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Bernier J, Breton M, Poitras ME. Co-designing a cardiac rehabilitation program with knowledge users for patients with cardiovascular disease from a remote area. BMC Health Serv Res 2024; 24:869. [PMID: 39085825 PMCID: PMC11290167 DOI: 10.1186/s12913-024-11321-4] [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: 02/21/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death worldwide. Cardiac rehabilitation (CR) programs are recognized as effective in reducing the burden of cardiovascular disease. However, CR programs are offered inequitably across regions and are available in less than 15% of remote areas worldwide. The main goal of this study was to design a CR program adapted to the contexts of remote areas to improve the service offered to patients. METHODS We used an iterative user-centered design approach to understand the user context and services offered in cardiac rehabilitation in remote areas. We conducted two co-design processes with knowledge users in two remote regions. Two advisory committees were created in each of these regions, comprising managers (n = 6), healthcare professionals (n = 12) and patients (n = 2). We utilized the BACPR guidelines and the Hautes Autorités de santé operational model to support data collection in coding sessions to develop the CR program. We conducted four cycles of co-design with each of the committees to develop the cardiac rehabilitation program. Qualitative data were analyzed iteratively after each cycle. RESULTS The co-design process resulted in developing a prototype cardiac rehabilitation program similar in both regions. It is based on a contextualized six-phase pathway of care designed for remote regions. For each phase 0 to 6 of the care pathway, knowledge users were asked to describe how to offer these phases in remote areas. Participants made structural changes to phases 0, 2, 3 and 4 in order to overcome staffing shortages in remote areas. These changes make it possible to decentralize cardiac rehabilitation expertise away from specialized centers, to ensure equity of service across the territory. Therapeutic patient education was integrated into phase 4 to meet patients' needs. Participants suggested that three follow-up offerings could come from nursing services to increase access to the cardiac rehabilitation program (primary care, home care, special chronic disease programs) in patients' home communities. CONCLUSION The co-design process enables us to meet the needs of remote regions in program development. This final program can be the subject of future implementation research.
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Affiliation(s)
- Jessica Bernier
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Saguenay-Lac-St-Jean, 305, Saint-Vallier, Chicoutimi, Québec, G7H 5H6, Canada
| | - Mylaine Breton
- Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Canada Research Chair in Clinical Governance on Primary Health Care, Université de Sherbrooke, 150 Pl. Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Saguenay-Lac-St-Jean, 305, Saint-Vallier, Chicoutimi, Québec, G7H 5H6, Canada.
- CRMUS Research Chair On Optimal Professional Practices in Primary Care, Centre Intégré Universitaire de Santé et de Services sociaux du, Saguenay-Lac-St-Jean, Saguenay, Canada.
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Zhang Y, Li ZH, Li SW, Liu ZH. The quality of guidelines on the pancreatic perioperative enhanced recovery after surgery: a systematic quality appraisal using AGREE II instrument. Support Care Cancer 2024; 32:456. [PMID: 38916656 DOI: 10.1007/s00520-024-08641-w] [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: 01/12/2024] [Accepted: 06/09/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE To evaluate the quality of guidelines on the pancreatic perioperative enhanced recovery after surgery both domestically and internationally, providing reference and reference for clinical practice. METHODS Systemically retrieved in the guideline websites, professional association websites and databases, such as up to date, BMJ Best Practice, PubMed, Embase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wan Fang Data, China Science and Technology Journal Database(VIP), China Biology Medicine disc (CBMdisc), Medlive, Guidelines International Network(GIN), National Guideline Clearinghouse(NGC), National Institute for Health and Care Excellence(NICE), Registered Nurses Association of Ontario(RNAO), Scottish Intercollegiate Guidelines Network(SIGN), Joanna Briggs Institute Library(JBI), including guidelines and expert consensus on enhanced postsurgical recovery in pancreatic surgery published as of December 20, 2023. The Appraisal of Guidelines for Research and Evaluation II(AGREE II) tool was applied to evaluate the quality of the guidelines by four assessors. RESULTS This study included seven guidelines, all of which were rated as Grade B in terms of quality, with ICC coefficients ranging from 0.752 to 0.884, indicating a high level of consistency. CONCLUSION When formulating guidelines in the future, it is recommended to use AGREE II as a reference, emphasizing the standardization of the guideline development process and methods, fully considering patients' values and preferences, focusing on the applicability of the guidelines, and striving to create high-quality evidence-based recommendations.
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Affiliation(s)
- Ying Zhang
- Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Zhi-Hua Li
- Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.
| | - Si-Wen Li
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health, Peking University, Beijing, China
| | - Zi-Han Liu
- Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
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Smits M, Rockall A, Constantinescu SN, Sardanelli F, Martí-Bonmatí L. Translating radiological research into practice-from discovery to clinical impact. Insights Imaging 2024; 15:13. [PMID: 38228934 DOI: 10.1186/s13244-023-01596-2] [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: 10/03/2023] [Accepted: 11/17/2023] [Indexed: 01/18/2024] Open
Abstract
At the European Society of Radiology (ESR), we strive to provide evidence for radiological practices that improve patient outcomes and have a societal impact. Successful translation of radiological research into clinical practice requires multiple factors including tailored methodology, a multidisciplinary approach aiming beyond technical validation, and a focus on unmet clinical needs. Low levels of evidence are a threat to radiology, resulting in low visibility and credibility. Here, we provide the background and rationale for the thematic series Translating radiological research into practice-from discovery to clinical impact, inviting authors to describe their processes of achieving clinically impactful radiological research. We describe the challenges unique to radiological research. Additionally, a survey was sent to non-radiological clinical societies. The majority of respondents (6/11) were in the field of gastrointestinal/abdominal medicine. The implementation of CT/MRI techniques for disease characterisation, detection and staging of cancer, and treatment planning and radiological interventions were mentioned as the most important radiological developments in the past years. The perception was that patients are substantially unaware of the impact of these developments. Unmet clinical needs were mostly early diagnosis and staging of cancer, microstructural/functional assessment of tissues and organs, and implant assessment. All but one respondent considered radiology important for research in their discipline, but five indicated that radiology is currently not involved in their research. Radiology research holds the potential for being transformative to medical practice. It is our responsibility to take the lead in studies including radiology and strive towards the highest levels of evidence.Critical relevance statement For radiological research to make a clinical and societal impact, radiologists should take the lead in radiological studies, go beyond the assessment of technical feasibility and diagnostic accuracy, and-in a multidisciplinary approach-address clinical unmet needs.Key points• Multiple factors are essential for radiological research to make a clinical and societal impact.• Radiological research needs to go beyond diagnostic accuracy and address unmet clinical needs.• Radiologists should take the lead in radiological studies with a multidisciplinary approach.
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Affiliation(s)
- Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands.
- Medical Delta, Delft, The Netherlands.
| | - Andrea Rockall
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Stefan N Constantinescu
- Ludwig Institute for Cancer Research, Brussels, Belgium
- de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
- WEL Research Institute, WELBIO Department, Wavre, Belgium
- Ludwig Institute for Cancer Research, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luis Martí-Bonmatí
- Department of Radiology and GIBI230 Research Group On Biomedical Imaging, Hospital Universitario y Politécnico La Fe and Instituto de Investigación Sanitaria La Fe, Valencia, Spain
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Hodder RK, Vogel JP, Wolfenden L, Turner T. Living Systematic Reviews and Living Guidelines to Maintain the Currency of Public Health Guidelines. Am J Public Health 2024; 114:21-26. [PMID: 38091567 PMCID: PMC10726929 DOI: 10.2105/ajph.2023.307450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Rebecca K Hodder
- Rebecca K. Hodder is with the College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia and Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia. Luke Wolfenden is with the College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia and Cochrane Public Health, The University of Newcastle, Callaghan, Australia. Joshua P. Vogel is with the School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, and the Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia. Tari Turner is with the School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joshua P Vogel
- Rebecca K. Hodder is with the College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia and Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia. Luke Wolfenden is with the College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia and Cochrane Public Health, The University of Newcastle, Callaghan, Australia. Joshua P. Vogel is with the School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, and the Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia. Tari Turner is with the School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Luke Wolfenden
- Rebecca K. Hodder is with the College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia and Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia. Luke Wolfenden is with the College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia and Cochrane Public Health, The University of Newcastle, Callaghan, Australia. Joshua P. Vogel is with the School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, and the Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia. Tari Turner is with the School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tari Turner
- Rebecca K. Hodder is with the College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia and Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia. Luke Wolfenden is with the College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia and Cochrane Public Health, The University of Newcastle, Callaghan, Australia. Joshua P. Vogel is with the School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, and the Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia. Tari Turner is with the School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Cheyne S, Fraile Navarro D, Hill K, McDonald S, Tunnicliffe D, White H, Whittle S, Karpusheff J, Mustafa R, Morgan RL, Sultan S, Turner T. Methods for living guidelines: early guidance based on practical experience. J Clin Epidemiol 2023; 155:84-96. [PMID: 36639038 DOI: 10.1016/j.jclinepi.2022.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To introduce methods for living guidelines based on practical experiences by the Australian Living Evidence Consortium (ALEC), the National Institute of Health and Care Excellence (NICE), and the Infectious Diseases Society of America (IDSA), with methodological support from the US Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Network. STUDY DESIGN AND SETTING Members of ALEC, NICE, and the US GRADE Network, convened a working group to share experiences of the methods used to develop living guidelines and outline the key differences between traditional and living guidelines methods. RESULTS The guidance includes the following steps: 1) deciding if the guideline is a priority for a living approach, 2) preparing for living guideline development, 3) literature surveillance and frequency of searching, 4) assessment and synthesis of the evidence, 5) publication and dissemination, and 6) transitioning recommendations out of living mode. CONCLUSION This paper introduces methods for living guidelines and provides examples of the similarities and differences in approach across multiple organizations conducting living guidelines. It also introduces a series of papers exploring methods for living guidelines based on our practical experiences, including consumer involvement, selecting and prioritizing questions, search decisions, and methods decisions.
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Affiliation(s)
- Saskia Cheyne
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia.
| | - David Fraile Navarro
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | | | - Steve McDonald
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - David Tunnicliffe
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Heath White
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Samuel Whittle
- Australia and New Zealand Musculoskeletal Clinical Trials Network, Melbourne, Australia; The Queen Elizabeth Hospital, South Australia, Australia; Department of Epidemiology and Preventive Medicine, School of Preventive Medicine and Public Health, Monash University, Melbourne, Australia
| | | | - Reem Mustafa
- University of Kansas Medical Center, KS, USA; The Evidence Foundation, Cleveland Heights, OH, USA
| | - Rebecca L Morgan
- The Evidence Foundation, Cleveland Heights, OH, USA; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Shahnaz Sultan
- The Evidence Foundation, Cleveland Heights, OH, USA; Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Tari Turner
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
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6
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Wilson DP. Improving Cholesterol Screening in Children-Is Educating Primary Care Providers Enough? J Pediatr 2022; 249:92-96. [PMID: 35709956 DOI: 10.1016/j.jpeds.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/25/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Don P Wilson
- Department of Pediatric Endocrinology and Diabetes, Cook Children's Medical Center, Fort Worth, TX.
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7
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Mann NK, Schmiedl S, Mortsiefer A, Bencheva V, Löscher S, Ritzke M, Drewelow E, Feldmeier G, Santos S, Wilm S, Thürmann PA. Development of a deprescribing manual for frail older people for use in the COFRAIL study and in primary care. Ther Adv Drug Saf 2022; 13:20420986221122684. [PMID: 36091625 PMCID: PMC9452796 DOI: 10.1177/20420986221122684] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/10/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Many older adults are affected by multimorbidity and subsequent polypharmacy which is associated with adverse outcomes. This is especially relevant for frail older patients. Polypharmacy may be reduced via deprescribing. As part of the complex intervention in the COFRAIL study, we developed a deprescribing manual to be used by general practitioners (GPs) in family conferences, in which GPs, patients and caregivers jointly discuss treatments. Methods We selected indications with a high prevalence in older adults in primary care (e.g. diabetes mellitus, hypertension) and conducted a literature search to identify deprescribing criteria for these indications. We additionally reviewed clinical practice guidelines. Based on the extracted information, we created a deprescribing manual which was then piloted in an expert workshop and in family conferences with volunteer patients according to the inclusion and exclusion criteria of the study protocol. Results Initially, 13 indications/topics were selected. The literature search identified deprescribing guides, reviews and clinical trials as well as lists of potentially inappropriate medication and systematic reviews on the risk and benefits of specific drugs and drug classes in older patients. After piloting and revisions, the deprescribing manual now covers 11 indications/topics. In each chapter, patient- and medication-related deprescribing criteria, monitoring and communication strategies, and information about concerns related to the use of specific drugs in older patients are provided. Discussion We found varying deprescribing strategies in the literature, which we consolidated in our deprescribing manual. Whether this approach leads to successful deprescribing in family conferences is being investigated in the cluster-randomised controlled COFRAIL study. Plain Language Summary Development of a manual to help doctors to identify which medications can be withdrawn Many older adults suffer from chronic diseases and take multiple medications concurrently. This can lead to side effects and other undesired events. We developed a manual to help doctors identify which medications can be withdrawn, so that they can discuss this with their patients. This manual was used in the COFRAIL study where doctors, patients and caregivers met in family conferences to discuss their preferences and decide together how future treatments should be handled. The manual contains information on common medications, symptoms and diseases in older patients such as diabetes and high blood pressure. Before the manual was used in the study, it was tested by volunteer patients and their doctors and caregivers to make sure that it is user-friendly.
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Affiliation(s)
- Nina-Kristin Mann
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany
| | - Sven Schmiedl
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany; Philipp Klee-Institute for Clinical Pharmacology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Achim Mortsiefer
- Institute of General Practice and Primary Care, Chair of General Practice II and Patient-Centredness in Primary Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany; Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Veronika Bencheva
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Susanne Löscher
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Manuela Ritzke
- Institute of General Practice, University Medical Center Rostock, Rostock, Germany
| | - Eva Drewelow
- Institute of General Practice, University Medical Center Rostock, Rostock, Germany
| | - Gregor Feldmeier
- Institute of General Practice, University Medical Center Rostock, Rostock, Germany
| | - Sara Santos
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Stefan Wilm
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Petra A. Thürmann
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany; Philipp Klee-Institute for Clinical Pharmacology, Helios University Hospital Wuppertal, Wuppertal, Germany
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Sargeant JM, Brennan ML, O'Connor AM. Levels of Evidence, Quality Assessment, and Risk of Bias: Evaluating the Internal Validity of Primary Research. Front Vet Sci 2022; 9:960957. [PMID: 35903128 PMCID: PMC9315339 DOI: 10.3389/fvets.2022.960957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/24/2022] [Indexed: 12/27/2022] Open
Abstract
Clinical decisions in human and veterinary medicine should be based on the best available evidence. The results of primary research are an important component of that evidence base. Regardless of whether assessing studies for clinical case management, developing clinical practice guidelines, or performing systematic reviews, evidence from primary research should be evaluated for internal validity i.e., whether the results are free from bias (reflect the truth). Three broad approaches to evaluating internal validity are available: evaluating the potential for bias in a body of literature based on the study designs employed (levels of evidence), evaluating whether key study design features associated with the potential for bias were employed (quality assessment), and applying a judgement as to whether design elements of a study were likely to result in biased results given the specific context of the study (risk of bias assessment). The level of evidence framework for assessing internal validity assumes that internal validity can be determined based on the study design alone, and thus makes the strongest assumptions. Risk of bias assessments involve an evaluation of the potential for bias in the context of a specific study, and thus involve the least assumptions about internal validity. Quality assessment sits somewhere between the assumptions of these two. Because risk of bias assessment involves the least assumptions, this approach should be used to assess internal validity where possible. However, risk of bias instruments are not available for all study designs, some clinical questions may be addressed using multiple study designs, and some instruments that include an evaluation of internal validity also include additional components (e.g., evaluation of comprehensiveness of reporting, assessments of feasibility or an evaluation of external validity). Therefore, it may be necessary to embed questions related to risk of bias within existing quality assessment instruments. In this article, we overview the approaches to evaluating internal validity, highlight the current complexities, and propose ideas for approaching assessments of internal validity.
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Affiliation(s)
- Jan M. Sargeant
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
- *Correspondence: Jan M. Sargeant
| | - Marnie L. Brennan
- Centre for Evidence-Based Veterinary Medicine, School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough, United Kingdom
| | - Annette M. O'Connor
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
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Karran EL, Wiles LK, Wilson DJ, Moseley GL. Best practice care for persistent pain in adults with spinal cord injuries: a systematic review and narrative synthesis of clinical practice guideline recommendations. Disabil Rehabil 2022:1-10. [DOI: 10.1080/09638288.2022.2093998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Emma L. Karran
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
| | - Louise K. Wiles
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
| | - Dianne J. Wilson
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
| | - G. Lorimer Moseley
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
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Jetté N, Kirkpatrick M, Lin K, Fernando SMS, French JA, Jehi L, Kumlien E, Triki CC, Wiebe S, Wimshurst J, Brigo F. What is a clinical practice guideline? A roadmap to their development. Special report from the Guidelines Task Force of the International League Against Epilepsy. Epilepsia 2022; 63:1920-1929. [PMID: 35722680 DOI: 10.1111/epi.17312] [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: 01/18/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
Abstract
Clinical practice guidelines (CPGs) are statements that provide evidence-based recommendations aimed at optimizing patient care. However, many other documents are often published as "guidelines" when they are not; these documents, although also important in clinical practice, are usually not systematically produced following rigorous processes linking the evidence to the recommendations. Specifically, the International League Against Epilepsy (ILAE) guideline development toolkit aims to ensure that high-quality CPGs are developed to fill knowledge gaps and optimize the management of epilepsy. In addition to adhering to key methodological processes, guideline developers need to consider that effective CPGs should lead to improvements in clinical processes of care and health care outcomes. This requires monitoring the effectiveness of epilepsy-related CPGs and interventions to remove the barriers to epilepsy CPG implementation. This article provides an overview of what distinguishes quality CPGs from other documents and discusses their benefits and limitations. We summarize the recently revised ILAE CPG development process and elaborate on the barriers and facilitators to guideline dissemination, implementation, and adaptation.
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Affiliation(s)
- Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Katia Lin
- Neurology Division, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Sanjaya M S Fernando
- Division of Pediatric Neurology, Colombo North Teaching Hospital and the National Epilepsy Center of Colombo, Colombo, Sri Lanka
| | - Jacqueline A French
- Department of Neurology, NYU Grossman School of Medicine, New York University, New York, New York, USA
| | - Lara Jehi
- Cleveland Clinic Epilepsy Center, Cleveland, Ohio, USA
| | - Eva Kumlien
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Chahnez C Triki
- Department of Child Neurology, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Samuel Wiebe
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jo Wimshurst
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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11
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Williams T, Wiener J, Lennox C, Kokai M. Lessons Learned: Achieving Consensus About Learning Disability Assessment and Diagnosis. CANADIAN JOURNAL OF SCHOOL PSYCHOLOGY 2022. [DOI: 10.1177/08295735221089457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current paper describes the process used for developing the Guidelines for Diagnosis and Assessment of Children, Adolescents, and Adults with Learning Disabilities-Consensus Statement and Supporting Documents, and the rationale for some of the decisions. The guidelines were developed by a cross-sectoral working group of psychologists who achieved a consensus on the criteria for diagnosis and the assessment process. We outline key features of the guidelines, describe topics where the group achieved consensus quickly and topics for which there was considerable debate (e.g., intelligence testing, ability/achievement discrepancy, and processing deficits). The group members shared information with each other about topics such as the advantages of early assessment, the importance of formally assessing effort and motivation, and assessment of culturally and linguistically diverse individuals. We conclude with the lessons learned and professional challenges regarding contextual influences on LD assessment and diagnosis and dissemination of research to practitioners.
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Affiliation(s)
- Tricia Williams
- Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, ON, Canada
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12
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Charles KR, Hall L, Ullman AJ, Schults JA. Methodology minute: Utilizing the RAND/UCLA appropriateness method to develop guidelines for infection prevention. Am J Infect Control 2022; 50:345-348. [PMID: 34973359 DOI: 10.1016/j.ajic.2021.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022]
Abstract
The use of the RAND/UCLA appropriateness method is an innovative way to provide practical, evidence based clinical guidance to infection preventionist (IP) in the absence of clinical trial data. This brief primer aims to introduce the IP to the methodology, including a short case study demonstrating the utilization of the method in the arena of infection prevention and management.
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Affiliation(s)
- Karina R Charles
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia; Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia.
| | - Lisa Hall
- School of Public Health, University of Queensland, Herston, Queensland, Australia
| | - Amanda J Ullman
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia; Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Jessica A Schults
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane Queensland, Australia; School of Public Health, University of Queensland, Herston, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia; Metro North Hospital and Health Service, Queensland, Australia
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13
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Sarkies MN, Jones LK, Gidding SS, Watts GF. Improving clinical practice guidelines with implementation science. Nat Rev Cardiol 2022; 19:3-4. [PMID: 34799708 DOI: 10.1038/s41569-021-00645-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Mitchell N Sarkies
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia. .,School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
| | - Laney K Jones
- Genomic Medicine Institute, Geisinger, Danville, PA, USA.,Heart Institute, Geisinger, Danville, PA, USA
| | - Samuel S Gidding
- Genomic Medicine Institute, Geisinger, Danville, PA, USA.,Heart Institute, Geisinger, Danville, PA, USA
| | - Gerald F Watts
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
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14
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Haw WY, Al-Janabi A, Arents BWM, Asfour L, Exton LS, Grindlay D, Khan SS, Manounah L, Yen H, Chi CC, van Zuuren EJ, Flohr C, Yiu ZZN. Global Guidelines in Dermatology Mapping Project (GUIDEMAP): a scoping review of dermatology clinical practice guidelines. Br J Dermatol 2021; 185:736-744. [PMID: 33937976 DOI: 10.1111/bjd.20428] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical practice guidelines (CPGs) play a critical role in standardizing and improving treatment outcomes based on the available evidence. It is unclear how many CPGs are available globally to assist clinicians in the management of patients with skin disease. OBJECTIVES To search for and identify CPGs for dermatological conditions with the highest burden globally. METHODS We adapted a list of 12 dermatological conditions with the highest burden from the Global Burden of Disease (GBD) study 2019. A systematic literature search was done to identify CPGs published between October 2014 to October 2019. The scoping review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. RESULTS A total of 226 CPGs were included. Melanoma had the greatest representation in the CPGs, followed by dermatitis and psoriasis. Skin cancers had a relatively high CPG representation but with lower GBD disease burden ranking. There was an uneven distribution by geographical region, with resource-poor settings being under-represented. The skin disease categories of the CPGs correlated weakly with the GBD disability-adjusted life-years metrics. Eighty-nine CPGs did not have funding disclosures and 34 CPGs were behind a paywall. CONCLUSIONS The global production of dermatology CPGs showed wide variation in geographical representation, article accessibility and reporting of funding. The number of skin disease CPGs were not commensurate with its disease burden. Future work will critically appraise the methodology and quality of dermatology CPGs and lead to the production of an accessible online resource summarizing these findings.
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Affiliation(s)
- W Y Haw
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - A Al-Janabi
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - B W M Arents
- Skin Patients Netherlands, Nieuwerkerk a/d IJssel, the Netherlands
| | - L Asfour
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - L S Exton
- Clinical Standards Unit, British Association of Dermatologists, London, UK
| | - D Grindlay
- Centre of Evidence Based Dermatology, University of Nottingham, UK
| | - S S Khan
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - L Manounah
- Clinical Standards Unit, British Association of Dermatologists, London, UK
| | - H Yen
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - C-C Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - E J van Zuuren
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - C Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, King's College London and Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Z Z N Yiu
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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15
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Uyagu OD, Ofoegbu C, Ikhidero J, Chukwuka E, Enwere O, Ogierakhi O, Adelosoye A. Quality assessment and comparative analysis on the recommendations of current guidelines on the management of peripheral arterial disease: a systematic review protocol. BMJ Open 2021; 11:e047980. [PMID: 34497080 PMCID: PMC8438866 DOI: 10.1136/bmjopen-2020-047980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Peripheral arterial disease (PAD) is the third leading atherosclerotic arterial disease. There is evidence that there is a high variation in the quality and recommendations of clinical practice guidelines for PAD, leading to the possibility of confusion among clinicians and patients. This study aims to conduct a quality assessment and comparative analysis of the clinical practice guidelines on PAD written between 2010 and 2020. METHOD AND ANALYSIS We aim to perform a systematic review of clinical practice guidelines written between 2010 and 2020. A search for guidelines will be conducted through medical databases Scope, Pubmed, TRIP, Guideline Clearinghouses and specialist international organisations' specific websites. Guidelines that meet the inclusion criteria will be extracted from the search result. The Appraisal of Guidelines for Research and Evaluation II (AGREE-II instrument) will assess the quality of the selected guidelines. The recommendations, level of evidence and other relevant information will be extracted in a datasheet for qualitative analysis. The score for each guideline's quality will be represented using charts and central tendency measures for comparison. The summary of recommendations will also be represented in tables for easy comparison for similarities and variations across sections. Finally, the level of evidence on which the recommendations are based will also be noted along with other significant characteristics such as the authors' financial relationship to the biomedical community. We aim to point out deficiencies present in current guidelines and elucidate areas where recommendations are made with low-level evidence. The results will enable the scientific community to design future research to fill in PAD management knowledge gaps. ETHICS AND DISSEMINATION No ethical approval was sought. Dissemination will be via journal articles and conference presentations. PROSPERO REGISTRATION NUMBER CRD42020219176.
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Affiliation(s)
- Oliseneku Damien Uyagu
- Thulutha Beni Essa Primary Health Care Center, Saudi Arabia Ministry of Health, Al Qunfudhah, Makkah, Saudi Arabia
| | - Cosmas Ofoegbu
- Primary Health Care Center, Saudi Arabia Ministry of Health, Al Lith, Makkah, Saudi Arabia
| | - Joseph Ikhidero
- Department of Internal Medicine, Cardiology Unit, General Hospital, Saudi Arabia Ministry of Health, Taleeth, Makkah, Saudi Arabia
| | - Emeka Chukwuka
- Department of Clinical Pathology/Hematology, Maternity and Children's Hospital, Saudi Arabia Ministry of Health, Al Hasa, Eastern Province, Saudi Arabia
| | - Okezie Enwere
- Department of Internal Medicine, Tathleeth General Hospital, Saudi Arabia Ministry of Health, Tathleeth, Asir, Saudi Arabia
| | - Omokharo Ogierakhi
- Primary Health Center, Saudi Arabia Ministry of Health, Tarbajah, Al Jouf, Saudi Arabia
| | - Alex Adelosoye
- Saudi Board for Family Medicine Program, Al Mukhatat Primary Health Care Center, Saudi Arabia Ministry of Health, Sakaka, Al Jouf, Saudi Arabia
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16
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Gyawali R, Toomey M, Stapleton F, Zangerl B, Dillon L, Ho KC, Keay L, Alkhawajah SMM, Liew G, Jalbert I. Systematic review of diabetic eye disease practice guidelines: more applicability, transparency and development rigor are needed. J Clin Epidemiol 2021; 140:56-68. [PMID: 34487836 DOI: 10.1016/j.jclinepi.2021.08.031] [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: 12/30/2020] [Revised: 06/09/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess the quality of diabetic eye disease clinical practice guidelines. STUDY DESIGN AND SETTING A systematic search of diabetic eye disease guidelines was conducted on six online databases and guideline repositories. Four reviewers independently rated quality using the Appraisal of Guidelines, Research, and Evaluation (AGREE II) instrument. Aggregate scores (%) for six domains and overall quality assessment were calculated. A "good quality" guideline was one with ≥60% score for "rigor of development" and in at least two other domains. RESULTS Eighteen guidelines met the inclusion criteria, of which 13 were evidence-based guidelines (involved systematic search and grading of evidence). The median scores (interquartile range (IQR)) for "scope and purpose," "stakeholder involvement," "rigor of development," "clarity of presentation," "applicability" and "editorial independence" were 73.6% (54.2%-80.6%), 48.6% (29.2%-71.5%), 60.2% (30.9%-78.1%), 86.6% (76.7%-94.4%), 28.6% (18.0%-37.8%) and 60.2% (30.9%-78.1%), respectively. The median overall score (out of 7) of all guidelines was 5.1 (IQR: 3.7-5.8). Evidence-based guidelines scored significantly higher compared to expert-consensus guidelines. Half (n = 9) of the guidelines (all evidence-based) were of "good quality." CONCLUSION A wide variation in methodological quality exists among diabetic eyecare guidelines, with nine demonstrating "good quality." Future iterations of guidelines could improve by appropriately engaging stakeholders, following a rigorous development process, including support for application in clinical practice and ensuring editorial transparency.
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Affiliation(s)
- Rajendra Gyawali
- School of Optometry and Vision Science, UNSW Sydney, Australia; Better Vision Foundation Nepal, Kathmandu, Nepal.
| | - Melinda Toomey
- School of Optometry and Vision Science, UNSW Sydney, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science, UNSW Sydney, Australia
| | - Lisa Dillon
- School of Optometry and Vision Science, UNSW Sydney, Australia; The George Institute for Global Health, Sydney, Australia
| | - Kam Chun Ho
- School of Optometry and Vision Science, UNSW Sydney, Australia; The George Institute for Global Health, Sydney, Australia; Singapore Eye Research Institute, Singapore
| | - Lisa Keay
- School of Optometry and Vision Science, UNSW Sydney, Australia; The George Institute for Global Health, Sydney, Australia
| | - Sally Marwan M Alkhawajah
- School of Optometry and Vision Science, UNSW Sydney, Australia; Department of Optometry and Vision Science, King Saud University, Riyadh, Saudi Arabia
| | - Gerald Liew
- Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
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17
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Davidson ZE, Bray P, Rose K, Rodrigues MJ, Corben L, North KN, Ryan MM, Burns J. Development of clinical practice guidelines for allied health and nursing assessment and management of Duchenne muscular dystrophy. Disabil Rehabil 2021; 44:5450-5467. [PMID: 34165385 DOI: 10.1080/09638288.2021.1936221] [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] [Indexed: 10/21/2022]
Abstract
PURPOSE To provide evidence-based guidance specific to allied health and nursing practice for the assessment and management of individuals with Duchenne muscular dystrophy (DMD). MATERIALS AND METHODS Thirteen key focus areas were identified in consultation with health professionals and consumer advocacy groups. A series of systematic literature reviews were conducted to identify assessment and management strategies for each key focus area. A consensus process using modified Delphi methodology, including an Australia-New Zealand expert consensus meeting, was conducted. Recommendations underwent consultative review with key groups before being finalised and prepared for dissemination. RESULTS This clinical practice guideline (CPG) generated 19 evidence-based recommendations, 117 consensus-based recommendations and five research recommendations across the 13 focus areas to inform allied health assessment and management of individuals with DMD. CONCLUSIONS The resulting recommendations can be used in conjunction with existing medical CPGs to improve, standardise and advocate for allied health and rehabilitation care in DMD. The process used here may be useful for the development of CPGs in other rare diseases.Implications for rehabilitationImplementation-ready evidence-based statements to guide clinical care of individuals with DMD are provided with the potential to improve participation, function in the community and quality of life.A model for developing best practice statements for other rare neurological diseases is described.Allied health and nursing health professionals should focus research efforts to generate quality evidence to support rehabilitation practice.
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Affiliation(s)
- Z E Davidson
- Murdoch Children's Research Institute, Parkville, Australia.,Neurology Department, Royal Children's Hospital, Parkville, Australia.,Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, Australia
| | - P Bray
- The Children's Hospital at Westmead, Westmead, Australia.,School of Health Sciences, University of Sydney, Sydney, Australia
| | - K Rose
- School of Health Sciences, University of Sydney, Sydney, Australia.,Department of Physiotherapy, Sydney Children's Hospital, Randwick, Australia.,ATOM International Pty Ltd, Newcastle upon Tyne, UK
| | - M J Rodrigues
- Muscular Dystrophy Association of New Zealand, Auckland, New Zealand.,Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - L Corben
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia.,School of Psychological Sciences, Monash University, Clayton, Australia
| | - K N North
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - M M Ryan
- Murdoch Children's Research Institute, Parkville, Australia.,Neurology Department, Royal Children's Hospital, Parkville, Australia.,Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - J Burns
- The Children's Hospital at Westmead, Westmead, Australia.,School of Health Sciences, University of Sydney, Sydney, Australia
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18
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Choi TY, Yeom SR, Choi J, Lee JA, Jun JH, Kang BK, Lee MS. Provision of a clinical practice guidelines leaflet improves levels of satisfaction for patients suffering from shoulder pain: A randomized crossover trial. Eur J Integr Med 2021. [DOI: 10.1016/j.eujim.2021.101321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Gyawali R, Toomey M, Stapleton F, Zangerl B, Dillon L, Keay L, Liew G, Jalbert I. Quality of the Australian National Health and Medical Research Council's clinical practice guidelines for the management of diabetic retinopathy. Clin Exp Optom 2021; 104:864-870. [PMID: 33689646 DOI: 10.1080/08164622.2021.1880862] [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] [Indexed: 12/12/2022] Open
Abstract
Clinical relevance: Understanding the quality of the commonly used clinical practice guidelines can help busy clinicians in selecting appropriate guidelines for evidence-based eye care for people with diabetes.Background: The National Health and Medical Research Council's (NHMRC) clinical practice guideline on diabetic retinopathy management has been widely used locally and internationally for over 10 years. However, the quality of this guideline has never been formally assessed. This study aimed to systematically evaluate the quality of the NHMRC guideline and compare it against other international guidelines.Methods: The 2008 NHMRC and another five established diabetic retinopathy management international guidelines (Scottish Intercollegiate Guidelines Network, 2017; American Academy of Ophthalmology, 2019; American Optometric Association, 2019; Royal College of Ophthalmologists, UK, 2013, and Canadian Ophthalmologic Society, 2012) were examined using the Appraisal of Guidelines, Research and Evaluation (AGREE II) instrument. Scoring by four independent reviewers was aggregated into six domain and overall rating scores. Consistency among the reviewers was assessed using intraclass correlation coefficient (ICC).Results: The AGREE II domain scores for the NHMRC guideline were: scope and purpose 72%, stakeholder involvement 64%, rigour of development 77%, clarity of presentation 96%, applicability 35%, and editorial independence 15%. The NHMRC guideline's overall score (5.3 of 7) was lower than that of most other guidelines. Compared to others, the NHMRC guideline scored well in clarity of presentation and rigour of development, but less well for editorial independence. The NHMRC guideline was the least current and a need to update it was recognised by all reviewers who identified key areas for improvement.Conclusion: The quality of the NHMRC guideline was comparable to most other established international guidelines. Several areas of strengths and weaknesses in this guideline were identified. Future updates should aim to improve transparency in development and applicability in clinical practice.
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Affiliation(s)
- Rajendra Gyawali
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Melinda Toomey
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Lisa Dillon
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Injury Division, The George Institute for Global Health, Sydney, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Injury Division, The George Institute for Global Health, Sydney, Australia
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology and the Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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20
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Poh D, Claus M, Smart L, Sharp CR. Transfusion practice in Australia: an internet-based survey. Aust Vet J 2021; 99:108-113. [PMID: 33442882 DOI: 10.1111/avj.13049] [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: 01/10/2020] [Revised: 11/15/2020] [Accepted: 12/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe small animal transfusion practices in Australia, including access to blood products and frequency of pre-transfusion compatibility testing and medication administration. METHODS An online survey was disseminated to target Australian veterinarians treating dogs and cats. Information collected included demographics, sources of blood products, blood storage, recipient compatibility testing and administration of medications pre-transfusion. Associations between the use of compatibility tests and premedications were assessed using the χ2 test. Significance was set at P < 0.05. RESULTS A total of 199 Australian veterinarians were included; however, there was some attrition of respondents over the course of the survey. The majority of respondents were in general practice (n = 133/199). Access to fresh whole blood was commonly reported for dogs (n = 179/199) and cats (n = 131/198), whereas blood components were less commonly available (canine red blood cells [RBC], n = 52/199 and plasma, n = 157/199; feline RBC, n = 9/198 and plasma, n = 21/198). Most blood was sourced from the pets of owners affiliated with the veterinary clinic (n = 179/196). The respondents who did not blood type or crossmatch dogs were significantly more likely to use premedication than those who did these tests (both comparisons: P < 0.001). Likewise, the respondents who did not blood-type cats were significantly more likely to use premedication (P = 0.003); however, there was no association between crossmatching and using premedication in cats (P = 0.183). CONCLUSION This is the first survey to describe transfusion practices across a variety of practice types throughout Australia. Future work is needed to determine how representative these results are of current transfusion practices across Australia, and if so, what can be done to optimise them.
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Affiliation(s)
- D Poh
- Comparative Health Research Group, School of Veterinary Medicine, Murdoch University, Perth, Western Australia, Australia
| | - M Claus
- Comparative Health Research Group, School of Veterinary Medicine, Murdoch University, Perth, Western Australia, Australia
| | - L Smart
- Comparative Health Research Group, School of Veterinary Medicine, Murdoch University, Perth, Western Australia, Australia
| | - C R Sharp
- Comparative Health Research Group, School of Veterinary Medicine, Murdoch University, Perth, Western Australia, Australia
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21
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Ryder M, Jacob E, Hendricks J. An integrative review to identify evidence of nurse practitioner-led changes to health-care delivery and the outcomes of such changes. Int J Nurs Pract 2020; 26:e12901. [PMID: 33291184 DOI: 10.1111/ijn.12901] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 12/23/2022]
Abstract
AIMS This study aimed to identify evidence of nurse practitioner-led changes to health-care delivery and the outcomes of such changes. BACKGROUND Changing health-care delivery is synonymous with the nurse practitioner role. The literature is critical of the lack of research by nurse practitioners, reporting the effects of a change to health-care delivery. DESIGN This study used a systematic integrative review by using Torraco's approach. DATA SOURCES Databases Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Web of Science and SCOPUS were searched for peer-reviewed publications from 2000 to 2019. REVIEW METHODS A systematic approach was used to screen and analyse the literature. Inclusion/exclusion criteria were applied, and quality appraisal was undertaken by two reviewers. RESULTS Eighteen articles were selected. The research projects were across the community and acute care settings. Research methodologies varied including preintervention and postintervention studies, evaluation of quality improvement projects, randomized controlled trial and descriptive studies. Multiple data collection tools were used. Two major themes were identified including evidence-based practice champions and improved patient outcomes. CONCLUSION The nurse practitioner role is pertinent toward improving evidence-based practice in clinical settings. Positive patient outcomes and praise for clinical leadership are evident in the literature. Research by nurse practitioners to date has focused on individual services.
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Affiliation(s)
- Mary Ryder
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.,Department of Nursing, St. Vincent's University Hospital, Dublin, Ireland
| | - Elisabeth Jacob
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia.,School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia
| | - Joyce Hendricks
- School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia.,School of Nursing, Central Queensland University, Rockhampton, QLD, Australia
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22
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Bauch A, Pellet J, Schleicher T, Yu X, Gelemanović A, Cristella C, Fraaij PL, Polasek O, Auffray C, Maier D, Koopmans M, de Jong MD. Informing epidemic (research) responses in a timely fashion by knowledge management - a Zika virus use case. Biol Open 2020; 9:bio053934. [PMID: 33148605 PMCID: PMC7725600 DOI: 10.1242/bio.053934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/28/2020] [Indexed: 01/24/2023] Open
Abstract
The response of pathophysiological research to emerging epidemics often occurs after the epidemic and, as a consequence, has little to no impact on improving patient outcomes or on developing high-quality evidence to inform clinical management strategies during the epidemic. Rapid and informed guidance of epidemic (research) responses to severe infectious disease outbreaks requires quick compilation and integration of existing pathophysiological knowledge. As a case study we chose the Zika virus (ZIKV) outbreak that started in 2015 to develop a proof-of-concept knowledge repository. To extract data from available sources and build a computationally tractable and comprehensive molecular interaction map we applied generic knowledge management software for literature mining, expert knowledge curation, data integration, reporting and visualization. A multi-disciplinary team of experts, including clinicians, virologists, bioinformaticians and knowledge management specialists, followed a pre-defined workflow for rapid integration and evaluation of available evidence. While conventional approaches usually require months to comb through the existing literature, the initial ZIKV KnowledgeBase (ZIKA KB) was completed within a few weeks. Recently we updated the ZIKA KB with additional curated data from the large amount of literature published since 2016 and made it publicly available through a web interface together with a step-by-step guide to ensure reproducibility of the described use case. In addition, a detailed online user manual is provided to enable the ZIKV research community to generate hypotheses, share knowledge, identify knowledge gaps, and interactively explore and interpret data. A workflow for rapid response during outbreaks was generated, validated and refined and is also made available. The process described here can be used for timely structuring of pathophysiological knowledge for future threats. The resulting structured biological knowledge is a helpful tool for computational data analysis and generation of predictive models and opens new avenues for infectious disease research. ZIKV Knowledgebase is available at www.zikaknowledgebase.eu.
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Affiliation(s)
| | - Johann Pellet
- European Institute of Systems Biology and Medicine, 69390 Lyon, France
| | | | - Xiao Yu
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, the Netherlands
| | - Andrea Gelemanović
- Department of Public Health, University of Split School of Medicine, 21000 Split, Croatia
| | - Cosimo Cristella
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, the Netherlands
| | - Pieter L Fraaij
- Department of Viroscience and Department of Paediatrics, Erasmus Medical Centre, 3000 CA Rotterdam, the Netherlands
| | - Ozren Polasek
- Department of Public Health, University of Split School of Medicine, 21000 Split, Croatia
| | - Charles Auffray
- European Institute of Systems Biology and Medicine, 69390 Lyon, France
| | | | - Marion Koopmans
- Department of Viroscience and Department of Paediatrics, Erasmus Medical Centre, 3000 CA Rotterdam, the Netherlands
| | - Menno D de Jong
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, the Netherlands
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Santiago de Araújo Pio C, Gagliardi A, Suskin N, Ahmad F, Grace SL. Implementing recommendations for inpatient healthcare provider encouragement of cardiac rehabilitation participation: development and evaluation of an online course. BMC Health Serv Res 2020; 20:768. [PMID: 32819388 PMCID: PMC7439558 DOI: 10.1186/s12913-020-05619-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 08/03/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A policy statement recommending that healthcare providers (HCPs) encourage cardiac patients to enroll in cardiac rehabilitation (CR) was recently endorsed by 23 medical societies. This study describes the development and evaluation of a guideline implementation tool. METHODS A stepwise multiple-method study was conducted. Inpatient cardiac HCPs were recruited between September 2018-May 2019 from two academic hospitals in Toronto, Canada. First, HCPs were observed during discharge discussions with patients to determine needs. Results informed selection and development of the tool by the multidisciplinary planning committee, namely an online course. It was pilot-tested with target users through a think-aloud protocol with subsequent semi-structured interviews, until saturation was achieved. Results informed refinement before launching the course. Finally, to evaluate impact, HCPs were surveyed to test whether knowledge, attitudes, self-efficacy and practice changed from before watching the course, through to post-course and 1 month later. RESULTS Seven nurses (71.4% female) were observed. Five (62.5%) initiated dialogue about CR, which lasted on average 12 s. Patients asked questions, which HCPs could not answer. The planning committee decided to develop an online course to reach inpatient cardiac HCPs, to educate them on how to encourage patients to participate in CR at the bedside. The course was pilot-tested with 5 HCPs (60.0% nurse-practitioners). Revisions included providing evidence of CR benefits and clarification regarding pre-CR stress test screening. HCPs did not remember the key points to convey, so a downloadable handout was embedded for the point-of-care. The course was launched, with the surveys. Twenty-four HCPs (83.3% nurses) completed the pre-course survey, 21 (87.5%) post, and 9 (37.5%) 1 month later. CR knowledge increased from pre (mean = 2.71 ± 0.95/5) to post-course (mean = 4.10 ± 0.62; p ≤ .001), as did self-efficacy in answering patient CR questions (mean = 2.29 ± 0.95/5 pre and 3.67 ± 0.58 post; p ≤ 0.001). CR attitudes were significantly more positive post-course (mean = 4.13 ± 0.95/5 pre and 4.62 ± 0.59 post; p ≤ 0.05). With regard to practice, 8 (33.3%) HCPs reported providing patients CR handouts pre-course at least sometimes or more, and 6 (66.7%) 1 month later. CONCLUSIONS Preliminary results support broader dissemination, and hence a genericized version has been created ( http://learnonthego.ca/Courses/promoting_patient_participation_in_CR_2020/promoting_patient_participation_in_CR_2020EN/story_html5.html ). Continuing education credits have been secured.
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Affiliation(s)
| | - Anna Gagliardi
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Neville Suskin
- Western University, London, ON, Canada
- St. Joseph's Health Care London, London, ON, Canada
| | | | - Sherry L Grace
- York University, Toronto, ON, Canada.
- University Health Network, University of Toronto, Toronto, ON, Canada.
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Goo B, Seo BK. Strategies to revise the Korean Medicine Clinical Practice Guideline for lumbar herniated intervertebral disc—A web based approach. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Baashar Y, Alhussian H, Patel A, Alkawsi G, Alzahrani AI, Alfarraj O, Hayder G. Customer relationship management systems (CRMS) in the healthcare environment: A systematic literature review. COMPUTER STANDARDS & INTERFACES 2020; 71:103442. [PMID: 34170994 PMCID: PMC7194637 DOI: 10.1016/j.csi.2020.103442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 05/15/2023]
Abstract
Customer relationship management (CRM) is an innovative technology that seeks to improve customer satisfaction, loyalty, and profitability by acquiring, developing, and maintaining effective customer relationships and interactions with stakeholders. Numerous researches on CRM have made significant progress in several areas such as telecommunications, banking, and manufacturing, but research specific to the healthcare environment is very limited. This systematic review aims to categorise, summarise, synthesise, and appraise the research on CRM in the healthcare environment, considering the absence of coherent and comprehensive scholarship of disparate data on CRM. Various databases were used to conduct a comprehensive search of studies that examine CRM in the healthcare environment (including hospitals, clinics, medical centres, and nursing homes). Analysis and evaluation of 19 carefully selected studies revealed three main research categories: (i) social CRM 'eCRM'; (ii) implementing CRMS; and (iii) adopting CRMS; with positive outcomes for CRM both in terms of patients relationship/communication with hospital, satisfaction, medical treatment/outcomes and empowerment and hospitals medical operation, productivity, cost, performance, efficiency and service quality. This is the first systematic review to comprehensively synthesise and summarise empirical evidence from disparate CRM research data (quantitative, qualitative, and mixed) in the healthcare environment. Our results revealed that substantial gaps exist in the knowledge of using CRM in the healthcare environment. Future research should focus on exploring: (i) other potential factors, such as patient characteristics, culture (of both the patient and hospital), knowledge management, trust, security, and privacy for implementing and adopting CRMS and (ii) other CRM categories, such as mobile CRM (mCRM) and data mining CRM.
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Affiliation(s)
- Yahia Baashar
- College of Graduate Studies, Universiti Tenaga Nasional (UNITEN), Kajang 43000, Malaysia
- Corresponding author.
| | - Hitham Alhussian
- Center for Research in Data Science (CERDAS), Institute of Autonomous Systems, Universiti Teknologi PETRONAS, Bandar Seri Iskandar 32610, Malaysia
| | - Ahmed Patel
- Computer Networks and Security Laboratory, State University of Ceara, Fortaleza 60020-181, Brazil
| | - Gamal Alkawsi
- College of Graduate Studies, Universiti Tenaga Nasional (UNITEN), Kajang 43000, Malaysia
| | | | - Osama Alfarraj
- Computer Science Department, King Saud University, Riyadh 11451, Saudi Arabia
| | - Gasim Hayder
- College of Graduate Studies, Universiti Tenaga Nasional (UNITEN), Kajang 43000, Malaysia
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Pedersen MS, Landheim A, Møller M, Lien L. First-line managers' experience of the use of audit and feedback cycle in specialist mental health care: A qualitative case study. Arch Psychiatr Nurs 2019; 33:103-109. [PMID: 31753214 DOI: 10.1016/j.apnu.2019.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 10/18/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Audit and feedback was the main strategy to facilitate implementation of The National Guideline for Persons with Concurrent Substance Use Disorders and Mental Disorders in specialist mental health services. Studies have shown that leadership support contributes to implementation success. The aim of the study was to explore how first-line managers in a District Psychiatric Centre experienced using audit and feedback cycle. METHOD The study had a qualitative case study design with individual interviews with five first-line managers from a District Psychiatric Centre in Norway. Qualitative content analysis was conducted. RESULTS First-line managers were positive to contribute to better practice for the patient group and apply available tools. Four themes emerged: 1) Lack of endurance, where first-line managers saw their role as being process leaders, but failed to persist, 2) Lack of support in the process, where first-line managers called for a stronger organisational focus 3) Lack of ownership, where first-line managers felt the process was imposed on them, and 4) Lack of leader autonomy, where first-line managers seemed insecure about their role between professional leadership and own management. CONCLUSION First-line managers were not sufficiently experienced or equipped to solve the implementation process satisfactorily. They were torn between different commitments, without the autonomy to act as process drivers or facilitators, and without taking the necessary leadership role. The potential impact of the use of audit and feedback may thus not be fully realized, in part, because of limited organisational support and capacity to respond effectively.
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Affiliation(s)
- Monica Stolt Pedersen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Norway; Faculty of Medicine, University of Oslo, Norway.
| | - Anne Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Norway
| | - Merete Møller
- Division of Mental Health, Østfold Hospital Trust, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Norway
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Curley JM, Penix EA, Srinivasan J, Sarmiento DM, McFarling LH, Newman JB, Wheeler LA. Development of the U.S. Army’s Suicide Prevention Leadership Tool: The Behavioral Health Readiness and Suicide Risk Reduction Review (R4). Mil Med 2019; 185:e668-e677. [DOI: 10.1093/milmed/usz380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Although numerous efforts have aimed to reduce suicides in the U.S. Army, completion rates have remained elevated. Army leaders play an important role in supporting soldiers at risk of suicide, but existing suicide-prevention tools tailored to leaders are limited and not empirically validated. The purpose of this article is to describe the process used to develop the Behavioral Health Readiness and Suicide Risk Reduction Review (R4) tools for Army leaders that are currently undergoing empirical validation with two U.S. Army divisions.
Materials and Methods
Consistent with a Secretary of the Army directive, approximately 76 interviews and focus groups were conducted with Army leaders and subject matter experts (SMEs) to obtain feedback regarding existing practices for suicide risk management, leader tools, and institutional considerations. In addition, reviews of the empirical literature regarding predictors of suicide and best practices for the development of practice guidelines were conducted. Qualitative feedback, empirical predictors of suicide, and design considerations were integrated to develop the R4 tools. A second series of 11 interviews and focus groups with Army leaders and SMEs was also conducted to validate the design and obtain feedback regarding the R4 tools.
Results
Leaders described preferences for tool processes (eg, incorporating engaged leadership, including multiple risk identification methods), formatting (eg, one page), organization (eg, low-intermediate-high risk scoring system), content (eg, excluding other considerations related to vehicle safety, including readiness implications), and implementation (eg, accounting for leadership judgment, tailoring process to specific leadership echelons, consideration of institutional barriers). Evidence-based predictors of suicide risk and practice guideline considerations (eg, design) were integrated with leadership feedback to develop the R4 tools that were tailored to specific leadership echelons. Leaders provided positive feedback regarding the R4 tools and described the importance of accounting for potential institutional barriers to implementation. This feedback was addressed by including recommendations regarding the implementation of standardized support meetings between different echelons of leadership.
Conclusions
The R4 development process entailed the simultaneous integration of leadership feedback with evidence-based predictors of suicide risk and design considerations. Thus, the development of these tools builds upon previous Army leadership tools by specifically tailoring elements of those tools to accommodate leader preferences, accounting for potential implementation barriers (eg, institutional factors), and empirically evaluating the implementation of those tools. Future studies should consider utilizing a similar process to develop empirically based resources that are more likely to be incorporated into the routine practice of leaders supporting soldiers at risk of suicide, very often located at the company level and below.
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Affiliation(s)
- Justin M Curley
- Department of Military Psychiatry, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910, United States
| | - Elizabeth A Penix
- Department of Military Psychiatry, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910, United States
| | | | - Dennis M Sarmiento
- Headquarters, Department of the Army, Office of the Surgeon General-Army, 7700 Arlington Blvd, Falls Church, VA 22042, United States
| | - Leslie H McFarling
- Headquarters, Department of the Army, G-1, 2530 Crystal Drive, Arlington, VA 22202, United States
| | - Jenna B Newman
- Headquarters, Department of the Army, G-1, 2530 Crystal Drive, Arlington, VA 22202, United States
| | - Laura A Wheeler
- Headquarters, Department of the Army, Office of the Deputy Under Secretary of the Army, 2530 Crystal Drive, Arlington, VA 22202, United States
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Miguel RTD, Silvestre MAA, Imperial MLS, Ho BLC, Dans LF. Appraisal of the methodological quality of clinical practice guidelines in the Philippines. Int J Health Plann Manage 2019; 34:e1723-e1735. [PMID: 31433544 DOI: 10.1002/hpm.2886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The Republic of the Philippines has recently enacted the Universal Health Care Law, which mandates the Philippines Department of Health (DOH) to operationalize evidence-based clinical practice guideline (CPG) development. As a baseline to the foregoing task, the aim of this study was to appraise the methodological quality of CPGs previously developed and currently being disseminated in the Philippines. A multimethod search for CPGs was implemented. CPGs were independently evaluated using a modified version of the Knowledge Management Plus CPG appraisal tool. FINDINGS Eighty-seven CPGs were included in the appraisal. Majority implemented processes to ensure validity, ie, consideration for patient groups, management options, benefits, and harms (99%), and indicated strength of their recommendations (89%). Seventy-seven CPGs (89%) evaluated the evidence for local applicability. Of the 87 CPGs, 20 CPGs (23%) considered equity in the development process. The development process differed among CPGs with varying degrees of utilization of GRADE methodology (52%), disclosure of funding sources (72%), and engagement of technical support external to the development body (3%). Mean duration of CPG development was 1 year (SD 5.9 months), and mean interval between updates was 6 years and 1 month (SD 37.8 months). CONCLUSION Although most of the CPGs fulfilled essential criteria for quality recommendations (validity and applicability), equity considerations were limited. Furthermore, only half used the GRADE approach and development and dissemination practices differed substantially between CPGs. Thus, it is recommended that a standard CPG development process be made available by the DOH to be utilized by CPG developers in the Philippines.
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Affiliation(s)
| | - Maria Asuncion A Silvestre
- Asia-Pacific Center for Evidence-Based Healthcare, Manila, Philippines.,Kalusugan ng Mag-Ina (Health of Mother and Child), Inc., Quezon City, Philippines
| | - Ma Lourdes S Imperial
- Kalusugan ng Mag-Ina (Health of Mother and Child), Inc., Quezon City, Philippines.,Dr. Jose Fabella Memorial Hospital, Manila, Philippines
| | - Beverly Lorraine C Ho
- Health Policy Development and Planning Bureau, Department of Health, Manila, Philippines
| | - Leonila F Dans
- Asia-Pacific Center for Evidence-Based Healthcare, Manila, Philippines.,College of Medicine, University of the Philippines, Manila, Philippines
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Deprescribing recommendations: An essential consideration for clinical guideline developers. Res Social Adm Pharm 2019; 15:806-810. [DOI: 10.1016/j.sapharm.2018.08.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 11/23/2022]
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Plishka CT, Rotter T, Penz ED, Hansia MR, Fraser SKA, Marciniuk DD. Effects of Clinical Pathways for COPD on Patient, Professional, and Systems Outcomes: A Systematic Review. Chest 2019; 156:864-877. [PMID: 31150639 DOI: 10.1016/j.chest.2019.04.131] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 04/18/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND COPD has a substantial burden seen in both patient quality of life and health-care costs. One method of minimizing this burden is the implementation of clinical pathways (CPWs). CPWs bring the best available evidence to a range of health-care professionals by adapting guidelines to a local context and detailing essential steps in care. METHODS A systematic review was conducted to address the following question: What are the effects of CPWs for COPD on patient-, professional-, and systems-level outcomes? The review used methods outlined by the Cochrane Collaboration. We included all studies that met our operational definition for CPWs and focused on COPD. All studies were evaluated for risk of bias, and all data regarding patient, professional, and systems outcomes were extracted. RESULTS The search strategy identified 497 potentially relevant titles. Of these, 13 studies were included in the review. These studies reported a total of 398 outcomes, with sufficient data for meta-analysis of five outcomes: complications, length of stay, mortality, readmissions, and quality of life. Results showed statistically significant reductions in complications, readmissions, and length of stay but did not show changes in mortality or quality of life. CONCLUSIONS This systematic review reveals evidence to suggest that CPWs for COPD have the potential to reduce complications, readmissions, and length of stay without negatively influencing mortality or quality of life. However, quality of evidence was generally low. The authors therefore acknowledge that results should be interpreted with caution and note the need for additional research in this area.
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Affiliation(s)
- Christopher T Plishka
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Thomas Rotter
- Health Quality Programs, School of Nursing, Queen's University, Kingston, ON, Canada
| | - Erika D Penz
- Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine, Respiratory Research Center, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Shana-Kay A Fraser
- British Virgin Islands Health Services Authority, Road Town, Tortola, British Virgin Islands
| | - Darcy D Marciniuk
- Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine, Respiratory Research Center, University of Saskatchewan, Saskatoon, SK, Canada
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Maric J, Childs J, Esterman A. Barriers and facilitators to the implementation of clinical practice guidelines in sonography. SONOGRAPHY 2019. [DOI: 10.1002/sono.12179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Jovana Maric
- School of Health SciencesUniversity of South Australia Adelaide South Australia Australia
| | - Jessie Childs
- SANSOM Research InstituteUniversity of South Australia Adelaide South Australia Australia
| | - Adrian Esterman
- UniSA Cancer Research InstituteUniversity of South Australia Adelaide South Australia Australia
- Australian Institute of Tropical Health and MedicineJames Cook University Townsville Queensland Australia
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Vähäniemi A, Välimäki M, Pekurinen V, Anttila M, Lantta T. Quality and utilization of the Finnish clinical practice guideline in schizophrenia: evaluation using AGREE II and the vignette approach. Neuropsychiatr Dis Treat 2019; 15:1239-1248. [PMID: 31190830 PMCID: PMC6512783 DOI: 10.2147/ndt.s192752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE This study aims to evaluate the quality of the Finnish clinical practice guideline related to schizophrenia care and how it can be utilized in psychiatric services. PARTICIPANTS AND METHODS The data were collected from one psychiatric ward and seven psychiatric outpatient units situated in two cities in Southern Finland. A total of 49 professionals working in these sites participated in this study. A descriptive study design was adopted. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument with six domains including 23 items was used to assess the quality of the guideline, whereas a vignette was implemented to describe how staff would use the guideline in hypothetical cases in daily practice. The analysis of AGREE II was based on rating each of the 23 items on a seven-point scale and calculating a quality score for the six domains. To describe the utilization of the guideline, eight key recommendations of the guideline were deductively rated out of the respondents' answers. RESULTS The results showed that the "scope and purpose" of the guideline were well described, but "applicability" was insufficient. The overall quality of the guideline was high (73%). Almost one fifth of the respondents were in agreement with key recommendations. CONCLUSION The overall quality of Guideline for Schizophrenia was good, but its "applicability" and utilization should be improved.
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Affiliation(s)
- Anu Vähäniemi
- Department of Nursing Science, University of Turku, Turku, Finland, .,Mental Health and Substance Abuse Services, City of Tampere, Tampere, Finland,
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland, .,Turku University Hospital, Turku, Finland.,School of Nursing, Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Virve Pekurinen
- Department of Nursing Science, University of Turku, Turku, Finland,
| | - Minna Anttila
- Department of Nursing Science, University of Turku, Turku, Finland,
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland,
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Kredo T, Cooper S, Abrams A, Muller J, Volmink J, Atkins S. Using the behavior change wheel to identify barriers to and potential solutions for primary care clinical guideline use in four provinces in South Africa. BMC Health Serv Res 2018; 18:965. [PMID: 30547793 PMCID: PMC6295099 DOI: 10.1186/s12913-018-3778-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/28/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Clinical practice guidelines risk having little impact on healthcare if not effectively implemented. Theory informed, targeted implementation may maximise their impact. Our study explored barriers to and facilitators of guideline implementation and use by South African primary care nurses and allied healthcare workers in four provinces in South Africa. We also proposed interventions to address the issues identified. METHODS We used qualitative research methods, comprising focus group discussions using semi-structured topic guides. Seven focus group discussions were conducted (48 providers) in four South African provinces (Eastern Cape, Western Cape, Kwazulu-Natal, Limpopo). Participants included mostly nurses, dieticians, dentists, and allied health practitioners, from primary care facilities in rural and peri-urban settings. The analysis proceeded in three phases. Firstly, two analysts conducted inductive thematic content analysis to develop themes of data. This was followed by fitting emergent themes to the Theoretical Domains Framework and finally to the associated Behaviour Change Wheel to identify relevant interventions. RESULTS Participants are knowledgeable about guidelines, generally trust their credibility and are receptive and motivated to use them. Guidelines are seen by nurses to provide confidence and reassurance, as well as professional authority and independence where doctors are scarce. Barriers to guideline use include: inadequate systems for printed book distribution, insufficient and substandard photocopies, linguistic inappropriateness (e.g. complicated language, lack of summaries, unavailable in local languages), unsupportive auditing procedures, limited involvement of end-users in guideline development, and patchy training that may not filter back to all providers. Future aspirations identified include: improving the design features of guidelines, accessible places to find guidelines, making digitally-formatted versions available, more supplementary materials (e.g. posters) to support patient engagement, accessible clinical support following training, and in-facility training for all professional cadres to ensure fair access, similar levels of capability and interdisciplinary consistency. CONCLUSIONS South African primary care nurses and allied health practitioners have high levels of motivation to use guidelines, but face many systemic barriers. We used the Behaviour Change Wheel to suggest relevant, implementable interventions addressing identified barriers. This theory-informed approach may improve clinical guideline implementation and impact healthcare for South Africa.
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Affiliation(s)
- Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa. .,Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Division of Social & Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Amber Abrams
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Jocelyn Muller
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Jimmy Volmink
- Dean's office and Centre for Evidence Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Salla Atkins
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 17177, Stockholm, Sweden.,New Social Research and Faculty of Social Sciences, University of Tampere, PO Box 100, Tampere, Finland
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Heydari F, Golestani N, Esmailian M. Effect of Implementation of Standard Clinical Practice Guideline on Management of Gastrointestinal Bleeding Patients in Emergency Department; a Cross-Sectional Study. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2018; 2:e42. [PMID: 31172105 PMCID: PMC6548148 DOI: 10.22114/ajem.v0i0.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A clinical practice guideline (CPG) is developed with the aim of improving the quality of health care and reducing unnecessary interventions, hospitalization time, and related costs. OBJECTIVE This study attempted to design a standard protocol for gastrointestinal bleeding (GIB) patients. METHODS This was a cross-sectional study conducted during 2013 and 2014 in an educational medical center in Isfahan, Iran. A checklist containing questions about waiting time for the services, hospitalization time, and costs was completed for the GIB patients. After this primary data gathering, a CPG was designed, codified, underwent several revisions, and finally implemented. Thereafter, the checklist was completed by GIB patients and compared with the previous ones. RESULTS Fifty patients in each of the two phases were included. The mean age and sex of the studied patients were not different.The time from emergency departments (ED) arrival until the first visit (14 ± 9.8 Vs. 19.4 ± 13.4 minutes; p = 0.03), hospitalization (73.7 ± 49.2 Vs. 116.2 ± 7.2 hours; p=0.003) and costs (1.3 ± 0.81 Vs. 3.68 ± 3.51 million rials; p < 0.001) were significantly reduced following the CPG implementation. The time from admission until conducting endoscopy was not different in the two study periods (16.5 ± 7.8 Vs. 23.9 ± 24.5 hours, p = 0.89). CONCLUSION The implementation of the CPG for the management of GIB patients in the ED resulted in a reduction in the waiting time for the services and, further, reduction of hospitalization time and related costs.
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Affiliation(s)
- Farhad Heydari
- Emergency Medicine Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasim Golestani
- Department of Emergency Medicine, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrdad Esmailian
- Emergency Medicine Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Kredo T, Cooper S, Abrams A, Daniels K, Volmink J, Atkins S. National stakeholders' perceptions of the processes that inform the development of national clinical practice guidelines for primary healthcare in South Africa. Health Res Policy Syst 2018; 16:68. [PMID: 30064440 PMCID: PMC6069850 DOI: 10.1186/s12961-018-0348-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/13/2018] [Indexed: 01/07/2023] Open
Abstract
Background There is increased international focus on improving the rigour of clinical practice guideline (CPG) development practices. However, few empirical studies on CPG development have been conducted in low- and middle-income countries. This paper explores national stakeholders’ perceptions of processes informing CPG development for primary healthcare in South Africa, focusing on both their aspirations and views of what is actually occurring. Methods A qualitative study design was employed including individual interviews with 37 South African primary care CPG development role-players. Participants represented various disciplines, sectors and provinces. The data were analysed through thematic analysis and an interpretivist conceptual framework. Results Strongly reflecting current international standards, participants identified six ‘aspirational’ processes that they thought should inform South African CPG development, as follows: (1) evidence; (2) stakeholder consultation; (3) transparency; (4) management of interests; (5) communication/co-ordination between CPG development groups; and (6) fit-for-context. While perceptions of a transition towards more robust processes was common, CPG development was seen to face ongoing challenges with regards to all six aspirational processes. Many challenges were attributed to inadequate financial and human resources, which were perceived to hinder capacity to undertake the necessary methodological work, respond to stakeholders’ feedback, and document and share decision-making processes. Challenges were also linked to a complex web of politics, power and interests. The CPG development arena was described as saturated with personal and financial interests, groups competing for authority over specific territories and unequal power dynamics which favour those with the time, resources and authority to make contributions. These were all perceived to affect efforts for transparency, collaboration and inclusivity in CPG development. Conclusion While there is strong commitment amongst national stakeholders to advance CPG development processes, a mix of values, politics, power and capacity constraints pose significant challenges. Contrasting perspectives regarding managing interests and how best to adapt to within-country contexts requires further exploration. Dedicated resources for CPG development, standardised systems for managing conflicting interests, and the development of a political environment that fosters collaboration and more equitable inclusion within and between CPG development groups are needed. These initiatives may enhance CPG quality and acceptability, with associated positive impact on patient care.
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Affiliation(s)
- Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Amber Abrams
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Karen Daniels
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.,Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jimmy Volmink
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Deans Office, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Salla Atkins
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,New Social Research and Faculty of Social Sciences, University of Tampere, Tampere, Finland
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[Barriers and facilitators for the development of sex/gender sensitive clinical practice guidelines: A qualitative interview study]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2018; 135-136:65-71. [PMID: 30049655 DOI: 10.1016/j.zefq.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/13/2018] [Accepted: 05/16/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Sex and gender health research evaluates biological and psychosocial differences between women and men which can influence the development, progress and experience of diseases. However, despite the increasing body of evidence about relevant differences between women and men regarding healthcare, the prevention, management and treatment of many common diseases do not yet reflect the knowledge of sex/gender characteristics. Furthermore, in the development of clinical practice guidelines, which are a valuable tool for knowledge transfer between scientific evidence and healthcare, sex/gender factors are only rarely explicitly and systematically considered. The goal of the current study therefore is to identify barriers and facilitators for the consideration and integration of sex/gender differences into guidelines, to create a basis for potential solutions and tools to increase the development of sex/gender sensitive guidelines in the future. METHODS Barriers and facilitators for the development of sex/gender sensitive guidelines were identified by conducting semi-structured interviews with twelve experts in national and international guideline development (guideline authors and coordinators), as well as gender experts (female: n=8). The selection of experts followed a purposeful sampling strategy and the interview data was analyzed using the qualitative content analysis according to Mayring. RESULTS The views on barriers and facilitators were allocated to and summarized in five categories with ten subcategories. The identified barriers mainly addressed the increasing complexity of guidelines, the lack of availability and quality of sex/gender sensitive evidence, and the shortage of resources. In addition, barriers were identified in an individual/professional context, such as deficiencies in awareness/knowledge about relevant sex/gender differences. The results of facilitating factors showed that experts see political policies and standards from guideline organizations as support for the consideration of sex/gender factors in guideline development. CONCLUSION The perspective of experts illustrates that besides organizational and political inventions, individual and social factors should also be addressed in order to achieve behavioral change.
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van Hoeve JC, Vernooij RWM, Lawal AK, Fiander M, Nieboer P, Siesling S, Rotter T. Effects of oncological care pathways in primary and secondary care on patient, professional, and health systems outcomes: protocol for a systematic review and meta-analysis. Syst Rev 2018; 7:49. [PMID: 29580293 PMCID: PMC5870525 DOI: 10.1186/s13643-018-0693-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/25/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The high impact of a cancer diagnosis on patients and their families and the increasing costs of cancer treatment call for optimal and efficient oncological care. To improve the quality of care and to minimize healthcare costs and its economic burden, many healthcare organizations introduce care pathways to improve efficiency across the continuum of cancer care. However, there is limited research on the effects of cancer care pathways in different settings. METHODS The aim of this systematic review and meta-analysis described in this protocol is to synthesize existing literature on the effects of oncological care pathways. We will conduct a systematic search strategy to identify all relevant literature in several biomedical databases, including Cochrane library, MEDLINE, Embase, and CINAHL. We will follow the methodology of Cochrane Effective Practice and Organisation of Care (EPOC), and we will include randomized trials, non-randomized trials, controlled before-after studies, and interrupted time series studies. In addition, we will include full economic evaluations (cost-effectiveness analyses, cost-utility analyses, and cost-benefit analyses), cost analyses, and comparative resource utilization studies, if available. Two reviewers will independently screen all studies and evaluate those included for risk of bias. From these studies, we will extract data regarding patient, professional, and health systems outcomes. Our systematic review will follow the PRISMA set of items for reporting in systematic reviews and meta-analyses. DISCUSSION Following the protocol outlined in this article, we aim to identify, assess, and synthesize all available evidence in order to provide an evidence base on the effects of oncological care pathways as reported in the literature. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017057592 .
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Affiliation(s)
- Jolanda C. van Hoeve
- Department Health Technology and Services Research (HTSR), University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands
- Netherlands Comprehensive Cancer Organisation (IKNL), P.O. Box 19079, 3501 DB Utrecht, the Netherlands
| | - Robin W. M. Vernooij
- Netherlands Comprehensive Cancer Organisation (IKNL), P.O. Box 19079, 3501 DB Utrecht, the Netherlands
| | - Adegboyega K. Lawal
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Michelle Fiander
- College of Pharmacy, Department of Pharmacology, University of Utah, Salt Lake City, USA
| | | | - Sabine Siesling
- Department Health Technology and Services Research (HTSR), University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands
- Netherlands Comprehensive Cancer Organisation (IKNL), P.O. Box 19079, 3501 DB Utrecht, the Netherlands
| | - Thomas Rotter
- Healthcare Quality Programs, School of Nursing, Queen’s University, Kingston, Ontario Canada
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Pedersen MS, Landheim A, Møller M, Lien L. Acting on audit & feedback: a qualitative instrumental case study in mental health services in Norway. BMC Health Serv Res 2018; 18:71. [PMID: 29386020 PMCID: PMC5793343 DOI: 10.1186/s12913-018-2862-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 01/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The National Guideline for Assessment, Treatment and Social Rehabilitation of Persons with Concurrent Substance Use and Mental Health Disorders, launched in 2012, is to be implemented in mental health services in Norway. Audit and feedback (A&F) is commonly used as the starting point of an implementation process. It aims to measure the research-practice gap, but its effect varies greatly. Less is known of how audit and feedback is used in natural settings. The aim of this study was to describe and investigate what is discussed and thematised when Quality Improvement (QI) teams in a District Psychiatric Centre (DPC) work to complete an action form as part of an A&F cycle in 2014. METHODS This was an instrumental multiple case study involving four units in a DPC in Norway. We used open non-participant observation of QI team meetings in their natural setting, a total of seven teams and eleven meetings. RESULTS The discussions provided health professionals with insight into their own and their colleagues' practices. They revealed insufficient knowledge of substance-related disorders and experienced unclear role expectations. We found differences in how professional groups sought answers to questions of clinical practice and that they were concerned about whether new tasks fitted in with their routine ways of working. CONCLUSION Acting on A&F provided an opportunity to discuss practice in general, enhancing awareness of good practice. There was a general need for arenas to relate to practice and QI team meetings after A&F may well be a suitable arena for this. Self-assessment audits seem valuable, particular in areas where no benchmarked data exists, and there is a demand for implementation of new guidelines that might change routines and develop new roles. QI teams could benefit from having a unit leader present at meetings. Nurses and social educators and others turn to psychiatrists or psychologists for answers to clinical and organisational questions beyond guidelines, and show less confidence or routine in seeking research-based information. There is a general need to emphasise training in evidence-based practice and information seeking behaviour for all professional groups.
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Affiliation(s)
- Monica Stolt Pedersen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B. 104, 2340, Brumunddal, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Anne Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B. 104, 2340, Brumunddal, Norway.,Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | | | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B. 104, 2340, Brumunddal, Norway.,Inland Norway University of Applied Sciences, Campus Elverum, Elverum, Norway
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Lei X, Liu F, Luo S, Sun Y, Zhu L, Su F, Chen K, Li S. Evaluation of guidelines regarding surgical treatment of breast cancer using the AGREE Instrument: a systematic review. BMJ Open 2017; 7:e014883. [PMID: 29138191 PMCID: PMC5695453 DOI: 10.1136/bmjopen-2016-014883] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Many clinical practice guidelines and consensus statements (CPGs/consensus statements) have been developed for the surgical treatments for breast cancer. This study aims to evaluate the quality of these CPGs/consensus statements. METHODS We systematically searched the PubMed and EMBASE databases, as well as four guideline repositories, to identify CPGs and consensus statements regarding surgical treatments for breast cancer between January 2009 and December 2016. We used the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument to assess the quality of the CPGs and consensus statements included. The overall assessment scores from the AGREE instrument and radar maps were used to evaluate the overall quality. We also evaluated some factors that may affect the quality of CPGs and consensus statements using the Mann-Whitney U test or Kruskal-Wallis H test. All analyses were performed using SPSS V.19.0. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS A total of 19 CPGs and four consensus statements were included. In general, the included CPGs/consensus statements (n=23) performed well in the 'Scope and Purpose' and 'Clarity and Presentation' domains, but performed poorly in the 'Applicability' domain. The American Society of Clinical Oncology (ASCO), National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), New Zealand Guidelines Group (NZGG) and Belgium Health Care Knowledge Centre (KCE) guidelines had the highest overall quality, whereas the Saskatchewan Cancer Agency, Spanish Society of Medical Oncology (SEOM), Japanese Breast Cancer Society (JBCS) guidelines and the D.A.C.H and European School of Oncology (ESO) consensus statements had the lowest overall quality. The updating frequency of CPGs/consensus statements varied, with the quality of consensus statements generally lower than that of CPGs. A total of six, eight and five CPGs were developed in the North American, European and Asian/Pacific regions, respectively. However, geographic region was not associated with overall quality. CONCLUSIONS The ASCO, NICE, SIGN, NZGG and KCE guidelines had the best overall quality, and the quality of consensus statements was generally lower than that of CPGs. More efforts are needed to identify barriers and facilitators for CPGs/consensus statement implementation and to improve their applicability.
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Affiliation(s)
- Xin Lei
- Breast Tumour Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Thyroid and Breast SurgeryDepartment, The First AffliatedHospital, Guangzhou, Guangdong, China
| | - Fengtao Liu
- Breast Tumour Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shuying Luo
- Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Pharmacy, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ya Sun
- Breast Tumour Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Liling Zhu
- Breast Tumour Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Fengxi Su
- Breast Tumour Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kai Chen
- Breast Tumour Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shunrong Li
- Breast Tumour Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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Abstract
Introduction Over 25 years, emergency medicine in the United States has amassed a large evidence base that has been systematically assessed and interpreted through ACEP Clinical Policies. While not previously studied in emergency medicine, prior work has shown that nearly half of all recommendations in medical specialty practice guidelines may be based on limited or inconclusive evidence. We sought to describe the proportion of clinical practice guideline recommendations in Emergency Medicine that are based upon expert opinion and low level evidence. Methods Systematic review of clinical practice guidelines (Clinical Policies) published by the American College of Emergency Physicians from January 1990 to January 2016. Standardized data were abstracted from each Clinical Policy including the number and level of recommendations as well as the reported class of evidence. Primary outcomes were the proportion of Level C equivalent recommendations and Class III equivalent evidence. The primary analysis was limited to current Clinical Policies, while secondary analysis included all Clinical Policies. Results A total of 54 Clinical Policies including 421 recommendations and 2801 cited references, with an average of 7.8 recommendations and 52 references per guideline were included. Of 19 current Clinical Policies, 13 of 141 (9.2%) recommendations were Level A, 57 (40.4%) Level B, and 71 (50.4%) Level C. Of 845 references in current Clinical Policies, 67 (7.9%) were Class I, 272 (32.3%) Class II, and 506 (59.9%) Class III equivalent. Among all Clinical Policies, 200 (47.5%) recommendations were Level C equivalent, and 1371 (48.9%) of references were Class III equivalent. Conclusions Emergency medicine clinical practice guidelines are largely based on lower classes of evidence and a majority of recommendations are expert opinion based. Emergency medicine appears to suffer from an evidence gap that should be prioritized in the national research agenda and considered by policymakers prior to developing future quality standards.
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Richter Sundberg L, Garvare R, Nyström ME. Reaching beyond the review of research evidence: a qualitative study of decision making during the development of clinical practice guidelines for disease prevention in healthcare. BMC Health Serv Res 2017; 17:344. [PMID: 28490325 PMCID: PMC5426017 DOI: 10.1186/s12913-017-2277-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 04/27/2017] [Indexed: 11/23/2022] Open
Abstract
Background The judgment and decision making process during guideline development is central for producing high-quality clinical practice guidelines, but the topic is relatively underexplored in the guideline research literature. We have studied the development process of national guidelines with a disease-prevention scope produced by the National board of Health and Welfare (NBHW) in Sweden. The NBHW formal guideline development model states that guideline recommendations should be based on five decision-criteria: research evidence; curative/preventive effect size, severity of the condition; cost-effectiveness; and ethical considerations. A group of health profession representatives (i.e. a prioritization group) was assigned the task of ranking condition-intervention pairs for guideline recommendations, taking into consideration the multiple decision criteria. The aim of this study was to investigate the decision making process during the two-year development of national guidelines for methods of preventing disease. Methods A qualitative inductive longitudinal case study approach was used to investigate the decision making process. Questionnaires, non-participant observations of nine two-day group meetings, and documents provided data for the analysis. Conventional and summative qualitative content analysis was used to analyse data. Results The guideline development model was modified ad-hoc as the group encountered three main types of dilemmas: high quality evidence vs. low adoptability of recommendation; insufficient evidence vs. high urgency to act; and incoherence in assessment and prioritization within and between four different lifestyle areas. The formal guideline development model guided the decision-criteria used, but three new or revised criteria were added by the group: ‘clinical knowledge and experience’, ‘potential guideline consequences’ and ‘needs of vulnerable groups’. The frequency of the use of various criteria in discussions varied over time. Gender, professional status, and interpersonal skills were perceived to affect individuals’ relative influence on group discussions. Conclusions The study shows that guideline development groups make compromises between rigour and pragmatism. The formal guideline development model incorporated multiple aspects, but offered few details on how the different criteria should be handled. The guideline development model devoted little attention to the role of the decision-model and group-related factors. Guideline development models could benefit from clarifying the role of the group-related factors and non-research evidence, such as clinical experience and ethical considerations, in decision-processes during guideline development.
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Affiliation(s)
- Linda Richter Sundberg
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE 901 87, Umeå, Sweden. .,Department of Clinical Science, Child and Adolescent Psychiatry, Umeå University, SE 901 87, Umeå, Sweden.
| | - Rickard Garvare
- Department of Business Administration, Technology and Social Sciences, Luleå University of Technology, SE 971 87, Luleå, Sweden
| | - Monica Elisabeth Nyström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE 901 87, Umeå, Sweden.,Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden
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Cichero JAY, Lam P, Steele CM, Hanson B, Chen J, Dantas RO, Duivestein J, Kayashita J, Lecko C, Murray J, Pillay M, Riquelme L, Stanschus S. Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework. Dysphagia 2017; 32:293-314. [PMID: 27913916 PMCID: PMC5380696 DOI: 10.1007/s00455-016-9758-y] [Citation(s) in RCA: 480] [Impact Index Per Article: 68.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/08/2016] [Indexed: 12/20/2022]
Abstract
Dysphagia is estimated to affect ~8% of the world's population (~590 million people). Texture-modified foods and thickened drinks are commonly used to reduce the risks of choking and aspiration. The International Dysphagia Diet Standardisation Initiative (IDDSI) was founded with the goal of developing globally standardized terminology and definitions for texture-modified foods and liquids applicable to individuals with dysphagia of all ages, in all care settings, and all cultures. A multi-professional volunteer committee developed a dysphagia diet framework through systematic review and stakeholder consultation. First, a survey of existing national terminologies and current practice was conducted, receiving 2050 responses from 33 countries. Respondents included individuals with dysphagia; their caregivers; organizations supporting individuals with dysphagia; healthcare professionals; food service providers; researchers; and industry. The results revealed common use of 3-4 levels of food texture (54 different names) and ≥3 levels of liquid thickness (27 different names). Substantial support was expressed for international standardization. Next, a systematic review regarding the impact of food texture and liquid consistency on swallowing was completed. A meeting was then convened to review data from previous phases, and develop a draft framework. A further international stakeholder survey sought feedback to guide framework refinement; 3190 responses were received from 57 countries. The IDDSI Framework (released in November, 2015) involves a continuum of 8 levels (0-7) identified by numbers, text labels, color codes, definitions, and measurement methods. The IDDSI Framework is recommended for implementation throughout the world.
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Affiliation(s)
- Julie A Y Cichero
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia.
- School of Pharmacy, Pharmacy Australia Centre of Excellence (PACE), The University of Queensland, 20 Cornwall St, Brisbane, QLD, 4102, Australia.
| | - Peter Lam
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, BC, Canada
- Peter Lam Consulting, Vancouver, BC, Canada
| | - Catriona M Steele
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ben Hanson
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Department of Mechanical Engineering, University College London, London, UK
| | - Jianshe Chen
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Zhejiang Gongshang University, Hangzhou, China
| | - Roberto O Dantas
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Janice Duivestein
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Access Community Therapists, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jun Kayashita
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Department of Health Sciences, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Caroline Lecko
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- National Health Service Improvement, London, UK
| | - Joseph Murray
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Ann Arbor Veterans Affairs, Ann Arbor, MI, USA
| | - Mershen Pillay
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Speech Pathology, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
- Manchester Metropolitan University, Manchester, UK
| | - Luis Riquelme
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Department of Speech-Language Pathology, New York Medical College, Valhalla, NY, USA
- Barrique Speech-Language Pathology at Center for Swallowing & Speech-Language Pathology, New York Methodist Hospital, Brooklyn, NY, USA
| | - Soenke Stanschus
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Swallowing and Speech Pathology, Hospital zum Heiligen Geist, Kempen, Germany
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Kwak L, Wåhlin C, Stigmar K, Jensen I. Developing a practice guideline for the occupational health services by using a community of practice approach: a process evaluation of the development process. BMC Public Health 2017; 17:89. [PMID: 28100201 PMCID: PMC5242042 DOI: 10.1186/s12889-016-4010-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 12/29/2016] [Indexed: 11/28/2022] Open
Abstract
Background One way to facilitate the translation of research into the occupational health service practice is through clinical practice guidelines. To increase the implementability of guidelines it is important to include the end-users in the development, for example by a community of practice approach. This paper describes the development of an occupational health practice guideline aimed at the management of non-specific low back pain (LBP) by using a community of practice approach. The paper also includes a process evaluation of the development providing insight into the feasibility of the process. Methods A multidisciplinary community of practice group (n = 16) consisting of occupational nurses, occupational physicians, ergonomists/physical therapists, health and safety engineers, health educators, psychologists and researchers from different types of occupational health services and geographical regions within Sweden met eleven times (June 2012–December 2013) to develop the practice guideline following recommendations of guideline development handbooks. Process-outcomes recruitment, reach, context, satisfaction, feasibility and fidelity were assessed by questionnaire, observations and administrative data. Results Group members attended on average 7.5 out of 11 meetings. Half experienced support from their workplace for their involvement. Feasibility was rated as good, except for time-scheduling. Most group members were satisfied with the structure of the process (e.g. presentations, multidisciplinary group). Fidelity was rated as fairly high. Conclusions The described development process is a feasible process for guideline development. For future guideline development expectations of the work involved should be more clearly communicated, as well as the purpose and tasks of the CoP-group. Moreover, possibilities to improve support from managers and colleagues should be explored. This paper has important implications for future guideline development; it provides valuable information on how practitioners can be included in the development process, with the aim of increasing the implementability of the developed guidelines.
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Affiliation(s)
- Lydia Kwak
- Unit of Intervention and Implementation Research for worker health, Institute for Environmental Medicine, Karolinska Institutet, Box 210, 171 77, Stockholm, Sweden.
| | - Charlotte Wåhlin
- Unit of Intervention and Implementation Research for worker health, Institute for Environmental Medicine, Karolinska Institutet, Box 210, 171 77, Stockholm, Sweden.,Occupational and Environmental Medicine Center, University Hospital, Region Östergötland, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Kjerstin Stigmar
- Physiotherapy, Department of Health Sciences, Lund University, Lund, Sweden.,Epidemiology and Register Centre South, Skåne University Hospital, Lund, Sweden
| | - Irene Jensen
- Unit of Intervention and Implementation Research for worker health, Institute for Environmental Medicine, Karolinska Institutet, Box 210, 171 77, Stockholm, Sweden
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Pavan S, Rommel K, Mateo Marquina ME, Höhn S, Lanneau V, Rath A. Clinical Practice Guidelines for Rare Diseases: The Orphanet Database. PLoS One 2017; 12:e0170365. [PMID: 28099516 PMCID: PMC5242437 DOI: 10.1371/journal.pone.0170365] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 12/27/2016] [Indexed: 12/31/2022] Open
Abstract
Clinical practice guidelines (CPGs) for rare diseases (RDs) are scarce, may be difficult to identify through Internet searches and may vary in quality depending on the source and methodology used. In order to contribute to the improvement of the diagnosis, treatment and care of patients, Orphanet (www.orpha.net) has set up a procedure for the selection, quality evaluation and dissemination of CPGs, with the aim to provide easy access to relevant, accurate and specific recommendations for the management of RDs. This article provides an analysis of selected CPGs by medical domain coverage, prevalence of diseases, languages and type of producer, and addresses the variability in CPG quality and availability. CPGs are identified via bibliographic databases, websites of research networks, expert centres or medical societies. They are assessed according to quality criteria derived from the Appraisal of Guidelines, REsearch and Evaluation (AGREE II) Instrument. Only open access CPGs and documents for which permission from the copyright holders has been obtained are disseminated on the Orphanet website. From January 2012 to July 2015, 277 CPGs were disseminated, representing coverage of 1,122 groups of diseases, diseases or subtypes in the Orphanet database. No language restriction is applied, and so far 10 languages are represented, with a predominance of CPGs in English, French and German (92% of all CPGs). A large proportion of diseases with identified CPGs belong to rare oncologic, neurologic, hematologic diseases or developmental anomalies. The Orphanet project on CPG collection, evaluation and dissemination is a continuous process, with regular addition of new guidelines, and updates. CPGs meeting the quality criteria are integrated to the Orphanet database of rare diseases, together with other types of textual information and the appropriate services for patients, researchers and healthcare professionals in 40 countries.
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Affiliation(s)
- Sonia Pavan
- Inserm, US14 - Orphanet, Paris, France
- * E-mail:
| | - Kathrin Rommel
- Orphanet Germany, Centre for Rare Diseases, Hannover Medical School, Hannover, Germany
| | | | | | | | - Ana Rath
- Inserm, US14 - Orphanet, Paris, France
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An SY, Seo KS, Kim S, Kim J, Lee DW, Hwang KG, Kim HJ. Developmental procedures for the clinical practice guidelines for conscious sedation in dentistry for the Korean Academy of Dental Sciences. J Dent Anesth Pain Med 2016; 16:253-261. [PMID: 28879313 PMCID: PMC5564190 DOI: 10.17245/jdapm.2016.16.4.253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 12/29/2016] [Accepted: 12/31/2016] [Indexed: 11/15/2022] Open
Abstract
Background Evidence-based clinical practice guidelines (CPGs) are defined as “statements that are scientifically reviewed about evidence and systematically developed to assist in the doctors' and patients' decision making in certain clinical situations.” This recommendation aims to promote good clinical practice for the provision of safe and effective practices of conscious sedation in dentistry. Methods The development of this clinical practice guideline was conducted by performing a systematic search of the literature for evidence-based CPGs. Existing guidelines, relevant systematic reviews, policy documents, legislation, or other recommendations were reviewed and appraised. To supplement this information, key questions were formulated by the Guideline Development Group and used as the basis for designing systematic literature search strategies to identify literature that may address these questions. Guideline documents were evaluated through a review of domestic and international databases for the development of a renewing of existing conscious sedation guidelines for dentistry. Clinical practice guidelines were critically appraised for their methodologies using Appraisal of guidelines for research and evaluation (AGREE) II. Results A total of 12 existing CPGs were included and 13 recommendations were made in a range of general, adult, and pediatric areas. Conclusion The clinical practice guidelines for conscious sedation will be reviewed in 5 years' time for further updates to reflect significant changes in the field.
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Affiliation(s)
- So-Youn An
- Department of Pediatric Dentistry, College of Dentistry, Wonkwang University, Daejeon, Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Seungoh Kim
- Department of Dental Anesthesiology, School of Dentistry, Dankook University, Cheonan, Korea
| | - Jongbin Kim
- Department of Pediatric Dentistry, School of Dentistry, Dankook University, Cheonan, Korea
| | - Deok-Won Lee
- Department of Oral and Maxillofacial surgery, Kyung Hee University Dental Hospital at Gangdong, Kyung Hee University, Seoul, Korea
| | - Kyung-Gyun Hwang
- Department of Dentistry/Oral & Maxillofacial Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyun Jeong Kim
- Department of Dental Anesthesiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
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Escaron AL, Weir RC, Stanton P, Clarke RM. Defining and Rating the Effectiveness of Enabling Services Using a Multi-stakeholder Expert Panel Approach. J Health Care Poor Underserved 2016; 26:554-76. [PMID: 25913350 DOI: 10.1353/hpu.2015.0035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Affordable Care Act provides opportunities to reimburse non-medical enabling services that promote the delivery of medical care for patients with social barriers. However, limited evidence exists to guide delivery of these services. We addressed this gap by convening community health center patients, providers, and other stakeholders in two panels that developed a framework for defining and evaluating these services. We adapted a group consensus method where the panelists rated services for effectiveness in increasing access to, use, and understanding of medical care. Panelists defined six broad categories, 112 services, and 21 variables including the type of provider delivering the service. We identified 16 highest-rated services and found that the service provider's level of training affected effectiveness for some but not all services. In a field with little evidence, these findings provide guidance to decision-makers for the targeted spread of services that enable patients to overcome social barriers to care.
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Semlitsch T, Blank WA, Kopp IB, Siering U, Siebenhofer A. Evaluating Guidelines: A Review of Key Quality Criteria. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016. [PMID: 26214233 DOI: 10.3238/arztebl.2015.0471] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Guidelines of high methodological quality make an essential contribution to the quality assurance of medical knowledge. The detailed evaluation of guideline quality is a complex and time-consuming task. The answers to a few key questions generally suffice for an initial, rapid assessment of the quality and utility of a guideline. METHOD We selectively searched the pertinent literature for guideline-assessing instruments and analyzed selected ones with respect to their target group, purpose, orientation, and comprehensiveness. We identified key questions from brief instruments that can be used to assess guideline quality rapidly. RESULTS A comparison of ten instruments revealed that most were designed to provide a highly detailed assessment of guideline quality. Four recently developed instruments enable a rough and rapid assessment. They focus, in essence, on four key questions: Was the evidence analyzed systematically? Does the evidence support the recommendations? Is the goal of the guideline formulated, and are the authors named? Is the organization of the guideline easy to follow, and are the recommendations clearly signposted? CONCLUSION Alongside the comprehensive instruments for assessing guidelines, such as DELBI and AGREE II, rapid-assessment instruments are a convenient tool for gaining a quick impression of the value of a guideline.
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Affiliation(s)
- Thomas Semlitsch
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria, Institute of General Practice, J.W. Goethe University, Frankfurt/Main, Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF), Institute of Medical Knowledge Management, Marburg, Institute for Quality and Efficiency in Health Care (IQWiG), Köln
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李 江, 苏 凯, 李 放, 唐 威, 黄 遥, 王 乐, 黄 慧, 石 菊, 代 敏. [Systematic Review of the Methodology Quality in Lung Cancer Screening Guidelines]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:692-699. [PMID: 27760601 PMCID: PMC5973420 DOI: 10.3779/j.issn.1009-3419.2016.10.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/12/2016] [Accepted: 06/20/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lung cancer is the most common malignancy and screening can decrease the mortality. High quality screening guideline is necessary and important for effective work. Our study is to review and evaluate the basic characteristics and methodology quality of the current global lung cancer screening guidelines so as to provide useful information for domestic study in the future. METHODS Electronic searches were done in English and Chinese databases including PubMed, the Cochrane Library, Web of Science, Embase, CNKI, CBM, Wanfang, and some cancer official websites. Articles were screened according to the predefined inclusion and exclusion criteria by two researchers. The quality of guidelines was assessed by AGREE II. RESULTS At last, a total of 11 guidelines with methodology were included. The guidelines were issued mainly by USA (81%). Canada and China developed one, respectively. As for quality, the average score in the "Scale and objective" of all guidelines was 80, the average score in the "Participants" was 52, the average score in the "rigorism" was 50, the average score in the "clarity" was 76, the average score in the "application" was 43 and the average score in the "independence" was 59. The highest average score was found in 2013 and 2015. Canada guideline had higher quality in six domains. 7 guidelines were evaluated as A level. CONCLUSIONS The number of clinical guidelines showed an increasing trend. Most guidelines were issued by developed countries with heavy burden. Multi-country contribution to one guideline was another trend. Evidence-based methodology was accepted globally in the guideline development.
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Affiliation(s)
- 江 李
- 100021 北京,国家癌症中心/中国医学科学院北京协和医学院肿瘤医院,城市癌症早诊早治项目办公室Program ofce for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - 凯 苏
- 100021 北京,国家癌症中心/中国医学科学院北京协和医学院肿瘤医院,胸外科Department of Toracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - 放 李
- 100021 北京,国家癌症中心/中国医学科学院北京协和医学院肿瘤医院,胸外科Department of Toracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - 威 唐
- 100021 北京,国家癌症中心/中国医学科学院北京协和医学院肿瘤医院,影像诊断科Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - 遥 黄
- 100021 北京,国家癌症中心/中国医学科学院北京协和医学院肿瘤医院,影像诊断科Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - 乐 王
- 100021 北京,国家癌症中心/中国医学科学院北京协和医学院肿瘤医院,城市癌症早诊早治项目办公室Program ofce for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - 慧瑶 黄
- 100021 北京,国家癌症中心/中国医学科学院北京协和医学院肿瘤医院,城市癌症早诊早治项目办公室Program ofce for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - 菊芳 石
- 100021 北京,国家癌症中心/中国医学科学院北京协和医学院肿瘤医院,城市癌症早诊早治项目办公室Program ofce for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - 敏 代
- 100021 北京,国家癌症中心/中国医学科学院北京协和医学院肿瘤医院,城市癌症早诊早治项目办公室Program ofce for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Prevention of Clostridium difficile Infection: A Systematic Survey of Clinical Practice Guidelines. Infect Control Hosp Epidemiol 2016; 37:901-908. [PMID: 27267201 DOI: 10.1017/ice.2016.104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Clostridium difficile infection (CDI) is the most common cause of hospital-acquired infectious diarrhea. OBJECTIVE To analyze the methodological quality, content, and supporting evidence among clinical practice guidelines (CPGs) on CDI prevention. DESIGN AND SETTING We searched medical databases and gray literature for CPGs on CDI prevention published January 2004-January 2015. Three reviewers independently screened articles and rated CPG quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, composed of 23 items, rated 1-7, within 6 domains. We reported each domain score as a percentage of its maximum possible score and standardized range. We summarized recommendations, extracted their supporting articles, and rated individually the level of evidence using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS Of 2,578 articles screened, 5 guidelines met inclusion criteria. Median AGREE II scores and interquartile ranges were: clarity of presentation, 75.9% (75.9%-79.6%); scope and purpose, 74.1% (68.5%-85.2%); editorial independence, 63.9% (47.2%-66.7%); applicability, 43.1% (19.4%-55.6%); stakeholder involvement, 40.7% (38.9%-44.4%); and rigor of development, 18.1% (17.4%-35.4%). CPGs addressed several common strategies for CDI prevention, including antibiotic stewardship, hypochlorite solutions, probiotic prophylaxis, and bundle strategies. Recommendations were often not consistent with evidence, and most were based on low-level studies. CONCLUSION CPGs did not adhere well to AGREE II reporting standards. Furthermore, there was limited transparency in moving from evidence to recommendations. CDI prevention CPGs need to better adhere to AGREE-II and be transparent in moving from evidence to recommendations, and recommendations need to be consistent with available evidence. Infect Control Hosp Epidemiol 2016;37:901-908.
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Crome E, Baillie AJ. Better Access and equitable access to clinical psychology services: what do we need to know? Med J Aust 2016; 204:341-3. [PMID: 27169963 DOI: 10.5694/mja15.01393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/22/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Erica Crome
- Centre for Emotional Health and NHMRC Centre of Research Excellence in Mental Health and Substance Use, Macquarie University, Sydney, NSW
| | - Andrew J Baillie
- Centre for Emotional Health and NHMRC Centre of Research Excellence in Mental Health and Substance Use, Macquarie University, Sydney, NSW
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