bluuebunny/crossref_metadata_2025_split huggingface dataset:
P233 How Confident Are You In The Results Given Only One Rct? Ticagrelor Vs Clopidogrel: Case Report By Clinical Guideline On Acute Coronary Syndrome In Colombia
Authors: Acosta-Baena N , Lugo L , Mejia A , Senior J 
Published: August 2013

BackgroundTicagrelor is oral antagonist of adenosine diphosphate receptors of subtype P2Y12. It is indicated for the prevention of atherothrombotic events in adults with acute coronary syndromes (ACS) and it act faster and shorter than clopidogrel.ObjectivesThe authors review and discuss clinical findings and health-economic evidence of ticagrelor compared with clopidogrel to reduced myocardial infarction, stroke or death, major bleeding, in patients with ACS in Colombia, when only one RCT has been published comparing both drugs.MethodsThis question was part of the guideline development. The process included search, assessment, rating the quality of evidence and economic evaluation. The recommendations were classified according to the methodology described by GRADE Working Group: consideration benefit/harm, preferences and resources.Results1 clinical study was identified. The efficacy outcome was favourable for the group of patients receiving ticagrelor. The result of the economic analysis suggests that the probability of ticagrelor is a cost effective alternative in the Colombian health system is more than 76.6%.DiscussionWe recommend ticagrelor plus ASA for patients with non-STEMI, intermediate to high-risk, and for patients with STEMI if they have not received fibrinolysis in the last 24 hours.Implications for Guideline Developers/UsersOur results hold in different scenarios and sensitivity analyses, as long as the time horizon is not limited to short-term assessment because may underestimate the costs and benefits and therefore lead to erroneous conclusions with a single primarily study. Our recommendation is strong, although there was a single RCT owing to time horizon and high quality of evidence.
P240 The Benefits of a Systematic Implementation Structure For Effective Implementation Support
Authors: Dunnink T 
Published: August 2013

BackgroundGuidelines do not implement themselves. Structural implementation activities are necessary to improve the usage of guidelines by professionals. At a national level this centre oversees the development, implementation, and evaluation of the Preventive Child Health Care (PCHC) guidelines.ContextIn The Netherlands, PCHC is provided by 50 organisations. They use guidelines to improve quality of care, however implementing them, which is their own responsibility, is difficult. They therefore want implementation support, which is then provided by the Dutch Centre for Child Health.Description of Best PracticeTo support PCHC organisations implementing guidelines, the Dutch Centre for Child Health developed an implementation structure. The aim of this structure is to provide a systematic implementation through various strategies. The elements of this structure are: a network of implementation coordinators, an implementation toolkit, education and e-learning, a helpdesk, and collaboration with educational institutes and network partners in the youth field. A one year follow-up survey showed that managers and implementation coordinators from PCHC organisations are positive about the support. They want our implementation activities to be continued and even like to see the support extended to guideline maintenance.Lessons for Guideline Developers, Adaptors, Implementers, and/or Usersorganisations want support, to implement guidelines into their own organisation. Beside that they want to know what and when to expect. Our way to achieve that, is to give the support through a clear implementation structure and to provide systematic implementation activities.
P290 Attitudes Of Professionals Involved In Dementia Care Towards Advance Directives And Its Impact On Their Adherence To Guideline Recommendations
Authors: Villanueva G , López-Argumedo M , Reviriego E , Gómez Poveda C , Aguirreche Ollo E , Elizondo A , Fuentes Gutiérrez R , Galnares-Cordero L 
Published: August 2013

BackgroundAlthough legal and ethical aspects related to the care of people with dementia have been long neglected, current guidelines highlight its importance. Specifically, the advanced directives document (ADs) is a useful instrument in decision-making in non-competent patients. Despite the promotion of guidelines related to the use of ADs, it is claimed that adherence is not as optimal as desired. An analysis of the barriers to implementation is therefore needed.ObjectivesTo explore health professionals’ knowledge and attitudes towards the use of ADs in three different health settings and to evaluate their adherence to the established recommendations.MethodsA cross sectional, descriptive study by means of a self-administered questionnaire was conducted with over 2,000 professionals working in dementia care in the Basque Country. On the other hand, the relevant recommendations from the ADs in cases of dementia are summarised and it is discussed whether professionals comply with them.ResultsData is currently being analysed and results will be available for presentation at GIN.DiscussionAdherence to CPG is a long discussed issue. Bringing ethical issues into the debate makes it more complex, since not only the knowledge but the personal values are in place. That may explain why ethical and legal related recommendations and clinical practice differ considerably and why the use of ADs in the real practice remains a taboo.Implications for Guideline Developers/UsersKnowing the barriers to comply with ADs may help to put the mechanism in place to reduce the gap between theory and practice.
P326 Implementing an Audit and Feedback Intervention to Reduce Antibiotic Prescribing in General Dental Practice
Authors: Young L , Stirling D , Elouafkaoui P , Rutherford S , Ramsay C , Clarkson J 
Published: August 2013

BackgroundIn Scotland, guidance for prescribing in dentistry was published in 2008 in response to concerns about over-prescribing of antibiotics. The guidance recommends that antibiotic prescribing must be kept to a minimum. However, evidence from routinely collected data demonstrates that dental antibiotic prescribing is steadily increasing, now accounting for 9% of primary care antibiotic prescriptions.ObjectivesTo compare the effectiveness of different audit and feedback (A&F) strategies for the implementation of recommendations on dental antibiotic prescribing.MethodsThe study is an 18 month, three-arm randomised controlled trial. All dentists in Scotland are being randomised to either: 1) access to a pre-approved national audit; 2) access to the audit plus individualised feedback; 3) access to the audit, individualised feedback and a persuasive message. The primary outcome is the number of antibiotic prescriptions per 100 patients. A process evaluation will be conducted to elucidate the mechanisms by which A&F influences practice. The trial was developed in collaboration with system-level stakeholders from policy, education and service providers.ResultsDevelopment of all interventions is complete and the trial will begin in March 2013. Processes are being developed to enable integration of the most effective intervention into national systems intended to reduce antibiotic prescribing.DiscussionCollaboration with system-level stakeholders has helped ensure that the trial addresses national priorities and has engendered system-level action for national implementation of the most effective intervention.Implications for Guideline Developers/UsersGenerating robust experimental evidence on an intervention’s effectiveness and collaboration with system-level stakeholders can increase the likelihood of its adoption as a policy initiative.
P331 Evaluation Of Quality Of Czech Neurology Clinical Practice Guidelines Using Agree Ii Instrument
Authors: Licenik R , Klikova K , Osinova D , Doubravska S , Ivanova K 
Published: August 2013

BackgroundThe quality of guidelines has been variable. Evidence-based clinical practice guidelines should be of the highest possible quality, which has to be systematically evaluated. Obj TRiaDS, Research Methodology Group.ObjectivesWe have evaluated quality of new set of CPGs developed by Czech neurological society between 2009 and 2011 using AGREE II instrument.MethodsSix CPGs developed by Czech neurology society were assessed using AGREE II instrument by 4 independent assessors. Uncertainties and missing information were solved by the authors. Expert opinion on the evaluation process and outcomes were obtained.ResultsAll evaluated CPGs were of high quality with average of 93.5% for total score domain. The CPGs had high scores in the Clarity and recommendations and Applicability (99.6%), Scope (99.0%), Rigour of development (97.6%) and Stakeholder involvement (97.1%). The lowest score was in Editorial independence (47.5%).DiscussionThe overall quality of neurology CPGs was high because of the methodology and support for developers was robust, systematic and standardised. Only the editorial independence scored low. The statement of conflict of interest is missing in all the CPGS as it is not a part of the methodology guidelines.Implications for Guideline Developers/UsersHigh quality CPGs can be developed even in a small country with limited budget if the methods of development are well designed, implemented and evaluated.
P342 Assessment Of The Recommendations Structure In Eight Clinical Practice Guidelines Developed In Colombia
Authors: Florez I , Perez A , Prieto L , Cañon L 
Published: August 2013

BackgroundThere is not enough information to guide editorial wording of recommendations within CPG (Clinical Practice Guidelines) development. The AGREE-II instrument suggests the inclusion of population, intervention and outcome (P-I-O) components within recommendations.ObjectiveTo evaluate P-I-O component in CPG recommendations and to analyse its relationship with the AGREE-II evaluation.MethodsEight recently developed in Colombia CPG were chosen and assessed by four methodological experts; the presence of P-I-O component in each recommendation was established, and compared with an external evaluation score of the 15th item of AGREE-II instrument.ResultsEight guidelines with a total of 691 recommendations were evaluated, all of them were appraised by external international review with the Spanish AGREE-II instrument and its use were recommended. An average of 9.9% of recommendations met P-I-O structure; the absence of each component was 31.2% for population, 6% for intervention and 85.2% had no outcome. The item 15 of AGREE-II instrument reported results between 4 and 7, scores of good quality.DiscussionRecommendations in CPG seem to be clear, but most of them don’t contain the evaluated criteria for their report. External evaluation emphasises in clarity of recommendation, and there is no agreement with the percentages obtained according to P-I-O structure, which enhance its understanding.ImplicationsIt is advisable to standardise methodology for recommendations to include all components that reflect the answer to the research question.
P353 The Current Status Of Evidence-Based Clinical Practice Guidelines On Stroke
Authors: Jang B , Park S , Park J , Cheon C , Go H , Sun S , Ko S 
Published: August 2013

BackgroundStroke is one of the main causes of death. It is important not only treating acute state after stroke event, but managing patients with disability.ObjectivesTo examine current status of evidence-based CPGs for stroke.MethodsWe were systematically examined CPGs of stroke since 2000. We searched Korean DB and PubMed, NGC, GIN using ‘stroke’. Data were extracted on types of treatment, management and rehabilitation, and level of evidence (LOE), grade of recommendation (GOR), and the included CPGs was evaluated though AGREE II.ResultsFinally 24 CPGs were selected, and 20 were since 2006. 9 CPGs were from academic societies or agencies in USA, 7 from Europe, and 8 from others. The number of CPGs wrote by academic institutes 24, and 14 published in the medical journals. On both hemorrhage and infarction were 15, on infarction 5, and on hemorrhage 4. Major issues of 6 CPGs were from treatment and management of acute stage to rehabilitation of chronic stage, 10 were only treatment and management of acute phase, and 8 were about stroke rehabilitation. All CPGs didn’t present the LOE and GOR. It is various that criteria for LOE and GOR.DiscussionAlthough all CPGs were ‘evidence-based’, there was not equal. When developing new CPGs from other regions, it is necessary to consider taking into account the diversity of these.Implications for Guideline DevelopersRecently there are many cases of ‘adaptation’ from existing CPGs, but it could be seen the diversity of contents and level of CPGs in this study.
265WS Improving Guideline Implementability With Guide-M (Guideline Implementability For Decision Excellence Model): An Interactive Workshop
Authors: Kastner M , Makarski J , Hayden L , Durocher L , Chatterjee A , Bhattacharyya O , Brouwers M 
Published: August 2013

BackgroundWe developed a framework of guideline uptake called GuIDE-M (Guideline Implementability for Decision Excellence-Model) based on an extensive literature review. It describes four domains covering guideline content to optimise the implementability of recommendations (Stakeholder development, Evidence synthesis, Considered Judgement and Feasibility) and two domains related to communication of content (Language and Format).Objectives/Goal(1) To learn about GuIDE-M, (2) To conduct an assessment of participants’ current use of the GuIDE-M domains in guideline development or assessment and (3) To determine priorities for tool development to operationalize GuIDE-M domains.Target Group, Suggested AudienceGuideline developers, guideline users and researchers. [5]Description of the Workshop and Methods used to Facilitate Interactions(1) Introduction (15 minutes). A brief foundational overview of GuIDE-M. (2) Facilitated Assessment (60 minutes). Participants will break into small groups to discuss one or more of the domains in GuIDE-M. There they will (a) conduct a more detailed review of the domain, (b) assess the extent to which their guideline-related activities align with GuIDE-M principles, (c) reflect on the extent to which improving in the area is a priority, (d) discuss methods and available tools to operationalize the domain concepts, and (e) explore the types of tool(s) that should be developed to incorporate domain concepts into guideline development. Participants will be invited to remain involved as evaluators, pilot-testers and developers of these tools. The facilitated assessment will happen twice (2 x 30 minutes) to allow participants to focus on two of the GuIDE-M domains. (3) Wrap-Up (15 minutes).
124WS The Web Of EBM Recommendations
Authors: Ploegmakers M , Vegchel T van , Molag M , Tilma M , Kersten S , Barneveld T van 
Published: August 2013

BackgroundGuidelines on specific diseases and interventions are connected to other guidelines on more general topics (eg perioperative care) or to other specific guidelines on comorbidity. Together all recommendations form a web of EBM knowledge. When searching for a recommendation for a specific type of patient, illness and comorbidity, it should be found immediately, without turning many pages. Furthermore, information should be unambiguous, correct and up to date. Therefore, in the Netherlands a web-based database was developed that contains all available CPG’s, cut into ready-to-use modules. Each module easily shows connections with related content like other modules, background information, flowcharts, summaries and implementation tools. Moreover, the web-based presentation facilitates updating of modules, without revising the whole CPG, making this process more flexible and efficient.Objectives• To present the modular set-up including the connections between related content of the Dutch Guideline Database. • To discuss how modular CPG-presentation can bring EBM closer to clinical practice and facilitate updating.Target GroupThis workshop will be of most interest for clinicians and guideline developers interested in optimising EBM dissemination, efficient updating and implementation.Description• Illustrate the need for a modular database based on examples from guidelines on anaesthesia. • Discuss quality regulation of content. • Discuss the role of patient involvement in the database. • Discuss to what extent content elements should be related to justify a ‘built-in’ relation (complexity of the web of recommendations). • Discuss possible connexions between the Dutch Guideline Database and the G-I-N Database.
073WS Collaborative Guideline Implementability Tool Development and Evaluation
Authors: Cheng J , Gagliardi A , Melissa B , Bhattacharyya O 
Published: August 2013

BackgroundResearch shows that guidelines are more easily translated to practice when accompanied by information that helps users accommodate, implement and evaluate use of the recommendations. We refer to this information in guidelines or other resources as guideline implementability tools (GItools). We identified exemplar GItools, generated criteria by which to assess and develop GItools through consultation with G-I-N members, and created an online directory for sharing of GItools. Discussion with G-I-N members would help us improve these resources and identify partners for collaborative GItool development. This work is a core activity of GIRAnet: the Guideline Implementability Research and Application Network (http://www.g-i-n.net/activities/implementation/giranet).ObjectivesTo share information about GItool resources; gather feedback on how to improve GItool resources; learn about other GItool initiatives; and establish partners for joint development or evaluation of GItools. AUDIENCE Guideline developers, implementers, users (clinicians, managers, policy-makers) and researchers.DescriptionA brief presentation will define GItools and describe their potential purpose and impact; review methods used to identify, describe and evaluate exemplar GItools; and demonstrate the GItool Directory (20 minutes). Participants will be asked to individually rate, then discuss enhancements for GItool assessment criteria (20 min). Open discussion will enable sharing and mutual learning about other GItool initiatives, and explore partnerships for future GItool initiatives (40 min). Remaining time will be used to identify priorities for ongoing research (10 min). Participant feedback will be used to improve GItool resources, and guide ongoing GIRAnet projects.
005 Clinical Practice Guidelines and Systematic Reviews: Point of Intersection?
Authors: Wilson L , Robinson K 
Published: August 2013

BackgroundGuideline committees (GCs) rely on the evidence synthesised in systematic reviews (SRs) to develop evidence-based guidelines. Institute of Medicine standards for clinical practice guidelines include an interaction between the GC and the team conducting the SR.ContextIn 2005, the Cystic Fibrosis Foundation moved from consensus-based to evidence-based guideline development. SRs are now commissioned to inform specific guidelines. A methodologist, serving as a member of each multidisciplinary GC and as the lead investigator for the SR teams, provides the link for the scope, approach, and output of both processes.Description of Best PracticeThe methodologist, as part of the GC, facilitates the definition of the scope and refines the questions for the SRs. The methodologist oversees the conduct of the SR, ensuring that the review team addresses relevant questions, appropriately conducts searches, and establishes inclusion criteria and provides informative details to the GC. The methodologist provides training, where needed, and ensures consistency across guidelines in the drafting and grading of the recommendations. The methodologist also helps to address peer review comments and draft the guideline documents.Lessons for Guideline Developers, Adaptors, Implementers, and/or UsersHaving a methodologist serve on both the GC and the SR team ensures that there is appropriate and timely intersection of the guideline and SR processes. The methodologist can ensure that the SR team meets the needs of the GC and illuminate for the GC the methods and outcomes of the SR.
006 Translating Knowledge Into Practice: A Systematic Review Of Barriers, Facilitators And Interventions Impacting On Uptake Of Systematic Reviews
Authors: Wallace J , Byrne C , Clarke M 
Published: August 2013

BackgroundThe increased uptake of evidence from systematic reviews is advocated because of their potential to improve the quality of decision making for patient care and their use in clinical practice guidelines.ObjectivesTo identify how uptake of evidence from systematic reviews can be enhanced.MethodsData sources: We searched 19 databases covering the full range of publication years.Study selection: Studies of barriers and natural facilitators to uptake of evidence from systematic reviews and meta-analyses were eligible. These studies encompassed survey, focus group and interview designs. Intervention, or outcome, studies were also included.Data extraction: Two reviewers independently assessed quality and extracted data that were summarised and then analysed. Using a pre-established taxonomy, the barriers and facilitators were organised into a framework according to their effect on knowledge, attitudes, or behaviour. For the intervention studies, two reviewers also independently assessed quality and extracted data.Data synthesis: Twenty-seven studies dealing with barriers were detected and 15 studies that included investigation of natural facilitators. Ten publications addressing interventions met inclusion criteria. A synthesis of findings was conducted to find out to what extent the interventions overcome the perceived barriers and built on the facilitators detected.ResultsEducational visits, summaries of systematic reviews, and targeted messaging had a significant impact on systematic review uptake and also addressed a range of identified barriers and facilitators.ConclusionOn the basis of this study, specific strategies addressing a range of barriers and facilitators are recommended to enhance uptake of systematic reviews and meta-analyses. Promising interventions are also identified.