bluuebunny/crossref_metadata_2025_split huggingface dataset:
P151 Culture And Guidelines: How Cultural Differences In Treatment Approach Affect Interpretation Of Literature And Guideline Recommendations
Authors: Schwartz S , Drumheller C 
Published: August 2013

BackgroundGuideline development activity is primarily focused in Western Europe and North America. Consequently, western medical interventions and approaches are disproportionately represented among guideline developers. scepticism about cultural variations in treatment, concern of publication bias in specific regions or languages, and resulting scepticism of foreign literature compounds the problem of accurately assessing evidence and making sound recommendations. When accounting for publication bias and/or prevailing cultural paradigms, guideline developers may struggle to determine the benefit-harm ratio of alternative/complementary interventions.ContextA recent guideline development panel struggled with precisely these issues when reviewing available literature to formulate a recommendation on acupuncture therapy for Bell’s palsy patients. All physicians on the panel practiced medicine in the United States, and were unfamiliar with acupuncture therapy. Available literature came predominantly from one country with evidence of severe publication bias. The panel was unable to determine the benefit-harm ratio of acupuncture therapy, and ultimately could make no recommendation for the use of acupuncture for Bell’s palsy patients.Description of Best PracticeGuideline developers need to give careful consideration to interpretation of literature when there may be significant cultural differences in treatment approach, cultural bias among the panel, or publication bias that may affect recommendations. Transparent discussion that recognises these issues will help ensure that recommendations regarding alternative/complementary interventions are sound.Lesson for Guideline DevelopersGuideline developers need to be aware of potential bias as to how cultural differences in treatments are represented in guideline recommendations, and be mindful regarding the cross-cultural applicability of guideline content.
P154 Development of the Documentation And Appraisal Review Tool (Dart) For Systematic Reviews
Authors: Diekemper R , Ireland B , Merz L 
Published: August 2013

BackgroundSystematic reviews are the foundation for evidence-based guidelines. Rigorous standards exist, but there is wide variation in implementation, highlighting the need for a more comprehensive quality assessment tool for systematic reviews.ObjectiveTo develop a tool that sufficiently evaluates major biases relevant to experimental and observational study designs.MethodsThe Documentation and Appraisal Review Tool (DART) was developed using epidemiologic principles of study design and the following resources: Overview Quality Assessment Questionnaire (OQAQ), Assessment of Multiple Systematic Reviews (AMSTAR), the Cochrane Handbook, and the standards promoted by the Agency for Healthcare Research and Quality, and the Institutes of Medicine (IOM). DART underwent multiple rounds of testing and revisions.ResultsCompared to OQAQ and AMSTAR, DART includes two unique questions and several questions covered by OQAQ or AMSTAR but not both. OQAQ and DART had the highest reporting consistency. Four AMSTAR questions elicited inconsistent responses. Identifying reviewer rationale was most difficult using the OQAQ tool, and easiest using DART.DiscussionDART allows for documentation of reviewer rationale, facilitating reconciliation between reviewers and documentation for future updates. DART also allows for evaluation of major biases relevant to observational study designs and the assessment of standards recommended by the March 2011 IOM Standards for Systematic Review.Implications for Guideline Developers/UsersThe proliferation of systematic reviews provides guideline developers the opportunity to utilise pre-existing research to produce evidence-based guidelines. However, the wide variation in quality means developers will need to carefully assess the quality of systematic reviews using a tool such as DART.
P174 A Systematic Review Of Transcatheter Aortic Valve Implantation
Authors: Jung Y , Choi M 
Published: August 2013

BackgroundTranscather Aortic Valve Implantation (TAVI) was developed as an alternative to surgical aortic valve replacement (AVR) for patients with severe symptomatic aortic stenosis (AS) and high or unacceptable surgical risk.ObjectivesTo evaluate the safety and effectiveness of TAVI compared with AVR or standard therapy.MethodsThe searches were conducted via electronic databases including MEDLINE, EMBASE and the Cochrane Library and retrieved 1537 non-duplicate citations. Total 17 studies (2 RCT, 5 non-RCT, 10 cohort studies) were included for this review.ResultsCompared with standard therapy, TAVI significantly increased major stroke (risk ratio, 3.91; 95% CI, 1.16-13.22) in two studies, although rate of major stroke was not significantly different in the TAVI compared with surgical AVR. Compared with standard therapy in inoperable patients, TAVI significantly reduced the all-cause mortality (risk ratio, 0.045, 95% CI, 0.26-0.77) at 1 year and improved functional status (NYHA functional classification). Among high-risk patients, the mortality was not significantly different in the TAVI compared with surgical AVR. However, a RCT of 699 high-risk patients who were randomised to treatment either by TAVI or by surgical AVR reported that the all-cause mortality at 1 year was 24.2% and 26.8%, respectively and TAVI was non-inferior to surgical AVR (p = 0.44).ConclusionOn the basis of current data, we recommend that TAVI is possible treatments as an alternative to surgical AVR for patients with AS who are considered to be inoperable or high risk for surgical AVR.
P184 Including Work Participation In Dutch Multidisciplinairy Guidelines - An Overview
Authors: Bruinvels D 
Published: August 2013

BackgroundIn 2006 an innovative programme for the development of multidisciplinary guidelines (KKCZ) was started in The Netherlands. The KKCZ programme aimed to develop multidisciplinary guidelines, to facilitate collaboration between professional groups, to enhance patient participation, and to avoid duplication of efforts on a national level. Context One of the innovative aspects of the KKCZ-programme was to stimulate guideline developers to include (work) participation in the guidelines. Therefore The Netherlands Society of Occupational Medicine (NVAB) has developed a “Blueprint Participation in Guidelines” to facilitate guideline developers to include work participation in KKCZ-guidelines.DescriptionThe KKCZ-programme has led to 53 multidisciplinary guidelines. In an evaluation study the contents of eight KKCZ-guidelines and two other multidisciplinary guidelines was assessed. This was accomplished by first developing a list of process indicators describing essential steps of the Blueprint. Second, the use of the Blueprint was evaluated using this list. All eight KKCZ-guidelines were developed using the Blueprint. Because process indicators do not give information on the actual contents of a guideline, a web based survey was held among Dutch occupational physicians. 253 occupational physicians reported on the inclusion of work participation in the guidelines. The majority found that work participation was included in these guidelines. However, they also found that many of the key recommendations in the guidelines were difficult to implement.LessonsThe use of a Blueprint for guideline developers has stimulated the inclusion of work participation in multidisciplinary guidelines. However, the use of this Blueprint is no guarantee that key recommendations on work participation are implemented in daily practice.
P187 Developing A Framework And Criteria To Sort, Select And Reduce Measurement Instruments For Daily Practice In Physical Therapy
Authors: Meerhoff G , Beurskens S , Swinkels R , van der Wees P , de Graaf-Peters V 
Published: August 2013

ObjectivesThe amount and diversity of measurement instruments in the Dutch physiotherapy guidelines is too extensive: in total 111 instruments. Many of these instruments are too long and concern identical domains and concepts. The aim of this bottom-up project is to develop a framework and criteria that will guide the structure, selection and reduction of instruments for application in daily practice.MethodsThe project consist of the next steps: 1. Defining the aim of the framework and review the (inter)national literature; 2. Developing a concept framework; 3. An inventory of domains and overlap of instruments in the Dutch guidelines; 4. An inventory made by professionals of domains and concepts relevant for musculoskeletal functioning in physiotherapy and instruments used; 5. Consensus meetings with representatives of professionals and guideline developers; 6. Processing results and preparation of field tests: sorting, selection and reduction of instruments for domains and concepts by using the framework and criteria for feasibility and use in daily practice; 7. Implementation- and dissemination planning.ResultsA Conceptual framework based on the structure of clinical reasoning and International Classification of Functioning. An inventory of domains that are relevant for physiotherapy and feasibility criteria for the selection of instruments. A guide for the selection and reduction of recommended instruments in guidelines and use in daily practice.ConclusionsThe framework gives professionals and guideline developers the same structure and a clearer understanding about the selection of instruments for daily practice. It helps professionals to learn when to use which instrument for what patient.
P002 Systematic Reviews; the policy maker’s dilemma
Authors: Sarah Garner 
Published: August 2013

Evidence-based policy making calls for the use of the best available evidence to support decision-making. Traditional hierarchies of evidence interpret this as focus on RCTs with most placing systematic reviews at the top. The proliferation of systematic reviews has now led to ‘tertiary analysis’ – reviews of multiple sources of secondary analysis. However, experienced users recognise there are good and bad systematic reviews. The systematic review may not answer the exact policy question being posed and it is only as useful as good as the underpinning evidence base. Best practice would suggest new systematic review is undertaken for each policy decision. Yet there are often time constraints and funding pressures and a limited skill set. Prioritisation is therefore necessary.On a strategic level, the use of average data derived from RCTs to make decisions about individual patients is being questioned. There are multiple stratified and personalised medicine initiatives backed by funding for methods and infrastructure to support the use of observational data for comparative effectiveness research. Yet little attention has been given as to how to integrate these different types of evidence to make decisions.Dr Garner has provided technical advice to NICE for the past 12 years and in addition to consuming systematic reviews for policy decisions she is a writer and editor of systematic reviews. Dr Garner will provide insights into the policy maker’s dilemma and the scientific arguments underpinning the debate. She will share a number of initiatives at the policy level and put forward potential options for how the evidence-based medicine community can address the policy maker’s dilemma.
P199 The Challenges For An Alcohol And Drug Education Guideline For Community Health Workers
Authors: Stein A , Fernandes A , Giugliani C 
Published: August 2013

IntroductionThere is a need to train and develop a guideline for Community Health Workers (CHW) on how to tackle alcohol and drugs problem.ObjectiveTo identify the profile and mental health problems of CHW and how they manage drug problem.MethodologyA descriptive study was performed and data collected from all CHW who work at Primary Health Care of Passo Fundo (Brazil). A Self Report Questionnaire (SRQ) was collected to screen mental health on CHW and scores higher than 7 were identified as positive for mental health problem. Their knowledge about drugs was also collected using a standard questionnaire. The Project was approved by the Passo Fundo University IRB. Descriptive statistics were applied.ResultsAll 78 CHW were women, age 41.1 ± 9.6 years old, 57.7% have completed high school level, 69.2% were married and 98.7% were from lower social class. Half of the CHW were sedentaries, 32% were smokers, 93.6% did not report alcohol dependency, although 59% reported to have a member of their family as having drug or an alcohol problem. They reported that alcohol and drug is a major problem in the community. There were 29.5% of CHW who have SRQ score higher than 7. The mean grade of the knowledge test was 34%.ConclusionThere is a need to develop a guideline on alcohol and drugs for CHW. The profile of CHW had shown a high level of psychiatric problems and lack of basic information.
P211 Systematic Review And Quality Appraisal Of Clinical Practice Guidelines For The Treatment Of Patients With Acute Coronary Syndrome
Authors: Lugo L , Acosta N , Senior J 
Published: August 2013

BackgroundIn Colombia, ischemic heart disease was the leading cause of death in people over 55 years of age. In the next five years, the Colombian population over 45 years of age will triple leading to an increase in the incidence and prevalence of atherosclerotic heart disease. Under this scenario, the Colombian Ministry of Health commissioned us the development of a clinical practice guideline (CPG) for the comprehensive treatment of patients with acute coronary syndrome (ACS). Therefore, as part of this process we conducted a systematic review and a quality appraisal of the published CPGs for this condition.MethodsBy undertaking a systematic search of multiple databases, reviewing the reference lists of included studies and the input of experts, we identified CPG for ACS with and without ST elevation, published from 2005 to 2011. We assessed the quality of each guideline using the AGREE II instrument.ResultsWe identified 121 CPG and assessed the quality of 28 that met the inclusion criteria. The overall average for the 28 guides in all domains was: clarity of presentation 91%, reach and objectives 78%, methodological rigour 72%, stakeholder involvement 62%, editorial independence 72%, and applicability 44%. 11 of 28 guidelines had a low methodological rigour (score less than 60%).DiscussionThe applicability of the guideline, that is, to provide clear identification of tools to implement the recommendations of the guideline, should be strengthened in the CPG for SCA.
145WS Evidence-Based Guideline Development for Diagnostic Questions
Authors: Vella E , Yao X 
Published: August 2013

BackgroundDeveloping guidelines to inform decisions regarding diagnostic tests presents unique challenges that are not encountered when addressing intervention questions. In many cases, diagnostic studies only provide test accuracy results and lack patient outcomes; outcomes that are typically sought to make recommendations.Objectives/GoalUsing the lessons from our guideline group, the objectives of this workshop are for participants to learn practical skills related to the development of guidelines for diagnostic questions. Specifically, the following areas will be addressed: Generating an appropriate research question. Developing relevant eligibility criteria for choosing diagnostic studies. Critically appraising diagnostic studies using existing tools and quality criteria. Determining what types of recommendations can be generated when different types of evidence and information are available and to respond when the most relevant information is not available.Target Group, Suggested AudienceGuideline developers or anyone interested in how to develop a guideline for diagnostic questions.Description of the Workshop and of the Methods used to Facilitate InteractionsUsing a problem-based educational approach, the workshop will begin with a quick review of the background information and objectives, and an illustrative example will be presented. Participants will then be guided through the steps of guideline development for diagnostic questions, and given problems in each step to consider and work through in small groups. Finally, participants will develop recommendations for one or two guidelines, based on evidence from diagnostic guideline projects we have completed in our guideline group.
P219 Engaging Consumers In The Guideline Development Process – The US Perspective
Authors: Robertson P , Hussey H , Jones S 
Published: August 2013

BackgroundIn the United States, there have been increasing calls for guideline developers to engage consumers throughout the guideline development process. The Guidelines International Network (G-I-N) and the Institute of Medicine (IOM) have both released guideline development best practices encouraging consumer involvement; ranging from consumer input during the formulation of clinical questions, to serving as a guideline panel member and participating in the review process.ContextOur organisation has been developing evidence based clinical practice guidelines for nearly a decade and has incorporated consumers in the development process for over five years. By including consumers, our guidelines now feature more patient-centred recommendations; establishing a more balanced discussion of patient preferences and improving how we assess benefits and harms.Description of Best PracticeTo more readily identify consumers for guideline development, our organisation has built a collaborative relationship with a consumer advocacy alliance. Through this relationship, we have been able to support two consumer advocates as full members on each guideline panel. To assist their participation, we provide education about our guideline development process, and outline the expectations of their involvement throughout the process.Lessons for Guideline DevelopersOur experience with consumer engagement can serve as an example for other US guideline developers. Consumers can bring invaluable insight and perspective throughout guideline development and have substantially improved our guidelines. We believe consumer participation will become increasingly important in the coming years, particularly as guideline developers move towards a standardised approach to development.
P224 Adapting Guidelines with Conflicting Recommendations: The Case of Microscopic Asymptomatic Microhematuria
Authors: Whittaker J , Loo R 
Published: August 2013

BackgroundExisting clinical practice guidelines (CPGs) conflict on the best approach to the work-up of patients with asymptomatic microscopic hematuria who are at low risk of urinary tract cancer. Consequently, while adapting existing CPGs to a local context can be an attractive alternative tode novodevelopment, when there are conflicting guidelines, disagreement with recommendations, or missing critical outcomes, potential time and resource gains are often minimised due to the need for additional evidence assessment and stakeholder consensus building activities.ContextTo reconcile conflicting recommendations and address gaps in evaluation of critical outcomes, a Guideline Development Team (GDT) in a regional health care organisation used existing CPGs and systematic reviews, supplemented by additional evidence reviews, to develop recommendations for asymptomatic microscopic hematuria.Description of Best PracticeBased on review of evidence synthesised in external guidelines, supplementalde novoevidence reviews on critical outcomes, and risk assessment analysis of patient data, the GDT reached consensus on recommendations that differed from external guidelines, concluding that asymptomatic hematuria patients without risk factors were at sufficiently low-risk for urinary tract cancer to safely eliminate multiphase CT urograms from most urologic evaluations. Guidelines to reduce unnecessary CTs and radiation exposure in low-risk patients were developed, and knowledge transfer interventions aimed at the practitioner and healthcare system levels were implemented.Lessons for Guideline DevelopersWhen adapting external guidelines with conflicting recommendations and gaps in critical outcomes, additional evidence searches, data analysis, and consensus building can negate anticipated gains in time and resources expected from guideline adaptation.
P225 The Development Of Evidence Based Guidelines For Opioid Pain Treatment
Authors: Effiong A , Hegmann K , Thiese M , Wolfkiel C , Ording J , Harris J , Schwei K 
Published: August 2013

BackgroundOpioid analgesic-related deaths more than tripled in the US from 1999 through 2006. According to the CDC, 27,000 unintentional drug overdose deaths occurred in the United States in 2007; the most potent epidemic in the past 100 years.ObjectivesTo develop opioid guidelines to improve opioid pain treatment and reduce fatalities.MethodsA systematic literature search (including Google Scholar and Medline) was conducted. Randomised controlled trials (RCTs) were categorised into acute, subacute (1–3mo), chronic, and mixed chronicity. The quality of RCTs was determined using previously developed guideline scoring methods; low quality (3.5 or less), moderate quality (4.0–7.5), and high quality (8.0–11.0).ResultsA total of 153 RCTs were identified; 11 acute, 2 subacute, 137 chronic, and 3 of mixed chronicity. Of the 11 acute pain RCTs, 1 was low quality, 6 moderate quality, and 4 high quality. Both subacute pain RCTs were moderate quality. Of the 137 chronic pain RCTs, 28 were low quality, 95 moderate quality, and 14 high quality. The RCTs with mixed chronicities were of moderate quality. All trials were under 6 months, with most under 4-weeks duration, precluding statements on long-term safety.DiscussionThese opioid guidelines provide more informed recommendations for prescribing opioids for pain treatment with details to be presented.ImplicationsThese guidelines may have considerable implications among prescribing health professionals.
P226 A Multidisciplinary Approach To Creating Behavioral Health Guidelines: Challenges Of Adhering To IOM Standards
Authors: Halfond R , Bufka L , Kurtzman H , Galper D , Beattie S 
Published: August 2013

BackgroundIn 2010 our organisation began creating evidence-based clinical practice guidelines for behavioural health, focusing initially on depression, PTSD, and obesity, following emerging IOM standards.ContextSelected challenges in five areas: 1. Terminology. For many years, our organisation used guideline terminology that was inconsistent with the field. 2. Representation. Given the diverse types of professionals in behavioural health and the breadth/depth of each topic, attaining sufficiently diverse panel membership has been challenging. 3. Stakeholders. Obtaining the patient perspective has been challenging, particularly given the stigma and privacy concerns often associated with mental health. 4. Systematic Reviews. The high cost of developingde novosystematic reviews, especially for large scope topic areas, is limiting. 5. Education. Professionals have varying knowledge and lexicons for the process, requiring education, particularly surrounding non-financial conflicts of interest.Description of Best Practice•Terminology- Implemented organisation-wide systemic change in lexicon via change in organisation policy and routine dissemination. •Representation- Used multi-step consensus nomination process to assemble multidisciplinary panels. •Stakeholders- Using multi-tiered approach to involve stakeholders via Consultation, Participation, and Communication models and outreach to mental health peer support programmes. •Systematic Reviews- Applied Delphi poll method in topic scoping/refinement to work within organisational resources. Other mechanisms to enhance resources include topic nominations to AHRQ, possible organisational partnerships, and developing products from guidelines. •Education- Creating a series of self-study educational modules on guideline development.Lessons for Guideline Developers and OthersOur challenges and resolutions could be helpful to others in guideline development.