bluuebunny/crossref_metadata_2025 huggingface dataset:
091 If we Build It, Will you Search for It? Finding Multiple Chronic Condition Guidelines in the National Guideline Clearinghouse
Authors: Haskell L , Jue J. , Cunningham S. , Nix M. , Coates V.
Published: August 2013

Background

In the US, it is estimated more than 25% of Americans have multiple chronic conditions (MCCs) and their care accounts for approximately 66% of total health care spending. Few clinical practice guidelines address MCCs.

Objectives

Determine the number and scope of guidelines represented in the National Guideline Clearinghouse (NGC), funded by the Agency for Healthcare Research and Quality, addressing MCCs and provide strategies to identify these guidelines and facilitate quick retrieval by NGC users.

Methods

We searched for guidelines within NGC to identify those that address MCCs. We characterised these guidelines defining the number and type of MCCs addressed, the number of recommendations addressing MCCs, whether they addressed treatment, diagnosis, prevention or counselling, whether they graded the level of evidence, and whether the MCCs were concordant/discordant with the guideline’s primary disease/condition.

Results

Final analysis of information collected and recommendations and strategies for facilitating retrieval of this content in NGC will be completed by June 2013.

Discussion

Traditionally, guidelines focus on individual diseases so their application to the growing MCC population is limited. At the same time, evidence supporting recommendations for MCCs is lacking. Although our preliminary findings indicate that there are some guidelines addressing MCCs, there has been no obvious way to locate them on NGC.

Implications for Guideline Developers/Users

Guideline developers need to create guidelines addressing MCCs. NGC aims to create ways to highlight MCC guidelines and make them easier to find and use.
092 From Manuscript to Mouse-Click: Moving From Print to Electronic Guidelines
Authors: Claase L , Phillips S , Hughes S , Norquay C
Published: August 2013

Background

The rapid uptake of electronic devices and information sources has enormous implications for guideline developers and implementers. In 2000, our organisation anticipated this trend and developed an electronic production system.

Objectives

To develop the capacity to publish and update electronic versions of a comprehensive set of clinical guidelines.

Methods

An audit of technology and resourcing requirements was undertaken, new software was commissioned, and staff with IT and electronic publishing skills were recruited. Stringent quality control and editorial processes were developed to ensure the fidelity of electronic versions. A comprehensive communications and marketing plan was implemented.

Results

All guidelines, covering 14 books titles and around 3000 topics, were integrated into an electronic, searchable website with links to other quality electronic resources, tools and reference materials.- Electronic subscriptions and site licenses have grown by 200% between 2004 and2012, and currently make up 75% of users; 25% continue to use books.

Discussion

The switch from paper to computer and mobile devices presents both financial and logistical challenges and requires long-term commitment. Furthermore, as the diversity of electronic integration systems multiplies, there are challenges in keeping up with technological advances. It is clear from the uptake of our electronic guidelines that health professionals and other users want access to comprehensive, up-to-date and easy-to-use electronic guidelines.

Implications for Guideline Developers/Users

For guidelines to be useful in practice in 2013 and beyond, they must be available electronically and be able to interact with other electronic resources used in health settings.
P005 Integration of evidence on patient preferences in health care decision-making: current state of play
Authors: Utens C , Weijden T van der , Joore M , Dirksen C
Published: August 2013

Background

Active patient participation is embedded in health care decision-making, like clinical practice guideline (CPG) development and coverage decisions. The systematic use of the available evidence on patient preferences (passive participation) is still limited.

Objectives

To describe how and what type of evidence on patient preferences is considered in health care policy decisions in The Netherlands, England, Scotland, Germany and France.

Methods

A document search on website and database of responsible organisations for material on current development procedures. Scoping literature search on opinion papers on the use of research on patient preferences in CPG development and coverage decisions (HTA). Selected CPG and coverage decisions were checked.

Results

Procedures for coverage decisions do not mention the search for or use of research on patient preferences, nor was information found in the coverage case studies. In CPG development procedure a mandatory (Scotland) or optional (Netherlands) search for studies that reflect patients’ experiences and preferences is described. The CPG case studies show various use of patient preferences in different conceptualisations.

Discussion

In coverage decisions research on patient preferences has no formal role yet. In CPG this role is limited. Integration of research on patient preferences is hampered by several factors.

Implications for Guideline Developers/Users

Directions for the future include: 1) conceptual work on defining and measuring patient preferences; 2) reaching consensus on the value and place of research on patient preferences for and in procedures and 3) developing a strategy for integration in procedures.
P012 Systematic review of HPV test [Invader Technology/Real-Time PCR]
Authors: Shin H , Lee S , Lee K , Choi W , Kim T , Moon H , Kim H , Lee K , Kim E
Published: August 2013

Objective

HPV Test [Invader Technology/Real-Time PCR] is a molecular genetic test performed for confirming the presence of infection by detecting 14 types of HPV and additionally, for classifying types 16 and 18 genotypes.

Methods

It was assessed using 8 domestic databases including Korea Med and Ovid-MEDLINE, Ovid-EMBASE. 1,214 works were identified. Of them, animal experimental or studies not published in Korean or English were excluded. Total of 23 literatures composed of 8 literatures for Invader Technology and 15 literatures on Real-Time PCR were included in the final assessment. Two reviewers screened all references independently, for assessing included articles quality and extracted data.

Results

Index tests were assessed to be a safe test, since it does not impart direct harm to the patients as it is conducted outside the patients body by collecting uterus cervical cells. Effectiveness was assessed by diagnostic accuracy, concordance rate, detection rate. Diagnostic accuracy of Invader Technology with sequencing was high (sensitivity=0.89, specificity=0.92). As the result of comparison between Invader Technology and Hybrid Capture 2(HC2), the false positive rate of index test (5.8%) was lower than HC2 (5.5–21.9%). The concordance rate was 83.1%-94.0%. Diagnostic accuracy of Real-Time PCR with DNA chip was high level (sensitivity=0.96, specificity=1.00). Rate of concordance between Real-Time PCR and HC2 was in the range of 82.6–98.3%, with DNA chip was in the range of 66.7–98.3%.

Conclusion

These tests are safety. Also, there are the effectiveness of additional diagnosis for genotypes 16 and 18, high level of concordance with the existing tests and high level of detection of HPV genotypes 16 and 18 in high risk group.
P016 A guideline on undescended testis: more transparency by a decision analysis
Authors: Kamphuis M , Marle E van den Akker-van , Gameren-Oosterom H van , Pierik F
Published: August 2013

Background

Undescended testis (UDT) is the most common genital anomaly seen in boys and can be treated surgically by orchiopexy. The age at which orchiopexy should be performed is controversial for both congenital and acquired UDT.

Objectives

Performing a decision analysis in order to develop a guideline on UDT.

Methods

A decision analysis was performed in which all available knowledge is combined to assess the outcomes of orchiopexy at different ages, expressed in quality adjusted life years (QALY). Furthermore a sensitivity analysis was performed to assess whether the determined optimal age of orchiopexy is influenced by gaps in current knowledge.

Results

Surgery at the earliest age (at detection of UDT) will lead to the lowest loss in QALY for UDT compared to no surgery. For bilateral UDT (both congenital and acquired) this was caused by increased paternity and for unilateral UDT by cosmetic aspects. Sensitivity analyses did not change the preferences for strategies. However, given the modest differences in outcomes, there is room for patient preference with respect to performance and timing of surgery in case of unilateral UDT.

Discussion

The choice for no surgery in case of unilateral UDT was not acceptable for the expert group. Therefore, a consensus based guideline was developed in which surgery was recommended also for unilateral UDT. More clinical evidence on issues related to timing may in the future modify these results and hence this advice.

Implications for Guideline Developers/Users

A decision analyses provides a clear insight in the data available and argumentations made.
P023 Observational Drug Therapy Trials Add Up Useful Information As Compared With Randomised Controlled Trials: Case Multiple Sclerosis
Authors: Atula S , Lodenius L , Komulainen J
Published: August 2013

Background

Clinical practice guidelines (CPG’s) are predominantly based on randomised controlled trials (RCT’s). However, the number of published observational, non-randomised trials is high and yet, the information they contain is often excluded while compiling CPG’s.

Objectives

We compared randomised and observational clinical treatment trials, published within one year, using multiple sclerosis (MS) as a model. The aim was to find out whether valuable information for CPG’s can be discovered by using observational studies.

Methods

We collected all publications of MS treatment in Medline during year 2012, using Scottish Intercollegiate Guidelines Network (SIGN) search filtres for randomised and observational trials for making a systematic literature review. The clinical drug trials on adults with MS, published in English were included. Case reports and symptomatic treatment trials were excluded.

Results

A total of 24 RCT’s and 45 observational trials were found. The median number of participants in RCT’s was 430 (range 66 to 2244) and in observational trials 118 (range 5 to 22255). Twenty RCT’s were efficacy trials, 2 evaluated health economics and one each safety and pharmacology. Twenty-eight observational trials had efficacy as a primary end-point, 10 addressed safety, 5 treatment adherence and one each pharmacology and health economics.

Discussion

Most trials addressing safety or compliance issues were observational, therefore important safety and adherence data could be lost by omitting them.

Implications for Guideline Developers/Users

Observational trials should be considered while compiling CPG’s.
P030 E-Tool For Patients with Non-Hodgkin’s Lymphoma to Improve Guideline Adherence
Authors: Stienen J , Hermens R , Krieken H van , Schans S van de , Dekker H , Maazen R van der , Wennekes L , Blijlevens N , Ottevanger N
Published: August 2013

Background

Patient education should be part of improvement strategies to increase guideline adherence by professionals.

Objectives

This study evaluates an e-tool designed in response to patients’ need for more complete information regarding diagnostics, therapy and after-care (based on previous research). The e-tool aims to inform patients about non-Hodgkin’s lymphoma (NHL)-care and gives patients the possibility to check their own care pathway and register personal experiences.

Methods

The e-tool was developed in consultation with the Dutch Lymphoma Patients Organization and evaluated by NHL-patients, professionals and laymen. Feedback was asked concerning lay-out, user convenience, information provision and general strengths and weaknesses of the e-tool. The effect of the e-tool is now tested in 9 Dutch hospitals. Patients are included from November 2012 to November 2013. All patients receive patient information and an informed consent form. The process of inclusion is continuously monitored.

Results

In the development phase, 18 out of 26 feedback forms were filled out. Information needs were satisfactory and clearness of navigation and information on new therapies were improved after feedback. In the first 3 months of the testing phase, 25 of the historically estimated 50 patients received patient information, 12 consented and 8 used the e-tool.

Discussion

The e-tool seems feasible to empower patients regarding their NHL-care pathway. However, distribution of patient information is not yet optimal. Patients’ experiences with the e-tool and possible effects on quality of care is tested in a randomised controlled trial.

Implications

Educational e-tools for patients may help to improve guideline development and adherence.
P041 Sustaining organizational capacities of knowledge utilization: A complete toolbox for the health and social services organizations
Authors: Chagnon F , Bardon C , Houlfort N , Proulx R , Labelle P , Gervais M
Published: August 2013

Background

Despite research and funding, the understanding of organization’s capacities of knowledge utilisation remains incomplete in health and social field.

Objectives

To better understand organisational determinants of research result utilisation.

Method

Between 2009 and 2012, managers (n = 75) from health and social services organisations (N = 8) have actively contributed in a participative research action process. Additionally professionals and managers (N = 2161) have answered questionnaires. Qualitative and quantitative data gathered on the organisational outcomes as well as on the process of using our tool provided empirical validation. This iterative process led to the creation of a complete toolbox designed to help organisations raise to the knowledge transfer and utilisation challenge.

Results

The toolbox includes a conceptual framework, a user’s guide and two questionnaires to establish a diagnostic of the organisation’s capacities of knowledge utilisation and to identify the main strategies to improve them. At the root of our toolbox is a theoretical model of organisational capacities to use knowledge, specific to health and social services organisations, that we have developed. Our model includes eight components: organisational culture, vision and leadership, knowledge acquisition, reflexivity, integration, creation and dissemination, adaptation, and relationships.

Discussion

The results demonstrate that the toolbox helps decision makers to develop a common understanding of their organisation’s strengths and weaknesses in terms of research knowledge utilisation capacities. Implications:The research and toolbox developed by our team provide a first step in unveiling the intricacies of knowledge utilisation in the social services sector. Eight key organisational capacities were found to be essential in facilitating and promoting knowledge utilisation in health and social services.
P042 Evidence-based guideline on pharmacological management of osteoarthritis of knee in primary care settings in Hong Kong
Authors: Ng M , Lam W , Hui Y
Published: August 2013

Background

Osteoarthritis (OA) is a common degenerative joint condition. Family physician plays an important role in the management.

Objectives

The guideline seeks to assist primary health care professionals to help patients with OA knee to improve quality of life using pharmacological measures to relieve symptoms, improve drug use and reduce adverse drug incidents.

Methods

The guideline is based on evidence-based literature review and was synthesised in accordance with SIGN methodology. A systematic review of literature was carried out using an explicit search strategy devised by a SIGN Information Officer. Each of the selected papers was evaluated using standard SIGH methodological checklists and the articles were subsequently reviewed. The guideline was synthesised by adaptation recommendations using the AGREE Tool. The recommendations were then modified based on the latest best available evidence. The guideline was finally reviewed internally and externally.

Results

The first line drug treatment of OA knee is paracetamol in regular divided doses to a maximum of 4g/day. There is good evidence to prescribe NSAID or COX-2 NSAID for reducing pain in short term. Family physician may consider prescribing weak or strong opioids with caution for moderate or severe pain. Intra-articular corticosteroid injections for short term relief can be considered. Family physician may also consider use of topical NSAIDs and hyaluronic acid.

Conclusions

Use of appropriate pharmacological measures can effectively relieve symptoms, improve functions and reduce adverse drug incidents.
P044 Quality assessment of traditional Chinese clinical guidelines: 2003–2012
Authors: Chen Y , Yao L , Wang Q , Wei D , Wang X , Yang K
Published: August 2013

Background

Little is known about quality and quantity of traditional Chinese clinical guidelines. We aim to systematically review all of traditional Chinese clinical guidelines.

Methods

We searched CNKI (China National Knowledge Infrastructure/Chinese Academic Journals full text Database), VIP (a fulltext database of China), WANFANG (a fulltext database of China) and CBM (China Biomedicine Database Disc). Two groups of review authors independently applied inclusion criteria, assessed trial quality, and extracted data.

Results

We identified 75 traditional Chinese clinical guidelines from 2003 to 2012, and only 11(15%) were claimed that an evidence based approached were used in the process of development. From the assessment with the Appraisal of Guidelines for Research and Evaluation II (AGREE II), the mean scores were low for the domains ‘clarity of presentation’ (28%), ‘scope and purpose’ (15%) and ‘editorial independence’ 12%; and very low for the other domains (‘stakeholder involvement’ 8%, ‘rigour of development’ 5% and ‘applicability’ 3%). AGREE II mean scores of traditional Chinese clinical guidelines lower than Chinese clinical practice guidelines and the world average.

Conclusions

Traditional Chinese clinical guidelines received lower scores, which indicate a relatively poor quality of the guidelines. However, there was some increase over time. Meanwhile, given the characteristics of Traditional Chinese medicine, CONSORT group has been developing CONSORT for TCM and for Acupuncture, we plan to develop AGREE TCM to be used to inform the development, appraisal and reporting of evidence-informed traditional Chinese clinical guidelines.
P050 ‘Food and Eating behaviour’ – Development of a Guideline for Dutch Preventive Child Health Care
Authors: Lanting C , Heerdink-Obenhuijsen N , Kamphuis M
Published: August 2013

Background

Many parents worry that their child is eating either too much or too little. In The Netherlands, Preventive Child Health Care (PCHC) is the main source of advice and information on food and eating behaviour. Yet, evidence on the subject is sparse and scattered. The Dutch Ministry of Health Welfare and Sports, therefore, requested a guideline; the PCHC-guideline should fit together with a guideline for paediatricians on the same subject, which was developed concurrently.

Objectives

To develop a national guideline for PCHC-professionals on the subject to enhance uniform, evidence-based practice.

Methods

A working group of guideline developers, epidemiologists, and dieticians, together with professionals in PCHC, child-psychology and -pedagogics, and a pre-speech therapist developed the guideline, according to the principles of evidence-based medicine. Close collaboration took place with a group of paediatricians developing the new guideline ‘Signalling somatic causes of abnormal nutritional behaviour in children’. Questions were formulated by the working group and evidence was extracted from literature, supplemented by practice-based consensus. The guideline was piloted in several PCHC settings.

Results

Together with a group of child psychologists and psychiatrists, referral criteria for eating disorders were agreed on. Paediatricians formulated ‘Somatic alarm symptoms’. Discussion Working with a large, interdisciplinary group of guideline developers carries the risk of collaboration problems, but when managed successfully, adds value to the end product.

Implications for Guideline Developers/Users

In order to avoid collaboration problems, the scope of the guideline was agreed on in an early stage. Interdisciplinary collaboration enhanced guideline quality.
P055 Does the Canadian Task force on Preventive Health Care Meet the Institute of Medicine Standards in Guideline Development?
Authors: Gorber S , Jaramillo A , Pottie K , Singh H
Published: August 2013

Background

There are a plethora of guideline development groups in operation, each with its own methods for summarising evidence and processes for developing recommendations, which can leave consumers with questions about which guidelines to follow. In 2011 the Institute of Medicine (IOM) released a set of standards for developing trustworthy systematic reviews and clinical practice guidelines (CPGs). These standards address the structure, process, reporting and final products associated with evidence-based CPGs. The Canadian Task Force on Preventive Health Care (CTFPHC) was recently re-established with a mandate to develop clinical practice guidelines for primary care practitioners based on a systematic assessment of scientific evidence.

Objectives

To compare the Canadian Task Force on Preventive Health Care’s methods with the standards outlined in the IOM.

Methods

The methods of the CTFPHC were compared to the IOM standards for both systematic reviews and CPGs and to the methods of other international guideline producers.

Results

The CTFPHC methods are consistent with those of the IOM and international guideline development groups. Some differences include how patient and consumer input is incorporated into guidelines, the review of documents, and the final recommendation statements, the degree to which documents are publicly available and the processes for dissemination and knowledge translation.

Discussion

New processes put in place to address the differences between CTFPHC methods and IOM standards will be explored.

Implications for Guideline Developers/Users

Comparing the methods of guideline development groups to the IOM standards may provide users with a way to ascertain potential areas for enhancement of their CPG development process.
P056 The Canadian Task Force on Preventive Health Care: Interpretation tool to compare previous grading of recommendations to GRADE
Authors: Dunfield L , Gorber S , Shane A
Published: August 2013

Background

Guideline producers use various methods to grade their recommendations. The Canadian Task Force on Preventive Health Care (CTFPHC) previously assigned letter grades to their recommendations based on an evaluation of the evidence considering only study design. The CTFPHC now uses GRADE (Grading of Recommendations Assessment, Development and Evaluation), which considers the quality of the evidence and the strength of the recommendations.

Objectives

The objectives were to develop a tool that would allow interpretation of the previous CTFPHC grading system to GRADE to enable comparison of guidelines.

Methods

A comparison and mapping of each level of evidence and strength of recommendation for each grading system was undertaken. The methods working group and the knowledge translation working group of the CTFPHC reviewed the mapping system, which was then tested with a previous CTFPHC recommendation from 2001.

Results

An interpretation tool which maps the level of evidence and the strength of recommendation was created and applied to a previous CTFPHC recommendation statement.

Implications for Guideline Developers/Users

The tool is not meant to be a perfect system and does not require a formal assessment of the evidence from former guidelines. The evidence from previous guidelines is not assessed using GRADE, but rather interpreted for GRADE language. This tool will be useful in helping guideline developers compare guidelines using different grading systems and will allow the CTFPHC to compare previous guidelines to GRADE. This tool may also be applied when critically appraising guidelines from other guideline development groups.
P059 Dynamic Updating of Clinical Practice Guidelines (CPGS)
Authors: Regidor D , Robbins C
Published: August 2013

Background

We have been developing CPGs for use within our organisation since 2002. Our lengthy, text- based rationales were not widely read by guideline users. We created a decision support (rationale) table, based on GRADE methodology, and added a summary statement (basis of recommendation) to allow readers a concise and transparent snapshot of our justification for recommendation and strength.

Context

The rationale serves as a bridge between systematic review and recommendation, and provides users with a high-level justification for a recommendation. The basis of recommendation (BoR) summarises the 4 GRADE domains of strength of recommendation and how they are integrated to derive the final recommendation & strength. The BoR serves to: •Provide information to the Guideline Development Team and frontline clinicians to facilitate discussion and consensus and aid clinical decision-making. •Provide a structured, standardised portal into more detailed information in the CPG.

Description of Best Practice

We follow GRADE’s 2-level designation of recommendation strength (strong/weak), and developed standardised recommendation language to align with recommendation strength. We considered two approaches to derive the final recommendation strength, finally settling on an approach that allows flexible weighting of the contribution of each domain to recommendation strength. With this approach, in special circumstances, a strong recommendation may be given in the absence of a high-level of certainty. We plan to provide direct links from the CPG to our electronic medical record’s decision support tools.

Implications for Guideline Developers/Users

A concise and targeted rationale helps clinicians understand how the evidence was used to develop clinical practice recommendations.
P069 Clinical Practice Guidelines Manuals and Toolkits. Are They Different Among Languages, Countries And Developers?
Authors: Florez I , Perez Á , Prieto L , Peña E , Cañón L
Published: August 2013

Background

Manuals and Toolkits (MT) are standards for developing Clinical Practice Guidelines (CPG). Most developers have their own MT. There isn’t enough information about characteristics of MT in other languages than English.

Objective

To assess the characteristics of MT for developing CPG from different developers in English and Spanish.

Methods

We searched electronic databases, national clearinghouses and non-electronic sources such as guidelines developer’s sites. Epidemiologists independently assessed MT retrieved. Information about scoping, development group, Conflict of Interests (COI), updating, evidence systems among others, were extracted.

Results

Twenty MT were retrieved, 8 in Spanish, and 12 in English. It is not clear how COI is declared and handled in most of the MT. GRADE and SIGN were the most recommended systems for assessment of quality of evidence, nevertheless many didn’t recommend any system. Only 2 MT had a complete explanation about patient’s participation. Three years is the most common recommendation for updating CPG. Only a few include an economic component. There isn’t clarity in how recommendations are reported and how should be the external review of MT.

Discussion

There is heterogeneity in CPG development. Spanish MT are less specific than English ones. It is important to improve quality of Spanish-language MT’s, in order to enhance quality of Spanish CPG. There is an important lack of information about patient’s participation and drafting of recommendations.

Implications for Guideline Developers/Users

It’s important to improve the contents and quality of MT in order to achieve high quality standards on CPG development for both developed and developing countries.
032PS Asking the Right Questions: Effective Partnerships between Guideline Groups and Systematic Review Groups
Authors: Chang S , Shekelle P , Buckley D , Melnikow J
Published: August 2013

Guideline groups increasingly are seeking to leverage the value of independent systematic reviews. Compared with less formal approaches, systematic reviews are less likely to introduce bias. Such reviews require a pre-planned and structured process, in which the key questions clearly and precisely reflect the evidence needs of the guideline. Designing and conducting systematic reviews to support guideline development requires coordination and communication between guideline committees and systematic review investigators. This panel session is geared to guideline developers interested in partnering with independent systematic review groups. Guideline groups will hear about the benefits and challenges of systematic reviews and how to be an effective partner in the systematic review process to produce useful reviews. Stephanie Chang, Director of the Agency for Healthcare Research and Quality Evidence-based Practice Center (EPC) programme will moderate the session. Paul Shekelle, Director of the RAND EPC, Chair of the American College of Physicians Clinical Guidelines Committee, and co-Chair of the National Guideline Clearinghouse Editorial Board will review challenges and suggestions for how guideline groups and systematic review investigators can complement one another for effective partnerships. David Buckley, core investigator with the Pacific Northwest EPC at Oregon Health & Science University will focus on how guideline groups can work with systematic reviewers to shape effective questions for systematic review. Joy Melikow, member of the US Preventive Services Task Force Committee will share her perspective as a guideline developer experienced in using systematic reviews and the lessons she has learned in how to be an effective partner.
P081 Design Of Physician Printed Educational Materials: Making Good Ideas Stick
Authors: Versloot J , Kastner M , Grudniewicz A , Chatterjee A , Hayden L , Bhattacharyya O
Published: August 2013

Background

It is difficult to communicate new and complex clinical evidence to physicians already experiencing information overload. Proper use of design principles may increase uptake of guidelines and other printed educational materials (PEM) and improve practice.

Objectives

We aimed to determine whether physician-oriented PEMs are created in accordance with design principles.

Methods

We analysed PEMs identified in a 2012 Cochrane review of their effect on professional and patient outcomes and developed a checklist of design principles based on a literature review of clinical guideline implementability. Two analysts independently evaluated each PEM to determine how design principles were applied.

Results

Though the sample consisted of PEMs designed and developed to influence care, no single PEM scored well across all categories. Some PEMs failed to differentiate major recommendations and did not present them in a stepwise fashion. Most used clear and easy to read text, but highlighting was often inappropriate. Some algorithms lacked logic and consistency. Images were poorly designed and used, which may distract and confuse the reader.

Discussion

Design principles are not consistently applied in the development of PEMs and improvements are needed to images, presentation of recommendations, and usability of algorithms. Improvements to the design of PEMs may influence their uptake by combating information overload and increasing their perceived ease of use and perceived usefulness.

Implications for Guideline Developers/Users

Those who create guidelines and other PEMs consider some design principles, but do not implement them consistently. Our checklist can assist guideline developers in employing a range of design principles.
P082 Adherence to Recommendations of Clinical Practice Guidelines
Authors: Sosa-Garcia J , Martinez-Aldana S , Hernandez-Santillan D
Published: August 2013

Background

The use of the recommendation of clinical practice guidelines (CPGs) by health professionals, depends on the diffusion process and local strategies of implementation of a particular guide in a specific service of the institution.

Objectives

Assess the adherence to the recommendations of CPGs by health professionals internationally.

Methods

A systematic review of the literature in PubMed was conducted (MeSH term ‘Guideline Adherence’, filters: published in the last 5 years, meta-analysis).

Results

Out of 33 documents that were obtained, seven were selected, one systematic review and one document in google academic (Mexico). The percentage of adherence differs markedly depending on the directory in question and on the professionals involved from 61.1 to 72.2%. The median adherence was 45%. The professionals with the greatest adherence were dentists, whereas cardiologists and surgeons did not change their behaviour due to the recommendations of a CPG.

Discussion

The degree of adherence to the recommendations of the CPG is influenced by different factors, related to the efforts of professional associations, the management of health care organisations, the professionals themselves involved in the care of the patient and the patient himself.

Implications for Guideline Developers/Users

The key elements for adherence to the recommendations of the CPG are: involvement of the professionals with the strategy, occupational type, and suggested recommendations.
P084 Experiences With The Novel Policy For Managing Conflicts Of Interest Implemented In The 9th Edition Of The American College Of Chest Physicians Antithrombotic Guidelines (At9)
Authors: Neumann I , Karl R , Rajpal A , Akl E , Guyatt G
Published: August 2013

Background

The executive committee of the American College of Chest Physicians 9th edition of the Antithrombotic Guidelines (AT9) developed a novel policy for managing conflicts of interest (COI): methodologists bore primary responsibility for each chapter; there was equal emphasis on intellectual and financial COI; and content experts with COI participated, but the intent was to exclude them from the final decisions on recommendations on which they had conflicts.

Objectives

To explore the experiences of the AT9 methodologists and content experts with the COI policy.

Methods

A descriptive qualitative study: We conducted two rounds of semi-structured interviews with 15 participants and presented the results to the remaining 4 for verification.

Results

Methodologists were more positive about the policy than content experts. Six of 10 content experts expressed a more positive view than prior to participation in the AT9 process. The other 4 content experts remained sceptical, especially regarding the emphasis on intellectual COI. It was not possible to completely exclude conflicted panellists from the final decisions of the recommendations on which they had COI.

Discussion

After its implementation, some content experts were more favourable to the policy, but some retained major reservations. The influence of the policy on recommendations may have been more through the leading role of the methodologists than exclusion of conflicted participants in making recommendations.

Implications for Guideline Developers/Users

The leading role of methodologists was a positive innovation. However, restrictions to conflicted panellists were difficult to fully implement.
P086 Describing Guideline Development Process: Responding to New Challenges and Ensuring Transparency
Authors:   The Finnish Medical Society Duodecim/Current Care
Published: August 2013

Background

Evidence-based guidelines should be developed with rigorous methodological standards such as described by AGREE, G-I-N and IOM. One of the main aims is that the development process is repeatable and transparent. To follow these principles, process descriptions and methodological handbook are needed to enable appraisal.

Context

Our organisation has developed EBM guidelines for two decades. A methodological handbook was first published in 1998, with the latest (6th) revision published in 2012. Until 2012, processes have been described as simple flowcharts, covering mainly the work phases, not the whole process.

Description of Best Practice

Handbook was revised in co-operation with other national EBM organisations. It describes composition of guideline development group, methods for developing a guideline, consensus methods and decision-making process, patient involvement, peer review methods, and updating procedure. The process description was initiated in a workshop where all work phases and activities of guideline development process were written down and placed on a process flow diagram (swimlane) in chronological order. At the same time, the performer for each activity was acknowledged. Subsequently, main phases of the process were identified and described as subprocesses. The software used enabled linking between subprocess descriptions which made it possible to build up an overall picture of the process.

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

Visualising the overall picture of the process enables understanding of responsibilities of different performers in chronological order. Explicit process descriptions increase transparency, facilitate future process development, and help to maintain the rigorous guideline standards.
P089 Constraints for Clinical Guideline Implementation In Mongolian Primary Health Care Facilities
Authors: Sumberzul N , Maximenco E , Ouynbileg S , Munkhtaivan A , Jousilahti P
Published: August 2013

Background

The goal of the Millennium Challenge Account Mongolia (MCA-Mongolia) Health Project is to reduce morbidity and mortality due to Non-Communicable Diseases (NCD) through extensive training of health staff, development of clinical guidelines and provision of equipment and other material resources. Four clinical guidelines were developed within the framework of the project: hypertension, type 2 diabetes, and breast and cervical cancers.

Objectives

Facility Based Impact Study (FBIS) in 2010 gathered information on the capacity of health facilities to provide NCD services prior the project, and to assess the quality of services. Multi-stage stratified (urban and rural) sampling was used to select 194 primary health care facilities, and 730 individual respondents - representing different health worker categories - were selected within the facilities. The quantity and quality of NCD related services were assessed based on five factors; (1) human resources, (2) NCD screening activities, (3) availability of standards and guidelines, (4) health education materials, and (5) equipment and supplies.

Results

Only 10% of the facilities met the defined requirements for ‘high quality’ in the provision of NCD services, 38% met the level of ‘middle quality’, 28% of facilities met the ‘minimum level’, and 24% were classified as facilities not meeting basic requirements and categorised as below the minimum quality level.

Conclusions

At least half of the health facilities need a marked improvement, and for one quarter the need is urgent. Insufficient training and time, and lack of materials were main barriers for effective NCD prevention and control.
P095 The Role Of National Guidelines In Developing Regional Working Arrangements Between Medical Specialists And General Practitioners
Authors: Meijer L , Schellevis F
Published: August 2013

Background

In the Dutch health care system, general practitioners (GPs) are gatekeepers for secondary health care. A referral is needed before consulting a medical specialist. In 20 Dutch regions Medical Coordinating centres develop Regional Agreements (RAs) about patient care at the interface between primary and secondary health care. Ideally, national evidence-based guidelines are used as the basis for RAs.

Objectives

To provide insight into the usefulness of national guidelines in the development of RAs.

Methods

Qualitative semi-structured interviews were conducted in 2009 with medical coordinators (N = 9), GPs (N = 16) and medical specialists (N = 14), from seven coordinating centres. All participated in developing an RA about different subjects (hematuria, gastroscopy, postmenopausal bleeding, stroke or exercise ECGs). The recorded interviews were transcripted, encoded and analysed in MAXQDA.

Results

National guidelines were used in the development of most RAs. GPs and medical specialists reported to use national guidelines from their own (monodisciplinary) organisation. Medical coordinators introduced the most national guidelines. Developing or revising an RA often started on the occasion of a newly published or revised national guideline. The problems in the use of national guidelines are: limited information about cooperation, conflicting information between different guidelines, no trust in the guideline development procedure, and guidelines are not up to date.

Discussion

National guidelines have an important role in the development of RAs. National guidelines should pay more attention to recommendations for regional collaboration.

Implications

After the development of a national guideline, the developers should keep in touch with GPs and medical specialists in the regions to pick-up their implementation problems.
062PS The Role of Rapid Systematic Reviews for Development of Rapid Guidance in Health Care and Health Policy Settings
Authors: Koster M , Garritty C , Gallagher C , Schunemann H , Norris S
Published: August 2013

Background

Conducting systematic evidence reviews on a set of focused clinical questions has become one of the “gold standards” for development of “trustworthy” clinical guidance. Time, resource constraints, and other issues, however, may require the application of more pragmatic means for reviewing the evidence to support rapid guidance development.

Target Group, Suggested Audience

Developers of guidance for health systems and health policy settings.

Objectives/Goals

To actively engage panellists and session participants in a discussion of the role of rapid systematic reviews in the development of rapid guidance, the strengths and limitations of rapid vs. full/complete systematic review methods, and lessons learned from recent national and international rapid review and guidance efforts within health care and health policy settings.

Description of Session and Speaker Topics

Chantelle Garritty will discuss OHRI’s rapid review work with the Ottawa Hospital Technology Assessment Programme, and the Cochrane Collaboration’s new “Cochrane Response” rapid review methodology; Catherine Gallagher will present results of a pilot Cochrane Response rapid review within the GMU Health System, and organisation of an international group to develop rapid review standards; Holger Schunemann will present examples of rapid systematic reviews and their value in rapid guidance development; and Susan Norris will present on the WHO’s development of rapid guidance in the setting of urgent public health needs. Marguerite Koster will moderate the discussion.
P097 Adherence to Guidelines for Preventive Child Health Care in The Netherlands
Authors: Lanting C , Fleuren M , Broekhuizen K , Dunnink T
Published: August 2013

Background

Since 1998, several evidence-based guidelines for Preventive Child Health Care (PCHC) were developed at request of the Dutch Ministry of Ministry of Health Welfare and Sports. The Dutch Centre for Child Health oversees the development, implementation and evaluation of guidelines. Adherence to guidelines is a prerequisite for clients to receive the intended care and benefit.

Objective

To assess the extent to which professionals in PCHC adhere to key recommendations of nine PCHC-guidelines.

Methods

We undertook a survey among a representative sample of PCHC-professionals (n = 472). Guideline developers selected key activities/recommendations in their guideline. Participants indicated, for each key activity, the proportion of children they applied the activity to. From this, we calculated the proportion of all prescribed key activities the professionals had actually adhered to (i.e. completeness of use). Participants marked obstructers to adhere to the guidelines.

Results

299 (63%) professionals filled-out the questionnaire; 91 doctors, 159 nurses, and 49 medical assistants. Completeness of use varied from 28% to 98% per key activity. Lack of time and lack of client cooperation were often mentioned as obstructers.

Discussion

There is room for improvement. Problems in measuring adherence have arisen when key recommendations were not very specific.

Implications for Guideline Developers/Users

To enable future monitoring, guideline developers should be specific in formulating key activities, and make sure that, in the guideline, key activities are clearly recognisable. Assessment of adherence is recommended as a way to point out weaknesses in guidelines and their implementation.
P100 IHC Testing For Sebaceous Neoplasms: A Rapid Review Of Screening Accuracy And Application Of GRADE
Authors: Natoli J , Alvarado M
Published: August 2013

Background

Lynch syndrome is the most common form of inherited colorectal cancer (∼3% of cases). Among patients with colorectal cancer tumours, immunohistochemistry (IHC) for mismatch repair proteins has demonstrated validity and utility as a screening test for Lynch syndrome, although guidelines differ on whether screening should be limited to patients at increased risk. IHC can be performed on other Lynch-related tumours, including sebaceous neoplasms, although it is unclear if IHC should be part of routine pathologic evaluation for sebaceous neoplasms.

Objectives

To determine the clinical validity and utility of routine IHC testing of sebaceous neoplasms to inform development of guidance on screening for the Muir-Torre variant of Lynch syndrome.

Methods

An AHRQ-based analytic framework was created. We conducted comprehensive searches to identify clinical studies that evaluated IHC testing of sebaceous neoplasms as a method of screening for Muir-Torre syndrome. GRADE was used for critical appraisal.

Results

The body of evidence included 14 clinically heterogeneous studies representing approximately 300 patients. The weighted mean screen positive rate was 37%. Few studies reported measures of clinical validity, although half of the studies reported the prevalence of visceral malignancy and/or results of germline mutation testing, suggesting possible reporting bias.

Discussion

The overall body of evidence is of low quality and does not provide conclusive evidence for or against IHC testing for sebaceous neoplasms, either as a routine protocol or only among patients at high risk for Muir-Torre syndrome.

Implications for Guideline Developers/Users

Rapid evidence reviews are useful for informing guidance development on rare/genetic conditions.