bluuebunny/crossref_metadata_2025_split huggingface dataset:
077 Development of an Evidence to Recommendation Table for Guideline Users
Authors: Rigau D , Neumann I , Sanabria A , Kristiansen A , Brandt L , Vandvik P , Alonso-Coello P 
Published: August 2013

BackgroundThe DECIDE project aims to improve the dissemination of recommendations using GRADE. Clinical practice guidelines (CPGs) summary tables do not include all the relevant factors for moving from evidence to recommendations: quality of the evidence, balance of benefits and harms, values and preferences and cost.ObjectivesDevelopment of an optimal presentation table to inform about the evidence to recommendation (EtR) process to healthcare professionals.MethodsIterative process including brainstorming and design, user testing with semi-structured interviews, and stakeholder consultation. We analysed the feedback to our initial prototype, defined barriers and facilitators, and generated alternative formats.ResultsThe table was well rated overall by users. It was found useful to understand in more depth the rationale of the recommendation and of use for teaching sessions. Some users found it potentially useful for shared decision making while others did not find it useful at the point of care. Most frustrations came from misunderstanding some terms, the general purpose of the table or the GRADE system.DiscussionThis EtR table could be a useful tool for CPGs users and tabulates all the relevant information beneath the EtR process. We are preparing a second round of user testing and stakeholder consultation, and will present a new format at the conference.Implications for GL Developers and UsersThis table will provide users a concise summary of the factors influencing the EtR process. The efficiency of including an EtR table in real CPGs needs to be further evaluated.
078 What Does an Evidence-Based Guideline Committee Do When There is Insufficient Evidence to Make a Recommendation
Authors: Wilson L , Robinson K 
Published: August 2013

BackgroundWhen guidelines are called evidence-based (EBGs) the implication is that there was a transparent and systematic assessment of evidence. However, evidence is often insufficient to draw conclusions. In these cases, what do guideline committees do?ObjectivesTo estimate the proportion of recommendations in a set of EBGs for which there was insufficient evidence and to determine the implications for the guidelines.MethodsWe reviewed EBGs developed by the Cystic Fibrosis Foundation and classified each recommendation as developed using evidence (i.e., graded) or consensus.ResultsWe identified 143 recommendations from 7 EBGs. More than half of the recommendations were consensus-based (61%) while 39% were evidence-based. Of those classified as evidence-based, 41% were non-recommendations; these were statements where the committee felt unable to make a recommendation for or against a particular action (insufficient grade). The consensus-based recommendations included 11% adopted from other organisations; only a quarter of the consensus-based statements were developed using an apparent formal method.DiscussionCommittee members often feel compelled to provide recommendations for the community even in the face of insufficient evidence. This limits the transparency of the EBG. Further research is needed to determine the potential implications for implementation.Implications for Guideline Developers/UsersGuidance is needed for guideline developers on best practices for if or when to consider consensus-based recommendations and how to develop such recommendations. The guidelines should clearly outline choices, such as when a consensus-based recommendation was made versus not making a recommendation, and the methods used.
084 PLUGGED-IN (Providing Likeable and Understandable Guidelines using GRADE in the EMR with Direct links to Individual patient data) Phase 2
Authors: Brandt L , Elde T , Agoritsas T , Guyatt G , Kristiansen A , Alonso-Coello P , Akl E , Meerpohl J , Vandvik P 
Published: August 2013

BackgroundTraditional clinical decision support systems in Electronic Medical Records (EMR) use algorithms with inclusion/exclusion criteria to provide direction to clinicians. Improved systems for developing trustworthy guidelines (e.g. GRADE,) typically include many weak recommendations unsuited for clear inclusion/exclusion criteria, and in which the right decision varies from patient to patient. Through PLUGGED-IN phase 1 we developed a conceptual framework and a guideline authoring/publication platform to allow use of trustworthy guidelines directly as decision support in EMRs, not dependent on traditional algorithms or reproduction of the content. Our framework is based on a multilayered guideline presentation format developed in DECIDE.ObjectivesTo implement and test our novel approach to decision support where relevant patient specific information is shown alongside evidence based recommendations in EMRs.MethodsWe used a web guideline published through the MAGIC (Making Grade the Irresistible Choice) application, which allowed our EMR partner to make use of its structured content, ontology-coded clinical questions and recommendation-specific EMR elements.ResultsThe EMR system was able to interact with the guideline, suggest relevant recommendations displayed along with relevant patient specific information (lab tests, measurements, medications), and offer these to facilitate direct ordering. We will show real examples and live products.DiscussionResults suggest we can offer a complementary approach to traditional algorithm-based systems that is compatible with a large number of EMRs.Implications for Guideline Developers/UsersPLUGGED-IN provides a model for direct use of guidelines as decision support in EMRs.
085 Implementing a Knowledge Application Program for Anxiety and Depression in Community-Based Primary Mental Health Care: The Clinical Decision Support Component
Authors: Roberge P , Fournier L , Brouillet H , Benoit A 
Published: August 2013

BackgroundWe developed a knowledge application programme to support the improvement of the organisation and delivery of care for anxiety and depressive disorders in community-based primary mental health care teams (CMHTs) in Quebec (Canada). The programme is based on the Chronic Care Model, including a Decision Support component, and the PARiHS framework.Objectives1- To implement and evaluate a knowledge application programme, 2- to explore barriers and facilitators associated with the implementation of Decision Support strategies, particularly the uptake of clinical practice guidelines.MethodsThe design is a mixed-methods prospective multiple case study, with data drawn from the two phases of the project (2008-2010; 2011-2014). Multidisciplinary local working committees in the six CMHTs were required to develop and implement local quality improvement plans with the support of a knowledge broker.ResultsWhile we observed barriers and facilitators at the clinician level in terms of knowledge (e.g familiarity) and attitudes (e.g. applicability, agreement), contextual factors (e.g resources, access) also played an important role in the uptake of clinical practice guidelines into the six local CHMTs.DiscussionDecision Support is a central component of the Chronic Care Model that aims to promote clinical care that is consistent with scientific evidence.ImplicationsThe uptake of evidence in primary care is a complex process that requires careful consideration of the context in which innovations are introduced, and our assessment of barriers and facilitators can be relevant to other primary health care organisations seeking to increase the uptake of anxiety and depression clinical guidelines.
086 Guidelines adaptation in Low and Middle Income Countries (LMIC): Results and lessons learnt from an 8-year-capacity building (CB) experience in Argentina (2005–2012)
Authors: Esandi M , Luca M De , Ortiz Z 
Published: August 2013

BackgroundCapacity building (CB) is an essential element for guideline adaptation in the context of LMIC.ObjectivesTo describe the approach and results from a CB process for guidelines adaptation implemented by the National Academy of Medicine (NAM) in Argentina between 2005 and 2012.MethodsThe CB process is described on the basis of the matrix of capacity-building strategies. Duration, objectives, entities targeted and results through the different stages of the CB process are provided.ResultsThe CB process has been supported on a “learning by doing” approach, and comprised 2 stages: a local capacity development stage (2005–2008) and a knowledge transfer (KT) stage (2008–2012). As a result of the 1st stage, 120 health professionals were involved during the adaptation process; 3 guidelines were produced and a guide to adapt guidelines was published. KT started in 2008 and was initially performed through e-learning courses targeted to individuals. In 2009, a strategy based on continuous online support through a virtual campus and workshops and targeted to institutions was adopted. Four institutions were involved: 1 did not progress; 1 completed the whole process and published an evidence-based guideline and 2 are on-going.Implications for Guideline Developers/UsersIn the context of LMIC, CB processes based on the “learning by doing” approach and focused to institutions seem to be more appropriate although challenging: not only technical capacities have to be built, but also those related to human resources management, group-working and use of Internet resources. Different level of achievement of these capacities could explain the results observed alongside the CB process implemented by NAM.
088 Cohort of Clinical Practice Guidelines from the Spanish National Guideline Programme: A Survival Analysis
Authors: García L Martínez , Sanabria A , David R , Barajas L , Fontecha P Díaz del Campo , Sabadell M Estrada , Ikobaltzeta I Etxeandia , Álvarez E García , González A Louro , Fernandez F Salcedo , Trujill M , Alonso-Coello P 
Published: August 2013

BackgroundClinical Practice Guidelines (CPGs) recommendations need to be updated to maintain their validity.ObjectivesTo provide empirical estimates of the average time after which CPGs recommendations become obsolete.MethodsWe developed a strategy to assess the validity of CPG recommendations, which included assessing their validity by surveying clinical experts, updating the literature search, screening references by pertinence and matching them with recommendations, and identifying pertinent, relevant and key references, and potential changes in each recommendation. A convenience sample of four CPGs was selected. We piloted our strategy in 20% of the recommendations from these CPGs (feasibility test) and we estimated our sample size. We performed a survival analysis and considered a CPG outdated when more than 20% of recommendations needed to be updated.ResultsThe four CPGs included 250 recommendations. A total of 39.133 (range 3.343–14.784) references were identified in the exhaustive literature search in a time frame of 3–5 years. The feasibility test identified 16 key references updating 8 recommendations. The number of recommendations required for the study was 113. A total of 674 references were marked as pertinent to these recommendations.DiscussionWe developed a rigorous, replicable evaluation strategy to assess the validity of recommendations and estimate CPG obsolescence. Full final results will be present at the GIN meeting.Implications for Guideline Developers/UsersOur work is relevant for guideline developers because it provides information about the expected validity of CPGs recommendations.
093 Measurement Instrument for Determinants of Innovations (MIDI)
Authors: Fleuren M , Paulussen T , Dommelen P van , Buuren S van 
Published: August 2013

BackgroundIn 2002, we developed a list of 60 potential relevant determinants that are critical for a successful implementation of innovations in health care, such as guidelines. This list was a result of a review of empirical studies and a Delphi study among implementation experts. Since 2002, we used the list in eight empirical studies concerning the implementation of guidelines/programs.ObjectivesThe development of a generic measurement instrument for the assessment of determinants of implementation of innovations.MethodsIn each study, a similar method was used to measure implementation of the guideline/program as well as the determinants. The information of the eight empirical studies were combined into one data set. Missing values in the final data set were replaced by plausible values using multiple imputation. We assessed which determinants ‘predict’ the implementation: separately and in combination with each other. In addition, 22 implementation experts commented on the results of the meta-analyses.ResultsAn instrument with 29 determinants was established; 7 are related to the guideline/programme itself; 11 to the user; 11 to the organisation and socio-political context.DiscussionThis instrument is to be used before or after a guideline is introduced in order to gain insight into critical determinants that need to be targeted in order to improve implementation.Implications for Guideline Developers/UsersSince 7 determinants are related to the innovation itself (e.g. clear procedures) developers should take these into account when developing a guideline.
P002 A Summary of the Methods That the Alexandria Centre for Evidence-Based Clinical Practice Guidelines (CEBCPGs) uses to produce Clinical Practice Guidelines for the Healthcare Quality Directorate of Alexandria University Hospitals and Healthcare Sectors in Alexandria
Authors: Amer Y , Elzalabany M , Omar T , Ibrahim A 
Published: August 2013

BackgroundThe CEBCPGs produces CPGs on high priority health topics to establish recommendations based on best evidence. The authors summarise the main methods used in adaptation and implementation of these CPGs.ObjectivesThe aim of this work was to promote simplicity, avoid redundancy and decrease delay in the process of CPG adaptation.MethodsPart 1) Cross-sectional/ or retrospective study and assessment of the current situation of practice in selected healthcare settings to identify/select high priority health topic(s) and to justify the need for producing a CPG for this topic(s) and expected benefit and outcome for its implementation; Part 2) consists of the Methodology for CPGs adaptation, based on an adaptation of The ADAPTE Process developed by the ADAPTE Collaboration.ResultsThree main ADAPTE steps were identified as cornerstones of the process and another two steps in the assessment module were replaced by the AGREE Domains scores.Implications for Guideline Developers/Adapters/Users1. Health Topics for CPG Adaptation & Implementation should be selected based on Cross-sectional study/surveys for local Healthcare Professionals. 2. Adaptation of CPGs as a valid alternative tode novodevelopment has many benefits for resource utilisation and unifying practice. 3. The ADAPTE process is that it is adaptable to local context and resources. 3. Successful CPGs Implementation Strategies; i)For Practitioners: Implementation tools designed to facilitate behavioural/practice changes (e.g. Posters & Brochures of Clinical algorithms & Flow charts), Educational material, Educational meetings (e.g. conferences, lectures & workshops) and Local Clinical Champions; ii) For Patients/Carers: Education materials and meetings.
P013 Using networks to facilitate international guideline implementation: allergic rhinitis as an example
Authors: Bousquet Jean 
Published: August 2013

Allergic rhinitis and asthma represent global health problems for all age groups. Asthma and rhinitis frequently co-exist in the same subjects. Patients, clinicians and other health care professionals are confronted with various treatment choices for the management of allergic rhinitis. This contributes to considerable variation in clinical practice and, worldwide, patients, clinicians and other health care professionals are faced with uncertainty about the relative merits and downsides of the various treatment options. The outcomes of an expert workshop (ARIA: Allergic Rhinitis and its Impact on Asthma) held at the World Health Organization (WHO) in December 1999 were published in 2001. The ARIA workshop report was innovative in:Proposing a new AR classification using persistence and severity of symptoms (mild/moderate-severe and intermittent/persistent).Promoting the concept of co-morbidities in asthma and rhinitis as a key factor for patients’ management.Developing guidelines in collaboration with relevant stakeholders including primary care physicians, and patients.Including experts from developed and developing countries.Adopting an evidence-based approach for the first time in guidelines on rhinitis.Initiating global implementation among health care professionals and patients.As new evidence about treatments for allergic rhinitis emerged, the methodology for guideline development changed. ARIA went with the times and move, after an evidence based update in 2008, to adopting the GRADE approach with its 2010 update. ARIA is disseminated and implemented in over 50 countries of the world. The Pocket Guide has been translated in 52 languages and it is arguably one of the most disseminated guidelines. We will report on the opportunities for international dissemination that evolved over time, report on how we accomplished it and how new media, such as Apps, can be used to facilitate the process of dissemination, using ARIA as an example.
P038 Completing the PDCA circle for guidelines within one organisation
Authors: Stemkens D , Aben K , Osanto S , Groot J de , Verhoof E 
Published: August 2013

BackgroundOur organisation is closely involved in the continuous process of developing, implementing and evaluating (evidence based) guidelines for oncological and palliative care. we use the unique combination of data from our national cancer registry, our knowledge and experience as well as the knowledge and experience of medical professionals and patient representatives available through national and regional networks. As part of this process, each evidence based guideline is evaluated with the objective: 1. to get insight in the adherence; 2. to get insight in possible bottlenecks for the implementation in daily practice; 3. to stimulate further implementation by giving feedback.Description of Best PracticeThe case of the guideline renal cell carcinoma will be presented. This includes the following steps: 1. selection of recommendations (based on the new guideline) by the guideline working group; 2. definition of indicators; 3. registration by trained registration staff of our national cancer registry; 4. analysis of the results; 5. presentation of results to professionals; 6. specific promotion of expertise and skills to further implement the guideline.Lessons for Guideline Developers/UsersThe combination of development, implementation and evaluation of guidelines ’in one hand’ offers special opportunities for quality improvement. During guideline development it already becomes clear which recommendations will need extra attention during implementation. These recommendations are very interesting to evaluate, so that the feedback about these recommendations can help the professionals to further implement the guideline.
P060 When Evidence is Weak or Insufficient, how can we Produce Guidance that is Trustworthy?
Authors: Lewis S Zelman , Ornelas J , Casey K 
Published: August 2013

BackgroundThe GuideLine Implementability Appraisal (GLIA) instrument has been suggested for identifying potentially remediable implementability issues during the guideline development process.ObjectiveTo explore to what extent using GLIA during the development process would result in guideline revision before publication.MethodsThe development process of the European hyponatremia guideline -coordinated by European Renal Best Practice - was our study context. Using the GLIA web-tool, eleven clinicians and methodologists from eight countries individually appraised 27 guideline statements. In a face-to-face consensus meeting, four GLIA panelists and one guideline development group (GDG) representative summarized potential implementability issues. The GDG discussed these issues, and revised the guideline if deemed necessary.ResultsWe identified 33 issues; the GDG accepted 26 as potentially hampering implementability. This resulted in statement reformulation with (n=5) and without (n=10) influencing clinical content, adding or (re)moving entire statements (n=8), and adding information to tables or rationales (n=3). The majority of issues declined by the GDG (n=7) addressed clinical situations that were covered elsewhere in the guideline or were considered to be uncommon.DiscussionUsing GLIA during the development process resulted in a revised guideline. We felt that GDG representation in the consensus meeting optimize our appraisal process.Implications for Guideline DevelopersGuideline organizations may want to consider incorporating GLIA into their development process. This may raise GDGs’ awareness of potential implementability issues, and allow revision of the guideline accordingly prior to publication. Future research should explore the effect of GLIA-based revisions on implementability as assessed by guideline users.
P066 What kinds of changes did the publication of large-scale RCTs related to HPV testing lead to in cervical cancer screening guidelines?
Authors: Hamashima C , Kishi T 
Published: August 2013

ObjectivesAlthough the mortality of cervical cancer has decreased in developed countries, HPV testing has been anticipated as a new technique for cervical cancer screening. Since 2009, three RCTs have reported final outcomes that evaluated reduction of the mortality of cervical cancer or of the incidence of invasive cancer. Changes in the assessment of HPV testing in guidelines, evidence reports, and statements are examined.MethodsA search was performed from January 2010 to January 2012 using MEDLINE, the GIN library, and the National Guidelines Clearinghouse to identify guidelines, evidence reports, and statements that evaluated HPV testing. Additional reports recommended by experts were also included as needed. Assessments of HPV testing and related evidence were compared.ResultsEight guidelines and two evidence reports matching our criteria were identified. When HPV testing was recommended and introduced, it was based on the results of studies conducted in the respective countries. The methods of HPV testing were different, because interpretations of the results of the RCTs were different among these guidelines and reports.DiscussionAlthough new techniques are expected to be introduced early in comminutes, long follow-up is needed to evaluate efficacy. In such situations, studies conducted in respective countries are often considered to represent favourable results. To resolve this problem, a modelling approach could be used, but the appropriateness of such an approach for guideline development needs to be investigated.Implication for Guideline DevelopersTo evaluate the efficacy of a new technique, modelling studies should be standardised for guideline development.