bluuebunny/crossref_metadata_2025 huggingface dataset:
P235 From Clinical Practice Guidelines To The Comprehensive Care Guideline For Patients: Beyond The Scientific Process, A Task Of Cultural Construction
Authors: Bonilla Mahecha L , Moreno M , Mosquera P , Gaitan H
Published: August 2013

Background

Patients guideline development is a complex process that must combine harmoniously clinic expert knowledge, values, preferences and patient’s information needs; it means in itself the possibility of transforming social imaginary, practices, beliefs and behaviours health. The design of a qualitative methodology systematic and rigorous a guideline for patients would allow producing efficient results. The paper contains the design of a systematic and rigorous type of qualitative methodology, a guidelines for patients, was allowed producing efficient results.

Objective

Design a methodology for patients’ guidelines development in the Colombian context.

Methods

A qualitative type study was developed in three phases: 1) Review of materials and patients guidelines targeting populations, creating an array of identification of information needs. 2) Development of a proposal for a context-sensitive communication expert team. 3) Validation of contents.

Results

Designed a methodology with ten steps and developed the guidelines for patients which included scientific evidence, socio-cultural practices and participation of patients. The validation of the sexually transmitted infections the Guide was attended to people with a variety of gender, age and educational level. During the process was verified that although this methodology was systematic and rigorous, was flexible and allowed adapting independently the guideline the nature of the disease, life cycle, and the information’s circulation.

Discussion

Leading the developing process of guidelines. patients by systematic and flexible methodologies allow to make a better sizing of the process incorporating valid contextual factor, suggests the need to be validated and involve patients in the process.
P236 Documentation Of Intellectual Conflicts Of Interests Proved Critical In A Clinical Practice Guideline
Authors: Akl E , El-Hachem P , Abou-Haidar H , Guyatt G
Published: August 2013

Background

The American College of Chest Physicians (ACCP) Antithrombotic Guidelines (AT9) addressed both financial and intellectual COI, and restricted panellists from voting on recommendations on which they declared a primary conflict. The extent to which intellectual COI restricted participation beyond financial COI is uncertain.

Objective

The objective is to describe financial and intellectual COI among AT9 panellists and assess their overlap.

Methods

The AT9 executive committee developed definitions and categorizations of primary and secondary financial and intellectual COI. panellists reported, for each recommendation, their financial and intellectual COIs. We analysed their declarations.

Results

Among 102 panellists, the average number of recommendations for which panellist declared COI was: 2.1 (SD 5.7) for secondary financial COI, 1.7 (SD 3.5) for primary financial COI, 5.0 (SD 9.9) for secondary intellectual COI, and 2.5 (SD 5.0) for primary intellectual COI. Of the 102 panellists 37 (36%) declared a primary intellectual but no primary financial COI for at least one recommendation. Among 431 recommendations, the average number of panellists per recommendation who declared COI was: 0.5 (SD 0.8) for secondary financial COI, 0.4 (SD 0.9) for primary financial COI, 1.2 (SD 1.2) for secondary intellectual COI, and 0.6 (SD 1.2) for primary intellectual COI. In 63 recommendations (23%) at least one panellist had a primary intellectual COI but no primary financial COI

Conclusion

A substantial number of declarations resulted in restrictions based on intellectual COI in the absence of financial COI.
P239 Breaking New Ground To Close The Gaps Between Physcian’s Knowledge And Prcatice
Authors: Bhushan R , Gist D
Published: August 2013

Background

Effective dissemination of evidence-based clinical practice guidelines (EBCPG) help clinicians practice evidence-based-medicine, close practice gaps, thus improving medical care.

Objectives

To determine the effectiveness of an educational intervention to measure changes in practice/self reported performance improvement for the management and treatment of psoriasis and psoriatic arthritis.

Methods

EBCPG were leveraged and repurposed as an interactive guideline translational CME course to expand physicians’ knowledge base and improve clinician confidence and effectiveness in treating patients with psoriasis and psoriatic arthritis. Participants were given i) an assessment questionnaire before and after the session to measure knowledge and competence, ii) guidelines application tools useful in the clinic. A follow-up assessment questionnaire was conducted one year later to assess if session and application tools were easy to translate in clinic.

Results

Approximately 90% of the participants felt the session improved their knowledge, confidence and will have an impact on their practice. Over 60% of case vignettes based questions showed significant improvement compared to the pre assessments p < 0.05. A one-year follow up indicated that 63% of the participants had changed their practice after attending the session.

Discussion

The session will optimise usability of EBCPG in physician’s daily practice and lead to improvement of patient quality of life and help in closing gaps in practice care.

Implications for Guideline Developers/Users

EBCPG translational session with application tools is an effective method for implementing clinical guidelines and helps physicians practice evidence-based-medicine enhancing quality patient care.
P241 Considering Patients’ Values And Preferences When Formulating Recommendations With GRADE
Authors: Ibargoyen-Roteta N , Etxeandia-Ikobaltzeta I , Zaragoza-Gaynor G , Carrasco-Gimeno J , Lizarraga-Azparren M , Elorz-Lambarri J , Villar-Alvarez M
Published: August 2013

Background

The GRADE approach takes into account the variability that may exist in patients’ values and preferences when formulating recommendations. Nevertheless, in the updating process of the Clinical Practice Guideline (CPG) for children with asthma no related information could be found in the literature.

Objectives

To obtain information about the values and preferences of caregivers of children with asthma to be considered when formulating recommendations.

Methods

A focus group was designed to explore caregivers’ perceptions and opinions about some of the issues addressed in the CPG. Twelve possible participants were identified by paediatricians and specialists involved in the development of the GPC, and finally 9 mothers of children with asthma were convened. Twenty-two questions were defined by the research team. The focus group, previous consent recorded, was transcribed and analysed. Triangulation was made by two of the researchers for all the analysis.

Results

The information obtained was taken into account in 11 of the 16 clinical questions. The most relevant information obtained was related to the relevance of self-management and the importance of having good information, for caregivers and children, to manage the disease. The concern about what happened when caregivers were not with the children, for example at school, was also identified.

Discussion

The focus group helped to obtain information about patients’ values and preferences to be considered when formulating recommendations.

Implications for Guideline Developers/Users

Focus groups specifically designed to obtain information about patients’ opinions in relation to particular clinical questions provides valuable context-dependent information to take into account when formulating recommendations.
P242 Managing Etiology Questions With Grade
Authors: Ibargoyen-Roteta N , Etxeandia-Ikobaltzeta I , Etxeberria-Agirre A , Rotaeche-del Campo R , Aldasoro-Ruiz A , Lizarraga-Asparren M , Elorz-Lambarri J , Villar-Alvarez M , Galardi-Andonegui E , Irizar-Aranburu M
Published: August 2013

Background

Currently the GRADE approach only considers the development of recommendations for treatment and diagnosis related clinical questions.

Objectives

To develop a proposal using GRADE to formulate recommendations for aetiology questions.

Methods

The exposure to paracetamol in the first year of life and asthma at the age of 6 years was chosen as an example. A systematic review was made, searching in Cochrane, CRD, Medline and Embase databases. Cohort studies or Meta-analysis of observational studies were selected, and CASPE and MOOSE checklists used for quality assessment. The evidence was considered high when there were no factors affecting our confidence on the estimates.

Results

One systematic review (including 4 related cross-sectional studies) and 4 cohorts were found. To assess the evidence with GRADE two outcomes were used (increase of asthma and wheezing at 6 years). Risk of bias was assessed taking into account the cohort design and aetiology studies characteristics, but inconsistency, indirectness and imprecision were considered in the same manner. In contrast to cross-sectional studies, cohort studies (3 out of 4) did not find a significant relationship between paracetamol and asthma development. Due to possible risk of bias and imprecision, the quality of the evidence was downgraded two levels and a recommendation in favour of the rational use of paracetamol in children was made.

Discussion

A proposal to address aetiology questions based on the GRADE approach has been developed. More examples are needed to validate it.

Implications for Guideline Developers

To be able to use the GRADE approach independently of the question type.
P244 Development Of A Tailor-Made Implementation Strategy To Facilitate Adherence To The Dutch Postpartum Hemorrhage Guideline And Moet-Instructions
Authors: De Visser S , Woiski M , Hulscher M , Vandenbussche F , Scheepers L , Hermens R
Published: August 2013

Background

Despite the introduction of a national guideline and the Managing Obstetric Emergencies and Trauma (MOET) course the incidence of postpartum haemorrhage (PPH) is increasing. We suspected inadequate guideline implementation to be underlying.

Objective

Our objective was to develop and pilot test a tailor-made implementation strategy for the Dutch PPH guideline and the MOET course to increase guideline adherence.

Methods

Firstly, we aggregated the results of a current care and diagnostic analysis, which yielded barriers for guideline implementation, together with evidence found in international literature. Main barriers among professionals were lack of a checklist available in the labour ward, inadequate high-risk patient identification and lack of team communication. Patients mentioned insufficient information supply. Secondly, we developed different implementation tools for professionals and patients, based on these results. These tools were evaluated in a pilot testing among both groups.

Results

The strategy affects the period between the last trimester of the pregnancy till the end of the third stage of delivery. The tools for professionals consisted of a high-risk identification checklist, a care bundle for PPH prevention, and a PPH treatment checklist. As patient empowerment tools a patient passport and an information website were developed. Professionals had no points for improvement concerning the tools. Patients commented on the website, and changes were made accordingly.

Discussion

We developed a tailor-made strategy for PPH guideline implementation. The next step in the implementation process is to evaluate the feasibility of the strategy, including an effect, process and cost evaluation.
P260 A Model For Bridging The Translational Valley Of Death In Spinal Cord Injury
Authors: Barrable B , Thorogood N , Noonan V , Joshi P , Stephenson K , Kwon B , Dvorak M
Published: August 2013

Background

Despite the amount of funding that supports basic research, few research discoveries achieve their potential. The transition from bench-to-bedside research is so fraught with obstacles that it is referred to as the “valley of death”.

Objective

The Rick Hansen Institute (RHI) developed a unique Praxis Model for translational research in the field of spinal cord injury (SCI). At RHI this means bringing knowledge into action; to improve healthcare outcomes for people with SCI and decrease the financial impact on the healthcare system.

Methods

The research continuum begins with discovery science which feeds into the knowledge cycle, continues with the acceptance and uptake into the treatment of spinal cord injuries. The core activity within the Praxis Model is a knowledge cycle that consists of a four-phased strategy: 1) Environmental scan, 2) Knowledge generation and synthesis, 3) Knowledge validation, and 4) Implementation.

Results

RHI has participated and supported over 60 studies since 2007 and engaged researchers from nine countries, 46 academic institutions and various accreditation and professional associations. Currently, the model is being independently evaluated to determine strengths and limitations. Examples of RHI initiatives using the Praxis Model and results of the evaluation will be presented.

Discussion

RHI has developed an innovative solution to move knowledge into action. The Praxis Model strives to lead collaboration across the global SCI community by providing funding, infrastructure, strategic partnerships, governance and a network.

Implications

Lessons learned in developing the Praxis Model may assist other organisations dealing with similar translational research challenges.
P263 Implementing A New Standard For Medical Specialty Society Guideline Development
Authors: Wolfkiel C , Smith Begolka W , Fulda G
Published: August 2013

Background

The Council of Medical Specialty Societies (CMSS) approved “Principles for the Development of Specialty Society Clinical Guidelines” as a set of standards that member societies could draw upon in developing their own development methodologies. Developed by the member societies in late 2012, the Principles are intended to provide a degree of interpretive flexibility not offered by other standard sets but based upon an expected level of transparency that individual interpretations would be explained.

Objectives

Principles were labelled as “must”, “should” and “may” in an effort to impart suggested implementation flexibility as designed by the Principles development team. This proposed analysis of society feedback is intended to assess the actual concordance with the Principles by societies implementing their methodologies or updating them.

Methods

An electronic survey was sent to Societies who identified themselves as creating new or adapting existing methodologies asking agreement on ease of implementation in 10 previously identified contentious standards. The survey will also include opportunity for responders to identify other difficult to implement/interpret principles as well as new principles that should be considered.

Results

Data from respondents will be presented.

Discussion

Medical Specialty Societies developing clinical practice guidelines are diverse in terms of size, scope and resources. The recent IOM standards were developed by as best practice with little guidance for potential interpretation or resource requirements. The CMSS Principles are intended to be a step towards practical guidelines standards and this research the first feedback step as to measuring that practicality.
P266 At What Rate Does New Evidence Change Guidance
Authors: Ording J , Thiese M , Hegmann K , Wolfkiel C , Ott U
Published: August 2013

Background

New research is continually shaping guidelines; however, the rate of change has not been assessed.

Objectives

Review articles from 2010 to 2013 to assess rate of change of guidelines for the elbow.

Methods

A systematic literature search was conducted to identify randomised controlled trials (RCTs) on elbow disorders published between 2010 and 2013. Identified RCTs were scored using established scoring methods and incorporated into guidelines to determine if any recommendations needed to be changed or new recommendations added.

Results

Fifteen new RCTs were identified (4 high-, 9 moderate-, and 2 low-quality). Nine (69%) studies were used to make 3 new recommendations and 4 changes to recommendations to guidelines on elbow disorders. Seven of these studies prompted new guidance on soft tissue mobilisation, autologous blood injections, periarticular blood injections for lateral epicondylalgia (LE). Two of these studies caused changes to the recommendation level for manipulation/mobilisation for LE and evidence level changes for exercises, glucocorticosteroid injections, and platelet rich plasma injections for LE. Seven (53%) studies did not change any of the recommendations but added to the body of evidence to support the current recommendations.

Discussion

New studies may be higher quality and have significant impact on guidelines. Two-thirds of new evidence triggered recommendations changes or development of new recommendations for treating LE. Additional assessments of low back and other body parts are underway.

Implications for Guideline Developers/Users

It is beneficial to do a yearly review of the literature to determine if any new evidence will impact changes to current guidelines.
144WS How to Make Judgements About the Quality or Strength of Evidence Transparent
Authors: Langendam M , Mustafa R , Ventresca M , Heus P , Santesso N , Carrasco A , Moustgaard R , Lasserson T , Schunemann H
Published: August 2013

Background

When assessing the confidence in intervention effects, i.e. the quality of evidence, guideline developers should make their judgement about this confidence transparent and provide an overall assessment (or grade) of the evidence (GIN & IOM standards 2011). The GRADE approach requires these judgments to be described in comments and footnotes. In a recent review of GRADE evidence summaries, we observed important variability in how guideline developers and authors of Cochrane systematic reviews perform these tasks.

Objectives

In this interactive workshop the participants will learn how to formulate understandable and informative reasons for down- and upgrading the quality of evidence by using a footnotes checklist.

Target Group

Systematic reviewers and guideline developers assessing the quality or strength of evidence.

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

We will present the development of the footnotes checklist. To get hands-on experience the participants will work in large and small groups to: 1) use the checklist on several examples of GRADE evidence profiles and 2) make a judgement about how informative these footnotes are, in particular with guideline panel meetings in mind. The examples will include challenging topics like evidence from single RCT and narrative reviews (no pooled estimates). The outcomes of these exercises will be discussed with the large group and will be used to further improve the checklist.
P270 Development Of Quality Indicators Of Low Risk Labor Provided Primarily By Midwives: Based On Clinical Practice Guidelines With A Modified Delphi Method
Authors: Ueda K , Ohtera S , Misato K , Nakayama T
Published: August 2013

Background

In Japan some labour units have started services for low risk labour provided primarily by midwives with the assistance of obstetricians. However, real practices varied with facilities and quality of care has not been sufficiently assured.

Objectives

We aimed to develop quality indicators of low-risk labour provided primarily by midwives in Japan.

Methods

We systematically searched databases to select related indicators and clinical practice guidelines. Using a modified Delphi method, a multidisciplinary panel including two women who experienced labour and were not health professionals was assembled and a meeting was held. After the panel members rated the candidates individually, consensus was attained for each indicator.

Results

An electronic search retrieved 104 guidelines (2043 key recommendations) from which 32 guidelines (166 key recommendations) were selected. Some recommendations were excluded due to difficulties in measuring and others due to evidence against following certain guidelines. Additionally, 31 existing quality indicators were identified. The panel discussed 25 candidate indicators: 18 indicators were adopted, six indicators were not adopted, one indicator was modified. Four indicators were added later following discussion. Consequently, 23 quality indicators of care were chosen.

Discussion

A pilot test of these indicators at multiple facilities should contribute to future development of guideline-based quality indicators.

Implications for Guideline Developers/Users

Guideline developers should be more conscious in making recommendations that are potentially used as quality indicators.
P273 Effects Of Korean-Agree Scoring Guide On Improving The Reliability Of The Scores
Authors: Oh M , Jo H , Lee Y
Published: August 2013

Background

The Korean translated AGREE II instrument has been distrubuted to Korean medical societies in 2011. But inter-rater disagreement issues still existed. The Korean AGREE II scoring guide was therefore developed to reduce inter-rater differences.

Objectives

To examine effects of the Korean AGREE II scoring guide on reduction of the inter-rater differences.

Methods

Appraisers were randomly assigned to group A or B. The Korean AGREE II instument was provided to all participants, but the Korea AGREE II scoring guide was offered to only group A. Total of 14 appraisers participated and each gudeline was assessed by 8 appraisers. To evaluate the reliability of the Korean AGREE II scoring guide, correlation of scores among appraisers and domain-specific intra-class correlation (ICC) were calculated.

Results

Most scores of two groups were comparable. And scoring guide user group showed higher reliability at all guidelines. It showed higher correlation among appraisers and higher ICC values at almost all domains (from 0.272∼0.792 to 0.667∼0.888 in CPG A, from 0.273∼0.682 to 0.424∼0.815 in CPG B).

Discussion

Scoring guide reduces the inter-rater disagreement and improves the overall reliability of the Korean-AGREE II instrument.

Implications for Guideline Developers/Users

This study identified the performance and utility of the scoring guide as a useful guidance to Korean-AGREE II instrument users.
P275 Guideline-Based Quality Indicators For Cardiac Rehabilitation Of Patients With Ischemic Heart Disease In Japan: Use Of A Modified Delphi Technique For Indicator Development
Authors: Ohtera S , Ueshima K , Nakayama T
Published: August 2013

Background

Cardiac rehabilitation improves quality of life and mortality in patients with ischemic heart disease, but it is underutilised and quality in practice is unknown. Quality indicators are increasingly used to quantify healthcare quality. In Japan, however, such indicators for cardiac rehabilitation have not been developed yet.

Objectives

The purpose of this study was to develop quality indicators considering clinical circumstances in Japan.

Methods

To determine quality indicator candidates, we systematically searched electronic databases and reviewed existing related guidelines indicators. Using a modified Delphi technique, a domestic multidisciplinary panel of ten experts was assembled for a face-to-face meeting. After panel members rated the candidates individually on a questionnaire, a final consensus was determined for each measure.

Results

A literature search identified 894 clinical guidelines and 38 existing quality indicators. Some of them were excluded due to inconsistency with a priori criteria. Then, 26 guidelines and 16 indicators were selected to create a list of indicator candidates. The panel discussed 27 candidates: six indicators were adopted, one indicator was not adopted, 20 indicators were reconstituted into four indicators, and three new additional indicators were suggested. Consequently, 13 indicators were chosen.

Discussion

Guideline-based quality indicator development may be time-efficient and resource saving, but further methodology research is needed. We are planning a pilot test of these indicators at multiple facilities.

Implications for Guideline Developers/Users

Guideline developers should take potential use as quality indicators into account for making recommendations.
P282 Management Of Patients With Bipolar Disorder: An Adapted Clinical Practice Guideline >From King Saud University, King Khalid University Hospital, Clinical Practice Guidelines Committee, Faculty Of Medicine, Department Of Psychiatry
Authors: Abahussain E , Fatani S , Altuwarigi M , Al-Ansary L , Amer Y
Published: August 2013

Objectives

Adaptation of CPGs for Treatment of Bipolar disorder in King Khalid University Hospital, Psychiatry Department

Methods

The ADAPTE process for CPGs adaptation. Results: the final decision of the panel after full assessments of 3 source CPGs was full acceptance (adoption) of the Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder (updated 2009).

Results

Examples of Recommendations Lithium, valproate, and several atypical antipsychotics monotherapy is recommended to be used as first line treatments for acute mania, combination pharmacology with antipsychotics and mood stabiliser can be used as first line option. Paliperidone monotherapy and asenapine alone or in combination with lithium or divalproex can be used as a second line treatment; tamoxifen is suggested as a third line augmentation option. For the Management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI bupropion are first-line options. Adjunctive modafinil is recommended as a second-line option. lithium, lamotrigine, valoproate and olanzapine are first-line options for maintenance treatment of bipolar disorder.

Conclusion

New data support the use of quetiapine monotherapy and adjunctive therapy for the prevention of manic and depressive events, aripiprazole monotherapy for the prevention of manic events, and risperidone long-acting injection monotherapy and adjunctive therapy, and adjunctive ziprasidone for the prevention of mood events.
P283 Development Of A Clinical Practice Guideline On Intravenous Therapy Using Grade: Integrating Available Evidence And Expert Opinion
Authors: Briones E , Marín-León I , Buzón M , García-Aguilar R , Romero-Tabares A , Romero-Alonso A , Medrano J. , Calderón E. , López L.
Published: August 2013

Background

Intravenous therapy is one of the most frequently used interventions in health care, with increasing complexity and duration of treatments. A clinical practice guideline (CPG) on this topic was developed within the framework of the Spanish programme (National Health System) aimed to provide recommendations on intravenous therapy best practice.

Objective

To describe CPG development process, considering methodological issues, such as updating and adapting existing guidelines and expert inputs.

Methods

Using the GRADE approach, an evidence synthesis was developed for each clinical question, including adoption or update of valid recommendations from selected guidelines. Expert panel followed methodology proposed by Jaesckeet alwith predefined consensus criteria to categorise recommendations.

Results

After assessment with AGREE II instrument, 3 guidelines were considered highly recommended and selected for adaptation/updating. Evidence synthesis and recommendations for each 63 initial clinical question were drafted and sent to the expert panel who voted individually. Areas of disagreement were identified and discussed in a face-to-face meeting. After the second voting round 55 recommendations remained, of which 27 were rated as strong, 12 as weak and 14 as good practice recommendations. Six of them were adopted/updated from previous guidelines. In 2 cases there was no agreement in the panel and no recommendation was issued.

Discussion

GRADE proved to be a useful method to develop a complex guideline, incorporating evidence from previous guidelines and expert opinion. The method was well accepted and followed by the panel and improved the elaboration of recommendations.
P284 A Survey Of The Updating Of Clinical Practice Guidelines In China
Authors: Chen Y , Wang X , Wu Q , Wang Q , Wei D , Yao L , Liang F , Wang M , Yang K
Published: August 2013

Background

Clinical Practice Guidelines (CPGs) should be updated when new evidence suggests the need for modification of clinically important recommendations. Some guideline handbooks suggest that CPGs should update every 2 to 5 years. Little is known about the updating of CPGs in China.

Objectives

To investigate the current situation of the updating of CPGs in China.

Methods

We searched WangFang, VIP, Chinese National Knowledge Infrastructure (CNKI) and Chinese Biomedical Literature Database (CBM) up to December 2012. And then we screened all included papers.

Results

A total of 380 Chinese CPGs were included. There were 345 of guidelines (91%) had not been updated. 35 (9%) were updated and the average update cycle of them was 5.6 years(from 1 to 9 years). No guideline described the details of methods of uptodate .

Conclusions

Updating the CPGs is important for the better dissemination and utilisation. But in China, most of the CPGs had never been updated, and the average update cycle (5.6 years) of the updated is longer than international standard (5 years). We suggest Chinese guideline developers should pay more attention to the updating the guideline in time.
P289 Variability In Guidelines Recommendations For Screening Of Gestational Diabetes Mellitus. A Systematic Review
Authors: Villanueva G , Bayón Yusta J , López-Argumedo M
Published: August 2013

Background

Gestational diabetes mellitus (GDM) is a frequent complication in pregnancy, however there is lacking agreement on international CPG on the best screening strategy: whom, when and how to screen. Following the HAPO study, the International Association of Diabetes and Pregnancy Study Group (IADPSG) recommended a new strategy consisting on a 1-step 2-hour 75 g. oral glucose tolerance test.

Objectives

To systematically review the evidence that compares alternative tests for diagnosis of GDM, in terms of maternal and infant health and costs.

Methods

MEDLINE, EMBASE, EBM reviews and NHS EED were searched. Studies comparing the IADPSG guidelines with other strategies were retrieved. Besides, recommendations currently in place in different countries were summarised.

Results

Eleven studies were selected. The results showed that the IADPSG criteria nearly threefold GDM prevalence. Women who fulfilled IADPSG criteria but were normal using other criteria experienced significantly higher adverse outcomes (macrosomia, preterm delivery, neonatal hypoglycaemia and pre-eclampsia). Although the IADPSG screening strategy was more costly, considering the long-term maternal benefits and the neonatal outcomes it might be cost-effective.

Discussion

Implementing the IADPSG criteria will increase GDM diagnosis and this may pose a strain on health care systems, but it is also an opportunity to reduce adverse outcomes for mother and child. In fact, the IADPSG strategy appeared to be cost-effective strategy under certain conditions. Further large well-designed trials are needed to determine the best strategy.

Implications for Guideline Developers/Users

Considering the high inconsistency across guidelines the new IADPSG screening strategy may outdate current strategies proposed on CPG.
P291 Is The Training Provided To Professionals Caring For People With Alzheimer’s Disease Adequate According To CPG Recommendations?
Authors: Villanueva G , López-Argumedo M , Reviriego E , Aguirreche Ollo E , Gómez Poveda C , Elizondo A , Galnares-Cordero L , Fuentes Gutiérrez R
Published: August 2013

Background

Despite the rapid increase in the knowledge of epidemiology, genetics, risk factors and underlying neuropathological mechanisms of Alzheimer’s disease (AD) and the rising number of consensus statements and guidelines for its diagnosis and treatment, little has been done concerning the training of the involved professionals. In particular, the European ALCOVE project (Alzheimer COOperative valuation in Europe) has indeed addressed this issue. Therefore there is a need to assess to what extent professionals in the Basque Country are receiving the recommended education.

Objectives

1. To compare the current training practices in dementia in the Basque Country with the recommendations proposed by ALCOVE. 2. To propose region-specific recommendations on the education of professionals working with patients with AD (neurologists, psychiatrists, primary care providers, nurses).

Methods

A questionnaire (both electronic and paper version) was distributed to over 2,000 professionals in the Basque Country in early 2013. The results will be compared with the data arising from the ALCOVE project.

Results

Collected data is currently being analysed and final results will be available for presentation at GIN.

Discussion

Available guidelines recommend that professionals caring for patients with AD and their families should receive formal education and professional training. However, existing educational programmes might not adhere to these recommendations. Also there might be barriers for these programmes to be correctly implemented.

Implications for Guideline Developers/Users

Specific training in dementia should be included in the medical schools’ curriculum in every country given that AD affects an ever increasing number of elderly people worldwide.
P295 Evaluation Of French Microbiology Laboratories Practices Concerning Antibiotic Therapy And Antimicrobial Resistance
Authors: Durocher A , Vernet-Garnier V , Cornille M , Delzenne M , Methenni M , Rousseau D , Van Hecke E
Published: August 2013

Background

Guidelines on prevention of bacterial resistance and quality of microbiology labs have been promoted by HAS.

Objectives

Analysis of implementation of guidelines in 2011 versus 2009.

Methods

Checklists for practices of 230 representative hospital labs.

Results

Between 2009 and 2011, there was an increase in (i) survey of bacterial resistance by labs (98% vs 95%), (ii) internal quality control (88% vs 85% of public, 71% vs 64% of private labs -p = 0.01), (iii) evaluation of procedures (67% vs 57% -p = 0.01), (iv) basic service maintained in 89% vs 85% of labs, (v) information system (96% vs 88% of public, 82% vs 75% of private labs -p = 0.003), (vi) liaison with the pharmacy (86% vs 78% of public, 76% vs 63% of private labs), (vii) epidemiological surveillance (96% vs 87%), (viii) alert system (97% vs 93%) mostly by computer in public or by phone in private labs). Results on resistance rates were more often submitted to the committee for the prevention of hospital infection (97% vs 93%) or of anti-infectives (77% vs 71%), to the clinical departments in 62% vs 50% of public, 85% vs 75% of private hospitals (p = 0.018). Bacterial resistances were more often compared with antibiotic consumption in 57% vs 45% of general, 86% vs 61% of university, 37% vs 34% of private hospitals (p = 0.002)

Conclusions

Quality of microbiology laboratory practices increased since 2009 but efforts have to be continued in evaluation of internal quality procedures, communication about bacterial resistances to clinical departments and comparison resistances-antibiotic consumption.
P300 Theory-Informed Tailored Implementation Of Guidelines In Swedish Primary Care Physiotherapy: Development Of A Strategy
Authors: Bernhardsson S , Johansson K , Nilsen P , Öberg B , Larsson M
Published: August 2013

Background

There is little knowledge about effective guideline implementation strategies in primary care physiotherapy. The use of theory for the development of implementation strategies is advocated by some, a pragmatic approach by others.

Objectives

To adapt a theoretical model to Swedish primary care physiotherapy using a pragmatic approach, to identify barriers and facilitators for the use of guidelines in physiotherapy, and to tailor an intervention to address these.

Methods

We searched the literature for evidence of effectiveness of implementation strategies. We analysed various implementation theories and selected the Grol 5-step model to guide our implementation process. We adapted the model to the context in which we wanted to introduce the guidelines. We identified barriers and facilitators and possible intervention components to address these via a survey and a literature review.

Results

The adaptation and addressing the identified barriers and facilitators resulted in a tailored, evidence-based, theory-informed implementation strategy. The most important barriers identified were lack of time, low awareness, knowledge, and access to guidelines. An active, multifaceted implementation intervention was developed. The main implementation activity was a seminar with group discussions. Other components were a website, email reminders, email support, and patient information leaflets.

Discussion

Using a model to systematically develop a strategy and a pragmatic approach to adapt it to the context in which it was to be implemented, helped to identify barriers and facilitators and to tailor an implementation intervention to Swedish primary care physiotherapy.

Implications for Guideline Developers/Implementers

A theory-informed but pragmatic approach can be recommended.
P303 Successful Implementation Of Infection Prevention And Management Guidelines In An Integrated Health Care System: Structure, Process And Outcomes
Authors: Harris J
Published: August 2013

Background

Infection is one of the leading causes of inpatient morbidity and mortality. Sepsis, central line infections, surgical site infections, ventilator-acquired pneumonia and c. difficile infections account for the majority of these cases.

Objectives

To describe the process, structure and results of efforts to better manage sepsis, central line infections, surgical site infections, and hospital acquired infections in an integrated health system using organisational best practices; to present results of these risk reduction and proactive disease treatment programmes

Methods

Analysis of morbidity and mortality was the first step. Evidence for effective practices was assessed. Pilot projects based on the best evidence were conducted and results disseminated by organisation leaders, who emphasised doing the right thing at the right time all the time. Suggested order sets were incorporated in the EMR. Progress towards goals was disseminated regularly.

Results

Mortality rates for severe sepsis dropped substantially over the last 4 years. Inpatient clostridium difficile infections, blood stream infections, and surgical site infections have also dropped dramatically.

Discussion

Guideline recommendations were adopted across our delivery system when supported by top leadership, testing, training, specific care processes, EMR prompts for tests and treatments, regularly reviewed process metrics and group financial incentives. Practice variance was reduced and outcomes markedly improved.

Implications for Guideline Developers

Guideline recommendations are more likely to be adopted in a uniform manner if they include specific recommendation, suggestions for implementation use in organised settings, and process and outcome metrics to track improvements.
P305 Challenges Of Developing Clinical Practice Guidelines (Cpg) For Pediatric Cancer In Colombia
Authors: Linares A , Torres M , Pardo R
Published: August 2013

Background

WHO estimates for the year 2013 that approximately 12 million deaths will be attributed to cancer. In developing countries, 180.000 childhood cancer cases occur every year.

Context

the need to standardise the management of childhood haematological cancers and reach the same survival rates in developed and developing countries require the elaboration of clinical practice guidelines (CPG) in Colombia. The overall survival for acute lymphoid leukaemia is around 50% while in other countries is near 80%. description of best practice: the ministry of health assigned the development of a CPG of childhood acute leukemias and lymphomas. The guideline development group (GDG) had to face some challenges due to the amount/quality of evidence and the patients’ point of view. lessons for guideline developers, adaptors, implementers, and/or users: during the formulation of the recommendations, not only effectiveness is a critical outcome but treatment toxicity and adverse effects such as secondary neoplasies need to be evaluated. In order to identify relevant information of safety, the GDG had to include observational studies which brought up some challenges. The GDG developed a qualitative exercise for the identification of patients’ point of view that were weighted in equal manner with the risk and benefits of the interventions. Once the guideline was finished, the recommendations were driven towards patient safety and the implementation implied to make changes in public policies, improve the access to continuous therapy, proper diagnosis, modifications in resources assignment and work around the available treatment so the overall survival can reach international standards.
P307 Guideline Development Tool (GDT) – Web-Based Solution For Guideline Developers And Authors Of Systematic Reviews
Authors: Brozek J , Akl E , Falck-Ytter Y , Kunstman P , Meerpohl J , Mustafa R , Nowak A , Oxman A , Santesso N , Wiercioch W , Schünemann H
Published: August 2013

Background

Guideline developers and other health care decision makers benefit from following a structured process of specifying the health care questions they intend to answer and the outcomes of interest, assessing the confidence in the available evidence, gathering information about the values and preferences of the target population, and presentation of their results and decisions to the target users. Many guideline developers use the GRADE Profiler (GRADEpro) software used to conduct this work.

Context

GRADE’s approach is currently being further defined in the DECIDE (Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence) project.

Description of Best Practice

The Guideline Development Tool (GDT) is the extension of the GRADE Profiler (GRADEpro) software. The GDT provides an integrated platform-independent web-based solution for health care decision makers offering support for the whole process of making decisions and developing recommendations including question formulation, generation and prioritisation of outcomes, support for teamwork, management of potential conflicts of interest, presentation of results (including the functionality of GRADEpro) and decision support. We tested the software with individual users and in workshops as well as in guideline development processes.

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

Following a structured and systematic process, transparency and clarity of presentation facilitates the use of results of systematic reviews and facilitates development, updating and adaptation of evidence-based recommendations and decisions. Storing all information in a uniform, structured, transparent and annotated way also greatly facilitates updating and adaptation of systematic reviews and guidelines.
P308 Data Driven Best Practice In General Practice Prescribing
Authors: Huang N
Published: August 2013

Background

A national quality improvement programme to understand how medicines are used was launched in 2011. The programme collects clinical data from general practice electronic health records to identify prescribing/management gaps.

Context

The delivery of primary care is complex. The majority of medicines are prescribed by GPs. There is huge potential to use routinely collected clinical information to reduce evidence-treatment gaps and improve population health outcomes.

Description of Best Practice

A scan of the literature and keynote international and national agencies is undertaken to identify the range of interventions and tools that support change in general practice prescribing. Activities reported as most effective, value for money and applicable to general practice, with a focus on those using prescribing or clinical data as key inputs are collated (including which activities were used singly or in combination). These activities are entered into an overarching intervention framework for data driven activities in general practice. A group of local clinical experts are invited to identify the barriers and enablers to apply this framework to the local primary care sector. Three topic areas are selected to model these approaches and verify the elements of the framework. An implementation plan including evaluation of effectiveness will be presented.

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

The design of the intervention framework illustrates ways to design an ‘implementation strategy’ that draws on three dimensions:literature on effectiveness of implementation interventions; applied experience of clinical leaders; local context of primary care.
P311 A Survey On The Likely Resources Of Guideline Dissemination And The Perceived Barriers To The Utilization In Korea
Authors: Shin E , Jo H , Lee S , Chang S , Oh M
Published: August 2013

Background

Dissemination resources are very important to utilise Guidelines. To provide useful information to make a strategy for promoting implementation effectiveness, identifying the barriers to the utilisation should be done.

Objectives

To identify the likely resources of guideline dissemination and find out the barriers to the utilisation of a clinical practice guideline in Korea.

Methods

Likely resources of dissemination and the perceived barriers to the utilisation of a clinical practice guideline for sexually transmitted infections which is developed in 2011 by The Korean Urological Association were surveyed using structured questionnaire by e-mailing to physicians working at primary health care clinics from 1st Nov – 30thNov 2012. Total number of respondents was 305 and the response rate was 6%.

Results

There were various likely resources of a guideline dissemination; the most likely resource was a printed full version guideline (76.3%), followed by web and mobile application (Guideline APP) (65.6%) and learning modules such as workshop (51.5%). Barriers to the utilisation of clinical practice guideline were ‘not knowing because of the improper promotion’, ‘unclear compensatory mechanisms like the fee schedule for practice guidelines’, and ‘insufficient treatment time to check the recommendation of practice guidelines’.

Discussion

To maximise guidelines dissemination benefits, various resources should be provided at the same time. The current surveyed knowledge of barriers may be very important information for implementing guidelines.

Implications for Guideline Developers/Users

Identifying resources of dissemination and understanding barriers to the utilisation is important for development efficient tailor-made implementation strategies.