bluuebunny/crossref_metadata_2025_split huggingface dataset:
004 Partnering to Transform Clinical Research Into Evidence-Based Health Care Guidelines
Authors: Wasson N , Chang C , Smith MEB , Qaseem A , Starkey M , Buckley D , Chou R , Saha S 
Published: August 2013

BackgroundA guideline-making body nominated pressure ulcer risk assessment, prevention, and treatment as evidence review topics to support the development of clinical practice guidelines, partnering with a funding agency and a systematic review team to conduct the research.ContextCollaboration may enhance evidence-based health care given that multiple organisations bring diverse resources and expertise to the process of guideline development. By partnering to develop systematic reviews (SR) with focused research questions, funders, review teams, and guideline committees can effectively evaluate and synthesise the voluminous evidence required to inform guidelines.Description of Best PracticeWe describe our processes for linking reviews to guideline development, including: •Nomination/refinement of focused review topics •Clearly defined roles for each participant •Development of comprehensive SRs •Well defined processes to preserve the scientific integrity of the review while allowing for input from stakeholders •Stakeholder and funder participation throughout the review process •Development of the guideline •Publication of the research results and guidelines.Lessons for Guideline Developers, Adaptors, Implementers, and/or UsersChallenges include balancing the interests of the nominator/guideline developer and a broader stakeholder audience; answering the clinically important questions needed to develop a guideline; effectively presenting the findings; and coordinating among groups. Collaboration ensures that SRs are focused and relevant to guideline committees, aiding in the development of research that meaningfully informs clinical guidelines. Synergy between partner organisations can lead to wider dissemination of findings and facilitate timely guideline development for implementing best practices to improve health outcomes.
007 Partnering To Transform Clinical Research Into Evidence-Based Health Care Guidelines
Authors: Al-Ansary L , Amer Y , Fattouh R , Adi Y 
Published: August 2013

BackgroundDespite the availability of clinical practice guidelines (CPGs) on the management of diabetes mellitus type 2 (DMT2), optimal control is not achieved in many parts of the world.ObjectivesTo assess whether recent nationally-endorsed DMT2 CPGs refer to Cochrane reviews that relate to the recommendations of these CPGs.MethodsMEDLINE, EMBASE, guideline agency websites and Google were searched for CPGs written in English on the management of DMT2 in any practice setting published between Jan 2008 – Jan 2013. Four raters independently appraised each CPG using the AGREE-II instrument. The Cochrane Library (CL) was searched for published reviews using ‘Diabetes mellitus, Type 2’ [MeSH]. Reviews published one year prior to the CPG’s publication date were considered ‘available’ reviews. Two reviewers independently assessed their relevance for the CPGs’ recommendations.ResultsFive CPGs were identified. The highest scores were for ‘clarity-of-presentation’ and the lowest were for ‘applicability’. The CL search retrieved 45 reviews; 7 of them were assessed as irrelevant. The Canadian-2008, the Australian-2009 and the UK-NICE-2008/2009 guidance referred respectively to 80%, 85.7% and 93.8% of “potential” Cochrane reviews. The American-Diabetes-Association Standards of Medical Care in Diabetes 2013 cited 9/38 and the Malaysian 1/18 recent review. This variation in the uptake of relevant Cochrane reviews was not directly related to the rigour-of-development domain score.Implications for Guideline Developers, Adaptors, Implementers, and/or UsersDespite the increased production of Cochrane reviews, guidelines developers do not consistently refer to them. This needs to be explored and the practical means for maximising their uptake should be entertained.
P004 Guidelines and Performance
Authors: Daniel Keenan 
Published: August 2013

The Guidelines and performance measures allow us to reduce variation in the provision of care and to provide reassurance to all that care is optimum.In England we continue to look at clinical performance and have focused of the three main tenants of quality; clinical effectiveness, safety and patient experience from institution down to individual. Institutional effectiveness has been looked at in relation to targets which are “must do”, such as primary angioplasty times (previously thrombolysis) and performance against standards such as time to scan for stroke. Next come such measures as the percentage of patients admitted to a dedicated stroke unit and the use of cognitive behavioural interventions. In relation to individual performance, we have looked at mortality rates following open-heart surgery. This year, under the government’s transparency agenda, individual results are to be published from additional national interventional audits. More are to follow and virtually all the national audits and registries will be published with a high degree of granularity in the next few years.In primary care the quality and outcomes framework, which is a remuneration package for primary care physicians, is used to manage performance and has driven up the quality of the services offered. It is based on a basket of process measures, which are managed by the National Institute for Health and Care Excellence (NICE), and are renegotiated to drive increasing improvement that is evident by improved performance against the indicators.With recent changes in government policy, increasing interest has focused on the quality of commissioning and measures have been derived from NICE Quality Standards (in effect an amalgamation of guidelines into 12 standards) to assess this. Further, with the introduction in the UK this year of medical revalidation, there is an increased emphasis on individual information to support re licensing.Overall, therefore, we have a dual track of the increasing development of guidance and the condensation of these into easily manageable standards and the measurement of performance, at many levels, against these standards.
009 Ethical principles in guidelines, it is never ending story
Authors: Licenik R , Klikova K , Osinova D , Doubravska S , Ivanova K 
Published: August 2013

BackgroundBioethical principles should be an integral part of all guidelines. Recently, there has been a movement towards ethical principles to be explicit in guidelines. They should be systematically evaluated.ObjectivesWe have done a systematic review on ethical principles in guidelines and developed an instrument for evaluation of ethical principles in guidelines based on the AGREE II instrument.MethodsThe Questionnaire and User’s guide have been developed and tested. The questionnaire covers basic ethical principles, i.e. respect for autonomy, beneficence, non-maleficence and justice, as well as other very important issues such as health professional-patient relationship and inter-professional collaboration. The last question is whether a particular CPG contains examples of ethical dilemmas. New domain on equity was added. A pilot version of case reports for some domains was developed. The instrument will be disseminated, implemented, evaluated and updated if needed.ResultsInstrument for evaluation of ethical principles in guidelines.Discussion:Useful instrument for the evaluation of ethical principles in guidelines has been developing.Implications for Guideline Developers/UsersThe instrument can be used during guideline development process as well as during implementation and for evaluation of the quality.
011 Methodological Issues Related To Mandatory Coverage Policies of the Brazilian Regulatory Agency (ANS) To Be Followed By Brazilian Private Health Plans (BPHP)
Authors: Pazos M Cabanelas , Silva S Alves da , Souza P Pereira de , Cardoso P Rascão 
Published: August 2013

ContextBrazilian private health plans (BPHP) are regulated by ANS mainly through a list of procedures for mandated coverage, some of which are supported by guidelines formulated by Medical Societies. Where guidelines exist quality varies widely. Penalties imposed on BPHP by ANS have frequently involved coverage mandates not supported by guidelines. An example is treadmill testing, which is ordered more often than can be administered to patients due to lack of providers. A dialogue for collaboration on specific issues between Brazil’s largest health plan and the regulatory agency started in 2012.Description of Best PracticeFour areas of interest were selected based on 1)high economic impact; and 2) utilisation issues: cardiovascular and genetic testing, neurosurgery and oncologic procedures. ANS interest focuses on new technologies to be addressed in the upcoming revision of the mandatory coverage list. We used the AGREE II instrument to identify inconsistencies in the ANS guidelines. Most weaknesses related to “Rigour of development” issues.Lessons for Guideline Developers, Adaptors, Implementers, and/or UsersBrazilian regulators currently seek improved criteria for regulation of health technologies. Independently developed guidelines are sparsely used by regulators in Brazil. We initiated a public-private partnership which brings methodological standards to the table such that scientifically sound guidelines may play an enhanced role in Brazilian regulatory policy. Such a step may increase appropriate utilisation of resources and diminish penalties applied by ANS due to requests not supported by scientific- evidence. Full development of the partnership will require participation of the medical societies.
013 Cases for Action: a new approach to addressing gaps between research evidence and health policy and practice in Australia
Authors: Berry M , McCallum J , Ghersi D , Fitzgerald A , Clydesdale J , Goodwin A , Singh A 
Published: August 2013

BackgroundIn 2012, Australia’s peak body for supporting health and medical research established a Research Translation Faculty of 2,500 researchers to address challenges of translating research evidence into policy/practice. The initial focus of the Faculty is developing Cases for Action to address Australia’s major health issues through high-level advocacy.ObjectivesTo work collaboratively with senior researchers to develop compelling cases for actions that could be taken to address the most significant gaps between research evidence and health policy/practice in Australia.MethodsFaculty members will search literature, consult with stakeholder networks and debate issues in developing a paper of published evidence, recommending actions to address each prioritised gap and providing the rationale for prioritisation. Steering Groups will oversee the development of each Case for Action.ResultsThis presentation will share the experiences and lessons learnt to-date in developing Cases for Action.DiscussionThere is a gap between what we know and what we do. Cases for Action will draw on the combined expertise of researchers to systematically consider and prioritise actions to best address these gaps. Possible actions that could be proposed include advice to government about health policy, clinical or public health guidelines, or opportunities to collaborate with strategic partners to leverage investment in health or to provide support in the implementation of heath strategies.Implications for Guideline Developers/UsersThe lessons learnt from the Cases for Action process will benefit attendees who are considering how to focus their effort to ensure that healthcare policy and practice best reflects available evidence.
014 Can health care networks develop autonomy over development and implementation of guidance within an environment shaped by accreditation standards?
Authors: Goldman S , Koster M , Schottinger J 
Published: August 2013

BackgroundStandards for clinical practice enacted by external accreditation organisations can limit the ability of health care organisations to develop and implement evidence-based guidance to improve clinical practice and health system efficiency, and reduce unnecessary testing.ContextAs part of a system-wide effort to improve patient quality and access, medical specialists in a large group practice sought to determine whether standard bilateral venous duplex ultrasound (VDUS) scans were medically necessary in patients with unilateral signs and symptoms of deep vein thrombosis (DVT). Typically these patients receive bilateral exams; however, the high number of negative test results in non-symptomatic legs suggested bilateral testing may not be necessary.Description of Best PracticeAn evidence review was conducted to evaluate whether unilateral VDUS scanning accurately identifies patients who can safely undergo unilateral VDUS exams in the symptomatic limb without missing a DVT in the unscanned, asymptomatic limb. The evidence review concluded that the number of undetected DVTs in the unscreened asymptomatic limb was very low, suggesting that unilateral VDUS screening in lower-risk patients (i.e., outpatients and patients without malignancy) could be safely performed. Accreditation standards, however, require bilateral screening in all patients, regardless of DVT risk status.Lessons for Guideline Developers, Adaptors, Implementers, and/or UsersAccreditation standards can hinder practice change and limit research for more effective and efficient practices. Some accrediting organisations accept feedback and adjust standards as new data emerges. Providing evidence-based information to these organisations may initiate changes in standards.
015 Tracking the Impact of the Agency for Healthcare Research and Quality’s (AHRQ) Effective Health Care Program through Uptake by Clinical Practice Guideline and Quality Measure Developers
Authors: Erinoff E , Coates V , Nix M 
Published: August 2013

BackgroundPublic and private funders evaluate health care investments in terms of outcomes and accountability. Citation analysis can approximate the dissemination and impact of funded research outputs.ObjectivesUse references in guidelines and measures represented in the National Guideline Clearinghouse (NGC) and National Quality Measures Clearinghouse (NQMC) to track the uptake of AHRQ Effective Health Care (EHC) programme outputs.Methods442 EHC-related titles were searched against the full-text corpus of the Clearinghouses. Documents that cited the titles were examined for the context of the citations. References were considered strong when tied to a specific metric or recommendation or noted as important to the guideline’s methodology; moderate if discussed in the body of the citing document; and weak if they appeared only in the reference list.Results174 individual guidelines and measures cited EHC-related titles (n = 341). 50% of the guideline references were strong, 28% moderate and the remainder weak or undetermined (22%). All measure references were strong.DiscussionThis analysis has been done annually since 2010 with the numbers of detected citations increasing each year. The method used not only assesses whether a work was referenced in a guideline or measure, but its relative importance to the guideline or measure providing evidence of impact of the EHC programme.ImplicationsSystematic reviews and other research published through the EHC programme are being used to develop guidelines and measures that meet inclusion criteria for NGC and NQMC. EHC reports may be downloaded and topics nominated atwww.effectivehealthcare.ahrq.gov
018 The Implementation Field Team 6 Years On: Approaches to Engagement and Evaluating Impact
Authors: Moore J , Moore V 
Published: August 2013

BackgroundThe Implementation Field Team for this national guidance producing organisation has been established for six years. Seven consultants visit around 800 organisations annually, providing updates on national guidance, sharing examples of implementing good practice, and collecting feedback on our national guidance and barriers to implementation.ContextWe have consistently evaluated our activities, but have found inherent difficulties with identifying impact, and have relied on proxy measures of success. As a new system for commissioning health services develops, we reviewed evidence around effective implementation activities and evaluating their impact. This led to innovative approaches to engagement and improved methods of evaluating impact.Description of Best PracticeWe revised field team implementation strategies and activities to fit better with the new system of health commissioning. We conducted our own small scale survey, and also invited an external organisation to conduct a larger survey with field team clients to evaluate impact and to inform the planning and delivery of services in the future. We have moved from proxy measures of effectiveness evaluated every six months to newly developed “success criteria”, which are outcomes focused, owned by the whole organisation, and identify three year incremental objectives for external engagement. This informs operational plans for future engagement activities.Lessons for Guideline Developers, Adaptors, Implementers, and/or UsersEvaluating the impact of implementation activities and teams is difficult but important and achievable. Focusing on immediate and intermediate implementation outcomes over longer timescales, and developing success criteria for field team implementation and engagement activities is valuable.
021 Reducing OverPOPulation: Achieving More By Doing Less
Authors: Schottinger J , Koster M 
Published: August 2013

BackgroundToo-frequent screening for cervical cancer can increase costs, lead to unnecessary invasive procedures associated with overtreatment, and shift resources away from the one in five women who do not receive recommended routine screening.ContextA large, US-based integrated healthcare system with centralised evidence services and eight independent regions developed and implemented an evidence-based guideline for cervical cancer screening. Novel implementation strategies and performance monitoring in one region in Southern California led to significant improvements and are described below.Description of Best PracticeGraded evidence summaries were conducted by a centralised analytic unit, and recommendations developed by a guideline team with representation from each region. In one large region with more than 3 million patients, interventions aimed at the practitioner, patient and systems levels were implemented for routine Pap and HPV co-testing. Practitioner interventions included electronic distribution of guidelines, point-of-care electronic prompts, and workflow support. Patient-level interventions included point-of-care education, and in-reach/outreach activities. System-level interventions focused on centralised patient outreach letters and reminder calls, computerised decision support, and unscreened cancer lists for panel management. Monthly performance monitoring on a measure of “overpopulation” was reported at medical centre, department and provider levels. In a five-year period, over 100,000 fewer unnecessary Pap tests were performed, while screening rates increased by 7%.Lessons for Guideline Developers, Adaptors, Implementers, and/or UsersCentralised guideline development, coupled with coordinated implementation and performance monitoring, can reduce unnecessary screening and invasive procedures, focus resources on appropriate routine screening in underscreened populations, improve patient access and reduce costs.
025 The Efficiency-Validity Methodological Continuum (EVMC) For Sustainable Guideline (CPG) Development: A Negotiating Tool for Credible Compromises in Quality for Affordable Trustworthy Guidelines
Authors: Browman G , Somerfield M , Lyman G 
Published: August 2013

BackgroundResearch methodologists and guideline sponsors are on a collision course as growing demands for scientific rigour raise costs and lengthen delays in CPG production.ObjectivesTo design a tool for CPG developers and sponsors to negotiate methodological compromises while preserving CPG trustworthiness. There are already variations in CPG quality that we tolerate. Flawless systematic reviews and guidelines are unrealistic. Methodological compromises are inevitable and imposed by practical constraints. Negotiating and reporting methodological compromises can fill a transparency gap where methodological choices are made in the development of a CPG.MethodsThree individuals with guideline development experience collaborated to design a tool that aligns stakeholders’ interests while preserving ‘trustworthiness’ and enhancing transparency.ResultsThe Efficiency-Validity Methodological Continuum (EVMC) is anchored at the extremes by “practical” at the “efficiency” pole and “best achievable” at the “validity” pole, highlighting the tradeoffs. The continuum between these is represented as a solid line. A ‘zone of preference’ closer to the ‘validity’ and a ‘zone of acceptability’ closer to efficiency are negotiating zones. Beyond the anchors, represented as broken lines, are “expedience” at the efficiency end and “ideal” at the validity end. Guideline development should operate within the solid segment of the continuum. The broken segment towards ‘expedient’ risks methods with unacceptable threats to validity; and towards ideal, an unaffordable standard not worth the incremental costs. Examples highlight the tool’s utility.ConclusionsNegotiating and reporting compromises in methodological quality can lead to sensible, transparent methodological choices acceptable to both CPG developers and sponsors.
026 What organisational resources have to be considered when adapting guidelines in the context of Low and Middle Income Countries (LMIC)? The Argentinean experience
Authors: Esandi M , Luca M De , Ortiz Z 
Published: August 2013

BackgroundAdapting guidelines in resource-constraints countries represents a great challenge. Availability of organisational resources has to be considered before implementing this methodology.Objectives a)To compare the availability of different organisational resources during seven guidelines adaptation initiatives facilitated by the National Academy of Medicine (Argentina) between 2005 and 2013; b) to analyse the relevance of each type of resource category for adapting guidelines in the context of LMIC.Methods7 guidelines adaptation initiatives facilitated by the NAM since 2005 and 2013 are described. Organisational resources were categorised in 4 categories: organisational culture, human resources, economic resources, and condition resources (or states) within the organisation. Conservation of resources (COR) theory was used as the theoretical basis for analysing the relevance of each type of resource for the guideline adaptation process.ResultsFour of the 7 initiatives completed the whole process and produced an evidence-based guideline; 1 was interrupted and 2 are still ongoing although 1 of them shows a considerable delay. Among all organisational resource categories, culture and human resource were perceived as the most critical, particularly in what respects to the availability in the guideline developer group of change agents (i.e. internal and external facilitation); disposition to change and motivation and an appropriate mix of skills including leadership, communication, team work, technical competences.DiscussionGuidelines adapting in resource-constraint countries is not easy, although possible if different critical organisational resources are provided from the outset of the process.Implications for Guideline Developers/UsersA minimum organisational resource threshold is necessary for guarantying guidelines adaptation in the context of LMIC.