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Pepin KM, Carlisle K, Anderson D, Baker MG, Chipman RB, Benschop J, French NP, Greenhalgh S, McDougall S, Muellner P, Murphy E, O'Neale DR, Plank MJ, Hayman DT. Steps towards operationalizing One Health approaches. One Health 2024; 18:100740. [PMID: 38707934 PMCID: PMC11067352 DOI: 10.1016/j.onehlt.2024.100740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/21/2024] [Indexed: 05/07/2024] Open
Abstract
One Health recognizes the health of humans, agriculture, wildlife, and the environment are interrelated. The concept has been embraced by international health and environmental authorities such as WHO, WOAH, FAO, and UNEP, but One Health approaches have been more practiced by researchers than national or international authorities. To identify priorities for operationalizing One Health beyond research contexts, we conducted 41 semi-structured interviews with professionals across One Health sectors (public health, environment, agriculture, wildlife) and institutional contexts, who focus on national-scale and international applications. We identify important challenges, solutions, and priorities for delivering the One Health agenda through government action. Participants said One Health has made progress with motivating stakeholders to attempt One Health approaches, but achieving implementation needs more guidance (action plans for how to leverage or change current government infrastructure to accommodate cross-sector policy and strategic mission planning) and facilitation (behavioral change, dedicated personnel, new training model).
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Affiliation(s)
- Kim M. Pepin
- United States Department of Agriculture's National Wildlife Research Center (USDA-NWRC), Fort Collins, CO, USA
| | - Keith Carlisle
- United States Department of Agriculture's National Wildlife Research Center (USDA-NWRC), Fort Collins, CO, USA
| | - Dean Anderson
- Manaaki Whenua - Landcare Research, Lincoln, New Zealand
| | - Michael G. Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Richard B. Chipman
- United States Department of Agriculture, Animal and Plant Health Inspection Services, Wildlife Services, National Rabies Management Program, NH, USA
| | | | | | | | | | - Petra Muellner
- Massey University, Palmerston North, Manawatu, New Zealand
- Epi-interactive, Wellington, New Zealand
| | - Emil Murphy
- Deer Industry New Zealand, Wellington, New Zealand
| | - Dion R.J. O'Neale
- University of Auckland, Auckland, New Zealand
- Te Pūnaha Matatini, Auckland, New Zealand
| | - Michael J. Plank
- School of Mathematics and Statistics, University of Canterbury, Christchurch, New Zealand
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Durão S, Effa E, Mbeye N, Mthethwa M, McCaul M, Naude C, Brand A, Blose N, Mabetha D, Chibuzor M, Arikpo D, Chipojola R, Kunje G, Vandvik PO, Esu E, Lewin S, Kredo T. Using a priority setting exercise to identify priorities for guidelines on newborn and child health in South Africa, Malawi, and Nigeria. Health Res Policy Syst 2024; 22:48. [PMID: 38627761 PMCID: PMC11020907 DOI: 10.1186/s12961-024-01133-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/30/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Sub-Saharan Africa is the region with the highest under-five mortality rate globally. Child healthcare decisions should be based on rigorously developed evidence-informed guidelines. The Global Evidence, Local Adaptation (GELA) project is enhancing capacity to use global research to develop locally relevant guidelines for newborn and child health in South Africa (SA), Malawi, and Nigeria. The first step in this process was to identify national priorities for newborn and child health guideline development, and this paper describes our approach. METHODS We followed a good practice method for priority setting, including stakeholder engagement, online priority setting surveys and consensus meetings, conducted separately in South Africa, Malawi and Nigeria. We established national Steering Groups (SG), comprising 10-13 members representing government, academia, and other stakeholders, identified through existing contacts and references, who helped prioritise initial topics identified by research teams and oversaw the process. Various stakeholders were consulted via online surveys to rate the importance of topics, with results informing consensus meetings with SGs where final priority topics were agreed. RESULTS Based on survey results, nine, 10 and 11 topics were identified in SA, Malawi, and Nigeria respectively, which informed consensus meetings. Through voting and discussion within meetings, and further engagement after the meetings, the top three priority topics were identified in each country. In SA, the topics concerned anemia prevention in infants and young children and post-discharge support for caregivers of preterm and LBW babies. In Malawi, they focused on enteral nutrition in critically ill children, diagnosis of childhood cancers in the community, and caring for neonates. In Nigeria, the topics focused on identifying pre-eclampsia in the community, hand hygiene compliance to prevent infections, and enteral nutrition for LBW and preterm infants. CONCLUSIONS Through dynamic and iterative stakeholder engagement, we identified three priority topics for guideline development on newborn and child health in SA, Malawi and Nigeria. Topics were specific to contexts, with no overlap, which highlights the importance of contextualised priority setting as well as of the relationships with key decisionmakers who help define the priorities.
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Affiliation(s)
- Solange Durão
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Emmanuel Effa
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Nyanyiwe Mbeye
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Mashudu Mthethwa
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Michael McCaul
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Celeste Naude
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Amanda Brand
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ntombifuthi Blose
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Denny Mabetha
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Moriam Chibuzor
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Dachi Arikpo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Roselyn Chipojola
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Gertrude Kunje
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Per Olav Vandvik
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Department of Medicine, Lovisenberg Diaconal Trust, Oslo, Norway
| | - Ekpereonne Esu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Simon Lewin
- Department of Health Sciences Alesund, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tamara Kredo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Oerbekke MS, Gaasterland CMW, van der Laan MJ, Hooft L. Introducing re-weighted range voting in clinical practice guideline prioritization: Development and testing of the re-weighted priority-setting (REPS) tool. PLoS One 2024; 19:e0300619. [PMID: 38578723 PMCID: PMC10997121 DOI: 10.1371/journal.pone.0300619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/03/2024] [Indexed: 04/07/2024] Open
Abstract
We aimed to develop and test a tool based on the re-weighted range voting mechanism to prioritize items (i.e. key questions) in a priority-setting assessment for clinical practice guidelines. The secondary aim was to provide methodological context of the tool. We iteratively developed the tool and used qualitative methods (i.e. think-aloud and semi-structured interviews) to test the tool's usability and make adjustments accordingly. An observational approach was used to test the tool's outcome satisfaction in a real-world priority-setting assessment within a rare-disease guideline of a European Reference Network and under four different conditions in the tool. Four guideline methodologists tested the usability of the tool. The real-world testing was performed with a guideline panel consisting of a core working group, five expertise working groups, and a working group with patient representatives. Thirty-one panel members assigned scores in the priority-setting assessment. Seventeen panel members rated the priority-setting outcome, and sixteen panel members rated the outputs generated under the four conditions. Upon initial use, guideline methodologists found the tool to be quite overwhelming. However, with some initial effort they were able to easily identify the tool's structure. Based on observations and feedback, the tool was further refined and user guidance was developed. Guideline panel members expressed (high) satisfaction with the priority-setting outcome. They particularly preferred the condition when using mean subgroup scores as input or employing aggressive penalties in the weighting method to determine the outputs. The tool generates a ranked list of items and offers flexibility for different choices in priority-setting assessments as long as its input format requirements are met. Although it is not a consensus method, the tool assists in narrowing down a set of priority items. Additional steps in the priority-setting assessment can lead to a consensus being reached regarding the final outcome.
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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
| | - Charlotte M. W. Gaasterland
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
- Emma Center for Personalized Medicine, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, 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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Whittle SL, Glennon V, Buchbinder R. Prioritization of clinical questions for the Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis. Int J Rheum Dis 2023; 26:2410-2418. [PMID: 37740642 PMCID: PMC10946502 DOI: 10.1111/1756-185x.14926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
AIM Living guidelines aim to reduce delays in translating new knowledge into practice by updating individual recommendations as soon as relevant new evidence emerges. We surveyed members of the Australian Rheumatology Association (ARA) to develop a list of priority questions for the Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis (ALG) and to explore clinicians' use of clinical practice guidelines. METHODS An electronic survey of ARA members was performed in two phases. The first survey contained questions about current guideline use and beliefs and invited participants to submit at least three questions relevant to the management of rheumatoid arthritis (RA). In the second round, participants selected 10 questions they considered to be the highest priority from the collated list and ranked them in priority order. The sum of ranks was used to generate a final priority list. RESULTS There were 115 (21%) and 78 (14%) responses to the first and second survey rounds respectively. 87% of respondents use existing rheumatology guidelines in their usual practice, primarily EULAR guidelines. Most respondents favored the development of Australian rheumatology guidelines. In total, 34 potential recommendation topics were identified and ranked in order of priority. CONCLUSION A list of 34 clinical questions about RA management, ranked in order of importance by clinicians, has informed the development of the ALG. Similar prioritization exercises in other contexts may permit guidelines to be tailored to the needs of guideline users in their specific context, which may facilitate international collaboration and promote efficient translation of evidence to practice.
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Affiliation(s)
- Samuel L. Whittle
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Rheumatology UnitQueen Elizabeth HospitalAdelaideSouth AustraliaAustralia
| | - Vanessa Glennon
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Rachelle Buchbinder
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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Ho L, Lloyd K, Taylor-Rowan M, Dawson S, Logan M, Leitch S, Quinn TJ, Shenkin SD, Parry SW, Jarman H, Henderson EJ. Comparing Research Priority-Setting Partnerships for Older Adults Across International Health Care Systems: A Systematic Review. J Am Med Dir Assoc 2023; 24:1726-1745. [PMID: 37848169 DOI: 10.1016/j.jamda.2023.09.003] [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: 05/15/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVES Priority setting partnerships (PSPs) attempt to shape the research agenda to address the needs of local populations of interest. We reviewed the PSPs for older adults, with a focus on exemplar health care systems: United Kingdom (UK; publicly funded), United States (private health insurance-based), South Korea (national health insurance-based), and Africa (out-of-pocket). DESIGN Systematic review. SETTING AND PARTICIPANTS We searched databases and sources (January 2011-October 202l; updated in February 2023) for PSPs of older adults' health care. METHODS Based on the British geriatric medicine curriculum, we extracted and categorized the PSP topics by areas and the research priorities by themes, and generated evidence maps depicting and comparing the research gaps across the systems. We evaluated PSP quality using the Nine Common Themes of Good Clinical Practice. RESULTS We included 32 PSPs (United Kingdom: n = 25; United States: n = 7; South Korea and Africa: n = 0) and identified priorities regarding 27 conditions or service arrangements in the United Kingdom and 9 in the United States (predominantly in neurology/psychiatry). The UK priorities focused on treatments and interventions whereas the US on prognostic/predictive factors. There were notable research gaps within the existing PSPs, including common geriatric conditions like continence and frailty. The PSP quality evaluation revealed issues around lacking inclusion of ethnic minorities. CONCLUSIONS AND IMPLICATIONS Research priorities for older adult health care vary internationally, but certain health care systems/countries have no available PSPs. Where PSPs are available, fundamental aspects of geriatric medicine have not been included. Future researchers should conduct prioritizations in different countries, focus on core geriatric syndromes, and ensure the inclusion of all relevant stakeholder groups.
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Affiliation(s)
- Leonard Ho
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
| | - Katherine Lloyd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Martin Taylor-Rowan
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Monica Logan
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Stephanie Leitch
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Terence J Quinn
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Susan D Shenkin
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; Ageing and Health Research Group, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Steve W Parry
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Heather Jarman
- Emergency Department Clinical Research Group, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
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Khabsa J, Yaacoub S, Omair MA, Al Rayes H, Akl EA. Methodology for the adolopment of recommendations for the treatment of rheumatoid arthritis in the Kingdom of Saudi Arabia. BMC Med Res Methodol 2023; 23:224. [PMID: 37817088 PMCID: PMC10563247 DOI: 10.1186/s12874-023-02031-2] [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: 06/10/2022] [Accepted: 09/06/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Currently, there are no guidelines for the treatment of rheumatoid arthritis (RA) tailored to the context of the Kingdom of Saudi Arabia (KSA). Adaptation of guidelines accounts for contextual factors and becomes more efficient than de novo guideline development when relevant, good quality, and up-to-date guidelines are available. The objective of this study is to describe the methodology used for the adolopment of the 2021 American College of Rheumatology (ACR) guidelines for the treatment of RA in the KSA. METHODS We followed the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE)-ADOLOPMENT methodology. The adolopment KSA panel included relevant stakeholders and leading contributors to the original guidelines. We developed a list of five adaptation-relevant prioritization criteria that the panelists applied to the original recommendations. We updated the original evidence profiles with newly published studies identified by the panelists. We constructed Evidence to Decision (EtD) tables including contextual information from the KSA setting. We used the PanelVoice function of GRADEPro Guideline Development Tool (GDT) to obtain the panel's judgments on the EtD criteria ahead of the panel meeting. Following the meeting, we used the PANELVIEW instrument to obtain the panel's evaluation of the process. RESULTS The KSA panel prioritized five recommendations, for which one evidence profile required updating. Out of five adoloped recommendations, two were modified in terms of direction, and one was modified in terms of certainty of the evidence. Criteria driving the modifications in direction were valuation of outcomes, balance of effects, cost, and acceptability. The mean score on the 7-point scale items of the PANELVIEW instrument had an average of 6.47 (SD = 0.18) across all items. CONCLUSION The GRADE-ADOLOPMENT methodology proved to be efficient. The panel assessed the process and outcome positively. Engagement of stakeholders proved to be important for the success of this project.
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Affiliation(s)
- Joanne Khabsa
- AUB Grade Center, American University of Beirut Medical Center, Beirut, Lebanon
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sally Yaacoub
- AUB Grade Center, American University of Beirut Medical Center, Beirut, Lebanon
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammed A. Omair
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hanan Al Rayes
- Division of Rheumatology, Department of Internal Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Elie A. Akl
- Department of Internal Medicine, American University of Beirut, Riad-El-Solh, P.O. Box: 11-0236, Beirut, 1107 2020 Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON Canada
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Akl EA, Cuker A, Mustafa RA, Nieuwlaat R, Stevens A, Schünemann HJ. Prospective collaborative recommendation development: a novel model for more timely and trustworthy guidelines. J Clin Epidemiol 2023; 162:156-159. [PMID: 37648070 DOI: 10.1016/j.jclinepi.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Adam Cuker
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Adrienne Stevens
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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Atkins B, Briffa T, Connell C, Buttery AK, Jennings GLR. Improving prioritization processes for clinical practice guidelines: new methods and an evaluation from the National Heart Foundation of Australia. Health Res Policy Syst 2023; 21:26. [PMID: 37020238 PMCID: PMC10075165 DOI: 10.1186/s12961-022-00953-9] [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: 08/23/2021] [Accepted: 12/21/2022] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Releasing timely and relevant clinical guidelines is challenging for organizations globally. Priority-setting is crucial, as guideline development is resource-intensive. Our aim, as a national organization responsible for developing cardiovascular clinical guidelines, was to develop a method for generating and prioritizing topics for future clinical guideline development in areas where guidance was most needed. METHODS Several novel processes were developed, adopted and evaluated, including (1) initial public consultation for health professionals and the general public to generate topics; (2) thematic and qualitative analysis, according to the International Classification of Diseases (ICD-11), to aggregate topics; (3) adapting a criteria-based matrix tool to prioritize topics; (4) achieving consensus through a modified-nominal group technique and voting on priorities; and (5) process evaluation via survey of end-users. The latter comprised the organization's Expert Committee of 12 members with expertise across cardiology and public health, including two citizen representatives. RESULTS Topics (n = 405; reduced to n = 278 when duplicates removed) were identified from public consultation responses (n = 107 respondents). Thematic analysis synthesized 127 topics that were then categorized into 37 themes using ICD-11 codes. Exclusion criteria were applied (n = 32 themes omitted), resulting in five short-listed topics: (1) congenital heart disease, (2) valvular heart disease, (3) hypercholesterolaemia, (4) hypertension and (5) ischaemic heart diseases and diseases of the coronary artery. The Expert Committee applied the prioritization matrix to all five short-listed topics during a consensus meeting and voted to prioritize topics. Unanimous consensus was reached for the topic voted the highest priority: ischaemic heart disease and diseases of the coronary arteries, resulting in the decision to update the organization's 2016 clinical guidelines for acute coronary syndromes. Evaluation indicated that initial public consultation was highly valued by the Expert Committee, and the matrix tool was easy to use and improved transparency in priority-setting. CONCLUSION Developing a multistage, systematic process, incorporating public consultation and an international classification system led to improved transparency in our clinical guideline priority-setting processes and that topics chosen would have the greatest impact on health outcomes. These methods are potentially applicable to other national and international organizations responsible for developing clinical guidelines.
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Affiliation(s)
- Brooke Atkins
- National Heart Foundation of Australia, 2/850 Collins Street, Melbourne, VIC, 3008, Australia.
| | - Tom Briffa
- School of Population and Global Health, University of Western Australia, Clifton Street Building, Clifton St, Nedlands, WA, 6009, Australia
| | - Cia Connell
- National Heart Foundation of Australia, 2/850 Collins Street, Melbourne, VIC, 3008, Australia
| | - Amanda K Buttery
- National Heart Foundation of Australia, 2/850 Collins Street, Melbourne, VIC, 3008, Australia
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Aleksovska K, Bassetti CLA, Berger T, Carvalho V, Costa J, Deuschl G, Frederiksen KS, Jaarsma J, Kobulashvili T, Leone M, Pavlakova L, Romoli M, Vignatelli L. Prioritization process for European Academy of Neurology clinical practice guidelines. Eur J Neurol 2023; 30:305-320. [PMID: 36263630 DOI: 10.1111/ene.15608] [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: 08/11/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE The development of high-quality clinical practice guidelines (CPGs) takes substantial time, effort, and resources. During the past years, the European Academy of Neurology (EAN) guideline production was significantly increased, so the need to develop clear, transparent, and methodologically solid criteria for prioritizing guideline topics became apparent. With this paper, we aim to define a set of criteria to be applied for prioritizing topics for future EAN guidelines, as well as the procedure for their implementation. METHODS After review of the literature, we identified a recent systematic review that reported on the main prioritization criteria used by health organizations. Based on these, we developed a list of 20 preliminary criteria, which were voted on through a Delphi consensus procedure, including 160 stakeholders. Finally, we established a working procedure on how to submit and select new guideline topic proposals within the EAN. This procedure was reviewed by the EAN Scientific Committee and the Board. RESULTS The first round, 61.3% of the participants voted, and 86% of them participated in the second round. Seven criteria were approved with this procedure. After the selection of the criteria, a prioritization procedure was launched, and the first 30 topics are reported in this paper. This bottom-up process that involved the whole EAN community was followed by a top-down process, using additional criteria for further selection by the EAN board members. CONCLUSIONS We describe the development of prioritization criteria to be applied in the process of topic selection for future EAN CPGs. We will perform regular reviews and adjustments of the process.
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Affiliation(s)
- Katina Aleksovska
- European Academy of Neurology, Vienna, Austria
- Department of Neurology, Saints Cyril and Methodius University, Skopje, Macedonia
| | | | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Vanessa Carvalho
- Department of Neurosciences and Mental Health, Neurology, Santa Maria Hospital, CHULN, Lisbon, Portugal
| | - Joao Costa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, Institute of Molecular Medicine, University of Lisbon, Lisbon, Portugal
| | - Günther Deuschl
- Department of Neurology, Christian Albrecht University, Kiel, Germany
| | - Kristian S Frederiksen
- Department of Neurology, Danish Dementia Research Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Joke Jaarsma
- European Federation of Neurological Associations, Brussels, Belgium
| | - Teia Kobulashvili
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, affiliated partner of the European Reference Network EpiCARE, Salzburg, Austria
| | - Maurizio Leone
- SC Neurology, Department of Emergency and Critical Care, Home for the Relief of Suffering, Scientific Institute for Research and Health Care Foundation, San Giovanni Rotondo, Italy
| | | | - Michele Romoli
- Neurology Unit, Maurizio Bufalini Hospital, Cesena, Italy
- Neurology Clinic, University of Perugia-Saint Mary of Mercy Hospital, Perugia, Italy
| | - Luca Vignatelli
- Bologna Institute of Neurological Sciences, Scientific Institute for Research and Health Care, Bologna, Italy
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Logan M, Leitch S, Bosakh Z, Beishon L, Quinn TJ. Comparing international dementia research priorities-Systematic review. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5836. [PMID: 36326065 PMCID: PMC9828247 DOI: 10.1002/gps.5836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 10/21/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Research priority setting aims to collate stakeholder opinion to determine the most pressing research questions. Priority setting exercises influence decisions around research funding, development and policy. We compared published dementia research priority setting exercises from international healthcare systems. METHODS Four multidisciplinary, international, electronic databases were searched for relevant studies (2010 until 2021). Priorities were extracted, coded and assigned to categories using thematic analysis. The Nine Common Themes of Good Practice (9CTGP) and the Reporting guideline for priority setting of health research (REPRISE) checklists were used to assess methodological and reporting quality respectively. RESULTS From 265 titles, 10 priority setting exercises (1179 participants, 147 priorities) were included. Studies spanned four continents and the majority included people living with dementia and their care-givers in the priority setting process (68%). Only one paper met all the best practice indicators. Issues around inclusiveness, implementation and evaluation of the priorities were apparent in nine papers. We categorised priorities under eight themes: caregivers (25%, n = 37), support (24%, n = 35), awareness and education (16%, n = 24), drugs and interventions (14%, n = 21), diagnosis (8%, n = 12), pathology (6%, n = 9), research design (5%, n = 7), and prevention (1%, n = 2). Priorities varied by geographical region, with awareness and education of higher priority in low-middle income countries, compared to caregivers and support in high income countries. CONCLUSIONS Key priorities were identified with some commonality around themes considered of greatest importance. There is scope to improve the process and reporting of priority setting. Priorities differed according to contextual factors and so, priorities specific to one healthcare setting may not be applicable to others.
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Affiliation(s)
- Monica Logan
- School of MedicineUniversity of GlasgowGlasgowUK
| | | | | | - Lucy Beishon
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | - Terence J. Quinn
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
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11
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Baseline Assessment of Health Research Systems in Saudi Arabia: Harnessing Efforts and Mobilizing Actions. J Epidemiol Glob Health 2022; 12:400-412. [PMID: 36168093 PMCID: PMC9514713 DOI: 10.1007/s44197-022-00058-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/28/2022] [Indexed: 10/29/2022] Open
Abstract
Major transformations are taking place in the Kingdom of Saudi Arabia (KSA) to achieve the 2030 vision for the health sector. A key component in strengthening the health system is a strong research governance strategy that can support the decision-making process by providing timely and accurate evidence that reflects local context and needs. This paper sought to better understand governance structures and policies for health research systems and support clusters so that they function effectively. This paper outlines the findings of an in-depth baseline assessment of existing health research efforts, activities, and plans of eight research clusters in the KSA and identifies key gaps and strengths in health research governance and capabilities. A cross-sectional design was used to survey research clusters in KSA. A six-part survey was developed to better understand the research clusters' health research governance and capacities. The survey was sent to all KSA clusters and was completed in a group setting during meetings. Findings clearly show strong efforts to support research governance initiatives in health clusters in KSA. While some clusters are more advanced than others, there are plenty of opportunities to share knowledge and combine efforts to help achieve the goals set out for KSA health transformation. This baseline assessment also reflects the first attempt of its kind to understand the KSA experience and provide much-needed lessons on country-wide efforts to support the health system given the trickling effect of this sector on all others, enhancing and advancing national growth.
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Zaror C, Deana NF, Espinoza-Espinoza G, Aravena-Rivas Y, Muñoz-Millán P, Pineda P, Burdiles P, Nahuelhual P, Canelo-Aybar C, Alonso-Coello P. Questions and health outcomes prioritization for the development of a COVID-19 dental clinical practice guideline: A case study. J Eval Clin Pract 2022; 28:404-410. [PMID: 35080284 DOI: 10.1111/jep.13658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES In the context of a pandemic, the rapid development of clinical practice guidelines (CPGs) is critical. The guideline development process includes prioritization of the guideline topic, questions and health outcomes. This case study describes the application of a new methodology to prioritize questions and rate the importance of health outcomes for a COVID-19 dental guideline. METHODS Panel members rated the topic and the questions' overall importance, using a 9-point scale (1 = least important; 9 = most important). In addition, they rated six criteria if multiple questions received the same overall importance rating: common in practice, uncertainty in practice, variation in practice, new evidence available, cost consequences, not previously addressed. Panellists also rated the importance of each outcome, defined with health outcome descriptors, using a 9-point scale and the utility of health outcomes on a visual analogue scale. The correlation between each criterion and overall question importance was tested by Spearman correlation coefficient. RESULTS Of seven topics, four were rated as high priority and three were rated as important, but not of high priority. Thirty-six percent of the questions (18/50) were rated as high priority to address in the guideline and 64% (32/50) were rated as an important question but not of high priority. Of the 11 outcomes, 72.7% were rated as critical for decision making. The mean utility rating was 0.57 (SD 0.32), with a minimum mean rating of 0.16 and a maximum of 0.76 (SD 0.23). CONCLUSION This case study demonstrated that this approach provides a rigorous and transparent methodology to conduct the prioritizations of guideline topics, questions and health outcomes.
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Affiliation(s)
- Carlos Zaror
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.,Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
| | - Naira Figueiredo Deana
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.,Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
| | - Gerardo Espinoza-Espinoza
- Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.,Department of Public Health, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Yanela Aravena-Rivas
- Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
| | - Patricia Muñoz-Millán
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.,Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
| | - Patricia Pineda
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.,Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
| | - Pamela Burdiles
- Departamento Evaluación de Tecnologías Sanitarias y Salud Basada en la Evidencia, Ministerio de Salud, Santiago, Chile.,Escuela de Obstetricia, Universidad Andres Bello, Santiago, Chile
| | - Paula Nahuelhual
- Departamento Evaluación de Tecnologías Sanitarias y Salud Basada en la Evidencia, Ministerio de Salud, Santiago, Chile.,Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Fadlallah R, Daher N, El-Harakeh A, Hammam R, Brax H, Bou Karroum L, Lopes LC, Arnous G, Kassamany I, Baltayan S, Harb A, Lotfi T, El-Jardali F, Akl EA. Approaches to prioritising primary health research: a scoping review. BMJ Glob Health 2022; 7:bmjgh-2021-007465. [PMID: 35501067 PMCID: PMC9062777 DOI: 10.1136/bmjgh-2021-007465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To systematically identify and describe approaches to prioritise primary research topics in any health-related area. Methods We searched Medline and CINAHL databases and Google Scholar. Teams of two reviewers screened studies and extracted data in duplicate and independently. We synthesised the information across the included approaches by developing common categorisation of relevant concepts. Results Of 44 392 citations, 30 articles reporting on 25 approaches were included, addressing the following fields: health in general (n=9), clinical (n=10), health policy and systems (n=10), public health (n=6) and health service research (n=5) (10 addressed more than 1 field). The approaches proposed the following aspects to be addressed in the prioritisation process: situation analysis/ environmental scan, methods for generation of initial list of topics, use of prioritisation criteria, stakeholder engagement, ranking process/technique, dissemination and implementation, revision and appeal mechanism, and monitoring and evaluation. Twenty-two approaches proposed involving stakeholders in the priority setting process. The most commonly proposed stakeholder category was ‘researchers/academia’ (n=17, 77%) followed by ‘healthcare providers’ (n=16, 73%). Fifteen of the approaches proposed a list of criteria for determining research priorities. We developed a common framework of 28 prioritisation criteria clustered into nine domains. The criterion most frequently mentioned by the identified approaches was ‘health burden’ (n=12, 80%), followed by ‘availability of resources’ (n=11, 73%). Conclusion We identified and described 25 prioritisation approaches for primary research topics in any health-related area. Findings highlight the need for greater participation of potential users (eg, policy-makers and the general public) and incorporation of equity as part of the prioritisation process. Findings can guide the work of researchers, policy-makers and funders seeking to conduct or fund primary health research. More importantly, the findings should be used to enhance a more coordinated approach to prioritising health research to inform decision making at all levels.
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Affiliation(s)
- Racha Fadlallah
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon.,Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Najla Daher
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Amena El-Harakeh
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Rima Hammam
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Hneine Brax
- Faculty of Medicine, Université Saint-Joseph, Beirut, Lebanon
| | - Lama Bou Karroum
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon.,Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | | | - Ghida Arnous
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Inas Kassamany
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Stephanie Baltayan
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Aya Harb
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Tamara Lotfi
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Fadi El-Jardali
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon.,Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon .,Clinical Research Institute, American University of Beirut, Beirut, Lebanon.,Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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Tan A, Nagraj SK, Nasser M, Sharma T, Kuchenmüller T. What do we know about evidence-informed priority setting processes to set population-level health-research agendas: an overview of reviews. BULLETIN OF THE NATIONAL RESEARCH CENTRE 2022; 46:6. [PMID: 35013662 PMCID: PMC8733764 DOI: 10.1186/s42269-021-00687-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 12/16/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND This overview aimed to synthesize existing systematic reviews to produce a draft framework of evidence-informed health priority setting that supports countries in identifying appropriate steps and methods when developing and implementing national research agendas. MAIN BODY We searched Ovid MEDLINE® and the WHO Institutional Repository for Information Sharing from 2010 to 2020 for critical or systematic reviews that evaluated research priority setting exercises. We adapted the AMSTAR checklist to assess the quality of included reviews and used adapted frameworks for data extraction and analysis. The search resulted in 2395 titles, of which 31 were included. Populations included in the reviews typically involved patients, families and carers, researchers, clinicians, policymakers and research funders. The topics covered in the reviews varied from specific diseases or conditions, approaches for healthcare practice or research priority setting methods itself. All the included systematic reviews were of low or critically low quality. The studies were thematically grouped based on their main focus: identifying and engaging with stakeholders; methods; context; and health area. CONCLUSION Our overview of reviews has reconfirmed aspects of existing frameworks, but has also identified new concepts for countries to consider while developing their national research agendas. We propose a preliminary framework for consideration that highlights four key phases: (1) preparatory, (2) priority setting, (3) follow-up phase and (4) sustainability phase, which have thirteen sub-domains to consider.
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Affiliation(s)
- Audrey Tan
- Office of the Vice-Provost (Research, Innovation and Global Engagement), University College London, 2 Taviton Street, London, WC1H 0BT UK
| | - Sumanth Kumbagere Nagraj
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, The John Bull Building, Research Way, Plymouth, PL6 8BU Devon UK
| | - Mona Nasser
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, The John Bull Building, Research Way, Plymouth, PL6 8BU Devon UK
| | - Tarang Sharma
- WHO Regional Office for Europe, UN City, Marmorvej 51, 2100 Copenhagen, Denmark
| | - Tanja Kuchenmüller
- WHO Regional Office for Europe, UN City, Marmorvej 51, 2100 Copenhagen, Denmark
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Wiercioch W, Nieuwlaat R, Zhang Y, Alonso-Coello P, Dahm P, Iorio A, Manja V, Mustafa RA, Neumann I, Ortel TL, Rochwerg B, Santesso N, Vesely SK, Akl EA, Schünemann HJ. New methods facilitated the process of prioritizing questions and health outcomes in guideline development. J Clin Epidemiol 2021; 143:91-104. [PMID: 34843861 DOI: 10.1016/j.jclinepi.2021.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/06/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Health guideline development requires sequential prioritization of the guideline topic, questions, and health outcomes. In this paper we report on new approaches for prioritizing questions and outcomes in guidelines. METHODS Ten guideline panels on venous thromboembolism rated potential guideline questions on a 9-point scale according to their overall importance and 6 criteria: common in practice, uncertainty in practice, variation in practice, new evidence available, cost consequences, not previously addressed. We randomized panelists to rate one potential question with and without the 6 criteria. Panelists rated importance of outcomes, defined with health outcome descriptors (HODs), using a 9-point scale, and health utility of outcomes on a visual analogue scale. RESULTS Of 469 potential questions identified, 72.5% were rated as important but not of high priority, and 25.4% as high priority. Each criterion was significantly associated with the overall importance rating. The overall importance rating means were 5.96 (SD 2.38) and 6.53 (SD 2.45) (P = 0.25) for those randomized to rate questions with and without the criteria, respectively. The mean importance rating for 121 outcomes was 6.01 (SD 1.25), with 35.5% rated as critical for decision-making. Panelists provided health utility ratings for 127 outcomes, with a minimum mean rating of 0.12 (SD 0.10) and maximum of 0.91 (SD 0.15). CONCLUSION Our structured process provided information to help explain perspectives of question importance, to facilitate panels' outcome prioritization, and to facilitate decision-making in guideline development.
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Affiliation(s)
- Wojtek Wiercioch
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Robby Nieuwlaat
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yuan Zhang
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Philipp Dahm
- Minneapolis VAMC, Urology Section and University of Minnesota Department of Urology, Minneapolis, Minnesota
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Canada
| | - Veena Manja
- Department of Surgery, University of California Davis, California, USA; Department of Medicine, Veterans Affairs Northern California Health Care System, Mather, California
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Nephrology and Hypertension, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ignacio Neumann
- Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Thomas L Ortel
- Departments of Medicine and Pathology, Duke University Medical Center, Durham, North Carolina
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Canada
| | - Nancy Santesso
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sara K Vesely
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Elie A Akl
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Internal Medicine, American University of Beirut, Lebanon
| | - Holger J Schünemann
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Canada; Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Sanabria AJ, Alonso-Coello P, McFarlane E, Niño de Guzman E, Roqué M, Martínez García L. The UpPriority tool supported prioritization processes for updating clinical guideline questions. J Clin Epidemiol 2021; 139:149-159. [PMID: 34363971 DOI: 10.1016/j.jclinepi.2021.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We aim to 1) use the UpPriority tool to identify which clinical questions (CQs) within the clinical guidelines (CGs) need to be prioritized for updating and 2) assess the implementation of the tool in a real-world set of CGs. STUDY DESIGN AND SETTING We systematically assessed CQs from a sample of CGs developed in the Spanish National Health System CG program. We applied the UpPriority tool to each CG using a step-by-step process that included: 1) establishment of the UpPriority Implementation Working Group, 2) mapping of the original CG questions and recommendations, 3) development of a survey to prioritize CQs, 4) assessment of CQ's priority according to six items, 5) calculation and ranking of priority scores, 6) decision of prioritized CQs for updating, and 7) development of the priority report. We assessed the tool implementation process (appraisers' experience when using the tool) and the inter-observer reliability of the tool, and we provided suggestions for improvement. RESULTS We included four CGs with a total of 107 CQs on the following topics: chronic heart failure (10 CQs), inherited retinal dystrophies (39 CQs), menopause (20 CQs), and open-angle glaucoma (38 CQs). We included a total of 30 participants, most of them clinicians that were members of the original CG development groups. CQs were classified in three groups: 1) high priority (CQs prioritized for updating [16/107; 15.0%]), 2) medium priority (CQs that could be prioritized for updating [47/107; 43.9%]), and low priority (CQs that were not prioritized for updating [44/107; 41.1%]). The mean time each appraiser needed to assess the CQs with the tool was 3.8 hours (range 0.5 to 10). Agreement among the appraisers varied among the CGs. Appraisers considered that the tool was useful. We suggest some areas for consideration when using the tool including: 1) identification of key appraisers, 2) customization of training materials, 3) establishment of priority thresholds, and 4) provision of methodological support. CONCLUSION The UpPriority is a useful tool to identify which CQs within a CG need to be prioritized for update in a real-world scenario. Recruitment and training of topic experts are the main challenges when using the tool.
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Affiliation(s)
- Andrea Juliana Sanabria
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Emma McFarlane
- National Institute for Health and Care Excellence, Manchester, UK
| | - Ena Niño de Guzman
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Marta Roqué
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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Contextual differences considered in the Tunisian ADOLOPMENT of the European guidelines on breast cancer screening. Health Res Policy Syst 2021; 19:80. [PMID: 33985535 PMCID: PMC8117583 DOI: 10.1186/s12961-021-00731-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 04/30/2021] [Indexed: 12/23/2022] Open
Abstract
Background Breast cancer is a common disease in Tunisia and is associated with high mortality rates. The “Instance Nationale de l’Evaluation et de l’Accréditation en Santé” (INEAS) and the Tunisian Society of Oncology decided to develop practice guidelines on the subject. While the development of de novo guidelines on breast cancer screening is a demanding process, guideline adaptation appears more appropriate and context sensitive. The objective of this paper is to describe the adaptation process of the European Guidelines on Breast Cancer Screening and Diagnosis to the Tunisian setting in terms of the methodological process, contextual differences between the source and adoloped guideline, and changes in the recommendations. Methods We used the ‘Grading of Recommendations Assessment, Development and Evaluation’ (GRADE)-ADOLOPMENT methodology to prioritize the topic, select the source guideline, and prioritize the questions and the outcomes. Once the source guideline was selected—the European Breast Cancer Guidelines—the European Commission´s Joint Research Centre shared with the project team in Tunisia all relevant documents and files. In parallel, the project team searched for local studies on the disease prevalence, associated outcomes’ baseline risks, patients’ values and preferences, cost, cost-effectiveness, acceptability, and feasibility. Then, the adoloping panel reviewed the GRADE evidence tables and the Evidence to Decision tables and discussed whether their own judgments were consistent with those from the source guideline or not. They based their judgments on the evidence on health effects, the contextual evidence, and their own experiences. Results The most relevant contextual differences between the source and adoloped guidelines were related to the perspective, scope, prioritized questions, rating of outcome importance, baseline risks, and indirectness of the evidence. The ADOLOPMENT process resulted in keeping 5 out of 6 recommendations unmodified. One recommendation addressing “screening versus no screening with ultrasound in women with high breast density on mammography screening” was modified from ‘conditional against’ to ‘conditional for either’ due to more favorable ratings by the adoloping panel in terms of equity and feasibility. Conclusion This process illustrates both the feasibility of GRADE-ADOLOPMENT approach and the importance of consideration of contextual evidence. It also highlights the value of collaboration with the organization that developed the source guideline.
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Sanabria AJ, Pardo-Hernandez H, Ballesteros M, Canelo-Aybar C, McFarlane E, Niño de Guzman E, Penman K, Posso M, Roqué i Figuls M, Selva A, Vernooij RW, Alonso-Coello P, Martínez García L, Agarwal A, Blanchard S, Brereton L, Brouwers M, Etxeandia-Ikobaltzeta I, Flórez ID, Haynes C, Ibargoyen Roteta N, James R, Kwong J, Minister C, Nolan K, Qaseem A, Rotaeche del Campo R, Shaw B, Shin ES, Tam I, Thornton J, Vandvik Per O. The UpPriority tool was developed to guide the prioritization of clinical guideline questions for updating. J Clin Epidemiol 2020; 126:80-92. [DOI: 10.1016/j.jclinepi.2020.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 11/28/2022]
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Chakraborty S, Brijnath B, Dermentzis J, Mazza D. Defining key questions for clinical practice guidelines: a novel approach for developing clinically relevant questions. Health Res Policy Syst 2020; 18:113. [PMID: 32993665 PMCID: PMC7523054 DOI: 10.1186/s12961-020-00628-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/04/2020] [Indexed: 12/12/2022] Open
Abstract
Background There is no standardised protocol for developing clinically relevant guideline questions. We aimed to create such a protocol and to apply it to developing a new guideline. Methods We reviewed international guideline manuals and, through consensus, combined steps for developing clinical questions to produce a best-practice protocol that incorporated qualitative research. The protocol was applied to develop clinical questions for a guideline for general practitioners. Results A best-practice protocol incorporating qualitative research was created. Using the protocol, we developed 10 clinical questions that spanned diagnosis, management and follow-up. Conclusions Guideline developers can apply this protocol to develop clinically relevant guideline questions.
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Affiliation(s)
- Samantha Chakraborty
- Department of General Practice, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Victoria, 3150, Australia.
| | - Bianca Brijnath
- Department of General Practice, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Victoria, 3150, Australia.,National Ageing Research Institute Ltd, Parkville, Australia
| | - Jacinta Dermentzis
- Department of General Practice, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Victoria, 3150, Australia
| | - Danielle Mazza
- Department of General Practice, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Victoria, 3150, Australia
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El-Harakeh A, Lotfi T, Ahmad A, Morsi RZ, Fadlallah R, Bou-Karroum L, Akl EA. The implementation of prioritization exercises in the development and update of health practice guidelines: A scoping review. PLoS One 2020; 15:e0229249. [PMID: 32196520 PMCID: PMC7083273 DOI: 10.1371/journal.pone.0229249] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/02/2020] [Indexed: 02/07/2023] Open
Abstract
Background The development of trustworthy guidelines requires substantial investment of resources and time. This highlights the need to prioritize topics for guideline development and update. Objective To systematically identify and describe prioritization exercises that have been conducted for the purpose of the de novo development, update or adaptation of health practice guidelines. Methods We searched Medline and CINAHL electronic databases from inception to July 2019, supplemented by hand-searching Google Scholar and the reference lists of relevant studies. We included studies describing prioritization exercises that have been conducted during the de novo development, update or adaptation of guidelines addressing clinical, public health or health systems topics. Two reviewers worked independently and in duplicate to complete study selection and data extraction. We consolidated findings in a semi-quantitative and narrative way. Results Out of 33,339 identified citations, twelve studies met the eligibility criteria. All included studies focused on prioritizing topics; none on questions or outcomes. While three exercises focused on updating guidelines, nine were on de novo development. All included studies addressed clinical topics. We adopted a framework that categorizes prioritization into 11 steps clustered in three phases (pre-prioritization, prioritization and post-prioritization). Four studies covered more than half of the 11 prioritization steps across the three phases. The most frequently reported steps for generating initial list of topics were stakeholders’ input (n = 8) and literature review (n = 7). The application of criteria to determine research priorities was used in eight studies. We used and updated a common framework of 22 prioritization criteria, clustered in 6 domains. The most frequently reported criteria related to the health burden of disease (n = 9) and potential impact of the intervention on health outcomes (n = 5). All the studies involved health care providers in the prioritization exercises. Only one study involved patients. There was a variation in the number and type of the prioritization exercises’ outputs. Conclusions This review included 12 prioritization exercises that addressed different aspects of priority setting for guideline development and update that can guide the work of researchers, funders, and other stakeholders seeking to prioritize guideline topics.
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Affiliation(s)
- Amena El-Harakeh
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Clinical Research Institute (CRI), American University of Beirut Medical Center, Beirut, Lebanon
| | - Tamara Lotfi
- Global Evidence Synthesis Initiative (GESI) Secretariat, American University of Beirut, Beirut, Lebanon
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ali Ahmad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Rami Z. Morsi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Racha Fadlallah
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Lama Bou-Karroum
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Elie A. Akl
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Clinical Research Institute (CRI), American University of Beirut Medical Center, Beirut, Lebanon
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada
- * E-mail:
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