bluuebunny/crossref_metadata_2025_split huggingface dataset:
P268 What Kind Of Evidence Supported The Clinical Practice Guideline For The Syndromic Management Of Sexually Transmitted Infections And Other Infection Of The Genital Tract 2012
Authors: Gaitan H , Torres M , Rodriguez A 
Published: August 2013

BackgroundIn recent years, the GRADE approach has been broadly accepted by many GDG. There is a lack of information about the relationship between the types of evidence with the strength of recommendations using GRADE.ObjectiveTo present the evidence mapping of the literature used to develop recommendations in the Guideline for Syndromic management of the Genital Tract Infections.MethodsThe evidence of each recommendation was reviewed and was classified according to the type, quality and quantity of evidence and strength of the recommendation. A descriptive analysis was performed as well as a cross-analysis to find out the relationship between the strength of the recommendation and the underlying quality of the evidence.Results80 recommendations were identified. Systematic reviews supported the 29.1% of the recommendations, RCT 25.6%, observational studies 5.9%, guidelines 9.3% and expert opinion 30.1%. The quality of the evidence was high (14%), moderate (15%), low (16%) and very low (55%). 63.7% of the recommendations were strong in favour. 14% of the strong recommendations came from high quality evidence and 49% came from very low quality evidence.DiscussionThe evidence shows a similar percentage of systematic reviews, RCT and expert opinion in the guideline. Despite the quality of the evidence, the number of strong recommendations is high due to the other criteria of the GRADE approach.Implications for Guideline DevelopersThe GRADE approach allows weighting other factors beyond the quality of the evidence. Research needs to be done on the most important factors in grading the recommendations.
P281 Applying The Re-Aim Framework To Evaluate Dissemination And Implementation Of Clinical Practice Guideline For Sexually Transmitted Infections In Korea
Authors: Jo H , Chang S , Lee Y , Shin E , Oh M , Oh H 
Published: August 2013

BackgroundClinical practice guideline for Sexually Transmitted Infections were developed in 2011 by The Korean Urological Association supported financially by the Korean government. It is necessary to establish the theory-based strategy to disseminate and implement guideline more effectively.ObjectivesTo evaluate dissemination and implementation of clinical practice guideline for Sexually Transmitted Infections in primary health care in Korea.MethodsThe RE-AIM framework in terms of reach, effectiveness, adoption, implementation and maintenance was applied. Structured questionnaire was formulated. Survey was performed by e-mailing to physicians working at primary health care clinics from 1st Nov – 30thNov 2012 and 305 physicians responded.ResultsOf the total respondents, 37.5% answered ‘Reach’- no problem for the accessibility of clinical guidelines, cognitive level, and adoption. For Effectiveness measurement, the use of practice guidelines would help the determination of the direction of treatment and communication with patients (52.2%). For the Adoption-environment to apply clinical practice guidelines, there were no problems (50.6%). For Implementation-the degree of application with Practice Guidelines, 17.8% of respondents frequently used the guidelines and, 91.0% of respondents are willing to use them in the future. For Maintenance, 54.8% of respondents used the clinical practice guidelines for more than 6 months.DiscussionThe reach has been low and even in the respondents with the guideline, the rate of clinical application has been low as well.Implications for Guideline Developers/UsersRE-AIM framework is a useful tool to evaluate the effect of using guidelines and develop strategies to disseminate them.
064WS How to Use the GRADE ”Evidence-to-Recommendations Framework” to Develop Guideline Recommendations for Therapeutic Interventions
Authors: Schunemann H , Brignardello-Petersen R , Chan W , Alonso-Coello P , Koster M , Robbins C 
Published: August 2013

BackgroundMoving from evidence to recommendations in guideline development requires balancing evidence quality with the benefits and harms of therapeutic interventions, patient preferences, and resource and cost considerations. The GRADE Working Group has developed an approach to integrate these factors into development of clinical practice recommendations that is currently further defined in the DECIDE (Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence) project.Objectives/GoalTo train guideline developers and those working with guideline panels to facilitate the decision-making process for development of recommendations for therapeutic interventions using the GRADE “Evidence-to-Recommendations Framework.”Target AudienceGuideline developers, especially those working with guideline panels to develop recommendations for clinical practice.Description of the Workshop and of the Methods used to Facilitate InteractionsAn overview of the GRADE “Evidence-to-Recommendations Framework” will be followed by facilitated small group work to develop guideline recommendations. Participants will work together in a simulated guideline panel, and be asked to develop guideline recommendations taking into consideration the quality of evidence from a GRADE evidence summary profile, the balance of benefits vs. harms of an intervention, patient preferences and resource implications. Facilitators will guide the small workgroups through the decision-making process using materials from recent examples of guidelines developed using the “Evidence-to-Recommendations Framework.”
P312 A French Project Of Interregional And Shared Guidelines In Supportive Care
Authors: Farsi F , Klein I , Jovenin N , Labrosse H , Brunet M , Block V , Krakowski I 
Published: August 2013

BackgroundIn France, access to supportive care is a right for cancer patients It is enshrined in the health regulations (1st and 2nd national cancer plans). But equity in this access is still evolving. In this context a national learned society and the regional oncology networks are desired to support professionals by organising the sharing and exchanges on the decision support toolsObjectivesGradually enlist all French regional cancer networks and all French experts in selecting the priority thematic, methodological support in the working groups and in objectives of implementation involve the maximum of professionals in the re-reading and validation of shared guidelinesMethodEstablishment of a national committee dedicated to supporting methodological and organisational project. - Needs analysis and choice of themes by regional cancer networks - recruitment of experts by both the networks and the learned societies - establishment of inter-disciplinary working group - organisation of a re-reading solicitant learned society and cancer networks - National Day (J2R) with dedicated workshops and plenary sessions to confirm or update the guidelines.Results and ConclusionAfter 4 years, this project with regional networks complete 30 different shared guidelines and the attended by professionals of all the French regions (oncologist; surgeons, supportive care specialists, nurses).
313WS Electronic multilayered guideline format: a novel structure and presentation of trustworthy guidelines at the point of care
Authors: Kristiansen A , Vandvik P , Alonso-Coello P , Rigau D , Brandt L , Guyatt G 
Published: August 2013

BackgroundThe DECIDE Project – created by the GRADE Working Group and funded by the European Union – aims at developing and evaluating strategies to improve dissemination and uptake of evidence-based recommendations. Work Package I targets health care professionals and has developed an electronic multilayered guideline format that includes the top layer; consisting of the minimum set of information components deemed necessary for clinicians to act on a recommendation. The first phase of iterative refinements through stakeholder feedback and user testing is completed and we’re now initiating the second phase consisting of surveys and randomised trials of alternative formats.ObjectivesTo update participants on the DECIDE project (WP1) and gather feedback on current and alternative guideline formats.Target GroupGuideline developers.DescriptionThe workshop will open with an introduction to the background and progress of the DECIDE project/WP1. Participants will be given a clinical scenario together with relevant examples of guidelines after which they’re asked to provide anonymous information on attitudes and perceptions of trustworthy guidelines, the use of GRADE and current presentation formats. Following this they’ll be given a systematic review on the same subject and asked to write a draft recommendation in the top layer format using a prototype online authoring tool tailored for the format. Participants will at the end of the session be asked to provide feedback on the novel format, specifically on relevance, comprehension, likability and feasibility of production. Feedback is collected using a multiple-choice survey with clickers in addition to a final discussion
P340 Sources Of Information For Development Of Clinical Practice Guidelines In Japan
Authors: Hatakeyama Y , Okumura A , Takahashi N , Yoshida M , Kojimahara N , Kiyohara K , Sato Y , Htun N , Group MINDS , Yamaguchi N 
Published: August 2013

BackgroundA Systematic search for literature is the basis of systematic review for development of trustworthy clinical practice guidelines (CPGs). Recently, standard method of literature search has been established. However, it is not clear what sources of information are used for development of CPGs in Japan.ObjectivesThe aim is to clarify what sources of information are used for development of CPGs in Japan.MethodsWe reviewed Japanese CPGs that have been selected by MINDS (Medical Information Network Distribution Service) through process of screening and evaluation in 2011-2013, and abstracted description about sources of information used in these CPGs in February 2012.ResultsA total of 88 Japanese CPGs selected by MINDS in 2011-2013. 65 (73.9%) CPGs used Medline, 29 (33.0%) used Cochrane database of systematic reviews, and 51 (58.0%) used Ichushi. Related CPGs was used in 30 (34.1%) CPGs. Hand search was used in 56 (63.6%) CPGs. There was no clear description of source of information in 18 (20.5%) CPGs.DiscussionMedline was used in most CPGs, and Cochrane database of systematic reviews was used in a relatively small number of CPGs. Ichushi, which is a database of domestic medical literature information in Japan, was used in about a half of Japanese CPGs.Implications for Guideline Developers/UsersIt is necessary for further study to clarify what sources of information should be used for development of trustworthy CPGs.
P352 Game-It (Games For Improving Treatment-Recommendations)
Authors: Brandt L , McCallum S , Kristiansen A , Agoritsas T , Akl E , Vandvik P , Montori V 
Published: August 2013

BackgroundTraditionally patients are not involved in the development of clinical guidelines, and most current panels include only clinical and methodological experts. We therefore know little about what patients (or healthy lay people) would have recommended if they were provided with the same evidence as experts.ObjectivesDevelop a prototype ‘Recommendation-making game’ which can be used for: (1) Exploring patients and lay people’s reasoning when facing the same evidence as an expert guideline panel; (2) assess whether they give similar value to the outcomes or burdens if the decision of making a recommendation for a patient group was up to them; (3) determine whether their recommendation concur with what they would have decided for themselves.MethodsWe used game technology to make a generic prototype of an online “Recommendation-making game”, based on structured guidelines published in the MAGIC (Making Grade the Irresistible Choice) application. This approach will enable us to automatically make online surveys out of any guideline/recommendation in the system. In making it into a game we believe people would want to participate, and we can potentially harvest information from a large group of people. The game can also be used in small focus groups for qualitative data collection.ResultsWe will display the prototype at the conference.DiscussionDoes clinical experts reasoning effects that of patient representatives in a guideline panel?Implications for Guideline Developers/UsersGAME-IT explores a new way of harvesting information from patients (or healthy lay people) regarding treatment recommendations.
012 Development of an Analytic Framework for Making Evidence-Based Coverage Policy Decisions
Authors: King V , Vandegriff S , Little A , Coffman D , Livingston C , Shaffer W , Gingerich J 
Published: August 2013

BackgroundComprehensive health reform legislation in 2009 directed a US state to develop processes by which evidence can be translated into coverage guidance, and be applied rapidly and uniformly across public and private settings.ContextTopics for development of coverage guidance were chosen if they represented a significant burden of disease, had important uncertainty with regard to efficacy or harms, had important variation or controversy in clinical care, significant economic impact and/or were of high public interest.Description of Best PracticeA list of evidence sources was developed and vetted through the Governor-appointed committee that manages the state Medicaid benefit package. An analytic framework algorithm was developed to guide coverage decisions that consider six stepwise decision points: sufficiency of evidence; effectiveness of the treatment and availability of alternatives; treatment risk; cost; prevalence of treatment and feasibility of clinical research studies. The GRADE process was also used to specify the addition of patient values and preferences as a factor. The algorithm allows the committee to determine whether a service is recommended or not, with two levels of strength of recommendation (strong and weak). Using a public process, the committee has reviewed the evidence and has made coverage policy recommendations for 15 topics, to date. Decisions have been applied to Medicaid, and are also made available to other public and private payers.Lessons for Guideline Developers, Adaptors, Implementers, and/or UsersUse of a discreet analytic framework can aid in the development of coverage decisions, and may accelerate the dissemination of research evidence into clinical practice.
017 Guideline Based Performance Measures: towards G-I-N Standards
Authors: Nothacker M , Shaw T B , Stokes T 
Published: August 2013

BackgroundQuality improvement in health care requires the development and use of performance measures (PMs) that address health care processes, outcomes and patient perspectives. PMs are increasingly being developed explicitly from clinical guideline (CG) recommendations. There are no agreed international standards for the development of guidelines based PM. The development of such standards has been agreed by the G-I-N-PM Working Group (PMWG).ObjectivesTo develop a core set of standards for guidelines based PMs.Methods• Systematic literature review of PM development methods • Identification of core components of guidelines based PM development • Development of draft standards for each core component • DELPHI process (at least 2 rounds) within the PMWG group to develop final set of standardsResultsEssential components identified are: CG selection, extraction of CG recommendations, development of PMs from CG recommendations, assessment of potential PMs, intended use of PMs, piloting and review of PMs. The final agreed standards will be presented.DiscussionThese guideline based PM standards will be refined and validated in future G-I-N PMWG projects.Implications for Guideline Developers/UsersThis set of core standards for guideline based PM development offers guidance for PM developers on consensus based good practice. The resulting PM development process may also guide guideline developers to formulate more specific and measurable CG recommendations.
P005 Do guidelines guide the clinical practice?
Authors: Sang il Lee 
Published: August 2013

Clinical practice guidelines and performance measures can be used to improve quality of health care. Medical review criteria and performance measures are used to determine the extent to which care has followed specified processes and whether the expected outcomes have been achieved. Recently there are increasing tendencies to release the healthcare organisations’ performance to the public and to introduce pay-for-performance in many countries.In countries where development, dissemination, and implementation of clinical practice guidelines are relatively slow, other interventions such as claims review activities, report cards, and pay-for-performance may have stronger influence on clinical practice in the real world than guidelines. In this presentation issues around the relationship among clinical practice guidelines, performance measures, claims review criteria, and clinical practice in the settings where guideline activities are not so active will be discussed
019 Successful Implementation of Cardiovascular Prevention and Treatment Guidelines in an Integrated Health Care System: Structure, Process and Outcomes
Authors: Harris J , Jaffe M 
Published: August 2013

BackgroundEvidence based guideline recommendations can support effective prevention and treatment of cardiovascular disorders, leading causes of morbidity and mortality in our population. Improvements result if recommendations are implemented in a uniform and effective manner.ObjectivesTo describe the process, structure and results of efforts to better manage cardiovascular risks and events in an integrated health system using organisational best practices; To present results of risk reduction, disease management and acute care programmes.MethodsDatabase analyses revealed opportunities for improvement. Pilot projects were conducted, followed by training about successful processes and practices, supported by organisational leaders. Ongoing comparative feedback supports improvements. Suggested order sets are incorporated in the EMR. Financial incentives for meeting targets accrue to medical centres.ResultsThe incidence of acute myocardial infarctions dropped significantly in the last 5 years, as did the mortality rate. Stroke mortality dropped significantly as well. The population levels of lipids, blood sugar, blood pressure and CHF control continue to improve.DiscussionGuideline recommendations were adopted across our delivery system when supported by top leadership, testing, training, specific care processes, EMR prompts for tests and treatments, regularly reviewed process metrics and group financial incentives. Practice variance was reduced and outcomes markedly improved.Implications for Guideline DevelopersGuideline recommendations are more likely to be adopted in a uniform manner if they include specific recommendation, suggestions for implementation use in organised settings, and process and outcome metrics to track improvements.
020 Best Practices and Performance Measures for Systemic Treatment Perscriber Order Entry Systems (STCPOE) in Chemotherapy Delivery
Authors: Kukreti V , Cheung A , Hertz S , Kaizer L , Lankshear S 
Published: August 2013

BackgroundWhile information technology (IT) has the potential to improve the quality and safety of patient care, solutions such as computerised physician order entry (CPOE) are often designed and executed without end-user involvement and lack performance measures for monitoring quality and impact. To address this gap, an evidence based guideline for systemic treatment (ST) CPOE was developed incorporating both clinical and technological best practices. Performance measures for monitoring clinical impacts and system functionality were also developed.ContextThe ST CPOE guideline was developed by a panel of physicians, nurses, pharmacists, IT specialists and human factors experts. Two Expert Panels (i.e. Clinical and Technology) were convened, to review and provide feedback on guideline content.Description of Best PracticeThe guideline contains two distinct yet interconnected parts: clinical practice (e.g. error prevention, utilisation, clinical decision support), and technology requirements (e.g. usability, system integration, effective alerts). Also included are evidence based indicators to support the evaluation of ST CPOE systems and indicators reflecting clinician practice and patient outcomes. Quality monitoring of ST CPOE utilisation reveal that 75.5% of all chemotherapy visits are being supported by an ST CPOE system. A provincial evaluation of existing ST CPOE systems against the technology best practices is currently underway.Lessons for Guideline Developers, Adaptors, Implementers, and/or UsersThis innovative guideline focuses on clinical practice driving IT solutions, not the other way around. A priori commitment to indicator development allowed for expanding beyond describing best practices to including indicators for monitoring progress toward achieving best practice, thus increasing relevance and uptake by end users.
030 Primary Care Physicians’ Views On Relevance Of Clinical Guideline Recommendations: Delphi Panel
Authors: Steel N , Abdelhamid A , Stokes T , Fleetcroft R , Qureshi N , Howe A 
Published: August 2013

BackgroundNational clinical guideline developers, such as the UK’s National Institute for Health and Clinical Excellence (NICE), produce high quality guidelines, yet primary care practitioners (PCPs) may question the relevance of the evidence and recommendations to a primary care (PC) population.ObjectivesTo evaluate PCPs’ views about the relevance of NICE clinical guidelines to PC.MethodsAn online Delphi panel of 28 PCPs, recruited regionally and nationally, reviewed 14 guideline recommendations: 8 supported by PC relevant evidence and 6 by evidence from elsewhere. Panellists scored recommendations twice, on a scale of 1–9 (9 = highly relevant for PC), before and then again after reading a summary of the evidence, including study setting and population. They also commented on factors influencing guideline validity and PC implementability.Results25 PCPs (89%) completed the Delphi. Overall mean scores were 7.4 (range 6.2–8.2) before reading the evidence summary, and 6.6 (4.6–8.3) after. Mean scores for the 8 recommendations supported by PC evidence were 7.4 before and 7.2 after (change -0.2). Mean scores for the 6 with evidence from elsewhere were 7.4 before and 5.8 after (change -1.6). Factors perceived to influence implementation included clarity, brevity, and relevance to PC.DiscussionPCPs’ ratings of PC guideline validity dropped when they became aware that substantial supporting evidence for the guidelines had come from non PC settings. The relevance of the evidence to PC patients was important.Implications for Guideline Developers/UsersDevelopers should explicitly describe the relevance of available evidence for PCPs and their patients.