bluuebunny/crossref_metadata_2025_split huggingface dataset:
P100 IHC Testing For Sebaceous Neoplasms: A Rapid Review Of Screening Accuracy And Application Of GRADE
Authors: Natoli J , Alvarado M 
Published: August 2013

BackgroundLynch syndrome is the most common form of inherited colorectal cancer (∼3% of cases). Among patients with colorectal cancer tumours, immunohistochemistry (IHC) for mismatch repair proteins has demonstrated validity and utility as a screening test for Lynch syndrome, although guidelines differ on whether screening should be limited to patients at increased risk. IHC can be performed on other Lynch-related tumours, including sebaceous neoplasms, although it is unclear if IHC should be part of routine pathologic evaluation for sebaceous neoplasms.ObjectivesTo determine the clinical validity and utility of routine IHC testing of sebaceous neoplasms to inform development of guidance on screening for the Muir-Torre variant of Lynch syndrome.MethodsAn AHRQ-based analytic framework was created. We conducted comprehensive searches to identify clinical studies that evaluated IHC testing of sebaceous neoplasms as a method of screening for Muir-Torre syndrome. GRADE was used for critical appraisal.ResultsThe body of evidence included 14 clinically heterogeneous studies representing approximately 300 patients. The weighted mean screen positive rate was 37%. Few studies reported measures of clinical validity, although half of the studies reported the prevalence of visceral malignancy and/or results of germline mutation testing, suggesting possible reporting bias.DiscussionThe overall body of evidence is of low quality and does not provide conclusive evidence for or against IHC testing for sebaceous neoplasms, either as a routine protocol or only among patients at high risk for Muir-Torre syndrome.Implications for Guideline Developers/UsersRapid evidence reviews are useful for informing guidance development on rare/genetic conditions.
P107 Developing A Customised Web-Based Data Extraction Tool Using An Existing Customer Relationship Service: Thinking Outside The Box
Authors: Nagler E , Liébaut V , Haller M , van der Veer S , Bolignano D , Nistor I , Van Biesen W 
Published: August 2013

BackgroundStandardised duplicate data extraction and tabulation can be challenging for organisations that develop multiple guidelines involving multiple and remote systematic review teams simultaneously.ObjectivesTo develop a web-based tool for facilitating duplicate data extraction and efficient discrepancy resolution.MethodsBased on previous experiences with word-processing and spreadsheet tools, European Renal Best Practice listed their system requirements and collaborated with a consultancy company to identify appropriate customisable software.ResultsWe wanted the system to: be web-based, guide reviewers through a standardised data extraction form, be easy-to-use and manage, allow enough flexibility to accommodate different guideline topics, be free-of-charge and easily accessible from different locations without the need for downloading software. We identified a customer relationship management service, Salesforce, that allowed us to build a data extraction module using their backbone structure. It incorporates centralised management of multiple systematic reviews simultaneously, batch allocation of studies to individual reviewers, guided customised point-and-click data extraction, generation of tables to assist discrepancy resolution with easy export to a cvs-file extension format.DiscussionThis project represents a continuous effort to facilitate efficient and high-quality systematic reviewing with participation of our guideline development groups throughout the systematic reviewing process. A first version of the system is currently being evaluated.Implications for Guideline Developers/UsersCustomising existing software for guideline development purposes might be an attractive and inexpensive alternative to developing new tools for data extraction when full participation of the guideline development group in the systematic review process is desired.
P114 The Quality Of Evidence Of Systematic Reviews Of Traditional Chinese Medicine: A Cross-Sectional Study
Authors: Chen Y , Wu Q , Wang X , Wang Q , Wei D , Yao L , Liang F , Wang M , Yang K 
Published: August 2013

BackgroundThere has been an increasing interest in systematic reviews of traditional Chinese medicine (SR-TCM) over the past 10 years. Little is known about the quality of evidence of SR-TCM.MethodsGRADE (Grading of Recommendations Assessment, Development and Evaluation) system is a tool to rate evidence quality of SRs and other evidence body. We searched CBM (China Biomedicine Database) from 1978 to 2012 and included all SR-TCM in the field of cancer treatment. We used GRADE system to assess the quality of evidence of those SRs. Two reviewers independently screened the titles and abstracts of identified studies. Full texts of potentially included articles were further assessed. Disagreements were resolved by discussion.ResultsThe preliminary results showed that the quality of evidence of SR-TCM were: high (1%), moderate (25%), low (50%), very low (24%). We also compared with the quality of evidence of SRs published in Chinese medical journals (5%, 27%, 49%, 19%) and Cochrane SRs (5%, 27%, 49%, 19%). Risk of bias, inconsistency and publication bias were the major factors for downgrading evidence of SR-TCM.ConclusionMore and more SR-TCM had been published in Chinese medical journals, however, the proportion of high quality evidence is lower and the very low quality evidence is higher compared with national and international levels.
P115 How Many Cluster Randomized Controlled Trials Were Used In Clinical Practice Guidelines?
Authors: Chen Y , Wu Q , Wang X , Wang Q , Wei D , Yao L , Liang F , Wang M , Yang K 
Published: August 2013

BackgroundThere has been an increasing interest in cluster randomised controlled trial (CRT) over the past 20 years. Little is known about how many CRTs were used by clinical practice guidelines.MethodsWe searched National Guideline Clearinghouse (NGC) which is a public resource for evidence-based clinical practice guidelines on December 31, 2012. We selected guidelines which provide MEDLINE full-text linking and then we checked all references cited by those guidelines.ResultsWe included 564 guidelines and they contained 57495 references. We identified 13 guidelines cited 17 cluster randomised controlled trials as their references. Guidelines are about primary care, cancer, obesity, breastfeeding, cardiovascular and orthopaedics disease. Screening studies accounts for as much as 35% (6) of all CRTs.ConclusionCluster randomised controlled trial is considered as the golden standard to assess the effect of intervention in health research. Based on the retrieval strategy study for cluster randomised controlled trial we developed, we estimated that there are about 8000 CRTs in Medline, however, only 17 CRTs were used or cited by clinical practice guidelines, the reasons of low utilisation of CRTs in guidelines are now being investigated and we are going to present the final findings.
P117 Uniformity In Anaesthesiology Recommendations
Authors: Loman I , Schuurhuis A 
Published: August 2013

BackgroundThe field of anaesthesiology is multidisciplinary and includes the perioperative trajectory, but also the domains of pain, palliative, intensive and emergency care. In The Netherlands there are numerous guidelines on anaesthesiology, from generic to disease and target group specific. These were developed by different stakeholders and were not always thoroughly checked on consistency with other guidelines.ObjectiveTo assess uniformity in recommendations in the field of anesthesiology.MethodsFour guidelines were considered the base of anaesthesiology care; pre-, peri- and postoperative care and postoperative pain treatment. The recommendations of these four guidelines were combined with a number of consensus statements and matched with disease and target group specific recommendations. These recommendations were categorised into three groups: 1) no controversy; 2) controversy, update necessary; 3) new guideline(s) needed. For the recommendations in the categories 2 and 3 a working group was formed to address these issues.ResultsThe inventory is on-going and will be finished in spring 2013.DiscussionThe total number of guidelines and recommendations on the topic of anaesthesiology are great. This makes it complex for the clinician to find the right recommendation and calls for a more convenient way of presenting them. Supervision from the anaesthesiology association is required for the development of new guidelines to guarantee uniformity between anaesthesiology recommendations.Implications for Guideline Developers/UsersIt is of great importance that recommendations throughout guidelines are never conflicting. An electronic modular database could be a more convenient way of presenting recommendations.
017PS Using Computerized Decision Support Systems to Improve the Uptake of Guidelines: Perspectives from Different Countries
Authors: Lugtenberg M , Brandt L , Kunnamo I , Shiffman R , Burgers J 
Published: August 2013

BackgroundComputerised decision support systems (CDSSs) are increasingly used to improve the uptake of guidelines. However, there is large variation in types of decision support provided, types of supported guidelines and recommendations, and types of healthcare settings in which CDSSs are applied. In addition, the effectiveness varies across systems, whereas determinants for success and failure are largely unknown.ObjectivesTo provide opportunities for sharing experiences and discussing lessons learned in the use of CDSSs in different countries.Target GroupGuideline developers, guideline implementers, clinicians, researchers, policy makers.ModeratorJako Burgers, Dutch College of General Practitioners (NHG), The NetherlandsInvited speakers: Marjolein Lugtenberg, IQ healthcare, Radboud University Nijmegen Medical Centre, The Netherlands. Linn Brandt, Inlandet Hospital Trust/University of Oslo, Norway. Ilkka Kunnamo, Duodecim Medical Publications Ltd./University of Helsinki, Finland. Richard Shiffman, Center for Medical Informatics, Yale University, USA.Description of Session and Speaker TopicsIn this session initiatives on CDSSs from four different countries (The Netherlands, Norway, Finland, and the USA) will be presented, each taking a different perspective on the use of CDSSs to improve the uptake of guidelines. Issues that will be considered are how to deal with various alerts within multiple disease areas, distinguishing alerts from strong and weak guideline recommendations, and creating composite views of data and recommendations. Finally, conclusions are drawn on the strengths and weaknesses of developing, implementing, and evaluating each system and lessons learned will be discussed with the audience.
P118 Are Levels Of Evidence From Different Clinical Practice Guidelines Comparable? – Testing Of A Method For Standardization Of Different Evidence Grading Systems
Authors: Hoffmann-Eßer W , Großelfinger R , Holzmann N , Brockhaus C , Ein Waldt S , Ernsting C , Yurdakul A , Rüther A , Siering U 
Published: August 2013

BackgroundIn 2009 we presented a method for standardisation of different evidence grading systems (EGS) to simplify the comparison of levels of evidence (LoE) from different guidelines. For this purpose, LoE from guidelines were allocated to a reference standard, the EGS from the Federal Joint Committee’s (G-BA) Code of Procedure. This approach has not yet been tested on several different EGS from guidelines.ObjectiveTo test the feasibility of a method for standardisation of different EGS from COPD, asthma and breast cancer guidelines.MethodsWe conducted a systematic search for the above guidelines in guideline databases and websites of guideline providers. The search period covered 11/2007 to 7/2012. Eligible guidelines were evidence-based English or German guidelines using an EGS. The LoE reported were allocated to the EGS from the G-BA’s Code of Procedure.Results43 guidelines on chronic diseases with 19 different EGS and 188 different LoE were included. With 4 exceptions, all LoE used in the EGS could be allocated to at least one category of the reference standard. In 44 cases, the LoE from the identified EGS could be allocated to exactly one category and in 63, an LoE was allocated to several categories. Several LoE from one guideline were allocated to one category in 15 cases; this can result in loss of information.DiscussionThe testing of a method for standardisation of different EGS indicates that standardisation of LoE using a reference standard can be successfully implemented and can simplify the comparison of different EGS.
P121 Clinical Decision Support: A Valuable Tool For Many Reasons
Authors: Van Vegchel T , Kersten S , Harmsen M 
Published: August 2013

BackgroundOncology is complex and time-consuming care. Because evidence changes frequently, implementation of knowledge is viable for putting evidence into daily practice and decreasing variation in treatment advice.ContextClinical Decision Support (CDS) based on Clinical Practice Guidelines improves both individual care for cancer patients, including increase in safety, efficiency and transparency and supports guideline developers adjusting implementation strategies and improving updating.Description of Best PracticeWe developed a prototype, which uses input based on disease (TNM, stadium) and patient characteristics (co-morbidity, e.g.). First, recommendations were formulated as computer interpretable recommendations using IF…THEN rules. Second, the application assembled all information and combined them with alerts, namely contraindications and side effects, finally leading to treatment advice. We found that CDS is a viable way of assisting doctors and patients. Treatment advice is better suited to both evidence based recommendations and specific patient characteristics. Insight into why a certain choice is made improves confidence in the suggested treatment and compliance. Also, more gaps in knowledge were found and trial participation was improved.Lessons for Guideline Developers/UsersCDS: Can provide insight into the use of guidelines. For example, when a recommendation isn’t followed, possible efforts in implementation (recommendation is not/poorly implemented) or update (recommendation is outdated) are needed. Rewriting recommendations increased consistent language used in guidelines, which include easy reuse of data between professionals, hospitals and Cancer Registry Updating guidelines is expensive and time consuming. The doctors (and patients) ability to respond to existing recommendations supports faster, more efficient and cheaper modular updates.
P127 Comprehensive Model For Implementation Of Guidelines For Disease Prevention
Authors: Elgstrand M , Carlsson I , Månsdotter A , Sorsa R , Strååt C 
Published: August 2013

BackgroundThe National Board of Health and Welfare (NBHW) has developed guidelines for disease prevention, which include interventions to reduce smoking, hazardous use of alcohol, insufficient physical activity and unhealthy diet.ContextTo support the implementation of these guidelines, the Government has commissioned the NBHW to disseminate knowledge, create Web-based training, and ensure data access and methodological development.Description of Best PracticeImplementation of guidelines for disease prevention deserves a comprehensive approach, since it involves most health care settings and professions. The NBHW coordinates national stakeholders, including decision makers at the regional level, in several networks. Organisations for health professionals such as doctors, nurses, physiotherapists and dieticians, receive support to disseminate knowledge of the guidelines among their members. Other ways of disseminating knowledge include information on the NBHW website and leaflets for patients, managers and professionals. The NBHW will also develop a Webb-based training for health care professionals, covering the methods recommended in the guidelines. To support improvements in methods for disease prevention, research groups have been awarded financial support, for example to study how P4P can be used to improve implementation of guidelines and how to support patients with special needs. Furthermore, the NBHW supports harmonisation of registration and reporting on data. The NBHW will also publish a national assessment and evaluation, in order to identify differences between regions regarding organisational factors, processes, clinical outcomes and costs.Lessons LearnedWe will share our experiences of a comprehensive approach, targeting decision makers, health care professionals and patients, and discuss challenges when translating guidelines into health care.
P133 Approaching Economic Evaluation in Social Care Guidance
Authors: Smith T , Shaw E , Baillie N 
Published: August 2013

BackgroundWe have a statutory responsibility to produce social care guidance. For economic evaluation challenges include: 1. Methodology for a multi-stakeholder perspective (costs and outcomes), and determining measures of effects using standardised outcomes. 2. Decision making in the absence of accepted willingness to pay thresholds, and alignment with principles used for health guidelines.ObjectivesTo define an economic reference case for social care guidance.MethodsA workshop on methods identified potential approaches. Health economists who work on clinical and public health guidelines were consulted to ensure consistency. Methodological issues were discussed with academic experts.ResultsA reference case for social care economic evaluation was produced within a methods manual before commencing guidance development. It recognises the need for flexibility as methodology develops.DiscussionSocial care economic evaluation is constrained by the quality of evidence, and the transferability of studies. Equity considerations in the context of means-tested service provision, and the issue of unpaid care, represent examples of how decision making on cost-effectiveness must take account of factors not usually considered for clinical and public health guidelines.Implications for Guideline Developers/UsersConsistent decision-making principles must be applied across all guidance development programmes, including social care cost-effectiveness. Social care guidance, developers need to recognise and work within the context of emerging methodologies when undertaking social care economic evaluation in, but ensure that such evaluations remain in line with general principles of guidance development and decision making.
P155 Lessons Learned: Applying Grade Methodology To Evidence-Based Health Technology Assessment Within A Managed Care Setting
Authors: Lam J 
Published: August 2013

BackgroundHealth technology assessment (HTA) within the context of a managed care organisation requires rigorous evidence assessment completed in a timely and efficient manner. A modified version of the GRADE evidence grading system was piloted in a long-standing HTA programme to evaluate new and existing medical technologies with high-cost, high-volume impact.ContextAn HTA programme developing evidence-based guidance to inform technology acquisition and implementation strategies within a large, US-based healthcare system.Description of Best PracticeA modified GRADE approach was used to assess the quality of evidence for six health technologies over a 6-month period. Although the application of GRADE required additional analytical time, evidence assessments were completed within a reasonable timeframe. Application of the GRADE framework allowed technology committee members to more easily understand the quality of a body of evidence, weigh the benefits and harms, account for patient values, and assess potential resource and operational implications.Lesson for Guideline DevelopersPrior to adopting GRADE, many new technologies were assessed as having “insufficient” evidence. The GRADE approach provided greater clarity, and evidence that would previously have been classified as “insufficient” was graded as either “low” or “very low” quality, allowing for greater flexibility and transparency in decision-making when moving from evidence to recommendations. Diagnostic and prognostic tests or devices continued to present unique challenges as well as technologies for which limited comparative evidence was available, and more guidance for in these areas is needed. Additional elaboration on resource and operational concerns specific to evaluating new technologies would be useful to HTA programmes.
P157 Clinical Practice Guidelines in the Czech and Slovak Republic
Authors: Klikova K , Licenik R 
Published: August 2013

BackgroundPalacky University Faculty of Medicine Centre for clinical practice guidelines is the independent academic centre focused on guidelines methodology.ObjectivesThe aim of this study is to analyse methods of development, adaptation, implementation and evaluation of CPGs in the Czech and Slovak Republic from 2010 to 2013.MethodsThe database of all Czech and Slovak CPGs and specialty societies was developed in 2010 and updated on a regular basis. The analysis of methods of development was made. AGREE II instrument was used both in Czech and English version to evaluate quality of some CPGs.ResultsThere are 112 Czech specialty societies and the national Reference Centre developing CPGs. 1331 CPGS were developed till 2013 in total with increase of 33% between 2010 and 2013. The number of adopted international CPGs has increased significantly. Majority of CPGs have not stated funding and conflicts of interest. In the Slovak Republic, there are 125 specialty societies and the Ministry of Health developing CPGs. 342 CPGs were developed till 2013. Majority of CPGs were developed by government. A few CPGs stated non-governmental funding, which is always a private company support.DiscussionThere has been increasing number of developed CPGs in both countries. Standardised high quality methods are not used systematically. High quality methodology was developed and used by Czech National Reference Centre.Implications for Guideline Developers/UsersThere should be high quality methods used for CPG development. The developing bodies should adopt methodology already exist in the Czech Republic.
P164 The Abyss Between Rcts And Guidelines; And The Bridging Role Of Cochrane Systematic Reviews
Authors: Middleton P , Crowther C , Green S 
Published: August 2013

BackgroundRandomised trials (RCTs) and Cochrane systematic reviews (CRs) are mainstays of most clinical practice guidelines (CPGs). It is important that all relevant high level evidence is included in CPGs.ObjectiveTo determine rates of RCT inclusion in perinatal CPGs, either directly or via CRs.MethodsWe used a database of all known Australian perinatal RCTs with findings released between 1986–2010 (n = 303), compiled for a project addressing impact of evidence. International and national perinatal CPGs were manually searched for cites of any of the 303 RCTs, or perinatal CRs including the RCTs, as at January 2013.Results59/303 RCTs (19%) were cited in at least one perinatal CPG. Ninety per cent of the 59 RCTs (n = 53) were included in CRs; and in 25/59 cases the RCT was only included in a CPG via the CR. All 59 included RCTs had a maternal/perinatal rather than a neonatal focus.DiscussionOver 80% of RCTs in this dataset were not included in relevant CPGs. The chance of a trial being in a CPG increased if was included in a CR and if it had a maternal/perinatal focus. Possible ways to close the RCT-CPG abyss will be presented.Implications for Guideline Developers/UsersWhile translation from RCT to CR is common, we need to better understand the reasons why high level RCT and CR evidence is often missing from CPGs and what the impact is on quality of CPG recommendations.