bluuebunny/crossref_metadata_2025 huggingface dataset:
P199 The Challenges For An Alcohol And Drug Education Guideline For Community Health Workers
Authors: Stein A , Fernandes A , Giugliani C
Published: August 2013

Introduction

There is a need to train and develop a guideline for Community Health Workers (CHW) on how to tackle alcohol and drugs problem.

Objective

To identify the profile and mental health problems of CHW and how they manage drug problem.

Methodology

A descriptive study was performed and data collected from all CHW who work at Primary Health Care of Passo Fundo (Brazil). A Self Report Questionnaire (SRQ) was collected to screen mental health on CHW and scores higher than 7 were identified as positive for mental health problem. Their knowledge about drugs was also collected using a standard questionnaire. The Project was approved by the Passo Fundo University IRB. Descriptive statistics were applied.

Results

All 78 CHW were women, age 41.1 ± 9.6 years old, 57.7% have completed high school level, 69.2% were married and 98.7% were from lower social class. Half of the CHW were sedentaries, 32% were smokers, 93.6% did not report alcohol dependency, although 59% reported to have a member of their family as having drug or an alcohol problem. They reported that alcohol and drug is a major problem in the community. There were 29.5% of CHW who have SRQ score higher than 7. The mean grade of the knowledge test was 34%.

Conclusion

There is a need to develop a guideline on alcohol and drugs for CHW. The profile of CHW had shown a high level of psychiatric problems and lack of basic information.
P207 Toolkit: Implementation Of Best Practice Guidelines – A Framework For Success!
Authors: McConnell H , Stewart-Pyne A , Bajnok I
Published: August 2013

A signature programme lead by a professional nursing association in Canada has a mandate to develop, disseminate, implement, evaluate and support the uptake of clinical guidelines. This programme’s success has resulted in international reach, due to its rigorous guideline development process, and innovative implementation strategies. These strategies include a key resource, the Toolkit: Implementation of Best Practice Guidelines, which delineates a systematic, well-planned implementation process, and is designed to assist nurses and other health-care professionals to support evidence-informed clinical decision-making. This Toolkit is based on emerging evidence that the likelihood of achieving successful uptake of best practice in health care increases when: • Guidelines are selected for implementation through systematic, participatory processes including relevant stakeholder engagement and environmental readiness assessment • Guidelines are tailored to the local context • Barriers and facilitators to guideline use are assessed and addressed • Guideline use is systematically monitored and sustained • Evaluation of the impacts of guideline use is an integral part of the entire process • There are adequate resources to support completion of all aspects of implementation This Toolkit will help guideline users take best evidence and integrate it into practice, education and policy using a systematic approach consistent with the local context of practice. This presentation will share the key phases of guideline implementation outlined in the Toolkit, and discuss how this resource is being utilised to address the key challenges of developing evidence based practice cultures through guideline implementation.
P211 Systematic Review And Quality Appraisal Of Clinical Practice Guidelines For The Treatment Of Patients With Acute Coronary Syndrome
Authors: Lugo L , Acosta N , Senior J
Published: August 2013

Background

In Colombia, ischemic heart disease was the leading cause of death in people over 55 years of age. In the next five years, the Colombian population over 45 years of age will triple leading to an increase in the incidence and prevalence of atherosclerotic heart disease. Under this scenario, the Colombian Ministry of Health commissioned us the development of a clinical practice guideline (CPG) for the comprehensive treatment of patients with acute coronary syndrome (ACS). Therefore, as part of this process we conducted a systematic review and a quality appraisal of the published CPGs for this condition.

Methods

By undertaking a systematic search of multiple databases, reviewing the reference lists of included studies and the input of experts, we identified CPG for ACS with and without ST elevation, published from 2005 to 2011. We assessed the quality of each guideline using the AGREE II instrument.

Results

We identified 121 CPG and assessed the quality of 28 that met the inclusion criteria. The overall average for the 28 guides in all domains was: clarity of presentation 91%, reach and objectives 78%, methodological rigour 72%, stakeholder involvement 62%, editorial independence 72%, and applicability 44%. 11 of 28 guidelines had a low methodological rigour (score less than 60%).

Discussion

The applicability of the guideline, that is, to provide clear identification of tools to implement the recommendations of the guideline, should be strengthened in the CPG for SCA.
145WS Evidence-Based Guideline Development for Diagnostic Questions
Authors: Vella E , Yao X
Published: August 2013

Background

Developing guidelines to inform decisions regarding diagnostic tests presents unique challenges that are not encountered when addressing intervention questions. In many cases, diagnostic studies only provide test accuracy results and lack patient outcomes; outcomes that are typically sought to make recommendations.

Objectives/Goal

Using the lessons from our guideline group, the objectives of this workshop are for participants to learn practical skills related to the development of guidelines for diagnostic questions. Specifically, the following areas will be addressed: Generating an appropriate research question. Developing relevant eligibility criteria for choosing diagnostic studies. Critically appraising diagnostic studies using existing tools and quality criteria. Determining what types of recommendations can be generated when different types of evidence and information are available and to respond when the most relevant information is not available.

Target Group, Suggested Audience

Guideline developers or anyone interested in how to develop a guideline for diagnostic questions.

Description of the Workshop and of the Methods used to Facilitate Interactions

Using a problem-based educational approach, the workshop will begin with a quick review of the background information and objectives, and an illustrative example will be presented. Participants will then be guided through the steps of guideline development for diagnostic questions, and given problems in each step to consider and work through in small groups. Finally, participants will develop recommendations for one or two guidelines, based on evidence from diagnostic guideline projects we have completed in our guideline group.
P219 Engaging Consumers In The Guideline Development Process – The US Perspective
Authors: Robertson P , Hussey H , Jones S
Published: August 2013

Background

In the United States, there have been increasing calls for guideline developers to engage consumers throughout the guideline development process. The Guidelines International Network (G-I-N) and the Institute of Medicine (IOM) have both released guideline development best practices encouraging consumer involvement; ranging from consumer input during the formulation of clinical questions, to serving as a guideline panel member and participating in the review process.

Context

Our organisation has been developing evidence based clinical practice guidelines for nearly a decade and has incorporated consumers in the development process for over five years. By including consumers, our guidelines now feature more patient-centred recommendations; establishing a more balanced discussion of patient preferences and improving how we assess benefits and harms.

Description of Best Practice

To more readily identify consumers for guideline development, our organisation has built a collaborative relationship with a consumer advocacy alliance. Through this relationship, we have been able to support two consumer advocates as full members on each guideline panel. To assist their participation, we provide education about our guideline development process, and outline the expectations of their involvement throughout the process.

Lessons for Guideline Developers

Our experience with consumer engagement can serve as an example for other US guideline developers. Consumers can bring invaluable insight and perspective throughout guideline development and have substantially improved our guidelines. We believe consumer participation will become increasingly important in the coming years, particularly as guideline developers move towards a standardised approach to development.
P224 Adapting Guidelines with Conflicting Recommendations: The Case of Microscopic Asymptomatic Microhematuria
Authors: Whittaker J , Loo R
Published: August 2013

Background

Existing clinical practice guidelines (CPGs) conflict on the best approach to the work-up of patients with asymptomatic microscopic hematuria who are at low risk of urinary tract cancer. Consequently, while adapting existing CPGs to a local context can be an attractive alternative tode novodevelopment, when there are conflicting guidelines, disagreement with recommendations, or missing critical outcomes, potential time and resource gains are often minimised due to the need for additional evidence assessment and stakeholder consensus building activities.

Context

To reconcile conflicting recommendations and address gaps in evaluation of critical outcomes, a Guideline Development Team (GDT) in a regional health care organisation used existing CPGs and systematic reviews, supplemented by additional evidence reviews, to develop recommendations for asymptomatic microscopic hematuria.

Description of Best Practice

Based on review of evidence synthesised in external guidelines, supplementalde novoevidence reviews on critical outcomes, and risk assessment analysis of patient data, the GDT reached consensus on recommendations that differed from external guidelines, concluding that asymptomatic hematuria patients without risk factors were at sufficiently low-risk for urinary tract cancer to safely eliminate multiphase CT urograms from most urologic evaluations. Guidelines to reduce unnecessary CTs and radiation exposure in low-risk patients were developed, and knowledge transfer interventions aimed at the practitioner and healthcare system levels were implemented.

Lessons for Guideline Developers

When adapting external guidelines with conflicting recommendations and gaps in critical outcomes, additional evidence searches, data analysis, and consensus building can negate anticipated gains in time and resources expected from guideline adaptation.
P225 The Development Of Evidence Based Guidelines For Opioid Pain Treatment
Authors: Effiong A , Hegmann K , Thiese M , Wolfkiel C , Ording J , Harris J , Schwei K
Published: August 2013

Background

Opioid analgesic-related deaths more than tripled in the US from 1999 through 2006. According to the CDC, 27,000 unintentional drug overdose deaths occurred in the United States in 2007; the most potent epidemic in the past 100 years.

Objectives

To develop opioid guidelines to improve opioid pain treatment and reduce fatalities.

Methods

A systematic literature search (including Google Scholar and Medline) was conducted. Randomised controlled trials (RCTs) were categorised into acute, subacute (1–3mo), chronic, and mixed chronicity. The quality of RCTs was determined using previously developed guideline scoring methods; low quality (3.5 or less), moderate quality (4.0–7.5), and high quality (8.0–11.0).

Results

A total of 153 RCTs were identified; 11 acute, 2 subacute, 137 chronic, and 3 of mixed chronicity. Of the 11 acute pain RCTs, 1 was low quality, 6 moderate quality, and 4 high quality. Both subacute pain RCTs were moderate quality. Of the 137 chronic pain RCTs, 28 were low quality, 95 moderate quality, and 14 high quality. The RCTs with mixed chronicities were of moderate quality. All trials were under 6 months, with most under 4-weeks duration, precluding statements on long-term safety.

Discussion

These opioid guidelines provide more informed recommendations for prescribing opioids for pain treatment with details to be presented.

Implications

These guidelines may have considerable implications among prescribing health professionals.
P226 A Multidisciplinary Approach To Creating Behavioral Health Guidelines: Challenges Of Adhering To IOM Standards
Authors: Halfond R , Bufka L , Kurtzman H , Galper D , Beattie S
Published: August 2013

Background

In 2010 our organisation began creating evidence-based clinical practice guidelines for behavioural health, focusing initially on depression, PTSD, and obesity, following emerging IOM standards.

Context

Selected challenges in five areas: 1. Terminology. For many years, our organisation used guideline terminology that was inconsistent with the field. 2. Representation. Given the diverse types of professionals in behavioural health and the breadth/depth of each topic, attaining sufficiently diverse panel membership has been challenging. 3. Stakeholders. Obtaining the patient perspective has been challenging, particularly given the stigma and privacy concerns often associated with mental health. 4. Systematic Reviews. The high cost of developingde novosystematic reviews, especially for large scope topic areas, is limiting. 5. Education. Professionals have varying knowledge and lexicons for the process, requiring education, particularly surrounding non-financial conflicts of interest.

Description of Best Practice

•Terminology- Implemented organisation-wide systemic change in lexicon via change in organisation policy and routine dissemination. •Representation- Used multi-step consensus nomination process to assemble multidisciplinary panels. •Stakeholders- Using multi-tiered approach to involve stakeholders via Consultation, Participation, and Communication models and outreach to mental health peer support programmes. •Systematic Reviews- Applied Delphi poll method in topic scoping/refinement to work within organisational resources. Other mechanisms to enhance resources include topic nominations to AHRQ, possible organisational partnerships, and developing products from guidelines. •Education- Creating a series of self-study educational modules on guideline development.

Lessons for Guideline Developers and Others

Our challenges and resolutions could be helpful to others in guideline development.
P233 How Confident Are You In The Results Given Only One Rct? Ticagrelor Vs Clopidogrel: Case Report By Clinical Guideline On Acute Coronary Syndrome In Colombia
Authors: Acosta-Baena N , Lugo L , Mejia A , Senior J
Published: August 2013

Background

Ticagrelor is oral antagonist of adenosine diphosphate receptors of subtype P2Y12. It is indicated for the prevention of atherothrombotic events in adults with acute coronary syndromes (ACS) and it act faster and shorter than clopidogrel.

Objectives

The authors review and discuss clinical findings and health-economic evidence of ticagrelor compared with clopidogrel to reduced myocardial infarction, stroke or death, major bleeding, in patients with ACS in Colombia, when only one RCT has been published comparing both drugs.

Methods

This question was part of the guideline development. The process included search, assessment, rating the quality of evidence and economic evaluation. The recommendations were classified according to the methodology described by GRADE Working Group: consideration benefit/harm, preferences and resources.

Results

1 clinical study was identified. The efficacy outcome was favourable for the group of patients receiving ticagrelor. The result of the economic analysis suggests that the probability of ticagrelor is a cost effective alternative in the Colombian health system is more than 76.6%.

Discussion

We recommend ticagrelor plus ASA for patients with non-STEMI, intermediate to high-risk, and for patients with STEMI if they have not received fibrinolysis in the last 24 hours.

Implications for Guideline Developers/Users

Our results hold in different scenarios and sensitivity analyses, as long as the time horizon is not limited to short-term assessment because may underestimate the costs and benefits and therefore lead to erroneous conclusions with a single primarily study. Our recommendation is strong, although there was a single RCT owing to time horizon and high quality of evidence.
P240 The Benefits of a Systematic Implementation Structure For Effective Implementation Support
Authors: Dunnink T
Published: August 2013

Background

Guidelines do not implement themselves. Structural implementation activities are necessary to improve the usage of guidelines by professionals. At a national level this centre oversees the development, implementation, and evaluation of the Preventive Child Health Care (PCHC) guidelines.

Context

In The Netherlands, PCHC is provided by 50 organisations. They use guidelines to improve quality of care, however implementing them, which is their own responsibility, is difficult. They therefore want implementation support, which is then provided by the Dutch Centre for Child Health.

Description of Best Practice

To support PCHC organisations implementing guidelines, the Dutch Centre for Child Health developed an implementation structure. The aim of this structure is to provide a systematic implementation through various strategies. The elements of this structure are: a network of implementation coordinators, an implementation toolkit, education and e-learning, a helpdesk, and collaboration with educational institutes and network partners in the youth field. A one year follow-up survey showed that managers and implementation coordinators from PCHC organisations are positive about the support. They want our implementation activities to be continued and even like to see the support extended to guideline maintenance.

Lessons for Guideline Developers, Adaptors, Implementers, and/or Users

organisations want support, to implement guidelines into their own organisation. Beside that they want to know what and when to expect. Our way to achieve that, is to give the support through a clear implementation structure and to provide systematic implementation activities.
P290 Attitudes Of Professionals Involved In Dementia Care Towards Advance Directives And Its Impact On Their Adherence To Guideline Recommendations
Authors: Villanueva G , López-Argumedo M , Reviriego E , Gómez Poveda C , Aguirreche Ollo E , Elizondo A , Fuentes Gutiérrez R , Galnares-Cordero L
Published: August 2013

Background

Although legal and ethical aspects related to the care of people with dementia have been long neglected, current guidelines highlight its importance. Specifically, the advanced directives document (ADs) is a useful instrument in decision-making in non-competent patients. Despite the promotion of guidelines related to the use of ADs, it is claimed that adherence is not as optimal as desired. An analysis of the barriers to implementation is therefore needed.

Objectives

To explore health professionals’ knowledge and attitudes towards the use of ADs in three different health settings and to evaluate their adherence to the established recommendations.

Methods

A cross sectional, descriptive study by means of a self-administered questionnaire was conducted with over 2,000 professionals working in dementia care in the Basque Country. On the other hand, the relevant recommendations from the ADs in cases of dementia are summarised and it is discussed whether professionals comply with them.

Results

Data is currently being analysed and results will be available for presentation at GIN.

Discussion

Adherence to CPG is a long discussed issue. Bringing ethical issues into the debate makes it more complex, since not only the knowledge but the personal values are in place. That may explain why ethical and legal related recommendations and clinical practice differ considerably and why the use of ADs in the real practice remains a taboo.

Implications for Guideline Developers/Users

Knowing the barriers to comply with ADs may help to put the mechanism in place to reduce the gap between theory and practice.
P326 Implementing an Audit and Feedback Intervention to Reduce Antibiotic Prescribing in General Dental Practice
Authors: Young L , Stirling D , Elouafkaoui P , Rutherford S , Ramsay C , Clarkson J
Published: August 2013

Background

In Scotland, guidance for prescribing in dentistry was published in 2008 in response to concerns about over-prescribing of antibiotics. The guidance recommends that antibiotic prescribing must be kept to a minimum. However, evidence from routinely collected data demonstrates that dental antibiotic prescribing is steadily increasing, now accounting for 9% of primary care antibiotic prescriptions.

Objectives

To compare the effectiveness of different audit and feedback (A&F) strategies for the implementation of recommendations on dental antibiotic prescribing.

Methods

The study is an 18 month, three-arm randomised controlled trial. All dentists in Scotland are being randomised to either: 1) access to a pre-approved national audit; 2) access to the audit plus individualised feedback; 3) access to the audit, individualised feedback and a persuasive message. The primary outcome is the number of antibiotic prescriptions per 100 patients. A process evaluation will be conducted to elucidate the mechanisms by which A&F influences practice. The trial was developed in collaboration with system-level stakeholders from policy, education and service providers.

Results

Development of all interventions is complete and the trial will begin in March 2013. Processes are being developed to enable integration of the most effective intervention into national systems intended to reduce antibiotic prescribing.

Discussion

Collaboration with system-level stakeholders has helped ensure that the trial addresses national priorities and has engendered system-level action for national implementation of the most effective intervention.

Implications for Guideline Developers/Users

Generating robust experimental evidence on an intervention’s effectiveness and collaboration with system-level stakeholders can increase the likelihood of its adoption as a policy initiative.
P331 Evaluation Of Quality Of Czech Neurology Clinical Practice Guidelines Using Agree Ii Instrument
Authors: Licenik R , Klikova K , Osinova D , Doubravska S , Ivanova K
Published: August 2013

Background

The quality of guidelines has been variable. Evidence-based clinical practice guidelines should be of the highest possible quality, which has to be systematically evaluated. Obj TRiaDS, Research Methodology Group.

Objectives

We have evaluated quality of new set of CPGs developed by Czech neurological society between 2009 and 2011 using AGREE II instrument.

Methods

Six CPGs developed by Czech neurology society were assessed using AGREE II instrument by 4 independent assessors. Uncertainties and missing information were solved by the authors. Expert opinion on the evaluation process and outcomes were obtained.

Results

All evaluated CPGs were of high quality with average of 93.5% for total score domain. The CPGs had high scores in the Clarity and recommendations and Applicability (99.6%), Scope (99.0%), Rigour of development (97.6%) and Stakeholder involvement (97.1%). The lowest score was in Editorial independence (47.5%).

Discussion

The overall quality of neurology CPGs was high because of the methodology and support for developers was robust, systematic and standardised. Only the editorial independence scored low. The statement of conflict of interest is missing in all the CPGS as it is not a part of the methodology guidelines.

Implications for Guideline Developers/Users

High quality CPGs can be developed even in a small country with limited budget if the methods of development are well designed, implemented and evaluated.
P342 Assessment Of The Recommendations Structure In Eight Clinical Practice Guidelines Developed In Colombia
Authors: Florez I , Perez A , Prieto L , Cañon L
Published: August 2013

Background

There is not enough information to guide editorial wording of recommendations within CPG (Clinical Practice Guidelines) development. The AGREE-II instrument suggests the inclusion of population, intervention and outcome (P-I-O) components within recommendations.

Objective

To evaluate P-I-O component in CPG recommendations and to analyse its relationship with the AGREE-II evaluation.

Methods

Eight recently developed in Colombia CPG were chosen and assessed by four methodological experts; the presence of P-I-O component in each recommendation was established, and compared with an external evaluation score of the 15th item of AGREE-II instrument.

Results

Eight guidelines with a total of 691 recommendations were evaluated, all of them were appraised by external international review with the Spanish AGREE-II instrument and its use were recommended. An average of 9.9% of recommendations met P-I-O structure; the absence of each component was 31.2% for population, 6% for intervention and 85.2% had no outcome. The item 15 of AGREE-II instrument reported results between 4 and 7, scores of good quality.

Discussion

Recommendations in CPG seem to be clear, but most of them don’t contain the evaluated criteria for their report. External evaluation emphasises in clarity of recommendation, and there is no agreement with the percentages obtained according to P-I-O structure, which enhance its understanding.

Implications

It is advisable to standardise methodology for recommendations to include all components that reflect the answer to the research question.
P353 The Current Status Of Evidence-Based Clinical Practice Guidelines On Stroke
Authors: Jang B , Park S , Park J , Cheon C , Go H , Sun S , Ko S
Published: August 2013

Background

Stroke is one of the main causes of death. It is important not only treating acute state after stroke event, but managing patients with disability.

Objectives

To examine current status of evidence-based CPGs for stroke.

Methods

We were systematically examined CPGs of stroke since 2000. We searched Korean DB and PubMed, NGC, GIN using ‘stroke’. Data were extracted on types of treatment, management and rehabilitation, and level of evidence (LOE), grade of recommendation (GOR), and the included CPGs was evaluated though AGREE II.

Results

Finally 24 CPGs were selected, and 20 were since 2006. 9 CPGs were from academic societies or agencies in USA, 7 from Europe, and 8 from others. The number of CPGs wrote by academic institutes 24, and 14 published in the medical journals. On both hemorrhage and infarction were 15, on infarction 5, and on hemorrhage 4. Major issues of 6 CPGs were from treatment and management of acute stage to rehabilitation of chronic stage, 10 were only treatment and management of acute phase, and 8 were about stroke rehabilitation. All CPGs didn’t present the LOE and GOR. It is various that criteria for LOE and GOR.

Discussion

Although all CPGs were ‘evidence-based’, there was not equal. When developing new CPGs from other regions, it is necessary to consider taking into account the diversity of these.

Implications for Guideline Developers

Recently there are many cases of ‘adaptation’ from existing CPGs, but it could be seen the diversity of contents and level of CPGs in this study.
265WS Improving Guideline Implementability With Guide-M (Guideline Implementability For Decision Excellence Model): An Interactive Workshop
Authors: Kastner M , Makarski J , Hayden L , Durocher L , Chatterjee A , Bhattacharyya O , Brouwers M
Published: August 2013

Background

We developed a framework of guideline uptake called GuIDE-M (Guideline Implementability for Decision Excellence-Model) based on an extensive literature review. It describes four domains covering guideline content to optimise the implementability of recommendations (Stakeholder development, Evidence synthesis, Considered Judgement and Feasibility) and two domains related to communication of content (Language and Format).

Objectives/Goal

(1) To learn about GuIDE-M, (2) To conduct an assessment of participants’ current use of the GuIDE-M domains in guideline development or assessment and (3) To determine priorities for tool development to operationalize GuIDE-M domains.

Target Group, Suggested Audience

Guideline developers, guideline users and researchers. [5]

Description of the Workshop and Methods used to Facilitate Interactions

(1) Introduction (15 minutes). A brief foundational overview of GuIDE-M. (2) Facilitated Assessment (60 minutes). Participants will break into small groups to discuss one or more of the domains in GuIDE-M. There they will (a) conduct a more detailed review of the domain, (b) assess the extent to which their guideline-related activities align with GuIDE-M principles, (c) reflect on the extent to which improving in the area is a priority, (d) discuss methods and available tools to operationalize the domain concepts, and (e) explore the types of tool(s) that should be developed to incorporate domain concepts into guideline development. Participants will be invited to remain involved as evaluators, pilot-testers and developers of these tools. The facilitated assessment will happen twice (2 x 30 minutes) to allow participants to focus on two of the GuIDE-M domains. (3) Wrap-Up (15 minutes).
124WS The Web Of EBM Recommendations
Authors: Ploegmakers M , Vegchel T van , Molag M , Tilma M , Kersten S , Barneveld T van
Published: August 2013

Background

Guidelines on specific diseases and interventions are connected to other guidelines on more general topics (eg perioperative care) or to other specific guidelines on comorbidity. Together all recommendations form a web of EBM knowledge. When searching for a recommendation for a specific type of patient, illness and comorbidity, it should be found immediately, without turning many pages. Furthermore, information should be unambiguous, correct and up to date. Therefore, in the Netherlands a web-based database was developed that contains all available CPG’s, cut into ready-to-use modules. Each module easily shows connections with related content like other modules, background information, flowcharts, summaries and implementation tools. Moreover, the web-based presentation facilitates updating of modules, without revising the whole CPG, making this process more flexible and efficient.

Objectives

• To present the modular set-up including the connections between related content of the Dutch Guideline Database. • To discuss how modular CPG-presentation can bring EBM closer to clinical practice and facilitate updating.

Target Group

This workshop will be of most interest for clinicians and guideline developers interested in optimising EBM dissemination, efficient updating and implementation.

Description

• Illustrate the need for a modular database based on examples from guidelines on anaesthesia. • Discuss quality regulation of content. • Discuss the role of patient involvement in the database. • Discuss to what extent content elements should be related to justify a ‘built-in’ relation (complexity of the web of recommendations). • Discuss possible connexions between the Dutch Guideline Database and the G-I-N Database.
073WS Collaborative Guideline Implementability Tool Development and Evaluation
Authors: Cheng J , Gagliardi A , Melissa B , Bhattacharyya O
Published: August 2013

Background

Research shows that guidelines are more easily translated to practice when accompanied by information that helps users accommodate, implement and evaluate use of the recommendations. We refer to this information in guidelines or other resources as guideline implementability tools (GItools). We identified exemplar GItools, generated criteria by which to assess and develop GItools through consultation with G-I-N members, and created an online directory for sharing of GItools. Discussion with G-I-N members would help us improve these resources and identify partners for collaborative GItool development. This work is a core activity of GIRAnet: the Guideline Implementability Research and Application Network (http://www.g-i-n.net/activities/implementation/giranet).

Objectives

To share information about GItool resources; gather feedback on how to improve GItool resources; learn about other GItool initiatives; and establish partners for joint development or evaluation of GItools. AUDIENCE Guideline developers, implementers, users (clinicians, managers, policy-makers) and researchers.

Description

A brief presentation will define GItools and describe their potential purpose and impact; review methods used to identify, describe and evaluate exemplar GItools; and demonstrate the GItool Directory (20 minutes). Participants will be asked to individually rate, then discuss enhancements for GItool assessment criteria (20 min). Open discussion will enable sharing and mutual learning about other GItool initiatives, and explore partnerships for future GItool initiatives (40 min). Remaining time will be used to identify priorities for ongoing research (10 min). Participant feedback will be used to improve GItool resources, and guide ongoing GIRAnet projects.
005 Clinical Practice Guidelines and Systematic Reviews: Point of Intersection?
Authors: Wilson L , Robinson K
Published: August 2013

Background

Guideline committees (GCs) rely on the evidence synthesised in systematic reviews (SRs) to develop evidence-based guidelines. Institute of Medicine standards for clinical practice guidelines include an interaction between the GC and the team conducting the SR.

Context

In 2005, the Cystic Fibrosis Foundation moved from consensus-based to evidence-based guideline development. SRs are now commissioned to inform specific guidelines. A methodologist, serving as a member of each multidisciplinary GC and as the lead investigator for the SR teams, provides the link for the scope, approach, and output of both processes.

Description of Best Practice

The methodologist, as part of the GC, facilitates the definition of the scope and refines the questions for the SRs. The methodologist oversees the conduct of the SR, ensuring that the review team addresses relevant questions, appropriately conducts searches, and establishes inclusion criteria and provides informative details to the GC. The methodologist provides training, where needed, and ensures consistency across guidelines in the drafting and grading of the recommendations. The methodologist also helps to address peer review comments and draft the guideline documents.

Lessons for Guideline Developers, Adaptors, Implementers, and/or Users

Having a methodologist serve on both the GC and the SR team ensures that there is appropriate and timely intersection of the guideline and SR processes. The methodologist can ensure that the SR team meets the needs of the GC and illuminate for the GC the methods and outcomes of the SR.
006 Translating Knowledge Into Practice: A Systematic Review Of Barriers, Facilitators And Interventions Impacting On Uptake Of Systematic Reviews
Authors: Wallace J , Byrne C , Clarke M
Published: August 2013

Background

The increased uptake of evidence from systematic reviews is advocated because of their potential to improve the quality of decision making for patient care and their use in clinical practice guidelines.

Objectives

To identify how uptake of evidence from systematic reviews can be enhanced.

Methods

Data sources: We searched 19 databases covering the full range of publication years.Study selection: Studies of barriers and natural facilitators to uptake of evidence from systematic reviews and meta-analyses were eligible. These studies encompassed survey, focus group and interview designs. Intervention, or outcome, studies were also included.Data extraction: Two reviewers independently assessed quality and extracted data that were summarised and then analysed. Using a pre-established taxonomy, the barriers and facilitators were organised into a framework according to their effect on knowledge, attitudes, or behaviour. For the intervention studies, two reviewers also independently assessed quality and extracted data.Data synthesis: Twenty-seven studies dealing with barriers were detected and 15 studies that included investigation of natural facilitators. Ten publications addressing interventions met inclusion criteria. A synthesis of findings was conducted to find out to what extent the interventions overcome the perceived barriers and built on the facilitators detected.

Results

Educational visits, summaries of systematic reviews, and targeted messaging had a significant impact on systematic review uptake and also addressed a range of identified barriers and facilitators.

Conclusion

On the basis of this study, specific strategies addressing a range of barriers and facilitators are recommended to enhance uptake of systematic reviews and meta-analyses. Promising interventions are also identified.
008 Principles for the Development of Specialty Society Clinical Guidelines
Authors: Fulda G , Wolfkiel C , Begolka W Smith , Campos-Outcalt D , Groman R , Rubin K , Davidson C , May C , Starkey M , Qaseem A
Published: August 2013

Background

In 2011 the Institute of Medicine (IOM) issued a report “Clinical Practice Guidelines We Can Trust” and “Standards for Systematic Reviews”. These documents represent an idealised approach to guideline development. The Council of Medical Specialty Societies (CMSS) was challenged to provide leadership on a pragmatic pathway for developing “Trustworthy” guidelines. CMSS representing 38 societies and the Clinical Practice Guideline (CPG) group is the largest of nine component groups.

Context

The IOM Trustworthy report contains 20 standards addressing transparency, conflict of interest and other recommendations. Guidelines International Network (GIN) published a set of 11 key components for high quality and trustworthy guidelines. Reconciling and applying these standards is challenging for specialty societies who by their very nature may be insular and sometime resource limited.

Description of Best Practice

The CPG writing group including representatives from AAD, AAFP, AANS AAP, ACC, ACP, ACOEM and SCCM developed a set of 80 principles that were approved as policy by the CMSS Board in late 2012. These Principles include areas that a specialty society should, must or may consider in developing their own guidelines development methodology.

Lessons for Guideline Developers, Adaptors, Implementers, and/or Users

These areas correspond to those outlined by the IOM and GIN but are intended to detail more specific issues that specialty societies are confronted by such as balancing panel expertise and potential bias. The overriding CMSS concepts include a practice approach to extensive evidence review, transparent conflict of interest management and broad stakeholder involvement. The CMSS Principles are intended to be interpreted transparently by member societies developing clinical practice guidelines.
010 “Ethics Consultation” and “Clinical Ethics Committees“ (CECs) in Medicine: Entirely “experimental” and not yet “fit for purpose”
Authors: Stratling M , Sedemund-Adib B
Published: August 2013

Background

Internationally multiple initiatives are under way (e.g. Germany, Switzerland, UK) to recommend “Clinical Ethics Consultation” and “Clinical Ethics Committees“ (CECs) in guidelines.

Objectives

These aim to improve ethical discourse and decision making in medicine.

Methods

Appraisal of available evidence and literature [1].

Results

For CE-Consultation, mostly CECs are implemented. Empirically their acceptance is poor, despite a large “demand”. Historically this international paradox is stable (“failure to thrive phenomenon”). Repeated initiatives and “re-brandings” can be identified. They made no tangible difference. Theories and methods are heterogeneous, patchy and contradictory. Their efficacy is unproven. A multitude of issues concerning quality, competence, qualifications, relevance, transparency, independence, conflicts of interests and legitimacy are unresolved.

Discussion

From the perspective of clinically and scientifically oriented Ethics in Medicine, present CE-Consultation represents a “cluster” of highly “experimental” tools, techniques and methods. The available evidence consistently suggests grave deficits. In developing medical guidelines and recommendations, professional bodies are duty-bound to adhere to robust, evidence-based processes. Applying such criteria, CE-Consultation and CECs fail to meet all requirements. The apparent intention to apply a “double-standard” to promote a “laudable” medico-“ethical” intention raises grave (not least ethical and scientific) concerns. These are presented and discussed in detail.

Reference

1. Strätling M. (2012) MedR 30: 428–436.
016 Retirement of Performance Measures In A National Pay for Performance (P4P) Scheme
Authors: Sutcliffe D , Hobbs L , Flatt G , Shaw E , Stokes T , Baillie N
Published: August 2013

Background

P4P schemes, providing financial incentives across a range of improvement indicators, are widely used and can improve health outcomes. These systems can work at different levels, including at the national level. It is important that performance measures (PMs) used in such systems have a robust and up-to-date evidence base to support continued use and they remain fit for purpose; this involves selecting PMs for ‘retirement’.

Objectives

To: i) describe methods used in selecting PMs for retirement, ii) present alternative methods for selecting PMs for retirement.

Methods

Identifying PMs for retirement have been based on several methods including: i) reported trends in achievement and exception reporting ii) review of paired PMs iii) review of supporting evidence and/or technical specifications iv) modified Delphi.

Results

We will present results of using these methods, and discuss alternatives to these (e.g., the Nominal Group Technique), and implications for retirement of PMs.

Discussion

These methods have been successful in identifying indicators for retirement. To ensure continual improvements in quality of care delivered through the P4P scheme and provide opportunities for new areas to be added, the review and retirement of PMs remains important.

Implications for Guideline Developers/Users

Guideline developers should be aware of key PMs based on guidance recommendations and have systems to ensure that underpinning evidence is up-to-date. PM developers should have processes to ensure that PMs are based on up-to-date evidence and remain fit for purpose.
023 Feasibility and Efficiency of Strategies For Updating Clinical Practice Guidelines
Authors: García L Martínez , Sanabria A , Araya I , Vernooij R , Solàà I , Lawson J , Navarro T , Haynes B , Román J Gracia San , Kotzeva A , Marti T , Alonso-Coello P
Published: August 2013

Background

Exhaustive search strategies (ESS) for updating clinical practice guidelines (CPGs) recommendations are laborious and expensive. Highly sensitive and specific alternative search strategies are necessary to improve the efficiency in recommendations updating.

Objectives

To compare alternative search strategies against ESS

Methods

We ran three different search strategies in a convenience sample of four CPGs from the CPGs National Programme in Spain: 1) Original ESS (gold standard); 2) Search strategy in the McMaster Premium LiteratUre Service (PLUS) database; and 3) Restrictive strategy with the least number of MeSH terms and text words from the original ESS. We retrieved the key references (which triggered an update) from the original ESS and evaluated their presence in the PLUS and restrictive strategies results. We calculated the sensitivity, specificity, precision, and accuracy for the PLUS and restrictive strategies compared to the ESS.

Results

The overall number of references in the PLUS strategy was lower than in the ESS (39,133 versus 2,635). The PLUS strategy retrieved a range of 1.12% to 12.1% of the total number of references retrieved by the ESS per guideline.

Discussion

Our project assessed two novel restrictive search strategies for the updating of CPGs, which could reduce the workload while displaying similar results. Full final findings of this project will be presented at the GIN meeting.

Implications for Guideline Developers/Users

Our project has important implications for updating CPGs, informing on the feasibility and efficiency of two novel search strategies.
024 Maximising efficiency in updating guidelines through prioritisation of clinical questions
Authors: Amos Q , Chan W , Tom G
Published: August 2013

Background

To maximise efficiency in updating clinical guidelines it is important to understand which of its component clinical questions impact patient care most. Evaluating, editing, and prioritising of each clinical question is required to identify those that warrant updating.

Objectives

To describe the methods used by a US health care delivery organisation to prioritise questions within an integrated cardiovascular guideline to determine those that were most important for updating.

Methods

127 clinical questions within an integrated cardiovascular guideline were ranked (using a Likert scale of 1–9) by importance for literature monitoring by clinical experts in each disease domain of the guideline. Examples of factors that influenced rankings included existence of high quality systematic reviews, knowledge that current evidence was relatively unchanged, and the notion that the question was no longer clinically relevant. Questions ranked 7–9 in importance for literature monitoring were considered most important for updating. Conversely, questions with low rankings were considered for retirement.

Results

Of 127 questions ranked, 16 were identified as important for literature updating; 12 were retired. We were able to address the most important questions and avoid updating delays of 6–18 months.

Discussion

Having these questions prioritised at the outset of updating allowed the healthcare organisation to ensure that the most important clinical questions were being addressed thus making the most efficient use of resources.

Implications for Guideline Developers/Users

Evaluating, editing, and prioritising clinical questions improves efficiency when updating guidelines.