Clinical and Public Health Guidelines最新文献

{"title":"Analysis of European Association of Urology Guidelines 2023 and its adherence to GRADE methodology","authors":"Philipp Dahm,&nbsp;Mathew Holten,&nbsp;John P. Ratanawong,&nbsp;Andrew Lauwagie,&nbsp;Daniel A. Gonzalez-Padilla","doi":"10.1002/gin2.70004","DOIUrl":"https://doi.org/10.1002/gin2.70004","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The European Association of Urology (EAU) has reported the use of a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for developing guideline recommendations since 2018; however, the full adoption of GRADE remains a work in progress.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Two members of the research team identified and independently abstracted all individual recommendations and summary of evidence statements available from all EAU guidelines published in 2023. We evaluated the current adherence to established criteria for appropriate GRADE use, the proportion of strong and weak recommendations, the underlying strength of evidence, and criteria for appropriate use of GRADE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included a total of 20 guideline documents with a total number of 1985 recommendations. The median number of strong recommendations was 46 (interquartile range: 32–87), representing 62.6% of all recommendations. The surgical thromboprophylaxis guideline had the lowest percentage of strong recommendations (18.2%; 30/165), and the neuro-urology guideline had the highest percentage (95.5%; 42/44). EAU guidelines provided 2580 summaries of evidence statements, of which 1608 reported a level of evidence. The reported levels of evidence were I, II, III and IV/V at 31.8%, 28.5%, 32.4% and 7.3%, respectively. Of the six criteria for the appropriate use of GRADE, criterion 6, which reports the framing of recommendations as strong or weak, was met consistently; all other criteria were met only by a single guideline on thromboprophylaxis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The EAU guidelines adoption of GRADE has been largely limited to the framing of recommendations as strong or weak. In all but one guideline, published guidelines did not meet any of the other criteria for appropriate GRADE use. Increased efforts to fully adopt GRADE, similar to its implementation in the thromboprophylaxis guideline in future editions, may enhance trust and uptake of EAU guidelines, thereby assisting policymakers and improving patient care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100266,"journal":{"name":"Clinical and Public Health Guidelines","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gin2.70004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142435269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MATCH-IT: A decision support tool for multiple comparisons presenting data from network meta-analysis to facilitate guideline development","authors":"Birk S. Hunskaar,&nbsp;Per O. Løvsletten,&nbsp;Frankie Achille,&nbsp;Anja F. Heen,&nbsp;Thomas Agoritsas,&nbsp;Per O. Vandvik","doi":"10.1002/gin2.70003","DOIUrl":"https://doi.org/10.1002/gin2.70003","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Network meta-analysis (NMA) provides unprecedented opportunities to compare multiple treatment options (multiple comparisons) and are increasingly being used to inform clinical practice guidelines. However, the overwhelming amount of data generated from NMAs is challenging to present in comprehensible overviews for end-users, guideline panelists included. Acknowledging these challenges, we developed MATCH-IT—an interactive evidence summary displaying NMA results for multiple comparisons. In this study, we conducted user-testing and further developed MATCH-IT to support guideline panels in moving from NMA evidence to recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We user-tested the tool with guideline panelists and observed the use of the tool in panel meetings. User-testing sessions and guideline meetings were recorded, transcribed, and analyzed. The analysis informed the iterative development in the tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included four guideline panels and tested the tool with 15 panelists (four chairs, four methodologists, five clinical experts and two patient partners). User testing revealed both positive aspects and limitations of the tool. Interactivity allowed for dynamic display of the evidence during panels meetings and was highlighted as valuable. Further, participants felt that the tool provided overview of complex evidence, further facilitated by categorization of effects through colour coding. The inclusion of information on burden of treatment was highlighted as relevant and valuable. Regarding limitations, some users had issues discovering the interactive features. Earlier versions of MATCH-IT did not include sufficiently detailed information, such as the imprecision of effect estimates, which the users felt was needed for decision making. These findings led to refinements of the tool, including a new tutorial, inclusion of confidence intervals, and a new layer displaying more detailed information.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our study suggests that MATCH-IT may play a role in facilitating guideline development by easing understanding of NMA evidence and alleviating information overload in guideline panelists.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100266,"journal":{"name":"Clinical and Public Health Guidelines","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gin2.70003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing the Society of Obstetric Medicine Australia and New Zealand (SOMANZ) Hypertension in Pregnancy Guideline 2023: Guideline development approaches, challenges and contextual considerations","authors":"Renuka Shanmugalingam,&nbsp;Zachary Munn,&nbsp;Timothy H. Barker,&nbsp;Helen L. Barrett,&nbsp;Amanda Beech,&nbsp;Lucy Bowyer,&nbsp;Tim Crozier,&nbsp;Amanda Davidson,&nbsp;Marloes Dekker Nitert,&nbsp;Aunty Kerrie Doyle,&nbsp;Luke Grzeskowiak,&nbsp;Nicole Hall,&nbsp;Hicham Cheikh Hassan,&nbsp;Annemarie Hennessy,&nbsp;Amanda Henry,&nbsp;David Langsford,&nbsp;Vincent W. Lee,&nbsp;Michael Peek,&nbsp;Joanne M. Said,&nbsp;Helen Tanner,&nbsp;Rachel Taylor,&nbsp;Meredith Ward,&nbsp;Jason Waugh,&nbsp;Linda Yen,&nbsp;Ellie Medcalf,&nbsp;Katy Bell,&nbsp;Deonna Ackermann,&nbsp;Robin Turner,&nbsp;Angela Makris","doi":"10.1002/gin2.70000","DOIUrl":"https://doi.org/10.1002/gin2.70000","url":null,"abstract":"<p>The Society of Obstetric Medicine Australia and New Zealand (SOMANZ) Hypertension in Pregnancy Guideline 2023 is the first evidence-based guideline for hypertensive disorders of pregnancy that has been developed to the standards of the Australian National Health and Medical Research Council (NHMRC). This article describes the methodology, challenges and considerations in developing the guideline and includes details on group composition, literature search, evidence synthesis and development of recommendations. We also discuss several practical considerations and challenges related to contextual issues, topics of interest and resources available for guideline developers working with similar jurisdictions or topics.</p>","PeriodicalId":100266,"journal":{"name":"Clinical and Public Health Guidelines","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gin2.70000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consumer engagement in living evidence “a beautiful opportunity”: International qualitative study with patients and methodologists","authors":"Anneliese Synnot,&nbsp;Laura Weeks,&nbsp;Sophie J. Hill,&nbsp;Lyubov Lytvyn,&nbsp;Tamara Radar,&nbsp;Rebecca Randall,&nbsp;Richard Morley,&nbsp;Allison Jaure,&nbsp;Julian H. Elliott,&nbsp;Tari Turner","doi":"10.1002/gin2.70002","DOIUrl":"https://doi.org/10.1002/gin2.70002","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We aimed to explore the opportunities, challenges and practical strategies for consumer engagement (i.e., patient and public involvement) in living evidence (systematic reviews, guidelines and health technology assessments that are continually updated with the latest evidence).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design and Setting</h3>\u0000 \u0000 <p>In this international qualitative study, methodologists (producers of systematic reviewers, guidelines and health technology assessments) with an interest in living evidence, and consumers (patients, informal carers, the public and their representatives) with experience contributing to evidence synthesis production participated in either a face-to-face workshop, online focus group or semistructured interview. We analysed data using descriptive synthesis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-one methodologists and seven consumers from nine countries participated. A minority of participants in both groups had direct experience with living evidence synthesis. We identified seven themes: harnessing consumer enthusiasm in recruitment; ‘better’ consumer engagement based on deeper relationships; improved and ongoing orientation, support and remuneration; maintaining an ongoing commitment; potentially different guideline development stages and tasks; larger groups of consumers and multiple roles; and ongoing incorporation of consumer insights.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Methodologists and consumers believe living evidence approaches present an imperative and an opportunity to explore new models of consumer engagement, bringing together larger and more diverse communities of consumers in true partnerships with methodologists. Consumer engagement strategies for living evidence allow ongoing improvement to engagement methods and ongoing incorporation of consumer experiences, preferences and values as they develop and change over time.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100266,"journal":{"name":"Clinical and Public Health Guidelines","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gin2.70002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lifespan of COVID-19 living guideline recommendations: A survival analysis","authors":"Emma McFarlane,&nbsp;Toby Mercer,&nbsp;Steve Sharp,&nbsp;Debra Hunter,&nbsp;Kate Kelley,&nbsp;Fiona Glen,&nbsp;Maria Majeed","doi":"10.1002/gin2.12012","DOIUrl":"https://doi.org/10.1002/gin2.12012","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>NICE has maintained a portfolio of coronavirus disease 2019 (COVID-19) living guidelines since March 2020. Recommendations within these living guidelines are subject to continuous surveillance and updates in response to triggers. However, the lifespan of individual living guideline recommendations and features that may impact whether a recommendation becomes out of date sooner is unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study describes the length of time NICE COVID-19 living guideline recommendations have remained valid.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All guidelines within NICE's COVID-19 portfolio were included to determine the lifespan of living guideline recommendations. Data were collected on all recommendations that had been developed, undergone surveillance or updated between 1 March 2020 and 31 August 2022. The initial publication date, decision to update and updated publication date were extracted. Updates were labelled as major changes in evidence synthesis or minor changes without a substantial change in the evidence base. Any recommendation that had not been updated or withdrawn was censored. Survival analysis (Kaplan–Meier curve) was carried out to determine the lifespan of recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 26 COVID-19 living guidelines and 1182 recommendations were included in the analysis. Living recommendations had a median survival time of 739 days (interquartile range [IQR]: 332, 781). Based on recommendation type, intervention recommendations had a shorter survival time (354 days, IQR: 312, 775) compared to diagnosis (368 days, IQR: 328, 795), patient experience (733 days, IQR: 345, 795) and service delivery (739 days, IQR: 643, 781). Within intervention type, pharmacological recommendations had the shortest survival time versus nonpharmacological recommendations (335 days, IQR: 161, 775 vs. 775 days, IQR: 354, 775). Updates were published an average of 29.12 days following a surveillance decision.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Within living guidelines, some recommendations need to be updated sooner than others. This study outlines the value of a flexible responsive approach to surveillance according to the pace of change and expectation of update triggers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100266,"journal":{"name":"Clinical and Public Health Guidelines","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gin2.12012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: The relevance of core outcome sets to clinical guideline development","authors":"Sarah Rhodes,&nbsp;Paula Williamson,&nbsp;Ivan D. Florez","doi":"10.1002/gin2.12026","DOIUrl":"https://doi.org/10.1002/gin2.12026","url":null,"abstract":"<p>A core outcome set (COS) is ‘an agreed standard set of outcomes that should be measured and reported, as a minimum in trials for a specific health condition’,<span>¹</span> developed via consensus with stakeholders. Although the focus on COS originated on randomised trials, their use in systematic reviews, routine care, audit and, importantly, in clinical guidelines, is being increasingly recognised. The core outcome measures in effectiveness trials (COMET) initiative is an organisation for anyone interested in the development and application of COS and they host a database of studies relating to COS (https://comet-initiative.org/Resources/Database).</p><p>There are at least three main reasons why we would advocate the use of a relevant COS when developing a clinical guideline. First, there is the desire to have a research ecosystem where this minimum set of outcomes considered and reported in trials, combined in systematic reviews and used for clinical decision-making and monitoring patient progress are the same. Consistency will reduce bias and increase efficiency, and COS are a means to facilitating this. Second, it reduces duplication of effort. COS developers go through a rigorous, transparent process and involve all relevant parties including patients and members of the public in determining the outcomes of critical importance;<span>^{1, 2}</span> guideline authors commonly repeat an almost identical procedure. Third, using COS in guidelines would encourage researchers to consider using them when designing trials.</p><p>The International Guideline Development Credentialing and Certification Programme (https://inguide.org/) mentions COS and some guideline organisations, including National Institute for Clinical Excellence (NICE) in the United Kingdom (https://www.nice.org.uk/), recommend the use of COS in their manual. However, to date, very little is known about the consideration and use of COS by guideline authors. We conducted a piece of research to examine whether or not COS were being referenced in guidelines and the extent to which the guideline outcomes selected agreed with outcomes listed in a relevant COS.<span>³</span> We focussed on 10 disease areas with a published high-quality COS and 38 guidelines with matching scope. What we found is that none of those guidelines explicitly mentioned or referenced the COS, and the agreement between the guideline outcomes and COS outcomes was variable. Although limited in terms of disease groups and geographical coverage, this exercise tells us that guideline authors are not yet routinely considering COS when choosing outcomes for their PICO statements (PICO is a framework to construct clinical questions and stands for Population, Intervention, Comparator and Outcome).</p><p>These findings were presented at the 2023 GIN conference in Glasgow and the response from the guideline community was very encouraging. We ran a workshop introducing the COMET database and d","PeriodicalId":100266,"journal":{"name":"Clinical and Public Health Guidelines","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gin2.12026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142013627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modifications to the NEATS instrument for more appropriate and reproducible assessment of guidelines trustworthiness","authors":"Maryam Ghadimi,&nbsp;Gordon Guyatt,&nbsp;Romina Brignardello-Petersen","doi":"10.1002/gin2.12025","DOIUrl":"10.1002/gin2.12025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rational</h3>\u0000 \u0000 <p>The National Guideline Clearinghouse Extent of Adherence to Trustworthy Standards (NEATS) instrument measures the adherence of clinical practice guidelines to the trustworthiness standards proposed by the Institute of Medicine. However, rather than trustworthiness or methodological quality, the NEATS instrument evaluates the quality of reporting in addressing the management of conflict of interest of guideline development group members, systematic review process and assessment of the certainty of the evidence, rating the strength of recommendations, and updating plans. Furthermore, the NEATS instrument instructions on rating items are sufficiently limited that they may compromise the reproducibility of the instrument.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods (Modifications to the NEATS Instrument)</h3>\u0000 \u0000 <p>In the context of a specific methodological research project, we developed modifications to the NEATS instrument that include modifying the wording of items to capture trustworthiness rather than reporting quality and creating an algorithm for all items that maps responses to a series of prompting questions and guides the user in arriving at a rating from 1 to 5 or yes, no, or unknown, as applicable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Implications</h3>\u0000 \u0000 <p>Modifications to the NEATS instrument present a structured and practical framework to assess the degree to which clinical practice guidelines are trustworthy, and they ensure that items evaluate trustworthiness and improve the reproducibility of assessments across a range of raters' level of expertise in guideline methodology.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100266,"journal":{"name":"Clinical and Public Health Guidelines","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gin2.12025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodology and reporting quality of patient and public versions of guidelines in China: A systematic review","authors":"Hui Liu,&nbsp;Yuanyuan Yao,&nbsp;Nan Yang,&nbsp;Zijun Wang,&nbsp;Xufei Luo,&nbsp;Dongrui Peng,&nbsp;Huayu Zhang,&nbsp;Junxian Zhao,&nbsp;Hongfeng He,&nbsp;Xingrong Liu,&nbsp;Yaolong Chen,&nbsp;Janne Estill","doi":"10.1002/gin2.12024","DOIUrl":"https://doi.org/10.1002/gin2.12024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The development of patient and public versions of guidelines (PVGs) in China is still in its early stages. The aim of this article is to systematically identify the PVGs published or released in China, analyse their development methods, and assess their reporting quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched five major literature databases and conducted supplementary searches to identify all PVGs published or released by 8 January 2023 in China. After screening the literature according to the inclusion and exclusion criteria, we analysed the development methodology and evaluated the reporting quality of the included PVGs using the Reporting Items for Practice Guidelines in Healthcare-Public or Patient Versions of Guidelines (RIGHT-PVG). We reported this systematic review in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 3795 records were first identified, and 17 PVGs were included. Nine PVGs reported their development methodology: seven used de novo development (similar to developing clinical practice guidelines [CPGs]), and two rewrote the recommendations of an existing CPG. The reporting quality differed substantially between the PVGs. The PVGs adhered to between 8 and 16 (47.1%–94.1%) of the 17 RIGHT-PVG items, with a median of 9. All PVGs specified the topic addressed in the PVGs, introduced the target condition, described the purpose, scope and target users and had precise recommendations. In contrast, none of the PVGs listed questions for patients to ask their healthcare providers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Only few PVGs have so far been released in China. Most PVGs were developed de novo from the evidence, while some were instead rewritten from an existing CPG. In addition, we encourage PVGs developers to follow RIGHT-PVG checklist when writing the guidelines in the future.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100266,"journal":{"name":"Clinical and Public Health Guidelines","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gin2.12024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141584074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is ‘too much medicine’ a guideline-driven phenomenon? Ten years' report and reflections of the Guidelines International Network Multimorbidity Working Group","authors":"Martin Scherer,&nbsp;Jako S. Burgers,&nbsp;the Guidelines International Network Multimorbidity Working Group","doi":"10.1002/gin2.12016","DOIUrl":"https://doi.org/10.1002/gin2.12016","url":null,"abstract":"<p>Established at the Guidelines International Network (GIN) annual conference in 2013 in San Francisco, the GIN Multimorbidity Working Group has existed for 10 years. Its aim was and is to explore the questions of how and to what extent multimorbidity and its related constructs can be reflected in guideline development. A major methodological challenge is to find a balance between not getting lost in the thousands of different disease combinations and formulating recommendations that are useful in everyday clinical practice.</p><p>Cynthia Boyd, founding member and first chair of the GIN multimorbidity working group, published a frequently cited article on the accumulation of guideline recommendations for an individual 72-year-old patient with multimorbidity. She described the complexity of the patient's condition and the number of diagnoses that can affect the number of guideline recommendations and thus maximize the treatment burden for those involved.<span>¹</span> Today, 18 years later, the topic of multimorbidity, with its associated phenomena such as polypharmacy, is well established and a topic of several guidelines.<span>^2-5</span></p><p>There are a variety of definitions of multimorbidity, from the simple counting of diagnoses to the use of complex indices that account for disease severity and drug therapy, biopsychosocial and somatic risk factors.<span>^{6, 7}</span> They all have in common that multimorbidity is defined as the simultaneous presence of several chronic diseases, with no one disease initially taking priority.<span>⁸</span> In contrast, if one disease is dominant (called index disease), the term co-morbidity is often used.<span>⁹</span></p><p>In recent years, it has been recognized that ‘too much medicine’ is being practiced overall and that many diagnostic and therapeutic measures are either superfluous at best or often even harmful.<span>¹⁰</span> Since too much medicine is a widespread problem across all medical disciplines, it is obvious that the overwhelming number of symptoms and problems associated with multimorbidity can lead to an abundance of diagnostic and therapeutic measures. Moreover, too much medicine means an increase in treatment burden and potential harm for the multimorbid patient.</p><p>A key issue for the GIN Multimorbidity Working Group is how guidelines for multimorbidity can address this problem. How can we ensure that the necessary is done and the unnecessary avoided for people with multimorbidity? Last but not least, how can the ‘less-is-more approach’ to multimorbidity be implemented?</p><p>At the GIN Annual Congress 2023 in Glasgow, the working group discussed the scope and purpose of guidelines, healthcare system issues and guideline developers' challenges.</p><p>The working group cited the hamster wheel phenomenon as a major system-related flaw. Across healthcare systems and countries, every medical discipline suffers from a seemin","PeriodicalId":100266,"journal":{"name":"Clinical and Public Health Guidelines","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gin2.12016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141245846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Living methods for living guidelines: Changes to evidence synthesis methods in the Australian National Clinical Evidence Taskforce COVID-19 living guidelines","authors":"Heath White,&nbsp;Tari Turner,&nbsp;Claire Beecher,&nbsp;Alex Poole,&nbsp;Steve McDonald,&nbsp;Jessie Hewitt,&nbsp;Samantha Chakraborty,&nbsp;David Fraile-Navarro,&nbsp;Saskia Cheyne,&nbsp;Joshua Vogel,&nbsp;Britta Tendal Jeppesen,&nbsp;Steve McGloughlin,&nbsp;National Clinical Evidence Taskforce","doi":"10.1002/gin2.12017","DOIUrl":"https://doi.org/10.1002/gin2.12017","url":null,"abstract":"<p>Living evidence methods, such as those used to produce living guidelines, can evolve over time as the context or evidence changes. In Australia, the National Clinical Evidence Taskforce has been developing living guidelines for the management and care of people with coronavirus disease 2019 (COVID-19) since March 2020, undertaking daily searches, and producing over 130 updates of more than 200 recommendations. Over the 3 years of the guidelines, the methods have also been ‘living’. In this paper, we describe why, how and with what impact changes to our methods have been made. When changes were required to the methods, the Taskforce Evidence Team developed a ‘Methods Brief’ outlining the proposed changes, rationale and any risks. This was presented to the Guidelines Leadership Group for approval and to the Steering Committee for noting. Changes were then reflected in the online, publicly available description of our methods. Methods to develop the living guidelines evolved through five phases, reflecting changes in the availability of evidence, the degree and nature of clinical uncertainty and resource availability. Largely these changes were to the criteria we used to select evidence for inclusion, and our expected level of responsiveness to new evidence. In the initial phases, inclusion criteria were very broad, and as the evidence base stabilised our focus narrowed to areas of high clinical importance and evidence certainty. The rapidly evolving nature of the pandemic, understanding of the illness, clinical questions and evidence base during development of the living COVID-19 guidelines, necessitated multiple changes to the methods used to produce the guidelines. In this context, the ongoing revision of the methods for living guideline production was a necessity and a strength of the living approach. Questions remain about how best to ensure rigour is maintained while methods evolve.</p>","PeriodicalId":100266,"journal":{"name":"Clinical and Public Health Guidelines","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gin2.12017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141073746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}