bluuebunny/crossref_metadata_2025_split huggingface dataset:
P099 Assessment of the Diffusion and Implementation of the Clinical Practice Guidelines in Mexico
Authors: Sosa-Garcia J , Martinez-Aldana S , Puente-Rosas E , Pineda-Perez D , Hernandez-Santillan D 
Published: August 2013

BackgroundThe clinical practice guidelines (CPGs) of the National Health System of Mexico (NHSM) aim to improve the quality and to reduce the heterogeneity of medical care.ObjectivesTo assess the success of the implementation of the CPGs in medical units of the NHSM.Methods480 health units were randomly sampled. In each one, the following items were applied: a checklist in order to verify the existence of CPGs, a questionnaire for physicians to document their knowledge, training and awareness on CPGs, and another one to those in charge of the dissemination and implementation process. Clinical records were reviewed to document the use of CPGs.ResultsThe diffusion of the CPGs is conducted via internet through the Master Catalogue (MC). The MC was identified in 80% of the sample. The overall level of training on CPGs was 56% (45% -100%). 88% of doctors are aware of the existence of CPGs and 71% reported the utilisation of a CPG during the last month. 30% of the people in charge of dissemination do not have the necessary resources for the dissemination and implementation. The adherence level falls below 50%.DiscussionOne limitation to the dissemination of the CPG is internet access, along with training variability among institutions. The main barrier to the use of CPGs, is the lack of resources (physical material, human and time) for the dissemination and implementation.Implications for Guideline Developers/UsersThe knowledge of CPGs is high, however there are barriers that limit their implementation.
P108 Publications Improve Wound Care Guideline Quality And Impact
Authors: Bolton L , Girolami S , Corbett L , Merkle D 
Published: August 2013

BackgroundHigh quality evidence based (EB) wound care guidelines reduce costs of care and improve outcomes. They may help stem the growing burden of chronic wound care only if disseminated and used.ContextPublications supported development, quality and dissemination of EB wound care guidelines with content-validity (CV).Description of Best PracticeMultidisciplinary volunteer guideline developers from a global, non-profit wound care organisation with patient and wound-related specialty membership, used standardised evidence strength criteria and independently-rated CV Index as standardised recommendation strength to develop inclusive venous and pressure ulcer “Guidelines of Guidelines”. Representatives of six North American societies collaboratively published research and educational opportunities identified by this unique guideline development process.Lessons for Guideline Developers, Adapters, Implementers, and/or UsersPublications accessible at the organisation website transparently described the guideline development process, a hallmark of guideline quality while enhancing awareness of the guidelines and EB CV recommendations worth implementing. Publications in multidisciplinary journals minimised sampling bias by inviting readership to complete online CV surveys. Publishing research and educational opportunities focused the field on EB research and education needs and fostered international cooperation, helping unify wound care across countries, settings and specialties. Medical school and university nursing and physical therapy programmes are disseminating core messages of EB CV wound care by using the guidelines, publications, patient brochures, algorithms and implementation tools to improve quality and consistency of care.ConclusionPublications enhanced venous and pressure ulcer guideline development quality, awareness and use while unifying wound care and highlighting needed research and education initiatives.
P119 The Rare-Best practices Project: An Overview
Authors: Taruscio D , Morciano C , Laricchiuta P , Vincenti G , Agresta L , Mincarone P , Palazzo F , Leo C , Sabina S , Guarino R , Auld J , Sejersen T 
Published: August 2013

BackgroundRARE-Best Practices is a 4-year project (2013-2016) funded by the EU FP7.ObjectiveDeveloping a sustainable networking platform, supporting an efficient exchange of reliable and up to date information on the management of rare diseases (RD) to improve patient health outcomes.MethodsRARE-Best Practices will reach its goals by promoting collaboration among partners with a strong track record in RD research as well as in clinical practice guidelines (CPG) and systematic review development from academic institutions, governmental bodies, patients organisations and networks.ResultsProject expected outputs: 1) identification of challenges to be considered in deriving high quality standards for CPG on RD; 2) creation of transparent procedures and criteria for the evaluation and the collection of CPG on RD in a publicly searchable database; 3) identification of the available notations for graphic representation of processes within CPG to improve user understandability and implementation; 4) production of mechanisms to identify and prioritise RD clinical research needs to optimise the research agenda on RD; 5) development of training activities targeted to key stakeholders to disseminate process and tools for developing and evaluating CPG.Discussion/Implication for Guidelines Developers UsersRARE-Best Practices will address the patients and health care providers demand for updated and high quality CPG on RD. It intends also to respond to the Directive 2011/24/EU which encourages EU MS to the development of European Reference Networks in the area of RD which, among other criteria and conditions, ‘should have the capacity to produce good practice guidelines’.
P132 Quality of Guidelines Developed by the World Health Organization: Preliminary Results
Authors: Burda B , Chambers A 
Published: August 2013

BackgroundThe World Health Organization (WHO) annually publishes hundreds of guidelines. Its guideline development process, however, is often criticised even after the implementation of a Guideline Review Committee (GRC) that ensure guidelines are developed using the highest methodological quality, transparent and evidence-based processes.ObjectivesTo quality rate a cohort of GRC-approved WHO guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool.MethodsWe searched the WHO website for GRC-approved guidelines published between 2008 and November 2012. Two individuals independently appraised the guidelines using AGREE II. Scores were standardised across six domains and overall quality was determined through consensus.ResultsEighty guidelines fulfilled inclusion criteria and were appraised. Twenty-seven guidelines were recommended, 47 were recommended with modifications, and six were not recommended. Two domains of AGREE scored highly across all guidelines: scope and purpose and clarity of presentation. The rigour of development and applicability domains were variable across guidelines. The lowest scoring domains were stakeholder involvement and editorial independence.DiscussionWHO guidelines still need improvement in the following areas: stakeholder engagement, use of systematically reviewed evidence, defining the funder’s role, consideration of barriers and resources (including costs) when implementing recommendations, and providing monitoring criteria. Most issues may be resolved through increased transparency and better reporting of the recommendation development process by more closely following the standards set forth in the WHO guideline development handbook.Implications for Guideline Developers/UsersGuideline developers need to ensure systematic guideline development processes are followed and adequately reported in each guideline.
P135 Using Current Practice Information to Identify Areas Of Variation
Authors: Lacey T , Ayiku L , Shaw E , Baillie N 
Published: August 2013

BackgroundQuality standards describe high-priority areas for quality improvement in a defined area.ObjectivesTo describe the processes by which areas for quality improvement are identified for quality standards.MethodsA topic overview, which describes core elements of the standard, such as the population and condition or services to be covered, is published on our website at the beginning of development. We then request written submissions from specialists and registered stakeholders asking them to i identify key areas for quality improvement ii provide examples of published information on current practice (such as, reports of variation in care, evaluations of guidance compliance, or patient experience) to support the identified areas. We also undertake a focused literature search for published current practice information (such as descriptions of practice variation) and identify national audits.ResultsTo date, we have undertaken at least 10 such reviews. We will present the types of information we receive, challenges (with a specific focus on quality of information and certainty of decisions made). We will also present how this information was used to identify area for improvement, and whether these decisions were valid.DiscussionWe consider this a novel and practical approach to identifying improvement areas, bringing together views from a diverse audience, supplemented with published information.Implications for Guideline Developers/UsersGuideline developers could use similar methods to identify areas where evidence based recommendations could be focused, to define and guide best practice.
P143 Projet Jalons: A Provincial Adaptation Of Clinical Practice Guidelines For Depression In Primary Care
Authors: Roberge P , Fournier L , Brouillet H 
Published: August 2013

BackgroundThe development of a care protocol for major depression in primary care emerged as an extension of a knowledge application programme developed in Quebec (Canada) to improve care for anxiety and depressive disorders in primary care (2012; JALONS:http://www.qualaxia.org/ms/jalons/). The main goal of the project was to develop or adapt tools to support primary mental health care providers in their clinical practice.ContextThe 2005 reform in Quebec’s mental health services aimed at strengthening primary care services, and included the creation of multidisciplinary community-based primary mental healthcare teams.Description of Best PracticeWe used the ADAPTE method to develop a care protocol for major depression in primary care tailored for the local context, with a consideration of the organisation of health care services in primary care. The work was monitored by an expert committee composed of mental health specialists, general practitioners, health care administrators and decision-makers at regional and provincial levels. The care protocol is based on two clinical practice guidelines: the NICE guideline on the treatment and management of depression in adults (2010) and the CANMAT clinical guidelines for the management of major depressive disorder in adults (2009).LessonsWe will share the challenges associated with the adaptation of clinical recommendations and organisational strategies to the local context, and the actual implementation of the care protocol in primary care. We will discuss issues dealing with the applicability and successful uptake of recommendations in local contexts (ex.: availability of resources for guideline adaptation, types of professionals involved, barriers).
P146 Adapting and Implementing Guidelines For Chronic Obstructive Pulmonary Disease (COPD)
Authors: Pham C , Koster M 
Published: August 2013

BackgroundAdaptation of high-quality external guidelines can be an efficient and effective means to develop guidance more rapidly, allowing for shifting of resources to knowledge transfer and health system implementation efforts.ContextTo describe successful guideline adaptation and implementation strategies used by a large US health care organisation to improve the quality of care for adults with chronic obstructive pulmonary disease (COPD).Description of Best PracticeA multidisciplinary guideline team evaluated and adapted a guideline on Chronic Obstructive Pulmonary Disease (COPD) developed by the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society (ACP/ACCP/ATS/ERS). Recommendations were evaluated and modified for implementability based on several dimensions of the GLIA tool. Implementation strategies targeted to physicians included electronic distribution of guidelines, interactive online continuing medical education, and point-of-care encounter support. Implementation efforts targeted to patients included point-of-care education booklets, online resources for COPD self-management, and proactive outreach for spirometry testing. Systems- level interventions included development of patient outreach lists and computerised decision support. Monthly reporting and review on three measures was conducted to monitor performance. Ongoing implementation efforts resulted in increased rates of spirometry testing and management of COPD exacerbations with systemic corticosteroid and bronchodilator medications over a four-year period.LessonsChallenges arise when externally developed guidelines lack the specificity necessary for recommendations to be successfully implemented. Systematic evaluation and modification of recommendations is necessary to enhance implementability at the patient, provider and systems levels, as well as to improve performance.
P150 Translating Recommendations Into Clinical Decision Support: Cancerlinq Prototype Experience
Authors: Duffy E , Michel J , Jue J , Erinoff E , Coates V , Mann J , Temin S 
Published: August 2013

BackgroundThe Guideline Elements Model (GEM) has been widely used to translate natural language clinical practice guidelines (CPGs) into clinical decision support (CDS) using a highly replicable, guideline-centric approach. A CPG recommendation-to-CDS translation process, which uses GEM-processed content to support an oncology rapid learning system (RLS) prototype, is examined here.ObjectivesTo develop rules for a breast cancer-specific CDS prototype using GEM-processed guideline content.MethodsWe created five breast cancer patient scenarios with expert input from oncologists based on nine published CPGs. Using the Yale Center for Medical Informatics-developed GEM Cutter III editor, we parsed the narrative CPG recommendations into an XML-based, machine-readable format. GEM-processed content was then encoded into a Drools business rule management system to develop an integrated platform prototype for rules, workflow, and event processing. We used meta-tags to create value sets for key components of each recommendation by selecting terms from UMLS vocabularies, including SNOMED CT and LOINC.ResultsForty-five recommendations spanning nine CPGs were processed and converted into Drools rules. We identified 138 decision variables and 91 actions within the selected recommendations. From these, we encoded 148 concepts associated with value set meta-tags and 238 decision rules.DiscussionThe level of difficulty required to encode the recommendations was directly related to the specificity, complexity, and decidability of each recommendation; there was significant variability among the recommendations.Implications for Guideline Developers/UsersCPG developers may need new processes in order to optimise recommendations for incorporation into CDS systems.
P189 Ischemic Stroke: Through Adapted Clinical Guideline To Local Clinical Protocols
Authors: Morozov A , Stepanenko A , Chagarna N , Shylkina O 
Published: August 2013

BackgroundThe health care system of Ukraine required improvement in treatment of stroke patients based on evidence present in GIN.ObjectivesTo compare Ukrainian treatment practices with the best strategies for stroke management and to improve quality of health care on the basis of the identified differences.MethodsMultidisciplinary working group has prepared adapted guidelines “Modern principles of diagnosis and management of patients with acute ischemic stroke and TIA”, “Recommendations for the management of patients with ischemic stroke and TIA”, “Rehabilitation, prevention and management of complications and discharge planning in ischemic stroke” with regard of the evidence-based strategies for stroke treatment. Simultaneously, unified clinical protocols of medical care “Ischemic stroke” and “Systemic thrombolysis for stroke” were developed on the basis of the guidelines and then approved by the Ministry of Health of Ukraine in August 2012.ResultsThere were identified differences in the stroke treatment in Ukraine compared to the best practice, which resulted in amendments to the corresponding regulations in health care. In order to integrate these changes into clinical practice local protocols and critical pathways for management of stroke are developing in all healthcare facilities taking into account peculiarities of the region and available resources of the hospitals.DiscussionLocal protocols comprise evidence-based statements which represent the best practice from clinical guidelines from GIN and other databases.Implications for Guideline Developers/UsersMeasures enabling changes in existing medical practice are identified to ensure effective treatment of stroke patients within 4.5 hours after symptoms onset.
P190 Registry Of Medical Technological Documents For Supporting Guidelines Accessibility
Authors: Morozov A , Stepanenko A , Lishchyshyna O , Gorokh Y , Khachaturyan V 
Published: August 2013

BackgroundThe Ministry of Health of Ukraine has approved the methodology for development of medical and technological documents on the basis of evidence. The first documents on the basis of evidence were developed by multidisciplinary working groups in recent years. We can witness the process of guidelines adaptation and their implementation into health care practice.ContextIt is necessary to ensure the availability of new documents for doctors, health care providers, and public. Transparency at all stages of medical and technical documents development is also very important.Description of Best PracticeThe website of the registry of medical and technological documents has been created and posted athttp://www.dec.gov.ua/mtd/index.html. The website includes: - Adapted clinical guidelines and unified clinical protocols of medical care developed by multidisciplinary working groups; - Draft documents submitted for public discussion; - Information on clinical topics under consideration; - Methodological materials for developers - members of multidisciplinary working groups; - Links to international sources of evidential information. The development of the content of the website continues.Lessons for Guideline Developers, Adaptors, Implementers, and/or UsersCreating a specialised website that integrates methodological materials, adapted clinical guidelines, unified clinical protocols, and information about the documents under consideration provides accessibility of documents, convenience for users, and improves confidence of professionals and the public in new documents.
P196 Updating the Evidence For CPGs: The Usefulness Of RSS Feeds
Authors: Etxeandia-Ikobaltzeta I , Ibargoyen-Roteta N , Roteche-del Campo R , Etxeberria-Agirre A , Callén-Blecua M 
Published: August 2013

BackgroundScientific knowledge is in constant evolution and even if Clinical Practice Guidelines (CPGs) get out of date in five years time, there is a lack of standardised method for an efficient updating process.ContextA proposal used to update efficiently the bibliographic searches during the development of a CPG on childhood asthma management is described.Description of Best PracticeBibliographic searches were performed in Medline, Embase and All EBM databases using Ovid, and in BMJ update database. Search strategies and RSS-feeds were created and saved when possible. E-mail alerts for those searches carried out in databases with no RSS services were also created. All the RSS-feeds were centralised in a Netvibes web portal and organised into tabs (one tab by clinical question). New alerts were revised periodically during the guideline development process and new references incorporated in the guideline when relevant. RSS-feeds could be created for Medline and Embase searches. The centralization of RSS-feeds in a Netvibes portal facilitated the reviewing process of the latest published articles by clinical question. The review of the email-alert services generated for those sources with no RSS services was more time-consuming.Lessons-for-Guideline-Developers-Adaptors-Implementers-and/or-UsersThe management of RSS-feeds is considered as a more effective tool to check and follow all the new references published during the guideline development process, being useful also after the CPG publication. Nevertheless, not all databases allowed the creation of RSS feeds, an issue that should be considered by their managers, and in all cases, the updating process has to be supported by professionals.
P212 Review of Systematic Reviews Related to Clinical Guidelines Implementation
Authors: Geba D , Chan W , Moreno M , Pearson T 
Published: August 2013

BackgroundClinical guidelines should be implemented using evidence-based implementation strategies. However, guideline development programmes rarely allocate resources to perform evidence-based reviews of implementation strategies required to implement their guidelines. A streamlined approach to obtain such summaries of evidence in preparation for development of cardiovascular risk reduction guidelines sponsored by a national-level organisation was a review of systematic reviews (SRs) of implementation strategies.ObjectivesTo explore whether SRs of implementation strategies provide support for the effectiveness of these strategies. Methods Rx for Change database of the Canadian Agency for Drugs and Technologies in Health (CADTH) was selected a priori as data source for this review of systematic reviews. The review was limited to high quality SRs of interventions targeting clinicians.ResultsA total of 12 SRs met study inclusion criteria. These SRs suggest that implementation strategies, such as audit and feedback, academic detailing, and educational meetings, are generally effective in improving providers’ behaviours, with small to moderate effect sizes.DiscussionThis review of SRs provides support for the overall efficacy of guideline implementation strategies, while highlighting the need for further comparative and cost effectiveness research to address gaps in the knowledge identified (e.g., limited information on head-to-head comparisons between strategies, clinical context, and cost of interventions).Implications for Guideline Developers/UsersGuideline developers should include recommendations for guideline implementation in their future guidelines. Making specific recommendations on choosing one implementation strategy over the others should be avoided until further head-to-head comparisons are available.