bluuebunny/crossref_metadata_2025_split huggingface dataset:
P071 Guidelines For Guideline Developers: A Systematic Review Of Grading Systems For Medical Tests
Authors: Gopalakrishna G , Langendam M , Scholten R , Bossuyt P , Leeflang M 
Published: August 2013

BackgroundDevelopment of guidelines for medical tests are challenging given the indirectness of evidence on patient outcomes. We compared grading systems for medical tests in terms of basic guideline quality requirements and on how they use indirect evidence.MethodsWe used a systematic search to identify grading systems specific to medical tests in PubMed, professional guideline websites and handsearching back references of key articles. Using the AGREE instrument as a starting point, we defined two sets of characteristics to describe these systems: process and methodological ones. Process characteristics were features related to the guideline development process. Methodological characteristics were defined as features relating to how evidence is gathered, appraised and recommendations development. Data was extracted in duplicate and differences resolved through discussion.ResultsTwelve grading systems were included. Process characteristics least often addressed were whether the system was piloted (3/12) and funder information (3/12). Methodologically, developing a clinical scenario, care pathway and/or analytical framework, having explicit criteria for appraising and linking indirect evidence, and having explicit methodologies for translating evidence into recommendations were least frequently addressed. Five systems at most addressed these to varying degrees of completeness.Implications for Guideline DevelopersThere is a need for standardisation of basic guideline features a grading system should address. No one system adequately addressed the complexity of gathering, assessing and linking different bodies of evidence. There is a need for critical appraisal of these features in each system and for targeted user testing among guideline developers.
P092 Does The Addition Of Symbols Make Guidelines Recommendations Clearer? Results From An Online Survey
Authors: Nast A , Rosumeck S , Jacobs A , Sporbeck B 
Published: August 2013

BackgroundA recent study has shown that the perceived meaning of wordings in recommendations such as “should” or “must” can vary among guideline users. In addition to the wordings, many guidelines use graphic symbols such as arrows or smileys to support their recommendations.ObjectivesTo determine whether such symbols influence the perceived meaning of the recommendations or may help to reduce variation in the perception of the meaning between different guidelines’ users.MethodsWith the help of an online-survey, using a visual analogue scale (0–100), participating physicians from different specialties were asked to express their perceived levels of obligation when confronted with different guidelines recommendations in combination with different symbols.Results269 physicians participated, the addition of a “single arrow” or “double arrow” to the recommendation did not lead to relevant changes in the perceived obligation expressed by the recommendation (median: soll/shall: 83 vs. 87; “sollte/should”: 77 vs. 78). In comparison to the prior study, variations in the interpretation of typical guideline wordings were not reduced if symbols were used additionally.DiscussionIn this study, the impact of symbols on the understanding of a guidelines recommendation was limited. Important methodological limitations apply but this study questions the impact of symbols to clarify a recommendation’s message. However, visual aids are likely to be very important for users to help to identify recommendations within larger text document and therefore make guidelines easier to use and implement.
P111 A Workflow Checklist for Improving Management of the Guideline Development Process
Authors: Haller M , Nagler E , van der Veer S , Nistor I , Bolignano D , Van Biesen W 
Published: August 2013

BackgroundKeeping track of progress and meeting deadlines can be difficult for organisations that simultaneously develop multiple guidelines involving multiple systematic review teams.ObjectivesTo improve planning, organising and managing of guideline development projects by creating a standardised workflow checklist.MethodsIn a one-day meeting, the five guideline development methodologists, the chairman and the editorial assistant identified the main steps involved in the guideline development process. For each step, we identified specific tasks and ordered them chronologically. All decisions were made based on group consensus. The identified steps and tasks formed the basic elements of the workflow checklist.ResultsWe identified the need for two separate checklists per guideline development project; one for overall workflow and one for each clinical question covered by the guideline. The overall guideline development workflow checklist comprised 42 tasks organised in 11 sequential steps, including items such as topic selection, composition of the guideline development group, and framing the questions. For each clinical question we identified 27 tasks organised in 8 sequential steps, excluding steps already covered by the overall workflow.DiscussionThis workflow checklist represents a first step in developing a standardised project management strategy to improve efficient management of the guideline development process. Further development of this tool involves selecting appropriate software for practical implementation applicable not only for our own means but also for those of other groups.Implications for Guideline Developers/UsersWe believe developing a standardised workflow checklist will improve efficient management of guideline development and allows transparent and up-to-date communication of its progress.
P129 Estimating Service Capacity for Commissioning an Anticoagulation Service in Line with NICE Guidance in the NHS, England
Authors: Moran D , Griffiths P , Moore V 
Published: August 2013

BackgroundImproving quality, patient outcomes and cost effectiveness is an assumed aim of health and social care commissioning. A key aspect for commissioners in the planning phase of the commissioning cycle for an anticoagulation service, in line with NICE guidance, is the ability to estimate the level of service that will be required in order to appropriately commission or decommission services.ObjectivesEstablish the level of integration of information, alongside clinical and management knowledge, required to successfully calculate appropriate service levels when commissioning or decommissioning an anticoagulation services in the NHS.MethodsA critical appraisal of clinical research studies, epidemiological data, NHS activity data and other information was carried out in combination with clinical and NHS management oversight to inform an estimate of service levels for an anticoagulation service. A systematic literature search of 3 electronic databases, Medline, Embase and Cochrane was carried out. Routinely collected activity data was reviewed through a sample of GP practice systems for primary care information and hospital episode statistics for secondary care information. Healthcare professionals and commissioners with a specialty or interest in an anticoagulation service were consulted.ResultsInterim results suggest integration of multiple information sources in combination with clinical and management knowledge produces more robust estimates of service levels for an anticoagulation service.DiscussionThe accuracy, and therefore the utility of estimates of service levels for an anticoagulation service will be improved by information linkage, and by using intelligence from multiple sources. This approach could be applied to estimating service levels for other commissioned services.
P149 Development Of Evidence Based Guidelines For The Treatment Of Seizures And Epilepsy
Authors: Ott U , Hegmann K , Thiese M , Passey D , Caughey W , Carter Z 
Published: August 2013

BackgroundSeizures in the past year affect approximately 20% of patients with epilepsy. Vehicle crashes are also well associated with epilepsy. Different requirements for drivers with epilepsy exist across state, regional and national jurisdictions. However, a widely accepted threshold for risk of crash of 1% is common in safety sensitive positions.ObjectivesTo develop evidence based guidelines for the treatment and return to work/driving for those with a history of seizures and epilepsy.MethodsA panel of 5 experts developed a set of specific questions regarding the prevalence of seizures and risks of recurrence. A research team developed a search strategy which included utilisation of specific search terms for each question. A systematic literature review was performed. Databases searched included Pubmed, EBSCO and Google Scholar.Results246 research articles were reviewed. For individuals with a history of a single, unprovoked seizure, evidence supports a minimum of 82.02 months (6.8 years) off anti-seizure medication and seizure free. A worker with a history of seizures should have a minimum of 10 years off anti-seizure medications and seizure free prior to returning to a safety sensitive position.DiscussionThese analyses provide guidance for the treatment of seizures and epilepsy and return to safety sensitive positions. Implications The breadth of safety sensitive jobs includes fork lifting driving, truck drivers, bus drivers, overhead crane operations, and the airline industry.
P156 Clinical Practice Guidelines In Paediatrics In The Czech Republic
Authors: Klikova K , Licenik R , Mihal V 
Published: August 2013

BackgroundHigh quality clinical practice guidelines in paediatrics (CPGP) should be developed with standard and rigour methods. There are specialty societies in the Czech Republic developing guidelines of variable quality using different methods of development, adaptation, implementation and evaluationObjectivesThe aim of this study was to analyse the methods of development, adaptation, dissemination, implementation and evaluation of Czech CPGP.MethodsThe database of all CPGP was developed in 2011 and updated on a regular basis. The three types of specialty societies were decided: 1. Paediatric and neonatology societies 2. Other specialty societies developing CPGP 3. Specialty societies developing guidelines with relevant recommendation for paediatric care. The search and analysis of open resources were made to find the information about guideline methodology. Questionnaire survey to get the missing information was made.ResultsThere are 113 specialty medical societies in the Czech Republic. 31 societies developed 140 CPGS. 31% developed by paediatric and neonatology societies, 51% by other societies and 18% by societies developing CPGs with some paediatric recommendations. The questionnaire survey is ongoing.DiscussionThe methods of development CPGP in the Czech Republic is of low quality. There are no explicit strategies for dissemination, implementation and evaluation.Implications for Guideline Developers/UsersThe methods of guideline development need be standardised and should be of highest possible quality. There is already high quality methodology in the Czech Republic developed by National Reference Centre, which has been using by different specialty societies and could be used for CPGP.
P162 Rigor of Development Of Clinical Practice Guidelines In Dentistry
Authors: Brignardello-Petersen R , Carrasco-Labra A , AbdelAziz A , Hartshorne J , Azarpazhooh A 
Published: August 2013

BackgroundSome reports have shown the varying quality of clinical practice guidelines (CPGs), but this aspect has not been explored in the field of dentistry. With a growing number of guidelines in dentistry being published every year, and an increase in dentist’s interest to inform their practice with such documents, it is relevant to learn whether their development process has been appropriate.ObjectivesTo assess the rigour of development of evidence-based CPG’s in dentistry.MethodsWe searched Pubmed, EMBASE, and the National Guideline Clearinghouse among others. We included all evidence-based CPGs with explicit clinical recommendations, published since 2004 in English. Two independent evaluators assessed the guidelines using the “Rigour of development” domain of AGREE II.ResultsA total of 73 CPGs were assessed. The mean score of the rigour of development domain across all guidelines was 34.54% (SD=19.18%). The items that scored the lowest were the description of a procedure for updating the guideline and the strengths and limitations of the evidence; whereas the items best rated were the explicit link between the evidence supporting the recommendations and the pondering of benefits, harms and risk for formulating the recommendations.DiscussionCPGs aim to support clinical decision-making, and thus they can impact the quality of health-care. Thus, the rigour in their development is a relevant aspect to consider. There is a lot of room for improvement in this regard in CPGs in dentistry.Implications for Guideline DevelopersGuideline developers in dentistry should enhance the methodology when creating new guidelines or updating existing ones.
P180 Systematic Review Of Continuous Interscalene Brachial Plexus Block For The Shoulder Or Humerus Surgery Patients
Authors: Choi M , Ko Y , Yeon J , Oh H , Han S 
Published: August 2013

ObjectiveThe safety and effectiveness of continuous interscalene brachial plexus block for the shoulder or humerus surgery.MethodsContinuous interscalene brachial plexus block for the shoulder or humerus surgery patients was assessed using 8 domestic databases including Korea Med and Ovid-MEDLINE, Ovid-EMBASE and Cochrane Library. Through a search strategy, a total of 348 works were identified and total of 21 works were included in the final assessment. Two reviewers screened all references independently, for assessing included articles quality and extracted data.ResultsSide effects of the drug were reported to have occurred less or at similar level in the intervention group than the control group, although procedure related complications were reported to have occurred more often in the intervention group compared to the control group. The average pain score following the surgery was reported to be significantly lower or similar for the intervention group compared with the control group. The intervention group also had lower or similar level of quantity of additional analgesics used in comparison to the control group. In addition, the intervention group displayed either similar or higher level of satisfaction of patients on the pain control method.ConclusionContinuous interscalene brachial plexus block was assessed to be a safe and effective technology when used for the purpose of reduction in pain in shoulder or humerus surgery patients since it was found to be relatively safe when compared with the existing procedures, and similar or more effective in terms of pain control and usage of additional analgesics in comparison to the existing pain control methods.
P217 The Effect Of Print Or Online Educational Materials For Primary Care Physicians: A Systematic Review
Authors: Grudniewicz A , Rodseth R , Kealy R , Rudoler D 
Published: August 2013

BackgroundPrint and online materials such as guideline summaries are commonly used to distribute evidence to primary care physicians; they are easy to implement and scale across many primary clinics.ObjectivesWe sought to determine: 1) if providing primary care physicians with print and online educational materials has an effect on physician behaviour or on patient outcomes, 2) how these materials were developed, and 3) whether design attributes impact outcomes.MethodsWe systematically identified studies that reported a print or online educational intervention for primary care physicians. Studies were identified by searching four electronic databases, scanning reference lists, and contacting experts. A sub-analysis was conducted to collect data on how these materials were developed and on their use of design principles.ResultsThirty studies met eligibility criteria after full-text screening. Studies targeted physician advice-giving behaviour, diagnostic procedures, prescribing behaviour, change in knowledge, and clinical patient outcomes. Results suggest that print and online materials targeted at primary care physicians have little to no effect on outcomes.DiscussionPrint and online educational materials provided to primary care physicians have little effect on physician or patient outcomes. This is concerning as they are a common method of disseminating evidence. Most studies do not describe how interventional materials were developed or whether design principles were applied.Implications for Guideline Developers/UsersDesign principles should be considered when developing evidence-based materials and the development processes should be described in order to determine if better designs influence uptake and use of evidence.
P227 Capacity Enhancement Through A Distance Learning Course For Primary Health Care (Phc) Professionals: The First Approach For A Guideline Development
Authors: Stein A , Wendland E , Pinto M , D’Avila O , Dahmer A 
Published: August 2013

BackgroundThere is a need to develop strategies for guideline development. It is essential to learn educational needs of health professionals who work at PHC level. Evidence based guidelines should be applied for these health professionals taking into account their context.ObjectivesTo identify skills and resources of primary health professionals in a distance learning course (UNASUS from UFCSPA – Federal University of Health Science of Porto Alegre).MethodsA quasi-experiment study had been carried out and the inclusion criteria were dentists, nurses and family physicians that provide PHC. Data had been collected in the beginning of the distant course, as a baseline and one year after the enrollment. This course enables specialisation for primary health care. A web-based questionnaire was applied to these subjects.ResultsThe sample size was 251 eligible subjects. The mean age of the responders was 35.2±8.27DP (range: 25–68), from 48 different towns from South Brazil. The majority (88.8%) were women and 67.3% had nurse degree. 94% of the subjects reported that the distance course was a good strategy to change their practice. Interactive activities resembling their daily routine had a higher impact.DiscussionThe results have shown that distance learning is effective to enhance primary health care professional’s behaviour, especially when simulating real cases.Implications for guideline developers/usersThe present research has identified that it is essential to improve access to evidence-based clinical practice guidelines and resources across Brazil, and to increase skill capacity in using evidence to inform clinical decision-making.
138WS The US Institute Of Medicine (IOM) Criteria For Trustworthy Guidelines, The National Guideline Clearinghouse (NGC) And You: A Workshop On NGC’s Revised Inclusion Criteria
Authors: Nix M , Jue J , Haskell L , Cunningham S , Coates V 
Published: August 2013

BackgroundThe National Guideline Clearinghouse (NGC), funded by the Agency for Healthcare Research and Quality, will adopt the 2011 IOM revised definition of an evidence-based clinical practice guideline (CPG) and change its criteria for inclusion; thereby raising the bar CPGs must meet in order to be included. Systematic evidence review and benefits and harms of care options are the key changes.Objectives/GoalAt the end of the workshop, participants will be able to recognise the new aspects of the inclusion criteria; understand how the criteria will be applied; apply them to CPGs provided by instructors and estimate eligibility for inclusion; and apply this learning to their organisation’s readiness to submit new/updated guidelines to NGC.Target Group, Suggested AudienceCurrent and future CPG developers; CPG implementers and disseminators; researchers and clinicians.Description of the Workshop and of the Methods used to Facilitate InteractionsThis workshop will discuss the revised NGC inclusion criteria and describe specific requirements around a systematic review underpinning the CPG as well as descriptions of benefits and harms. The workshop will include a didactic portion, an interactive exercise, and a take-away checklist. There will be ample question and answer opportunities. Instructors will distribute guidelines and materials and participants will determine eligibility for inclusion in NGC. A checklist will enable participants to understand the changes needed to ensure inclusion of their CPGs in NGC.
P247 A Simple Guideline Appraisal Instrument Based On IOM Standards
Authors: Mitchell M , Leas B , Lavenberg J , Goldmann D , Umscheid C 
Published: August 2013

BackgroundScales like AGREE provide a systematic means for appraising guideline quality, but they are lengthy, emphasise methodology over practicality, and are best applied by guideline experts.ObjectivesCreate a short instrument for guideline appraisal, based on widely accepted standards.MethodsThe Institute of Medicine (IOM) identified eight principles that make a guideline ‘trustworthy’. We adapted each principle into an item graded ‘A’, ‘B’, ‘C’, or “NR” (not reported). Guideline assessments are presented as a grid rather than a single score, with each row representing an item, each column a guideline, and cells coloured green, yellow, red or white to reflect the above grades, respectively. Concordance tables mapping AGREE and G-I-N standards to IOM domains were also created.ResultsPiloted use of the tool suggests it can distinguish guidelines developed using weak methods and those that are poorly documented. Grids highlight guideline strengths and weaknesses, as well as guidelines that are more trustworthy than their comparators. The concordance table found that AGREE lacks standards for guideline currency and updating, while IOM lacks standards for resource implications.DiscussionOur pilot use of this instrument suggests that while the overall trustworthiness of guidelines is important, using IOM domains to understand sources of guidelines’ weaknesses can help organisations select guidelines best suited for their needs. Further work will examine our instrument’s reliability across users with different levels of expertise.Implications for Guideline Developers/UsersPilot use of this tool suggests it can be applied by clinicians and administrators who have limited training and time.