bluuebunny/crossref_metadata_2025_split huggingface dataset:
051 Can We Automatically Produce Generic Decision Aids for the Clinical Encounter Directly from GRADE Guideline Recommendations? Experience from the Share-It Project
Authors: Agoritsas T , Brandt L , Heen A Anja , Kristiansen A , Alonso-Coello P , Akl E , Neumann I , Tikkinen K , Montor V , Guyatt G , Vandvik P 
Published: August 2013

BackgroundAlthough decision aids (DA) can help to communicate evidence to patients, their production is time consuming, often not based on the best available evidence or rapidly outdated. Linking trustworthy guidelines and DA for shared-decision making could both overcome these limitations and enhance guideline dissemination.ObjectivesTo test the feasibility of automatically translating any recommendations from GRADE guidelines into generic and interactive DA accessible on tablet computers for clinicians and their patients in the clinical encounter.MethodsAs part of the DECIDE project, we developed a framework for translating components of GRADE into DA, following the International Patient Decision Aid Standards. Using a recently published guideline, we implemented that framework in our MAGIC (Making Grade the Irresistible Choice) application – a prototype electronic guideline tool and publication platform that can automatically display recommendations in multilayered presentation formats.ResultsOur prototype was able to automatically translate a large number of GRADE recommendations and their supporting evidence into electronic and interactive DA. Preliminary results of user-testing in real patient-clinician interactions suggest that these DA can be used at the point of care to discuss estimates of treatment effects for patient relevant outcomes, confidence in estimates, burden of treatment, and cost issues.DiscussionThis study provides a proof-of-concept that components of GRADE recommendations can be interactively displayed in generic tools for interactive shared-decision making in a wide range of treatment alternatives.Implications for Guideline Developers/UsersOur electronic DA offer promising opportunities to disseminate guidelines at the point of care.
052 Tools for Communicating Main Messages Conveyed By Clinical Practice Guidelines (CPGS) – Making Patient Resources User Friendly
Authors: Moga C , Angus D , Chojecki D , Harstall C , Moffatt J , Taenzer P 
Published: August 2013

BackgroundBackground The Alberta Ambassador Guideline Adaptation Programme developed two CPGs on the management of low back pain and headache in primary care. Various guideline companion documents were developed for patients.ObjectivesTo review the process and outcomes of involving patients/public in the development of guideline resource documents.MethodsFocus groups of different compositions and using various sampling strategies were called upon: self-selected members from national patient pain association (patient information sheets); members of the public who serve on a standing Lay Committee (patient information sheets, comic book); purposive recruitment by market research company (comic book). Participants answered questions related to the content, format, and presentation of patient resources using different interview methods.ResultsDiscussion themes included wordiness of documents, language accessibility, use of logos, and trustworthiness. Multiple suggestions for improvements that were sensitive to the needs of participants were considered before publication of final products. The comic book was not published.DiscussionEven though the focus group procedures varied, there was significant overlap and repetition in the feedback received on the same guideline resources. The patient focus group facilitated by a clinician engaged participants in discussions oriented to clinical issues. The comic book was considered to be a novel communication vehicle by clinicians but not so by public.Implications for Guideline Developers/UsersInvolving a motivated Lay Committee facilitated by someone not directly related to the project seems to be a valuable alternative to other focus groups of patients which may require more effort and resources.
056 Addressing Continuous Data For Participants Excluded From Trial Analysis: A Guide
Authors: Ebrahim S , Akl E , Mustafa R , Sun X , Walter S , Heels-Ansdell D , Alonso-Coello P , Johnston B , Guyatt G 
Published: August 2013

BackgroundGuideline developers addressing quality of evidence commonly confront studies with missing data.ObjectivesTo develop a framework for assessing risk of bias resulting from missing participant data for continuous outcomes in systematic reviews.MethodsWe developed a range of progressively more stringent imputation strategies to challenge the robustness of the pooled estimates. We applied our approach to two systematic reviews.ResultsWe used 5 sources of data for imputing means for participants with missing data: [A] the best mean score among the intervention arms of included trials, [B] the best mean score among the control arms of included trials, [C] the mean score from the control arm of the same trial, [D] the worst mean score among the intervention arms of included trials, [E] the worst mean score among the control arms of included trials. Using these sources of data, we developed four progressively more stringent imputation strategies. In the first example review, effect estimates were diminished and lost significance as the strategies became more stringent, suggesting the need to rate down confidence in estimates of effect for risk of bias. In the second review, effect estimates maintained statistical significance using even the most stringent strategy, suggesting missing data does not undermine confidence in the results.DiscussionOur approach provides rigorous yet reasonable and relatively simple, quantitative guidance that guideline developers can use for judging the impact of risk of bias as a result of missing participant data in systematic reviews of continuous outcomes.
057 Handling Trial Participants with Missing Data in Meta-Analyses Of Dichotomous Outcomes: Guidance for Systematic Reviewers
Authors: Akl E , Johnston B , Alonso-Coello P , Neumann I , Ebrahim S , Briel M , Cook D , Guyatt G 
Published: August 2013

BackgroundSystematic reviewers including all randomised participants in their meta-analyses need to make assumptions about the outcomes of those with missing data.ObjectivesTo provide systematic review authors with guidance on dealing with participants with missing data for dichotomous outcomes.MethodsThe authors used an iterative process of suggesting guidance and obtaining feedback to arrive at a proposed approach.ResultsFor participants with missing data, systematic reviewers can use a range of plausible assumptions in the intervention and control arms. Extreme assumptions include ‘all’ or ‘none’ of the participants had an event, but these assumptions are not plausible. Less extreme assumptions may draw on the incidence rates within the trial (e.g., same incidence in the trial control arm) or in all trials included in the meta-analysis (e.g., highest incidence among control arms of all included trials). The primary meta-analysis may use either a complete case analysis or a plausible assumption. Sensitivity meta-analyses to test the robustness of the primary meta-analysis results should include extreme plausible assumptions. When the meta-analysis results are robust to extreme plausible assumptions, inferences are strengthened. Vulnerability to extreme plausible assumptions suggests rating down confidence in estimates of effect for risk of bias.ConclusionsThis guide proposes an approach to establishing confidence in estimates of effect when systematic reviewers are faced with missing participant data for binary dichotomous outcomes in randomised trials.
059 Nonrandomised Studies as a Source of Complementary, Sequential or Replacement Evidence for Randomised Controlled Trials in Systematic Reviews and Guidelines
Authors: Schünemann H , Tugwell P , Reeves B , Akl E , Santesso N , Spencer F , Shea B , Wells G , Helfand M 
Published: August 2013

BackgroundThe terms applicability, generalizability, external validity, transferability generally describe one overarching theme: can available research evidence be utilised to answer the health care questions at hand, ideally supported by a judgement about the degree of confidence in this utilisation. This concept has been called directness.ObjectivesTo offer conceptual and practical guidance to those judging directness and using research evidence from non-randomised studies (NRS).MethodsWe used a literature review and feedback from participants of a workshop funded by the Agency for Healthcare Quality and Research and the Cochrane Collaboration.ResultsGuideline developers can use NRS as a source of complementary, sequential or replacement evidence for randomised controlled trials (RCTs) by focusing on judgements about the population, intervention, comparison and outcomes. They use NRS to complement judgements about inconsistency, the rationale and credibility of subgroup analysis, baseline risk estimates for the determination of absolute benefits and downsides, and the directness of surrogate outcomes. Authors use NRS as sequential evidence to provide evidence when the evidence from RCTs is insufficient (e.g. long-term harms). Use of evidence from NRS may also replace RCT evidence when RCTs provide indirect evidence but NRS provide overall higher quality, direct evidence. We developed a simple tool and algorithm to make judgements about indirectness more transparent.DiscussionsThese judgements need to be made in the context of other quality of evidence domains.Implications for Guideline Developers/UsersThe transparency of the framework will support interaction with those making health care decision and policy.
060 Appraising Implementability During the Development Process Resulted in Guideline Revision
Authors: Veer S van der , Simon A , Weismann D , Lehner G , Coentrão L , Dongelmans D , Laecke S van , Lapauw B , Ortiz A , Schiller A , Tesar V , Nagler E 
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 summarised 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 Developers/UsersGuideline 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.
061 Guideline Implementability Appraisal (GLIA) in US National Guidelines
Authors: Chan W , Pearson T 
Published: August 2013

BackgroundGuidelines must be implemented in order to impact health outcomes. Identifying and addressing potential barriers to implementation during guideline development can improve implementability.ObjectivesTo describe the processes and results of embedding guideline implementability appraisal, into prominent US cardiovascular disease risk reduction guidelines.MethodsThe GuideLine Implementability Appraisal (GLIA) tool (Yale Center for Medical Informatics), was integrated into the guideline development processes of a US national-level organisation. A member of the Implementation Science Work Group (ISWG) with prior experience in GLIA appraisals trained the Guideline Development Teams (GDTs), early in the guideline development process, with the intent of raising awareness of potential barriers to implementation so they might be addressed during guideline development. Formal GLIA appraisals were performed on the drafts of the guideline reports, by members of the ISWG, as well as volunteers from outside the guideline programme. To minimise interference with timelines, appraisals were carried out and written reports returned to the GDTs within 2 weeks of release of the draft reports.ResultsA number of potential barriers to implementation were identified in the draft reports, such as: use of inexplicit terms in recommendation language, inconsistency of thresholds and terms used within a guideline, unclear applicability of assessment or treatment recommendations in specific subgroups. GDTs considered GLIA appraisal findings when they revised their reports and found the GLIA appraisals helpful in creating more implementable guidelines.Implications for Guideline Developers/UsersGLIA training for GDTs, and formal use of the GLIA tool help produce more implementable guidelines.
063 Enhancing the Uptake of Clinical Practice Guidelines: The Development of a Guideline Implementability Tool (Guide-It)
Authors: Kastner M , Versloot J , Hayden L , Chatterjee A , Bhattacharyya O 
Published: August 2013

BackgroundGuidelines have the potential to facilitate implementation of evidence into practice but this has not been consistently achieved. We developed a guideline implementability tool (GUIDE-IT), which can assess the implementability of guideline recommendations.ObjectiveTo determine if GUIDE-IT can improve the Language and Format of guideline recommendations.MethodsUsing a mixed-methods approach to develop GUIDE-IT, we conducted 1) a Realist Review of guideline factors influencing uptake, and used its results to build a conceptual model of guideline implementability; 2) qualitative interviews with 20 family physicians to determine factors influencing guideline uptake and to obtain input on tool design; 3) created a prototype and conducted validity assessments with experts in guideline development and human factors. GUIDE-IT was then pilot tested with the Canadian Diabetes/Paediatric Associations (CDA, CPS) to determine its potential for assessing the implementability of guideline recommendations.ResultsPilot testing with CDA and CPS developers showed that factors across 4 sub-domains of Language (clarity, simplicity, specificity, and actionability) and 3 sub-domains of Format (presentation, components, and multiple versions) were applicable for modifying recommendations. GUIDE-IT was feasible to use by guideline developers to identify implementability problems and to improve recommendations.DiscussionGUIDE-IT is based on a robust evidentiary base with the potential to improve guidelines. Next steps include evaluating GUIDE-IT in a controlled trial to determine its impact on end-user clinical decision making.Implications for Guideline Developers/UsersGUIDE-IT has potential to be a practical tool for developers to improve the language and format of guideline recommendations.
066 How Are We Feeling Today? The Sensitivity of a Literature Search Filter for Patients’ Values and Preferences
Authors: Wessels M , Hielkema L 
Published: August 2013

BackgroundThe patient perspective in guideline development is of vital importance. To find out what this perspective entails, different methods may be considered, such as participation of patients or their representatives in guideline development groups or in focus group discussions, or by conducting patient surveys addressing specific problems and needs. In addition, a review of the literature in the early stages of guideline development can provide relevant information. Literature search filtres for patients’ perspectives and preferences applicable for Medline (OVID), PubMed, and Embase were developed and validated in 2012. The specificity was 98% but the sensitivity was only 90%.ObjectivesTo verify the sensitivity of the filtres by means of a newly available ‘gold standard’.MethodsWe re-estimated the sensitivity of the search filtres by using the references of a recent Cochrane Review, Interventions for providers to promote a patient-centred approach in clinical consultations 2012;(12):CD003267, as a gold standard.ResultsThe search filtres for patients’ values and preferences retrieved 72 (Medline (OVID/Pubmed) and 67 (Embase) titles, respectively, out of 73 references included in the Cochrane Review (mean sensitivity 96%).DiscussionApplying filtres for patients’ perspectives and preferences retrieved almost all references. Minor adaptations to the Embase filtre were needed to enhance the sensitivity without compromising the specificity. Validation of filtres is an iterative process, illustrating that filtres are dynamic tools.Implications for Guideline Developers/UsersAvailability of a validated tool for retrieving literature on patients’ values and preferences can support integration of the patient perspective in guideline development.
An angiographic atlas of intracranial arterial diameters associated with cerebral aneurysms
Authors: Mocco J , Huston John , Fargen Kyle M , Torner James , Brown Robert D 
Published: August 2013

IntroductionThe successful treatment of intracranial aneurysms is dependent on a full understanding of the anatomic relationship of a given aneurysm to its parent artery(s) and nearby branches. Furthermore, new endovascular technologies are often limited by size constraints. Currently, there is no complete atlas describing diameters for each major intracranial arterial segment. We sought to obtain these data by performing a systematic analysis of selected cerebral angiography images from the International Study of Unruptured Intracranial Aneurysms (ISUIA).MethodsFour hundred and forty-five patients with unruptured intracranial aneurysms from the ISUIA database were reviewed. Using previously described techniques, artery diameters were measured for all arteries involved in the aneurysm neck for each patient.ResultsMeasurements were obtained from 695 different aneurysm-associated arterial segments among 445 patient angiograms (mean 1.6 measurements per aneurysm). Artery diameters, mean, median, SEM and IQRs based upon the different arterial segments are presented.ConclusionsThis angiographic almanac of aneurysm-associated intracranial arterial diameters may be of benefit in establishing standard norms through which devices, protocols and research aims may be developed.
Microparticle-associated tissue factor is recycled by endothelial cells resulting in enhanced surface tissue factor activity
Authors: Xiao Yupei , Maraveyas Anthony , Collier Mary E. W. , Mah Pui-Mei , Ettelaie Camille 
Published: August 2013

SummaryIn this study the uptake of tissue factor (TF)-positive microparticles by endothelial cells and the recycling of the TF component were examined. Human dermal blood endothelial cells (HDBEC) were incubated with microparticles derived from cancer cell lines for up to 6 hours. Measurement of HDBEC cell surface TF antigen revealed two distinct peaks at 30 and 180–240 minutes post-incubation with TF-positive, but not TF-deficient microparticles. However, only the second peak was concurrent with high TF activity as determined by a chromogenic thrombin-generation assay. Annexin V-labelling of HDBEC showed phosphatidylserine exposure following 90 minutes incubation with microparticles, which explains the high TF activity associated with the second antigen peak. Analysis of TF mRNA levels revealed no de novo expression of TF mRNA in response to microparticles, and pre-incubation of cells with cycloheximide did not prevent the appearance of TF. However, blocking endocytosis with a dynamin inhibitor prolonged the disappearance and prevented the reappearance of TF antigen on the cell surface. Incubation of HDBEC with microparticles containing TF-GFP revealed the early co-localisation of TF with Rab4 and Rab5, followed by co-localisation with the late endosomal/trans-Golgi network marker Rab9, and the recycling endosome marker Rab11. siRNAmediated suppression of Rab11 reduced the reappearance of TF on the cell surface. These data suggest a mechanism by which TF-containing microparticles are internalised by endothelial cells and the TF moiety recycled to the cell surface. Together with the exposure of phosphatidylserine, this is capable of inducing a substantial increase in the procoagulant potential of the surface of endothelial cells.
A worldwide survey to assess the current approach to the treatment of patients with cancer and venous thromboembolism
Authors: Aggarwal Anita , Geer Annemarie van de , Faselis Charles , Büller Harry R. , Di Nisio Marcello , Rickles Frederick R. , Kamphuisen Pieter , Kleinjan Ankie 
Published: August 2013

SummaryLow-molecular-weight heparin (LWMH) is recommended as the preferred anticoagulant treatment over vitamin K antagonists (VKA) for venous thromboembolism (VTE) in patients with cancer. However, there is uncertainty about the duration and dose of LMWH treatment. Therefore, we designed this multinational survey to assess the current approach to the treatment of patients with cancer and VTE. An electronic survey tool was used to disseminate a survey containing 49 questions on different aspects of the treatment of patients with cancer and VTE, among both thrombosis and non-thrombosis specialists. A total of 229 invitations were sent, and 141 completed the survey (60% of the total). Fifty-eight percent of the respondents were from Europe, 35% from the US and the remaining 7% from other countries. Respondent’s specialties included haematology (23%), oncology (18%), pulmonology (15%) and general internal medicine (15%). LMWH was indicated as the first choice for the long-term treatment by 82% of the respondents, of whom 60% used full therapeutic doses and 40% chose a dose reduction. When continuing anticoagulants after the long-term treatment period, 44% of respondents preferred LMWH, 10% VKA, while the remaining 45% chose per individual patient for either LMWH or VKA. In conclusion, we observed a relatively high observance rate of the guidelines with respect to the use of LMWH for the long-term treatment of VTE in cancer. In contrast, the dose of LMWH and the type of anticoagulant chosen after the initial 3–12 months varied substantially, probably reflecting the limited available evidence.
Ophiocordyceps xuefengensis sp. nov. from larvae of Phassus nodus (Hepialidae) in Hunan Province, southern China
Authors: WEN TING-CHI , ZHU RU-CAI , KANG JI-CHUAN , HUANG MING-HE , TAN DIAN-BO , ARIYAWANSHA HIRAN , HYDE KEVIN D. , LIU HAO 
Published: August 2013

An entomogenous taxon, associated with larvae of Phassus nodus (Hepialidae) collected from Xuefeng Mountains, Hunan Province, China, was found to be a new species, Ophiocordyceps xuefengensis sp. nov. It differs from similar species in having long stromata, without a sterile apex, narrow asci, long ascospores and by its occurrence on Phassus nodus in living root or trunk of Clerodendrum cyrtophyllum. Combined sequence data from the 5.8S-ITS rDNA, nrSSU, EF-1α, and RPB1 gene loci also confirmed the distinctiveness of this new species. It is presently the world’s largest known Cordyceps sensu lato species.