bluuebunny/crossref_metadata_2025 huggingface dataset:
P180 Systematic Review Of Continuous Interscalene Brachial Plexus Block For The Shoulder Or Humerus Surgery Patients
Authors: Choi M , Ko Y , Yeon J , Oh H , Han S
Published: August 2013

Objective

The safety and effectiveness of continuous interscalene brachial plexus block for the shoulder or humerus surgery.

Methods

Continuous interscalene brachial plexus block for the shoulder or humerus surgery patients was assessed using 8 domestic databases including Korea Med and Ovid-MEDLINE, Ovid-EMBASE and Cochrane Library. Through a search strategy, a total of 348 works were identified and total of 21 works were included in the final assessment. Two reviewers screened all references independently, for assessing included articles quality and extracted data.

Results

Side effects of the drug were reported to have occurred less or at similar level in the intervention group than the control group, although procedure related complications were reported to have occurred more often in the intervention group compared to the control group. The average pain score following the surgery was reported to be significantly lower or similar for the intervention group compared with the control group. The intervention group also had lower or similar level of quantity of additional analgesics used in comparison to the control group. In addition, the intervention group displayed either similar or higher level of satisfaction of patients on the pain control method.

Conclusion

Continuous interscalene brachial plexus block was assessed to be a safe and effective technology when used for the purpose of reduction in pain in shoulder or humerus surgery patients since it was found to be relatively safe when compared with the existing procedures, and similar or more effective in terms of pain control and usage of additional analgesics in comparison to the existing pain control methods.
P217 The Effect Of Print Or Online Educational Materials For Primary Care Physicians: A Systematic Review
Authors: Grudniewicz A , Rodseth R , Kealy R , Rudoler D
Published: August 2013

Background

Print and online materials such as guideline summaries are commonly used to distribute evidence to primary care physicians; they are easy to implement and scale across many primary clinics.

Objectives

We sought to determine: 1) if providing primary care physicians with print and online educational materials has an effect on physician behaviour or on patient outcomes, 2) how these materials were developed, and 3) whether design attributes impact outcomes.

Methods

We systematically identified studies that reported a print or online educational intervention for primary care physicians. Studies were identified by searching four electronic databases, scanning reference lists, and contacting experts. A sub-analysis was conducted to collect data on how these materials were developed and on their use of design principles.

Results

Thirty studies met eligibility criteria after full-text screening. Studies targeted physician advice-giving behaviour, diagnostic procedures, prescribing behaviour, change in knowledge, and clinical patient outcomes. Results suggest that print and online materials targeted at primary care physicians have little to no effect on outcomes.

Discussion

Print and online educational materials provided to primary care physicians have little effect on physician or patient outcomes. This is concerning as they are a common method of disseminating evidence. Most studies do not describe how interventional materials were developed or whether design principles were applied.

Implications for Guideline Developers/Users

Design principles should be considered when developing evidence-based materials and the development processes should be described in order to determine if better designs influence uptake and use of evidence.
P227 Capacity Enhancement Through A Distance Learning Course For Primary Health Care (Phc) Professionals: The First Approach For A Guideline Development
Authors: Stein A , Wendland E , Pinto M , D’Avila O , Dahmer A
Published: August 2013

Background

There is a need to develop strategies for guideline development. It is essential to learn educational needs of health professionals who work at PHC level. Evidence based guidelines should be applied for these health professionals taking into account their context.

Objectives

To identify skills and resources of primary health professionals in a distance learning course (UNASUS from UFCSPA – Federal University of Health Science of Porto Alegre).

Methods

A quasi-experiment study had been carried out and the inclusion criteria were dentists, nurses and family physicians that provide PHC. Data had been collected in the beginning of the distant course, as a baseline and one year after the enrollment. This course enables specialisation for primary health care. A web-based questionnaire was applied to these subjects.

Results

The sample size was 251 eligible subjects. The mean age of the responders was 35.2±8.27DP (range: 25–68), from 48 different towns from South Brazil. The majority (88.8%) were women and 67.3% had nurse degree. 94% of the subjects reported that the distance course was a good strategy to change their practice. Interactive activities resembling their daily routine had a higher impact.

Discussion

The results have shown that distance learning is effective to enhance primary health care professional’s behaviour, especially when simulating real cases.

Implications for guideline developers/users

The present research has identified that it is essential to improve access to evidence-based clinical practice guidelines and resources across Brazil, and to increase skill capacity in using evidence to inform clinical decision-making.
138WS The US Institute Of Medicine (IOM) Criteria For Trustworthy Guidelines, The National Guideline Clearinghouse (NGC) And You: A Workshop On NGC’s Revised Inclusion Criteria
Authors: Nix M , Jue J , Haskell L , Cunningham S , Coates V
Published: August 2013

Background

The National Guideline Clearinghouse (NGC), funded by the Agency for Healthcare Research and Quality, will adopt the 2011 IOM revised definition of an evidence-based clinical practice guideline (CPG) and change its criteria for inclusion; thereby raising the bar CPGs must meet in order to be included. Systematic evidence review and benefits and harms of care options are the key changes.

Objectives/Goal

At the end of the workshop, participants will be able to recognise the new aspects of the inclusion criteria; understand how the criteria will be applied; apply them to CPGs provided by instructors and estimate eligibility for inclusion; and apply this learning to their organisation’s readiness to submit new/updated guidelines to NGC.

Target Group, Suggested Audience

Current and future CPG developers; CPG implementers and disseminators; researchers and clinicians.

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

This workshop will discuss the revised NGC inclusion criteria and describe specific requirements around a systematic review underpinning the CPG as well as descriptions of benefits and harms. The workshop will include a didactic portion, an interactive exercise, and a take-away checklist. There will be ample question and answer opportunities. Instructors will distribute guidelines and materials and participants will determine eligibility for inclusion in NGC. A checklist will enable participants to understand the changes needed to ensure inclusion of their CPGs in NGC.
P247 A Simple Guideline Appraisal Instrument Based On IOM Standards
Authors: Mitchell M , Leas B , Lavenberg J , Goldmann D , Umscheid C
Published: August 2013

Background

Scales like AGREE provide a systematic means for appraising guideline quality, but they are lengthy, emphasise methodology over practicality, and are best applied by guideline experts.

Objectives

Create a short instrument for guideline appraisal, based on widely accepted standards.

Methods

The Institute of Medicine (IOM) identified eight principles that make a guideline ‘trustworthy’. We adapted each principle into an item graded ‘A’, ‘B’, ‘C’, or “NR” (not reported). Guideline assessments are presented as a grid rather than a single score, with each row representing an item, each column a guideline, and cells coloured green, yellow, red or white to reflect the above grades, respectively. Concordance tables mapping AGREE and G-I-N standards to IOM domains were also created.

Results

Piloted use of the tool suggests it can distinguish guidelines developed using weak methods and those that are poorly documented. Grids highlight guideline strengths and weaknesses, as well as guidelines that are more trustworthy than their comparators. The concordance table found that AGREE lacks standards for guideline currency and updating, while IOM lacks standards for resource implications.

Discussion

Our pilot use of this instrument suggests that while the overall trustworthiness of guidelines is important, using IOM domains to understand sources of guidelines’ weaknesses can help organisations select guidelines best suited for their needs. Further work will examine our instrument’s reliability across users with different levels of expertise.

Implications for Guideline Developers/Users

Pilot use of this tool suggests it can be applied by clinicians and administrators who have limited training and time.
P269 Adaptation Of A North American Institutionally Based Health Technology Assessment (Ihta) Model To A Private Brazilian Health Care Organization (Bhco)
Authors: Alves Da Silva S , Cabanelas Pazos M , Pereira de Souza P , Rascão Cardoso P , Wyer P
Published: August 2013

Background

Brazilian Guidelines, developed by medical societies, are sparsely used by federal agencies to determine coverage. To date there is no organised approach to clinical policy and guideline development or for dialogue with regulators within BHCOs. Amil, the largest BHCO, covers 6 million lives distributed across 8 regions and delivers care to many through its own medical centres.

Objectives

To develop a minimally resourced clinical policy and implementation capability within Amil together with a training programme on a national level.

Methods

Our approach is based on observation of the Penn Health System and the Kaiser Permanente (KP) models of IHTA. We are profiling current capacity for integrating umbrella reviews with mining and interpretation of internally generated practice data, and are identifying resource and manpower needs. To promote cultural change on national scale we reformulated an annual training workshop made in partnership with NYAM and McMaster and opened to participants within and without Amil, including Health Ministry and Regulatory Agencies, by addressing guideline development, adaptation and implementation skills.

Results

Our approach identifies knowledge gaps within the organisation and develops related guidelines and outcomes assessment to be internally used through Electronic Health Records and to be presented to regulators as proposal for change. The framework was built on a piloted approach on bariatric surgery and on the identification of additional target areas. Our capacity building programme has trained over 250 individuals within and without Amil, including policy developers within regional and national health ministries.

Conclusion

An IHTA programme within a BHCO may offer a capacity building model useful for national development.
P271 Computerized Guidelines Analysis: 5-Years Experience And User Feedback
Authors: Georg G , Siddle J , Truran M , Cavazza M
Published: August 2013

Background

In 2007, HAS (Haute Autorité de Santé, France) started experimenting the use of computerised guidelines analysis with the G-DEE software as part of the guidelines production process. G-DEE uses shallow natural language processing techniques to recognise the expression of recommendations in a guidelines’ text, and structures the document accordingly using on-screen text highlighting and colouring. Project managers were offered, on an entirely voluntary basis, the possibility of using this tool during the final phases of guidelines production to i) analyse overall guidelines structure and ii) review the formulation of individual recommendations. To date, this experiment has concerned 38% of guidelines that have been officially released.

Objectives

Improving the performance and usability of the deployed G-DEE system.

Methods

We have collected feedback from guidelines’ project managers who have identified clear benefits in terms of readability of individual recommendations, overall text balance, fine-tuning and testing of alternative wording. Main limitations identified were processing time, which required additional planning and the absence of a tuning facility that would allow different levels of grammar coverage.

Results

Notable enhancements include faster document processing (x10) and incremental document analysis allowing direct text input in the system.

Discussion

These will make its use possible throughout the production process, e.g. directly as part of consensus meetings once the first draft is available. In addition, the possibility to define additional grammar files for text processing supports the processing of new document types (shorter guidelines, summaries) which may adopt different writing styles.
P274 New National Governmental Guideline Program In Hungary
Authors: Kis E , Nagy E , Dobos E , Karpati E
Published: August 2013

Background

In Hungary officially 493 clinical practice guidelines (CPGs) were released by the Ministry of Health. Since most of the published guidelines were developed in 2005 and 2006, the updating process is necessary. In Hungary traditionally, professional associations develop guidelines. In lack of a dedicated guideline clearinghouse with an evidence-based methodological support function, mostly non-systematic, non-evidence-based or traditional methods were used when formulating recommendations.

Context

To solve these anomalies, the National Institute for Quality- and Organisational Development in Healthcare and Medicines (NIQODHM) set up an expert group of evidence based methodologists to systematically revise the existing clinical guidelines and support the updating process. The expert group assessed the methodological quality of 90% of the existing CPGs by the AGREE instrument: most CPGs scored rather low on the stakeholder involvement, rigour of development, applicability, and editorial independence domains. Therefore our aim is to encourage the professional associations to improve these shortcomings.

Description of Best Practice

The NIQODHM developed a web-based application to support this project and coordinates the participation of all relevant professional groups in the development teams. User-friendly tools for adaptation of evidence-based guidelines, based on internationally published methods and materials are developed and personal consultations are provided by the expert group of methodologists. To guarantee the independence of national guidelines, a regulated declaration process for Conflict of Interest is also introduced.

Lessons for Guideline Developers, Adaptors

We do believe that methodological support tools will contribute to the development of higher quality and more applicable recommendations.
279WS Using A New Analytic Framework To Create Evidence-Based Coverage Guidance
Authors: King V , Little A , Vandegriff S
Published: August 2013

Background

A state passed comprehensive health reform legislation in 2009 that directed it to develop a process to translate evidence into coverage guidance to be applied rapidly and uniformly across public and private healthcare payers. A Governor-appointed committee managing the state’s Medicaid benefit package developed an analytic framework with a decision algorithm to facilitate coverage decisions. The framework is built upon six decision point priorities: sufficiency of evidence, effectiveness of the treatment and availability of alternatives, treatment risk, cost, prevalence of treatment and research feasibility.

Objectives/Goal

To practice applying decision-making principles and best available evidence to reach coverage decisions.

Target Group, Suggested Audience

Policy makers, guideline developers and users.

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

A short didactic presentation will present the analytic framework development history. We will discuss alternative priorities that could have been adopted. Participants will then work in facilitated small groups to reach coverage decisions using the framework and algorithm. Each small group will have a summary of the evidence available. The topics will include surgery for femoroacetabular syndrome, carotid endarterectomy and treatment of attention deficit hyperactivity disorder. Facilitators will encourage participants to attempt to reach a coverage decision as if they were a policy-making body and will assist with interpretation of the evidence. The group will identify and consider any potential implementation barriers or considerations and propose management strategies. The groups will share their experience using the framework and the facilitators will present the actual decisions the state committee made.
P309 Serious Games As A New Medium For Patients Guidelines Dissemination
Authors: Georg G , Cavazza M , Charles F , Smith C
Published: August 2013

Background

Patient education documents are faced with a number of issues that limit their dissemination, from intrinsic readability to how they appeal to patients. Previous studies have demonstrated a positive impact of visual media across the range of patients’ literacy skills, both health-specific and generic.

Objectives

To devise a production mechanism for serious games in patient education aligned with the current development of patient guidelines, keeping costs manageable in the long term.

Methods

The MUSE FP7 Project, funded by the European Commission, brings together computer scientists, cognitive psychologists and one GIN member. The project investigates the long-term potential of automatic generation of serious games from patient guidelines documents. It uses state-of-the art commercial gaming technology as well as developing new text analysis software.

Results

A first prototype has been developed on the topic of bariatric surgery education. It features male and female patient avatars in a hospital environment and supports the interactive exploration and rehearsal of the various stages of the process. All the game actions can be related to specific portions of the patient education document.

Discussion

The popularity of new media such as computer games improves dissemination prospects for patient education information. In addition, as suggested by recent research, the interactive nature of serious games makes the information more accessible, facilitates learning and addresses issues not covered by textual dissemination such as patient anxiety.

Implications for Guideline Developers/Users

Serious gaming is poised to become a major health-related medium, hence the need for specific development processes.
P003 Clinical Guidelines: The Supply Chain to Performance Measurement
Authors: Helen Burstin
Published: August 2013

Ideally, performance measures are based on high quality evidence regarding the interventions and services that will achieve desired outcomes and reflect high quality care. As guidelines and performance measures are increasingly used for public reporting and payment, the necessity for a strong evidence base has become more urgent and compelling. To achieve the intended positive effects of quality measurement and minimise potential unintended consequences, measures should be based on the best evidence for the focus of measurement. While outcome measurement is increasingly preferred, many measures continue to focus on process steps distal from the desired outcome, even when there is evidence for a more proximal intervention or intermediate outcome that can be linked to the desired outcome. Guidelines are a critical step in the supply chain to performance measures and ultimately evidence-based improvement processes. The quality of the guideline and the evidence review has significant downstream implications for measure development. The complexity of guidelines may also limit the ability to translate into feasible performance measures. The degree of specificity in the guideline has implications for the precision of the measure specifications. Measurement is impeded by the lack of specificity in guidelines, such as imprecise “high risk” population designations and insufficient information regarding periodicity. Though potentially useful for clinical care, extensive use of exceptions in guidelines makes them difficult to operationalize into measures. To ensure that guidelines can be readily adaptable for performance measurement, greater communication and collaboration is needed between the guideline and measurement communities. Ideally, guidelines would be developed with experts in performance measurement and clinical decision support at the table to ensure that evidence synthesis and guidelines can effectively serve the needs of measurement and improvement.
003 Towards optimal patient involvement in guideline development groups
Authors: Lange-Tichelaar T De , Pittens C , Verhoof E , Maes L , Kersten S , Broerse J
Published: August 2013

Background

The involvement of patient representatives in guideline development groups (GDGs) could increase legitimacy and quality of clinical practice guidelines (CPGs), since the experiential knowledge of patients could complement scientific evidence. By their involvement, patients have the opportunity to share (consultation) and incorporate their views and experiences into CPGs (decision-making). Although the importance of this approach is emphasised, little methodological support and systematic reflection exist on effective strategies.

Objectives

To gain insight in how patient involvement in GDGs can be optimised in order to develop strategies which can be implemented in practice.

Methods

The evaluation consisted of a desk study and 23 semi-structured interviews with stakeholders in CPGs, including patient representatives. The acquired insights were used to develop an evaluation framework, which guided monitoring and evaluation of four ongoing oncological guideline development processes. Validation took place through a triangulated approach (e.g. observations, document-analyses, interviews). Two patient representatives were included in the research team.

Results

The evaluation revealed that successful patient involvement in GDGs depends on a broad scale of factors (e.g. members of the GDGs, support of patient representatives) which could facilitate or constrain patient involvement. The factors were used to develop practical strategies for patient involvement, ranging from preparation meetings to regular reflections with the patient representatives and dialogue sessions with patients.

Discussion

The strategies could lead to more successful patient involvement in GDGs and provide valuable insights on how to involve patients in guideline development processes on other disease areas.
022 Developing guidelines and quality indicators simultaneously: effects on guideline content and implications on the guideline development process
Authors: Follmann M , Wesselmann S , Kopp I , Nothacker M
Published: August 2013

Background

The German Guideline programme in Oncology (GGPO) funds and supports the development, implementation and evaluation of evidence based guidelines. An essential part of the programme is the development of quality indicators (QI) before a guideline is published. QI groups representing the multidisciplinary guideline development group including patient representatives and experts from organisations responsible for QI assessment and evaluation realise this following a standardised methodology.

Objectives

To explore the effects of a standardised Quality Indicator Development Process (QIDP) on the content of guidelines and possible implications on the guideline development process.

Methods

Retrospective content analysis of current guideline manuscripts. Description and categorization of changes in the guideline draft after the QIDP. Structured interview of QI groups.

Results

9 oncological guidelines including 87 QI were analysed. Changes in guideline drafts after the QIDP included: • formulation of new recommendations • specification of the wording of recommendations • specification and amendment of the predefined aims of a guideline • identification of aspects to consider for an update of the guideline. Results of the interview will be presented at the conference.

Discussion

This investigation suggests a positive effect of the simultaneous QI development on guideline content concerning specificity of recommendations, clarity of aims to improve quality of care and identification of clinical questions to be addressed in future systematic reviews and/or guidelines.

Implications for Guideline Developers

A simultaneous process to develop guidelines and QI is favourable not only to facilitate the assessment of guideline implementation and impact but also to improve guideline content and implementability.
029 Clinical Practice Guidelines for Australian General Practitioners: How Implementable Are They?
Authors: Chakraborty S , Mazza D
Published: August 2013

Background

Many guidelines have been published that are relevant to Australian general practitioners. However, it is unclear whether these guidelines have the attributes required for facilitating implementation.

Objectives

To determine the proportion of current Australian general practice guidelines that have incorporated the attributes required for facilitating implementation.

Methods

We conducted an audit of the National Health and Medical Research Council Clinical Guidelines Portal to identify guidelines published between 2007 and 2011 that listed general practitioners (GPs) as a primary user and examined them for attributes identified in literature as facilitating implementation.

Results

A total of 146 guidelines targeting Australian GPs were identified in our study. Approximately 46% of these guidelines were developed by “collaborating authors”, with 27% and 19% developed by “government organisations” and “not-for-profit organisations”, respectively. Almost half (43%) of the guidelines did not state the methodology used, with 33% using “expert opinion” and only 16% using “systematic literature reviews”. Only 14% of the guidelines were endorsed by professional colleges and only 10% of the guidelines were government-approved. Additional resources to facilitate guideline uptake were included for only 23% of the guidelines.

Discussion

While some attributes of implementation have been incorporated into general practice guidelines, many are absent from most of these guidelines. Given the rapid growth in evidence-based guidelines in Australia, it is imperative that clinical practice guidelines incorporate the attributes necessary for facilitating implementation.

Implications for Guideline Developers/Users

Developing an evidence-based guideline implementability framework may be useful for improving the development and dissemination of guidelines.
031 If Rapid Reviews are the Answer, what is the Question?
Authors: Ireland B
Published: August 2013

Background

The Institute of Medicine recommended standards for systematic review, but some guideline developers find the standards time and resource intensive. Rapid reviews are becoming a popular method to appraise and summarise evidence. But what are rapid reviews and do they replace or rely on systematic review?

Objectives

To clarify major differences between rapid reviews and systematic reviews, especially aims, methods and uses for guidelines and policy.

Methods

Overview of reviews and examination of organisational policies for rapid review focusing on reasons users request rapid review, methods used to produce them, and the uses of those syntheses.

Results

There is no standards methodology for producing rapid review, nor is there consistency in intended use. Some organisations rely on systematic reviews to produce rapid review, while others incorporate short cuts in systematic review process. In addition to faster production, some users of rapid review are seeking product that is more clinically relevant and ready for implementation.

Discussion

There are many ways to speed up systematic review, some at risk of introducing bias. Without clear understanding of the reasons users request rapid review and their expectations for the evidence product, simply speeding the time frame may not address all of user needs for evidence they can implement quickly.

Implications for Guideline Developers/Users

Until there is consensus on what the label rapid review describes, users will need to identify their own minimal standards and evaluate adherence. Developers should be clear about user expectations for using the evidence.
032 Rapid Guidelines: A Systematic Review
Authors: Falavigna M , Ikobaltzeta I , Sakhia F , Zhang Y , Santesso N , Norris S , Schünemann H
Published: August 2013

Background

Guidelines often take two or more years to be developed. This timeframe is not practical for providing guidance in situations when rapid advice is needed.

Objectives

To describe current practices about the development of rapid guidelines and to provide advice about adequate methodology.

Methods

We performed a systematic review, including grey literature, to identify (1) rapid guidelines, defined as guidelines produced in a shortened time frame, and (2) methodological manuals addressing its development.

Results

We only documents by WHO and NICE that described methods and actual guidelines. The WHO handbook describes “rapid advice guidelines”; guidelines produced in response to a public health emergency in which WHO is required to provide rapid global leadership and guidance. This advice should be produced within 1 to 3 months and be evidence-informed, however, it may not be supported by full reviews of the evidence. We identified six WHO rapid guidelines and one methodological guidance paper based on a WHO guideline. NICE produces “short clinical guidelines”; guidelines that address only part of a care pathway, allowing rapid (11–13-month) development of guidance on aspects of care for which the NHS requires urgent advice. We identified 18 NICE short clinical guidelines.

Discussion

Literature is lacking about rapid guidelines and the intended role appears to differ. Despite its relevance, there are few rapid guidelines published and clarity about the terminology is needed.

Implications for Guideline Developers

We will provide a framework for those developing rapid guidelines, including practical advice and clarification about the terminology used.
042 Strong Recommendation – Strong Evidence? An Analysis of Evidence-Based Guidelines on Various Chronic Diseases
Authors: Siering U , Waldt S Ein , Hoffmann-Eber W , Rüther A
Published: August 2013

Background

Several studies have investigated the award of Grades of Recommendation (GoR) and Levels of Evidence (LoE) in clinical practice guidelines of medical societies.

Objectives

To assess to what extent recommendations with high GoR are also linked to high LoE in guidelines on various chronic diseases.

Methods

We conducted a systematic search for German, English, and French-language evidence-based guidelines on type 1 and 2 diabetes, coronary heart disease, and heart failure published after 1995. Guideline recommendations on the healthcare aspects “diagnosis”, “treatment” and “cooperation of health care sectors”, including their LoE and GoR, were extracted. LoE and GoR were then rated according to aggregated evidence or recommendation categories (weak, medium, strong).

Results

71 guidelines were identified and 3918 recommendations extracted. 3073 (78%) and 2541 (65%) recommendations were supported by GoR and LoE respectively. 1879 recommendations (48%) were supported by both GoR and LoE. In this group, strong GoR were awarded in 839 cases (45%), but only 353 (42%) of them were also linked to strong LoE. Weak and medium LoE were awarded in 264 (32%) and 222 (27%) cases, respectively.

Discussion

A large proportion of recommendations in evidence-based guidelines are not supported by both GoR and LoE; the quality of guidelines could be improved here. If both are reported, less than half of recommendations with strong GoR are also linked to strong LoE. This raises the question whether too high GoR are systematically awarded in clinical practice guidelines.
062 Partially Updating a Guideline to Improve its Implementation
Authors: Warttig S , Elliott N
Published: August 2013

Background

We were commissioned to partially update a clinical guideline. The remit was to develop new service delivery recommendations to support implementation of the guideline whilst leaving the existing clinical recommendations unchanged.

Objectives

To describe the approach taken in partially updating a guideline to improve its implementation. To discuss the problems encountered and possible solutions.

Methods

At the time, there was limited guidance on conducting service delivery evidence reviews. A methodology was developed and agreed by the developers, the NICE Methodology Team and the GDG which aimed to ensure the process was as robust, reproducible and transparent as possible.

Results

Limited evidence was identified using the agreed methodology. This prevented identification of successful service delivery models. It also became apparent that that some of the implementation issues were embedded in the original guideline recommendations, and these could not be changed.

Discussion

The methodology used could not adequately address the implementation issues, as it was not possible to amend any of the problematic recommendations, or describe a method of service delivery that was clinically and cost effective. Agreement could not be reached on how to progress with developing the recommendations, and so a decision was made to cease publication of the service delivery recommendations.

Implications for Guideline Developers/Users

Partial updates are more challenging for guidelines requiring implementation support and should: 1) Go through a process to assess the issues before deciding how guideline should be updated. Or 2) Come with a remit to enable the developers to amend the recommendations for which implementation support is sought.
064 Identifying, Describing and Evaluating Guideline Implementability Tools
Authors: Cheng J , Gagliardi A , Brouwers M , Bhattacharyya O
Published: August 2013

Background

Research shows that guidelines are more easily translated to practice when accompanied by information that helps users accommodate, implement and evaluate use of the recommendations. Guidelines vary in whether and how they offer such information, which we refer to as guideline implementability tools (GItools).

Objectives

To identify, describe and evaluate exemplar GItools that address Resource Implications, Implementation and Evaluation, and suggest how they could be improved.

Methods

GItools were identified in several sources (guidelines, Medline, professional organisation web sites, Implementation Science, Internet, expert referrals) and two individuals independently assessed each on criteria recommended by G-I-N members: purpose statement, instructions for use, citations for source of content, and how it was developed.

Results

The search produced 228 potential tools. Of these 94 were ineligible and 63 met no assessment criteria. Of the remaining 71 tools, 13 (18.3%), 24 (33.8%), 23 (32.4%) and 11 (15.5%) met 1, 2, 3 and 4 criteria, respectively; and 57 (80.3%), 37 (52.1%), 41 (57.7%) and 41 (57.7%) provided purpose, instructions, citations and development details, respectively. Most tools addressed Implementation (44, 62.0%). Twenty-eight (39.4%) were guideline-specific and 43 (60.6%) were generic.

Discussion

Few GItools met all assessment criteria. GItools could be more informative across all criteria. Few GItools were available to help users assess resource needs or evaluate guideline use. Many GItools were applicable to a variety of guidelines.

Implications

We identified a number of ways to improve GItools. Collaborative development and sharing of both generic and condition-specific GItools could make efficient use of resources.
065 Pubmed vs. Google Scholar: A Database Arms Race?
Authors: Thiese M , Effiong A , Passey D , Ott U , Hegmann K
Published: August 2013

Background

Currently there are two widely used databases, PubMed and Google Scholar, are used for guidelines development. Research suggests PubMed is superior, however recent evidence suggests Google Scholar may have closed that gap. One family of journals reports 60% of their traffic is coming from Google Scholar.

Objectives

Assess efficiency and completeness of searching for known moderate and high quality RCTs in PubMed and Google Scholar.

Methods

Searches were performed by two experienced researchers using the same search terms to identify RCTs for a specific treatment. In a crossover design, one researcher performed the search in PubMed (PM1), the other in Google Scholar (GS1). Subsequently each performed the same searches in the other database (PM2 and GS2). Total numbers of articles identified, relevant articles found, and the time to complete were collected. Articles were compared to a known comprehensive list of 5 RCTs used for guideline preparation that was drawn from 6 exhaustive database searches.

Results

GS1 identified 2 and GS2 identified 3 of the RCTs. PM1 identified 2 and PM2 identified 2 RCTs. PubMed and Google Scholar searches averaged 63 and 194 minutes to complete respectively.

Discussion

Each database consistently identified one of the two highest quality studies, but neither database identified both. Difference search time is nearly 3-fold. No single search identified all quality studies. Additional trials are planned.

Implications for Guideline Developers/Users

For comprehensive literature searches both databases should be searched.
067 Challenges of Developing Rapid Guidance for Complex Interventions
Authors: Franek J
Published: August 2013

Background

Rigorous guideline development requires extensive time and resources. Rapid review—a streamlined approach to synthesising evidence—offers an attractive alternative to systematic review for informing decision-making on complex interventions in a timely manner. Complex interventions are those that contain extensive number of interacting components.

Context

A rapid evidence assessment service of a large US-based health care organisation developed guidance through rapid review on transitional residential recovery services (TRSS) for substance abusers.

Description of Best Practice

Complex interventions present unique challenges for evaluation by rapid review. Significant scoping and upfront communication with end users was undertaken to understand the target populations, intervention-related components, outcomes, timing and settings associated with TRSS. Thorough refinement of Ovid search algorithms using date-based limits was needed to generate a feasible and appropriate literature database. Issues relating to complex interventions—such as limited generalisability, lack of effect may be driven by poor implementation rather than ineffectiveness of intervention, variability in outcomes, etc.—were communicated to end users in conjunction with findings. Changes to existing programmes were enacted based on findings and will be discussed.

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

Studies of complex interventions are notoriously difficult to evaluate and summarise through traditional evidence assessment methods. Rapid review offers an attractive option for providing evidence for timely decision-making; however, its application to complex interventions requires careful planning, execution and understanding.
068 Integrating guidelines into local clinical practice and policy using hospital-based health technology assessment
Authors: Mitchell M , Leas B , Lavenberg J , Williams K , Umscheid C
Published: August 2013

Background

Most existing centres for health technology assessment (HTA) are associated with payers or government agencies, and review and analyse emerging and costly technologies. Yet, such centres can exist within individual medical centres as well, and can use HTA methods locally to synthesise, disseminate and implement best clinical practices to improve the quality, safety and value of patient care.

Objectives

Describe the structure, processes and outcomes of a model of hospital-based HTA (HB-HTA) in the US, such that it can be applied elsewhere.

Methods

Our academic medical centre established the centre for Evidence-based Practice (CEP) in 2006. CEP synthesises guidelines and studies for clinical and administrative leaders to inform decision-making, integrates select syntheses into practice through clinical decision support (CDS), and provides education in evidence-based practice. Local utilisation and cost data are incorporated where appropriate.

Results

Nearly 200 evidence reports have been completed to date, and over 35 reports have been integrated into CDS. The median time from project opening to first draft is 4 weeks. CEP also contracts with external organisations such as the CDC and AHRQ on systematic reviews and guidelines.

Discussion

To complete reviews rapidly, we work closely with requestors to define the questions up front and limit the scope, use experienced analysts to perform high yield searches with single study reviews and extraction, and use best available evidence and existing guidelines and reviews.

Implications for Guideline Developers/Users

An HB-HTA centre can develop, adapt and implement guidelines locally to support a culture of evidence-based practice and decision-making.
Impact of the World Health Organization's Decision-Making Tool for Family Planning Clients and Providers on the quality of family planning services in Iran
Authors: Farrokh-Eslamlou Hamidreza , Aghlmand Siamak , Eslami Mohammad , Homer Caroline S E
Published: August 2013

Objective

We investigated whether use of the World Health Organization's (WHO's) Decision-Making Tool (DMT) for Family Planning Clients and Providers would improve the process and outcome quality indicators of family planning (FP) services in Iran.

Methods

The DMT was adapted for the Iranian setting. The study evaluated 24 FP quality key indicators grouped into two main areas, namely process and outcome. The tool was implemented in 52 urban and rural public health facilities in four selected and representative provinces of Iran. A pre-post methodology was undertaken to examine whether use of the tool improved the quality of FP services and client satisfaction with the services. Quantitative data were collected through observations of counselling and exit interviews with clients using structured questionnaires.

Results

Different numbers of FP clients were recruited during the baseline and the post-intervention rounds (n=448 vs 547, respectively). The DMT improved many client-provider interaction indicators, including verbal and non-verbal communication (p<0.05). The tool also impacted positively on the client's choice of contraceptive method, providers’ technical competence, and quality of information provided to clients (p<0.05). Use of the tool improved the clients’ satisfaction with FP services (from 72% to 99%;p<0.05).

Conclusions

The adapted WHO's DMT has the potential to improve the quality of FP services.
Rapid screening and analysis of alcohol dehydrogenase binders from Glycyrrhiza uralensis root extract using functionalized magnetic nanoparticles coupled with HPLC−MS/MS
Authors: Chen Miao , Liu Liangliang , Chen Xiaoqing
Published: August 2013

Alcohol dehydrogenase (ADH) is a key enzyme that converts ethanol into acetaldehyde. Its binders could be used to efficiently treat human toxic alcohol poisoning and suppress the acetaldehyde accumulation in alcohol hypersensitive alcoholics. In the present study, a new assay based on ADH-functionalized magnetic nanoparticles coupled with high-performance liquid chromatography − tandem mass spectrometry (HPLC−MS/MS) was developed for the rapid screening and identification of ADH binders. ADH was immobilized on silica-coated Fe3O4 magnetic nanoparticles via covalent bonds and the synthesized nanoparticles were characterized by TEM, XRD, FT-IR, and VSM. The amount of bound ADH onto magnetic nanoparticles was 80.6 μg/mg. The optimum temperature and pH for the enzymatic activity of immobilized ADH were 25 °C and 7.0, respectively. The relative activity of immobilized ADH remained 68.14% after 10 times of recycle, which exhibited good durability. Nine compounds with ADH-binding activity were screened and identified in Glycyrrhiza uralensis root extracts, among which seven compounds were first screened and identified. Experimental results proved that the proposed method could rapidly screen ADH binders from complex mixtures.
Approximate and analytical bound state solutions of the Frost–Musulin potential
Authors: Adepoju A.G. , Eweh E.J.
Published: August 2013

Despite all the attempts made by several authors to investigate the bound state solutions of the Schrödinger equation with various potentials, until now, such investigations have not been conducted for Frost–Musulin diatomic potential. In this study, we obtain the approximate bound state solution of this potential via the functional analysis method. We also numerically solved the Schrödinger equation without any approximation to centrifugal term for the same potential. The comparisons between the results reveal the accuracy of our approximate results for short-range potential.
Effects of vegetable oils on biochemical and biophysical properties of membrane retinal pigment epithelium cells
Authors: Said Toihiri , Tremblay-Mercier Jennifer , Berrougui Hicham , Rat Patrice , Khalil Abdelouahed
Published: August 2013

The aim of this study was to investigate the effect of vegetable oil enrichment of retinal pigment epithelial (RPE) cells on their biochemical and biophysical properties. For this, RPE cells were incubated with 4 different vegetables oils (olive oil, corn oil, argan oil, and camelina oil). The cytotoxicity of these vegetable oils was assessed in vivo on 8-week-old mice and in vitro by using the neutral red and YO-PRO-1 tests. Membrane fluidity was evaluated by fluorescence anisotropy using the fluorescent probe diphenylhexatriene, and membrane fatty acid composition was assessed by gas chromatography. None of the oils tested displayed cytotoxic effects. In vitro, omega-3 rich oils improved membrane fluidity by 47% compared with the control cells. The omega-3 PUFA content within membranes decreased by 38% to 55% when cells were incubated separately with olive oil, corn oil, or argan oil, and increased when cells were incubated with a mixture of those oils, or with camelina oil alone (50% and 103% increase, respectively). Our results show that the fatty acids in vegetable oil incorporate into retinal cells and increase the plasma membrane fluidity.