bluuebunny/crossref_metadata_2025_split huggingface dataset:
P222 Evolution Of Evidence Grading Systems In The American Academy Of Ophthalmology’s Preferred Practice Patterns
Authors: Emptage N , Lum F 
Published: August 2013

BackgroundClinical practice guidelines are an important component of efforts to improve quality of care and rationalise the introduction of new medical technologies. As evidence-based medicine and comparative effectiveness research become more prominent, the rigour and transparency of guideline development is becoming increasingly important.ContextSince 1988, the American Academy of Ophthalmology has published ophthalmic practice guidelines known as Preferred Practice Patterns (PPPs). Over time, the Academy has introduced increasingly rigorous processes for grading the evidence underpinning the PPPs.Description of Best PracticePrior to 2000, the PPPs were effectively consensus-based, with no formal processes for identifying or synthesising evidence, and no system for grading evidence quality. In 2000, a three-level system was introduced to denote the quality of the evidence supporting PPP recommendations, with Level I denoting strongly evidence-based statements and Level III denoting statements unsupported by evidence. In 2001, the level definitions were revised to denote the quality of specific study designs, and explicit guidance for synthesising bodies of evidence was developed. A third revision in 2006 tightened the criteria for Levels I and II, and created a Level IV to differentiate poor-quality studies from expert opinion. In 2011, the levels were revamped to be consistent with SIGN and GRADE methods.LessonsThe Academy has worked for years to make its evidence grading systems more rigorous. This has included using a level-based system to clearly link PPP recommendations to evidence quality, revising the level definitions for greater clarity, and providing explicit direction on evidence synthesis.
P235 From Clinical Practice Guidelines To The Comprehensive Care Guideline For Patients: Beyond The Scientific Process, A Task Of Cultural Construction
Authors: Bonilla Mahecha L , Moreno M , Mosquera P , Gaitan H 
Published: August 2013

BackgroundPatients guideline development is a complex process that must combine harmoniously clinic expert knowledge, values, preferences and patient’s information needs; it means in itself the possibility of transforming social imaginary, practices, beliefs and behaviours health. The design of a qualitative methodology systematic and rigorous a guideline for patients would allow producing efficient results. The paper contains the design of a systematic and rigorous type of qualitative methodology, a guidelines for patients, was allowed producing efficient results.ObjectiveDesign a methodology for patients’ guidelines development in the Colombian context.MethodsA qualitative type study was developed in three phases: 1) Review of materials and patients guidelines targeting populations, creating an array of identification of information needs. 2) Development of a proposal for a context-sensitive communication expert team. 3) Validation of contents.ResultsDesigned a methodology with ten steps and developed the guidelines for patients which included scientific evidence, socio-cultural practices and participation of patients. The validation of the sexually transmitted infections the Guide was attended to people with a variety of gender, age and educational level. During the process was verified that although this methodology was systematic and rigorous, was flexible and allowed adapting independently the guideline the nature of the disease, life cycle, and the information’s circulation.DiscussionLeading the developing process of guidelines. patients by systematic and flexible methodologies allow to make a better sizing of the process incorporating valid contextual factor, suggests the need to be validated and involve patients in the process.
P236 Documentation Of Intellectual Conflicts Of Interests Proved Critical In A Clinical Practice Guideline
Authors: Akl E , El-Hachem P , Abou-Haidar H , Guyatt G 
Published: August 2013

BackgroundThe American College of Chest Physicians (ACCP) Antithrombotic Guidelines (AT9) addressed both financial and intellectual COI, and restricted panellists from voting on recommendations on which they declared a primary conflict. The extent to which intellectual COI restricted participation beyond financial COI is uncertain.ObjectiveThe objective is to describe financial and intellectual COI among AT9 panellists and assess their overlap.MethodsThe AT9 executive committee developed definitions and categorizations of primary and secondary financial and intellectual COI. panellists reported, for each recommendation, their financial and intellectual COIs. We analysed their declarations.ResultsAmong 102 panellists, the average number of recommendations for which panellist declared COI was: 2.1 (SD 5.7) for secondary financial COI, 1.7 (SD 3.5) for primary financial COI, 5.0 (SD 9.9) for secondary intellectual COI, and 2.5 (SD 5.0) for primary intellectual COI. Of the 102 panellists 37 (36%) declared a primary intellectual but no primary financial COI for at least one recommendation. Among 431 recommendations, the average number of panellists per recommendation who declared COI was: 0.5 (SD 0.8) for secondary financial COI, 0.4 (SD 0.9) for primary financial COI, 1.2 (SD 1.2) for secondary intellectual COI, and 0.6 (SD 1.2) for primary intellectual COI. In 63 recommendations (23%) at least one panellist had a primary intellectual COI but no primary financial COIConclusionA substantial number of declarations resulted in restrictions based on intellectual COI in the absence of financial COI.
P239 Breaking New Ground To Close The Gaps Between Physcian’s Knowledge And Prcatice
Authors: Bhushan R , Gist D 
Published: August 2013

BackgroundEffective dissemination of evidence-based clinical practice guidelines (EBCPG) help clinicians practice evidence-based-medicine, close practice gaps, thus improving medical care.ObjectivesTo determine the effectiveness of an educational intervention to measure changes in practice/self reported performance improvement for the management and treatment of psoriasis and psoriatic arthritis.MethodsEBCPG were leveraged and repurposed as an interactive guideline translational CME course to expand physicians’ knowledge base and improve clinician confidence and effectiveness in treating patients with psoriasis and psoriatic arthritis. Participants were given i) an assessment questionnaire before and after the session to measure knowledge and competence, ii) guidelines application tools useful in the clinic. A follow-up assessment questionnaire was conducted one year later to assess if session and application tools were easy to translate in clinic.ResultsApproximately 90% of the participants felt the session improved their knowledge, confidence and will have an impact on their practice. Over 60% of case vignettes based questions showed significant improvement compared to the pre assessments p < 0.05. A one-year follow up indicated that 63% of the participants had changed their practice after attending the session.DiscussionThe session will optimise usability of EBCPG in physician’s daily practice and lead to improvement of patient quality of life and help in closing gaps in practice care.Implications for Guideline Developers/UsersEBCPG translational session with application tools is an effective method for implementing clinical guidelines and helps physicians practice evidence-based-medicine enhancing quality patient care.
P241 Considering Patients’ Values And Preferences When Formulating Recommendations With GRADE
Authors: Ibargoyen-Roteta N , Etxeandia-Ikobaltzeta I , Zaragoza-Gaynor G , Carrasco-Gimeno J , Lizarraga-Azparren M , Elorz-Lambarri J , Villar-Alvarez M 
Published: August 2013

BackgroundThe GRADE approach takes into account the variability that may exist in patients’ values and preferences when formulating recommendations. Nevertheless, in the updating process of the Clinical Practice Guideline (CPG) for children with asthma no related information could be found in the literature.ObjectivesTo obtain information about the values and preferences of caregivers of children with asthma to be considered when formulating recommendations.MethodsA focus group was designed to explore caregivers’ perceptions and opinions about some of the issues addressed in the CPG. Twelve possible participants were identified by paediatricians and specialists involved in the development of the GPC, and finally 9 mothers of children with asthma were convened. Twenty-two questions were defined by the research team. The focus group, previous consent recorded, was transcribed and analysed. Triangulation was made by two of the researchers for all the analysis.ResultsThe information obtained was taken into account in 11 of the 16 clinical questions. The most relevant information obtained was related to the relevance of self-management and the importance of having good information, for caregivers and children, to manage the disease. The concern about what happened when caregivers were not with the children, for example at school, was also identified.DiscussionThe focus group helped to obtain information about patients’ values and preferences to be considered when formulating recommendations.Implications for Guideline Developers/UsersFocus groups specifically designed to obtain information about patients’ opinions in relation to particular clinical questions provides valuable context-dependent information to take into account when formulating recommendations.
P242 Managing Etiology Questions With Grade
Authors: Ibargoyen-Roteta N , Etxeandia-Ikobaltzeta I , Etxeberria-Agirre A , Rotaeche-del Campo R , Aldasoro-Ruiz A , Lizarraga-Asparren M , Elorz-Lambarri J , Villar-Alvarez M , Galardi-Andonegui E , Irizar-Aranburu M 
Published: August 2013

BackgroundCurrently the GRADE approach only considers the development of recommendations for treatment and diagnosis related clinical questions.ObjectivesTo develop a proposal using GRADE to formulate recommendations for aetiology questions.MethodsThe exposure to paracetamol in the first year of life and asthma at the age of 6 years was chosen as an example. A systematic review was made, searching in Cochrane, CRD, Medline and Embase databases. Cohort studies or Meta-analysis of observational studies were selected, and CASPE and MOOSE checklists used for quality assessment. The evidence was considered high when there were no factors affecting our confidence on the estimates.ResultsOne systematic review (including 4 related cross-sectional studies) and 4 cohorts were found. To assess the evidence with GRADE two outcomes were used (increase of asthma and wheezing at 6 years). Risk of bias was assessed taking into account the cohort design and aetiology studies characteristics, but inconsistency, indirectness and imprecision were considered in the same manner. In contrast to cross-sectional studies, cohort studies (3 out of 4) did not find a significant relationship between paracetamol and asthma development. Due to possible risk of bias and imprecision, the quality of the evidence was downgraded two levels and a recommendation in favour of the rational use of paracetamol in children was made.DiscussionA proposal to address aetiology questions based on the GRADE approach has been developed. More examples are needed to validate it.Implications for Guideline DevelopersTo be able to use the GRADE approach independently of the question type.
P244 Development Of A Tailor-Made Implementation Strategy To Facilitate Adherence To The Dutch Postpartum Hemorrhage Guideline And Moet-Instructions
Authors: De Visser S , Woiski M , Hulscher M , Vandenbussche F , Scheepers L , Hermens R 
Published: August 2013

BackgroundDespite the introduction of a national guideline and the Managing Obstetric Emergencies and Trauma (MOET) course the incidence of postpartum haemorrhage (PPH) is increasing. We suspected inadequate guideline implementation to be underlying.ObjectiveOur objective was to develop and pilot test a tailor-made implementation strategy for the Dutch PPH guideline and the MOET course to increase guideline adherence.MethodsFirstly, we aggregated the results of a current care and diagnostic analysis, which yielded barriers for guideline implementation, together with evidence found in international literature. Main barriers among professionals were lack of a checklist available in the labour ward, inadequate high-risk patient identification and lack of team communication. Patients mentioned insufficient information supply. Secondly, we developed different implementation tools for professionals and patients, based on these results. These tools were evaluated in a pilot testing among both groups.ResultsThe strategy affects the period between the last trimester of the pregnancy till the end of the third stage of delivery. The tools for professionals consisted of a high-risk identification checklist, a care bundle for PPH prevention, and a PPH treatment checklist. As patient empowerment tools a patient passport and an information website were developed. Professionals had no points for improvement concerning the tools. Patients commented on the website, and changes were made accordingly.DiscussionWe developed a tailor-made strategy for PPH guideline implementation. The next step in the implementation process is to evaluate the feasibility of the strategy, including an effect, process and cost evaluation.
P260 A Model For Bridging The Translational Valley Of Death In Spinal Cord Injury
Authors: Barrable B , Thorogood N , Noonan V , Joshi P , Stephenson K , Kwon B , Dvorak M 
Published: August 2013

BackgroundDespite the amount of funding that supports basic research, few research discoveries achieve their potential. The transition from bench-to-bedside research is so fraught with obstacles that it is referred to as the “valley of death”.ObjectiveThe Rick Hansen Institute (RHI) developed a unique Praxis Model for translational research in the field of spinal cord injury (SCI). At RHI this means bringing knowledge into action; to improve healthcare outcomes for people with SCI and decrease the financial impact on the healthcare system.MethodsThe research continuum begins with discovery science which feeds into the knowledge cycle, continues with the acceptance and uptake into the treatment of spinal cord injuries. The core activity within the Praxis Model is a knowledge cycle that consists of a four-phased strategy: 1) Environmental scan, 2) Knowledge generation and synthesis, 3) Knowledge validation, and 4) Implementation.ResultsRHI has participated and supported over 60 studies since 2007 and engaged researchers from nine countries, 46 academic institutions and various accreditation and professional associations. Currently, the model is being independently evaluated to determine strengths and limitations. Examples of RHI initiatives using the Praxis Model and results of the evaluation will be presented.DiscussionRHI has developed an innovative solution to move knowledge into action. The Praxis Model strives to lead collaboration across the global SCI community by providing funding, infrastructure, strategic partnerships, governance and a network.ImplicationsLessons learned in developing the Praxis Model may assist other organisations dealing with similar translational research challenges.
P263 Implementing A New Standard For Medical Specialty Society Guideline Development
Authors: Wolfkiel C , Smith Begolka W , Fulda G 
Published: August 2013

BackgroundThe Council of Medical Specialty Societies (CMSS) approved “Principles for the Development of Specialty Society Clinical Guidelines” as a set of standards that member societies could draw upon in developing their own development methodologies. Developed by the member societies in late 2012, the Principles are intended to provide a degree of interpretive flexibility not offered by other standard sets but based upon an expected level of transparency that individual interpretations would be explained.ObjectivesPrinciples were labelled as “must”, “should” and “may” in an effort to impart suggested implementation flexibility as designed by the Principles development team. This proposed analysis of society feedback is intended to assess the actual concordance with the Principles by societies implementing their methodologies or updating them.MethodsAn electronic survey was sent to Societies who identified themselves as creating new or adapting existing methodologies asking agreement on ease of implementation in 10 previously identified contentious standards. The survey will also include opportunity for responders to identify other difficult to implement/interpret principles as well as new principles that should be considered.ResultsData from respondents will be presented.DiscussionMedical Specialty Societies developing clinical practice guidelines are diverse in terms of size, scope and resources. The recent IOM standards were developed by as best practice with little guidance for potential interpretation or resource requirements. The CMSS Principles are intended to be a step towards practical guidelines standards and this research the first feedback step as to measuring that practicality.
P266 At What Rate Does New Evidence Change Guidance
Authors: Ording J , Thiese M , Hegmann K , Wolfkiel C , Ott U 
Published: August 2013

BackgroundNew research is continually shaping guidelines; however, the rate of change has not been assessed.ObjectivesReview articles from 2010 to 2013 to assess rate of change of guidelines for the elbow.MethodsA systematic literature search was conducted to identify randomised controlled trials (RCTs) on elbow disorders published between 2010 and 2013. Identified RCTs were scored using established scoring methods and incorporated into guidelines to determine if any recommendations needed to be changed or new recommendations added.ResultsFifteen new RCTs were identified (4 high-, 9 moderate-, and 2 low-quality). Nine (69%) studies were used to make 3 new recommendations and 4 changes to recommendations to guidelines on elbow disorders. Seven of these studies prompted new guidance on soft tissue mobilisation, autologous blood injections, periarticular blood injections for lateral epicondylalgia (LE). Two of these studies caused changes to the recommendation level for manipulation/mobilisation for LE and evidence level changes for exercises, glucocorticosteroid injections, and platelet rich plasma injections for LE. Seven (53%) studies did not change any of the recommendations but added to the body of evidence to support the current recommendations.DiscussionNew studies may be higher quality and have significant impact on guidelines. Two-thirds of new evidence triggered recommendations changes or development of new recommendations for treating LE. Additional assessments of low back and other body parts are underway.Implications for Guideline Developers/UsersIt is beneficial to do a yearly review of the literature to determine if any new evidence will impact changes to current guidelines.
144WS How to Make Judgements About the Quality or Strength of Evidence Transparent
Authors: Langendam M , Mustafa R , Ventresca M , Heus P , Santesso N , Carrasco A , Moustgaard R , Lasserson T , Schunemann H 
Published: August 2013

BackgroundWhen assessing the confidence in intervention effects, i.e. the quality of evidence, guideline developers should make their judgement about this confidence transparent and provide an overall assessment (or grade) of the evidence (GIN & IOM standards 2011). The GRADE approach requires these judgments to be described in comments and footnotes. In a recent review of GRADE evidence summaries, we observed important variability in how guideline developers and authors of Cochrane systematic reviews perform these tasks.ObjectivesIn this interactive workshop the participants will learn how to formulate understandable and informative reasons for down- and upgrading the quality of evidence by using a footnotes checklist.Target GroupSystematic reviewers and guideline developers assessing the quality or strength of evidence.Description of the Workshop and of the Methods used to Facilitate InteractionsWe will present the development of the footnotes checklist. To get hands-on experience the participants will work in large and small groups to: 1) use the checklist on several examples of GRADE evidence profiles and 2) make a judgement about how informative these footnotes are, in particular with guideline panel meetings in mind. The examples will include challenging topics like evidence from single RCT and narrative reviews (no pooled estimates). The outcomes of these exercises will be discussed with the large group and will be used to further improve the checklist.
P270 Development Of Quality Indicators Of Low Risk Labor Provided Primarily By Midwives: Based On Clinical Practice Guidelines With A Modified Delphi Method
Authors: Ueda K , Ohtera S , Misato K , Nakayama T 
Published: August 2013

BackgroundIn Japan some labour units have started services for low risk labour provided primarily by midwives with the assistance of obstetricians. However, real practices varied with facilities and quality of care has not been sufficiently assured.ObjectivesWe aimed to develop quality indicators of low-risk labour provided primarily by midwives in Japan.MethodsWe systematically searched databases to select related indicators and clinical practice guidelines. Using a modified Delphi method, a multidisciplinary panel including two women who experienced labour and were not health professionals was assembled and a meeting was held. After the panel members rated the candidates individually, consensus was attained for each indicator.ResultsAn electronic search retrieved 104 guidelines (2043 key recommendations) from which 32 guidelines (166 key recommendations) were selected. Some recommendations were excluded due to difficulties in measuring and others due to evidence against following certain guidelines. Additionally, 31 existing quality indicators were identified. The panel discussed 25 candidate indicators: 18 indicators were adopted, six indicators were not adopted, one indicator was modified. Four indicators were added later following discussion. Consequently, 23 quality indicators of care were chosen.DiscussionA pilot test of these indicators at multiple facilities should contribute to future development of guideline-based quality indicators.Implications for Guideline Developers/UsersGuideline developers should be more conscious in making recommendations that are potentially used as quality indicators.
P273 Effects Of Korean-Agree Scoring Guide On Improving The Reliability Of The Scores
Authors: Oh M , Jo H , Lee Y 
Published: August 2013

BackgroundThe Korean translated AGREE II instrument has been distrubuted to Korean medical societies in 2011. But inter-rater disagreement issues still existed. The Korean AGREE II scoring guide was therefore developed to reduce inter-rater differences.ObjectivesTo examine effects of the Korean AGREE II scoring guide on reduction of the inter-rater differences.MethodsAppraisers were randomly assigned to group A or B. The Korean AGREE II instument was provided to all participants, but the Korea AGREE II scoring guide was offered to only group A. Total of 14 appraisers participated and each gudeline was assessed by 8 appraisers. To evaluate the reliability of the Korean AGREE II scoring guide, correlation of scores among appraisers and domain-specific intra-class correlation (ICC) were calculated.ResultsMost scores of two groups were comparable. And scoring guide user group showed higher reliability at all guidelines. It showed higher correlation among appraisers and higher ICC values at almost all domains (from 0.272∼0.792 to 0.667∼0.888 in CPG A, from 0.273∼0.682 to 0.424∼0.815 in CPG B).DiscussionScoring guide reduces the inter-rater disagreement and improves the overall reliability of the Korean-AGREE II instrument.Implications for Guideline Developers/UsersThis study identified the performance and utility of the scoring guide as a useful guidance to Korean-AGREE II instrument users.