bluuebunny/crossref_metadata_2025_split huggingface dataset:
P275 Guideline-Based Quality Indicators For Cardiac Rehabilitation Of Patients With Ischemic Heart Disease In Japan: Use Of A Modified Delphi Technique For Indicator Development
Authors: Ohtera S , Ueshima K , Nakayama T 
Published: August 2013

BackgroundCardiac rehabilitation improves quality of life and mortality in patients with ischemic heart disease, but it is underutilised and quality in practice is unknown. Quality indicators are increasingly used to quantify healthcare quality. In Japan, however, such indicators for cardiac rehabilitation have not been developed yet.ObjectivesThe purpose of this study was to develop quality indicators considering clinical circumstances in Japan.MethodsTo determine quality indicator candidates, we systematically searched electronic databases and reviewed existing related guidelines indicators. Using a modified Delphi technique, a domestic multidisciplinary panel of ten experts was assembled for a face-to-face meeting. After panel members rated the candidates individually on a questionnaire, a final consensus was determined for each measure.ResultsA literature search identified 894 clinical guidelines and 38 existing quality indicators. Some of them were excluded due to inconsistency with a priori criteria. Then, 26 guidelines and 16 indicators were selected to create a list of indicator candidates. The panel discussed 27 candidates: six indicators were adopted, one indicator was not adopted, 20 indicators were reconstituted into four indicators, and three new additional indicators were suggested. Consequently, 13 indicators were chosen.DiscussionGuideline-based quality indicator development may be time-efficient and resource saving, but further methodology research is needed. We are planning a pilot test of these indicators at multiple facilities.Implications for Guideline Developers/UsersGuideline developers should take potential use as quality indicators into account for making recommendations.
P282 Management Of Patients With Bipolar Disorder: An Adapted Clinical Practice Guideline >From King Saud University, King Khalid University Hospital, Clinical Practice Guidelines Committee, Faculty Of Medicine, Department Of Psychiatry
Authors: Abahussain E , Fatani S , Altuwarigi M , Al-Ansary L , Amer Y 
Published: August 2013

ObjectivesAdaptation of CPGs for Treatment of Bipolar disorder in King Khalid University Hospital, Psychiatry DepartmentMethodsThe ADAPTE process for CPGs adaptation. Results: the final decision of the panel after full assessments of 3 source CPGs was full acceptance (adoption) of the Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder (updated 2009).ResultsExamples of Recommendations Lithium, valproate, and several atypical antipsychotics monotherapy is recommended to be used as first line treatments for acute mania, combination pharmacology with antipsychotics and mood stabiliser can be used as first line option. Paliperidone monotherapy and asenapine alone or in combination with lithium or divalproex can be used as a second line treatment; tamoxifen is suggested as a third line augmentation option. For the Management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI bupropion are first-line options. Adjunctive modafinil is recommended as a second-line option. lithium, lamotrigine, valoproate and olanzapine are first-line options for maintenance treatment of bipolar disorder.ConclusionNew data support the use of quetiapine monotherapy and adjunctive therapy for the prevention of manic and depressive events, aripiprazole monotherapy for the prevention of manic events, and risperidone long-acting injection monotherapy and adjunctive therapy, and adjunctive ziprasidone for the prevention of mood events.
P283 Development Of A Clinical Practice Guideline On Intravenous Therapy Using Grade: Integrating Available Evidence And Expert Opinion
Authors: Briones E , Marín-León I , Buzón M , García-Aguilar R , Romero-Tabares A , Romero-Alonso A , Medrano J. , Calderón E. , López L. 
Published: August 2013

BackgroundIntravenous therapy is one of the most frequently used interventions in health care, with increasing complexity and duration of treatments. A clinical practice guideline (CPG) on this topic was developed within the framework of the Spanish programme (National Health System) aimed to provide recommendations on intravenous therapy best practice.ObjectiveTo describe CPG development process, considering methodological issues, such as updating and adapting existing guidelines and expert inputs.MethodsUsing the GRADE approach, an evidence synthesis was developed for each clinical question, including adoption or update of valid recommendations from selected guidelines. Expert panel followed methodology proposed by Jaesckeet alwith predefined consensus criteria to categorise recommendations.ResultsAfter assessment with AGREE II instrument, 3 guidelines were considered highly recommended and selected for adaptation/updating. Evidence synthesis and recommendations for each 63 initial clinical question were drafted and sent to the expert panel who voted individually. Areas of disagreement were identified and discussed in a face-to-face meeting. After the second voting round 55 recommendations remained, of which 27 were rated as strong, 12 as weak and 14 as good practice recommendations. Six of them were adopted/updated from previous guidelines. In 2 cases there was no agreement in the panel and no recommendation was issued.DiscussionGRADE proved to be a useful method to develop a complex guideline, incorporating evidence from previous guidelines and expert opinion. The method was well accepted and followed by the panel and improved the elaboration of recommendations.
P284 A Survey Of The Updating Of Clinical Practice Guidelines In China
Authors: Chen Y , Wang X , Wu Q , Wang Q , Wei D , Yao L , Liang F , Wang M , Yang K 
Published: August 2013

BackgroundClinical Practice Guidelines (CPGs) should be updated when new evidence suggests the need for modification of clinically important recommendations. Some guideline handbooks suggest that CPGs should update every 2 to 5 years. Little is known about the updating of CPGs in China.ObjectivesTo investigate the current situation of the updating of CPGs in China.MethodsWe searched WangFang, VIP, Chinese National Knowledge Infrastructure (CNKI) and Chinese Biomedical Literature Database (CBM) up to December 2012. And then we screened all included papers.ResultsA total of 380 Chinese CPGs were included. There were 345 of guidelines (91%) had not been updated. 35 (9%) were updated and the average update cycle of them was 5.6 years(from 1 to 9 years). No guideline described the details of methods of uptodate .ConclusionsUpdating the CPGs is important for the better dissemination and utilisation. But in China, most of the CPGs had never been updated, and the average update cycle (5.6 years) of the updated is longer than international standard (5 years). We suggest Chinese guideline developers should pay more attention to the updating the guideline in time.
P289 Variability In Guidelines Recommendations For Screening Of Gestational Diabetes Mellitus. A Systematic Review
Authors: Villanueva G , Bayón Yusta J , López-Argumedo M 
Published: August 2013

BackgroundGestational diabetes mellitus (GDM) is a frequent complication in pregnancy, however there is lacking agreement on international CPG on the best screening strategy: whom, when and how to screen. Following the HAPO study, the International Association of Diabetes and Pregnancy Study Group (IADPSG) recommended a new strategy consisting on a 1-step 2-hour 75 g. oral glucose tolerance test.ObjectivesTo systematically review the evidence that compares alternative tests for diagnosis of GDM, in terms of maternal and infant health and costs.MethodsMEDLINE, EMBASE, EBM reviews and NHS EED were searched. Studies comparing the IADPSG guidelines with other strategies were retrieved. Besides, recommendations currently in place in different countries were summarised.ResultsEleven studies were selected. The results showed that the IADPSG criteria nearly threefold GDM prevalence. Women who fulfilled IADPSG criteria but were normal using other criteria experienced significantly higher adverse outcomes (macrosomia, preterm delivery, neonatal hypoglycaemia and pre-eclampsia). Although the IADPSG screening strategy was more costly, considering the long-term maternal benefits and the neonatal outcomes it might be cost-effective.DiscussionImplementing the IADPSG criteria will increase GDM diagnosis and this may pose a strain on health care systems, but it is also an opportunity to reduce adverse outcomes for mother and child. In fact, the IADPSG strategy appeared to be cost-effective strategy under certain conditions. Further large well-designed trials are needed to determine the best strategy.Implications for Guideline Developers/UsersConsidering the high inconsistency across guidelines the new IADPSG screening strategy may outdate current strategies proposed on CPG.
P291 Is The Training Provided To Professionals Caring For People With Alzheimer’s Disease Adequate According To CPG Recommendations?
Authors: Villanueva G , López-Argumedo M , Reviriego E , Aguirreche Ollo E , Gómez Poveda C , Elizondo A , Galnares-Cordero L , Fuentes Gutiérrez R 
Published: August 2013

BackgroundDespite the rapid increase in the knowledge of epidemiology, genetics, risk factors and underlying neuropathological mechanisms of Alzheimer’s disease (AD) and the rising number of consensus statements and guidelines for its diagnosis and treatment, little has been done concerning the training of the involved professionals. In particular, the European ALCOVE project (Alzheimer COOperative valuation in Europe) has indeed addressed this issue. Therefore there is a need to assess to what extent professionals in the Basque Country are receiving the recommended education.Objectives1. To compare the current training practices in dementia in the Basque Country with the recommendations proposed by ALCOVE. 2. To propose region-specific recommendations on the education of professionals working with patients with AD (neurologists, psychiatrists, primary care providers, nurses).MethodsA questionnaire (both electronic and paper version) was distributed to over 2,000 professionals in the Basque Country in early 2013. The results will be compared with the data arising from the ALCOVE project.ResultsCollected data is currently being analysed and final results will be available for presentation at GIN.DiscussionAvailable guidelines recommend that professionals caring for patients with AD and their families should receive formal education and professional training. However, existing educational programmes might not adhere to these recommendations. Also there might be barriers for these programmes to be correctly implemented.Implications for Guideline Developers/UsersSpecific training in dementia should be included in the medical schools’ curriculum in every country given that AD affects an ever increasing number of elderly people worldwide.
P295 Evaluation Of French Microbiology Laboratories Practices Concerning Antibiotic Therapy And Antimicrobial Resistance
Authors: Durocher A , Vernet-Garnier V , Cornille M , Delzenne M , Methenni M , Rousseau D , Van Hecke E 
Published: August 2013

BackgroundGuidelines on prevention of bacterial resistance and quality of microbiology labs have been promoted by HAS.ObjectivesAnalysis of implementation of guidelines in 2011 versus 2009.MethodsChecklists for practices of 230 representative hospital labs.ResultsBetween 2009 and 2011, there was an increase in (i) survey of bacterial resistance by labs (98% vs 95%), (ii) internal quality control (88% vs 85% of public, 71% vs 64% of private labs -p = 0.01), (iii) evaluation of procedures (67% vs 57% -p = 0.01), (iv) basic service maintained in 89% vs 85% of labs, (v) information system (96% vs 88% of public, 82% vs 75% of private labs -p = 0.003), (vi) liaison with the pharmacy (86% vs 78% of public, 76% vs 63% of private labs), (vii) epidemiological surveillance (96% vs 87%), (viii) alert system (97% vs 93%) mostly by computer in public or by phone in private labs). Results on resistance rates were more often submitted to the committee for the prevention of hospital infection (97% vs 93%) or of anti-infectives (77% vs 71%), to the clinical departments in 62% vs 50% of public, 85% vs 75% of private hospitals (p = 0.018). Bacterial resistances were more often compared with antibiotic consumption in 57% vs 45% of general, 86% vs 61% of university, 37% vs 34% of private hospitals (p = 0.002)ConclusionsQuality of microbiology laboratory practices increased since 2009 but efforts have to be continued in evaluation of internal quality procedures, communication about bacterial resistances to clinical departments and comparison resistances-antibiotic consumption.
P300 Theory-Informed Tailored Implementation Of Guidelines In Swedish Primary Care Physiotherapy: Development Of A Strategy
Authors: Bernhardsson S , Johansson K , Nilsen P , Öberg B , Larsson M 
Published: August 2013

BackgroundThere is little knowledge about effective guideline implementation strategies in primary care physiotherapy. The use of theory for the development of implementation strategies is advocated by some, a pragmatic approach by others.ObjectivesTo adapt a theoretical model to Swedish primary care physiotherapy using a pragmatic approach, to identify barriers and facilitators for the use of guidelines in physiotherapy, and to tailor an intervention to address these.MethodsWe searched the literature for evidence of effectiveness of implementation strategies. We analysed various implementation theories and selected the Grol 5-step model to guide our implementation process. We adapted the model to the context in which we wanted to introduce the guidelines. We identified barriers and facilitators and possible intervention components to address these via a survey and a literature review.ResultsThe adaptation and addressing the identified barriers and facilitators resulted in a tailored, evidence-based, theory-informed implementation strategy. The most important barriers identified were lack of time, low awareness, knowledge, and access to guidelines. An active, multifaceted implementation intervention was developed. The main implementation activity was a seminar with group discussions. Other components were a website, email reminders, email support, and patient information leaflets.DiscussionUsing a model to systematically develop a strategy and a pragmatic approach to adapt it to the context in which it was to be implemented, helped to identify barriers and facilitators and to tailor an implementation intervention to Swedish primary care physiotherapy.Implications for Guideline Developers/ImplementersA theory-informed but pragmatic approach can be recommended.
P303 Successful Implementation Of Infection Prevention And Management Guidelines In An Integrated Health Care System: Structure, Process And Outcomes
Authors: Harris J 
Published: August 2013

BackgroundInfection is one of the leading causes of inpatient morbidity and mortality. Sepsis, central line infections, surgical site infections, ventilator-acquired pneumonia and c. difficile infections account for the majority of these cases.ObjectivesTo describe the process, structure and results of efforts to better manage sepsis, central line infections, surgical site infections, and hospital acquired infections in an integrated health system using organisational best practices; to present results of these risk reduction and proactive disease treatment programmesMethodsAnalysis of morbidity and mortality was the first step. Evidence for effective practices was assessed. Pilot projects based on the best evidence were conducted and results disseminated by organisation leaders, who emphasised doing the right thing at the right time all the time. Suggested order sets were incorporated in the EMR. Progress towards goals was disseminated regularly.ResultsMortality rates for severe sepsis dropped substantially over the last 4 years. Inpatient clostridium difficile infections, blood stream infections, and surgical site infections have also dropped dramatically.DiscussionGuideline recommendations were adopted across our delivery system when supported by top leadership, testing, training, specific care processes, EMR prompts for tests and treatments, regularly reviewed process metrics and group financial incentives. Practice variance was reduced and outcomes markedly improved.Implications for Guideline DevelopersGuideline recommendations are more likely to be adopted in a uniform manner if they include specific recommendation, suggestions for implementation use in organised settings, and process and outcome metrics to track improvements.
P305 Challenges Of Developing Clinical Practice Guidelines (Cpg) For Pediatric Cancer In Colombia
Authors: Linares A , Torres M , Pardo R 
Published: August 2013

BackgroundWHO estimates for the year 2013 that approximately 12 million deaths will be attributed to cancer. In developing countries, 180.000 childhood cancer cases occur every year.Contextthe need to standardise the management of childhood haematological cancers and reach the same survival rates in developed and developing countries require the elaboration of clinical practice guidelines (CPG) in Colombia. The overall survival for acute lymphoid leukaemia is around 50% while in other countries is near 80%. description of best practice: the ministry of health assigned the development of a CPG of childhood acute leukemias and lymphomas. The guideline development group (GDG) had to face some challenges due to the amount/quality of evidence and the patients’ point of view. lessons for guideline developers, adaptors, implementers, and/or users: during the formulation of the recommendations, not only effectiveness is a critical outcome but treatment toxicity and adverse effects such as secondary neoplasies need to be evaluated. In order to identify relevant information of safety, the GDG had to include observational studies which brought up some challenges. The GDG developed a qualitative exercise for the identification of patients’ point of view that were weighted in equal manner with the risk and benefits of the interventions. Once the guideline was finished, the recommendations were driven towards patient safety and the implementation implied to make changes in public policies, improve the access to continuous therapy, proper diagnosis, modifications in resources assignment and work around the available treatment so the overall survival can reach international standards.
P307 Guideline Development Tool (GDT) – Web-Based Solution For Guideline Developers And Authors Of Systematic Reviews
Authors: Brozek J , Akl E , Falck-Ytter Y , Kunstman P , Meerpohl J , Mustafa R , Nowak A , Oxman A , Santesso N , Wiercioch W , Schünemann H 
Published: August 2013

BackgroundGuideline developers and other health care decision makers benefit from following a structured process of specifying the health care questions they intend to answer and the outcomes of interest, assessing the confidence in the available evidence, gathering information about the values and preferences of the target population, and presentation of their results and decisions to the target users. Many guideline developers use the GRADE Profiler (GRADEpro) software used to conduct this work.ContextGRADE’s approach is currently being further defined in the DECIDE (Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence) project.Description of Best PracticeThe Guideline Development Tool (GDT) is the extension of the GRADE Profiler (GRADEpro) software. The GDT provides an integrated platform-independent web-based solution for health care decision makers offering support for the whole process of making decisions and developing recommendations including question formulation, generation and prioritisation of outcomes, support for teamwork, management of potential conflicts of interest, presentation of results (including the functionality of GRADEpro) and decision support. We tested the software with individual users and in workshops as well as in guideline development processes.Lessons for Guideline Developers, Adaptors, Implementers, and/or UsersFollowing a structured and systematic process, transparency and clarity of presentation facilitates the use of results of systematic reviews and facilitates development, updating and adaptation of evidence-based recommendations and decisions. Storing all information in a uniform, structured, transparent and annotated way also greatly facilitates updating and adaptation of systematic reviews and guidelines.
P308 Data Driven Best Practice In General Practice Prescribing
Authors: Huang N 
Published: August 2013

BackgroundA national quality improvement programme to understand how medicines are used was launched in 2011. The programme collects clinical data from general practice electronic health records to identify prescribing/management gaps.ContextThe delivery of primary care is complex. The majority of medicines are prescribed by GPs. There is huge potential to use routinely collected clinical information to reduce evidence-treatment gaps and improve population health outcomes.Description of Best PracticeA scan of the literature and keynote international and national agencies is undertaken to identify the range of interventions and tools that support change in general practice prescribing. Activities reported as most effective, value for money and applicable to general practice, with a focus on those using prescribing or clinical data as key inputs are collated (including which activities were used singly or in combination). These activities are entered into an overarching intervention framework for data driven activities in general practice. A group of local clinical experts are invited to identify the barriers and enablers to apply this framework to the local primary care sector. Three topic areas are selected to model these approaches and verify the elements of the framework. An implementation plan including evaluation of effectiveness will be presented.Lessons for Guideline Developers, Adaptors, Implementers, and/or UsersThe design of the intervention framework illustrates ways to design an ‘implementation strategy’ that draws on three dimensions:literature on effectiveness of implementation interventions; applied experience of clinical leaders; local context of primary care.