the guideline development group in the systematic review process is desired.
P114 The Quality Of Evidence Of Systematic Reviews Of Traditional Chinese Medicine: A Cross-Sectional Study
Authors: Chen Y , Wu Q , Wang X , Wang Q , Wei D , Yao L , Liang F , Wang M , Yang K
Published: August 2013

Background

There has been an increasing interest in systematic reviews of traditional Chinese medicine (SR-TCM) over the past 10 years. Little is known about the quality of evidence of SR-TCM.

Methods

GRADE (Grading of Recommendations Assessment, Development and Evaluation) system is a tool to rate evidence quality of SRs and other evidence body. We searched CBM (China Biomedicine Database) from 1978 to 2012 and included all SR-TCM in the field of cancer treatment. We used GRADE system to assess the quality of evidence of those SRs. Two reviewers independently screened the titles and abstracts of identified studies. Full texts of potentially included articles were further assessed. Disagreements were resolved by discussion.

Results

The preliminary results showed that the quality of evidence of SR-TCM were: high (1%), moderate (25%), low (50%), very low (24%). We also compared with the quality of evidence of SRs published in Chinese medical journals (5%, 27%, 49%, 19%) and Cochrane SRs (5%, 27%, 49%, 19%). Risk of bias, inconsistency and publication bias were the major factors for downgrading evidence of SR-TCM.

Conclusion

More and more SR-TCM had been published in Chinese medical journals, however, the proportion of high quality evidence is lower and the very low quality evidence is higher compared with national and international levels.
P115 How Many Cluster Randomized Controlled Trials Were Used In Clinical Practice Guidelines?
Authors: Chen Y , Wu Q , Wang X , Wang Q , Wei D , Yao L , Liang F , Wang M , Yang K
Published: August 2013

Background

There has been an increasing interest in cluster randomised controlled trial (CRT) over the past 20 years. Little is known about how many CRTs were used by clinical practice guidelines.

Methods

We searched National Guideline Clearinghouse (NGC) which is a public resource for evidence-based clinical practice guidelines on December 31, 2012. We selected guidelines which provide MEDLINE full-text linking and then we checked all references cited by those guidelines.

Results

We included 564 guidelines and they contained 57495 references. We identified 13 guidelines cited 17 cluster randomised controlled trials as their references. Guidelines are about primary care, cancer, obesity, breastfeeding, cardiovascular and orthopaedics disease. Screening studies accounts for as much as 35% (6) of all CRTs.

Conclusion

Cluster randomised controlled trial is considered as the golden standard to assess the effect of intervention in health research. Based on the retrieval strategy study for cluster randomised controlled trial we developed, we estimated that there are about 8000 CRTs in Medline, however, only 17 CRTs were used or cited by clinical practice guidelines, the reasons of low utilisation of CRTs in guidelines are now being investigated and we are going to present the final findings.
P117 Uniformity In Anaesthesiology Recommendations
Authors: Loman I , Schuurhuis A
Published: August 2013

Background

The field of anaesthesiology is multidisciplinary and includes the perioperative trajectory, but also the domains of pain, palliative, intensive and emergency care. In The Netherlands there are numerous guidelines on anaesthesiology, from generic to disease and target group specific. These were developed by different stakeholders and were not always thoroughly checked on consistency with other guidelines.

Objective

To assess uniformity in recommendations in the field of anesthesiology.

Methods

Four guidelines were considered the base of anaesthesiology care; pre-, peri- and postoperative care and postoperative pain treatment. The recommendations of these four guidelines were combined with a number of consensus statements and matched with disease and target group specific recommendations. These recommendations were categorised into three groups: 1) no controversy; 2) controversy, update necessary; 3) new guideline(s) needed. For the recommendations in the categories 2 and 3 a working group was formed to address these issues.

Results

The inventory is on-going and will be finished in spring 2013.

Discussion

The total number of guidelines and recommendations on the topic of anaesthesiology are great. This makes it complex for the clinician to find the right recommendation and calls for a more convenient way of presenting them. Supervision from the anaesthesiology association is required for the development of new guidelines to guarantee uniformity between anaesthesiology recommendations.

Implications for Guideline Developers/Users

It is of great importance that recommendations throughout guidelines are never conflicting. An electronic modular database could be a more convenient way of presenting recommendations.
017PS Using Computerized Decision Support Systems to Improve the Uptake of Guidelines: Perspectives from Different Countries
Authors: Lugtenberg M , Brandt L , Kunnamo I , Shiffman R , Burgers J
Published: August 2013

Background

Computerised decision support systems (CDSSs) are increasingly used to improve the uptake of guidelines. However, there is large variation in types of decision support provided, types of supported guidelines and recommendations, and types of healthcare settings in which CDSSs are applied. In addition, the effectiveness varies across systems, whereas determinants for success and failure are largely unknown.

Objectives

To provide opportunities for sharing experiences and discussing lessons learned in the use of CDSSs in different countries.

Target Group

Guideline developers, guideline implementers, clinicians, researchers, policy makers.

Moderator

Jako Burgers, Dutch College of General Practitioners (NHG), The NetherlandsInvited speakers: Marjolein Lugtenberg, IQ healthcare, Radboud University Nijmegen Medical Centre, The Netherlands. Linn Brandt, Inlandet Hospital Trust/University of Oslo, Norway. Ilkka Kunnamo, Duodecim Medical Publications Ltd./University of Helsinki, Finland. Richard Shiffman, Center for Medical Informatics, Yale University, USA.

Description of Session and Speaker Topics

In this session initiatives on CDSSs from four different countries (The Netherlands, Norway, Finland, and the USA) will be presented, each taking a different perspective on the use of CDSSs to improve the uptake of guidelines. Issues that will be considered are how to deal with various alerts within multiple disease areas, distinguishing alerts from strong and weak guideline recommendations, and creating composite views of data and recommendations. Finally, conclusions are drawn on the strengths and weaknesses of developing, implementing, and evaluating each system and lessons learned will be discussed with the audience.
P118 Are Levels Of Evidence From Different Clinical Practice Guidelines Comparable? – Testing Of A Method For Standardization Of Different Evidence Grading Systems
Authors: Hoffmann-Eßer W , Großelfinger R , Holzmann N , Brockhaus C , Ein Waldt S , Ernsting C , Yurdakul A , Rüther A , Siering U
Published: August 2013

Background

In 2009 we presented a method for standardisation of different evidence grading systems (EGS) to simplify the comparison of levels of evidence (LoE) from different guidelines. For this purpose, LoE from guidelines were allocated to a reference standard, the EGS from the Federal Joint Committee’s (G-BA) Code of Procedure. This approach has not yet been tested on several different EGS from guidelines.

Objective

To test the feasibility of a method for standardisation of different EGS from COPD, asthma and breast cancer guidelines.

Methods

We conducted a systematic search for the above guidelines in guideline databases and websites of guideline providers. The search period covered 11/2007 to 7/2012. Eligible guidelines were evidence-based English or German guidelines using an EGS. The LoE reported were allocated to the EGS from the G-BA’s Code of Procedure.

Results

43 guidelines on chronic diseases with 19 different EGS and 188 different LoE were included. With 4 exceptions, all LoE used in the EGS could be allocated to at least one category of the reference standard. In 44 cases, the LoE from the identified EGS could be allocated to exactly one category and in 63, an LoE was allocated to several categories. Several LoE from one guideline were allocated to one category in 15 cases; this can result in loss of information.

Discussion

The testing of a method for standardisation of different EGS indicates that standardisation of LoE using a reference standard can be successfully implemented and can simplify the comparison of different EGS.
P121 Clinical Decision Support: A Valuable Tool For Many Reasons
Authors: Van Vegchel T , Kersten S , Harmsen M
Published: August 2013

Background

Oncology is complex and time-consuming care. Because evidence changes frequently, implementation of knowledge is viable for putting evidence into daily practice and decreasing variation in treatment advice.

Context

Clinical Decision Support (CDS) based on Clinical Practice Guidelines improves both individual care for cancer patients, including increase in safety, efficiency and transparency and supports guideline developers adjusting implementation strategies and improving updating.

Description of Best Practice

We developed a prototype, which uses input based on disease (TNM, stadium) and patient characteristics (co-morbidity, e.g.). First, recommendations were formulated as computer interpretable recommendations using IF…THEN rules. Second, the application assembled all information and combined them with alerts, namely contraindications and side effects, finally leading to treatment advice. We found that CDS is a viable way of assisting doctors and patients. Treatment advice is better suited to both evidence based recommendations and specific patient characteristics. Insight into why a certain choice is made improves confidence in the suggested treatment and compliance. Also, more gaps in knowledge were found and trial participation was improved.

Lessons for Guideline Developers/Users

CDS: Can provide insight into the use of guidelines. For example, when a recommendation isn’t followed, possible efforts in implementation (recommendation is not/poorly implemented) or update (recommendation is outdated) are needed. Rewriting recommendations increased consistent language used in guidelines, which include easy reuse of data between professionals, hospitals and Cancer Registry Updating guidelines is expensive and time consuming. The doctors (and patients) ability to respond to existing recommendations supports faster, more efficient and cheaper modular updates.
P127 Comprehensive Model For Implementation Of Guidelines For Disease Prevention
Authors: Elgstrand M , Carlsson I , Månsdotter A , Sorsa R , Strååt C
Published: August 2013

Background

The National Board of Health and Welfare (NBHW) has developed guidelines for disease prevention, which include interventions to reduce smoking, hazardous use of alcohol, insufficient physical activity and unhealthy diet.

Context

To support the implementation of these guidelines, the Government has commissioned the NBHW to disseminate knowledge, create Web-based training, and ensure data access and methodological development.

Description of Best Practice

Implementation of guidelines for disease prevention deserves a comprehensive approach, since it involves most health care settings and professions. The NBHW coordinates national stakeholders, including decision makers at the regional level, in several networks. Organisations for health professionals such as doctors, nurses, physiotherapists and dieticians, receive support to disseminate knowledge of the guidelines among their members. Other ways of disseminating knowledge include information on the NBHW website and leaflets for patients, managers and professionals. The NBHW will also develop a Webb-based training for health care professionals, covering the methods recommended in the guidelines. To support improvements in methods for disease prevention, research groups have been awarded financial support, for example to study how P4P can be used to improve implementation of guidelines and how to support patients with special needs. Furthermore, the NBHW supports harmonisation of registration and reporting on data. The NBHW will also publish a national assessment and evaluation, in order to identify differences between regions regarding organisational factors, processes, clinical outcomes and costs.

Lessons Learned

We will share our experiences of a comprehensive approach, targeting decision makers, health care professionals and patients, and discuss challenges when translating guidelines into health care.
P133 Approaching Economic Evaluation in Social Care Guidance
Authors: Smith T , Shaw E , Baillie N
Published: August 2013

Background

We have a statutory responsibility to produce social care guidance. For economic evaluation challenges include: 1. Methodology for a multi-stakeholder perspective (costs and outcomes), and determining measures of effects using standardised outcomes. 2. Decision making in the absence of accepted willingness to pay thresholds, and alignment with principles used for health guidelines.

Objectives

To define an economic reference case for social care guidance.

Methods

A workshop on methods identified potential approaches. Health economists who work on clinical and public health guidelines were consulted to ensure consistency. Methodological issues were discussed with academic experts.

Results

A reference case for social care economic evaluation was produced within a methods manual before commencing guidance development. It recognises the need for flexibility as methodology develops.

Discussion

Social care economic evaluation is constrained by the quality of evidence, and the transferability of studies. Equity considerations in the context of means-tested service provision, and the issue of unpaid care, represent examples of how decision making on cost-effectiveness must take account of factors not usually considered for clinical and public health guidelines.

Implications for Guideline Developers/Users

Consistent decision-making principles must be applied across all guidance development programmes, including social care cost-effectiveness. Social care guidance, developers need to recognise and work within the context of emerging methodologies when undertaking social care economic evaluation in, but ensure that such evaluations remain in line with general principles of guidance development and decision making.
P155 Lessons Learned: Applying Grade Methodology To Evidence-Based Health Technology Assessment Within A Managed Care Setting
Authors: Lam J
Published: August 2013

Background

Health technology assessment (HTA) within the context of a managed care organisation requires rigorous evidence assessment completed in a timely and efficient manner. A modified version of the GRADE evidence grading system was piloted in a long-standing HTA programme to evaluate new and existing medical technologies with high-cost, high-volume impact.

Context

An HTA programme developing evidence-based guidance to inform technology acquisition and implementation strategies within a large, US-based healthcare system.

Description of Best Practice

A modified GRADE approach was used to assess the quality of evidence for six health technologies over a 6-month period. Although the application of GRADE required additional analytical time, evidence assessments were completed within a reasonable timeframe. Application of the GRADE framework allowed technology committee members to more easily understand the quality of a body of evidence, weigh the benefits and harms, account for patient values, and assess potential resource and operational implications.

Lesson for Guideline Developers

Prior to adopting GRADE, many new technologies were assessed as having “insufficient” evidence. The GRADE approach provided greater clarity, and evidence that would previously have been classified as “insufficient” was graded as either “low” or “very low” quality, allowing for greater flexibility and transparency in decision-making when moving from evidence to recommendations. Diagnostic and prognostic tests or devices continued to present unique challenges as well as technologies for which limited comparative evidence was available, and more guidance for in these areas is needed. Additional elaboration on resource and operational concerns specific to evaluating new technologies would be useful to HTA programmes.
P157 Clinical Practice Guidelines in the Czech and Slovak Republic
Authors: Klikova K , Licenik R
Published: August 2013

Background

Palacky University Faculty of Medicine Centre for clinical practice guidelines is the independent academic centre focused on guidelines methodology.

Objectives

The aim of this study is to analyse methods of development, adaptation, implementation and evaluation of CPGs in the Czech and Slovak Republic from 2010 to 2013.

Methods

The database of all Czech and Slovak CPGs and specialty societies was developed in 2010 and updated on a regular basis. The analysis of methods of development was made. AGREE II instrument was used both in Czech and English version to evaluate quality of some CPGs.

Results

There are 112 Czech specialty societies and the national Reference Centre developing CPGs. 1331 CPGS were developed till 2013 in total with increase of 33% between 2010 and 2013. The number of adopted international CPGs has increased significantly. Majority of CPGs have not stated funding and conflicts of interest. In the Slovak Republic, there are 125 specialty societies and the Ministry of Health developing CPGs. 342 CPGs were developed till 2013. Majority of CPGs were developed by government. A few CPGs stated non-governmental funding, which is always a private company support.

Discussion

There has been increasing number of developed CPGs in both countries. Standardised high quality methods are not used systematically. High quality methodology was developed and used by Czech National Reference Centre.

Implications for Guideline Developers/Users

There should be high quality methods used for CPG development. The developing bodies should adopt methodology already exist in the Czech Republic.
P164 The Abyss Between Rcts And Guidelines; And The Bridging Role Of Cochrane Systematic Reviews
Authors: Middleton P , Crowther C , Green S
Published: August 2013

Background

Randomised trials (RCTs) and Cochrane systematic reviews (CRs) are mainstays of most clinical practice guidelines (CPGs). It is important that all relevant high level evidence is included in CPGs.

Objective

To determine rates of RCT inclusion in perinatal CPGs, either directly or via CRs.

Methods

We used a database of all known Australian perinatal RCTs with findings released between 1986–2010 (n = 303), compiled for a project addressing impact of evidence. International and national perinatal CPGs were manually searched for cites of any of the 303 RCTs, or perinatal CRs including the RCTs, as at January 2013.

Results

59/303 RCTs (19%) were cited in at least one perinatal CPG. Ninety per cent of the 59 RCTs (n = 53) were included in CRs; and in 25/59 cases the RCT was only included in a CPG via the CR. All 59 included RCTs had a maternal/perinatal rather than a neonatal focus.

Discussion

Over 80% of RCTs in this dataset were not included in relevant CPGs. The chance of a trial being in a CPG increased if was included in a CR and if it had a maternal/perinatal focus. Possible ways to close the RCT-CPG abyss will be presented.

Implications for Guideline Developers/Users

While translation from RCT to CR is common, we need to better understand the reasons why high level RCT and CR evidence is often missing from CPGs and what the impact is on quality of CPG recommendations.
083PS Incorporating Guidelines into Local Clinical Practice and Policy Through the Use of Practice-Based Health Technology Assessment
Authors: C Umscheid , M Koster , M Marchetti , M Helfand , P Wyer
Published: August 2013

Background

Practice-based health technology assessment (PB-HTA) has the potential to improve the quality, safety and value of patient care by synthesising evidence to provide timely guidance for clinical practice, policy, formulary management, operations, and purchasing decisions. Hospital-based HTA centres are active in Western Europe and Canada, but less so in the US, and some operate in conjunction with formal evidence-based guideline programmes.

Objectives/Goals

To actively engage leaders of PB-HTA to discuss strengths and limitations, lessons learned, and the role of PB-HTA in the development, dissemination, and implementation of guidance within health care systems.

Target Group/Suggested Audience

Senior executives/administrators, and clinical policy, quality and safety leaders in healthcare organisations and networks who develop, implement and measure performance related to clinical guidance.

Description of Aession and Speaker Topics

Dr. Wyer, who leads a PB-HTA capacity building programme for health care organisations at the NYAM SEBHC, will engage the panellists in a discussion of their experiences leading PB-HTA efforts at Kaiser Permanente (Ms. Koster), the Veterans Administration (Dr. Helfand), Penn Medicine (Dr. Umscheid) and the HTA unit at the Catholic University Hospital in Rome, Italy (Dr. Marchetti). The discussion will address the potential for guidance developed by PB-HTA centres to impact the quality, safety and value of patient care, similarities and differences in national and international efforts, and future directions for the field.
P168 Practice Guidelines And Professional Mind-Lines. Qualitative Research On Sysadoas For Osteoarthritis
Authors: Gutiérrez-Ibarluzea I , Ibargoyen-Roteta N , Mateos-del Pino M , Benguria-Arrate G , Regidor-Fuentes I , Domingo-Rico C , González-Santisteban R , Rada-Fdz de Jauregi D
Published: August 2013

Background

There is still a gap between what good quality CPGs recommend and real practice. For osteoarthritis, although best quality CPGs do not recommend SYSADOAS, a high degree of variability in prescription rates has been observed.

Objectives

To explore the reasons that explains SYSADOAS prescription for osteoarthritis.

Methods

A qualitative research was performed including one focus group to explore what General Practitioners (GPs) thought about this topic, and two in-depth interviews with specialised care. 8 GPs, one orthopaedic surgeon and one reumatologist participated. Focus group and interviews, previous consent recorded, were transcribed and analysed using MAXQDA software.

Results

GPs were aware of the lack of evidence about SYSADOAS efficacy, but they did not know which CPGs they should trust in. Prescription was mainly initiated by specialists, but GPs admitted that they also started it, being the respect for their colleagues and patients’ pressure the main reasons. Specialists did not use CPGs on this issue, but partially admitted that SYSADOAS had no effect. For them, health care pressure, high ratio of patients and a rapid way to discharge them were the main reasons.

Discussion

Clinician’s knowledge about CPGs and quality standards is scarce. The lack of communication among health care levels and the inadequate management of the disease are, among others, the reasons explaining SYSADOAS prescription.

Implications for Guideline Developers/Users

Provide clinicians skills and tools to empower them about which is considered good evidence and how to critically appraise CPGs, and promote the communication between levels to improve patient management.
P172 Challenges of Measuring the Uptake of National Public Health Guidance in the UK: A New Methodology
Authors: Lea R , Griffiths P , Moore V
Published: August 2013

Background

We use published evidence to measure the uptake of national public health guidance recommendations. Available sources of uptake include national audits and reports, and peer reviewed journal articles. These are summarised and uploaded to an online database. This database is used to inform several streams of work in our organisation, including an internal review decision process for public health guidance. Identifying sources of uptake information in this area is challenging.

Objectives

To assess the existing information on the database, and report on the effectiveness of a new approach to identifying potential sources of uptake information.

Methods

An evaluation of public health uptake sources on the database was conducted, and a stakeholder mapping tool developed, which was used to systematically search for sources of uptake information. Stakeholders were contacted to provide information. Existing literature search strategies were reviewed and revised. Following these actions, the database was updated with the new sources and the impact of the exercise assessed.

Results

The evaluation of the current database highlighted significant gaps regarding information relating to the uptake of public health guidance. Use of the methods outlined above identified a substantial amount of new information and a large number of potential sources of uptake for future reference.

Discussion

The uptake of public health guidance is increasingly in the spotlight for the NHS, and knowing if recommendations have been implemented is helpful when deciding if guidance needs to be reviewed and updated. It is therefore important to have an accurate picture of uptake.
P179 Facilitating Implementation Of Guidelines For The Prevention Of Vascular Disease In General Practice
Authors: Harris M , Litt J , Russell G , Mazza D , Lloyd J , Zwar N , Taylor R , Van Driel M , Del Mar C , Krastev Y , Parker S , Smith J
Published: August 2013

Background

Although evidence based guidelines have been developed and disseminated, up to a half of patients do not receive guideline based preventive care.

Objectives

This study aims to evaluate a model for the implementation of preventive care guidelines in general practice.

Methods

Following a development process for the intervention involving a mixed method study and a pilot carried out in three practices a cluster randomised controlled trial is being conducted in 31 practices across four states. The intervention involves training, preventive care audit, and visits from a facilitator based in the local primary care support organisation. The facilitator assists practices to review their clinical audit and implement a practice plan structured around the 5As to improve the reach and quality of preventive care. Quantitative and qualitative evaluation methods are being used to assess impact on planned change within the practice, recalled and recorded preventive care, and patient behaviours and risk factors for cardiovascular disease.

Results

Baseline data collection has been completed from practice staff and patients and the intervention is now complete. The recorded and patient recalled preventive care varied within and between practices resulting in a varied set of priorities for improvement. Early findings suggest that facilitation visits to review and plan improvements to the implementation of preventive guidelines are feasible, acceptable and can support organisational strategies to address gaps in care.

Discussion

Our results may provide a model for local primary care support organisations to assist practices to improve their quality of preventive care.
P181 Snoring, Gasping and ADAPTE!
Authors: Bruinvels D
Published: August 2013

Background

The Netherlands Society of Occupational Medicine (NVAB) has a tradition of guideline development since 1999. The development of a typical monodisciplinary guideline for occupational physicians takes two years. In order to save time and costs the NVAB initiated an ADAPTE process for a monodisciplinary guideline on Obstructive Sleep Apnea Syndrome (OSAS).

Context

OSAS is a major problem in the working population and may attribute to a substantial proportion of work related problems associated with fatigue. Examples are work accidents, work errors and productivity loss. Although a Dutch multidisciplinary guideline on OSAS exists, only a minority of the Dutch occupational physicians actually uses this guideline. To facilitate the implementation of the guideline, the NVAB provided a summary, a PowerPoint presentation, and medical case studies for occupational physicians. However, the guideline was still not implemented in clinical practice. Therefore the NVAB took the initiative to develop a monodisciplinary practice guideline for occupational physicians.

Description

The ADAPTE process was used to develop a monodisciplinary practice guideline for occupational physicians based on a Dutch multidisciplinary guideline developed by CBO in 2009. The aim was to develop a monodisciplinary guideline in one year. In the end it took almost 3 years to adapt the guideline.

Lessons

ADAPTE is a practical tool to adapt multidisciplinary guidelines into monodisciplinary practice guidelines. However, the use of the ADAPTE process does not guarantee time savings and reduction of development costs.
167PS Setting New Horizons In Optimizing Guideline Utility
Authors: Scott I , Norris S , Schünemann H , Guyatt G
Published: August 2013

Background

To maximise uptake, CPG recommendations must avoid of bias and be responsive to the needs of clinicians and patients from different populations and settings.

Objectives/Goal

To discuss three key challenges to CPG use: 1) building consensus and minimising conflicts of interest in formulating recommendations for specific patient populations; 2) taking account of patient multi-morbidity; 3) incorporating patient values and preferences for specific outcomes.

Target group

Suggested audience Guideline developers and writing groups, clinical researchers, users of guidelines (clinicians, patients).

Moderator

Prof Ian A Scott, Director of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Australia.Invited SpeakersDr Susan L Norris, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, USA. SLN is Technical Officer for the secretariat of the Guideline Review Committee at the World Health Association in Geneva, Switzerland and has conducted research on conflicts of interest. Professor Holger J Schünemann, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. HJS is co-chair of the GRADE working group, member of the GIN board of trustees and has co-authored reports on guideline methodology, including multimorbidity. Professor Gordon H Guyatt, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. GHG is co-chair of the GRADE working group and chaired the executive of 9th iteration of the American College of Chest Physicians Antithrombotic Guidelines.Description of session and speaker topicsSession will comprise 3 presentations (15 mins), one for each challenge, with 5 mins for questions of clarification then 30 mins of panel discussion.
P193 Adopting NICE Guidelines In Other Countries
Authors: Gholitabar M , McGuire H
Published: August 2013

Background

Although NICE guidelines are developed to inform clinical practice in England and Wales, they attract interest from researchers, clinicians and healthcare organisations all over the world. This has generated discourse about whether, and to what degree, recommendations from NICE guidelines are applicable to different countries.

Objectives

To consider if NICE recommendations should be adapted for use in other countries in terms of differences in health care systems, values and needs? - To discuss the varying approaches to adopting NICE guidelines and recommendations Methods Using the NICE Intrapartum Care clinical guideline, we will select illustrative examples of recommendations. Factual data and information from one developing country - Islamic Republic of Iran - will be used to evaluate the ease with which these could be implemented. We will consider the Iranian health care setting; economic situation; social values; geographical issues; cultural issues and priority health care policies.

Results

We will present the findings in three categories corresponding to the ease with which NICE recommendations can be implemented in another country.

Discussion

A focused discussion will centre on - whether adopting NICE guidelines and recommendations outside of England and Wales is feasible - what additional work may be need to carried out to facilitate this process - the ethics of such activity in terms of self-reliance and research capacity.

Implications for Guideline Developers/Users

This project will identify areas where existing guidance can be shared across borders thereby reducing duplication of effort; facilitating international collaboration and building capacity in guideline development methodology and implementation.
P198 Adherence To Infertility Guidelines With Regard To Treatment Policy
Authors: Kersten F , Nelen W , Goddijn M , Braat D , Mol B , Hermens R
Published: August 2013

Background

Nowadays, prognostic models are increasingly being used in reproductive medicine. One of these models calculates the chances of conception for couples with unexplained infertility and subsequently indicates the right treatment policy. The Dutch national network guideline on infertility recommends the use of this prognostic model to prevent unnecessary treatment. This strategy is supported by international guidelines on the management of infertility (ESHRE and NICE).

Objectives

The aim of this study is to evaluate guideline adherence regarding treatment policy for couples with unexplained infertility in 25 Dutch clinics.

Methods

In this retrospective study, we assessed guideline adherence with regard to 1) the use of the prognostic model and 2) the right treatment decision. Data were collected from medical records.

Results

In this abstract we present the preliminary data of ten clinics. At the GIN conference we will have the results of all 25 participating clinics. So far we included 208 couples with unexplained infertility. In 54% of the couples the prognostic model was used. In 69% of the couples the right treatment decision was primarily made. However, ultimately, 41% of all couples received unnecessary treatment.

Discussion

This study shows that adherence to the guideline regarding treatment policy is not optimal. Despite the guideline recommendations, more than one third of couples are exposed to unnecessary treatment and risks.

Implications for Guideline Developers/Users

Implementation of the guideline is not optimal. To improve guideline implementation a multifaceted strategy has to be developed and evaluated.
P200 Suicide Risk Assessment According to Best Practice Guidelines: The Development of a Chart Audit Performance Measure
Authors: Santa Mina E , O’Grady C , McCay E
Published: August 2013

Background

Best practice guidelines (BPGs) in suicide risk assessment documentation support nursing care of clients at risk for suicide. Investigation regarding nurses’ adherence to BPGs for suicide risk assessment documentation is minimal.

Objectives

In a mixed-methods study to investigate nurses’ knowledge of suicide risk assessment documentation, the researchers created a chart audit to measure nursing practice congruence with five recommendations from the suicide risk assessment BPG (RNAO, 2009).

Methods

Five recommendations, from the BPG: Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour (RNAO, 2009), were the benchmarks for the chart audit measure. Suicide risk indicators, as determined by the Minimum Data Set for Mental Health (MDS-MH) (Ontario Ministry of Health, 2011), were the criteria to identify charts of suicidal clients. The researchers integrated MDS-MH indicators with the five BPG recommendations and constructed compliance indicators that incorporated the Nurses Global Assessment of Suicide Risk (Cutcliffe & Barker, 2004).

Results

Five BPG recommendations, integrated with provincial suicide assessment criteria and a standardised suicide assessment scale produced a 3-point likert scale chart audit with 15 indicators. Possible ranges of scores for documentation congruence with the BPG are 0 to 30.

Discussion

This performance measure provides objective, proxy data to triangulate with nurses’ self-perception of suicide risk documentation and evaluate practice as per BPGs.

Implications for Guideline Developers/Users

A standardised instrument to monitor BPG practices can be used to inform implementation and education strategies.
P204 The Updating Process Guidance In Clinical Practice Guidelines Handbooks: A Systematic Review
Authors: Vernooij R , Sanabria A , Solà I , Alonso-Coello P , Martínez García L
Published: August 2013

Background

Updating is an important process for maintaining recommendations’ and clinical practice guidelines’ (CPGs) validity. CPGs methodological handbooks are designed to provide guidance on developing and updating CPGs, however, little is known about this guidance about the updating process.

Objectives

To identify and describe the guidance about the updating process in CPGs handbooks.

Methods

We included methodological handbooks that provide guidance about updating. We conducted a systematic search in the Guidelines International Network library, US National Guidelines Clearinghouse, MEDLINE and contacted main institutions. For extracting data we developed a list of key elements.

Results

We included thirty-six handbooks. Most of them (97%) focus mainly on developingde novoCPGs and include some information about updating. Half of the handbooks provide a time frame for updating guidelines. The majority of handbooks do not provide guidance about the updating process, namely: literature search, evidence selection, assessment, synthesis and external review. Finally, two handbooks (6%) provide information about publishing an updated CPG.

Discussion

Our study highlights that the updating process is poorly described in current methodological handbooks. Handbooks do not contain enough information for executing an optimal update.

Implications

Institutions responsible for updating and developing CPGs need to pay more attention to updating and reflect this in their handbooks. This guidance should be more rigorous, explicit and detailed. This could, consequently, lead to a more optimal updating process and, hence, more up-to-date recommendations.
P208 How Could Who Better Support National And Subnational Governments In Their Efforts To Adapt And Implement Global Recommendations And Decisions? A Systematic Analysis Of Health Systems Guidance And World Health Assembly Resolutions
Authors: Patino-Lugo D , Lavis J , Perel P , Wu Y , Haines A , Ranson M , Panisset U , Bosch-Capblanch X , Brouwers M
Published: August 2013

Background

The World Health Organization’s health systems guidance and the normative standards about health systems endorsed in World Health Assembly (WHA) have the potential to better support national and subnational health systems guidance and policy development processes by including information about the contextual factors that can shape decisions about health systems.

Objectives

To assess the extent to which WHO health systems guidance and the WHA technical documents include information about how to address a health system problem and how the health system arrangements and political system features can influence decision-making.

Methods

We reviewed all WHO guidance published since 2008 to 2012 and WHA resolutions published from 2005 to 2012 and included those with a focus on health systems. Two reviewers independently screened and applied the selection criteria to all the documents and extracted the information following pre-established data-extraction forms.

Results

13 out of 78 WHO guidance and 14 technical documents out of 207 WHA resolutions had a health system’s focus. Six WHO guidance and 12 WHA documents included information about how to address a health system problem. All WHO guidance included information about delivery arrangements but only three discussed financial arrangements. Two WHO guidance and five WHA documents discussed key features of political systems.

Discussions

The inclusion of contextual factors, mainly financial arrangements of health systems and political systems features was infrequent among the reviewed documents.

Implications for Guideline Developers/Users

It is necessary to understand better how to integrate these contextual factors in the process of global guidance development.
P210 Changes In Performance Of The Adaptation Methodology Used For Guideline Development From 2002 To 2012
Authors: Khan C , Schwarz S , Conrad S , Koltermann K , Dippmann A , Ollenschlaeger G
Published: August 2013

Background

Guideline adaptation has always been the methodological basis of the German National Disease Management Guideline (NDMG) Programme. Although it allows highly efficient and resource-saving workflows, the NDMG development process becomes an increasingly time-consuming and resource-intensive challenge.

Objective

The objective of the present project was to analyse the performance of the adaptation methods used for the NDMG guidelines development to identify the critical issues causing an extensive effort and to find possible coping solutions.

Methods

We reviewed each NDMG method report from the beginning of the programme in 2002 to 2012. We extracted and evaluated the duration of the process, the number of source guidelines used and number and themes of additional literature searches over the course of years also in comparison of the first and second editions.

Results

One of the 14 NDMGs was excluded because of missing adaptation method during the updating process. The comparison of first half of the programme between 2002 to 2007 and second half from 2007 to 2012 revealed an average duration of the development process of 22,7 versus 49,9 months. Until 2007 4,5 and after 2007 3,7 source guidelines were used on average. The number of topics of systematic literature searches has been rising over the years. On average 5 additional searches were conducted in the last 5 years. 42% of all topics covered pharmacotherapy.

Discussion

The adaptation methodology is still very useful and efficient. However, prioritisation and consensus processes and strict orientation on the selected source guidelines need to be optimised to reduce the increasing effort.
P222 Evolution Of Evidence Grading Systems In The American Academy Of Ophthalmology’s Preferred Practice Patterns
Authors: Emptage N , Lum F
Published: August 2013

Background

Clinical practice guidelines are an important component of efforts to improve quality of care and rationalise the introduction of new medical technologies. As evidence-based medicine and comparative effectiveness research become more prominent, the rigour and transparency of guideline development is becoming increasingly important.

Context

Since 1988, the American Academy of Ophthalmology has published ophthalmic practice guidelines known as Preferred Practice Patterns (PPPs). Over time, the Academy has introduced increasingly rigorous processes for grading the evidence underpinning the PPPs.

Description of Best Practice

Prior to 2000, the PPPs were effectively consensus-based, with no formal processes for identifying or synthesising evidence, and no system for grading evidence quality. In 2000, a three-level system was introduced to denote the quality of the evidence supporting PPP recommendations, with Level I denoting strongly evidence-based statements and Level III denoting statements unsupported by evidence. In 2001, the level definitions were revised to denote the quality of specific study designs, and explicit guidance for synthesising bodies of evidence was developed. A third revision in 2006 tightened the criteria for Levels I and II, and created a Level IV to differentiate poor-quality studies from expert opinion. In 2011, the levels were revamped to be consistent with SIGN and GRADE methods.

Lessons

The Academy has worked for years to make its evidence grading systems more rigorous. This has included using a level-based system to clearly link PPP recommendations to evidence quality, revising the level definitions for greater clarity, and providing explicit direction on evidence synthesis.