bluuebunny/crossref_metadata_2025 huggingface dataset:
Soluble Interleukin-6 Receptor-Mediated Innate Immune Response to DNA and RNA Viruses
Authors: Wang Qing , Chen Xueyuan , Feng Jian , Cao Yanhua , Song Yu , Wang Hui , Zhu Chengliang , Liu Shi , Zhu Ying
Published: August 2013

The interleukin-6 (IL-6) receptor, which exists as membrane-bound and soluble forms, plays critical roles in the immune response. The soluble IL-6 receptor (sIL6R) has been identified as a potential therapeutic target for preventing coronary heart disease. However, little is known about the role of this receptor during viral infection. In this study, we show that sIL6R, but not IL-6, is induced by viral infection via the cyclooxygenase-2 pathway. Interestingly, sIL6R, but not IL-6, exhibited extensive antiviral activity against DNA and RNA viruses, including hepatitis B virus, influenza virus, human enterovirus 71, and vesicular stomatitis virus. No synergistic effects on antiviral action were observed by combining sIL6R and IL-6. Furthermore, sIL6R mediated antiviral action via the p28 pathway and induced alpha interferon (IFN-α) by promoting the nuclear translocation of IFN regulatory factor 3 (IRF3) and NF-κB, which led to the activation of downstream IFN effectors, including 2′,5′-oligoadenylate synthetase (OAS), double-stranded RNA-dependent protein kinase (PKR), and myxovirus resistance protein (Mx). Thus, our results demonstrate that sIL6R, but not IL-6, plays an important role in the host antiviral response.
Structural and Functional Studies on the Interaction of Adenovirus Fiber Knobs and Desmoglein 2
Authors: Wang Hongjie , Yumul Roma , Cao Hua , Ran Liang , Fan Xiaolong , Richter Maximilian , Epstein Forrest , Gralow Julie , Zubieta Chloe , Fender Pascal , Lieber André
Published: August 2013

Human adenovirus (Ad) serotypes Ad3, Ad7, Ad11, and Ad14, as well as a recently emerged strain of Ad14 (Ad14p1), use the epithelial junction protein desmoglein 2 (DSG2) as a receptor for infection. Unlike Ad interaction with CAR and CD46, structural details for Ad binding to DSG2 are still elusive. Using an approach based on
Escherichia coli
expression libraries of random Ad3 and Ad14p1 fiber knob mutants, we identified amino acid residues that, when mutated individually, ablated or reduced Ad knob binding to DSG2. These residues formed three clusters inside one groove at the extreme distal end of the fiber knob. The Ad3 fiber knob mutant library was also used to identify variants with increased affinity to DSG2. We found a number of mutations within or near the EF loop of the Ad3 knob that resulted in affinities to DSG2 that were several orders of magnitude higher than those to the wild-type Ad3 knob. Crystal structure analysis of one of the mutants showed that the introduced mutations make the EF loop more flexible, which might facilitate the interaction with DSG2. Our findings have practical relevance for cancer therapy. We have recently reported that an Ad3 fiber knob-containing recombinant protein (JO-1) is able to trigger opening of junctions between epithelial cancer cells which, in turn, greatly improved the intratumoral penetration and efficacy of therapeutic agents (I. Beyer, et al., Clin. Cancer Res. 18:3340–3351, 2012; I. Beyer, et al., Cancer Res. 71:7080–7090, 2011). Here, we show that affinity-enhanced versions of JO-1 are therapeutically more potent than the parental protein in a series of cancer models.
Canine Distemper Virus: an Emerging Disease in Wild Endangered Amur Tigers (
Panthera tigris altaica
)
Authors: Seimon Tracie A. , Miquelle Dale G. , Chang Tylis Y. , Newton Alisa L. , Korotkova Irina , Ivanchuk Galina , Lyubchenko Elena , Tupikov Andre , Slabe Evgeny , McAloose Denise
Published: August 2013

Fewer than 500 Amur tigers (
Panthera tigris altaica
) remain in the wild. Due to low numbers and their solitary and reclusive nature, tiger sightings across their range in the Russian Far East and China are rare; sightings of sick tigers are rarer still. Serious neurologic disease observed in several wild tigers since 2001 suggested disease emergence in this endangered species. To investigate this possibility, histology, immunohistochemistry (IHC),
in situ
hybridization (ISH), and reverse transcription-PCR (RT-PCR) were performed on tissues from 5 affected tigers that died or were destroyed in 2001, 2004, or 2010. Our results reveal canine distemper virus (CDV) infection as the cause of neurologic disease in two tigers and definitively establish infection in a third. Nonsuppurative encephalitis with demyelination, eosinophilic nuclear viral inclusions, and positive immunolabeling for CDV by IHC and ISH were present in the two tigers with available brain tissue. CDV phosphoprotein (P) and hemagglutinin (H) gene products were obtained from brains of these two tigers by RT-PCR, and a short fragment of CDV P gene sequence was detected in lymph node tissue of a third tiger. Phylogenetically, Amur tiger CDV groups with an Arctic-like strain in Baikal seals (
Phoca siberica
). Our results, which include mapping the location of positive tigers and recognition of a cluster of cases in 2010, coupled with a lack of reported CDV antibodies in Amur tigers prior to 2000 suggest wide geographic distribution of CDV across the tiger range and recent emergence of CDV as a significant infectious disease threat to endangered Amur tigers in the Russian Far East.

IMPORTANCE
Recognition of disease emergence in wildlife is a rare occurrence. Here, for the first time, we identify and characterize a canine distemper virus (CDV), the second most common cause of infectious disease death in domestic dogs and a viral disease of global importance in common and endangered carnivores, as the etiology of neurologic disease and fatal encephalitis in wild, endangered Amur tigers. We establish that in 2010 CDV directly or indirectly killed ~1% of Amur tigers. Location of positive cases over an expansive geographic area suggests that CDV is widely distributed across the tiger range. Interspecies interactions are increasing as human populations grow and expand into wildlife habitats. Identifying animal reservoirs for CDV and identifying the CDV strains that are transmissible to and among wildlife species, including Amur tigers and sympatric critically endangered Amur leopards (
Panthera pardus orientalis
), is essential for guiding conservation and mitigation efforts.
The Activity and Specificity of the Outer Membrane Protein Chaperone SurA Are Modulated by a Proline Isomerase Domain
Authors: Ricci Dante P. , Schwalm Jaclyn , Gonzales-Cope Michelle , Silhavy Thomas J.
Published: August 2013

SurA is a component of the periplasmic chaperone network that plays a central role in biogenesis of integral outer membrane β-barrel proteins (OMPs) in
Escherichia coli
. Although SurA contains two well-conserved proline isomerase (PPIase) domains, the contribution of these domains to SurA function is unclear. In the present work, we show that defects in OMP assembly caused by mutation of the β-barrel assembly factors BamA or BamB can be corrected by gain-of-function mutations in SurA that map to the first PPIase domain. These mutations apparently bypass the requirement for a stable interaction between SurA and the Bam complex and enhance SurA chaperone activity
in vivo
despite destabilization of the protein
in vitro
. Our findings suggest an autoinhibitory mechanism for regulation of SurA chaperone activity through interdomain interactions involving a PPIase domain. We propose a model in which SurA activity is modulated by an interaction between SurA and the Bam complex that alters the substrate specificity of the chaperone.

IMPORTANCE
The dominant
surA
mutations described here alter amino acid residues that are highly conserved in eukaryotic homologs of SurA, including Pin1, the human proline isomerase (PPIase) implicated in Alzheimer’s disease and certain cancers. Consequently, a mechanistic description of SurA function may enhance our understanding of clinically important PPIases and their role(s) in disease. In addition, the virulence of Gram-negative bacterial pathogens, such as
Salmonella
,
Shigella
, and
Escherichia coli
O157:H7, is largely dependent on SurA, making this PPIase/chaperone an attractive antibiotic target. Investigating the function of SurA in outer membrane (OM) biogenesis will be useful in the development of novel therapeutic strategies for the disruption of the OM or the processes that are essential for its assembly.
Does access to neighbourhood green space promote a healthy duration of sleep? Novel findings from a cross-sectional study of 259 319 Australians
Authors: Astell-Burt Thomas , Feng Xiaoqi , Kolt Gregory S
Published: August 2013

Objectives

Experiments demonstrate that exposure to parks and other ‘green spaces’ promote favourable psychological and physiological outcomes. As a consequence, people who reside in greener neighbourhoods may also have a lower risk of short sleep duration (<6 h). This is potentially important as short sleep duration is a correlate of obesity, chronic disease and mortality, but so far this hypothesis has not been previously investigated.

Design

Cross-sectional data analysis.

Setting

New South Wales, Australia.

Participants

This study investigated whether neighbourhood green space was associated with a healthier duration of sleep (to the nearest hour) among 259 319 Australians who completed the 45 and Up Study baseline questionnaire between 2006 and 2009 inclusive.

Primary and secondary outcome measures

Multinomial logit regression was used to investigate the influence of an objective measure of green space on categories of sleep duration: 8 h (normal); between 9 and 10 h (mid-long sleep); over 10 h (long sleep); between 6 and 7 h (mid-short sleep); and less than 6 h (short sleep). Models were adjusted for psychological distress, physical activity and a range of demographic and socioeconomic characteristics.

Results

People living in greener neighbourhoods reported a lower risk of short sleep. For example, compared with participants living in areas with 20% green space land-use, the relative risk ratios for participants with 80%+ green space was 0.86 (95% CI 0.81 to 0.92) for durations between 6 and 7 h, and 0.68 (95% CI 0.57 to 0.80) for less than 6 h sleep. Unexpectedly, the benefit of more green space for achieving 8 h of sleep was not explained by controls for psychological distress, physical activity or other socioeconomic factors.

Conclusions

Green space planning policies may have wider public health benefits than previously recognised. Further research in the role of green spaces in promoting healthier sleep durations and patterns is warranted.
P001 Collaboration on evidence synthesis to support health care recommendations: what works, what doesn’t and what’s next
Authors: Schunemann Holger
Published: August 2013

Systematic reviews have become asine non quain guideline development. The reasons for this are obvious: recommendations must be based on the best available evidence and systematic reviews allow for transparent methods and processes for evaluating the evidence.

However, best practice of collaborating and implementing the laudable goal of basing recommendations in guidelines on systematic reviews has not been defined. For example, better coordination between guideline developers and systematic review authors is required to efficiently use resources (e.g. avoid unnecessary duplication of efforts, delays and non-credible evidence reviews). The Cochrane Collaboration and the Guideline International Network are looking for ways to collaborate. Attractive models include the development of a database of health care questions for which systematic reviews exist, are planned or missing. A database will allow guideline developers and systematic reviewers to work in synergy and ensure that evidence is synthesised when needed and used when recommendations are formulated. An interactive database of questions, linked to summaries of evidence and systematic reviews would support guideline developers and systematic reviewers to work together. This collaboration is not simple; it requires involvement of both review authors and guideline developers early on in the process of systematic reviews. In this presentation we will review challenges and proposed solutions based on existing models, examples and ideas to advance the field. It will report on work from the GIN Partnership Taskforce, the Cochrane Applicability and Recommendations Methods Group, other Cochrane entities and the GRADE working group to support these solutions.
P010 Developing and evaluating communication strategies to support informed decisions and practice based on evidence (DECIDE) for health professionals
Authors: Alonso Pablo
Published: August 2013

The DECIDE initiative, building on the work of GRADE, is exploring methods to ensure effective communication of evidence-based recommendations targeted at key stakeholders (healthcare professionals, policymakers, and managers, and patients and the general public). DECIDE will produce strategies for communicating recommendations that are being rigorously evaluated in diverse settings, and it will support the transfer of research into practice in healthcare systems globally. The methodology is an iterative process that includes; brainstorming, user feedback through user testing, surveys, trials and implementation and evaluation in real guidelines. All this is being done across a wide range of healthcare systems in Europe, North America, and other countries.

The work with healthcare professionals is developing three strategies: 1) An electronic multilayered guideline format that presents the essential information that healthcare professionals tell us they need to understand and act on a recommendation; 2) An evidence to recommendation table for users: this is a summary table with the factors for moving from evidence to a recommendation and the justification for each recommendation; 3) A decision aid template to semi-automatically build decision aids linked to guidelines to be used at the point of care. For strategies 1 and 3 DECIDE is also collaborating with theMAGIC programme.

These strategies will be implemented a guideline authoring tool that is being developed from GRADEpro (called the Guideline Development Tool, or GDT), and will also be implementable in other online guideline authoring tools, allowing guideline groups to decide which of these strategies to use when developing their guidelines. The GDT will be able to facilitate the full authoring of a typical guideline and allow the updating of these strategies when needed. Guideline outputs will be made available through multiple platforms (e.g., websites, smartphones and tablets apps).

These tools will help to make guidelines better suited to the information needs of health professionals, policymakers and consumers across diverse healthcare settings in Europe and elsewhere.
073 Implementing Updated US Federal Government Recommendations about HIV Prevention for Persons with HIV: A High-Impact Approach for HIV Prevention
Authors: Irwin K , Huang A , Wortley P , Patel A , Dumitru G
Published: August 2013

Background

More than one million people are living with HIV in the US; each year this number increases by ∼30,000. Nearly two-thirds of new infections occur in racial/ethnic minorities. The 2010 National HIV/AIDS Strategy emphasises cost-effective, high-impact strategies that reduce the infectiousness of HIV-infected persons over behavioural interventions for HIV-uninfected persons. To advance this Strategy, the US Department of Health and Human Services consolidated and updated existing federal government recommendations for HIV prevention for persons with HIV.

Objectives

Describe guideline development and implementation methods.

Methods

HIV prevention, care, and policy experts from CDC, HRSA, NIH and six non-governmental organisations updated existing federal government recommendations for clinicians, non-clinical prevention providers, health departments, and policy makers based on new evidence about biomedical, behavioural, and policy interventions.

Results

The updated recommendations emphasise new, and effective, but under-used interventions: evidence-based linkage-to-care strategies, early initiation of antiretroviral therapy, interventions supporting adherence to suppress viral load and reduce infectiousness, and new behavioural interventions. To implement guidelines, CDC and HRSA are coaching “champions” in public and private sectors; disseminating decision-support tools and low-cost implementation resources, aligning federal policies with the guidelines; advising states about regulations that promote implementation; and evaluating guideline adherence and enablers through national studies.

Discussion

Implementing these broad, inter-sector recommendations will require long-term engagement of governmental and non-governmental organisations. Successful implementation promises to invigorate America’s HIV prevention strategy, help reduce health disparities, and decrease the nation’s devastating HIV burden.

Implications for Guideline Developers/Users

Understanding the benefits of consolidated guidelines that advance national policy.
081 The Endocrine Society Guidelines: Implications of Strong Recommendations with Low Quality Evidence
Authors: Britto J , Domecq J , Murad M , Guyatt G , Montori V
Published: August 2013

Background

In 2005, the Endocrine Society (TES) adopted the GRADE system of developing clinical practice guidelines. This system facilitates the formulation of evidence-based recommendations by explicitly describing the confidence in estimates (quality of evidence) and strength of each recommendation.

Objectives

To describe and characterise the relationship between confidence in estimates and strength of recommendation in TES guidelines.

Methods

We included all published TES guidelines between 2005 (when TES started using GRADE) and 2011. Independently and in duplicate, reviewers extracted, for each recommendation: disease area, confidence in estimates and design of the studies considered, and strength of recommendation. In strong recommendations with low quality of we developed and applied a taxonomy of appropriate recommendations and identified those we considered inappropriate.

Results

Most of the 357 recommendations issued were supported by evidence warranting low or very low confidence in estimates (256, 72%). Evidence cited in support of these recommendations came exclusively from observational studies in 233 recommendations (65%). Most recommendations were strong (206, 58%); of these, 121 (59%) were supported by evidence warranting low or very low confidence in estimates. In 101/121 (83%), we identified a compelling rationale for the recommendations; in 20 (17%), we did not.

Conclusions

Most TES strong recommendation based on low quality evidence are justified and appropriate, but a substantial proportion are not.

Implications for Guideline Developers

Guideline developers should carefully justify any strong recommendations based on low confidence in effect estimates.
P008 What type of evidence do we need to develop guidelines for diagnostic imaging?
Authors: Reed M
Published: August 2013

Background

Diagnostic imaging (DI) is used several ways in patient management, and the evidence required for each of these roles is somewhat different. This presentation will focus on the evidence needed to develop guidelines for the use of DI in primary diagnosis.

Context

GRADE states that randomised control trials of patient outcomes are the highest level of evidence for assessing diagnostic tests but also that accuracy can be used as a proxy for outcomes. DI guidelines provide two basic types of information: whether DI is indicated in a particular clinical situation and what is the best DI modality to use. In choosing a modality the accuracy of different DI modalities is important. However, the question of whether DI is indicated in a given clinical situation is at least as important, and in determining this, accuracy is less important.

Best Practice

The type of evidence which is needed for this question relates to whether DI will affect the management of the patient. If the information that DI provides is not relevant to the management of the patient then DI is not indicated. If the pre-test probability of the diagnosis is very low or very high then DI is also not indicated.

Lessons

When developing guidelines for DI first consider whether the type of information DI can provide is important in patient management. If it is, clinical decision rules are important in assessing whether the pre-test probability justifies its use. Accuracy only becomes important in determining which imaging modality to recommend.
P013 A preliminary analysis of the clinical pathways in China
Authors: Wei M , Liu M
Published: August 2013

Background

Clinical pathway (CP) is an application of rational process and time management for specific disease and surgery in practice. The CP was firstly introduced into China in 1990s.

Objective

To find the current status of clinical pathways in China.

Methods

We used word clinical pathway in title by searching the web of clinical pathway (www.ch-cp.org.cn), CNKI, etc. and collected CP on title, date, specialties and main contents, etc. Search date till July 30, 2012.

Results

1) 331 CPs were issued in 2009-2011, 25,503 departments from 3,467 hospitals conducted CP and public hospital accounted for 46.9% by 2011 in China. 2) The CPs was pilot implemented in 110 selected hospitals from 23 provinces on 22 specialties, such as general surgery, cardiovascular, orthopaedics, etc. 3) The contents of CP mainly include: disease and target population, diagnosis, treatment option, standard length of stay in hospital, criteria for CP entrance, preoperative evaluation, time and choice for use of prophylactic antibiotics, operation day, postoperative hospital stay recovery, discharge standard, variance and reason analysis, etc. Few CP described the sources of funding, composition of group that authored the CP and financial disclosures. 4) The major influential factors of CP implementation include: the participation of doctors and patients, explanation of the various process and documents, payment problems, hospital management, appropriate incentive mechanisms, information systems and other support policies, etc.

Conclusions

Clinical pathway may a tool for hospital quality management and assessment criteria of disease effectiveness-costs. More communications with doctors and patients and innovative payment methods would be better for CP implementation.
P022 Ginseng for Health Care: A Systematic Review of Randomised Controlled Trials in Korean Literature
Authors: Choi J , Choi T , Lee M , Kim T
Published: August 2013

Objective

This systematic review was performed to summarise RCTs assessing the efficacy and safety of ginseng treatment in the Korean literature.

Method

The study involved systematic searches conducted in eight Korean Medical databases. The methodological quality of all of the included studies was assessed using the Cochrane ROB tool. We included all RCTs on any type of ginseng compared to placebo, active treatment or no treatment in healthy individuals or patients regardless of conditions.

Results

In total, 30 randomised clinical trials were included. Nine RCTs assessed the effects of ginseng on exercise capacity, cognitive performance, somatic symptoms, quality of life, and sleeping in healthy persons. Six RCTs tested ginseng compared with placebo for erectile dysfunction, while another four studies evaluated the effects of ginseng against no treatment for gastric and colon cancer. Two RCTs compared the effect of red ginseng on diabetes mellitus with no treatment or placebo, and the other nine RCTs assessed the effects of ginseng compared with placebo or no treatment on various conditions. However, the 20 newly added trials may provide useful information for future trials.

Discussion

Most RCTs published in the Korean literature have not been included in up-to-date systematic reviews. Although the quality of RCTs published in the Korean literature was generally poor, this review is useful for researchers to access studies that were originally published in languages that they would otherwise be unable to read and due to the paucity of evidence on this subject.
P049 Evidence Distribution of a Comprehensive Musculo-Skeletal Guideline
Authors: Wolfkiel C , Ording J , Thiese M , Stanhope M , Harris J , Hegmann K
Published: August 2013

Background

Occupational Medicine focuses on return to functionality and work, however the overwhelming majority of injuries are musculoskeletal and require very specific clinical situation evidence review. Body part areas addressed include spine, shoulder, elbow, hand/wrist/forearm, hip/groin, knee and ankle/foot. Interventions assessed include diagnostic, therapeutic and medical therapies.

Objectives

To assess the theoretical evidence distribution of a comprehensive musculoskeletal guideline and its potential application in practice. Methods: Evidence ratings (A,B,C) were determined by expert data extraction from over 5,000 randomised controlled trials (RCT), non-RCT evidence was designated as insufficient (I). RCT evidence ratings were quantified on an 11 point scale that assessed appropriateness, biases and effectiveness. High quality evidence was defined as 8.0–11 points, moderate 4.0–7.5, and low < 4.0 points. A level evidence (Strong) was defined as 2 or more high-quality RCTs, B (Moderate) 1 high-quality or multiple moderate-quality, C (Limited) at least one study of moderate-quality. Low quality, observational or conflicting evidence was designated as Insufficient (I). A similar profile was used for diagnostic evidence recommendations. Evidence ratings were verified by independent writing panels.

Results

Only 0% of 2500 recommendations were supported by a Limited (C) or better evidence base. When adjusting for frequency of occurrence from a claims data base, and cost was estimated in only 14% of costs were associated with quality RCT studies.

Conclusions

These data suggest that the majority of musculoskeletal clinical decisions do not have a sufficient evidence base for rules-based decision making.
P058 Developing a Youth Health Care guideline on sexual development with limited evidence
Authors: Maris S , Deurloo J , Lanting C , Kamphuis M , Vlugt I van der
Published: August 2013

Background

Children’s sexual development starts at an early age and is a very complex subject, comprising the physical but also the psychosocial development. Youth Health Care (YHC) professionals can prevent and detect problems in sexual development, and play a guiding role in stimulating sexual competency and positive sexual attitudes.

Objectives

Our goal was to develop an evidence based national YHC guideline for sexual development.

Methods

The content of the guideline is based on (inter)national guidelines, literature searches, consensus and experience. The guideline is now piloted for use in daily practice by YHC professionals. The way we handled the limited amount of evidence and the results of this pilot will be presented. We cooperated with an international centre of expertise on sexual and reproductive health and performed literature searches for a selected number of questions.

Results

The guideline describes the (physical and psychosocial) sexual development of children from 0–19 years old, determinants of sexual health and groups at risk. Discussion In this presentation, we would like to discuss the issue of dealing with the limited amount of evidence and we will show how we handled this issue. Working together with an experienced centre was crucial. Coming to consensus in the working group and performing a pilot test in addition, is essential in gaining obtaining support for the recommendations of the guideline.

Implications for Guideline Developers/Users

In YHC not much evidence of high quality is available. Exchange of experiences will help other guideline developers dealing with this as well.
P088 Exploring Possibilities For Integration Of Results Of Research In Patient Preferences In Guideline Development: Preliminary Results Of Interviews With Several Stakeholders.
Authors: Utens C , Joore M , Weijden T van der , Dirksen C
Published: August 2013

Background

There is full awareness of the urge to integrate patient perspectives in guidelines. Active patient participation in guideline development is advocated, the passive use of research results on patient preferences is rather limited.

Objectives

To explore ideas and opinions regarding potential barriers and facilitators for integrating research results on patient preferences in guideline development.

Methods

Eight interviews were held with patient representatives, guideline developers, policy-makers and researchers. Interviews were semi-structured along three themes: definition of patient preferences; consideration of research on patient preferences in guideline development and aspects of obtaining patient preferences through research.

Results

Most interviewees defined preferences broadly, using terms as ideas, values, wishes, needs, expectations and experiences. Others described preferences exclusively as comparative judgments. Interviewees had difficulties reflecting on considering patient preferences by using research results, instead of active participation. Although the general increasing focus on patient participation facilitates the use of research results, many barriers were mentioned: relevance of collective preference for individual decision-making; focus of evidence-based medicine on “hard evidence”; lack of reliable and valid data; unclear how to integrate research results into the development procedure.. Patient- and professional organisations often generate own evidence, with unclear scientific character.

Discussion

The results show which issues are important and need further clearance. Interviewees define patient preferences differently, do not believe in using such research results or do not know how to do it.

Implications for Guideline Developers/Users

Several issues need to be addressed to facilitate the integration of research results on patient preferences in guideline development.
P096 The Quality Of Clinical Practice Guidelines Of Acupuncture
Authors: Chen H , Gu Y , Zhang X , Li G , Xu B
Published: August 2013

Background

Acupuncture practice plays an important role in healthcare in China as well as in the world. 2011, the China Academy of the Chinese Medical Sciences (CACMS) published 5 Clinical practice guidelines (CPGS) of acupuncture, which were the only 5 CPGS specialised for acupuncture in China. Our research was to systematically review the quality of these 5 CPGS.

Methods

We evaluated the quality of the 5 CPGS through the guideline appraisal instrument: Appraisal of Guidelines for Research and Evaluation II (AGREE II). Four appraisers rated 6 domains separately.

Results

None of the included 5(0%) guidelines described the systematic methods for searching and selecting the evidence, and all (100%) appraised the quality of evidence and graded the strength of recommendations. 5 guidelines (100%) reported the guideline panel which involved special methodologists, and 5(100%) mentioned updates but no one (0%) described a procedure and frequency for updating the guideline. None of the guidelines (0%) considered the patients values, and no one (0%) used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. None (0%) reported the conflicts of interests. From the assessment with AGREE II, the mean scores were very low for the domains editorial independence (2%) and applicability (8%),while the other domains were low for the rigour of development (18%), stakeholder involvement (35%), ‘clarity of presentation’ (46%) and ‘scope and purpose’ (54%).

Implications

Now, the quantity of CPGS of acupuncture is very small. As the quality of the guidelines of acupuncture was low, they were still lots of limitations. The research in methodology of the CPGS of acupuncture still must be enhanced.
063PS Challenges and Opportunities in Low-Resource Settings: Guideline Development, Adaptation, Implementation and Performance Measurement
Authors: Huckson S , Beena M , Opiyo N , Lang E , Koster M
Published: August 2013

Background

Health care and health policy organisations seeking to improve medical care in low-resource settings with significant numbers of uninsured, medically underserved and/or low-income populations face significant challenges in developing, adapting, implementing and monitoring improvement with clinical practice guidelines.

Objectives/Goals

To provide opportunities for panel members and conference participants to exchange experiences, challenges, lessons learned, and opportunities for collaboration related to guideline development, adaptation, implementation and performance measurement in low-resource settings.

Target Group, Suggested Audience

Those involved in guideline development, adaptation, implementation and/or performance measurement activities, especially in medically underserved, low-income and low-resource settings.

Description of Session and Speaker Topics

The session will include brief speaker presentations, followed by interactive, facilitated discussion between panellists and audience members. Dr. Beena will discuss development of guideline-based quality standards to decrease maternal mortality in rural settings in Kerala, India; Dr. Opiyo will discuss guideline adaptation and implementation efforts in Nairobi to improve child and newborn health; Dr. Lang will discuss the G-I-N Emergency Care Community’s efforts to support collaboration across the field of international emergency care, including adaptation of sepsis guidelines for global use in low-resource settings. Sue Huckson will moderate the discussion.
P151 Culture And Guidelines: How Cultural Differences In Treatment Approach Affect Interpretation Of Literature And Guideline Recommendations
Authors: Schwartz S , Drumheller C
Published: August 2013

Background

Guideline development activity is primarily focused in Western Europe and North America. Consequently, western medical interventions and approaches are disproportionately represented among guideline developers. scepticism about cultural variations in treatment, concern of publication bias in specific regions or languages, and resulting scepticism of foreign literature compounds the problem of accurately assessing evidence and making sound recommendations. When accounting for publication bias and/or prevailing cultural paradigms, guideline developers may struggle to determine the benefit-harm ratio of alternative/complementary interventions.

Context

A recent guideline development panel struggled with precisely these issues when reviewing available literature to formulate a recommendation on acupuncture therapy for Bell’s palsy patients. All physicians on the panel practiced medicine in the United States, and were unfamiliar with acupuncture therapy. Available literature came predominantly from one country with evidence of severe publication bias. The panel was unable to determine the benefit-harm ratio of acupuncture therapy, and ultimately could make no recommendation for the use of acupuncture for Bell’s palsy patients.

Description of Best Practice

Guideline developers need to give careful consideration to interpretation of literature when there may be significant cultural differences in treatment approach, cultural bias among the panel, or publication bias that may affect recommendations. Transparent discussion that recognises these issues will help ensure that recommendations regarding alternative/complementary interventions are sound.

Lesson for Guideline Developers

Guideline developers need to be aware of potential bias as to how cultural differences in treatments are represented in guideline recommendations, and be mindful regarding the cross-cultural applicability of guideline content.
P153 Successful Strategies In The Implementation Of Clinical Practice Guidelines: Creating Evidence-Informed Practice Cultures
Authors: McConnell H , Grinspun D , Bajnok I
Published: August 2013

For over a decade, a professional nursing association has lead a programme focused on the development, dissemination, implementation and evaluation of clinical and healthy work environment guidelines. This programme has achieved considerable recognition around the globe based on its rigorous guideline development process, and innovative implementation strategies. These strategies are founded on an evidence-informed implementation model, and include individual, organisational and system level approaches. A key organisational level strategy within this programme, the Best Practice Spotlight Organization (BPSO) initiative, was designed to support health care organisations in their journey towards clinical excellence through the implementation and sustainability of multiple clinical practice guidelines. This initiative was launched in 2003 with nine organisations (acute care hospitals and home health care agencies), and has grown to include 68 BPSOs representing 294 sites. This reach has included international BPSOs in Spain, Australia, Chile, and the United States. The BPSO initiative provides specific coaching, mentoring, knowledge transfer and capacity building opportunities, and support to leaders in the BPSO sites as they implement, evaluate and work to sustain clinical guidelines both across their organisations and at the team/unit level. This strategic approach has served to trigger the development of evidence informed cultures, improve patient care and enrich the professional practice of nurses and other health care providers. This presentation will share some of the key outcomes of this guideline implementation strategy, and will highlight success storeys of how BPSOs are changing the nursing and health care landscape to foster a culture of evidence informed practice.
P154 Development of the Documentation And Appraisal Review Tool (Dart) For Systematic Reviews
Authors: Diekemper R , Ireland B , Merz L
Published: August 2013

Background

Systematic reviews are the foundation for evidence-based guidelines. Rigorous standards exist, but there is wide variation in implementation, highlighting the need for a more comprehensive quality assessment tool for systematic reviews.

Objective

To develop a tool that sufficiently evaluates major biases relevant to experimental and observational study designs.

Methods

The Documentation and Appraisal Review Tool (DART) was developed using epidemiologic principles of study design and the following resources: Overview Quality Assessment Questionnaire (OQAQ), Assessment of Multiple Systematic Reviews (AMSTAR), the Cochrane Handbook, and the standards promoted by the Agency for Healthcare Research and Quality, and the Institutes of Medicine (IOM). DART underwent multiple rounds of testing and revisions.

Results

Compared to OQAQ and AMSTAR, DART includes two unique questions and several questions covered by OQAQ or AMSTAR but not both. OQAQ and DART had the highest reporting consistency. Four AMSTAR questions elicited inconsistent responses. Identifying reviewer rationale was most difficult using the OQAQ tool, and easiest using DART.

Discussion

DART allows for documentation of reviewer rationale, facilitating reconciliation between reviewers and documentation for future updates. DART also allows for evaluation of major biases relevant to observational study designs and the assessment of standards recommended by the March 2011 IOM Standards for Systematic Review.

Implications for Guideline Developers/Users

The proliferation of systematic reviews provides guideline developers the opportunity to utilise pre-existing research to produce evidence-based guidelines. However, the wide variation in quality means developers will need to carefully assess the quality of systematic reviews using a tool such as DART.
P174 A Systematic Review Of Transcatheter Aortic Valve Implantation
Authors: Jung Y , Choi M
Published: August 2013

Background

Transcather Aortic Valve Implantation (TAVI) was developed as an alternative to surgical aortic valve replacement (AVR) for patients with severe symptomatic aortic stenosis (AS) and high or unacceptable surgical risk.

Objectives

To evaluate the safety and effectiveness of TAVI compared with AVR or standard therapy.

Methods

The searches were conducted via electronic databases including MEDLINE, EMBASE and the Cochrane Library and retrieved 1537 non-duplicate citations. Total 17 studies (2 RCT, 5 non-RCT, 10 cohort studies) were included for this review.

Results

Compared with standard therapy, TAVI significantly increased major stroke (risk ratio, 3.91; 95% CI, 1.16-13.22) in two studies, although rate of major stroke was not significantly different in the TAVI compared with surgical AVR. Compared with standard therapy in inoperable patients, TAVI significantly reduced the all-cause mortality (risk ratio, 0.045, 95% CI, 0.26-0.77) at 1 year and improved functional status (NYHA functional classification). Among high-risk patients, the mortality was not significantly different in the TAVI compared with surgical AVR. However, a RCT of 699 high-risk patients who were randomised to treatment either by TAVI or by surgical AVR reported that the all-cause mortality at 1 year was 24.2% and 26.8%, respectively and TAVI was non-inferior to surgical AVR (p = 0.44).

Conclusion

On the basis of current data, we recommend that TAVI is possible treatments as an alternative to surgical AVR for patients with AS who are considered to be inoperable or high risk for surgical AVR.
P184 Including Work Participation In Dutch Multidisciplinairy Guidelines - An Overview
Authors: Bruinvels D
Published: August 2013

Background

In 2006 an innovative programme for the development of multidisciplinary guidelines (KKCZ) was started in The Netherlands. The KKCZ programme aimed to develop multidisciplinary guidelines, to facilitate collaboration between professional groups, to enhance patient participation, and to avoid duplication of efforts on a national level. Context One of the innovative aspects of the KKCZ-programme was to stimulate guideline developers to include (work) participation in the guidelines. Therefore The Netherlands Society of Occupational Medicine (NVAB) has developed a “Blueprint Participation in Guidelines” to facilitate guideline developers to include work participation in KKCZ-guidelines.

Description

The KKCZ-programme has led to 53 multidisciplinary guidelines. In an evaluation study the contents of eight KKCZ-guidelines and two other multidisciplinary guidelines was assessed. This was accomplished by first developing a list of process indicators describing essential steps of the Blueprint. Second, the use of the Blueprint was evaluated using this list. All eight KKCZ-guidelines were developed using the Blueprint. Because process indicators do not give information on the actual contents of a guideline, a web based survey was held among Dutch occupational physicians. 253 occupational physicians reported on the inclusion of work participation in the guidelines. The majority found that work participation was included in these guidelines. However, they also found that many of the key recommendations in the guidelines were difficult to implement.

Lessons

The use of a Blueprint for guideline developers has stimulated the inclusion of work participation in multidisciplinary guidelines. However, the use of this Blueprint is no guarantee that key recommendations on work participation are implemented in daily practice.
P187 Developing A Framework And Criteria To Sort, Select And Reduce Measurement Instruments For Daily Practice In Physical Therapy
Authors: Meerhoff G , Beurskens S , Swinkels R , van der Wees P , de Graaf-Peters V
Published: August 2013

Objectives

The amount and diversity of measurement instruments in the Dutch physiotherapy guidelines is too extensive: in total 111 instruments. Many of these instruments are too long and concern identical domains and concepts. The aim of this bottom-up project is to develop a framework and criteria that will guide the structure, selection and reduction of instruments for application in daily practice.

Methods

The project consist of the next steps: 1. Defining the aim of the framework and review the (inter)national literature; 2. Developing a concept framework; 3. An inventory of domains and overlap of instruments in the Dutch guidelines; 4. An inventory made by professionals of domains and concepts relevant for musculoskeletal functioning in physiotherapy and instruments used; 5. Consensus meetings with representatives of professionals and guideline developers; 6. Processing results and preparation of field tests: sorting, selection and reduction of instruments for domains and concepts by using the framework and criteria for feasibility and use in daily practice; 7. Implementation- and dissemination planning.

Results

A Conceptual framework based on the structure of clinical reasoning and International Classification of Functioning. An inventory of domains that are relevant for physiotherapy and feasibility criteria for the selection of instruments. A guide for the selection and reduction of recommended instruments in guidelines and use in daily practice.

Conclusions

The framework gives professionals and guideline developers the same structure and a clearer understanding about the selection of instruments for daily practice. It helps professionals to learn when to use which instrument for what patient.
P002 Systematic Reviews; the policy maker’s dilemma
Authors: Sarah Garner
Published: August 2013

Evidence-based policy making calls for the use of the best available evidence to support decision-making. Traditional hierarchies of evidence interpret this as focus on RCTs with most placing systematic reviews at the top. The proliferation of systematic reviews has now led to ‘tertiary analysis’ – reviews of multiple sources of secondary analysis. However, experienced users recognise there are good and bad systematic reviews. The systematic review may not answer the exact policy question being posed and it is only as useful as good as the underpinning evidence base. Best practice would suggest new systematic review is undertaken for each policy decision. Yet there are often time constraints and funding pressures and a limited skill set. Prioritisation is therefore necessary.

On a strategic level, the use of average data derived from RCTs to make decisions about individual patients is being questioned. There are multiple stratified and personalised medicine initiatives backed by funding for methods and infrastructure to support the use of observational data for comparative effectiveness research. Yet little attention has been given as to how to integrate these different types of evidence to make decisions.

Dr Garner has provided technical advice to NICE for the past 12 years and in addition to consuming systematic reviews for policy decisions she is a writer and editor of systematic reviews. Dr Garner will provide insights into the policy maker’s dilemma and the scientific arguments underpinning the debate. She will share a number of initiatives at the policy level and put forward potential options for how the evidence-based medicine community can address the policy maker’s dilemma.