bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

BackgroundThere 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.ObjectivesTo compare the Canadian Task Force on Preventive Health Care’s methods with the standards outlined in the IOM.MethodsThe 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.ResultsThe 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.DiscussionNew processes put in place to address the differences between CTFPHC methods and IOM standards will be explored.Implications for Guideline Developers/UsersComparing 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

BackgroundGuideline 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.ObjectivesThe objectives were to develop a tool that would allow interpretation of the previous CTFPHC grading system to GRADE to enable comparison of guidelines.MethodsA 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.ResultsAn 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/UsersThe 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

BackgroundWe 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.ContextThe 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 PracticeWe 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/UsersA 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

BackgroundManuals 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.ObjectiveTo assess the characteristics of MT for developing CPG from different developers in English and Spanish.MethodsWe 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.ResultsTwenty 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.DiscussionThere 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/UsersIt’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.
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

BackgroundIt 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.ObjectivesWe aimed to determine whether physician-oriented PEMs are created in accordance with design principles.MethodsWe 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.ResultsThough 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.DiscussionDesign 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/UsersThose 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

BackgroundThe 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.ObjectivesAssess the adherence to the recommendations of CPGs by health professionals internationally.MethodsA systematic review of the literature in PubMed was conducted (MeSH term ‘Guideline Adherence’, filters: published in the last 5 years, meta-analysis).ResultsOut 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.DiscussionThe 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/UsersThe 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

BackgroundThe 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.ObjectivesTo explore the experiences of the AT9 methodologists and content experts with the COI policy.MethodsA descriptive qualitative study: We conducted two rounds of semi-structured interviews with 15 participants and presented the results to the remaining 4 for verification.ResultsMethodologists 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.DiscussionAfter 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/UsersThe 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

BackgroundEvidence-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.ContextOur 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 PracticeHandbook 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 UsersVisualising 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

BackgroundThe 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.ObjectivesFacility 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.ResultsOnly 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.ConclusionsAt 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

BackgroundIn 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.ObjectivesTo provide insight into the usefulness of national guidelines in the development of RAs.MethodsQualitative 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.ResultsNational 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.DiscussionNational guidelines have an important role in the development of RAs. National guidelines should pay more attention to recommendations for regional collaboration.ImplicationsAfter 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

BackgroundConducting 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 AudienceDevelopers of guidance for health systems and health policy settings.Objectives/GoalsTo 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 TopicsChantelle 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

BackgroundSince 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.ObjectiveTo assess the extent to which professionals in PCHC adhere to key recommendations of nine PCHC-guidelines.MethodsWe 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.Results299 (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.DiscussionThere is room for improvement. Problems in measuring adherence have arisen when key recommendations were not very specific.Implications for Guideline Developers/UsersTo 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.