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Oerbekke MS, Elbers RG, van der Laan MJ, Hooft L. Designing tailored maintenance strategies for systematic reviews and clinical practice guidelines using the Portfolio Maintenance by Test-Treatment (POMBYTT) framework. BMC Med Res Methodol 2024; 24:29. [PMID: 38308228 PMCID: PMC10835980 DOI: 10.1186/s12874-024-02155-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Organizations face diverse contexts and requirements when updating and maintaining their portfolio, or pool, of systematic reviews or clinical practice guidelines they need to manage. We aimed to develop a comprehensive, theoretical framework that might enable the design and tailoring of maintenance strategies for portfolios containing systematic reviews and guidelines. METHODS We employed a conceptual approach combined with a literature review. Components of the diagnostic test-treatment pathway used in clinical healthcare were transferred to develop a framework specifically for systematic review and guideline portfolio maintenance strategies. RESULTS We developed the Portfolio Maintenance by Test-Treatment (POMBYTT) framework comprising diagnosis, staging, management, and monitoring components. To illustrate the framework's components and their elements, we provided examples from both a clinical healthcare test-treatment pathway and a clinical practice guideline maintenance scenario. Additionally, our literature review provided possible examples for the elements in the framework, such as detection variables, detection tests, and detection thresholds. We furthermore provide three example strategies using the framework, of which one was based on living recommendations strategies. CONCLUSIONS The developed framework might support the design of maintenance strategies that could contain multiple options besides updating to manage a portfolio (e.g. withdrawing and archiving), even in the absence of the target condition. By making different choices for variables, tests, test protocols, indications, management options, and monitoring, organizations might tailor their maintenance strategy to suit specific contexts and needs. The framework's elements could potentially aid in the design by being explicit about the operational aspects of maintenance strategies. This might also be helpful for end-users and other stakeholders of systematic reviews and clinical practice guidelines.
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Affiliation(s)
- Michiel S Oerbekke
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands.
| | - Roy G Elbers
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Lotty Hooft
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Goossen K, Bieler D, Hess S, Becker M, Kalsen M, Flohé S, Pieper D. An adapted 'Ottawa' method allowed assessing the need to update topic areas within clinical practice guidelines. J Clin Epidemiol 2022; 150:1-11. [PMID: 35710055 DOI: 10.1016/j.jclinepi.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/12/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To adapt and evaluate a method for assessing the need to update guideline topic areas involving multiple recommendations. STUDY DESIGN AND SETTING The 'Ottawa method' uses literature signals to determine changes in evidence that trigger a need to update individual guideline questions. We adapted the Ottawa method to include a process for aggregating updating signals by topic area (e.g., resuscitation) and tested this method using the German guideline on the treatment of patients with severe/multiple injuries. This involved a focused systematic evaluation of current evidence to identify updating signals, and classifying the need to update for each topic area. Then, we surveyed the guideline group online about the modified method. RESULTS We conducted focused literature searches for 37 topic areas and screened a mean of 97 abstracts per topic area in 2021. The need to update was high for eight (21.6%), intermediate for eight (21.6%), and low for 21 topic areas (56.8%) based on updating signals. The survey response rate was 56% (24/43). Most guideline group members (94%, 16/17 responders) would use the Ottawa method again, but their comments identified some weaknesses. CONCLUSION The modified Ottawa method is a suitable, efficient tool to generate evidence-based updating signals for guideline topic areas involving multiple recommendations. Further fine-tuning is recommended.
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Affiliation(s)
- Käthe Goossen
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Dan Bieler
- Department of Orthopaedics and Trauma Surgery, Reconstructive Surgery, Hand Surgery, Plastic Surgery and Burn Medicine, German Armed Forces Central Hospital Koblenz and Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital Du¨sseldorf, Heinrich-Heine-University, Germany
| | - Simone Hess
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Monika Becker
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | | | - Sascha Flohé
- Department of Trauma Surgery, Orthopaedics and Hand Surgery, Städtisches Klinikum Solingen, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Institute for Health Services and Health System Research, Rüdersdorf, Germany; Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany
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Ceresoli M, Coccolini F, Biffl WL, Sartelli M, Ansaloni L, Moore EE, Di Saverio S, Kluger Y, Catena F. WSES guidelines updates. World J Emerg Surg 2020; 15:39. [PMID: 32522227 PMCID: PMC7288408 DOI: 10.1186/s13017-020-00318-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/31/2020] [Indexed: 02/06/2023] Open
Abstract
The World Society of Emergency Surgery promotes training and continuing medical education in the field of emergency surgery and trauma. One of the most important activities of the society is the development of guidelines. The debate about the process of developing and updating guidelines is very active with no clear consensus and different policies among scientific societies. The present commentary provides the position of the World Society of Emergency Surgery on guideline development process and their update.
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Affiliation(s)
- Marco Ceresoli
- General and Emergency Surgery Department, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy.
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Walter L Biffl
- Trauma Surgery Department, Scripps Memorial Hospital La Jolla, San Diego, CA, USA
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | | | - Salomone Di Saverio
- Department of General Surgery, University Hospital of Varese, University of Insubria, Varese, Italy
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Center, Haifa, Israel
| | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
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Becker M, Jaschinski T, Eikermann M, Mathes T, Bühn S, Koppert W, Leffler A, Neugebauer E, Pieper D. A systematic decision-making process on the need for updating clinical practice guidelines proved to be feasible in a pilot study. J Clin Epidemiol 2017; 96:101-109. [PMID: 29289763 DOI: 10.1016/j.jclinepi.2017.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 11/27/2017] [Accepted: 12/11/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objective of this study was to test and evaluate a new decision-making process on the need for updating within the update of a German clinical practice guideline (CPG). STUDY DESIGN AND SETTING The pilot study comprised (1) limited searches in Pubmed to identify new potentially relevant evidence, (2) an online survey among the members of the CPG group to assess the need for update, and (3) a consensus conference for determination and prioritization of guideline sections with a high need for update. Subsequently, we conducted a second online survey to evaluate the procedure. RESULTS The searches resulted in 902 abstracts that were graded as new potentially relevant evidence. Twenty five of 39 members of the CPG group (64%) participated in the online survey. Seventy six percent of those took part in the second online survey. The evaluation study found on average a grade of support of the procedure regarding the determination of the need for update of 3.65 (standard deviation: 0.76) on a likert scale with 1 = "no support" to 5 = "very strong support." CONCLUSION The conducted procedure presents a systematic approach for assessing whether and to what extent a CPG requires updating and enables setting priorities for which particular guideline section to update within a CPG.
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Affiliation(s)
- Monika Becker
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany.
| | - Thomas Jaschinski
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany
| | - Michaela Eikermann
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany; Department of Evidence Based Medicine, Medical Advisory Service of Social Health Insurance (MDS), Theodor-Althoff-Straße 47, 45133 Essen, Germany
| | - Tim Mathes
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany
| | - Stefanie Bühn
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany
| | - Wolfgang Koppert
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Andreas Leffler
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Edmund Neugebauer
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany; Brandenburg Medical School-Theodor Fontane, Fehrbelliner Str.38, 16816 Neuruppin, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany
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Vernooij RWM, Martínez García L, Florez ID, Hidalgo Armas L, Poorthuis MHF, Brouwers M, Alonso-Coello P. Updated clinical guidelines experience major reporting limitations. Implement Sci 2017; 12:120. [PMID: 29025429 PMCID: PMC5639761 DOI: 10.1186/s13012-017-0651-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 10/03/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Checklist for the Reporting of Updated Guidelines (CheckUp) was recently developed. However, so far, no systematic assessment of the reporting of updated clinical guidelines (CGs) exists. We aimed to examine (1) the completeness of reporting the updating process in CGs and (2) the inter-observer reliability of CheckUp. METHODS We conducted a systematic assessment of the reporting of the updating process in a sample of updated CGs using CheckUp. We performed a systematic search to identify updated CGs published in 2015, developed by a professional society, reporting a systematic review of the evidence, and containing at least one recommendation. Three reviewers independently assessed the CGs with CheckUp (16 items). We calculated the median score per item, per domain, and overall, converting scores to a 10-point scale. Multiple linear regression analyses were used to identify differences according to country, type of organisation, scope, and health topic of updated CGs. We calculated the intraclass coefficient (ICC) and 95% confidence interval (95% CI) for domains and overall score. RESULTS We included in total 60 updated CGs. The median domain score on a 10-point scale for presentation was 5.8 (range 1.7 to 10), for editorial independence 8.3 (range 3.3 to 10), and for methodology 5.7 (range 0 to 10). The median overall score on a 10-point scale was 6.3 (range 3.1 to 10). Presentation and justification items at recommendation level (respectively reported by 27 and 38% of the CGs) and the methods used for the external review and implementing changes in practice were particularly poorly reported (both reported by 38% of the CGs). CGs developed by a European or international institution obtained a statistically significant higher overall score compared to North American or Asian institutions (p = 0.014). Finally, the agreement among the reviewers on the overall score was excellent (ICC 0.88, 95% CI 0.75 to 0.95). CONCLUSIONS The reporting of updated CGs varies considerably with significant room for improvement. We recommend using CheckUp to assess the updating process in updated CGs and as a blueprint to inform methods and reporting strategies in updating.
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Affiliation(s)
- Robin W M Vernooij
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Ivan Dario Florez
- Department of Health Research Methods, Evidence and Impact; McMaster University, Hamilton, Canada
- Department of Pediatrics, University of Antioquia, Medellin, Colombia
| | - Laura Hidalgo Armas
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Melissa Brouwers
- Department of Health Research Methods, Evidence and Impact; McMaster University, Hamilton, Canada
- Department of Oncology, McMaster University, Hamilton, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Martínez García L, Pardo-Hernández H, Sanabria AJ, Alonso-Coello P. Continuous surveillance of a pregnancy clinical guideline: an early experience. Syst Rev 2017; 6:143. [PMID: 28705226 PMCID: PMC5512983 DOI: 10.1186/s13643-017-0506-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/24/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To date there is no consensus about the optimal strategy for keeping clinical guidelines (CGs) up-to-date. The aims of this study were (1) to develop a continuous surveillance and updating strategy for CGs and (2) to test the strategy in a specific CG. METHODS The main steps were as follows: (1) recruiting members for the CG Updating Working Group, (2) mapping the CG, (3) identifying new evidence from the CG Updating Working Group, (4) designing and running restricted literature searches, (5) reviewing drugs and medical devices alerts, (6) screening and assessing the new evidence, (7) reviewing and, if necessary, modifying clinical questions and recommendations, and (8) updating the CG document. RESULTS The Pregnancy CG Updating Working Group consisted of 29 members, including clinicians, patients and caregivers, and clinical guideline methodology experts. We selected 69 clinical questions (123 recommendations) from the "Assistance during pregnancy" section. For the first update cycle (32-month duration), 9710 references were identified. Of these, 318 were pertinent, 289 were relevant, and 55 were classified as potential key references. For the second and third update cycles (6-month duration each), 2160 and 2010 references were retrieved, respectively. The continuous surveillance and updating strategy has not yet been completely implemented. CONCLUSIONS Further resources are needed in updating the CG field, both for implementing updating strategies and for developing methodological research.
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Affiliation(s)
- Laura Martínez García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Hector Pardo-Hernández
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Andrea Juliana Sanabria
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Vernooij RWM, Alonso-Coello P, Brouwers M, Martínez García L. Reporting Items for Updated Clinical Guidelines: Checklist for the Reporting of Updated Guidelines (CheckUp). PLoS Med 2017; 14:e1002207. [PMID: 28072838 PMCID: PMC5224740 DOI: 10.1371/journal.pmed.1002207] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Scientific knowledge is in constant development. Consequently, regular review to assure the trustworthiness of clinical guidelines is required. However, there is still a lack of preferred reporting items of the updating process in updated clinical guidelines. The present article describes the development process of the Checklist for the Reporting of Updated Guidelines (CheckUp). METHODS AND FINDINGS We developed an initial list of items based on an overview of research evidence on clinical guideline updating, the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument, and the advice of the CheckUp panel (n = 33 professionals). A multistep process was used to refine this list, including an assessment of ten existing updated clinical guidelines, interviews with key informants (response rate: 54.2%; 13/24), a three-round Delphi consensus survey with the CheckUp panel (33 participants), and an external review with clinical guideline methodologists (response rate: 90%; 53/59) and users (response rate: 55.6%; 10/18). CheckUp includes 16 items that address (1) the presentation of an updated guideline, (2) editorial independence, and (3) the methodology of the updating process. In this article, we present the methodology to develop CheckUp and include as a supplementary file an explanation and elaboration document. CONCLUSIONS CheckUp can be used to evaluate the completeness of reporting in updated guidelines and as a tool to inform guideline developers about reporting requirements. Editors may request its completion from guideline authors when submitting updated guidelines for publication. Adherence to CheckUp will likely enhance the comprehensiveness and transparency of clinical guideline updating for the benefit of patients and the public, health care professionals, and other relevant stakeholders.
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Affiliation(s)
- Robin W. M. Vernooij
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Spain
- Clinical Epidemiology and Biostatistics Department, McMaster University, Hamilton, Canada
- * E-mail:
| | - Melissa Brouwers
- Program in Evidence-based Care, Cancer Care Ontario, Hamilton, Canada
| | - Laura Martínez García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
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Haby MM, Chapman E, Clark R, Barreto J, Reveiz L, Lavis JN. Designing a rapid response program to support evidence-informed decision-making in the Americas region: using the best available evidence and case studies. Implement Sci 2016; 11:117. [PMID: 27538384 PMCID: PMC4990866 DOI: 10.1186/s13012-016-0472-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 07/15/2016] [Indexed: 01/08/2023] Open
Abstract
Background The objective of this work was to inform the design of a rapid response program to support evidence-informed decision-making in health policy and practice for the Americas region. Specifically, we focus on the following: (1) What are the best methodological approaches for rapid reviews of the research evidence? (2) What other strategies are needed to facilitate evidence-informed decision-making in health policy and practice? and (3) How best to operationalize a rapid response program? Methods The evidence used to inform the design of a rapid response program included (i) two rapid reviews of methodological approaches for rapid reviews of the research evidence and strategies to facilitate evidence-informed decision-making, (ii) supplementary literature in relation to the “shortcuts” that could be considered to reduce the time needed to complete rapid reviews, (iii) four case studies, and (iv) supplementary literature to identify additional operational issues for the design of the program. Results There is no agreed definition of rapid reviews in the literature and no agreed methodology for conducting them. Better reporting of rapid review methods is needed. The literature found in relation to shortcuts will be helpful in choosing shortcuts that maximize timeliness while minimizing the impact on quality. Evidence for other strategies that can be used concurrently to facilitate the uptake of research evidence, including evidence drawn from rapid reviews, is presented. Operational issues that need to be considered in designing a rapid response program include the implications of a “user-pays” model, the importance of recruiting staff with the right mix of skills and qualifications, and ensuring that the impact of the model on research use in decision-making is formally evaluated. Conclusions When designing a new rapid response program, greater attention needs to be given to specifying the rapid review methods and reporting these in sufficient detail to allow a quality assessment. It will also be important to engage in other strategies to facilitate the uptake of the rapid reviews and to evaluate the chosen model in order to make refinements and add to the evidence base for evidence-informed decision-making. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0472-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelle M Haby
- Department of Chemical and Biological Sciences, Universidad de Sonora, Hermosillo, Sonora, México. .,Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia.
| | | | - Rachel Clark
- Centre of Excellence in Intervention and Prevention Science, Melbourne, Australia
| | - Jorge Barreto
- Fundação Oswaldo Cruz, Diretoria de Brasília, Brazil
| | - Ludovic Reveiz
- Knowledge Management, Bioethics and Research, Pan American Health Organization, Washington, DC, USA
| | - John N Lavis
- McMaster Health Forum, Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, and Department of Political Science, McMaster University, Hamilton, Canada.,Department of Global Health and Population Boston, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Gambito EDV, Gonzalez-Suarez CB, Grimmer KA, Valdecañas CM, Dizon JMR, Beredo MEJ, Zamora MTG. Updating contextualized clinical practice guidelines on stroke rehabilitation and low back pain management using a novel assessment framework that standardizes decisions. BMC Res Notes 2015; 8:643. [PMID: 26537008 PMCID: PMC4632672 DOI: 10.1186/s13104-015-1588-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/14/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Clinical practice guidelines need to be regularly updated with current literature in order to remain relevant. This paper reports on the approach taken by the Philippine Academy of Rehabilitation Medicine (PARM). This dovetails with its writing guide, which underpinned its foundational work in contextualizing guidelines for stroke and low back pain (LBP) in 2011. METHODS Working groups of Filipino rehabilitation physicians and allied health practitioners met to reconsider and modify, where indicated, the 'typical' Filipino patient care pathways established in the foundation guidelines. New clinical guidelines on stroke and low back pain which had been published internationally in the last 3 years were identified using a search of electronic databases. The methodological quality of each guideline was assessed using the iCAHE Guideline Quality Checklist, and only those guidelines which provided full text references, evidence hierarchy and quality appraisal of the included literature, were included in the PARM update. Each of the PARM-endorsed recommendations was then reviewed, in light of new literature presented in the included clinical guidelines. A novel standard updating approach was developed based on the criteria reported by Johnston et al. (Int J Technol Assess Health Care 19(4):646-655, 2003) and then modified to incorporate wording from the foundational PARM writing guide. The new updating tool was debated, pilot-tested and agreed upon by the PARM working groups, before being applied to the guideline updating process. RESULTS Ten new guidelines on stroke and eleven for low back pain were identified. Guideline quality scores were moderate to good, however not all guidelines comprehensively linked the evidence body underpinning recommendations with the literature. Consequently only five stroke and four low back pain guidelines were included. The modified PARM updating guide was applied by all working groups to ensure standardization of the wording of updated recommendations and the underpinning evidence bases. CONCLUSIONS The updating tool provides a simple, standard and novel approach that incorporates evidence hierarchy and quality, and wordings of recommendations. It could be used efficiently by other guideline updaters particularly in developing countries, where resources for guideline development and updates are limited. When many people are involved in guideline writing, there is always the possibility of 'slippage' in use of wording and interpretation of evidence. The PARM updating tool provides a mechanism for maintaining a standard process for guideline updating processes that can be followed by clinicians with basic training in evidence-based practice principles.
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Affiliation(s)
- Ephraim D V Gambito
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital, Manila, Philippines. .,Philippine Academy of Rehabilitation Medicine (PARM), Quezon City, Philippines.
| | - Consuelo B Gonzalez-Suarez
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital, Manila, Philippines. .,Philippine Academy of Rehabilitation Medicine (PARM), Quezon City, Philippines.
| | - Karen A Grimmer
- International Center for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, Australia.
| | - Carolina M Valdecañas
- Department of Rehabilitation Medicine, St. Luke's Medical Center, Quezon City, Philippines. .,Philippine Academy of Rehabilitation Medicine (PARM), Quezon City, Philippines.
| | - Janine Margarita R Dizon
- College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines. .,Philippine Academy of Rehabilitation Medicine (PARM), Quezon City, Philippines.
| | - Ma Eulalia J Beredo
- Department of Rehabilitation Medicine, Philippine Orthopedic Center, Quezon City, Philippines. .,Philippine Academy of Rehabilitation Medicine (PARM), Quezon City, Philippines.
| | - Marcelle Theresa G Zamora
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital, Manila, Philippines. .,Philippine Academy of Rehabilitation Medicine (PARM), Quezon City, Philippines.
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Martínez García L, Sanabria AJ, Araya I, Lawson J, Solà I, Vernooij RWM, López D, García Álvarez E, Trujillo-Martín MM, Etxeandia-Ikobaltzeta I, Kotzeva A, Rigau D, Louro-González A, Barajas-Nava L, Díaz del Campo P, Estrada MD, Gracia J, Salcedo-Fernandez F, Haynes RB, Alonso-Coello P. Efficiency of pragmatic search strategies to update clinical guidelines recommendations. BMC Med Res Methodol 2015; 15:57. [PMID: 26227021 PMCID: PMC4521498 DOI: 10.1186/s12874-015-0058-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/22/2015] [Indexed: 11/17/2022] Open
Abstract
Background A major challenge in updating clinical guidelines is to efficiently identify new, relevant evidence. We evaluated the efficiency and feasibility of two new approaches: the development of restrictive search strategies using PubMed Clinical Queries for MEDLINE and the use of the PLUS (McMaster Premium Literature Service) database. Methods We evaluated a random sample of recommendations from a national guideline development program and identified the references that would potentially trigger an update (key references) using an exhaustive approach. We designed restrictive search strategies using the minimum number of Medical Subject Headings (MeSH) terms and text words required from the original exhaustive search strategies and applying broad and narrow filters. We developed PLUS search strategies, matching Medical Subject Headings (MeSH) and Systematized Nomenclature of Medicine (SNOMED) terms with guideline topics. We compared the number of key references retrieved by these approaches with those retrieved by the exhaustive approach. Results The restrictive approach retrieved 68.1 % fewer references than the exhaustive approach (12,486 versus 39,136), and identified 89.9 % (62/69) of key references and 88 % (22/25) of recommendation updates. The use of PLUS retrieved 88.5 % fewer references than the exhaustive approach (4,486 versus 39,136) and identified substantially fewer key references (18/69, 26.1 %) and fewer recommendation updates (10/25, 40 %). Conclusions The proposed restrictive approach is a highly efficient and feasible method to identify new evidence that triggers a recommendation update. Searching only in the PLUS database proved to be a suboptimal approach and suggests the need for topic-specific tailoring. Electronic supplementary material The online version of this article (doi:10.1186/s12874-015-0058-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L Martínez García
- Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - A J Sanabria
- Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - I Araya
- Evidence Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Santiago, Chile.
| | - J Lawson
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
| | - I Solà
- Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - R W M Vernooij
- Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - D López
- Department of Epidemiology, Sub Secretariat of Public Health, Ministry of Health, Santiago, Chile.
| | | | - M M Trujillo-Martín
- Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain.
| | | | - A Kotzeva
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain. .,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
| | - D Rigau
- Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - A Louro-González
- Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS, A Coruña, Spain.
| | - L Barajas-Nava
- Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - P Díaz del Campo
- Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad, Madrid, Spain.
| | - M D Estrada
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain. .,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
| | - J Gracia
- National Clinical Practice Guideline Programme of the NHS, Madrid, Spain.
| | | | - R B Haynes
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
| | - P Alonso-Coello
- Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain. .,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
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11
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Gurgel RK. Updating Clinical Practice Guidelines: How Do We Stay Current? Otolaryngol Head Neck Surg 2015; 153:488-90. [PMID: 25754181 DOI: 10.1177/0194599815573735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 01/29/2015] [Indexed: 11/17/2022]
Abstract
Clinical practice guidelines (CPGs) are created to address quality improvement opportunities for all clinicians, optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in patient care. Tremendous resources are invested in creating CPGs we can trust. Once a guideline is created, however, how is it maintained to reflect the most up-to-date clinical evidence? This article reviews protocols for reviewing and maintaining CPGs with particular attention to the protocols established by the American Academy of Otolaryngology-Head and Neck Surgery.
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Affiliation(s)
- Richard K Gurgel
- Division of Otolaryngology, University of Utah, Salt Lake City, Utah, USA
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12
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Martínez García L, Sanabria AJ, García Alvarez E, Trujillo-Martín MM, Etxeandia-Ikobaltzeta I, Kotzeva A, Rigau D, Louro-González A, Barajas-Nava L, Díaz Del Campo P, Estrada MD, Solà I, Gracia J, Salcedo-Fernandez F, Lawson J, Haynes RB, Alonso-Coello P. The validity of recommendations from clinical guidelines: a survival analysis. CMAJ 2014; 186:1211-9. [PMID: 25200758 DOI: 10.1503/cmaj.140547] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Clinical guidelines should be updated to maintain their validity. Our aim was to estimate the length of time before recommendations become outdated. METHODS We used a retrospective cohort design and included recommendations from clinical guidelines developed in the Spanish National Health System clinical guideline program since 2008. We performed a descriptive analysis of references, recommendations and resources used, and a survival analysis of recommendations using the Kaplan-Meier method. RESULTS We included 113 recommendations from 4 clinical guidelines with a median of 4 years since the most recent search (range 3.9-4.4 yr). We retrieved 39 136 references (range 3343-14 787) using an exhaustive literature search, 668 of which were related to the recommendations in our sample. We identified 69 (10.3%) key references, corresponding to 25 (22.1%) recommendations that required updating. Ninety-two percent (95% confidence interval 86.9-97.0) of the recommendations were valid 1 year after their development. This probability decreased at 2 (85.7%), 3 (81.3%) and 4 years (77.8%). INTERPRETATION Recommendations quickly become outdated, with 1 out of 5 recommendations being out of date after 3 years. Waiting more than 3 years to review a guideline is potentially too long.
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Affiliation(s)
- Laura Martínez García
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont.
| | - Andrea Juliana Sanabria
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Elvira García Alvarez
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Maria Mar Trujillo-Martín
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Itziar Etxeandia-Ikobaltzeta
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Anna Kotzeva
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - David Rigau
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Arturo Louro-González
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Leticia Barajas-Nava
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Petra Díaz Del Campo
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Maria-Dolors Estrada
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Ivan Solà
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Javier Gracia
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Flavia Salcedo-Fernandez
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Jennifer Lawson
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - R Brian Haynes
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
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Vernooij RWM, Sanabria AJ, Solà I, Alonso-Coello P, Martínez García L. Guidance for updating clinical practice guidelines: a systematic review of methodological handbooks. Implement Sci 2014; 9:3. [PMID: 24383701 PMCID: PMC3904688 DOI: 10.1186/1748-5908-9-3] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 12/19/2013] [Indexed: 01/27/2023] Open
Abstract
Background Updating clinical practice guidelines (CPGs) is a crucial process for maintaining the validity of recommendations. Methodological handbooks should provide guidance on both developing and updating CPGs. However, little is known about the updating guidance provided by these handbooks. Methods We conducted a systematic review to identify and describe the updating guidance provided by CPG methodological handbooks and included handbooks that provide updating guidance for CPGs. We searched in the Guidelines International Network library, US National Guidelines Clearinghouse and MEDLINE (PubMed) from 1966 to September 2013. Two authors independently selected the handbooks and extracted the data. We used descriptive statistics to analyze the extracted data and conducted a narrative synthesis. Results We included 35 handbooks. Most handbooks (97.1%) focus mainly on developing CPGs, including variable degrees of information about updating. Guidance on identifying new evidence and the methodology of assessing the need for an update is described in 11 (31.4%) and eight handbooks (22.8%), respectively. The period of time between two updates is described in 25 handbooks (71.4%), two to three years being the most frequent (40.0%). The majority of handbooks do not provide guidance for the literature search, evidence selection, assessment, synthesis, and external review of the updating process. Conclusions Guidance for updating CPGs is poorly described in methodological handbooks. This guidance should be more rigorous and explicit. This could lead to a more optimal updating process, and, ultimately to valid trustworthy guidelines.
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Affiliation(s)
| | | | | | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Institute of Biomedical Research (IIB Sant Pau), C/ Sant Antoni Maria Claret 167, Barcelona 08025, Spain.
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Becker M, Neugebauer EAM, Eikermann M. Partial updating of clinical practice guidelines often makes more sense than full updating: a systematic review on methods and the development of an updating procedure. J Clin Epidemiol 2013; 67:33-45. [PMID: 24125894 DOI: 10.1016/j.jclinepi.2013.06.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 06/13/2013] [Accepted: 06/17/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To conduct a systematic review of the methods used to determine when and how to update clinical practice guidelines (CPGs) and develop a procedure for updating CPGs. STUDY DESIGN AND SETTING We searched MEDLINE, Embase, and the Cochrane Methodology Register for methodological publications on updating CPGs. Guideline development manuals were obtained from the Web sites of guideline-developing organizations. Using the information obtained from these records, a procedure for updating CPGs was developed. RESULTS A total of 5,116 journal articles were screened, and seven articles met the criteria for inclusion. Forty-seven manuals were included; of these, eight included details about the methods used to update the guidelines. Most of the included publications focused on assessing whether the CPGs needed updating and not on how to update them. The developed procedure includes a systematic monitoring system and a scheduled process for updating the CPGs, which includes guidance on how to determine the type and scope of an update. CONCLUSION Partial updating often makes more sense than updating the whole CPG because topics and recommendations differ in terms of the need for updating. Guideline developers should implement a systematic updating procedure that includes an ongoing monitoring system that is appropriate for the nature of the guideline topics and the capabilities of the developers.
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Affiliation(s)
- Monika Becker
- Institute for Research in Operative Medicine (IFOM), Department of Medicine, Faculty of Health, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany.
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Stelfox HT, Straus SE. Measuring quality of care: considering conceptual approaches to quality indicator development and evaluation. J Clin Epidemiol 2013; 66:1328-37. [PMID: 24018342 DOI: 10.1016/j.jclinepi.2013.05.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 04/25/2013] [Accepted: 05/17/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In this article, we describe one approach for developing and evaluating quality indicators. STUDY DESIGN AND SETTING We focus on describing different conceptual approaches to quality indicator development, review one approach for developing quality indicators, outline how to evaluate quality indicators once developed, and discuss quality indicator maintenance. RESULTS The key steps for developing quality indicators include specifying a clear goal for the indicators; using methodologies to incorporate evidence, expertise, and patient perspectives; and considering contextual factors and logistics of implementation. The Strategic Framework Board and the National Quality Measure Clearinghouse have developed criteria for evaluating quality indicators that complement traditional psychometric evaluations. Optimal strategies for quality indicator maintenance and dissemination have not been determined, but experiences with clinical guideline maintenance may be informative. CONCLUSION For quality indicators to effectively guide quality improvement efforts, they must be developed, evaluated, maintained, and implemented using rigorous evidence-informed practices.
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Affiliation(s)
- Henry T Stelfox
- Department of Critical Care Medicine, Institute for Public Health, University of Calgary, Teaching Research & Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada T2N 4Z6; Department of Medicine, Institute for Public Health, University of Calgary, Teaching Research & Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada T2N 4Z6; Department of Community Health Sciences, Institute for Public Health, University of Calgary, Teaching Research & Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada T2N 4Z6.
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Martínez García L, Sanabria AJ, Araya I, Lawson J, Haynes RB, Rigau D, Solà I, Díaz Del Campo P, Estrada MD, Etxeandia-Ikobaltzeta I, García Álvarez E, Gracia J, Kotzeva A, Louro-González A, Salcedo-Fernandez F, Trujillo-Martín MM, Alonso-Coello P. Strategies to assess the validity of recommendations: a study protocol. Implement Sci 2013; 8:94. [PMID: 23967896 PMCID: PMC3765147 DOI: 10.1186/1748-5908-8-94] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/02/2013] [Indexed: 11/10/2022] Open
Abstract
Background Clinical practice guidelines (CPGs) become quickly outdated and require a periodic reassessment of evidence research to maintain their validity. However, there is little research about this topic. Our project will provide evidence for some of the most pressing questions in this field: 1) what is the average time for recommendations to become out of date?; 2) what is the comparative performance of two restricted search strategies to evaluate the need to update recommendations?; and 3) what is the feasibility of a more regular monitoring and updating strategy compared to usual practice?. In this protocol we will focus on questions one and two. Methods The CPG Development Programme of the Spanish Ministry of Health developed 14 CPGs between 2008 and 2009. We will stratify guidelines by topic and by publication year, and include one CPG by strata. We will develop a strategy to assess the validity of CPG recommendations, which includes a baseline survey of clinical experts, an update of the original exhaustive literature searches, the identification of key references (reference that trigger a potential recommendation update), and the assessment of the potential changes in each recommendation. We will run two alternative search strategies to efficiently identify important new evidence: 1) PLUS search based in McMaster Premium LiteratUre Service (PLUS) database; and 2) a Restrictive Search (ReSe) based on the least number of MeSH terms and free text words needed to locate all the references of each original recommendation. We will perform a survival analysis of recommendations using the Kaplan-Meier method and we will use the log-rank test to analyse differences between survival curves according to the topic, the purpose, the strength of recommendations and the turnover. We will retrieve key references from the exhaustive search and evaluate their presence in the PLUS and ReSe search results. Discussion Our project, using a highly structured and transparent methodology, will provide guidance of when recommendations are likely to be at risk of being out of date. We will also assess two novel restrictive search strategies which could reduce the workload without compromising rigour when CPGs developers check for the need of updating.
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Affiliation(s)
- Laura Martínez García
- Iberoamerican Cochrane Centre- Biomedical Research Institute Sant Pau IIB Sant Pau, Barcelona, Spain.
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Strategies for monitoring and updating clinical practice guidelines: a systematic review. Implement Sci 2012; 7:109. [PMID: 23164220 PMCID: PMC3520818 DOI: 10.1186/1748-5908-7-109] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 09/12/2012] [Indexed: 11/29/2022] Open
Abstract
Background Scientific knowledge is in constant change. The flow of new information requires a frequent re-evaluation of the available research results. Clinical practice guidelines (CPGs) are not exempted from this phenomenon and need to be kept updated to maintain the validity of their recommendations. The objective of our review is to systematically identify, describe and assess strategies for monitoring and updating CPGs. Study design and setting We conducted a systematic review of studies evaluating one or more methods of updating (with or without monitoring) CPGs or recommendations. We searched MEDLINE (PubMed) and The Cochrane Methodology Register (The Cochrane Library) from 1966 to June 2012. Additionally, we hand-searched reference lists of the included studies and the Guidelines International Network book of abstracts. If necessary, we contacted study authors to obtain additional information. Results We included a total of eight studies. Four evaluated if CPGs were out of date, three updated CPGs, and one continuously monitored and updated CPGs. The most detailed reported phase of the process was the identification of new evidence. As opposed to studies updating guidelines, studies evaluating if CPGs were out of date applied restricted searches. Only one study compared a restricted versus an exhaustive search suggesting that a restricted search is sufficient to assess recommendations’ Validity. One study analyzed the survival time of CPGs and suggested that these should be reassessed every three years. Conclusions There is limited evidence about the optimal strategies for monitoring and updating clinical practice guidelines. A restricted search is likely to be sufficient to monitor new evidence and assess the need to update, however, more information is needed about the timing and type of search. Only the exhaustive search strategy has been assessed for the update of CPGs. The development and evaluation of more efficient strategies is needed to improve the timeliness and reduce the burden of maintaining the validity of CPGs.
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Shekelle P, Woolf S, Grimshaw JM, Schünemann HJ, Eccles MP. Developing clinical practice guidelines: reviewing, reporting, and publishing guidelines; updating guidelines; and the emerging issues of enhancing guideline implementability and accounting for comorbid conditions in guideline development. Implement Sci 2012; 7:62. [PMID: 22762242 PMCID: PMC3503794 DOI: 10.1186/1748-5908-7-62] [Citation(s) in RCA: 182] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 03/16/2012] [Indexed: 11/10/2022] Open
Abstract
Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this third paper we discuss the issues of: reviewing, reporting, and publishing guidelines; updating guidelines; and the two emerging issues of enhancing guideline implementability and how guideline developers should approach dealing with the issue of patients who will be the subject of guidelines having co-morbid conditions.
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Banzi R, Cinquini M, Liberati A, Moschetti I, Pecoraro V, Tagliabue L, Moja L. Speed of updating online evidence based point of care summaries: prospective cohort analysis. BMJ 2011; 343:d5856. [PMID: 21948588 PMCID: PMC3179203 DOI: 10.1136/bmj.d5856] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the ability of international point of care information summaries to update evidence relevant to medical practice. DESIGN Prospective cohort bibliometric analysis. SETTING Top five point of care information summaries (Clinical Evidence, EBMGuidelines, eMedicine, Dynamed, UpToDate) ranked for coverage of medical conditions, editorial quality, and evidence based methodology. MAIN OUTCOME MEASURES From June 2009 to May 2010 we measured the incidence of research findings relating to potentially eligible newsworthy evidence. As samples, we chose systematic reviews rated as relevant by international research networks (such as, Evidence-Based Medicine, ACP Journal Club, and the Cochrane Collaboration). Every month we assessed whether each sampled review was cited in at least one chapter of the five summaries. The cumulative updating rate was analysed with Kaplan-Meier curves. Results From April to December 2009, 128 reviews were retrieved; 53% (68) from the literature surveillance journals and 47% (60) from the Cochrane Library. At nine months, Dynamed had cited 87% of the sampled reviews, while the other summaries had cited less than 50%. The updating speed of Dynamed clearly led the others. For instance, the hazard ratios for citations in EBM Guidelines and Clinical Evidence versus the top performer were 0.22 (95% confidence interval 0.17 to 0.29) and 0.03 (0.01 to 0.05). Conclusions Point of care information summaries include evidence relevant to practice at different speeds. A qualitative analysis of updating mechanisms is needed to determine whether greater speed corresponds to more appropriate incorporation of new information.
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Affiliation(s)
- Rita Banzi
- Italian Cochrane Centre, Mario Negri Institute for Pharmacological Research, Milan, Italy.
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Farin E, Glattacker M, Jäckel WH. [Guidelines and guideline research. Overview and state of guideline implementation in medical rehabilitation]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:429-35. [PMID: 21465398 DOI: 10.1007/s00103-011-1238-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
"Guideline research" is understood here to be the area of healthcare research that deals with the methodology and evaluation of processes for developing, implementing, assessing, and evaluating guidelines. For example, guideline research deals with the selection of adequate implementation strategies and the proof of the effectiveness and efficiency of the implementation of guidelines. The current data situation does not allow any reliable statements to be made about whether and to what extent the health-related outcome for patients is actually improved by implementing guidelines. For medical rehabilitation, there are a number of guidelines which appear to be just as good with respect to quality as the guidelines for acute medicine. However, there is a need for improvement in the quality criteria for methods. Rehab-related guidelines and therapy standards can be found in the AWMF guidelines, in the program for national healthcare guidelines, and in the rehabilitation quality assurance of the German Pension Fund. Guideline research in rehabilitation should concentrate on topics that arise from the specific situation of this area of healthcare, e.g., development of interdisciplinary guidelines, applicability of guidelines for multiple diseases, or possibility of evidence-based guidelines for complex interventions.
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Affiliation(s)
- E Farin
- Abt. Qualitätsmanagement und Sozialmedizin, Universitätsklinikum Freiburg, Engelbergerstr. 21, 79106, Freiburg, Deutschland.
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Tsertsvadze A, Maglione M, Chou R, Garritty C, Coleman C, Lux L, Bass E, Balshem H, Moher D. Updating comparative effectiveness reviews: current efforts in AHRQ's Effective Health Care Program. J Clin Epidemiol 2011; 64:1208-15. [PMID: 21684114 DOI: 10.1016/j.jclinepi.2011.03.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 02/24/2011] [Accepted: 03/13/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To review the current knowledge and efforts on updating systematic reviews (SRs) as applied to comparative effectiveness reviews (CERs). STUDY DESIGN AND SETTING This article outlines considerations for updating CERs by including a definition of the updating process, describing issues around assessing whether to update, and providing general guidelines for the update process. Key points to consider include (1) identifying when to update CERs, (2) how to update CERs, and (3) how to present, report, and interpret updated results in CERs. RESULTS Currently, there is little information about what proportion of SRs needs updating. Similarly, there is no consensus on when to initiate updating and how best to carry it out. CONCLUSION CERs need to be regularly updated as new evidence is produced. Lack of attention to updating may lead to outdated and sometimes misleading conclusions that compromise health care and policy decisions. The article outlines several specific goals for future research, one of them being the development of efficient guideline for updating CERs applicable across evidence-based practice centers.
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Affiliation(s)
- Alexander Tsertsvadze
- University of Ottawa Evidence-Based Practice Center, Clinical Epidemiology Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada K1H 8L6.
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Forsner T, Wistedt AÅ, Brommels M, Janszky I, de Leon AP, Forsell Y. Supported local implementation of clinical guidelines in psychiatry: a two-year follow-up. Implement Sci 2010; 5:4. [PMID: 20181013 PMCID: PMC2832625 DOI: 10.1186/1748-5908-5-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Accepted: 01/26/2010] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The gap between evidence-based guidelines for clinical care and their use in medical settings is well recognized and widespread. Only a few implementation studies of psychiatric guidelines have been carried out, and there is a lack of studies on their long-term effects.The aim of this study was to measure compliance to clinical guidelines for treatment of patients with depression and patients with suicidal behaviours, two years after an actively supported implementation. METHODS Six psychiatric clinics in Stockholm, Sweden, participated in an implementation of the guidelines. The guidelines were actively implemented at four of them, and the other two only received the guidelines and served as controls. The implementation activities included local implementation teams, seminars, regular feedback, and academic outreach visits. Compliance to guidelines was measured using quality indicators derived from the guidelines. At baseline, measurements of quality indicators, part of the guidelines, were abstracted from medical records in order to analyze the gap between clinical guidelines and current practice. On the basis of this, a series of seminars was conducted to introduce the guidelines according to local needs. Local multidisciplinary teams were established to monitor the process. Data collection took place after 6, 12, and 24 months and a total of 2,165 patient records were included in the study. RESULTS The documentation of the quality indicators improved from baseline in the four clinics with an active implementation, whereas there were no changes, or a decline, in the two control clinics. The increase was recorded at six months, and persisted over 12 and 24 months. CONCLUSIONS Compliance to the guidelines increased after active implementation and was sustained over the two-year follow-up. These results indicate that active local implementation of clinical guidelines involving clinicians can change behaviour and maintain compliance.
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Affiliation(s)
- Tord Forsner
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, SE-171 76, Sweden
| | - Anna Åberg Wistedt
- Department of Clinical Neuroscience, Section of Psychiatry St Göran's Hospital, Karolinska Institutet, Stockholm, SE-112 81, Sweden
| | - Mats Brommels
- Medical Management Centre, Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, SE- 171 77, Sweden
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Imre Janszky
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, SE-171 76, Sweden
| | - Antonio Ponce de Leon
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, SE-171 76, Sweden
- Department of Epidemiology, Rio de Janeiro State University, Brazil
| | - Yvonne Forsell
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, SE-171 76, Sweden
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Voisin CE, de la Varre C, Whitener L, Gartlehner G. Strategies in assessing the need for updating evidence-based guidelines for six clinical topics: an exploration of two search methodologies. Health Info Libr J 2008; 25:198-207. [PMID: 18796080 DOI: 10.1111/j.1471-1842.2007.00765.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Because of the expense of updating practice guidelines, recent attention has focused on approaches that can reliably assess any updating required. Shekelle et al. (Journal of the American Medical Association 2001, 286, 1461-7) proposed using limited literature searches with expert involvement to reduce resources used in assessing whether a guideline needs updating. OBJECTIVES This study compared Shekelle's method and the traditional systematic review method regarding comprehensiveness and effort. METHODS Two research teams translated critical key questions on screening test treatments and outcomes to Medical Subjects Headings (MeSH) and search strategies. They refined Shekelle's method over three iterations, seeking greater efficiency. Using both methods independently, teams assessed the need to update six topics from the 1996 Guide to Clinical Preventive Services (US Preventive Services Task Force). Outcomes included completeness of study identification, importance of missed studies and effort involved. RESULTS The revised review approach produced fewer citations than the traditional approach and saved time, identifying fewer eligible studies than the traditional approach. None of the studies missed was rated important by the experts consulted. CONCLUSIONS The revised review approach provides an acceptable method for judging whether a guideline requires updating. Librarians were an integral part of the research process that streamlined the searches.
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Affiliation(s)
- Christiane E Voisin
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC 27599-7590, USA.
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Forsner T, Wistedt AÅ, Brommels M, Forsell Y. An approach to measure compliance to clinical guidelines in psychiatric care. BMC Psychiatry 2008; 8:64. [PMID: 18657263 PMCID: PMC2525637 DOI: 10.1186/1471-244x-8-64] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Accepted: 07/25/2008] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim of this study was to measure six months compliance to Swedish clinical guidelines in psychiatric care after an active supported implementation process, using structured measures derived from the guidelines. METHODS In this observational study four psychiatric clinics each participated in active implementation of the clinical guidelines for the assessment and treatment of depression and guidelines for assessment and treatment of patients with suicidal behaviours developed by The Stockholm Medical Advisory Board for Psychiatry. The implementation programme included seminars, local implementation teams, regular feedback and academic visits. Additionally two clinics only received the guidelines and served as controls. Compliance to guidelines was measured using indicators, which operationalised requirements of preferred clinical practice. 725 patient records were included, 365 before the implementation and 360 six months after. RESULTS Analyses of indicators registered showed that the actively implementing clinics significantly improved their compliance to the guidelines. The total score differed significantly between implementation clinics and control clinics for management of depression (mean scores 9.5 (1.3) versus 5.0 (1.5), p < 0.001) as well as for the management of suicide (mean scores 8.1 (2.3) versus 4.5 (1.9), p < 0.001). No changes were found in the control clinics and only one of the OR was significant. CONCLUSION Compliance to clinical guidelines measured by process indicators of required clinical practice was enhanced by an active implementation.
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Affiliation(s)
- Tord Forsner
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, SE-171 76, Sweden
| | - Anna Åberg Wistedt
- Department of Clinical Neuroscience, Section of Psychiatry St Göran's Hospital, Karolinska Institutet, Stockholm, SE-112 81, Sweden
| | - Mats Brommels
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, SE-171 77 Sweden
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Yvonne Forsell
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, SE-171 76, Sweden
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Albert US, Schulz† KD, Kopp I. Die Leitlinie „Brustkrebs-Früherkennung in Deutschland“. PRAVENTION UND GESUNDHEITSFORDERUNG 2008. [DOI: 10.1007/s11553-008-0123-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Moher D, Tsertsvadze A, Tricco AC, Eccles M, Grimshaw J, Sampson M, Barrowman N. When and how to update systematic reviews. Cochrane Database Syst Rev 2008; 2008:MR000023. [PMID: 18254126 PMCID: PMC8941847 DOI: 10.1002/14651858.mr000023.pub3] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Systematic reviews are most helpful if they are up-to-date. We did a systematic review of strategies and methods describing when and how to update systematic reviews. OBJECTIVES To identify, describe and assess strategies and methods addressing: 1) when to update systematic reviews and 2) how to update systematic reviews. SEARCH STRATEGY We searched MEDLINE (1966 to December 2005), PsycINFO, the Cochrane Methodology Register (Issue 1, 2006), and hand searched the 2005 Cochrane Colloquium proceedings. SELECTION CRITERIA We included methodology reports, updated systematic reviews, commentaries, editorials, or other short reports describing the development, use, or comparison of strategies and methods for determining the need for updating or updating systematic reviews in healthcare. DATA COLLECTION AND ANALYSIS We abstracted information from each included report using a 15-item questionnaire. The strategies and methods for updating systematic reviews were assessed and compared descriptively with respect to their usefulness, comprehensiveness, advantages, and disadvantages. MAIN RESULTS Four updating strategies, one technique, and two statistical methods were identified. Three strategies addressed steps for updating and one strategy presented a model for assessing the need to update. One technique discussed the use of the "entry date" field in bibliographic searching. Statistical methods were cumulative meta-analysis and predicting when meta-analyses are outdated. AUTHORS' CONCLUSIONS Little research has been conducted on when and how to update systematic reviews and the feasibility and efficiency of the identified approaches is uncertain. These shortcomings should be addressed in future research.
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Affiliation(s)
- D Moher
- Chalmers Research Group, Children's Hospital of Eastern Ontario, 401 Smyth Road, Room R226, Ottawa, Ontario, Canada, K1H 8L1.
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Moher D, Tsertsvadze A, Tricco AC, Eccles M, Grimshaw J, Sampson M, Barrowman N. A systematic review identified few methods and strategies describing when and how to update systematic reviews. J Clin Epidemiol 2007; 60:1095-1104. [PMID: 17938050 DOI: 10.1016/j.jclinepi.2007.03.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 12/04/2006] [Accepted: 03/14/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Systematic reviews (SRs) are convenient summaries of evidence for health care practitioners. They form a basis for clinical practice guidelines and suggest directions for new research. SRs are most helpful if they are current; however, most of them are not being updated. This SR summarizes strategies and methods describing when and how to update SRs. STUDY DESIGN AND SETTING We searched MEDLINE (1966 to December 2005), PsycINFO, the Cochrane Methodology Register, and the 2005 Cochrane Colloquium proceedings to identify records describing when and how to update SRs in health care. RESULTS Four updating strategies, one technique, and two statistical methods were identified. Three strategies addressed steps for updating, and one strategy presented a model for assessing the need to update. One technique discussed the use of the "entry date" field in bibliographic searching. The statistical methods were cumulative meta-analysis and a test for detecting outdated meta-analyses with statistically nonsignificant results. CONCLUSION Little research has been conducted on when and how to update SRs in contrast to other methodological areas of conducting SRs (e.g., publication bias, variance imputation). The feasibility and efficiency of the identified approaches is uncertain. More research is needed to develop pragmatic and efficient methodologies for updating SRs.
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Affiliation(s)
- David Moher
- Chalmers Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
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Van Hoecke H, Van Cauwenberge P. Critical look at the clinical practice guidelines for allergic rhinitis. Respir Med 2007; 101:706-14. [PMID: 16989993 DOI: 10.1016/j.rmed.2006.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Revised: 07/20/2006] [Accepted: 08/10/2006] [Indexed: 11/30/2022]
Abstract
Allergic rhinitis (AR) is a major health concern and numerous guidelines have been developed to standardize and to improve the management of this disease. As in many other areas of medicine, the methodology of the AR guidelines has evolved from opinion-based to evidence-based medicine. Although evidence-based medicine has many benefits, it also has limitations and cannot cancel the value of the individual clinical expertise. More important than the methodology of guideline development is the efficacy of guidelines to change patient and physician behaviour and to improve clinical outcomes. At present, however, studies on the effectiveness of guidelines are few. The International Consensus on Rhinitis from 1994 is the only guideline for AR that has been assessed for its effects on health outcomes. Furthermore, there is a lack of valid and reliable instruments to assess physician's and patient's attitude towards and compliance with guideline recommendations. There is no single effective way to ensure the use of guidelines into practice, but a carefully developed and multifaceted dissemination and implementation strategy and targeting and adapting guideline recommendations to the local and individual level are key elements. The final and most important step of putting guidelines into practice occurs at the level of the patient. Patients should be considered as effective partners in health care. Education of the patient and efforts to change patient's behaviour can maximize compliance, increase satisfaction and optimize health outcomes.
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Affiliation(s)
- H Van Hoecke
- Department of Otorhinolaryngology, De Pintelaan 185, 9000 Ghent University Hospital, Belgium.
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Oxman AD, Schünemann HJ, Fretheim A. Improving the use of research evidence in guideline development: 16. Evaluation. Health Res Policy Syst 2006; 4:28. [PMID: 17156460 PMCID: PMC1702533 DOI: 10.1186/1478-4505-4-28] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 12/08/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the last of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. OBJECTIVES We reviewed the literature on evaluating guidelines and recommendations, including their quality, whether they are likely to be up-to-date, and their implementation. We also considered the role of guideline developers in undertaking evaluations that are needed to inform recommendations. METHODS We searched PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. KEY QUESTIONS AND ANSWERS Our answers to these questions were informed by a review of instruments for evaluating guidelines, several studies of the need for updating guidelines, discussions of the pros and cons of different research designs for evaluating the implementation of guidelines, and consideration of the use of uncertainties identified in systematic reviews to set research priorities. How should the quality of guidelines or recommendations be appraised? WHO should put into place processes to ensure that both internal and external review of guidelines is undertaken routinely. A checklist, such as the AGREE instrument, should be used. The checklist should be adapted and tested to ensure that it is suitable to the broad range of recommendations that WHO produces, including public health and health policy recommendations, and that it includes questions about equity and other items that are particularly important for WHO guidelines. When should guidelines or recommendations be updated? Processes should be put into place to ensure that guidelines are monitored routinely to determine if they are in need of updating. People who are familiar with the topic, such as Cochrane review groups, should do focused, routine searches for new research that would require revision of the guideline. Periodic review of guidelines by experts not involved in developing the guidelines should also be considered. Consideration should be given to establishing guideline panels that are ongoing, to facilitate routine updating, with members serving fixed periods with a rotating membership. How should the impact of guidelines or recommendations be evaluated? WHO headquarters and regional offices should support member states and those responsible for policy decisions and implementation to evaluate the impact of their decisions and actions by providing advice regarding impact assessment, practical support and coordination of efforts. Before-after evaluations should be used cautiously and when there are important uncertainties regarding the effects of a policy or its implementation, randomised evaluations should be used when possible. What responsibility should WHO take for ensuring that important uncertainties are addressed by future research when the evidence needed to inform recommendations is lacking? Guideline panels should routinely identify important uncertainties and research priorities. This source of potential priorities for research should be used systematically to inform priority-setting processes for global research.
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Affiliation(s)
- Andrew D Oxman
- Norwegian Knowledge Centre for the Health Services, P.O. Box 7004, St. Olavs plass, N-0130 Oslo, Norway
| | - Holger J Schünemann
- INFORMA, S.C. Epidemiologia, Istitituto Regina Elena, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Atle Fretheim
- Norwegian Knowledge Centre for the Health Services, P.O. Box 7004, St. Olavs plass, N-0130 Oslo, Norway
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Oxman AD, Schünemann HJ, Fretheim A. Improving the use of research evidence in guideline development: 8. Synthesis and presentation of evidence. Health Res Policy Syst 2006; 4:20. [PMID: 17147809 PMCID: PMC1702353 DOI: 10.1186/1478-4505-4-20] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 12/05/2006] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the eighth of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. OBJECTIVES We reviewed the literature on the synthesis and presentation of research evidence, focusing on four key questions. METHODS We searched PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. KEY QUESTIONS AND ANSWERS We found two reviews of instruments for critically appraising systematic reviews, several studies of the importance of using extensive searches for reviews and determining when it is important to update reviews, and consensus statements about the reporting of reviews that informed our answers to the following questions. How should existing systematic reviews be critically appraised? Because preparing systematic reviews can take over a year and require capacity and resources, existing reviews should be used when possible and updated, if needed. Standard criteria, such as A MeaSurement Tool to Assess Reviews (AMSTAR), should be used to critically appraise existing systematic reviews, together with an assessment of the relevance of the review to the questions being asked. When and how should WHO undertake or commission new reviews? Consideration should be given to undertaking or commissioning a new review whenever a relevant, up-to-date review of good quality is not available. When time or resources are limited it may be necessary to undertake rapid assessments. The methods that are used to do these assessments should be reported, including important limitations and uncertainties and explicit consideration of the need and urgency of undertaking a full systematic review. Because WHO has limited capacity for undertaking systematic reviews, reviews will often need to be commissioned when a new review is needed. Consideration should be given to establishing collaborating centres to undertake or support this work, similar to what some national organisations have done. How should the findings of systematic reviews be summarised and presented to committees responsible for making recommendations? Concise summaries (evidence tables) of the best available evidence for each important outcome, including benefits, harms and costs, should be presented to the groups responsible for making recommendations. These should include an assessment of the quality of the evidence and a summary of the findings for each outcome. The full systematic reviews, on which the summaries are based, should also be available to both those making recommendations and users of the recommendations. What additional information is needed to inform recommendations and how should this information be synthesised with information about effects and presented to committees? Additional information that is needed to inform recommendations includes factors that might modify the expected effects, need (prevalence, baseline risk or status), values (the relative importance of key outcomes), costs and the availability of resources. Any assumptions that are made about values or other factors that may vary from setting to setting should be made explicit. For global guidelines that are intended to inform decisions in different settings, consideration should be given to using a template to assist the synthesis of information specific to a setting with the global evidence of the effects of the relevant interventions.
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Affiliation(s)
- Andrew D Oxman
- Norwegian Knowledge Centre for the Health Services, P.O. Box 7004, St. Olavs plass, N-0130 Oslo, Norway
| | - Holger J Schünemann
- INFORMA, S.C. Epidemiologia, Istitituto Regina Elena, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Atle Fretheim
- Norwegian Knowledge Centre for the Health Services, P.O. Box 7004, St. Olavs plass, N-0130 Oslo, Norway
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Clark E, Donovan EF, Schoettker P. From outdated to updated, keeping clinical guidelines valid. Int J Qual Health Care 2006; 18:165-6. [PMID: 16613986 DOI: 10.1093/intqhc/mzl007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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