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Sultan S, Siedler MR, Morgan RL, Ogunremi T, Dahm P, Fatheree LA, Getchius TSD, Ginex PK, Jakhmola P, McFarlane E, Murad MH, Temple Smolkin RL, Amer YS, Alam M, Kang BY, Falck-Ytter Y, Mustafa RA. An International Needs Assessment Survey of Guideline Developers Demonstrates Variability in Resources and Challenges to Collaboration between Organizations. J Gen Intern Med 2022; 37:2669-2677. [PMID: 34545466 PMCID: PMC9411275 DOI: 10.1007/s11606-021-07112-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/20/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The development of rigorous, high-quality clinical guidelines increases the need for resources and skilled personnel within guideline-producing organizations. While collaboration between organizations provides a unique opportunity to pool resources and save time and effort, the collaboration presents its own unique challenges. OBJECTIVE To assess the perceived needs and current challenges of guideline producers worldwide related to guideline development and collaboration efforts. DESIGN Survey questions were developed by the Guidelines International Network and the US GRADE Network, pilot-tested among attendees of a guideline development workshop, and disseminated electronically using convenience and snowball sampling methods. PARTICIPANTS A total of 171 respondents representing 30 countries and more than 112 unique organizations were included in this analysis. MAIN MEASURES The survey included free-response, multiple-choice, and seven-point Likert-scale questions. Questions assessed respondents' perceived value of guidelines, resource availability and needs, guideline development processes, and collaboration efforts of their organization. KEY RESULTS Time required to develop high-quality systematic reviews and guidelines was the most relevant need (median=7; IQR=5.5-7). In-house resources to conduct literature searches (median=4; IQR=3-6) and the resources to develop rigorous guidelines rapidly (median=4; IQR=2-5) were perceived as the least available resources. Difficulties reconciling differences in guideline methodology (median=6; IQR=4-7) and the time required to establish collaborative agreements (median=6; IQR=5-6) were the most relevant barriers to collaboration between organizations. Results also indicated a general need for improvement in conflict of interest (COI) disclosure policies. CONCLUSION The survey identified organizational challenges in supporting rigorous guideline development, including the time, resources, and personnel required. Connecting guideline developers to existing databases of high-quality systematic reviews and the use of freely available online platforms may facilitate guideline development. Guideline-producing organizations may also consider allocating resources to hiring or training personnel with expertise in systematic review methodologies or utilizing resources more effectively by establishing collaborations with other organizations.
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Affiliation(s)
- Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Health Care System, Minneapolis, MN, USA.
| | - Madelin R Siedler
- Kinesiology & Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Rebecca L Morgan
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Toju Ogunremi
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Philipp Dahm
- Department of Urology, Minneapolis VA Health Care System, University of Minnesota, Minneapolis, MN, USA
| | | | - Thomas S D Getchius
- Guideline Strategy and Operations, American Heart Association and American College of Cardiology, Dallas, TX, USA
| | - Pamela K Ginex
- Evidence-Based Practice, Oncology Nursing Society, Pittsburgh, PA, USA
| | - Priya Jakhmola
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emma McFarlane
- National Institute for Health and Care Excellence, Manchester, UK
| | - M Hassan Murad
- Evidence-based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | - Yasser S Amer
- Pediatrics, Quality Management, 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
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yngve Falck-Ytter
- Gastroenterology Seection, VA Northeast Ohio Healthcare System, Case Western Reserve University, Cleveland, OH, USA
| | - Reem A Mustafa
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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2
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Goossen K, Bieler D, Hess S, Becker M, Kalsen M, Flohé S, Pieper D. An adapted 'Ottawa' method allowed assessing the need to update topic areas within clinical practice guidelines. J Clin Epidemiol 2022; 150:1-11. [PMID: 35710055 DOI: 10.1016/j.jclinepi.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/12/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To adapt and evaluate a method for assessing the need to update guideline topic areas involving multiple recommendations. STUDY DESIGN AND SETTING The 'Ottawa method' uses literature signals to determine changes in evidence that trigger a need to update individual guideline questions. We adapted the Ottawa method to include a process for aggregating updating signals by topic area (e.g., resuscitation) and tested this method using the German guideline on the treatment of patients with severe/multiple injuries. This involved a focused systematic evaluation of current evidence to identify updating signals, and classifying the need to update for each topic area. Then, we surveyed the guideline group online about the modified method. RESULTS We conducted focused literature searches for 37 topic areas and screened a mean of 97 abstracts per topic area in 2021. The need to update was high for eight (21.6%), intermediate for eight (21.6%), and low for 21 topic areas (56.8%) based on updating signals. The survey response rate was 56% (24/43). Most guideline group members (94%, 16/17 responders) would use the Ottawa method again, but their comments identified some weaknesses. CONCLUSION The modified Ottawa method is a suitable, efficient tool to generate evidence-based updating signals for guideline topic areas involving multiple recommendations. Further fine-tuning is recommended.
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Affiliation(s)
- Käthe Goossen
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Dan Bieler
- Department of Orthopaedics and Trauma Surgery, Reconstructive Surgery, Hand Surgery, Plastic Surgery and Burn Medicine, German Armed Forces Central Hospital Koblenz and Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital Du¨sseldorf, Heinrich-Heine-University, Germany
| | - Simone Hess
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Monika Becker
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | | | - Sascha Flohé
- Department of Trauma Surgery, Orthopaedics and Hand Surgery, Städtisches Klinikum Solingen, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Institute for Health Services and Health System Research, Rüdersdorf, Germany; Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany
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3
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Hill K, English C, Campbell BCV, McDonald S, Pattuwage L, Bates P, Lassig C. Feasibility of national living guideline methods: the Australian Stroke Guidelines. J Clin Epidemiol 2021; 142:184-193. [PMID: 34785347 DOI: 10.1016/j.jclinepi.2021.11.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Maintaining clinical guideline currency has been one challenge to traditional guideline development. This paper describes the methods used to maintain a large national guideline for stroke management. STUDY DESIGN AND SETTING The Australian Stroke Clinical Guidelines are developed to meet Australian National Health and Medical Research Council (NHMRC) standards. Monthly surveillance is conducted for new systematic reviews and randomised controlled studies. Included studies undergo data extraction followed by preparation of updated evidence-to-decision frameworks which are used to inform updates, or development of new recommendations. Small writing groups made up of clinical experts and those with lived experience review and agree on changes, which are finally reviewed by a multidisciplinary Guidelines Steering Group. Draft changes are developed and published using the online MAGICapp platform, with dissemination and promotion via traditional methods as well as social media. RESULTS Each month approximately 350 abstracts are considered, covering 96 clinical topics and taking on average 16 hours to review. There have been four major guideline updates covering 34 new and updated recommendations. CONCLUSION It is feasible to use 'living' methods to maintain the Australian Clinical Guidelines for Stroke Management. Further work is now needed to understand the impact of living guidelines.
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Affiliation(s)
- Kelvin Hill
- Stroke Services, Stroke Foundation, Melbourne, Australia.
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Australia
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Steve McDonald
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Peta Bates
- Stroke Services, Stroke Foundation, Melbourne, Australia
| | - Chris Lassig
- Stroke Services, Stroke Foundation, Melbourne, Australia
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- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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4
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Sanabria AJ, Alonso-Coello P, McFarlane E, Niño de Guzman E, Roqué M, Martínez García L. The UpPriority tool supported prioritization processes for updating clinical guideline questions. J Clin Epidemiol 2021; 139:149-159. [PMID: 34363971 DOI: 10.1016/j.jclinepi.2021.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We aim to 1) use the UpPriority tool to identify which clinical questions (CQs) within the clinical guidelines (CGs) need to be prioritized for updating and 2) assess the implementation of the tool in a real-world set of CGs. STUDY DESIGN AND SETTING We systematically assessed CQs from a sample of CGs developed in the Spanish National Health System CG program. We applied the UpPriority tool to each CG using a step-by-step process that included: 1) establishment of the UpPriority Implementation Working Group, 2) mapping of the original CG questions and recommendations, 3) development of a survey to prioritize CQs, 4) assessment of CQ's priority according to six items, 5) calculation and ranking of priority scores, 6) decision of prioritized CQs for updating, and 7) development of the priority report. We assessed the tool implementation process (appraisers' experience when using the tool) and the inter-observer reliability of the tool, and we provided suggestions for improvement. RESULTS We included four CGs with a total of 107 CQs on the following topics: chronic heart failure (10 CQs), inherited retinal dystrophies (39 CQs), menopause (20 CQs), and open-angle glaucoma (38 CQs). We included a total of 30 participants, most of them clinicians that were members of the original CG development groups. CQs were classified in three groups: 1) high priority (CQs prioritized for updating [16/107; 15.0%]), 2) medium priority (CQs that could be prioritized for updating [47/107; 43.9%]), and low priority (CQs that were not prioritized for updating [44/107; 41.1%]). The mean time each appraiser needed to assess the CQs with the tool was 3.8 hours (range 0.5 to 10). Agreement among the appraisers varied among the CGs. Appraisers considered that the tool was useful. We suggest some areas for consideration when using the tool including: 1) identification of key appraisers, 2) customization of training materials, 3) establishment of priority thresholds, and 4) provision of methodological support. CONCLUSION The UpPriority is a useful tool to identify which CQs within a CG need to be prioritized for update in a real-world scenario. Recruitment and training of topic experts are the main challenges when using the tool.
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Affiliation(s)
- Andrea Juliana Sanabria
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Emma McFarlane
- National Institute for Health and Care Excellence, Manchester, UK
| | - Ena Niño de Guzman
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Marta Roqué
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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5
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Sanabria AJ, Pardo-Hernandez H, Ballesteros M, Canelo-Aybar C, McFarlane E, Niño de Guzman E, Penman K, Posso M, Roqué i Figuls M, Selva A, Vernooij RW, Alonso-Coello P, Martínez García L, Agarwal A, Blanchard S, Brereton L, Brouwers M, Etxeandia-Ikobaltzeta I, Flórez ID, Haynes C, Ibargoyen Roteta N, James R, Kwong J, Minister C, Nolan K, Qaseem A, Rotaeche del Campo R, Shaw B, Shin ES, Tam I, Thornton J, Vandvik Per O. The UpPriority tool was developed to guide the prioritization of clinical guideline questions for updating. J Clin Epidemiol 2020; 126:80-92. [DOI: 10.1016/j.jclinepi.2020.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 11/28/2022]
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6
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Posso M, Quintana MJ, Bellmunt S, Martínez García L, Escudero JR, Viteri-García A, Valli C, Bonfill X. GRADE-Based Recommendations for Surgical Repair of Nonruptured Abdominal Aortic Aneurysm. Angiology 2019; 70:701-710. [PMID: 30961349 DOI: 10.1177/0003319719838892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to provide evidence-based recommendations for endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) for patients with a nonruptured abdominal aortic aneurysm (AAA). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement and adhered to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Both low- and high surgical risk patients treated with EVAR showed decreased 30-day mortality, but the low-risk group had no differences in 4-year mortality. Compared with friendly anatomy, patients with hostile anatomy had an increased risk of type I endoleak. Young patients may prefer OSR. Endovascular aneurysm repair was not cost-effective in Europe. Four conditional recommendations were formulated: (1) OSR for low-risk patients up to 80 years old, (2) EVAR for low-risk patients older than 80 years, (3) EVAR for high-risk patients as long as is anatomically feasible, and (4) OSR in patients in whom it is not anatomically feasible to perform EVAR. Based on GRADE criteria, either OSR or EVAR can be suggested to patients with nonruptured AAA taking into account their surgical risk, hostile anatomy, and age. Given the weakness of the recommendations, personal preferences are determinant.
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Affiliation(s)
- Margarita Posso
- 1 Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau IIB Sant Pau, Barcelona, Spain.,2 Iberoamerican Cochrane Centre, IIB Sant Pau, Barcelona, Spain
| | - M Jesús Quintana
- 1 Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau IIB Sant Pau, Barcelona, Spain.,3 CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Sergi Bellmunt
- 4 Department of Angiology, Vascular and Endovascular Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.,5 Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | | | - José R Escudero
- 6 Joint Service of Angiology, Vascular and Endovascular Surgery, Sant Pau-Dos de Mayo Hospital, Barcelona, Spain.,7 Autonomous University of Barcelona, Barcelona, Spain.,8 CIBER of Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Andrés Viteri-García
- 9 Faculty of Health Sciences "Eugenio Espejo," Clinical Epidemiology and Public Health Research Centre (CISPEC), Universidad UTE, Quito, Ecuador
| | - Claudia Valli
- 2 Iberoamerican Cochrane Centre, IIB Sant Pau, Barcelona, Spain
| | - Xavier Bonfill
- 1 Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau IIB Sant Pau, Barcelona, Spain.,2 Iberoamerican Cochrane Centre, IIB Sant Pau, Barcelona, Spain.,3 CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,7 Autonomous University of Barcelona, Barcelona, Spain
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7
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Vernooij RWM, Martínez García L, Florez ID, Hidalgo Armas L, Poorthuis MHF, Brouwers M, Alonso-Coello P. Updated clinical guidelines experience major reporting limitations. Implement Sci 2017; 12:120. [PMID: 29025429 PMCID: PMC5639761 DOI: 10.1186/s13012-017-0651-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 10/03/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Checklist for the Reporting of Updated Guidelines (CheckUp) was recently developed. However, so far, no systematic assessment of the reporting of updated clinical guidelines (CGs) exists. We aimed to examine (1) the completeness of reporting the updating process in CGs and (2) the inter-observer reliability of CheckUp. METHODS We conducted a systematic assessment of the reporting of the updating process in a sample of updated CGs using CheckUp. We performed a systematic search to identify updated CGs published in 2015, developed by a professional society, reporting a systematic review of the evidence, and containing at least one recommendation. Three reviewers independently assessed the CGs with CheckUp (16 items). We calculated the median score per item, per domain, and overall, converting scores to a 10-point scale. Multiple linear regression analyses were used to identify differences according to country, type of organisation, scope, and health topic of updated CGs. We calculated the intraclass coefficient (ICC) and 95% confidence interval (95% CI) for domains and overall score. RESULTS We included in total 60 updated CGs. The median domain score on a 10-point scale for presentation was 5.8 (range 1.7 to 10), for editorial independence 8.3 (range 3.3 to 10), and for methodology 5.7 (range 0 to 10). The median overall score on a 10-point scale was 6.3 (range 3.1 to 10). Presentation and justification items at recommendation level (respectively reported by 27 and 38% of the CGs) and the methods used for the external review and implementing changes in practice were particularly poorly reported (both reported by 38% of the CGs). CGs developed by a European or international institution obtained a statistically significant higher overall score compared to North American or Asian institutions (p = 0.014). Finally, the agreement among the reviewers on the overall score was excellent (ICC 0.88, 95% CI 0.75 to 0.95). CONCLUSIONS The reporting of updated CGs varies considerably with significant room for improvement. We recommend using CheckUp to assess the updating process in updated CGs and as a blueprint to inform methods and reporting strategies in updating.
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Affiliation(s)
- Robin W M Vernooij
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Ivan Dario Florez
- Department of Health Research Methods, Evidence and Impact; McMaster University, Hamilton, Canada
- Department of Pediatrics, University of Antioquia, Medellin, Colombia
| | - Laura Hidalgo Armas
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Melissa Brouwers
- Department of Health Research Methods, Evidence and Impact; McMaster University, Hamilton, Canada
- Department of Oncology, McMaster University, Hamilton, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Akl EA, Meerpohl JJ, Elliott J, Kahale LA, Schünemann HJ. Living systematic reviews: 4. Living guideline recommendations. J Clin Epidemiol 2017; 91:47-53. [PMID: 28911999 DOI: 10.1016/j.jclinepi.2017.08.009] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 10/18/2022]
Abstract
While it is important for the evidence supporting practice guidelines to be current, that is often not the case. The advent of living systematic reviews has made the concept of "living guidelines" realistic, with the promise to provide timely, up-to-date and high-quality guidance to target users. We define living guidelines as an optimization of the guideline development process to allow updating individual recommendations as soon as new relevant evidence becomes available. A major implication of that definition is that the unit of update is the individual recommendation and not the whole guideline. We then discuss when living guidelines are appropriate, the workflows required to support them, the collaboration between living systematic reviews and living guideline teams, the thresholds for changing recommendations, and potential approaches to publication and dissemination. The success and sustainability of the concept of living guideline will depend on those of its major pillar, the living systematic review. We conclude that guideline developers should both experiment with and research the process of living guidelines.
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Affiliation(s)
- Elie A Akl
- Department of Internal Medicine and Clinical Research Institute, American University of Beirut, Beirut, Lebanon.
| | - Joerg J Meerpohl
- Cochrane Germany, Medical Center - University of Freiburg, Freiburg, Germany
| | - Julian Elliott
- Department of Infectious Diseases and Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lara A Kahale
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Holger J Schünemann
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada
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9
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Martínez García L, Pardo-Hernandez H, Niño de Guzman E, Superchi C, Ballesteros M, McFarlane E, Penman K, Posso M, Roqué i Figuls M, Sanabria AJ, Selva A, Vernooij RWM, Alonso-Coello P. Development of a prioritisation tool for the updating of clinical guideline questions: the UpPriority Tool protocol. BMJ Open 2017; 7:e017226. [PMID: 28775194 PMCID: PMC5724084 DOI: 10.1136/bmjopen-2017-017226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Due to a continuous emergence of new evidence, clinical guidelines (CGs) require regular surveillance of evidence to maintain their trustworthiness. The updating of CGs is resource intensive and time consuming; therefore, updating may include a prioritisation process to efficiently ensure recommendations remain up to date. The objective of our project is to develop a pragmatic tool to prioritise clinical questions for updating within a CG. METHODS AND ANALYSIS To develop the tool, we will use the results and conclusions of a systematic review of methodological research on prioritisation processes for updating and will adopt a methodological approach we have successfully implemented in a previous experience.We will perform a multistep process including (1) generation of an initial version of the tool, (2) optimisation of the tool (feasibility test of the tool, semistructured interviews, Delphi consensus survey, external review by CG methodologists and users and pilot test of the tool) and (3) approval of the final version of the tool.At each step of the process, we will (1) calculate absolute frequencies and proportions (quantitative data), (2) use content analysis to summarise and draw conclusions (qualitative data) and (3) draft a final report, discuss results and refine the previous versions of the tool. Finally, we will calculate intraclass coefficients with 95% CIs for each item and overall as indicators of agreement among reviewers. ETHICS AND DISSEMINATION We have obtained a waiver of approval from the Clinical Research Ethics Committee at the Hospital de la Santa Creu i Sant Pau (Barcelona). The results of the study will be published in peer-reviewed journal and communicated to interested stakeholders.The tool could support the standardisation of prioritisation processes for updating CGs and therefore have important implications for a more efficient use of resources in the CG field.
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Affiliation(s)
- Laura Martínez García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Ena Niño de Guzman
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Cecilia Superchi
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Monica Ballesteros
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Emma McFarlane
- National Institute for Health and Care Excellence, Manchester, UK
| | - Katrina Penman
- National Institute for Health and Care Excellence, Manchester, UK
| | - Margarita Posso
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Marta Roqué i Figuls
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Andrea Juliana Sanabria
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Anna Selva
- Clinical Epidemiology and Cancer Screening. Corporació Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
| | - Robin WM Vernooij
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Clinical Epidemiology and Biostatistics Department, McMaster University, Hamilton, Canada
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10
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Martínez García L, Pardo-Hernandez H, Superchi C, Niño de Guzman E, Ballesteros M, Ibargoyen Roteta N, McFarlane E, Posso M, Roqué I Figuls M, Rotaeche Del Campo R, Sanabria AJ, Selva A, Solà I, Vernooij RWM, Alonso-Coello P. Methodological systematic review identifies major limitations in prioritization processes for updating. J Clin Epidemiol 2017; 86:11-24. [PMID: 28549931 DOI: 10.1016/j.jclinepi.2017.05.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 04/19/2017] [Accepted: 05/10/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of the study was to identify and describe strategies to prioritize the updating of systematic reviews (SRs), health technology assessments (HTAs), or clinical guidelines (CGs). STUDY DESIGN AND SETTING We conducted an SR of studies describing one or more methods to prioritize SRs, HTAs, or CGs for updating. We searched MEDLINE (PubMed, from 1966 to August 2016) and The Cochrane Methodology Register (The Cochrane Library, Issue 8 2016). We hand searched abstract books, reviewed reference lists, and contacted experts. Two reviewers independently screened the references and extracted data. RESULTS We included 14 studies. Six studies were classified as descriptive (6 of 14, 42.9%) and eight as implementation studies (8 of 14, 57.1%). Six studies reported an updating strategy (6 of 14, 42.9%), six a prioritization process (6 of 14, 42.9%), and two a prioritization criterion (2 of 14, 14.2%). Eight studies focused on SRs (8 of 14, 57.1%), six studies focused on CGs (6 of 14, 42.9%), and none were about HTAs. We identified 76 prioritization criteria that can be applied when prioritizing documents for updating. The most frequently cited criteria were as follows: available evidence (19 of 76, 25.0%), clinical relevance (10 of 76; 13.2%), and users' interest (10 of 76; 13.2%). CONCLUSION There is wide variability and suboptimal reporting of the methods used to develop and implement processes to prioritize updating of SRs, HTAs, and CGs.
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Affiliation(s)
- Laura Martínez García
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain.
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Cecilia Superchi
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Ena Niño de Guzman
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Monica Ballesteros
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Nora Ibargoyen Roteta
- Department of Health and Consumer Affairs, Basque Office for Health Technology Assessment (Osteba), Basque Government, Calle Donostia 1, Vitoria-Gasteiz ES-01010, Spain
| | - Emma McFarlane
- National Institute for Health and Care Excellence, Level 1A City Tower, Piccadilly Plaza, Manchester M1 4BT, UK
| | - Margarita Posso
- Service of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Marta Roqué I Figuls
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Rafael Rotaeche Del Campo
- Alza Health Centre, Osakidetza-Basque Health Service, Avda Larratxo s/n, Donostia-San Sebastián 20013, Spain
| | - Andrea Juliana Sanabria
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain; Clinical Epidemiology and Cancer Screening, Corporació Sanitaria Parc Taulí de Sabadell, Parc Taulí s/n, Sabadell 08208, Spain
| | - Anna Selva
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Robin W M Vernooij
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
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