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Wolter A, Chuzaifah Y, Mustafainah A, Nurjanah N, Ramly AA, Widiyanti E, Waskito NB, Asriyanti Y, Fitriana CE, Wahyuni S, Kori R, Mayasari D, Haerani AP, Purba Y, Williams I. Adaptation of the RESPECT framework to prevent violence against women, Indonesia. Bull World Health Organ 2024; 102:730-735. [PMID: 39318896 PMCID: PMC11418856 DOI: 10.2471/blt.24.291479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/20/2024] [Accepted: 07/15/2024] [Indexed: 09/26/2024] Open
Abstract
Problem Violence against women is a global health problem. Effectively preventing such violence requires locally adapted strategies. Approach The World Health Organization in Indonesia, in collaboration with United Nations (UN) Population Fund, UN Women, United Nations Children's Fund, United Nations Development Programme and Joint United Nations Programme on HIV/AIDS, launched capacity-building initiatives to introduce RESPECT as an evidence-based framework to address violence against women. The initiatives included stakeholder engagement, module development, sensitization training, a workshop and evaluation sessions. These sessions introduced RESPECT strategies to government officials, UN officers and community representatives, mapped best practices and developed action plans. Local setting Indonesia has a substantial burden of violence against women, despite numerous laws and policies to combat it. The 2021 Indonesian violence against women survey showed that 26.1% (3341/12 800) of women aged 15-64 years had experienced violence in their lifetime, with 8.7% (1114/12 800) experiencing violence in the past year. Relevant changes The initiatives to introduce RESPECT led to securing government support, and verbal commitment was given by the Director for the Protection of Women's Rights against Domestic Violence and Vulnerability to integrate RESPECT into the 2025-2029 National Development Plan and National Strategy for Reducing Violence Against Women. Lessons learnt RESPECT can be adapted to local contexts through customization and capacity-building and by ensuring initial government support, dedicated personnel, resource allocation and use of established relationships with key stakeholders. Improved research, monitoring and evaluation are vital to promote evidence-informed decision-making, together with community engagement and multistakeholder collaboration. The UN can facilitate these efforts.
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Affiliation(s)
- Alegra Wolter
- World Health Organization, Indonesia, 5th floor, Gama Tower, Jl HR Rasuna Said Kav. C-22, 12940Jakarta, Indonesia
| | - Yuniyanti Chuzaifah
- World Health Organization, Indonesia, 5th floor, Gama Tower, Jl HR Rasuna Said Kav. C-22, 12940Jakarta, Indonesia
| | - Aflina Mustafainah
- World Health Organization, Indonesia, 5th floor, Gama Tower, Jl HR Rasuna Said Kav. C-22, 12940Jakarta, Indonesia
| | - Nunik Nurjanah
- United Nations Entity for Gender Equality and the Empowerment of Women, Jakarta, Indonesia
| | - Ali A Ramly
- United Nations Children’s Fund, Jakarta, Indonesia
| | - Eni Widiyanti
- Ministry of Women Empowerment and Child Protection, Jakarta, Indonesia
| | | | - Yuni Asriyanti
- United Nations Entity for Gender Equality and the Empowerment of Women, Jakarta, Indonesia
| | | | - Sri Wahyuni
- United Nations Population Fund, Jakarta, Indonesia
| | - Risya Kori
- United Nations Population Fund, Jakarta, Indonesia
| | - Dirna Mayasari
- World Health Organization, Indonesia, 5th floor, Gama Tower, Jl HR Rasuna Said Kav. C-22, 12940Jakarta, Indonesia
| | | | - Yasmin Purba
- Joint United Nations Programme on HIV/AIDS, Jakarta, Indonesia
| | - Inga Williams
- World Health Organization, Indonesia, 5th floor, Gama Tower, Jl HR Rasuna Said Kav. C-22, 12940Jakarta, Indonesia
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2
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Kredo T, Durão S, Effa E, Naude C, McCaul M, Brand A, Lewin S, Glenton C, Munabi-Babigumira S, Besnier E, Leong TD, Schmidt BM, Mbeye N, Hohlfeld A, Rohwer A, Hafver TL, Delvaux N, Nkonki L, Bango F, Thompson E, Cooper S. Building sustainable capacity to adopt, adapt or develop child health guidelines, Malawi, Nigeria and South Africa. Bull World Health Organ 2024; 102:749-756. [PMID: 39318893 PMCID: PMC11418851 DOI: 10.2471/blt.24.291564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 08/23/2024] [Accepted: 08/23/2024] [Indexed: 09/26/2024] Open
Abstract
Problem Many national child health guidelines in Malawi, Nigeria and South Africa are outdated and score poorly on rigorous methods and stakeholder participation. Approach In line with the World Health Organization's (WHO) emphasis on local guideline contextualization, the Global Evidence-Local Adaptation (GELA) project supported multistakeholder processes to adapt evidence-informed recommendations for child health in Malawi, Nigeria and South Africa. The GELA project team convened national steering groups, which conducted structured, iterative priority-setting exercises to identify priority topics. We identified appropriate source guidelines by systematically searching and screening available guidelines. We then matched recommendations in potential source guidelines to the relevant questions, and assessed the guidelines for timeliness and quality. Drawing on WHO's guideline process, we applied the GRADE-ADOLOPMENT process to develop contextualized recommendations from existing guidelines. If no source guideline or reviews were identified, we conducted new evidence syntheses. Local setting Malawi, Nigeria and South Africa are countries with varying health priorities and systems, all transitioning to universal health coverage. Guideline structures differ between countries, with processes largely led from national health ministries. Relevant changes National guideline groups, supported by GELA researchers and government-academic partners, developed five contextually-tailored child health recommendations. For most of these recommendations, additional evidence was required to inform contextually appropriate national decision-making. Formal capacity-building and on-the-job learning enhanced the competencies of national contributors and researchers in evidence-informed decision-making. Lessons learnt Developing context-relevant recommendations requires considerable resources and time. Further investment in strengthening local capacity is needed for sustainable national guideline development.
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Affiliation(s)
- Tamara Kredo
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, 7505, South Africa
| | - Solange Durão
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, 7505, South Africa
| | - Emmanuel Effa
- Department of Medicine, Faculty of Clinical Sciences, University of Calabar, Cross River, Nigeria
| | - Celeste Naude
- Centre for Evidence-based Health Care, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Michael McCaul
- Centre for Evidence-based Health Care, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Amanda Brand
- Centre for Evidence-based Health Care, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Simon Lewin
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, 7505, South Africa
| | - Claire Glenton
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Susan Munabi-Babigumira
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Elodie Besnier
- Department of Health Sciences in Ålesund, Norwegian University of Science and Technology, Ålesund, Norway
| | - Trudy D Leong
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, 7505, South Africa
| | - Bey-Marie Schmidt
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, 7505, South Africa
| | - Nyanyiwe Mbeye
- Department of Epidemiology and Biostatistics, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ameer Hohlfeld
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, 7505, South Africa
| | - Anke Rohwer
- Centre for Evidence-based Health Care, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | - Lungiswa Nkonki
- Division of Health System and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Funeka Bango
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, 7505, South Africa
| | | | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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3
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McCarthy M, Giltenane M, Doody O. A seesaw of equilibrium, midwives' experiences of infection prevention and control guideline adherence: A qualitative descriptive study. J Infect Prev 2024; 25:188-197. [PMID: 39318725 PMCID: PMC11418265 DOI: 10.1177/17571774241245259] [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: 04/03/2023] [Accepted: 02/28/2024] [Indexed: 09/26/2024] Open
Abstract
Background Infection prevention and control guidelines play a key role in preventing infections which can impact mothers and their newborn's quality of life. Despite the presence of evidenced-based infection prevention and control guidelines, midwives' adherence can be suboptimal internationally. The identification of facilitators and barriers to infection prevention and control guidelines can support practice and facilitate midwifery care. Aim To understand midwives' experiences of the barriers and facilitators when adhering to infection prevention and control guidelines. Methods A qualitative descriptive study using semi-structured interviews with 10 midwives from February to March 2022. The interviews were audio recorded, transcribed verbatim, and analysed utilising Braun and Clarke's thematic analysis framework involving the six steps of becoming familiar with the data, generating initial codes, generating themes, reviewing themes, defining and naming the themes, and presenting themes. Findings Two themes developed; seesaw for equilibrium and back to basics: learning on your feet. Midwives experienced conflicting emotional motivators in the need for professional integrity towards infection prevention and control guideline adherence. The work environment impacts on midwives' ability to adhere to guidelines and communication and education have a vital role to play in infection prevention and control guideline adherence. Conclusions While midwives have a strong sense of protection of professional integrity, work conditions such as environment, organisational structures, and management systems affect midwives' adherence to infection prevention and control guidelines. Effective education, training, and communication are required to promote infection prevention and control guideline adherence.
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Affiliation(s)
| | - Martina Giltenane
- Health Research Institute, Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Owen Doody
- Health Research Institute, Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
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Kredo T, Effa E, Mbeye N, Mabetha D, Schmidt BM, Rohwer A, McCaul M, Kallon II, Munabi-Babigumira S, Glenton C, Young T, Lewin S, Vandvik PO, Cooper S. Evaluating the impact of the global evidence, local adaptation (GELA) project for enhancing evidence-informed guideline recommendations for newborn and young child health in three African countries: a mixed-methods protocol. Health Res Policy Syst 2024; 22:114. [PMID: 39160559 PMCID: PMC11334341 DOI: 10.1186/s12961-024-01189-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/20/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Poverty-related diseases (PRD) remain amongst the leading causes of death in children under-5 years in sub-Saharan Africa (SSA). Clinical practice guidelines (CPGs) based on the best available evidence are key to strengthening health systems and helping to enhance equitable health access for children under five. However, the CPG development process is complex and resource-intensive, with substantial scope for improving the process in SSA, which is the goal of the Global Evidence, Local Adaptation (GELA) project. The impact of research on PRD will be maximized through enhancing researchers and decision makers' capacity to use global research to develop locally relevant CPGs in the field of newborn and child health. The project will be implemented in three SSA countries, Malawi, South Africa and Nigeria, over a 3-year period. This research protocol is for the monitoring and evaluation work package of the project. The aim of this work package is to monitor the various GELA project activities and evaluate the influence these may have on evidence-informed decision-making and guideline adaptation capacities and processes. The specific project activities we will monitor include (1) our ongoing engagement with local stakeholders, (2) their capacity needs and development, (3) their understanding and use of evidence from reviews of qualitative research and, (4) their overall views and experiences of the project. METHODS We will use a longitudinal, mixed-methods study design, informed by an overarching project Theory of Change. A series of interconnected qualitative and quantitative data collections methods will be used, including knowledge translation tracking sheets and case studies, capacity assessment online surveys, user testing and in-depth interviews, and non-participant observations of project activities. Participants will comprise of project staff, members of the CPG panels and steering committees in Malawi, South Africa and Nigeria, as well as other local stakeholders in these three African countries. DISCUSSION Ongoing monitoring and evaluation will help ensure the relationship between researchers and stakeholders is supported from the project start. This can facilitate achievement of common goals and enable researchers in South Africa, Malawi and Nigeria to make adjustments to project activities to maximize stakeholder engagement and research utilization. Ethical approval has been provided by South African Medical Research Council Human Research Ethics Committee (EC015-7/2022); The College of Medicine Research and Ethics Committee, Malawi (P.07/22/3687); National Health Research Ethics Committee of Nigeria (01/01/2007).
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Affiliation(s)
- Tamara Kredo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
- Division of Clinical Pharmacology, Department of Medicine, Stellenbosch University, Cape Town, South Africa.
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Emmanuel Effa
- University of Calabar Teaching Hospital, Calabar, Nigeria
| | | | - Denny Mabetha
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Bey-Marrié Schmidt
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Anke Rohwer
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Michael McCaul
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Idriss Ibrahim Kallon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | | | - Claire Glenton
- Western Norway University of Applied Sciences, Bergen, Norway
| | - Taryn Young
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Simon Lewin
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Per Olav Vandvik
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Department of Health Economics and Health Management, Institute for Health and Society, University of Oslo, Oslo, Norway
| | - Sara Cooper
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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5
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O’Brien E, Duffy S, Harkins V, Smith SM, O’Herlihy N, Walsh A, Clyne B, Wallace E. A scoping review of evidence-based guidance and guidelines published by general practice professional organizations. Fam Pract 2024; 41:404-418. [PMID: 36812366 PMCID: PMC11324327 DOI: 10.1093/fampra/cmad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND General practitioners (GPs) need robust, up-to-date evidence to deliver high-quality patient care. There is limited literature regarding the role of international GP professional organizations in developing and publishing clinical guidelines to support GPs clinical decision making. OBJECTIVE To identify evidence-based guidance and clinical guidelines produced by GP professional organizations and summarize their content, structure, and methods of development and dissemination. METHODS Scoping review of GP professional organizations following Joanna Briggs Institute guidance. Four databases were searched and a grey literature search was conducted. Studies were included if they were: (i) evidence-based guidance documents or clinical guidelines produced de novo by a national GP professional organization, (ii) developed to support GPs clinical care, and (iii) published in the last 10 years. GP professional organizations were contacted to provide supplementary information. A narrative synthesis was performed. RESULTS Six GP professional organizations and 60 guidelines were included. The most common de novo guideline topics were mental health, cardiovascular disease, neurology, pregnancy and women's health and preventive care. All guidelines were developed using a standard evidence-synthesis method. All included documents were disseminated through downloadable pdfs and peer review publications. GP professional organizations indicated that they generally collaborate with or endorse guidelines developed by national or international guideline producing bodies. CONCLUSION The findings of this scoping review provide an overview of de novo guideline development by GP professional organizations and can support collaboration between GP organizations worldwide thus reducing duplication of effort, facilitating reproducibility, and identifying areas of standardization. PROTOCOL REGISTRATION Open Science Framework: https://doi.org/10.17605/OSF.IO/JXQ26.
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Affiliation(s)
- Emer O’Brien
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Seamus Duffy
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Velma Harkins
- Irish College of General Practitioners, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Public Health and Primary Care, Trinity College Dublin, DublinIreland
| | | | - Aisling Walsh
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of General Practice, University College Cork, Cork, Ireland
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6
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Klugar M, Lotfi T, Darzi AJ, Reinap M, Klugarová J, Kantorová L, Xia J, Brignardello-Petersen R, Pokorná A, Hazlewood G, Munn Z, Morgan RL, Toews I, Neumann I, Bhatarasakoon P, Stein AT, McCaul M, Mathioudakis AG, D'Anci KE, Leontiadis GI, Naude C, Vasanthan LT, Khabsa J, Bala MM, Mustafa R, DiValerio Gibbs K, Nieuwlaat R, Santesso N, Pieper D, Mokrane S, Soghier I, Lertwatthanawilat W, Wiercioch W, Sultan S, Rozmarinová J, Drapačová P, Song Y, Amer M, Amer YS, Sayfi S, Verstijnen IM, Shin ES, Saz-Parkinson Z, Pottie K, Ruspi A, Marušić A, Saif-Ur-Rahman KM, Rojas MX, Akl EA, Schünemann HJ. GRADE guidance 39: using GRADE-ADOLOPMENT to adopt, adapt or create contextualized recommendations from source guidelines and evidence syntheses. J Clin Epidemiol 2024; 174:111494. [PMID: 39117011 DOI: 10.1016/j.jclinepi.2024.111494] [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: 12/24/2023] [Revised: 07/28/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND AND OBJECTIVE The Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-ADOLOPMENT methodology has been widely used to adopt, adapt, or de novo develop recommendations from existing or new guideline and evidence synthesis efforts. The objective of this guidance is to refine the operationalization for applying GRADE-ADOLOPMENT. METHODS Through iterative discussions, online meetings, and email communications, the GRADE-ADOLOPMENT project group drafted the updated guidance. We then conducted a review of handbooks of guideline-producing organizations, and a scoping review of published and planned adolopment guideline projects. The lead authors refined the existing approach based on the scoping review findings and feedback from members of the GRADE working group. We presented the revised approach to the group in November 2022 (approximately 115 people), in May 2023 (approximately 100 people), and twice in September 2023 (approximately 60 and 90 people) for approval. RESULTS This GRADE guidance shows how to effectively and efficiently contextualize recommendations using the GRADE-ADOLOPMENT approach by doing the following: (1) showcasing alternative pathways for starting an adolopment effort; (2) elaborating on the different essential steps of this approach, such as building on existing evidence-to-decision (EtDs), when available or developing new EtDs, if necessary; and (3) providing examples from adolopment case studies to facilitate the application of the approach. We demonstrate how to use contextual evidence to make judgments about EtD criteria, and highlight the importance of making the resulting EtDs available to facilitate adolopment efforts by others. CONCLUSION This updated GRADE guidance further operationalizes the application of GRADE-ADOLOPMENT based on over 6 years of experience. It serves to support uptake and application by end users interested in contextualizing recommendations to a local setting or specific reality in a short period of time or with limited resources.
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Affiliation(s)
- Miloslav Klugar
- Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic; Center of Evidence-based Education and Arts Therapies: A JBI Affiliated Group, Faculty of Education, Palacký University Olomouc, Prague, Czech Republic
| | - Tamara Lotfi
- World Health Organization Collaborating Center for Infectious Diseases, Research Methods and Recommendations, Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8, Ontario, Canada
| | - Andrea J Darzi
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8, Ontario, Canada; Department of Anesthesia, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Marge Reinap
- Division of Country Health Policies and Systems, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Jitka Klugarová
- Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic; Center of Evidence-based Education and Arts Therapies: A JBI Affiliated Group, Faculty of Education, Palacký University Olomouc, Prague, Czech Republic
| | - Lucia Kantorová
- Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic; Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jun Xia
- Agency for Clinical Practice Guideline, Korean Academy of Medical Sciences, Seoul, South Korea; Division of Lifespan and Population Health, The University of Nottingham, Nottingham, UK
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8, Ontario, Canada
| | - Andrea Pokorná
- Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic; Department of Health Sciences, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Glen Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zachary Munn
- Health Evidence Synthesis, Recommendations and Impact, School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8, Ontario, Canada; School of Medicine, Case Western Reserve University, Cleveland, OH USA
| | - Ingrid Toews
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ignacio Neumann
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8, Ontario, Canada; School of Medicine, Universidad San Sebastian, Santiago, Chile
| | - Patraporn Bhatarasakoon
- Thailand Center for Evidence-Based Health Care, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Airton Tetelbom Stein
- Department of Public Health, Universidade Federal de Ciências da Saúde de Porto Alegre (Ufcspa), Porto Alegre, Brazil
| | - Michael McCaul
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch Univeristy, Cape Town, South Africa
| | - Alexander G Mathioudakis
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK; North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Grigorios I Leontiadis
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8, Ontario, Canada
| | - Celeste Naude
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch Univeristy, Cape Town, South Africa
| | - Lenny T Vasanthan
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, India
| | - Joanne Khabsa
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland; Krakow GRADE Centre, Krakow, Poland
| | - Reem Mustafa
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8, Ontario, Canada; Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, MO, USA
| | | | - Robby Nieuwlaat
- World Health Organization Collaborating Center for Infectious Diseases, Research Methods and Recommendations, Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8, Ontario, Canada
| | - Nancy Santesso
- World Health Organization Collaborating Center for Infectious Diseases, Research Methods and Recommendations, Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8, Ontario, Canada
| | - Dawid Pieper
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Institute for Health Services and Health System Research, Rüdersdorf, Germany; Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany
| | - Saphia Mokrane
- Department of Primary Care, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium; Working group Development of Primary Care Guidelines, Antwerpen, Belgium
| | - Israa Soghier
- Department of Medicine, Massachusetts General Brigham/Salem Hospital, Boston, MA, USA
| | - Wanchai Lertwatthanawilat
- Thailand Center for Evidence-Based Health Care, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Wojtek Wiercioch
- World Health Organization Collaborating Center for Infectious Diseases, Research Methods and Recommendations, Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8, Ontario, Canada
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Jana Rozmarinová
- Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Pavla Drapačová
- Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Yang Song
- Iberoamerican Cochrane Centre, Biomedical Research, Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Marwa Amer
- Medical/Critical Pharmacy Division, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; College of Medicine and Pharmacy, Alfaisal University, Riyadh, Saudi Arabia
| | - Yasser S Amer
- Pediatrics Department, Quality Management Department, King Saud University Medical City, Research Chair for Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia; Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Shahab Sayfi
- World Health Organization Collaborating Center for Infectious Diseases, Research Methods and Recommendations, Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8, Ontario, Canada
| | - Ilse M Verstijnen
- Research and Development, National Health Care Institute, Zorginstituut, The Netherlands
| | - Ein-Soon Shin
- Department of Preventive Medicine and Public Health, School of Medicine, Ajou University, Suwon, South Korea
| | | | - Kevin Pottie
- Departments of Family Medicine and Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Alessandra Ruspi
- Clinical Epidemiology and Research Center (CERC), Humanitas University & Humanitas Research Hospital, Via Rita Levi Montalcini 4 - 20090 Pieve Emanuele, Milano, Italy; Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Ana Marušić
- Center for Evidence-based Medicine, Medicinski fakultet Sveucilista u Splitu, University of Split School of Medicine, Split, Croatia
| | - K M Saif-Ur-Rahman
- College of Medicine, Nursing, and Health Sciences, University Galway, Galway, Ireland; Evidence Synthesis Ireland and Cochrane Ireland University of Galway, Galway, Ireland
| | - Maria X Rojas
- Department of Clinical Epidemiology and Public Health, The Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Elie A Akl
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8, Ontario, Canada; Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8, Ontario, Canada; Clinical Epidemiology and Research Center (CERC), Humanitas University & Humanitas Research Hospital, Via Rita Levi Montalcini 4 - 20090 Pieve Emanuele, Milano, Italy; Nottingham Ningbo GRADE Centre, School of Economics, The University of Nottingham Ningbo China, Ningbo, China; China European Research Executive Agency, European Commission, Brussels, Belgium.
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7
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Batubo NP, Auma CI, Moore JB, Zulyniak MA. The Nigerian Dietary Screening Tool: A Step toward Improved Patient-Clinician Communication in Nigerian Hospitals: A Pilot Implementation Study. Nutrients 2024; 16:2286. [PMID: 39064729 PMCID: PMC11280457 DOI: 10.3390/nu16142286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/02/2024] [Accepted: 07/14/2024] [Indexed: 07/28/2024] Open
Abstract
Implementing dietary screening tools into clinical practice has been challenging, including in Nigeria. This study evaluated the impact of the Nigerian dietary screening tool (NiDST) on patient-clinician communication and barriers to and facilitators of implementation. A mixed methods approach was used to collect data from patients (n = 151) and clinicians (n = 20) from outpatient clinics in Nigeria. Patients completed the validated 25-item NiDST prior to outpatient consultations. Both patients and clinicians completed the Measurement Instrument for Determinants of Innovations (MIDI) questionnaire to assess implementation determinants post-consultation. Semi-structured interviews were conducted for in-depth feedback. The fidelity of implementation was 92% for NiDST-reported dietary discussion, with a mean completion time of <6 min and an accepted marginal increase in consultation time (<10 min). For clinicians, 25% reported time constraints and their additional nutritional knowledge as barriers, while facilitators of NiDST implementation were the clarity and completeness of the NiDST, clinical relevance and improved patient-clinician communication, as reported by all the clinicians. Over 96% of patients reported the NiDST as quick to complete, with 90.7% reporting self-reflection on dietary intake. This study demonstrated the NiDST's potential to enhance patient-clinician communication and highlighted major facilitators of implementation in clinical practice to improve dietary discussion in Nigeria.
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Affiliation(s)
- Nimisoere P. Batubo
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK; (N.P.B.); (C.I.A.); (J.B.M.)
| | - Carolyn I. Auma
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK; (N.P.B.); (C.I.A.); (J.B.M.)
| | - J. Bernadette Moore
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK; (N.P.B.); (C.I.A.); (J.B.M.)
| | - Michael A. Zulyniak
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK; (N.P.B.); (C.I.A.); (J.B.M.)
- Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
- Human Nutrition, University of British Columbia, Vancouver, BC V6T1Z4, Canada
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8
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Dalla Ali S, Alhiraki OA, Naeem T. Evaluating Compliance With the Ottawa Rules: A Retrospective Clinical Audit at a District General Hospital in the UK. Cureus 2024; 16:e65115. [PMID: 39171035 PMCID: PMC11338357 DOI: 10.7759/cureus.65115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND The Ottawa Rules are clinical decision tools designed to assist healthcare providers in determining the need for radiographs in patients with ankle or knee injuries. Compliance with these rules can lead to more efficient use of resources and reduced radiation exposure. OBJECTIVE This retrospective clinical audit aimed to evaluate healthcare provider's compliance with the Ottawa Rules in an Emergency Department setting and assess the positivity rates of requested knee and ankle X-rays. METHODS A two-cycle retrospective audit was conducted at Lincoln County Hospital's Emergency Department, involving 648 X-rays collected in two cycles. In between, multiple interventions were implemented to improve the outcomes. RESULTS The study revealed varying levels of compliance with the Ottawa Rules, with higher compliance observed for knee X-rays than ankle X-rays. The compliance for knee X-rays improved from 74.6% to 89.9% and ankle X-rays improved from 33.1% to 75.8%. Positivity rates for ankle radiographs were higher than knee radiographs in both cycles. The interventions implemented between the cycles significantly improved compliance rates with the Ottawa Rules. CONCLUSION The findings underscore the importance of adherence to the Ottawa Rules in optimizing patient care and resource utilization. The study suggests the need for continued education and periodic audits to maintain and further improve compliance rates. Additionally, the higher positivity rates for ankle radiographs highlight the importance of targeted imaging strategies based on clinical guidelines.
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Affiliation(s)
- Saif Dalla Ali
- General Surgery Department, Lincoln County Hospital, Lincoln, GBR
| | - Omar A Alhiraki
- Acute Medicine Department, Lincoln County Hospital, Lincoln, GBR
| | - Tahir Naeem
- Radiology Department, Lincoln County Hospital, Lincoln, GBR
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9
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Renaux Torres MC, Bouttefroy S, Letort-Bertrand M, Maurel V, Mouffak S, Scotté F, Slimano F, Treguier P, Dupuis LL, Poirée M, Thouvenin-Doulet S. [Chemotherapy-induced nausea and vomiting in pediatric oncology patients: 2023 recommendations from the Supportive Care Committee of the French Society of Cancer in Children and Adolescents]. Bull Cancer 2024; 111:608-619. [PMID: 38670821 DOI: 10.1016/j.bulcan.2024.02.017] [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: 11/04/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 04/28/2024]
Abstract
Chemotherapy-induced nausea and vomiting (CINV) are frequent and dreaded side effects in cancer treatments. CINV has a major impact on patient's condition and quality of life. Prophylaxis is tailored to patient's profile and the emetogenic level of their chemotherapy. The aim of this study is to update the recommendations for CINV prevention and management in pediatric onco-hematology for use in France, by adapting the guidelines of the Pediatric Oncology Group of Ontario (POGO). Clinical practice guideline adaptation is a recognized method for tailoring existing clinical practice guidelines to local context. A multidisciplinary French-speaking panel was formed to discuss about POGO guideline recommendations for the acute and delayed phases, breakthrough, refractory and anticipatory CINV and the evidence supporting them. Panel members were asked whether they wanted to adopt, modify or reject each of the POGO guideline recommendations. Panel members translated each recommendation and adapted recommendations for an implementation in France. Their acceptance required agreement at least 80 % of panel members. Algorithms and tables were created, listing all the recommendations and providing a better overview for decision-making process adapted to the patient's profile. These recommendations should be reviewed for implementation at French institutions caring for pediatric cancer patients and once implemented, the rates of adherence to recommendations and CINV control should be reported.
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Affiliation(s)
| | - Séverine Bouttefroy
- Institut d'hématologie et d'oncologie pédiatrique, Centre Léon-Bérard, hospices civils de Lyon, 1, place Professeur-Joseph-Renaut, 69008 Lyon, France
| | - Maïna Letort-Bertrand
- Service oncohématologie pédiatrique, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - Véronique Maurel
- Service oncohématologie pédiatrique, CHU de Nice, 151 route Saint-Antoine-de-Ginestière, 06202 Nice, France
| | - Samia Mouffak
- Service de pharmacie, Centre hospitalier de La Rochelle, rue du Docteur-Schweitzer, 17000 La Rochelle, France
| | - Florian Scotté
- Département interdisciplinaire d'organisation du parcours patient, Institut Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Florian Slimano
- Service de pharmacie, université de Reims Champagne-Ardenne, BioSpecT, CHU de Reims, rue du général Koenig, 51100 Reims, France
| | - Pauline Treguier
- Service oncohématologie pédiatrique, CHU de Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - L Lee Dupuis
- Research Institute and Department of Pharmacy, The Hospital for Sick Children, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Marilyne Poirée
- Service oncohématologie pédiatrique, CHU de Nice, 151 route Saint-Antoine-de-Ginestière, 06202 Nice, France
| | - Sandrine Thouvenin-Doulet
- CHU de Saint-Étienne, service d'hématologie et d'oncologie pédiatrique, rue Albert-Raimond, 42055 Saint-Étienne cedex 02, France
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10
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Kapiriri L, Vélez CM, Aguilera B, Essue BM, Nouvet E, Donya RS, Ieystn W, Marion D, Susan G, Abelson J, Suzanne K. A global comparative analysis of the the inclusion of priority setting in national COVID-19 pandemic plans: A reflection on the methods and the accessibility of the plans. Health Policy 2024; 141:105011. [PMID: 38350210 DOI: 10.1016/j.healthpol.2024.105011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Despite the swift governments' response to the COVID-19 pandemic, there remains a paucity of literature assessing the degree to which; priority setting (PS) was included in the pandemic plans and the pandemic plans were publicly accessible. This paper reflects on the methods employed in a global comparative analysis of the degree to which countries integrated PS into their COVID-19 pandemic plans based on Kapiriri & Martin's framework. We also assessed if the accessibility of the plans was related to the country's transparency index. METHODS Through a three stage search strategy, we accessed and reviewed 86 national COVID-19 pandemic plans (and 11 Canadian provinces and territories). Secondary analysis assessed any alignment between the readily accessible plans and the country's transparency index. RESULTS AND CONCLUSION 71 national plans were readily accessible while 43 were not. There were no systematic differences between the countries whose plans were readily available and those whose plans were 'missing'. However, most of the countries with 'missing' plans tended to have a low transparency index. The framework was adapted to the pandemic context by adding a parameter on the need to plan for continuity of priority routine services. While document review may be the most feasible and appropriate approach to conducting policy analysis during health emergencies, interviews and follow up document review would assess policy implementation.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada.
| | - Claudia-Marcela Vélez
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada; Faculty of Medicine, University of Antioquia, Cra 51d #62-29, Medellín, Antioquia, Colombia
| | - Bernardo Aguilera
- Facultad de Medicina y Ciencia, Universidad San Sebastian, Providencia, Santiago, Chile
| | - Beverley M Essue
- Centre for Global Health Research, St. Michael's Hospital, 30 Bond St, Toronto, Ontario M5B 1W8, Canada
| | - Elysee Nouvet
- School of Health Studies, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Razavi S Donya
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4M4, Canada
| | - Williams Ieystn
- School of Social Policy, HSMC, Park House, University of Birmingham, Edgbaston, Birmingham B15 2RT, UK
| | - Danis Marion
- Section on Ethics and Health Policy, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - Goold Susan
- Internal Medicine and Health Management and Policy, Center for Bioethics and Social Sciences in Medicine, University of Michigan, 2800 Plymouth Road, Bldg. 14, G016, Ann Arbor, MI 48109-2800, USA
| | - Julia Abelson
- Health Policy Program, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4M4, Canada
| | - Kiwanuka Suzanne
- Department of Health Policy Planning and Management, Makerere University College of Health Sciences, P.O. Box 7062, Kampala, Uganda
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11
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Qian Y, Tan JYB, Wang T, Bressington D, Zhou HJ, Li MY, Liu XL. Quality appraisal and descriptive analysis of clinical practice guidelines for self-managed non-pharmacological interventions of cardiovascular diseases: a systematic review. J Transl Med 2024; 22:215. [PMID: 38424641 PMCID: PMC10903016 DOI: 10.1186/s12967-024-04959-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are the leading cause of death around the world. Most CVDs-related death can be prevented by the optimal management of risk factors such as unhealthy diet and physical inactivity. Clinical practice guidelines (CPGs) for CVDs, provide some evidence-based recommendations which help healthcare professionals to achieve the best care for patients with CVDs. This systematic review aims to appraise the methodological quality of CPGs systematically and summarize the recommendations of self-managed non-pharmacological interventions for the prevention and management of CVDs provided by the selected guidelines. METHODS A comprehensive electronic literature search was conducted via six databases (PubMed, Medline, The Cochrane Library, Embase, CINAHL, and Web of Science), seven professional heart association websites, and nine guideline repositories. The Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument was adopted to critically appraise the methodological quality of the selected guidelines. Content analysis was used to summarise recommended self-managed non-pharmacological interventions for CVDs. RESULTS Twenty-three CPGs regarding different CVDs were included, in which four guidelines of CVDs, three for coronary heart diseases, seven for heart failure, two for atrial fibrillation, three for stroke, three for peripheral arterial disease, and one for hypertrophic cardiomyopathy. Twenty CPGs were appraised as high quality, and three CPGs as moderate quality. All twenty-three CPGs were recommended for use with or without modification. The domain of "Editorial Independence" had the highest standardized percentage (93.47%), whereas the domain of "Applicability" had the lowest mean domain score of 75.41%. The content analysis findings summarised some common self-managed non-pharmacological interventions, which include healthy diet, physical activity, smoking cessation, alcohol control, and weight management. Healthy diet and physical acidity are the most common and agreed on self-managed interventions for patients with CVDs. There are some inconsistencies identified in the details of recommended interventions, the intervention itself, the grade of recommendation, and the supported level of evidence. CONCLUSION The majority of the summarized non-pharmacological interventions were strongly recommended with moderate to high-quality levels of evidence. Healthcare professionals and researchers can adopt the results of this review to design self-managed non-pharmacological interventions for patients with CVDs.
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Affiliation(s)
- Yun Qian
- Faculty of Health, Charles Darwin University, Casuarina, Australia
- Maroondah Hospital, Eastern Health, Melbourne, Australia
| | - Jing-Yu Benjamin Tan
- Faculty of Health, Charles Darwin University, Casuarina, Australia
- School of Nursing and Midwifery, University of Southern Queensland, Ipswich, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia
| | - Tao Wang
- Faculty of Health, Charles Darwin University, Casuarina, Australia
| | | | - Hong-Juan Zhou
- School of Nursing, Putian University, Putian, Fujian, China
| | - Meng-Yuan Li
- Faculty of Health, Charles Darwin University, Casuarina, Australia
| | - Xian-Liang Liu
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Homantin, Kowloon, Hong Kong, China.
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12
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Meiliana M, Alexander T, Bloomfield FH, Cormack BE, Harding JE, Walsh O, Lin L. Nutrition guidelines for preterm infants: A systematic review. JPEN J Parenter Enteral Nutr 2024; 48:11-26. [PMID: 37855274 DOI: 10.1002/jpen.2568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/21/2023] [Accepted: 10/16/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND There is no consensus on optimal nutrition for preterm infants, leading to substantial practice variation. We aimed to assess the quality of nutrition guidelines for preterm infants, the consistency of recommendations, and the gaps in recommendations. METHODS We searched databases and websites for nutrition guidelines for preterm infants before first hospital discharge, which were endorsed, prepared, or authorized by a regional, national, or international body, written in English, and published between 2012 and 2023. Two reviewers independently screened articles and extracted the recommendations. Four reviewers appraised the included guidelines using Appraisal of Guidelines, Research, and Evaluation II. RESULTS A total of 7051 were identified, with 27 guidelines included, 26% of which were high in quality. Most guidelines lacked stakeholder involvement and rigor of development. We found considerable variation in recommendations, many of which lacked details on certainty of evidence and strength of recommendation. Recommendations for type of feed and breastmilk fortification were consistent among high-quality guidelines, but recommendations varied for intakes of almost all nutrients and monitoring of nutrition adequacy. Different guidelines gave different certainty of evidence for the same recommendations. Most gaps in recommendations were due to very low certainty of evidence. CONCLUSION Future development of nutrition guidelines for preterm infants should follow the standard guideline development method and ensure the rigorous process, including stakeholders' involvement, to improve the reporting of strength of recommendation, certainty of evidence, and gaps in recommendation. Evidence is needed to support recommendations about macro and micronutrient intakes, breastmilk fortification, and markers on adequacy of intake of different nutrients.
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Affiliation(s)
| | - Tanith Alexander
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Neonatal Unit, Kidz First, Middlemore Hospital, Auckland, New Zealand
| | | | | | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Orla Walsh
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Luling Lin
- Liggins Institute, University of Auckland, Auckland, New Zealand
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13
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Kim BN, Ahn JS. History of the Task Force for the Korean Clinical Guidelines of the Developmental Disorders. Soa Chongsonyon Chongsin Uihak 2024; 35:4-7. [PMID: 38204744 PMCID: PMC10774561 DOI: 10.5765/jkacap.230017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/17/2023] [Accepted: 12/03/2023] [Indexed: 01/12/2024] Open
Abstract
Under the Ministry of Health and Welfare of the Republic of Korea, the National Autism and Developmental Disorder Centers for people with developmental disabilities are gradually expanding. The headquarters of the National Autism and Developmental Disorder Center provides support for education, training, and research, and several centers have been effectively operating since 2020. This study aimed to provide practical recommendations and guidelines for specialists such as clinical psychologists, child psychiatrists, allied professionals, community workers, and related administrators. It was developed as a guideline to promote early diagnosis, provide important information on integrated treatment, and assist people with developmental disabilities in Korea to make the best decisions for their quality of life.
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Affiliation(s)
- Bung-Nyun Kim
- Division of Children and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
| | - Joung-Sook Ahn
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Korea
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14
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Langford AV, Bero L, Lin CWC, Blyth FM, Doctor JN, Holliday S, Jeon YH, Moullin JC, Murnion B, Nielsen S, Penm J, Reeve E, Reid S, Wale J, Osman R, Gnjidic D, Schneider CR. Context matters: using an Evidence to Decision (EtD) framework to develop and encourage uptake of opioid deprescribing guideline recommendations at the point-of-care. J Clin Epidemiol 2024; 165:111204. [PMID: 37931823 DOI: 10.1016/j.jclinepi.2023.10.020] [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: 03/07/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To describe the development and use of an Evidence to Decision (EtD) framework when formulating recommendations for the Evidence-Based Clinical Practice Guideline for Deprescribing Opioid Analgesics. STUDY DESIGN AND SETTING Evidence was derived from an overview of systematic reviews and qualitative studies conducted with healthcare professionals and people who take opioids for pain. A multidisciplinary guideline development group conducted extensive EtD framework review and iterative refinement to ensure that guideline recommendations captured contextual factors relevant to the guideline target setting and audience. RESULTS The guideline development group considered and accounted for the complexities of opioid deprescribing at the individual and health system level, shaping recommendations and practice points to facilitate point-of-care use. Stakeholders exhibited diverse preferences, beliefs, and values. This variability, low certainty of evidence, and system-level policies and funding models impacted the strength of the generated recommendations, resulting in the formulation of four 'conditional' recommendations. CONCLUSION The context within which evidence-based recommendations are considered, as well as the political and health system environment, can contribute to the success of recommendation implementation. Use of an EtD framework allowed for the development of implementable recommendations relevant at the point-of-care through consideration of limitations of the evidence and relevant contextual factors.
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Affiliation(s)
- Aili V Langford
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.
| | - Lisa Bero
- School of Medicine, Colorado School of Public Health and Center for Bioethics and Humanities, University of Colorado Anschutz Medical Center, Denver, CO, USA
| | - Chung-Wei Christine Lin
- Faculty of Medicine and Health, School of Public Health, Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia; Sydney Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Fiona M Blyth
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jason N Doctor
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Simon Holliday
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Yun-Hee Jeon
- Faculty of Medicine and Health, Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia
| | - Joanna C Moullin
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Bridin Murnion
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia; Department of Pharmacy, Prince of Wales Hospital, Randwick, Australia
| | - Emily Reeve
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Sharon Reid
- Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Drug Health Services, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Janet Wale
- Independent Consumer Representative, Melbourne, Victoria, Australia
| | - Rawa Osman
- NPS MedicineWise, Sydney, New South Wales, Australia
| | - Danijela Gnjidic
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Carl R Schneider
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
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15
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Baykemagn ND, Nigatu AM, Fikadie B, Tilahun B. Acceptance of mobile application-based clinical guidelines among health professionals in Northwestern Ethiopia: A mixed-methods study. Digit Health 2024; 10:20552076241261930. [PMID: 39229466 PMCID: PMC11369868 DOI: 10.1177/20552076241261930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 09/05/2024] Open
Abstract
Background Globally, healthcare providers have faced significant difficulties in adhering to clinical guidelines. Applying mobile health systems is a crucial strategy for enhancing the dissemination and accessibility of clinical guidelines. This study aimed to assess the acceptance of mobile app-based primary healthcare clinical guidelines and associated factors among health professionals in central Gondar health centers. Methods A cross-sectional study supplemented with qualitative data was conducted on 403 health workers. Data were collected using a pre-test structured printed questionnaire and entered into EpiData version 4.6. Analysis was conducted using Stata version 14, which included bivariable and multivariable logistic regression analyses. For qualitative data, thematic analysis was conducted using Open Code v.4.2. Results Approximately 28% (95% confidence interval (CI): 23%-32%) of health professionals had utilized mobile app-based clinical guidelines. The availability of IT support (adjusted odds ratio (AOR) = 3.51, 95% CI: 1.82-6.78), good knowledge (AOR = 3.46, 95% CI: 1.5-6.78), perceived usefulness (AOR = 2.21, 95% CI: 1.00-4.99), m-Health app exposure (AOR = 2.34, 95% CI: 1.2-4.50), and ease of use (AOR = 5.77, 95% CI: 2.50-13.32) were significantly associated with the acceptance of the mobile app-based clinical guideline. In qualitative data, lack of training and supervision and access to smartphones were barriers to acceptance of the mobile app-based clinical guideline. Conclusion In summary, acceptance of the app is currently low. However, it can be increased by improving the availability of IT support in the workplace, offering training and supervision, and enhancing access to smartphones.
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Affiliation(s)
- Nebebe Demis Baykemagn
- Department of Health Informatics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Araya Mesfin Nigatu
- Department of Health Informatics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Berhanu Fikadie
- Department of Health Informatics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Binyam Tilahun
- Department of Health Informatics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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16
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Al Zoubi FM, Wong AYL, Cheing GLY, Cheung JPY, Fu SN, Tsang HHL, Law RKY, So BCL, Tsang R, Tsang S, Wen C, Wong M, Yau YC, Bussières AE. Adapting a Clinical Practice Guideline for Management of Patients with Knee and Hip Osteoarthritis by Hong Kong Physiotherapists. Healthcare (Basel) 2023; 11:2964. [PMID: 37998457 PMCID: PMC10671134 DOI: 10.3390/healthcare11222964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/11/2023] [Accepted: 11/11/2023] [Indexed: 11/25/2023] Open
Abstract
Knee and hip osteoarthritis are common disabling conditions globally. Although numerous international clinical practice guidelines exist to guide physiotherapy management, not all recommendations issued from these guidelines can be translated to other contexts without considering the cultural acceptability and clinical implementability of targeted countries. Because the ADAPTE framework provides a robust methodology to adapt guidelines to the local context, this study used its methodology to adapt high-quality guideline recommendations to promote optimal physiotherapy care for knee and hip osteoarthritis in Hong Kong. The ADAPTE framework was used and modified to complete the adaptation process. International clinical practice guidelines were identified from eight guideline clearinghouses and six electronic databases. Two independent reviewers critically appraised the eligible guidelines using the AGREE II tool. We extracted and tabulated recommendations from high-quality guidelines. A voting-based consensus among interdisciplinary experts was conducted to decide on suitable recommendations for the Hong Kong context and whether there was a need to modify them. Pertinent recommendations were then translated into the traditional Chinese language. Our team members suggested modifying four tools and adding one to explore the patient's feedback on the recommendations, to the ADAPTE framework. The adaptation was performed on three high-quality guidelines. We adapted 28 and 20 recommendations for treating knee and hip osteoarthritis, respectively. We recommend a multimodal treatment for managing knee and hip osteoarthritis. Land- and aquatic-based exercises, patient education, and self-management were strongly recommended for patients with knee osteoarthritis. Land- and aquatic-based exercises were strongly recommended for patients with hip osteoarthritis. This is the first adaptation study in Hong Kong. It provides guidance to local physiotherapists on managing patients with knee and hip osteoarthritis. Future studies should test the effectiveness of implementing this adapted guideline to improve local physiotherapy care in Hong Kong.
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Affiliation(s)
- Fadi M. Al Zoubi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
| | - Arnold Y. L. Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
| | - Gladys L. Y. Cheing
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
| | - Jason P. Y. Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China;
| | - Siu Ngor Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
| | - Helen H. L. Tsang
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Rainbow K. Y. Law
- Physiotherapy Centre, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China
| | - Billy Chun Lung So
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
| | - Raymond Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
- Hong Kong Physiotherapy Association, Hong Kong SAR, China
- Physiotherapy Department, MacLehose Medical Rehabilitation Centre, Hong Kong SAR, China
| | - Sharon Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
| | - Chunyi Wen
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Michael Wong
- Rehabilitation Clinic, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Yim Ching Yau
- Nursing Mixed Surgical Ward, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China;
| | - André E. Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3G 2M1, Canada;
- Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC G8Z 4M3, Canada
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Wang S, Zhang Y, Wen Z, Yang Y, Zhang Y, Geng Y, Liu Y, Zhang J. Development, Evaluation, and impLemenTation for guideline adaptation: a quality improvement protocol for the DELTA study in global health practice. Health Res Policy Syst 2023; 21:114. [PMID: 37915056 PMCID: PMC10619317 DOI: 10.1186/s12961-023-01060-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/07/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Guideline adaptation is an emerging field to provide more appropriate recommendations for local clinical practice quality and to promote global health equity. However, its utilization status, adaptation procedures, and related materials remain to be studied. METHODS This study developed a quality improvement protocol for a study as the Development, Evaluation, and impLemenTation for guideline Adaptation (DELTA) study. Current adapted clinical practice guidelines (CPGs) will be systematically searched. Their characteristics, utilization status, and adaptation procedures will be extracted, compared, and analyzed. Whether these adapted CPGs rigorously followed the instruments and steps of adaptation frameworks will also be appraised. In addition, the advantages and limitations of current adaptation methods and their suitable application situations will be analyzed. In addition, future perspectives as DELTA series and DELTA system, aiming for comprehensively evaluating current needs for guideline adaptation and developing a unified framework and related materials were proposed to improve the acceptability, applicability, and implementation of guideline adaptation in clinical practice. The DELTA series are divided into four phases: phase I in analyzing status, characteristics, and procedures and completeness of adapted CPGs; phase II in analyzing differences, heterogeneity, and implementation between adapted and original CPGs; and phase III in collecting, analyzing, and comparing all available adaptation materials. With these research bases, an international working group will be established in phase IV and will develop unified guideline adaptation materials after Delphi consensus, including adaptation frameworks, appraisal tools and checklists, registries, and databases. DISCUSSION Guideline adaptation has been advanced as an efficient way to guide local clinical practice. However, it still faces several major challenges. The proposed DELTA study, series, and system will further contribute to this emerging topic. TRIAL REGISTRATION This study has been registered by the PROSPERO international database. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=400170 .
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Affiliation(s)
- Shu Wang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yuan Zhang
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Zhixuan Wen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yueming Yang
- Department of Hematology, Dalian Municipal Woman and Children's Medical Center (Group), Dalian, 116000, China
| | - Yuxuan Zhang
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yixiong Geng
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yali Liu
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
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Beynon F, Guérin F, Lampariello R, Schmitz T, Tan R, Ratanaprayul N, Tamrat T, Pellé KG, Catho G, Keitel K, Masanja I, Rambaud-Althaus C. Digitalizing Clinical Guidelines: Experiences in the Development of Clinical Decision Support Algorithms for Management of Childhood Illness in Resource-Constrained Settings. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200439. [PMID: 37640492 PMCID: PMC10461705 DOI: 10.9745/ghsp-d-22-00439] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/13/2023] [Indexed: 08/31/2023]
Abstract
Clinical decision support systems (CDSSs) can strengthen the quality of integrated management of childhood illness (IMCI) in resource-constrained settings. Several IMCI-related CDSSs have been developed and implemented in recent years. Yet, despite having a shared starting point, the IMCI-related CDSSs are markedly varied due to the need for interpretation when translating narrative guidelines into decision logic combined with considerations of context and design choices. Between October 2019 and April 2021, we conducted a comparative analysis of 4 IMCI-related CDSSs. The extent of adaptations to IMCI varied, but common themes emerged. Scope was extended to cover a broader range of conditions. Content was added or modified to enhance precision, align with new evidence, and support rational resource use. Structure was modified to increase efficiency, improve usability, and prioritize care for severely ill children. The multistakeholder development processes involved syntheses of recommendations from existing guidelines and literature; creation and validation of clinical algorithms; and iterative development, implementation, and evaluation. The common themes surrounding adaptations of IMCI guidance highlight the complexities of digitalizing evidence-based recommendations and reinforce the rationale for leveraging standards for CDSS development, such as the World Health Organization's SMART Guidelines. Implementation through multistakeholder dialogue is critical to ensure CDSSs can effectively and equitably improve quality of care for children in resource-constrained settings.
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Affiliation(s)
- Fenella Beynon
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | - Torsten Schmitz
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Rainer Tan
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Digital and Global Health Unit, Unisanté, Center for Primary Care and Public Health, Lausanne, Switzerland
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Natschja Ratanaprayul
- Department of Digital Health and Innovations, World Health Organization, Geneva, Switzerland
| | - Tigest Tamrat
- UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Gaud Catho
- Division of Infectious Diseases, Geneva University Hospital and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Global Health Institute, University of Geneva, Geneva, Switzerland
| | - Kristina Keitel
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Pediatric Emergency Medicine, Department of Pediatrics, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
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Kouanda S, Ouedraogo AM, Sogo AE, Bagaya O, Sorgho TEV, Hien YC, Gbenou DV, Sawadogo Windsouri SR, Zoungrana W, Dadjoari M, Zombré Sanou VM, Usmanova G, Jain Y, Chahar R, Kumar S, Kumar SVV, Srivastava A, Nair TS, Sarkar AH, Bajpai N, Patwardhan V, Joshi CS, Chotiya M, Baswal D, Musange S, Sayinzoga F, Mutabazi V, Murindahabi NK, Nzeyimana D, Rwabufigiri BN, Kabuteni TJ, Mugabo M, Mbizvo M, Chizuni C, Chelwa N, Muliokela R, Phiri C, Kasonda K, Okpara N, Nyirenda M, Malumo SB, Mwiche A, Simushi V, Nsubuga Bakyaita N, Barreix M, Tunçalp Ö, Thwin SS, Bucagu M, Tamrat T, Habib N, Lefevre AE, Lorencatto F. New Antenatal Model in Africa and India (NAMAI) study: implementation research to improve antenatal care using WHO recommendations. Health Res Policy Syst 2023; 21:82. [PMID: 37563619 PMCID: PMC10416399 DOI: 10.1186/s12961-023-01014-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/19/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND In 2020, an estimated 287 000 women died globally from pregnancy-related causes and 2 million babies were stillborn. Many of these outcomes can be prevented by quality healthcare during pregnancy and childbirth. Within the continuum of maternal health, antenatal care (ANC) is a key moment in terms of contact with the health system, yet it remains an underutilized platform. This paper describes the protocol for a study conducted in collaboration with Ministries of Health and country research partners that aims to employ implementation science to systematically introduce and test the applicability of the adapted WHO ANC package in selected sites across four countries. METHODS Study design is a mixed methods stepped-wedge cluster randomized implementation trial with a nested cohort component (in India and Burkina Faso). The intervention is composed of two layers: (i) the country- (or state)-specific ANC package, including evidence-based interventions to improve maternal and newborn health outcomes, and (ii) the co-interventions (or implementation strategies) to help delivery and uptake of the adapted ANC package. Using COM-B model, co-interventions support behaviour change among health workers and pregnant women by (1) training health workers on the adapted ANC package and ultrasound (except in India), (2) providing supplies, (3) conducting mentoring and supervision and (4) implementing community mobilization strategies. In Rwanda and Zambia, a fifth strategy includes a digital health intervention. Qualitative data will be gathered from health workers, women and their families, to gauge acceptability of the adapted ANC package and its components, as well as experience of care. The implementation of the adapted ANC package of interventions, and their related costs, will be documented to understand to what extent the co-interventions were performed as intended, allowing for iteration. DISCUSSION Results from this study aim to build the global evidence base on how to implement quality ANC across different settings and inform pathways to scale, which will ultimately lead to stronger health systems with better maternal and perinatal outcomes. On the basis of the study results, governments will be able to adopt and plan for national scale-up, aiming to improve ANC nationally. This evidence will inform global guidance. TRIAL REGISTRATION NUMBER ISRCTN, ISRCTN16610902. Registered 27 May 2022. https://www.isrctn.com/ISRCTN16610902.
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Goh SSL, Lai PSM, Ramdzan SN, Tan KM. Weighing the necessities and concerns of deprescribing among older ambulatory patients and primary care trainees: a qualitative study. BMC PRIMARY CARE 2023; 24:136. [PMID: 37391698 PMCID: PMC10311750 DOI: 10.1186/s12875-023-02084-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 06/19/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Deprescribing can be a challenging and complex process, particularly for early career doctors such as primary care trainees. To date, there is limited data from patients' and doctors' perspectives regarding the deprescribing of medications in older persons, particularly from developing countries. This study aimed to explore the necessities and concerns of deprescribing in older persons among older ambulatory patients and primary care trainees. METHODS A qualitative study was conducted among patients and primary care trainees (known henceforth as doctors). Patients aged ≥ 60 years, having ≥ 1 chronic disease and prescribed ≥ 5 medications and could communicate in either English or Malay were recruited. Doctors and patients were purposively sampled based on their stage of training as family medicine specialists and ethnicity, respectively. All interviews were audio-recorded and transcribed verbatim. A thematic approach was used to analyse data. RESULTS Twenty-four in-depth interviews (IDIs) with patients and four focus group discussions (FGDs) with 23 doctors were conducted. Four themes emerged: understanding the concept of deprescribing, the necessity to perform deprescribing, concerns regarding deprescribing and factors influencing deprescribing. Patients were receptive to the idea of deprescribing when the term was explained to them, whilst doctors had a good understanding of deprescribing. Both patients and doctors would deprescribe when the necessity outweighed their concerns. Factors that influenced deprescribing were doctor-patient rapport, health literacy among patients, external influences from carers and social media, and system challenges. CONCLUSION Deprescribing was deemed necessary by both patients and doctors when there was a reason to do so. However, both doctors and patients were afraid to deprescribe as they 'didn't want to rock the boat'. Early-career doctors were reluctant to deprescribe as they felt compelled to continue medications that were initiated by another specialist. Doctors requested more training on how to deprescribe medications.
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Affiliation(s)
- Sheron Sir Loon Goh
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia.
- School of Medical and Life Sciences, Sunway University, Sunway City, Selangor, 47500, Malaysia.
| | - Siti Nurkamilla Ramdzan
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Kit Mun Tan
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
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Abdel Baky A, Omar TEI, Amer YS. Adapting global evidence-based practice guidelines to the Egyptian healthcare context: the Egyptian Pediatric Clinical Practice Guidelines Committee (EPG) initiative. BULLETIN OF THE NATIONAL RESEARCH CENTRE 2023; 47:88. [PMID: 37334162 PMCID: PMC10262930 DOI: 10.1186/s42269-023-01059-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/04/2023] [Indexed: 06/20/2023]
Abstract
Background In Egypt, academic organizations, professional societies, and research groups develop clinical practice guidelines (CPGs) in order to improve patient quality care and safety. Although important improvements have been made over the past years, many of these consensus-based guideline documents still lack the transparency and methodological rigor of international standards and methodologies recommended by reference evidence-based healthcare and guideline organizations like the Guidelines International Network. Main body of the abstract In the Egyptian Pediatric Clinical Practice Guidelines Committee (EPG), we have adopted one of the CPG formal adaptation methodological frameworks named the 'Adapted ADAPTE', relevant CPG resources (e.g., the Appraisal of Guidelines for Research and Evaluation or AGREE II Instrument), and involved key stakeholders including clinical and healthcare topic experts and guideline methodologists in producing 32 trustworthy national evidence-based CPGs and one protocol customized to the healthcare context and services provided for Egyptian children. An EPG online website was launched to make these CPGs available and accessible as CPG summaries for pediatricians and relevant healthcare providers. Short conclusion The lessons learned, enablers, challenges, and solutions relevant to Egyptian National Pediatric CPGs identified in this paper could be used to address and enrich the debate on pediatric high-quality CPGs, especially for countries of similar contexts and systems. Supplementary Information The online version contains supplementary material available at 10.1186/s42269-023-01059-0.
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Affiliation(s)
- Ashraf Abdel Baky
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Pediatrics Department, MTI University, Cairo, Egypt
- Pediatrics Department, Armed Forces College of Medicine (AFCM), Cairo, Egypt
| | - Tarek E. I. Omar
- Egyptian Pediatric Clinical Practice Guidelines Committee (EPG), Cairo, Egypt
- Pediatrics Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yasser Sami Amer
- Egyptian Pediatric Clinical Practice Guidelines Committee (EPG), Cairo, Egypt
- Pediatrics Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Pediatrics Department, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Adaptation Working Group, Guidelines International Network, Perth, Scotland
| | - the Egyptian Pediatric Clinical Practice Guidelines Committee (EPG)
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Pediatrics Department, MTI University, Cairo, Egypt
- Pediatrics Department, Armed Forces College of Medicine (AFCM), Cairo, Egypt
- Egyptian Pediatric Clinical Practice Guidelines Committee (EPG), Cairo, Egypt
- Pediatrics Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Pediatrics Department, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Adaptation Working Group, Guidelines International Network, Perth, Scotland
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Mpasa F, van Rooyen DRM, Jordan PJ, Venter D, ten Ham-Baloyi W. Malawian critical care nurses' views on the implementation of an educational intervention to enhance sustained use of an evidence-based endotracheal tube cuff pressure management guideline: A survey study. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2023; 39:10.7196/SAJCC.2023.v39i1.550. [PMID: 37521961 PMCID: PMC10378196 DOI: 10.7196/sajcc.2023.v39i1.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 02/09/2023] [Indexed: 08/01/2023] Open
Abstract
Background Evidence-based guidelines can assist critical care nurses in promoting best practices, including those related to endotracheal tube cuff pressure management. However, these guidelines require tailored strategies to enhance their implementation, uptake, and sustained use in practice. Objectives To evaluate Malawian critical care nurses' views on the implementation of an endotracheal tube cuff pressure management guideline to enhance sustained guideline use. Methods An explorative-descriptive survey design was employed, using a questionnaire with closed- and open-ended questions that was distributed after implementation of an educational intervention based on an endotracheal tube cuff pressure management guideline. The questionnaire had a Cronbach's alpha score of 0.85. Results A total of 47 nurses working in four public and two private hospital intensive care units in Malawi participated. Quantitative findings showed that the majority of the participants (92%) indicated that the strategies used for the group that received the full intervention including both active (monitoring visits) and passive (a half-day educational session using a PowerPoint presentation, and a printed guideline and algorithm) strategies (intervention 1 group) were useful, clear and applicable and enhanced implementation of the guideline. These results were statistically significant (mean (standard deviation) 1.86 (0.84); t=6.07; p<0.0005). Qualitative data revealed three major themes related to recommendations for uptake and sustained use of the guideline in nursing practice: the guideline needs to be translated, updated, and made available to ICU staff; implementation strategies (continuous supervision and follow-up); and facilitating factors for successful implementation (education and training on guideline content, resources, and commitment to best practices). Conclusion The study highlighted that although the implementation strategies used were positively received by participants, they need to be further tailored to their context to enhance guideline uptake and sustained use in practice. Further study is required to ensure that tailored implementation strategies facilitate guideline uptake and sustained use, specifically in resource-constrained contexts. Contributions of the study The study findings can be used by nurses and academics when developing educational interventions for critical care units to enhance implementation of guidelines in this context.
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Affiliation(s)
- F Mpasa
- Lecturer, Department of Nursing and Midwifery Science, Faculty of Health Sciences, Mzuzu University, Luwinga, Malawi; Former PhD candidate,
Department of Nursing Science, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - Dalena R M van Rooyen
- Deputy Dean, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - P J Jordan
- Associate Professor and Head, Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town,
South Africa
| | - D Venter
- Consultant Statistician, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - W ten Ham-Baloyi
- Research Associate, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
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Vadiveloo MK, Thorndike AN, Lichtenstein AH. Integrating Diet Screening Into Routine Clinical Care: The Time Is Now. J Am Heart Assoc 2023; 12:e028583. [PMID: 36583426 PMCID: PMC9973602 DOI: 10.1161/jaha.122.028583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Maya K. Vadiveloo
- Department of Nutrition and Food Sciences, College of Health SciencesUniversity of Rhode IslandKingstonRI
| | - Anne N. Thorndike
- Harvard Medical SchoolBostonMA
- Division of General Internal Medicine, Department of MedicineMassachusetts General HospitalBostonMA
| | - Alice H. Lichtenstein
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on AgingTufts UniversityBostonMA
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Prochaska M, Meltzer D, Angelos P. When Guideline-Concordant Standardized Care Results in Healthcare Disparities. THE JOURNAL OF CLINICAL ETHICS 2023; 34:225-232. [PMID: 37831649 DOI: 10.1086/726815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
AbstractClinical red blood cell transfusion guidelines have been widely adopted in clinical practice, resulting in standardized transfusion practices in hospitalized patients with anemia. Standardization of transfusion practice has been welcomed by clinicians and health systems as a mechanism for reducing unnecessary, harmful, and costly practice variation that results in healthcare disparities. However, overzealously applied guidelines can have deleterious consequences for individual patients, ultimately resulting in and/or exacerbating healthcare disparities, rather than resolving them. This article provides empirical examples of the adverse consequences from the well-meaning attempt to standardize transfusion practice based on clinical practice guidelines and discusses the ethical implications of standardized transfusion practice.
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Amer YS, Anabrees J, Abdelmawla M, Abdalgader A, Almazroei A, Alhifzi I, AlOnazi AH, Sabr Y, Hneiny L, El-Malky A, Alshalawi A, Alayoubi A, Chaudhry IA, Elkhateeb O. Clinical practice guidelines for neonatal hypoxic-ischemic encephalopathy: A systematic review using the appraisal of guidelines for research and evaluation (AGREE) II instrument. Front Pediatr 2023; 11:1092578. [PMID: 37033166 PMCID: PMC10073446 DOI: 10.3389/fped.2023.1092578] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Background and Objective To systematically review, critically appraise the quality of recent clinical practice guidelines (CPGs) for neonatal hypoxic ischemic encephalopathy (HIE), and map their recommendations. Data Sources CPG databases (GIN, ECRI, NICE, SIGN, DynaMed), Bibliographic databases (PubMed, Embase, CINAHL), and related specialized professional societies (e.g., AAP, CPS, BAPM, RCPCH, and SNS). Study Selection Original de-novo developed evidence-based CPGs for HIE, group authorship, Arabic or English languages, and international or national scope. The systematic review was drafted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and Johnston et al methodological guide. Data Extraction Quality assessment of the included HIE CPGs by the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) Instrument and report their characteristics, AGREE II ratings, and recommendations. Data Synthesis Our search retrieved 2,489 citations, of which two recent HIE CPGs were eligible and appraised: Canadian Paediatric Society (CPS) and Queensland Maternity and Neonatal Services (QMN). The overall assessment of the QMN CPG was superior (83%). Domain 1 (Scope & Purpose) scored (47%, 63%), Domain 2 (Stakeholder Involvement) (72%, 39%), Domain 3 (Rigour of Development) (48%, 43%), Domain 4 (Clarity & Presentation) (100%, 96%), Domain 5 (Applicability) (59%, 9%), and Domain 6 (Editorial Independence) (67%, 17%) for the QMN and CPS CPGs respectively. All appraisers recommended the QMN CPG for use in practice. Conclusion The methodological quality of the QMN CPG was superior with the relevant recommendations for its use in neonatal practice. Limitations limited to Arabic and English languages. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258291, identifier: CRD42021258291.
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Affiliation(s)
- Yasser S. Amer
- Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
- Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
- Adaptation Working Group, Guidelines International Network, Perth, Scotland
- Correspondence: Yasser S. Amer Jasim Anabrees
| | - Jasim Anabrees
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Saudi Neonatology Society (SNS), Riyadh, Saudi Arabia
- Correspondence: Yasser S. Amer Jasim Anabrees
| | - Mohamed Abdelmawla
- Pediatrics Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Ayman Abdalgader
- Neonatology Department, Pediatric Hospital, King Saud Medical City, Riyadh, Saudi Arabia
| | - Asmaa Almazroei
- Pediatrics Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | | | - Abdullah Hawash AlOnazi
- Neonatal Intensive Care Unit, Critical Care Services, King Fahad Medical City, MOH, Riyadh, Saudi Arabia
| | - Yasser Sabr
- Obstetrics and Gynecology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Layal Hneiny
- Wegner Health Sciences Library, University of South Dakota, Sioux Falls, SD, United States
| | - Ahmed El-Malky
- Morbidity and Mortality Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Public Health and Community Medicine Department, Theodor Bilharz Research Institute (TBRI), Academy of Scientific Research, Cairo, Egypt
| | - Ayesha Alshalawi
- Nursing Department, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Ahmed Alayoubi
- Pediatric Department, Umm Al Qura University, Makkah, Saudi Arabia
| | - Iftikhar A. Chaudhry
- Obstetrics and Gynecology Department, Al-Yamamah Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Omar Elkhateeb
- Neonatal Intensive Care Unit, Critical Care Services, King Fahad Medical City, MOH, Riyadh, Saudi Arabia
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Nagavci B, Nyirenda JLZ, Balugaba BE, Osuret J, Meerpohl JJ, Grummich K, Kobusingye O, Toews I. Evidence-based guidelines for hypertension and diabetes in sub-Saharan Africa: a scoping review. BMJ Open 2022; 12:e067156. [PMID: 36549745 PMCID: PMC9791379 DOI: 10.1136/bmjopen-2022-067156] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/24/2022] Open
Abstract
OBJECTIVE The Collaboration for Evidence-Based Healthcare and Public Health in sub-Saharan Africa (CEBHA+), a research network, aims to build capacities for evidence-based healthcare. Hypertension (HTN) and diabetes mellitus (DM) are two priority areas of the network, both are major causes of burden of disease in this region. This review aimed to: (1) identify existing evidence-based guidelines for HTN and DM, (2) map their recommendations and (3) assess their quality. SETTING Sub-Saharan Africa. DESIGN Scoping review. METHODS Systematic searches for evidence-based guidelines, developed with systematic review of evidence and certainty of evidence assessment, were undertaken in electronic databases and grey literature, and ministries of health of all countries in this region were contacted. Included guidelines were assessed with the Appraisal of Guidelines for research and evaluation II (AGREE-II) tool. Searches were conducted between 7 December 2021 and 14 January 2022. Results are presented descriptively. RESULTS 66 potentially relevant guidelines were identified, developed in 23, out of 49 sub-Saharan African countries. Of these, only two guidelines (on DM) reported the use of systematic review of evidence and certainty of evidence assessment. Their quality appraisal showed that both have relatively similar scores on domains of AGREE-II, with higher scores on Scope and Purpose and Clarity and Presentation domains, and lower on Stakeholder Involvement, Applicability, Rigour of Development and Editorial independence domains. The overall scores of both guidelines were 50% and 58%, respectively. CONCLUSIONS Less than half of the countries in sub-Saharan Africa developed and published their own guidelines for HTN or DM. The quality appraisal showed that the two included guidelines scored relatively low in several crucial domains of AGREE-II. Countries in this region could consider adopting or adapting already published high-quality recommendations, in order to facilitate a more efficient and faster development of much needed trustworthy evidence-based guidance.
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Affiliation(s)
- Blin Nagavci
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - John L Z Nyirenda
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Bonny E Balugaba
- Department of Disease Control and Environmental Health, Makerere University, Kampala, Uganda
| | - Jimmy Osuret
- Department of Disease Control and Environmental Health, Makerere University, Kampala, Uganda
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- Cochrane Germany Foundation, Freiburg, Germany
| | - Kathrin Grummich
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Olive Kobusingye
- Department of Disease Control and Environmental Health, Makerere University, Kampala, Uganda
| | - Ingrid Toews
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Bierbaum M, Rapport F, Arnolda G, Delaney GP, Liauw W, Olver I, Braithwaite J. Clinical practice guideline adherence in oncology: A qualitative study of insights from clinicians in Australia. PLoS One 2022; 17:e0279116. [PMID: 36525435 PMCID: PMC9757567 DOI: 10.1371/journal.pone.0279116] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The burden of cancer is large in Australia, and rates of cancer Clinical Practice Guideline (CPG) adherence is suboptimal across various cancers. METHODS The objective of this study is to characterise clinician-perceived barriers and facilitators to cancer CPG adherence in Australia. Semi-structured interviews were conducted to collect data from 33 oncology-focused clinicians (surgeons, radiation oncologists, medical oncologists and haematologists). Clinicians were recruited in 2019 and 2020 through purposive and snowball sampling from 7 hospitals across Sydney, Australia, and interviewed either face-to-face in hospitals or by phone. Audio recordings were transcribed verbatim, and qualitative thematic analysis of the interview data was undertaken. Human research ethics committee approval and governance approval was granted (2019/ETH11722, #52019568810127). RESULTS Five broad themes and subthemes of key barriers and facilitators to cancer treatment CPG adherence were identified: Theme 1: CPG content; Theme 2: Individual clinician and patient factors; Theme 3: Access to, awareness of and availability of CPGs; Theme 4: Organisational and cultural factors; and Theme 5: Development and implementation factors. The most frequently reported barriers to adherence were CPGs not catering for patient complexities, being slow to be updated, patient treatment preferences, geographical challenges for patients who travel large distances to access cancer services and limited funding of CPG recommended drugs. The most frequently reported facilitators to adherence were easy accessibility, peer review, multidisciplinary engagement or MDT attendance, and transparent CPG development by trusted, multidisciplinary experts. CPGs provide a reassuring framework for clinicians to check their treatment plans against. Clinicians want cancer CPGs to be frequently updated utilising a wiki-like process, and easily accessible online via a comprehensive database, coordinated by a well-trusted development body. CONCLUSION Future implementation strategies of cancer CPGs in Australia should be tailored to consider these context-specific barriers and facilitators, taking into account both the content of CPGs and the communication of that content. The establishment of a centralised, comprehensive, online database, with living wiki-style cancer CPGs, coordinated by a well-funded development body, along with incorporation of recommendations into point-of-care decision support would potentially address many of the issues identified.
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Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- * E-mail:
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
| | - Geoff P. Delaney
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
- SWSLHD Cancer Services, Liverpool, Australia
| | - Winston Liauw
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
- SESLHD Cancer Service, Kogarah, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
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Hasson RE, Eisman AB, Wassmann A, Martin S, Pugh P, Winkelseth K, Zernicke R, Rabaut L. Rapid cycle adaptation of a classroom-based intervention to promote equity in access to youth physical activity. Transl Behav Med 2022; 12:945-955. [PMID: 36205474 PMCID: PMC9540976 DOI: 10.1093/tbm/ibac049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Our objective was to systematically adapt Interrupting Prolonged sitting with ACTivity (InPACT), a classroom-based physical activity intervention, for home delivery to equitably increase access to structured youth physical activity opportunities during the COVID-19 pandemic. Key steps in the rapid-cycle research adaptation process included: (Step 1) identifying partner organizations; (Steps 2 and 3) engaging in problem and knowledge exploration to examine the problem from different perspectives; (Steps 4 and 5) initiating solution development and testing by selecting an intervention and adapting the format and content for home delivery. Using Rapid RE-AIM to guide online assessment and refinement of InPACT at Home; and (Step 6) utilizing dissemination strategies to extend the reach of the program. Core elements of the InPACT program that were retained included: the use of exercise videos, maintenance of the intervention dose, and teacher-led physical activities. Key adaptations included: utilization of physical education specialists to develop the exercise videos, incorporation of health messaging in videos, and utilization of dissemination strategies (intervention website) to reach K-12 students across the state. Intervention website reach included all 83 counties in Michigan, but goals were not met for website pageviews (5,147; 85% of goal) and video view duration (7 min 19 sec; 37% of goal). Accordingly, dissemination was expanded to include public television broadcasting (monthly viewers: 500,000) and videos were shortened to 8 minutes. Dissemination and implementation science frameworks guided the rapid adaptation of an existing intervention, InPACT, to equitably increase access to structured youth physical activity opportunities at home during the pandemic.
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Affiliation(s)
- Rebecca E Hasson
- University of Michigan, School of Kinesiology, Ann Arbor, MI, USA
- University of Michigan, Exercise & Sport Science Initiative, Ann Arbor, MI, USA
| | - Andria B Eisman
- Wayne State University, College of Education, Detroit, MI, USA
- Wayne State University, Center for Health and Community Impact, Detroit, MI, USA
| | - Amy Wassmann
- Saginaw Intermediate School District, Saginaw, MI, USA
| | - Scott Martin
- Michigan Department of Education, Lansing, MI, USA
| | - Pamela Pugh
- Michigan State Board of Education Vice President, Lansing, MI, USA
| | - Kerry Winkelseth
- University of Michigan, School of Kinesiology, Ann Arbor, MI, USA
| | - Ronald Zernicke
- University of Michigan, Exercise & Sport Science Initiative, Ann Arbor, MI, USA
- University of Michigan Department of Orthopaedic Surgery, Ann Arbor, MI, USA
| | - Lisa Rabaut
- University of Michigan, Exercise & Sport Science Initiative, Ann Arbor, MI, USA
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Rourke L. Knowledge mobilization for primary care: Lessons learned from 40 years of the Rourke Baby Record. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:721-725. [PMID: 36241413 PMCID: PMC9833132 DOI: 10.46747/cfp.6810721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Leslie Rourke
- Professor Emerita in Family Medicine at Memorial University of Newfoundland in St John’s.,Correspondence Dr Leslie Rourke; e-mail
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30
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Rourke L. Mobilisation des connaissances pour les soins primaires. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:729-735. [PMID: 36241396 PMCID: PMC9833144 DOI: 10.46747/cfp.6810729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Leslie Rourke
- Professeure émérite de médecine familiale à l’Université Memorial de Terre-Neuve, à St John’s
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Patra KP, Hall M, DeLaroche AM, Tieder JS. Impact of the AAP Guideline on Management of Brief Resolved Unexplained Events. Hosp Pediatr 2022; 12:780-791. [PMID: 35965275 DOI: 10.1542/hpeds.2021-006427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES In May 2016, the American Academy of Pediatrics published a clinical practice guideline (CPG) defining apparent life-threatening events (ALTEs) as brief resolved unexplained events (BRUEs) and recommending risk-based management. We analyzed the association of CPG publication on admission rate, diagnostic testing, treatment, cost, length of stay (LOS), and revisits in patients with BRUE. METHODS Using the Pediatric Health Information Systems database, we studied patients discharged from the hospital with a diagnosis of ALTE/BRUE from January 2012 to December 2019. We grouped encounters into 2 time cohorts on the basis of discharge date: preguideline (January 2012-January 2016) and postguideline (July 2016-December 2019). We used interrupted time series to test if the CPG publication was associated with level change and change in slope for each metric. RESULTS The study included 27 941 hospitalizations for ALTE/BRUE from 36 hospitals. There was an early decrease in 12 diagnostic tests that the CPG strongly recommended against. There was a positive change in the use of electrocardiogram (+3.5%, P < .001), which is recommended by CPG. There was a significant reduction in admissions (-13.7%, P < .001), utilization of medications (-8.3%, P < .001), cost (-$1146.8, P < .001), and LOS (-0.2 days, P < .001), without a change in the revisit rates. In the postguideline period, there were an estimated 2678 admissions avoided out of 12 508 encounters. CONCLUSIONS Publication of the American Academy of Pediatrics BRUE CPG was associated with substantial reductions in testing, utilization of medications, admission rates, cost, and LOS, without a change in the revisit rates.
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Affiliation(s)
- Kamakshya P Patra
- West Virginia University Medicine Children's Hospital, Morgantown, West Virginia
| | | | | | - Joel S Tieder
- University of Washington and Seattle Children's Hospital, Seattle Washington
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32
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Amer YS, Shaiba LA, Hadid A, Anabrees J, Almehery A, AAssiri M, Alnemri A, Darwish ARA, Baqawi B, Aboshaiqah A, Hneiny L, Almaghrabi RH, El-Malky AM, Al-Dajani NM. Quality assessment of clinical practice guidelines for neonatal sepsis using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument: A systematic review of neonatal guidelines. Front Pediatr 2022; 10:891572. [PMID: 36052365 PMCID: PMC9424847 DOI: 10.3389/fped.2022.891572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objective Neonatal sepsis (NS) continues to be a critical healthcare priority for the coming decades worldwide. The aim of this study was to critically appraise the quality of recent clinical practice guidelines (CPGs) for neonatal sepsis and to summarize and compare their recommendations. Methods This study involves a systematic review of CPGs. We identified clinical questions and eligibility criteria and searched and screened for CPGs using bibliographic and CPG databases and professional societies. Each included CPG was assessed by four independent appraisers using the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument. We summarized the recommendations in a comparison practical table. The systematic review was drafted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Its protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42021258732). Results Our search retrieved 4,432 citations; of which five CPGs were eligible and appraised: American Academy of Pediatrics (AAP 2018) (35 and 34 weeks); Canadian Pediatric Society (CPS 2017); National Institute for Health and Care Excellence (NICE 2021); and Queensland Maternity and Neonatal Services (QH 2020). Among these, the overall assessment of two evidence-based CPGs scored > 70% (NICE and QH), which was consistent with their higher scores in the six domains of the AGREE II instrument. In domain 3 (rigor of development), NICE and QH scored 99 and 60%, respectively. In domain 5 (applicability), they scored 96 and 74%, respectively, and in domain 6 (editorial independence), they scored 90 and 71%, respectively. Conclusion The methodological quality of the NICE CPG was superior followed by the QH CPG with relevant recommendations for use in practice. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021258732, PROSPERO (CRD42021258732).
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Affiliation(s)
- Yasser S. Amer
- Pediatrics Department, King Khalid University Hospital, Riyadh, Saudi Arabia
- Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
- Adaptation Working Group, Guidelines International Network, Perth, Scotland
| | - Lana A. Shaiba
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Neonatal Intensive Care Unit, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Adnan Hadid
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Neonatal Intensive Care Unit, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Jasim Anabrees
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Neonatal Intensive Care Unit, King Saud University Medical City, Riyadh, Saudi Arabia
- Saudi Neonatology Society (SNS), Riyadh, Saudi Arabia
| | | | - Manal AAssiri
- Neonatology Department, King Abdulaziz Hospital, Ministry of Health, Jeddah, Saudi Arabia
| | - Abdulrahman Alnemri
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Neonatal Intensive Care Unit, King Saud University Medical City, Riyadh, Saudi Arabia
- Saudi Neonatology Society (SNS), Riyadh, Saudi Arabia
| | - Amira R. Al Darwish
- Clinical Pharmacy Department, Pharmacy Services, Second Health Cluster in Central Region, Riyadh, Saudi Arabia
- Pharmacy Department, King Fahad Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Badi Baqawi
- Obstetrics and Gynecology Department, King Fahad Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Layal Hneiny
- Saab Medical Library, University Libraries, American University of Beirut, Beirut, Lebanon
- Wegner Health Sciences Library, University of South Dakota, Sioux Falls, SD, United States
| | - Rana H. Almaghrabi
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ahmed M. El-Malky
- Morbidity and Mortality Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Public Health and Community Medicine Department, Theodor Bilharz Research Institute (TBRI), Academy of Scientific Research, Cairo, Egypt
| | - Nawaf M. Al-Dajani
- Neonatal Intensive Care Unit, Infectious Diseases Unit, Pediatrics Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Garcia ME, Hinton L, Neuhaus J, Feldman M, Livaudais-Toman J, Karliner LS. Equitability of Depression Screening After Implementation of General Adult Screening in Primary Care. JAMA Netw Open 2022; 5:e2227658. [PMID: 35980633 PMCID: PMC9389351 DOI: 10.1001/jamanetworkopen.2022.27658] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
IMPORTANCE Depression is a debilitating and costly medical condition that is often undertreated. Men, racial and ethnic minority individuals, older adults, and those with language barriers are at increased risk for undertreatment of depression. Disparities in screening may contribute to undertreatment. OBJECTIVE To examine depression screening rates among populations at risk for undertreatment of depression during and after rollout of general screening. DESIGN, SETTING, AND PARTICIPANTS This cohort study from September 1, 2017, to December 31, 2019, of electronic health record data from 52 944 adult patients at 6 University of California, San Francisco, primary care facilities assessed depression screening rates after implementation of a general screening policy. Patients were excluded if they had a baseline diagnosis of depression, bipolar disorder, schizophrenia, schizoaffective disorder, or dementia. EXPOSURES Screening year, including rollout (September 1, 2017, to December 31, 2017) and each subsequent calendar year (January 1 to December 31, 2018, and January 1 to December 31, 2019). MAIN OUTCOMES AND MEASURES Rates of depression screening performed by medical assistants using the Patient Health Questionnaire-2. Data collected included age, sex, race and ethnicity, and language preference (English vs non-English); to compare English and non-English language preference groups and also assess depression screening by race and ethnicity within the English-speaking group, a single language-race-ethnicity variable with non-English language preference and English language preference categories was created. In multivariable analyses, the likelihood of being screened was evaluated using annual logistic regression models for 2018 and 2019, examining sex, age, language-race-ethnicity, and comorbidities, with adjustment for primary care site. RESULTS There were 52 944 unique, eligible patients with 1 or more visits in one of the 6 primary care practices during the entire study period (59% female; mean [SD] age, 48.9 [17.6] years; 178 [0.3%] American Indian/Alaska Native, 13 241 [25.0%] English-speaking Asian, 3588 [6.8%] English-speaking Black/African American, 4744 [9.0%] English-speaking Latino/Latina/Latinx, 760 [1.4%] Pacific Islander, 22 689 [42.9%] English-speaking White, 4857 [9.0%] English-speaking other [including individuals who indicated race and ethnicity as other and individuals for whom race and ethnicity data were missing or unknown], and 2887 [5.5%] with language barriers [non-English language preference]). Depression screening increased from 40.5% at rollout (2017) to 88.8% (2019). In 2018, the likelihood of being screened decreased with increasing age (adusted odds ratio [aOR], 0.89 [95% CI, 0.82-0.98] for ages 45-54 and aOR, 0.75 [95% CI, 0.65-0.85] for ages 75 and older compared with ages 18-30); and, except for Spanish-speaking patients, patients with limited English proficiency were less likely to be screened for depression than English-speaking White patients (Chinese language preference: aOR, 0.59 [95% CI, 0.51-0.67]; other non-English language preference: aOR, 0.55 [95% CI, 0.47-0.64]). By 2019, depression screening had increased dramatically for all at-risk groups, and for most, disparities had disappeared; the odds of screening were only still significantly lower for men compared with women (aOR, 0.87 [95% CI, 0.81 to 0.93]). CONCLUSIONS AND RELEVANCE In this cohort study in a large academic health system, full implementation of depression screening was associated with a substantial increase in screening rates among groups at risk for undertreatment of depression. In addition, depression screening disparities narrowed over time for most groups, suggesting that routine depression screening in primary care may reduce screening disparities and improve recognition and appropriate treatment of depression for all patients.
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Affiliation(s)
- Maria E. Garcia
- Center for Aging in Diverse Communities, University of California, San Francisco, San Francisco
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco
- Implementation Science Training Program, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis
| | - John Neuhaus
- Implementation Science Training Program, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Mitchell Feldman
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco
| | | | - Leah S. Karliner
- Center for Aging in Diverse Communities, University of California, San Francisco, San Francisco
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco
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Amer YS, Alenezi S, Bashiri FA, Alawami AH, Alhazmi AS, Aladamawi SA, Alnemary F, Alqahtani Y, Buraik MW, AlSuwailem SS, Akhalifah SM, Augusta de Souza Pinhel M, Penner M, Elmalky AM. AGREEing on Clinical Practice Guidelines for Autism Spectrum Disorders in Children: A Systematic Review and Quality Assessment. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1050. [PMID: 35884034 PMCID: PMC9323940 DOI: 10.3390/children9071050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a multifaceted neurodevelopmental disorder requiring multimodal intervention and an army of multidisciplinary teams for a proper rehabilitation plan. Accordingly, multiple practice guidelines have been published for different disciplines. However, systematic evidence to detect and intervene must be updated regularly. Our main objective is to compare and summarize the recommendations made in the clinical practice guidelines (CPGs) for ASD in children released from November 2015 to March 2022. METHODS CPGs were subjected to a systematic review. We developed the inclusion and exclusion criteria and health-related questions, then searched and screened for CPGs utilizing bibliographic and CPG databases. Each of the CPGs used in the study were critically evaluated using the Appraisal of Guidelines for REsearch and Evaluation II (AGREE II) instrument. In a realistic comparison table, we summarized the recommendations. RESULTS Four eligible CPGs were appraised: Australian Autism CRC (ACRC); Ministry of Health New Zealand (NZ); National Institute for Health and Care Excellence (NICE); and Scottish Intercollegiate Guidelines Network, Healthcare Improvement Scotland (SIGN-HIS). The overall assessments of all four CPGs scored greater than 80%; these findings were consistent with the high scores in the six domains of AGREE II, including: (1) scope and purpose, (2) stakeholder involvement, (3) rigor of development, (4) clarity of presentation, (5) applicability, and (6) editorial independence domains. Domain (3) scored 84%, 93%, 86%, and 85%; domain (5) 92%, 89%, 54%, and 85%; and domain (6) 92%, 96%, 88%, and 92% for ACRC, NICE, NZ, and SIGN-HIS, respectively. Overall, there were no serious conflicts between the clinical recommendations of the four CPGs, but some were more comprehensive and elaborative than others. CONCLUSIONS All four assessed evidence-based CPGs demonstrated high methodological quality and relevance for use in practice.
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Affiliation(s)
- Yasser S. Amer
- Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, Riyadh 11451, Saudi Arabia
- Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh 11451, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh 11451, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria 5424041, Egypt
- Guidelines International Network, Perth PH16 5BU, Scotland, UK
| | - Shuliweeh Alenezi
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Fahad A. Bashiri
- Pediatric Neurology Division, Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Amel Hussain Alawami
- Johns Hopkins Aramco Healthcare, Dhahran 34465, Saudi Arabia; (A.H.A.); (M.W.B.)
| | - Ayman Shawqi Alhazmi
- Developmental Pediatric Department, Children’s Hospital, King Saud Medical City, Ministry of Health, Riyadh 12746, Saudi Arabia;
| | - Somayyah A. Aladamawi
- King Abdullah bin Abdulaziz University Hospital, Riyadh 11564, Saudi Arabia;
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
| | - Faisal Alnemary
- Autism Center of Excellence, Riyadh 11564, Saudi Arabia; (F.A.); (S.S.A.); (S.M.A.)
| | | | - Maysaa W. Buraik
- Johns Hopkins Aramco Healthcare, Dhahran 34465, Saudi Arabia; (A.H.A.); (M.W.B.)
| | - Saleh S. AlSuwailem
- Autism Center of Excellence, Riyadh 11564, Saudi Arabia; (F.A.); (S.S.A.); (S.M.A.)
| | - Shahad M. Akhalifah
- Autism Center of Excellence, Riyadh 11564, Saudi Arabia; (F.A.); (S.S.A.); (S.M.A.)
| | - Marcela Augusta de Souza Pinhel
- Department of Health Science, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, Brazil;
- Department of Molecular Biology, São José do Rio Preto Medical School, São José do Rio Preto 15090-000, Brazil
| | - Melanie Penner
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada;
- Department of Pediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Ahmed M. Elmalky
- Morbidity and Mortality Unit, King Saud University Medical City, King Saud University, Riyadh 11451, Saudi Arabia;
- Public Health and Community Medicine Department, Theodor Bilharz Research Institute (TBRI), Academy of Scientific Research, Cairo 3863130, Egypt
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Sayarifard A, Nazari M, Bahmanziari N, Mehrdad N, Ghadirian L. Challenges of Clinical Practice Guidelines Adaptation in Iran: Lesson learned for Low and Middle-Income Countries. Med J Islam Repub Iran 2022; 36:71. [PMID: 36128294 PMCID: PMC9448469 DOI: 10.47176/mjiri.36.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/29/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Developing a clinical practice guideline (CPG) is very time-consuming, expensive, and requires specialized knowledge; therefore, when an up-to-date and quality CPG is available, it is logical to adapt it according to local conditions. So this study aimed to identify the challenges of CPGs adaptation in Iran to help improve it and provide lessons for low and middle-income countries (LMICs). Methods: This was a qualitative study that was conducted in 2019. Semi-structured interviews were conducted with 17 participants from two levels, groups involved in the CPGs adaptation process, from research centers and specialized medical associations and policymakers and planners in CPG development and adaptation from the Ministry of Health and Medical Education (MoHME). Results: The identified challenges were classified into two basic and operational categories. Basic challenges include believing the need for CPGs adaptation, attention to CPGs adaptation in evaluation and reward systems, access to financial resources, and supervision of the adaptation process. Also, operational challenges were adaptation methodology, forming an adaptation team, consensus on interdisciplinary issues, changing programs and priorities, and external barriers in the work progress path. Conclusion: The main challenges of CPGs adaptation in Iran, as one of the LMICs, are related to education, financing, and supervision of adaptation process steps. The most significant proposed interventions to overcome the current obstacles in countries with similar contexts are holding new training courses and programs for these CPG users at different headquarters' and environmental levels, establishing an appropriate motivating system, designing an integrated adaptation system focusing on organizing related supervision affairs like planning, policy-making, and supervision at the MoHME and universities level.
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Affiliation(s)
- Azadeh Sayarifard
- Knowledge Utilization Research Center, Center for Academic and Health Policy, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nazari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmeh Bahmanziari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Mehrdad
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Knowledge Utilization Research Center, Center for Academic and Health Policy, Tehran University of Medical Sciences, Tehran, Iran
| | - Laleh Ghadirian
- Knowledge Utilization Research Center, Center for Academic and Health Policy, Tehran University of Medical Sciences, Tehran, Iran
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Breneol S, Curran JA, Marten R, Minocha K, Johnson C, Wong H, Langlois EV, Wozney L, Vélez CM, Cassidy C, Juvekar S, Rothfus M, Aziato L, Keeping-Burke L, Adjorlolo S, Patiño-Lugo DF. Strategies to adapt and implement health system guidelines and recommendations: a scoping review. Health Res Policy Syst 2022; 20:64. [PMID: 35706039 PMCID: PMC9202131 DOI: 10.1186/s12961-022-00865-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/09/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Evidence-based health system guidelines are pivotal tools to help outline the important financial, policy and service components recommended to achieve a sustainable and resilient health system. However, not all guidelines are readily translatable into practice and/or policy without effective and tailored implementation and adaptation techniques. This scoping review mapped the evidence related to the adaptation and implementation of health system guidelines in low- and middle-income countries. METHODS We conducted a scoping review following the Joanna Briggs Institute methodology for scoping reviews. A search strategy was implemented in MEDLINE (Ovid), Embase, CINAHL, LILACS (VHL Regional Portal), and Web of Science databases in late August 2020. We also searched sources of grey literature and reference lists of potentially relevant reviews. All findings were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS A total of 41 studies were included in the final set of papers. Common strategies were identified for adapting and implementing health system guidelines, related barriers and enablers, and indicators of success. The most common types of implementation strategies included education, clinical supervision, training and the formation of advisory groups. A paucity of reported information was also identified related to adaptation initiatives. Barriers to and enablers of implementation and adaptation were reported across studies, including the need for financial sustainability. Common approaches to evaluation were identified and included outcomes of interest at both the patient and health system level. CONCLUSIONS The findings from this review suggest several themes in the literature and identify a need for future research to strengthen the evidence base for improving the implementation and adaptation of health system guidelines in low- and middle-income countries. The findings can serve as a future resource for researchers seeking to evaluate implementation and adaptation of health system guidelines. Our findings also suggest that more effort may be required across research, policy and practice sectors to support the adaptation and implementation of health system guidelines to local contexts and health system arrangements in low- and middle-income countries.
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Affiliation(s)
- Sydney Breneol
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
- Strengthening Transitions in Care Lab, IWK Health Centre, 8th Floor Children's Site, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada
| | - Janet A Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada.
- Strengthening Transitions in Care Lab, IWK Health Centre, 8th Floor Children's Site, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada.
| | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Kirti Minocha
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Catie Johnson
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
- Strengthening Transitions in Care Lab, IWK Health Centre, 8th Floor Children's Site, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada
| | - Helen Wong
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
- Faculty of Health, Dalhousie University, Halifax, Canada
| | - Etienne V Langlois
- Partnership for Maternal, Newborn & Child Health (PMNCH), World Health Organization, Geneva, Switzerland
| | - Lori Wozney
- Nova Scotia Health Authority Policy and Planning, Dartmouth, Canada
| | - C Marcela Vélez
- Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Christine Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
- Strengthening Transitions in Care Lab, IWK Health Centre, 8th Floor Children's Site, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Melissa Rothfus
- W.K. Kellogg Health Science Library, Dalhousie University, Halifax, Canada
| | - Lydia Aziato
- School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana
| | - Lisa Keeping-Burke
- Department of Nursing & Health Sciences, University of New Brunswick, St. John, Canada
| | - Samuel Adjorlolo
- Department of Mental Health Nursing, University of Ghana, Legon, Accra, Ghana
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Song Y, Alonso-Coello P, Ballesteros M, Cluzeau F, Vernooij RWM, Arayssi T, Bhaumik S, Chen Y, Ghersi D, Langlois EV, Fuentes Padilla P, Schünemann HJ, Akl EA, Martínez García L, Amer Y, Arevalo-Rodriguez I, Barnes S, Barreto J, Collis D, Dyer S, Fahim C, Florez I, Gallegos-Rivero V, Klugar M, Kuijpers T, Mathew JL, Munn Z, Norris S, Patiño-Lugo DF, Pramesh CS, Rodriguez J, Roy S, Shin ES, Sosa O, Vandvik PO, Velez M, Woodcraft R. A Reporting Tool for Adapted Guidelines in Health Care: The RIGHT-Ad@pt Checklist. Ann Intern Med 2022; 175:710-719. [PMID: 35286143 DOI: 10.7326/m21-4352] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Adaptation of existing guidelines can be an efficient way to develop contextualized recommendations. Transparent reporting of the adaptation approach can support the transparency and usability of the adapted guidelines. OBJECTIVE To develop an extension of the RIGHT (Reporting Items for practice Guidelines in HealThcare) statement for the reporting of adapted guidelines (including recommendations that have been adopted, adapted, or developed de novo), the RIGHT-Ad@pt checklist. DESIGN A multistep process was followed to develop the checklist: establishing a working group, generating an initial checklist, optimizing the checklist (through an initial assessment of adapted guidelines, semistructured interviews, a Delphi consensus survey, an external review, and a final assessment of adapted guidelines), and approval of the final checklist by the working group. SETTING International collaboration. PARTICIPANTS A total of 119 professionals participated in the development process. MEASUREMENTS Participants' consensus on items in the checklist. RESULTS The RIGHT-Ad@pt checklist contains 34 items grouped in 7 sections: basic information (7 items); scope (6 items); rigor of development (10 items); recommendations (4 items); external review and quality assurance (2 items); funding, declaration, and management of interest (2 items); and other information (3 items). A user guide with explanations and real-world examples for each item was developed to provide a better user experience. LIMITATION The RIGHT-Ad@pt checklist requires further validation in real-life use. CONCLUSION The RIGHT-Ad@pt checklist has been developed to improve the reporting of adapted guidelines, focusing on the standardization, rigor, and transparency of the process and the clarity and explicitness of adapted recommendations. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Yang Song
- Iberoamerican Cochrane Centre (CCIb)-Biomedical Research Institute Sant Pau (IIB Sant Pau), and PhD Programme in Methodology of Biomedical Research and Public Health, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain (Y.S.)
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre (CCIb)-Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (P.A., L.M.G.)
| | - Monica Ballesteros
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (M.B.)
| | | | - Robin W M Vernooij
- Department of Nephrology and Hypertension and Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands (R.W.V.)
| | | | - Soumyadeep Bhaumik
- Meta-research & Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, India (S.B.)
| | - Yaolong Chen
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, and WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China (Y.C.)
| | - Davina Ghersi
- National Health and Medical Research Council, Canberra, Australian Capital Territory, Australia (D.G.)
| | - Etienne V Langlois
- Partnership for Maternal, Newborn & Child Health (PMNCH), World Health Organization, Geneve, Switzerland (E.V.L.)
| | | | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact (HEI), Michael G. DeGroote Cochrane Canada and McGRADE Centres, and Department of Medicine, McMaster University, Hamilton, Canada, and Department of Biomedical Sciences, Humanitas University, Milan, Italy (H.J.S.)
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon, and Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada (E.A.A.)
| | - Laura Martínez García
- Iberoamerican Cochrane Centre (CCIb)-Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (P.A., L.M.G.)
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Exploring the perceptions of governance arrangements for nurse practitioners: A pilot study. Collegian 2022. [DOI: 10.1016/j.colegn.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Brownson RC, Shelton RC, Geng EH, Glasgow RE. Revisiting concepts of evidence in implementation science. Implement Sci 2022; 17:26. [PMID: 35413917 PMCID: PMC9004065 DOI: 10.1186/s13012-022-01201-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 04/04/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Evidence, in multiple forms, is a foundation of implementation science. For public health and clinical practice, evidence includes the following: type 1 evidence on etiology and burden; type 2 evidence on effectiveness of interventions; and type 3: evidence on dissemination and implementation (D&I) within context. To support a vision for development and use of evidence in D&I science that is more comprehensive and equitable (particularly for type 3 evidence), this article aims to clarify concepts of evidence, summarize ongoing debates about evidence, and provide a set of recommendations and tools/resources for addressing the "how-to" in filling evidence gaps most critical to advancing implementation science. MAIN TEXT Because current conceptualizations of evidence have been relatively narrow and insufficiently characterized in our opinion, we identify and discuss challenges and debates about the uses, usefulness, and gaps in evidence for implementation science. A set of questions is proposed to assist in determining when evidence is sufficient for dissemination and implementation. Intersecting gaps include the need to (1) reconsider how the evidence base is determined, (2) improve understanding of contextual effects on implementation, (3) sharpen the focus on health equity in how we approach and build the evidence-base, (4) conduct more policy implementation research and evaluation, and (5) learn from audience and stakeholder perspectives. We offer 15 recommendations to assist in filling these gaps and describe a set of tools for enhancing the evidence most needed in implementation science. CONCLUSIONS To address our recommendations, we see capacity as a necessary ingredient to shift the field's approach to evidence. Capacity includes the "push" for implementation science where researchers are trained to develop and evaluate evidence which should be useful and feasible for implementers and reflect community or stakeholder priorities. Equally important, there has been inadequate training and too little emphasis on the "pull" for implementation science (e.g., training implementers, practice-based research). We suggest that funders and reviewers of research should adopt and support a more robust definition of evidence. By critically examining the evolving nature of evidence, implementation science can better fulfill its vision of facilitating widespread and equitable adoption, delivery, and sustainment of scientific advances.
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Affiliation(s)
- Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO 63130 USA
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63130 USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY 10032 USA
| | - Elvin H. Geng
- Division of Infectious Diseases, Department of Medicine and Center for Dissemination and Implementation in the Institute for Public Health, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110 USA
| | - Russell E. Glasgow
- Department of Family Medicine and Adult & Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045 USA
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ADAPTE with modified Delphi supported developing a National Clinical Guideline: Stratification of Clinical Risk in Pregnancy. J Clin Epidemiol 2022; 147:21-31. [DOI: 10.1016/j.jclinepi.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/14/2022] [Accepted: 03/14/2022] [Indexed: 11/21/2022]
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Schröder K, Öberg B, Enthoven P, Hedevik H, Abbott A. Improved adherence to clinical guidelines for low back pain after implementation of the BetterBack model of care: A stepped cluster randomized controlled trial within a hybrid type 2 trial. Physiother Theory Pract 2022:1-15. [PMID: 35230212 DOI: 10.1080/09593985.2022.2040669] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The BetterBack model of care (MoC) for low back pain (LBP) was recently developed in Swedish physiotherapy (PT) primary care. OBJECTIVE To evaluate if PTs' adherence to LBP clinical practice guidelines (CPGs) improves after implementation of the BetterBack MoC (intervention). METHODS This was a stepped, single-blinded cluster randomized controlled trial. Patients nested in the three clusters were allocated to routine care (n = 222) or intervention (n = 278). The primary outcome was referral to specialist consultation. This was among five best practice recommendations divided into an assessment quality index (no referral to specialist consultation and no medical imaging) and a treatment quality index (use of educational interventions; use of exercise interventions; no use of non-evidence-based physiotherapy). For overall adherence, patients had to be treated with all five recommendations fulfilled. Logistic regression was used for between-group comparisons. RESULTS The proportion of patients receiving referral to specialist consultation during the PT treatment period was low in both groups with no between-group differences. However, patients in the intervention group showed significantly higher assessment quality index, treatment quality index and overall adherence compared to routine care. Adherence to the separate recommendations showed improved stratified number of visits, use of exercise was maintained high, patient educational intervention increased and use of non-evidence-based physiotherapy decreased. A reduction of medical imaging during the physiotherapy treatment period was also observed. CONCLUSIONS The adoption of CPGs could be substantially improved by introducing a MoC through PT training and supportive materials.
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Affiliation(s)
- Karin Schröder
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Birgitta Öberg
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Paul Enthoven
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Henrik Hedevik
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Allan Abbott
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Wilson A, Hoang H, Bridgman H, Crocombe L, Bettiol S. Clinical practice guidelines and consensus statements for antenatal oral healthcare: An assessment of their methodological quality and content of recommendations. PLoS One 2022; 17:e0263444. [PMID: 35113944 PMCID: PMC8812839 DOI: 10.1371/journal.pone.0263444] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 01/19/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To review the content of recommendations within antenatal oral healthcare guidance documents and appraise the quality of their methodology to inform areas of development, clinical practice, and research focus. METHOD A systematic search of five electronic databases, Google search engine, and databases from relevant professional and guideline development groups published in English, developed countries, and between 2010 and 2020 was undertaken to identify guidance documents related to antenatal oral healthcare. Quality of documents was appraised using the Appraisal of Guidelines Research and Evaluation II tool, and a 3-step quality cut-off value was used. Inductive thematic analysis was employed to categories discreet recommendations into themes. RESULTS Six guidelines and one consensus statement were analysed. Two documents developed within Australia scored ≥60% across five of the six domains of the quality appraisal tool and were recommended for use. Four documents (developed in the United States and Canada) were recommended for use with modifications, whilst one document (developed in Europe) was not recommended. A total of 98 discreet recommendations were identified and demonstrated considerable unanimity but differed in scope and level of information. The main content and number of recommendations were inductively categorised within the following clinical practice points: risk factor assessments (n = 2), screening and assessment (n = 10), pre-pregnancy care (referral, n = 1), antenatal care (health education and advice, n = 14; management of nausea and vomiting, n = 7; referral, n = 2), postnatal care (health education and advice, n = 1; anticipatory guidance, n = 6), documentation (n = 4), coordinated care (n = 4), capacity building (n = 6), and community engagement (n = 1). CONCLUSION The methodological rigour of included guidance documents revealed areas of strengths and limitations and posit areas for improvement. Further research could centre on adapting antenatal oral healthcare guidelines and consensus statements to local contexts. More high-quality studies examining interventions within antenatal oral healthcare are needed to support the development of recommendations.
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Affiliation(s)
- Annika Wilson
- Centre for Rural Health, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Ha Hoang
- Centre for Rural Health, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Heather Bridgman
- Centre for Rural Health, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Leonard Crocombe
- Dentistry & Oral Health, Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Silvana Bettiol
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Mohammadpour S, Sadoughi F, Arshi S, Ayani S, Fallahpour M, Bagherzadeh R. Asthma Management System in Primary Care Based on Global Initiative for Asthma and Snell's Drug Interaction: Accuracy and Usability. TANAFFOS 2022; 21:193-200. [PMID: 36879741 PMCID: PMC9985120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/07/2021] [Indexed: 03/08/2023]
Abstract
Background The two main pillars of asthma management include regular follow-up and using guidelines in the treatment process. Patient portals enable regular follow-up of disease, and guideline-based decision-support-systems can improve the use of guidelines in the treatment process. Based on the Global Initiative for Asthma (GINA) and Snell's drug interaction, asthma management system in primary care (AMSPC) includes the capabilities of both mentioned systems. This system was developed to improve regular follow-up and use GINA in the asthma management process. This study aimed to assess the accuracy and usability of the AMSPC based on the GINA and Snell's drug interaction. Materials and Methods To assess the accuracy of the system, kappa test was used to calculate the degree of agreement between the suggestions made by the system and the physician's decision for a total of 64 patients selected through convenience sampling method. To assess usability, the Questionnaire for User Interface Satisfaction (QUIS) was used. Results The scores of the Kappa for the agreements between the system and the physician in determining "drug type and dosage", "follow-up time", and "drug interactions" were 0.90, 0.94, and 0.94, respectively. The average score of the QUIS was 8.6 out of 9. Conclusion Due to the high accuracy of the system in computerizing the GINA and Snell's drug interaction, as well as its proper usability, it is expected that the system be widely used to improve asthma management and reduce drug interactions.
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Affiliation(s)
- Saman Mohammadpour
- Department of Health Information Management and Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farahnaz Sadoughi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saba Arshi
- Department of Immunology and Allergy, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Morteza Fallahpour
- Department of Immunology and Allergy, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Rafat Bagherzadeh
- Department of English Language, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Abstract
Background: By 2040, the predicted global cancer burden is expected to be more than 27 million new cancer cases per year. Understanding primary health care workers’ (HCWs) perception on cancer can highlight new ways in which cancer advocacy can be increased. This study aimed to explore the perceptions of primary HCWs in Lautoka, Fiji, towards common cancers with focus on knowledge, risk perceptions, barriers and preventive approaches. Methods: The study used a qualitative method approach. The study was conducted among primary HCWs at four purposively selected health centres in Lautoka Subdivision, Fiji, from 1 March 2021 to 1 April 2021. Focus group discussions (FGDs) were conducted with primary HCWs. A semi-structured open-ended questionnaire was used to collect data, and the FGDs were audio-recorded. These audio recordings were transcribed and analysed using thematic analysis. Results: The responses from the four FGDs with six primary HCWs in each group emerged four major themes. These themes were cancer knowledge, health professional training, barriers and challenges and awareness strategies. Primary HCWs were not fully aware about common cancers and were not confident to discuss about cancer with their patients which is an important role of primary HCWs in cancer management. This lack of knowledge was attributed to less training received in primary care setting. Barriers to accessing cancer screening included misconceptions about cancer, negative attitudes from patients, stigmatization, lack of resources at health facility and less informed health staff. Community outreach programmes, opportunistic screening, community HCWs and the concept of a cancer hub centre were awareness strategies highlighted by primary HCWs. Conclusions: Lack of knowledge about common cancers among primary HCWs is a concern that is depicted well in this study. This low knowledge was attributed to lack of training on cancers received by primary HCWs. Guidelines on cancer screening and diagnosis can be developed by the health ministry to assist primary HCWs in detecting patients at pre-cancerous stage.
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Abdel Baky A, Fouda EM, Hussein SM, Sobeih AA, Abd Al Razek AM, Hassanain AI, Galal A, Hamed DHE, Elnady HG, Hamdi H, Metwally HMSED, Hegazy LAG, Mohamed MHA, Shaheen M, Saeed MA, Rashad MM, Elattar MM, Refaat N, Sakr NMA, Amer OT, Mansour SAA, Tawfik S, Hebish SNB, Reda S, Omar T, Kamel NA, Amer YS. Bronchiolitis diagnosis, treatment, and prevention in children: an evidence-based clinical practice guideline adapted for the use in Egypt based on the ‘Adapted ADAPTE’ Methodology. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2022. [DOI: 10.1186/s43054-021-00094-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The presented evidence-based clinical practice guideline (CPG) is proposed as a National CPG using an evidence-based and formal CPG adaptation methodology. The purpose of this study was to adapt the international CPGs’ recommendations for children with bronchiolitis to suit the healthcare system in the Egyptian context. This CPG, ‘diagnosis, treatment, and prevention of Bronchiolitis’, applies to children from 1 through 23 months of age. Other exclusions are noted. The quality of evidence, benefit-harm relationship, and strength of recommendations are indicated. This study is part of a larger collaborative initiative with the faculty staff of pediatric departments of 15 Egyptian universities and a national research center to formulate a national Committee (EPG) that aims to define the topics of, assign authors to, and assist in the adaptation of pediatric evidence-based CPGs according to a national strategic plan. The committee is guided by a formal CPG adaptation methodology: the ‘Adapted ADAPTE’.
Results
The Bronchiolitis Guideline Adaptation Group (BGAG) reviewed the results of the AGREE II assessment and decided to adapt mainly the Australasian (PREDICT) CPG and for the questions not answered in PREDICT we adapted the relevant recommendations from the American Academy of Pediatrics (AAP) CPG. Seven implementation tools were included: a care pathway for assessment of severity, a clinical algorithm for treatment of acute bronchiolitis in the emergency room, a separate flowchart for assessing babies with bronchiolitis, a power point slide presentation lecture for treatment of acute bronchiolitis, patient information in Arabic, a clinical score (Modified Tal Score) for prediction of bronchiolitis severity, and the criteria for admission and discharge in the hospital. A comprehensive set of multifaceted CPG implementation strategies was provided for the clinicians, patients, nurses, and other relevant stakeholders contextualized to the national settings
Conclusion
Our experience with this adaptation methodology provides useful insight into its utilization on a national level in Egypt. The BGAG recommended the next review of this adapted CPG to be after 3 years from its publication (i.e., 2022) after checking for updates in the original CPG.
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Wachholz PA, Stein AT, Melo DOD, Mello RGBD, Florez ID. Recommendations for the development of Clinical Practice Guidelines. GERIATRICS, GERONTOLOGY AND AGING 2022. [DOI: 10.53886/gga.e0220016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Clinical practice guidelines are statements that include recommendations intended to optimize patient care, are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options, and ensure that the best available clinical knowledge is used to provide effective and quality care. They can reduce inappropriate care and variability in clinical practice and can support the translation of new research knowledge into clinical practice. Recommendations from clinical practice guidelines can support health professionals by facilitating the decision-making process, empowering them to make more informed health care choices, clarifying which interventions should be priorities based on a favorable trade-off, and discouraging the use of those that have proven ineffective, dangerous, or wasteful. This review aims to summarize the key components of high-quality and trustworthy guidelines. Articles were retrieved from various libraries, databases, and search engines using free-text term searches adapted for different databases, and selected according to author discretion. Clinical practice guidelines in geriatrics can have a major impact on prevention, diagnosis, treatment, rehabilitation, health care, and the management of diseases and conditions, but they should only be implemented when they have high-quality, rigorous, and unbiased methodologies that consider older adult priorities and provide valid recommendations.
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Norris SL, Aung MT, Chartres N, Woodruff TJ. Evidence-to-decision frameworks: a review and analysis to inform decision-making for environmental health interventions. Environ Health 2021; 20:124. [PMID: 34876125 PMCID: PMC8653547 DOI: 10.1186/s12940-021-00794-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Evidence-to-decision (EtD) frameworks provide a structured and transparent approach for groups of experts to use when formulating recommendations or making decisions. While extensively used for clinical and public health recommendations, EtD frameworks are not in widespread use in environmental health. This review sought to identify, compare and contrast key EtD frameworks for decisions on interventions used in clinical medicine, public health or environmental health. This information can be used to develop an EtD framework suitable for formulating recommendations for interventions in environmental health. METHODS We identified a convenience sample of EtD frameworks used by a range of organizations. We searched Medline for systematic reviews of frameworks. We summarized the decision criteria in the selected frameworks and reviews in a qualitative manner. FINDINGS Fourteen organizations provided 18 EtD frameworks; most frameworks focused on clinical medicine or public health interventions; four focused on environmental health and three on economic considerations. Harms of interventions were examined in all frameworks and benefits in all but one. Other criteria included certainty of the body of evidence (15 frameworks), resource considerations (15), feasibility (13), equity (12), values (11), acceptability (11), and human rights (2). There was variation in how specific criteria were defined. The five identified systematic reviews reported a similar spectrum of EtD criteria. INTERPRETATION The EtD frameworks examined encompassed similar criteria, with tailoring to specific audience needs. Existing frameworks are a useful starting point for development of one tailored to decision-making in environmental health. FUNDER JPB Foundation.
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Affiliation(s)
- Susan L. Norris
- Department of Family Medicine, Oregon Health & Science University, Portland, OR 97239 USA
| | - Max T. Aung
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California USA
| | - Nicholas Chartres
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California USA
| | - Tracey J. Woodruff
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California USA
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Mardon AK, Leake HB, Chalmers KJ. A Review of Chronic Pelvic Pain in Women. JAMA 2021; 326:2206. [PMID: 34874427 DOI: 10.1001/jama.2021.17977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Amelia K Mardon
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - Hayley B Leake
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - K Jane Chalmers
- IIMPACT in Health, University of South Australia, Adelaide, Australia
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Song Y, Ballesteros M, Li J, Martínez García L, Niño de Guzmán E, Vernooij RWM, Akl EA, Cluzeau F, Alonso-Coello P. Current practices and challenges in adaptation of clinical guidelines: a qualitative study based on semistructured interviews. BMJ Open 2021; 11:e053587. [PMID: 34857574 PMCID: PMC8640632 DOI: 10.1136/bmjopen-2021-053587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study aims to better understand the current practice of clinical guideline adaptation and identify challenges raised in this process, given that published adapted clinical guidelines are generally of low quality, poorly reported and not based on published frameworks. DESIGN A qualitative study based on semistructured interviews. We conducted a framework analysis for the adaptation process, and thematic analysis for participants' views and experiences about adaptation process. SETTING Nine guideline development organisations from seven countries. PARTICIPANTS Guideline developers who have adapted clinical guidelines within the last 3 years. We identified potential participants through published adapted clinical guidelines, recommendations from experts, and a review of the Guideline International Network Conference attendees' list. RESULTS We conducted ten interviews and identified nine adaptation methodologies. The reasons for adapting clinical guidelines include developing de novo clinical guidelines, implementing source clinical guidelines, and harmonising and updating existing clinical guidelines. We identified the following core steps of the adaptation process (1) selection of scope and source guideline(s), (2) assessment of source materials (guidelines, recommendations and evidence level), (3) decision-making process and (4) external review and follow-up process. Challenges on the adaptation of clinical guidelines include limitations from source clinical guidelines (poor quality or reporting), limitations from adaptation settings (lacking resources or skills), adaptation process intensity and complexity, and implementation barriers. We also described how participants address the complexities and implementation issues of the adaptation process. CONCLUSIONS Adaptation processes have been increasingly used to develop clinical guidelines, with the emergence of different purposes. The identification of core steps and assessment levels could help guideline adaptation developers streamline their processes. More methodological research is needed to develop rigorous international standards for adapting clinical guidelines.
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Affiliation(s)
- Yang Song
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Monica Ballesteros
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jing Li
- Research Institute (VHIR), Universitat Autònoma de Barcelona, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Clinical practice guideline for end-of-life care in patients with cancer: a modified ADAPTE process. Support Care Cancer 2021; 30:2497-2505. [PMID: 34786639 DOI: 10.1007/s00520-021-06558-2] [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: 06/04/2021] [Accepted: 09/08/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This study seeks to adapt a guideline for end-of-life care in patients with cancer to be used by healthcare teams. METHODS This methodological study was conducted by modifying the ADAPTE process and adding to it a qualitative study and consensus ratings by a multidisciplinary panel of experts. A qualitative study was thus performed to identify the end-of-life needs of patients with cancer. Then, the source guidelines and the results of the qualitative study were used to draft the initial version of the guideline, with 85 adaptation recommendations. A multidisciplinary panel of healthcare experts performed the external review of the recommendations based on the four criteria of relatedness, comprehensibility, usefulness, and feasibility and scored them on a scale of 1-9. The mean score of each recommendation was calculated, and the recommendations were classified into three categories: appropriate (mean score of 7-9), uncertain (mean score of 4-6.99), and inappropriate (mean score of 1-3.99). RESULTS All the recommendations were approved, as they all had a mean score of 7 or higher, and were then categorized into 11 dimensions: communication management; participatory and evidence-based decision-making management; pain management; dyspnea management; nausea and vomiting management; anorexia and cachexia management; constipation management; death rattle management; management of delirium, anxiety, and restlessness; hydration management; and pharmacological considerations. CONCLUSION The adaptation of the guideline for end-of-life care in patients with cancer in Iran was performed by modifying the ADAPTE process with the participation of multidisciplinary stakeholders and based on the local needs.
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