bluuebunny/crossref_metadata_2025_split huggingface dataset:
P001 Collaboration on evidence synthesis to support health care recommendations: what works, what doesn’t and what’s next
Authors: Schunemann Holger 
Published: August 2013

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

The DECIDE initiative, building on the work of GRADE, is exploring methods to ensure effective communication of evidence-based recommendations targeted at key stakeholders (healthcare professionals, policymakers, and managers, and patients and the general public). DECIDE will produce strategies for communicating recommendations that are being rigorously evaluated in diverse settings, and it will support the transfer of research into practice in healthcare systems globally. The methodology is an iterative process that includes; brainstorming, user feedback through user testing, surveys, trials and implementation and evaluation in real guidelines. All this is being done across a wide range of healthcare systems in Europe, North America, and other countries.The work with healthcare professionals is developing three strategies: 1) An electronic multilayered guideline format that presents the essential information that healthcare professionals tell us they need to understand and act on a recommendation; 2) An evidence to recommendation table for users: this is a summary table with the factors for moving from evidence to a recommendation and the justification for each recommendation; 3) A decision aid template to semi-automatically build decision aids linked to guidelines to be used at the point of care. For strategies 1 and 3 DECIDE is also collaborating with theMAGIC programme.These strategies will be implemented a guideline authoring tool that is being developed from GRADEpro (called the Guideline Development Tool, or GDT), and will also be implementable in other online guideline authoring tools, allowing guideline groups to decide which of these strategies to use when developing their guidelines. The GDT will be able to facilitate the full authoring of a typical guideline and allow the updating of these strategies when needed. Guideline outputs will be made available through multiple platforms (e.g., websites, smartphones and tablets apps).These tools will help to make guidelines better suited to the information needs of health professionals, policymakers and consumers across diverse healthcare settings in Europe and elsewhere.
073 Implementing Updated US Federal Government Recommendations about HIV Prevention for Persons with HIV: A High-Impact Approach for HIV Prevention
Authors: Irwin K , Huang A , Wortley P , Patel A , Dumitru G 
Published: August 2013

BackgroundMore than one million people are living with HIV in the US; each year this number increases by ∼30,000. Nearly two-thirds of new infections occur in racial/ethnic minorities. The 2010 National HIV/AIDS Strategy emphasises cost-effective, high-impact strategies that reduce the infectiousness of HIV-infected persons over behavioural interventions for HIV-uninfected persons. To advance this Strategy, the US Department of Health and Human Services consolidated and updated existing federal government recommendations for HIV prevention for persons with HIV.ObjectivesDescribe guideline development and implementation methods.MethodsHIV prevention, care, and policy experts from CDC, HRSA, NIH and six non-governmental organisations updated existing federal government recommendations for clinicians, non-clinical prevention providers, health departments, and policy makers based on new evidence about biomedical, behavioural, and policy interventions.ResultsThe updated recommendations emphasise new, and effective, but under-used interventions: evidence-based linkage-to-care strategies, early initiation of antiretroviral therapy, interventions supporting adherence to suppress viral load and reduce infectiousness, and new behavioural interventions. To implement guidelines, CDC and HRSA are coaching “champions” in public and private sectors; disseminating decision-support tools and low-cost implementation resources, aligning federal policies with the guidelines; advising states about regulations that promote implementation; and evaluating guideline adherence and enablers through national studies.DiscussionImplementing these broad, inter-sector recommendations will require long-term engagement of governmental and non-governmental organisations. Successful implementation promises to invigorate America’s HIV prevention strategy, help reduce health disparities, and decrease the nation’s devastating HIV burden.Implications for Guideline Developers/UsersUnderstanding the benefits of consolidated guidelines that advance national policy.
081 The Endocrine Society Guidelines: Implications of Strong Recommendations with Low Quality Evidence
Authors: Britto J , Domecq J , Murad M , Guyatt G , Montori V 
Published: August 2013

BackgroundIn 2005, the Endocrine Society (TES) adopted the GRADE system of developing clinical practice guidelines. This system facilitates the formulation of evidence-based recommendations by explicitly describing the confidence in estimates (quality of evidence) and strength of each recommendation.ObjectivesTo describe and characterise the relationship between confidence in estimates and strength of recommendation in TES guidelines.MethodsWe included all published TES guidelines between 2005 (when TES started using GRADE) and 2011. Independently and in duplicate, reviewers extracted, for each recommendation: disease area, confidence in estimates and design of the studies considered, and strength of recommendation. In strong recommendations with low quality of we developed and applied a taxonomy of appropriate recommendations and identified those we considered inappropriate.ResultsMost of the 357 recommendations issued were supported by evidence warranting low or very low confidence in estimates (256, 72%). Evidence cited in support of these recommendations came exclusively from observational studies in 233 recommendations (65%). Most recommendations were strong (206, 58%); of these, 121 (59%) were supported by evidence warranting low or very low confidence in estimates. In 101/121 (83%), we identified a compelling rationale for the recommendations; in 20 (17%), we did not.ConclusionsMost TES strong recommendation based on low quality evidence are justified and appropriate, but a substantial proportion are not.Implications for Guideline DevelopersGuideline developers should carefully justify any strong recommendations based on low confidence in effect estimates.
P008 What type of evidence do we need to develop guidelines for diagnostic imaging?
Authors: Reed M 
Published: August 2013

BackgroundDiagnostic imaging (DI) is used several ways in patient management, and the evidence required for each of these roles is somewhat different. This presentation will focus on the evidence needed to develop guidelines for the use of DI in primary diagnosis.ContextGRADE states that randomised control trials of patient outcomes are the highest level of evidence for assessing diagnostic tests but also that accuracy can be used as a proxy for outcomes. DI guidelines provide two basic types of information: whether DI is indicated in a particular clinical situation and what is the best DI modality to use. In choosing a modality the accuracy of different DI modalities is important. However, the question of whether DI is indicated in a given clinical situation is at least as important, and in determining this, accuracy is less important.Best PracticeThe type of evidence which is needed for this question relates to whether DI will affect the management of the patient. If the information that DI provides is not relevant to the management of the patient then DI is not indicated. If the pre-test probability of the diagnosis is very low or very high then DI is also not indicated.LessonsWhen developing guidelines for DI first consider whether the type of information DI can provide is important in patient management. If it is, clinical decision rules are important in assessing whether the pre-test probability justifies its use. Accuracy only becomes important in determining which imaging modality to recommend.
P013 A preliminary analysis of the clinical pathways in China
Authors: Wei M , Liu M 
Published: August 2013

BackgroundClinical pathway (CP) is an application of rational process and time management for specific disease and surgery in practice. The CP was firstly introduced into China in 1990s.ObjectiveTo find the current status of clinical pathways in China.MethodsWe used word clinical pathway in title by searching the web of clinical pathway (www.ch-cp.org.cn), CNKI, etc. and collected CP on title, date, specialties and main contents, etc. Search date till July 30, 2012.Results1) 331 CPs were issued in 2009-2011, 25,503 departments from 3,467 hospitals conducted CP and public hospital accounted for 46.9% by 2011 in China. 2) The CPs was pilot implemented in 110 selected hospitals from 23 provinces on 22 specialties, such as general surgery, cardiovascular, orthopaedics, etc. 3) The contents of CP mainly include: disease and target population, diagnosis, treatment option, standard length of stay in hospital, criteria for CP entrance, preoperative evaluation, time and choice for use of prophylactic antibiotics, operation day, postoperative hospital stay recovery, discharge standard, variance and reason analysis, etc. Few CP described the sources of funding, composition of group that authored the CP and financial disclosures. 4) The major influential factors of CP implementation include: the participation of doctors and patients, explanation of the various process and documents, payment problems, hospital management, appropriate incentive mechanisms, information systems and other support policies, etc.ConclusionsClinical pathway may a tool for hospital quality management and assessment criteria of disease effectiveness-costs. More communications with doctors and patients and innovative payment methods would be better for CP implementation.
P022 Ginseng for Health Care: A Systematic Review of Randomised Controlled Trials in Korean Literature
Authors: Choi J , Choi T , Lee M , Kim T 
Published: August 2013

ObjectiveThis systematic review was performed to summarise RCTs assessing the efficacy and safety of ginseng treatment in the Korean literature.MethodThe study involved systematic searches conducted in eight Korean Medical databases. The methodological quality of all of the included studies was assessed using the Cochrane ROB tool. We included all RCTs on any type of ginseng compared to placebo, active treatment or no treatment in healthy individuals or patients regardless of conditions.ResultsIn total, 30 randomised clinical trials were included. Nine RCTs assessed the effects of ginseng on exercise capacity, cognitive performance, somatic symptoms, quality of life, and sleeping in healthy persons. Six RCTs tested ginseng compared with placebo for erectile dysfunction, while another four studies evaluated the effects of ginseng against no treatment for gastric and colon cancer. Two RCTs compared the effect of red ginseng on diabetes mellitus with no treatment or placebo, and the other nine RCTs assessed the effects of ginseng compared with placebo or no treatment on various conditions. However, the 20 newly added trials may provide useful information for future trials.DiscussionMost RCTs published in the Korean literature have not been included in up-to-date systematic reviews. Although the quality of RCTs published in the Korean literature was generally poor, this review is useful for researchers to access studies that were originally published in languages that they would otherwise be unable to read and due to the paucity of evidence on this subject.
P049 Evidence Distribution of a Comprehensive Musculo-Skeletal Guideline
Authors: Wolfkiel C , Ording J , Thiese M , Stanhope M , Harris J , Hegmann K 
Published: August 2013

BackgroundOccupational Medicine focuses on return to functionality and work, however the overwhelming majority of injuries are musculoskeletal and require very specific clinical situation evidence review. Body part areas addressed include spine, shoulder, elbow, hand/wrist/forearm, hip/groin, knee and ankle/foot. Interventions assessed include diagnostic, therapeutic and medical therapies.ObjectivesTo assess the theoretical evidence distribution of a comprehensive musculoskeletal guideline and its potential application in practice. Methods: Evidence ratings (A,B,C) were determined by expert data extraction from over 5,000 randomised controlled trials (RCT), non-RCT evidence was designated as insufficient (I). RCT evidence ratings were quantified on an 11 point scale that assessed appropriateness, biases and effectiveness. High quality evidence was defined as 8.0–11 points, moderate 4.0–7.5, and low < 4.0 points. A level evidence (Strong) was defined as 2 or more high-quality RCTs, B (Moderate) 1 high-quality or multiple moderate-quality, C (Limited) at least one study of moderate-quality. Low quality, observational or conflicting evidence was designated as Insufficient (I). A similar profile was used for diagnostic evidence recommendations. Evidence ratings were verified by independent writing panels.ResultsOnly 0% of 2500 recommendations were supported by a Limited (C) or better evidence base. When adjusting for frequency of occurrence from a claims data base, and cost was estimated in only 14% of costs were associated with quality RCT studies.ConclusionsThese data suggest that the majority of musculoskeletal clinical decisions do not have a sufficient evidence base for rules-based decision making.
P058 Developing a Youth Health Care guideline on sexual development with limited evidence
Authors: Maris S , Deurloo J , Lanting C , Kamphuis M , Vlugt I van der 
Published: August 2013

BackgroundChildren’s sexual development starts at an early age and is a very complex subject, comprising the physical but also the psychosocial development. Youth Health Care (YHC) professionals can prevent and detect problems in sexual development, and play a guiding role in stimulating sexual competency and positive sexual attitudes.ObjectivesOur goal was to develop an evidence based national YHC guideline for sexual development.MethodsThe content of the guideline is based on (inter)national guidelines, literature searches, consensus and experience. The guideline is now piloted for use in daily practice by YHC professionals. The way we handled the limited amount of evidence and the results of this pilot will be presented. We cooperated with an international centre of expertise on sexual and reproductive health and performed literature searches for a selected number of questions.ResultsThe guideline describes the (physical and psychosocial) sexual development of children from 0–19 years old, determinants of sexual health and groups at risk. Discussion In this presentation, we would like to discuss the issue of dealing with the limited amount of evidence and we will show how we handled this issue. Working together with an experienced centre was crucial. Coming to consensus in the working group and performing a pilot test in addition, is essential in gaining obtaining support for the recommendations of the guideline.Implications for Guideline Developers/UsersIn YHC not much evidence of high quality is available. Exchange of experiences will help other guideline developers dealing with this as well.
P088 Exploring Possibilities For Integration Of Results Of Research In Patient Preferences In Guideline Development: Preliminary Results Of Interviews With Several Stakeholders.
Authors: Utens C , Joore M , Weijden T van der , Dirksen C 
Published: August 2013

BackgroundThere is full awareness of the urge to integrate patient perspectives in guidelines. Active patient participation in guideline development is advocated, the passive use of research results on patient preferences is rather limited.ObjectivesTo explore ideas and opinions regarding potential barriers and facilitators for integrating research results on patient preferences in guideline development.MethodsEight interviews were held with patient representatives, guideline developers, policy-makers and researchers. Interviews were semi-structured along three themes: definition of patient preferences; consideration of research on patient preferences in guideline development and aspects of obtaining patient preferences through research.ResultsMost interviewees defined preferences broadly, using terms as ideas, values, wishes, needs, expectations and experiences. Others described preferences exclusively as comparative judgments. Interviewees had difficulties reflecting on considering patient preferences by using research results, instead of active participation. Although the general increasing focus on patient participation facilitates the use of research results, many barriers were mentioned: relevance of collective preference for individual decision-making; focus of evidence-based medicine on “hard evidence”; lack of reliable and valid data; unclear how to integrate research results into the development procedure.. Patient- and professional organisations often generate own evidence, with unclear scientific character.DiscussionThe results show which issues are important and need further clearance. Interviewees define patient preferences differently, do not believe in using such research results or do not know how to do it.Implications for Guideline Developers/UsersSeveral issues need to be addressed to facilitate the integration of research results on patient preferences in guideline development.
P096 The Quality Of Clinical Practice Guidelines Of Acupuncture
Authors: Chen H , Gu Y , Zhang X , Li G , Xu B 
Published: August 2013

BackgroundAcupuncture practice plays an important role in healthcare in China as well as in the world. 2011, the China Academy of the Chinese Medical Sciences (CACMS) published 5 Clinical practice guidelines (CPGS) of acupuncture, which were the only 5 CPGS specialised for acupuncture in China. Our research was to systematically review the quality of these 5 CPGS.MethodsWe evaluated the quality of the 5 CPGS through the guideline appraisal instrument: Appraisal of Guidelines for Research and Evaluation II (AGREE II). Four appraisers rated 6 domains separately.ResultsNone of the included 5(0%) guidelines described the systematic methods for searching and selecting the evidence, and all (100%) appraised the quality of evidence and graded the strength of recommendations. 5 guidelines (100%) reported the guideline panel which involved special methodologists, and 5(100%) mentioned updates but no one (0%) described a procedure and frequency for updating the guideline. None of the guidelines (0%) considered the patients values, and no one (0%) used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. None (0%) reported the conflicts of interests. From the assessment with AGREE II, the mean scores were very low for the domains editorial independence (2%) and applicability (8%),while the other domains were low for the rigour of development (18%), stakeholder involvement (35%), ‘clarity of presentation’ (46%) and ‘scope and purpose’ (54%).ImplicationsNow, the quantity of CPGS of acupuncture is very small. As the quality of the guidelines of acupuncture was low, they were still lots of limitations. The research in methodology of the CPGS of acupuncture still must be enhanced.
063PS Challenges and Opportunities in Low-Resource Settings: Guideline Development, Adaptation, Implementation and Performance Measurement
Authors: Huckson S , Beena M , Opiyo N , Lang E , Koster M 
Published: August 2013

BackgroundHealth care and health policy organisations seeking to improve medical care in low-resource settings with significant numbers of uninsured, medically underserved and/or low-income populations face significant challenges in developing, adapting, implementing and monitoring improvement with clinical practice guidelines.Objectives/GoalsTo provide opportunities for panel members and conference participants to exchange experiences, challenges, lessons learned, and opportunities for collaboration related to guideline development, adaptation, implementation and performance measurement in low-resource settings.Target Group, Suggested AudienceThose involved in guideline development, adaptation, implementation and/or performance measurement activities, especially in medically underserved, low-income and low-resource settings.Description of Session and Speaker TopicsThe session will include brief speaker presentations, followed by interactive, facilitated discussion between panellists and audience members. Dr. Beena will discuss development of guideline-based quality standards to decrease maternal mortality in rural settings in Kerala, India; Dr. Opiyo will discuss guideline adaptation and implementation efforts in Nairobi to improve child and newborn health; Dr. Lang will discuss the G-I-N Emergency Care Community’s efforts to support collaboration across the field of international emergency care, including adaptation of sepsis guidelines for global use in low-resource settings. Sue Huckson will moderate the discussion.