bluuebunny/crossref_metadata_2025_split huggingface dataset:
027 Determinants Of Guideline Use Among Primary Care Physiotherapists In Western Sweden: A Cross-Sectional Study
Authors: Bernhardsson S , Johansson K , Nilsen P , Öberg B , Larsson M 
Published: August 2013

BackgroundThe understanding of attitudes, knowledge, and behaviour related to evidence-based practice (EBP), in particular evidence-based clinical practice guidelines, in primary care physical therapy is limited.ObjectivesTo investigate self-reported attitudes, knowledge, behaviour, prerequisites, and barriers related to EBP and, in particular, guidelines among physical therapists (PTs) in primary care, and to explore associations of self-reported use of guidelines with these social-cognitive factors.MethodsCross-sectional survey of PTs (n = 400) in primary care in western Sweden using a web-based, validated questionnaire. Logistic regression analysis was used.ResultsThe response rate was 67.8%. Most PTs (82%–96%) had positive attitudes toward EBP and guidelines. Thirty-three percent reported being aware of guidelines, 13% knew where to find guidelines, and only 9% reported having easy access to guidelines. Less than half reported using guidelines frequently. The most important barriers to using guidelines were lack of time, poor availability and limited access to guidelines, that they are too general and take too long to read. Positive attitudes to EBP and guidelines, knowledge of where to find guidelines, self-efficacy, easy access, ability to integrate patient preferences, and encouragement of EBP in the workplace were associated with frequent use of guidelines.DiscussionUse of guidelines was not as frequent as could be expected in view of the positive attitudes. Attitudes, knowledge, self-efficacy, easy access, ability to integrate patient preferences, and encouragement of EBP may promote guideline use.Implications for Guideline Developers/ImplementersThe identified barriers and determinants can be addressed in the development of guideline implementation strategies.
033 Using Rapid Reviews to Influence Guidance Development in the Emergency Department Setting
Authors: Ramachandran J 
Published: August 2013

BackgroundDecision making within health care organisations often requires rapid response to emergent, controversial or high-impact issues affecting clinical and operational practices.ContextCT imaging without oral contrast for patients admitted into the Emergency Department (ED) for abdominal/pelvic pain has been proposed as a viable option to reduce the risk of contrast-induced nephropathy and allergic reactions, as well as emergency room delays and overall length of stay (LOS) in the ED. A centralised evidence assessment unit within a large health care organisation was asked to conduct a rapid evidence review to inform the development of evidence-based guidance.Description of Best PracticeA 5-step rapid review process was initiated, including: 1) Communicating with key stakeholders to determine relevant populations, interventions, comparisons, outcomes, timing and settings (PICOTS); 2) Conducting a comprehensive evidence search using a pre-established list of key databases and other sources to identify high-quality guidelines, systematic reviews and clinical trials evaluating the efficacy and diagnostic accuracy of conducting abdominal CT with and without oral contrast agents; 3) selecting and abstracting data from relevant studies; 4) evaluating and synthesising the literature; and 5) translating results for clinical/operational decision making. Findings of low- to moderate-quality evidence across outcomes, combined with operational and resource data, resulted in a decision not to implement the practice.Lessons for Guideline Developers, Adaptors, Implementers, and/or UsersCoupled with expert input from knowledgeable clinicians and stakeholders, rapid evidence reviews can be critical to shaping evidence-based guidance in Emergency Department settings.
034 Do Models of Rapid Guideline Updates Fit Within the Current Australian Guideline Standards? An Example From the National Stroke Foundation Clinical Guidelines
Authors: Hill K , Wright L 
Published: August 2013

BackgroundClinical guideline recommendations are developed to assist health professionals to make evidence-based decisions. This is reliant on having the most up-to-date evidence available. The current Australian National Health and Medical Research Council (NHMRC) standards require guidelines to be updated within five years. An online process which provides transparency and enables timely changes/updates, such as the wiki platform developed and used by the Cancer Council of Australia (CCA), would provide a more useful platform to update guidelines but is currently not considered within the NHMRC standards.ObjectivesTo evaluate if using the CCA wiki platform to update stroke guidelines would meet NHMRC standards.MethodsWe reviewed a potential CCA wiki platform (“wiki”) model against the existing NHMRC standards (2011) to determine compatibility and identify where changes to the wiki model might be required.ResultsThe processes utilising the wiki were methodologically robust and were deemed to comply with 45/50 of the mandatory elements of the NHMRC standards with minor changes needed to comply with the other five elements. Difficulties arise predominantly due to the fact that the NHMRC standards are based on physically published guidelines.DiscussionA model of rapid guideline updates utilising a wiki platform is able to accommodate robust methodology and meets most of the current Australian standards.
036 Development of A Statewide Guidelines Program Using The ADAPTE Framework
Authors: King V , Vandegriff S , Little A , Coffman D , Livingston C , Shaffer W , Gingerich J 
Published: August 2013

BackgroundThe legislature passed comprehensive health reform legislation in 2009 directing the state to “set standards for safe and effective care”, including development of “best practice guidelines and standards that can be uniformly applied across public and private health care”.ObjectivesDevelop guideline methodology and guidelines for statewide clinicians and payers.MethodsEmployed ADAPTE framework for guideline development. Initial guidelines selected for development included three low back pain (LBP) topics: general evaluation and management of LBP (results described below), advanced imaging for LBP, and percutaneous interventions for LBP. Existing (seed) guidelines identified by searching 17 databases. Quality evaluated using modified AGREE II instrument. Multidisciplinary guideline development group selected and adapted seed guidelines. Stakeholder, peer review and public comments were solicited.ResultsThirteen seed guidelines were identified and 10 met minimal inclusion criteria for LBP evaluation and management topic. Dual quality rating found five of good or fair quality. Final seed guideline selected based on quality and scope. Key recommendations were adopted for state Medicaid programme, including conservative and chiropractic care only in first month and no advanced imaging without clinical “red flags”. A consumer booklet was developed and distributed to consumer, provider, and payer groups. Over 2500 booklets were distributed, with over 11,000 page views on the website. The initial guideline process took over one year to complete.DiscussionStarting a new multi-stakeholder guideline development programme requires substantial investments of methodological expertise, staff time, funds and political capital, but can substantially impact state health policy decisions.
037 Updating an Adapted CPG: When Is Enough Enough?
Authors: Harstall C , Moga C , Scott A , Taenzer P , Findlay T 
Published: August 2013

BackgroundWithin 2 years of releasing a low back pain clinical practice guideline (CPG), the Alberta Ambassador Guideline Adaptation Programme was required to update its adapted guideline. No guidance or ‘how to’ manuals were located.ObjectivesTo develop a process for updating an adapted guideline. To expedite the process by determining which components can be removed without compromising rigour.MethodsCPGs and systematic reviews published since the release of the CPG were identified and appraised, and discordant and new recommendations were tabulated. The Guideline Development Group (GDG) was surveyed to identify new interventions of interest. Evidence from systematic reviews was included for ‘do not know’ recommendations and new interventions.ResultsThe original guideline had 50 recommendations, eight of which were in the ‘do not know’ category. This expanded to 85 recommendations in the update: 43 unchanged, 32 on GDG-nominated new interventions, and 10 revised. The updated CPG has 33 ‘do not know’ recommendations. One of the original eight ‘do not know’ recommendations was changed based on new evidence.DiscussionThe challenge of maintaining the integrity and high standards of the original guideline meant that the update consumed more time and resources than planned. Clearly, some components of the process can be jettisoned without jeopardising the methodological rigour and comprehensiveness of the final product.ImplicationsThe next update will be streamlined, including only new seed guidelines that meet the quality criteria of the modified AGREE and using systematic reviews to supplement the evidence base when there is discordance among recommendations.
038 Development of Multidisciplinary Symptom Management Tools Using The ADAPTE Approach
Authors: Harle I , Bak K , Molloy S , Green T 
Published: August 2013

BackgroundEvidence-based tools for symptom management were developed to assist healthcare providers in comprehensive assessment and appropriate management of symptoms. These evidence-based tools consist of comprehensive guides-to-practice, quick reference pocket guides, algorithms and smart phone apps.ObjectivesThe symptom management tools promote an interdisciplinary model of care that enables early identification and assessment of symptoms, appropriate documentation and communication regarding symptoms, optimal symptom management, and coordinated care throughout the illness trajectory. The tools are intended to be user-friendly, and are available in print, web and smart phone applications.MethodsThe tools were developed by an interdisciplinary panel of healthcare providers using the ADAPTE guideline adaptation approach. This included a literature search for recent guidelines and systematic reviews, guideline appraisal using the AGREE tool and selection, and in some instances modification, of recommendations. Expert feedback was obtained and subsequently appropriate revisions were made.ResultsThe symptom management tools provide recommendations based on the best available evidence and expert consensus, for assessing, determining aetiology, diagnosing potential problems and for recommending non-pharmacological and pharmacological interventions.Implications for Guideline Developers/UsersThe ADAPTE approach offers a comprehensive and rapid process of developing evidence-based tools for the cancer patient population. Following the global trend of creating user-friendly clinical guidance, the guides-to-practice, quick reference pocket guides, algorithms and smart phone apps are an innovative set of tools that are accessible to a diverse group of care providers, in a manner that would suit the individual’s clinical needs.
P007 Keeping a programme of clinical guidelines up-to-date
Authors: Roberta James 
Published: August 2013

Over the last 20 years, SIGN has published 132 guidelines. Of the 68 extant guidelines only 15 are under 3 years old. SIGN is committed to providing evidence based clinical practice guidelines to help accelerate the translation of new knowledge into action to meet our aim of reducing variations in practice, and improving patient-important outcomes.SIGN has an established process of scoping, consulting on, prioritising and updating published guidelines. This process, however, is time and resource intensive and has been based heavily on the age of the guideline and the emergence of new evidence rather than on any real need from guideline users.A full review of a guideline is equivalent to developing a new topic and takes 2–3 years. Some alternative approaches that SIGN has developed for keeping guidelines up to date in a more timely fashion include:a selective update based only on those key questions underpinning a guideline that are shown to identify new evidence that would change recommendations. This process takes around 15 months and topics are scoped and prioritised;a living guideline that is scoped and updated every year;a small change affecting one or two recommendations that is highlighted by a guideline user or initiated by a change in licensing, legislation or local healthcare policy. This process takes around 6 months, is more reactive and driven by guideline user need but may only be applicable to newer guidelines.This presentation will describe the risks, benefits, success and challenges in adopting these approaches. The key lessons learned include the need to:clarify the need for the updatescope the evidence base and define the breadth of the remitfollow established processes and work within existing methodologymanage guideline development group expectations.
039 Guideline Developers’ Self-Perceptions of Adherence to and Intentions to Adhere to the IOM Standards
Authors: Jue J , Haskell L , Cunningham S , Nix M , Coates V 
Published: August 2013

BackgroundThe 2011 IOM report called for more rigorous and transparent development of guidelines. Compliance with the IOM Standards may be challenging for developers. Developer perception of their current adherence to the Standards gives insight into their understanding of them and the likelihood of adhering to them in the future.Objectives(1) Assess developers’ self-perceptions of adherence to the IOM standards (2) Assess developers’ intentions to adhere to the IOM standards.MethodsThis AHRQ funded work used a mixed-methods approach. We performed semi-structured telephone interviews and surveys to query developers about impressions of and intentions to implement the IOM standards in their CPGs. We also performed our own assessments of guidelines and compared them with developer self-ratings.ResultsOf 14 developers, 43% utilised a systematic review to underpin their guidelines, and 57% felt they would in the future. Funding sources were not disclosed by 46% of the developers. While 80% utilised an evidence rating scheme, fewer rated the recommendations. Notable differences between developer self-ratings and researcher assessments of adherence occurred in several areas.DiscussionWhile some developers intend to improve processes to meet the Standards, others acknowledged they will not. Yet still others felt they already met the standards, but our assessment suggested a different estimation, revealing varying understanding among developers of the Standards.Implications for Guideline Developers/UsersThe IOM standards will help identify rigorous and transparent evidence-based guidelines, but will pose implementation challenges. Education of developers on the Standards and expectations around them will be critical.
040 Can Systems for Rating Evidence Quality and Recommendation Strength be Harmonised
Authors: Shiffman R 
Published: August 2013

BackgroundIn 2011 the IOM recommended that every guideline recommendation should be accompanied by an indication of Evidence Quality and Recommendation Strength and called for strategies to encourage harmonisation of development processes.ObjectivesTo characterise the differences in systems for rating Evidence Quality and Recommendation Strength as a prelude to possible standardisation.MethodsWe examined 17 international, English-language guideline development systems to identify rating parameters and applied descriptive statistics. We also searched for conceptual linkages in the rating system descriptions and identified systems where Strength of Recommendation was stated as an Evidence Quality parameter.ResultsRating systems were remarkably inconsistent in their application of category indicators—using letters, Arabic and Roman numerals and combinations. The modal and median number of Evidence Quality categories was 3 (range 0 to 10) and Recommendation Strength categories was 4 (range 0 to 6). 13/17 used randomised trials as indicators of highest quality evidence. 7 systems used “expert opinion,” 6 used “case reports” or “case series,” and 4 described “reasoning from first principles” to define lowest evidence quality. Definitions of intermediate levels varied considerably. 7 systems judged benefits and harms in deriving Recommendation Strength. In 7 rating systems, Strength of Recommendation was described entirely in terms of Evidence Quality.ImplicationThere is considerable disagreement about the requisite granularity and definition of categories of Evidence Quality and Recommendation Strength. Application of the concept of Recommendation Strength consonant with the IOM standard is limited. A straightforward mapping of rating systems to one another is elusive.
043 Development and Implementation of National Standards For Spinal Cord Injury: A Partnership Between Accreditation Canada and the Rick Hansen Institute
Authors: Barrable B , Carpenter S , Noonan V , Thorogood N , Belanger L , Dvorak M 
Published: August 2013

BackgroundRecent studies in Canada have identified variation in care delivery for acute and rehabilitation healthcare centres treating patients with spinal cord injury (SCI). The development of standards through an accreditation process ensures patients receive standards that are deemed important for their health condition. Accreditation Canada provides healthcare organisations with a rigorous and comprehensive accreditation process, and fosters quality improvement based on evidence-based standards and external peer review.ContextTo develop Accreditation Canada standards for SCI services across the continuum of care and provide an accountability framework to accelerate the implementation of best practices and improve quality of care for people living with SCI.Description of Best PracticeThrough a systematic review of literature and best evidence, standards for SCI care were defined for acute care management and rehabilitation. These standards were developed with input from an Advisory Committee with Canadian SCI experts and a web-based national consultation. The standards were piloted in 4 Canadian centres and received positive feedback. Suggestions are being integrated into the standards and in the next five years, the Rick Hansen Institute will work with centres in its network to accredit 50% or 16 centres using these standards.Lessons for Guideline Developers, Adaptors, Implementers, and/or UsersThrough providing a framework to evaluate quality and safety, Accreditation Canada and Rick Hansen Institute have an opportunity to improve the dissemination and implementation of best practices in SCI care that could serve as a model internationally.
048 Development of First Aid Guidelines For Recreational Athletes By Belgian Red Cross-Flanders
Authors: Pauwels N , Buck E De , Viroux P , Bellemans J , Meeusen R , Peers K , Verhelst K , Dieltjens T 
Published: August 2013

BackgroundBelgian Red Cross-Flanders (BRCFl) is active in many fields including first aid training, for which BRCFl develops evidence-based guidelines according to AGREE II.ObjectivesDevelopment of evidence-based recommendations for recreational athletes who perform one of 15 sport disciplines, defined by popularity, medical costs and injury risk in Flanders (Belgium). Initiatives concerning wording and accessibility were taken to develop implementable guidelines adapted for laypeople. These guidelines will also be used by the Flemish Government to update its information sources.Methods10 databases for guidelines, systematic reviews or individual studies were searched and draft recommendations were formulated based on the best current evidence. The quality of evidence was assessed using the GRADE approach. A guideline development group, including a multidisciplinary expert panel (co-authors PV, JB, RM and KP), discussed the draft recommendations while taking into account the evidence, and validated the final recommendations.Results32 systematic reviews and 2 guidelines that met the methodological criteria were identified as valuable source of studies. Additionally, 73 individual studies were included. The overall quality of the body of evidence varied from moderate to very low. Recommendations, written in active and explicit wording, were organised in a structure in order to be searchable via sports discipline, anatomical localisation, type of intervention, and injury.DiscussionPreferences of the target group were taken into account when selecting the sport disciplines and when formulation the evidence-based recommendations.Implications for Guideline Developers/UsersInvolving the target population is an added value for developing an implementable evidence-based guideline.
050 Developing Evidence-Based Clinical Practice Guidelines for Primary Care Physiotherapy: A Local Initiative
Authors: Bernhardsson S , Larsson M 
Published: August 2013

BackgroundIn primary care physiotherapy in Sweden, there is a lack of evidence-based clinical practice guidelines to support clinicians and patients in clinical decision making. A local initiative to develop and implement evidence-based clinical practice guidelines for PTs in primary care was initiated by a regional health authority.ObjectivesTo develop evidence-based clinical practice guidelines for physiotherapy treatment of low back pain, neck pain, and subacromial pain, for use in primary care physiotherapy in Sweden.MethodsThe guideline development was performed by a project team of five primary care physiotherapists in a systematic process that was guided by a 7-step guideline development model by Grol et al. We performed systematic database searches, critical appraisal of the evidence base using GRADE, and formulated evidence-based practice recommendations.ResultsThe guideline format follows recommendations from AGREE II. The guidelines consist of a brief summary on the first page; a brief introduction to the topic with up-to-date information on definition of the condition, prevalence and prognosis; recommendations on patient management according to strength of evidence; a discussion section, and a detailed reference list. Detailed search strategy and search results, summaries of the body of evidence, recommended outcome measures, and patient information were provided in appendices to the guidelines.DiscussionRigorous guideline development methodology was considered important to get clinicians’ attention and approval - a requisite for regular use. Clinicians welcomed the initiative.Implications for Guideline DevelopersIt is important for clinician acceptance that guidelines are brief, to the point and relevant.