Eady EA, Layton AM, Sprakel J, Arents BWM, Fedorowicz Z, van Zuuren EJ. AGREE II assessments of recent acne treatment guidelines: how well do they reveal trustworthiness as defined by the Institute of Medicine (IOM) criteria? Br.J.Dermatol. Epub 2017 Jul 1. PMID: 28667760.

Up-to-date, trustworthy guidelines are a widely relied-upon means of promoting excellent patient care.
To determine the quality of recently published acne treatment guidelines by utilizing the Appraisal of Guidelines for Research and Evaluation (AGREE) II Reporting Checklist, the US Institute of Medicine's (IOM) criteria of trustworthiness, Lenzer et al's red flags and CheckUp.
Systematic searches were conducted in bibliographic databases, guideline depositories and using Google to identify acne treatment guidelines published since 2013. Six assessors independently scored each guideline using the AGREE II Reporting Checklist. Guidelines were concomitantly assessed for trustworthiness using the IOM criteria and for Lenzer et al's red flags indicative of potential bias. Updates were screened using CheckUp.
Eight guidelines were identified, two of which were updates. Lowest scoring AGREE II domains across all guidelines were rigour (6/8 poor, one fair, one average) and applicability (4/8 poor, one fair, three average). Two out of the three highest scoring guidelines were developed using AGREE II. No guideline fully met each IOM criterion and all raised at least one red flag indicative of potential bias. One updated guideline did not address seven of 16 items on CheckUp and the other did not address four. Patient involvement in guideline development was minimal.
Use of the AGREE II Instrument during guideline development did not have as great an effect on guideline quality as might be expected. There is considerable room for improvement in acne treatment guidelines in order to satisfy the IOM trustworthiness criteria and avoid bias. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.

DOI: http://dx.doi.org/10.1111/bjd.15777.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=28667760.

Prayle AP, Cox T, Smith SJ, Rycroft-Malone J, Thomas KS, Hughes DA, Smyth AR. Do guidelines for treating chest disease in children use Cochrane Reviews effectively? A systematic review. Thorax. Epub 2017 Apr 26. PMID: 28446662.

Cochrane Reviews summarise best evidence and should inform guidelines. We assessed the use of Cochrane Reviews in the UK guidelines for paediatric respiratory disease. We found 21 guidelines which made 1025 recommendations, of which 96 could be informed by a Cochrane Review. In 38/96 recommendations (40%), some or all of the relevant Cochrane Reviews were not cited. We linked recommendations to 140 Cochrane Reviews. In 37/140 (26%) cases, the guideline recommendation did not fully agree with the Cochrane Review. Guideline developers may fail to use Cochrane Reviews or may make recommendations which are not in line with best evidence.

FREE FULL TEXT: http://thorax.bmj.com/content/early/2017/04/26/thoraxjnl-2016-208790.long
DOI: http://dx.doi.org/10.1136/thoraxjnl-2016-208790.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=28446662.

Abell B, Glasziou P, Hoffmann T. Exploration of the methodological quality and clinical usefulness of a cross-sectional sample of published guidance about exercise training and physical activity for the secondary prevention of coronary heart disease. BMC Cardiovasc.Disord. 2017 Jun 13;17(1):153. PMID: 28610621.

Clinicians are encouraged to use guidelines to assist in providing evidence-based secondary prevention to patients with coronary heart disease. However, the expanding number of publications providing guidance about exercise training may confuse cardiac rehabilitation clinicians. We therefore sought to explore the number, scope, publication characteristics, methodological quality, and clinical usefulness of published exercise-based cardiac rehabilitation guidance.
We included publications recommending physical activity, exercise or cardiac rehabilitation for patients with coronary heart disease. These included systematically developed clinical practice guidelines, as well as other publications intended to support clinician decision making, such as position papers or consensus statements. Publications were obtained via electronic searches of preventive cardiology societies, guideline databases and PubMed, to November 2016. Publication characteristics were extracted, and two independent assessors evaluated quality using the 23-item Appraisal of Guidelines Research and Evaluation II (AGREE) tool.
Fifty-four international publications from 1994 to 2016 were identified. Most were found on preventive cardiology association websites (n = 35; 65%) and were freely accessible (n = 50; 93%). Thirty (56%) publications contained only broad recommendations for physical activity and cardiac rehabilitation referral, while 24 (44%) contained the necessary detailed exercise training recommendations. Many were labelled as "guidelines", however publications with other titles (e.g. scientific statements) were common (n = 24; 44%). This latter group of publications contained a significantly greater proportion of detailed exercise training recommendations than clinical guidelines (p = 0.017). Wide variation in quality also existed, with 'applicability' the worst scoring AGREE II domain for clinical guidelines (mean score 53%) and 'rigour of development' rated lowest for other guidance types (mean score 33%).
While a large number of guidance documents provide recommendations for exercise-based cardiac rehabilitation, most have limitations in either methodological quality or clinical usefulness. The lack of rigorously developed guidelines which also contain necessary detail about exercise training remains a substantial problem for clinicians.

FREE FULL TEXT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470313/pdf/12872_2017_Article_589.pdf
DOI: http://dx.doi.org/10.1186/s12872-017-0589-z.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=28610621.
PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470313.

Blume LH, van Weert NJ, Busari JO, Delnoij DM. Good intentions getting out of hand - is there a future for health care guidelines? Risk Manag.Healthc.Policy. 2017 May 11;10:81-5. PMID: 28546778.

To date, the focus of research on guidelines has been directed toward professionals, and hospitals have merely served as the context. Little research has been performed on the dilemmas of guideline adherence in hospitals, as a setting in which multiple professional guidelines have to be implemented simultaneously; also, it is still unclear which clinical guidelines have to be aligned with other external demands, such as rules, regulations, standards, indicators, norms, and so on. Hence, different ways of studying the issue of guideline implementation are called for.

FREE FULL TEXT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436755/pdf/rmhp-10-081.pdf
DOI: https://doi.org/10.2147/RMHP.S134835.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=28546778.
PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436755/.

Chalmers J. Guidelines under fire again! J.Hypertens. 2017 Aug;35(8):1567-8. PMID: 28657973.

[First paragraph, reference html links removed]

In an editorial in this issue of the Journal of Hypertension, co-published in Hypertension, a group of luminaries in our field, led by Franz Messerli, takes issue with aspects of the recent ‘Clinical Practice Guidelines’ published in the Annals of Internal Medicine, on behalf of the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) [1,2]. A similar critique was made by Messerli in a letter to the editors of Hypertension in 2014 in relation to a Science Advisory issued by the American Heart Association (AHA), the American College of Cardiology (ACC) and the Centre for Disease Control (CDC) in 2014 [3,4].

Also published as:

Chalmers J. Guidelines Under Fire Again! Hypertension. 2017 Aug;70(2):238-239. doi: 10.1161/HYPERTENSIONAHA.117.09725. Epub 2017 Jun 26. PubMed PMID: 28652466.

DOI: http://dx.doi.org/10.1097/HJH.0000000000001422.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=28657973.

Deal C. . MCDA for the Development of Clinical Practice Guidelines and for the Prioritization Clinical Research Questions. In: Marsh K, Goetghebeur M, Thokala P, Baltussen R, editors. . Multi-Criteria Decision Analysis to Support Healthcare Decisions. Cham, Switzerland: Springer; 2017. ISBN: 9783319475400; 3319475401.

Representing the first collection on the topic, this book builds from foundations to case studies, to future prospects, providing the reader with a rich and comprehensive understanding of the use of multi-criteria decision analysis (MCDA) in healthcare. The first section of the collection presents the foundations of MCDA as it is applied to healthcare decisions, providing guidance on the ethical and theoretical underpinnings of MCDA and how to select MCDA methods appropriate to different decision settings. Section two comprises a collection of case studies spanning the decision continuum, including portfolio development, benefit–risk assessment, health technology assessment, priority setting, resource optimisation, clinical practice and shared decision making. Section three explores future directions in the application of MCDA to healthcare and identifies opportunities for further research to support these.

Available via WorldCat: http://www.worldcat.org/oclc/988384087.

Guthrie B, Thompson A, Dumbreck S, Flynn A, Alderson P, Nairn M, Treweek S, Payne K. Better guidelines for better care: accounting for multimorbidity in clinical guidelines – structured examination of exemplar guidelines and health economic modelling. Health Services and Delivery Research. 2017 April;5(16):1-178. PMID: 28459515.

Multimorbidity is common but most clinical guidelines focus on single diseases.
To test the feasibility of new approaches to developing single-disease guidelines to better account for multimorbidity.
Literature-based and economic modelling project focused on areas where multimorbidity makes guideline application problematic.
(1) Examination of accounting for multimorbidity in three exemplar National Institute for Health and Care Excellence guidelines (type 2 diabetes, depression, heart failure); (2) examination of the applicability of evidence in multimorbidity for the exemplar conditions; (3) exploration of methods for comparing absolute benefit of treatment; (4) incorporation of treatment pay-off time and competing risk of death in an exemplar economic model for long-term preventative treatments with slowly accruing benefit; and (5) development of a discrete event simulation model-based cost-effectiveness analysis for people with both depression and coronary heart disease.
(1) Comorbidity was rarely accounted for in the clinical research questions that framed the development of the exemplar guidelines, and was rarely accounted for in treatment recommendations. Drug–disease interactions were common only for comorbid chronic kidney disease, but potentially serious drug–drug interactions between recommended drugs were common and rarely accounted for in guidelines. (2) For all three conditions, the trials underpinning treatment recommendations largely excluded older, more comorbid and more coprescribed patients. The implications of low applicability varied by condition, with type 2 diabetes having large differences in comorbidity, whereas potentially serious drug–drug interactions were more important for depression. (3) Comparing absolute benefit of treatments for different conditions was shown to be technically feasible, but only if guideline developers are willing to make a number of significant assumptions. (4) The lifetime absolute benefit of statins for primary prevention is highly sensitive to the presence of both the direct treatment disutility of taking a daily tablet and competing risk of death. (5) It was feasible to use a discrete event simulation-based model to represent the relevant care pathways to estimate the relative cost-effectiveness of pharmacological treatments of major depressive disorder in primary care for patients who are also likely to go on and receive treatment for coronary heart disease but the analysis was reliant on eliciting some parameter values from experts, which increases the inherent uncertainty in the results. The key limitation was that real-life use in guideline development was not examined.
Guideline developers could feasibly (1) use epidemiological data characterising the guideline population to inform consideration of applicability and interactions; (2) systematically compare the absolute benefit of long-term preventative treatments to inform decision-making in people with multimorbidity and high treatment burden; and (3) modify the output from economic models used in guideline development to examine time to benefit in terms of the pay-off time and varying competing risk of death from other conditions.
Further research is needed to optimise presentation of comparative absolute benefit information to clinicians and patients, to evaluate the use of epidemiological and time-to-benefit data in guideline development, to better quantify direct treatment disutility and to better quantify benefit and harm in people with multimorbidity.
The National Institute for Health Research Health Services and Delivery Research programme.
Copyright © Queen’s Printer and Controller of HMSO 2017. This work was produced by Guthrie et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

FREE FULL TEXT: https://www.ncbi.nlm.nih.gov/books/NBK426098/pdf/Bookshelf_NBK426098.pdf
DOI: https://10.3310/hsdr05160.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=28459515.

Hoffmann-Eßer W, Siering U, Neugebauer EA, Brockhaus AC, Lampert U, Eikermann M. Guideline appraisal with AGREE II: Systematic review of the current evidence on how users handle the 2 overall assessments. PLoS One. 2017 Mar 30;12(3):e0174831. PMID: 28358870.

The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument is the most commonly used guideline appraisal tool. It includes 23 appraisal criteria (items) organized within 6 domains and 2 overall assessments (1. overall guideline quality; 2. recommendation for use). The aim of this systematic review was twofold. Firstly, to investigate how often AGREE II users conduct the 2 overall assessments. Secondly, to investigate the influence of the 6 domain scores on each of the 2 overall assessments.
A systematic bibliographic search was conducted for publications reporting guideline appraisals with AGREE II. The impact of the 6 domain scores on the overall assessment of guideline quality was examined using a multiple linear regression model. Their impact on the recommendation for use (possible answers: "yes", "yes, with modifications", "no") was examined using a multinomial regression model.
118 relevant publications including 1453 guidelines were identified. 77.1% of the publications reported results for at least one overall assessment, but only 32.2% reported results for both overall assessments. The results of the regression analyses showed a statistically significant influence of all domains on overall guideline quality, with Domain 3 (rigour of development) having the strongest influence. For the recommendation for use, the results showed a significant influence of Domains 3 to 5 ("yes" vs. "no") and Domains 3 and 5 ("yes, with modifications" vs. "no").
The 2 overall assessments of AGREE II are underreported by guideline assessors. Domains 3 and 5 have the strongest influence on the results of the 2 overall assessments, while the other domains have a varying influence. Within a normative approach, our findings could be used as guidance for weighting individual domains in AGREE II to make the overall assessments more objective. Alternatively, a stronger content analysis of the individual domains could clarify their importance in terms of guideline quality. Moreover, AGREE II should require users to transparently present how they conducted the assessments.

FREE FULL TEXT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5373625/pdf/pone.0174831.pdf
DOI: http://dx.doi.org/10.1371/journal.pone.0174831.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=28358870.
PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5373625.

Howe MS. What is the methodological quality of published dental implant guidelines? Evid Based.Dent. 2017 Jun 23;18(2):35-6. PMID: 28642562.

Data sourcesSix implant dentistry journals with impact factors (2014) assigned by Journal Citation Reports (Clinical Oral Implants Research, Clinical Implant Dentistry and Related Research, European Journal of Oral Implants, The International Journal of Oral and Maxillofacial Implants, Journal of Oral Implantology, and Implant Dentistry) and the Medline database.Study selectionTwo reviewers independently selected guidelines published between May 2009 and February 2016.Data evaluationFollowing training four reviewers independently applied the Agree II tool (http://www.agreetrust.org/) to the selected guidelines with disagreements being resolved by discussion. Scores for the six domains of the AGREE II tool were presented as median percentages of the maximum possible with their respective interquartile ranges (IQR). Domain scores were divided into consensus guidelines, and consensus guidelines with systematic reviews.ResultsTwenty-seven consensus guidelines were included, with 19 contributing to the comparisons between groups. Twenty-six guidelines were developed after meetings in Europe, with the European Association of Osseointergration developing the most guidelines (n=9). The number of authors for the guidelines varied from 2-27 (median, 9). For consensus guidelines only domain four scored highest. Guidelines with systematic review scored higher for all domains with the exception of domain five (Table 1).ConclusionsThere is room to improve the quality of consensus guidelines published in highly ranked implant dentistry journals. Clinicians' and researchers' development of consensus guidelines to improve clinical treatment with dental implants is laudable. However, as for primary and secondary research, these guidelines should adhere to high and transparent standards. The AGREE II instrument can be used as a reference for the development of high-quality guidelines to provide unbiased and adequate clinical recommendations to clinicians working with dental implants.

DOI: http://dx.doi.org/10.1038/sj.ebd.6401231.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28642562.

Lowenhoff C. Is it time for a review of the way that NICE guidelines are developed, presented and used to inform policy and practice? Evid Based.Nurs. 2017 Jul;20(3):65-6. PMID: 28601801.

[First paragraph]

Catherine Lowenhoff emphasises the need to share the uncertainties inherent in the National Institute for Health and Care Excellence guidelines with policy makers, commissioners, regulators, managers and clinicians to facilitate the paradigm shift from evidence-based practice to evidence-informed practice.

DOI: http://dx.doi.org/10.1136/eb-2017-102714.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=28601801.

Nissen T, Wayant C, Wahlstrom A, Sinnett P, Fugate C, Herrington J, Vassar M. Methodological quality, completeness of reporting and use of systematic reviews as evidence in clinical practice guidelines for paediatric overweight and obesity. Clin.Obes. 2017 Feb;7(1):34-45. PMID: 28112500.

Paediatric obesity rates remain high despite extensive efforts to prevent and treat obesity in children. We investigated the quality of the methodology and reporting within systematic reviews (SRs) underpinning paediatric content in US clinical practice guidelines (CPGs). In June 2016 we searched guideline clearinghouses and professional organization websites for guidelines published by national or professional organizations in the United States from January 2007 onwards. In our primary, a priori analysis, we used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) instruments to score SRs and meta-analyses that included paediatric populations and were cited by included CPGs. In a secondary, post hoc analysis, we determined the extent to which US CPGs use available, relevant SRs and meta-analyses compared with non-US CPGs. Eight US-based CPGs with 27 references to 22 unique SRs were found. AMSTAR and PRISMA scores were low overall, with only three SRs having 'high' methodological quality. Items dealing with bias assessments and search strategies had especially low scores. US CPGs were also older on average and cited fewer SRs than their international counterparts. Low quality scores and dated guidelines should be a cause for concern among practicing clinicians and a call to action for future guideline developers, publishers and research institutions.

DOI: http://dx.doi.org/10.1111/cob.12174.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=28112500.

Richter Sundberg L, Garvare R, Nyström ME. Reaching beyond the review of research evidence: a qualitative study of decision making during the development of clinical practice guidelines for disease prevention in healthcare. BMC Health Serv.Res. 2017 May 11;17(1):344. PMID: 28490325.

The judgment and decision making process during guideline development is central for producing high-quality clinical practice guidelines, but the topic is relatively underexplored in the guideline research literature. We have studied the development process of national guidelines with a disease-prevention scope produced by the National board of Health and Welfare (NBHW) in Sweden. The NBHW formal guideline development model states that guideline recommendations should be based on five decision-criteria: research evidence; curative/preventive effect size, severity of the condition; cost-effectiveness; and ethical considerations. A group of health profession representatives (i.e. a prioritization group) was assigned the task of ranking condition-intervention pairs for guideline recommendations, taking into consideration the multiple decision criteria. The aim of this study was to investigate the decision making process during the two-year development of national guidelines for methods of preventing disease.
A qualitative inductive longitudinal case study approach was used to investigate the decision making process. Questionnaires, non-participant observations of nine two-day group meetings, and documents provided data for the analysis. Conventional and summative qualitative content analysis was used to analyse data.
The guideline development model was modified ad-hoc as the group encountered three main types of dilemmas: high quality evidence vs. low adoptability of recommendation; insufficient evidence vs. high urgency to act; and incoherence in assessment and prioritization within and between four different lifestyle areas. The formal guideline development model guided the decision-criteria used, but three new or revised criteria were added by the group: 'clinical knowledge and experience', 'potential guideline consequences' and 'needs of vulnerable groups'. The frequency of the use of various criteria in discussions varied over time. Gender, professional status, and interpersonal skills were perceived to affect individuals' relative influence on group discussions.
The study shows that guideline development groups make compromises between rigour and pragmatism. The formal guideline development model incorporated multiple aspects, but offered few details on how the different criteria should be handled. The guideline development model devoted little attention to the role of the decision-model and group-related factors. Guideline development models could benefit from clarifying the role of the group-related factors and non-research evidence, such as clinical experience and ethical considerations, in decision-processes during guideline development.

FREE FULL TEXT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426017/pdf/12913_2017_Article_2277.pdf
DOI: http://dx.doi.org/10.1186/s12913-017-2277-1.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=28490325.
PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426017.

Scott IA, Chew DP, Branagan M. Raising the bar on guideline utility and trustworthiness. Intern.Med.J. 2017 Jun;47(6):613-6. PMID: 28580750.

[First paragraph, reference html links removed]

Clinical practice guidelines (CPG) are designed to aid medical decision-making and to improve care. However, the clinical utility and trustworthiness of many guidelines have been challenged on the grounds of poor quality of evidence used to formulate recommendations,[1] lack of transparency in the guideline development process and potential conflicts of interest (COI),[2] inadequate customisation of recommendations to patients with special needs[3] or competing risks from co-morbidities,[4] failure to consider patient values and preferences, and little attention to implementation challenges.[5] In Australia, 2006 guidelines for acute coronary syndromes (ACS) were perceived by one editorialist as being controversial[6] and independent reviewers noted some limitations in methodological rigour, editorial independence and applicability.[7] A review of 313 Australian guidelines issued between 2003 and 2007 noted deficiencies in evidence synthesis in 70% and no mention of possible competing interests of guideline development groups in 79%.[8]

DOI: http://dx.doi.org/10.1111/imj.13444.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=28580750.

Scott J, Howard B, Sinnett P, Schiesel M, Baker J, Henderson P, Vassar M. Variable methodological quality and use found in systematic reviews referenced in STEMI clinical practice guidelines. Am.J.Emerg.Med. 2017 Jun 14. PMID: 28623004.

The objective of this study was to assess the methodological quality and clarity of reporting of the systematic reviews (SRs) supporting clinical practice guideline (CPG) recommendations in the management of ST-elevation myocardial infarction (STEMI) across international CPGs.
We searched 13 guideline clearinghouses including the National Guideline Clearinghouse and Guidelines International Network (GIN). To meet inclusion criteria CPGs must be pertinent to the management of STEMI, endorsed by a governing body or national organization, and written in English. We retrieved SRs from the reference sections using a combination of keywords and hand searching. Two investigators scored eligible SRs using AMSTAR and PRISMA.
We included four CPGs. We extracted 71 unique SRs. These SRs received AMSTAR scores ranging from 1 (low) to 9 (high) on an 11-point scale. All CPGs consistently underperformed in areas including disclosure of funding sources, risk of bias, and publication bias according to AMSTAR. PRISMA checklist completeness ranged from 44% to 96%. The PRISMA scores indicated that SRs did not provide a full search strategy, study protocol and registration, assessment of publication bias or report funding sources. Only one SR was referenced in all four CPGs. All CPGs omitted a large subset of available SRs cited by other guidelines.
Our study demonstrates the variable quality of SRs used to establish recommendations within guidelines included in our sample. Although guideline developers have acknowledged this variability, it remains a significant finding that needs to be addressed further.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Copyright © 2017 Elsevier Inc. All rights reserved.

DOI: http://dx.doi.org/10.1016/j.ajem.2017.06.010.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=28623004.

Sever P. Will the recent hypertension trials change the guidelines? J.Renin Angiotensin Aldosterone Syst. 2017 Apr-Jun;18(2):1470320317710891. PMID: 28664788.

[First paragraph]

Despite the fact that the treatment of hypertension remains one of the most extensively investigated areas of clinical medicine, there remain a number of important questions, the answers to which would affect guidelines for hypertension management and a change in clinical practice.

DOI: http://dx.doi.org/10.1177/1470320317710891.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28664788.

Siemieniuk RAC, Guyatt GH. The next frontier in critical care guidelines: rapid and trustworthy recommendations | Prochaine étape Pour Les Directives en Soins Intensifs : Des Recommandations Rapides Et Dignes De Confiance. Can.J.Anaesth. 2017 Jul;64(7):689-92. PMID: 28497425.

[First paragraph, reference html links removed]

Optimal clinical care requires application of the best available evidence to patient care decisions.1 Trustworthy clinical practice guidelines synthesize the available evidence and provide suggestions for front-line clinicians.
Historically, guideline panels take months to, most commonly, years to process the evidence and produce their recommendations. Many conventional guidelines are outdated by the time of publication, and almost all are outdated before the panel produces an update. In the hiatus between the publication of new evidence and its inclusion in a guideline, clinicians and patients are left wondering whether the new evidence should change practice—assuming they are even aware of the new evidence. As a result, many patients are at risk of receiving inadequate or inappropriate care.

DOI: http://dx.doi.org/10.1007/s12630-017-0876-2.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=28497425.

van Driel ML, Spurling G. Guidelines and systematic reviews: Sizing up guidelines in general practice. Aust.Fam.Physician. 2017 Jun;46(6):438-40. PMID: 28609602.

This article is the second in a series on general practice research in Australia. The series explores strategies to strengthen general practice research and further develop the evidence base for primary care.

PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=28609602.

Vernooij RW, Alonso-Coello P, Brouwers M, Martínez García L, CheckUp Panel. Reporting Items for Updated Clinical Guidelines: Checklist for the Reporting of Updated Guidelines (CheckUp). PLoS Med. 2017 Jan 10;14(1):e1002207. PMID: 28072838.

Scientific knowledge is in constant development. Consequently, regular review to assure the trustworthiness of clinical guidelines is required. However, there is still a lack of preferred reporting items of the updating process in updated clinical guidelines. The present article describes the development process of the Checklist for the Reporting of Updated Guidelines (CheckUp).
We developed an initial list of items based on an overview of research evidence on clinical guideline updating, the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument, and the advice of the CheckUp panel (n = 33 professionals). A multistep process was used to refine this list, including an assessment of ten existing updated clinical guidelines, interviews with key informants (response rate: 54.2%; 13/24), a three-round Delphi consensus survey with the CheckUp panel (33 participants), and an external review with clinical guideline methodologists (response rate: 90%; 53/59) and users (response rate: 55.6%; 10/18). CheckUp includes 16 items that address (1) the presentation of an updated guideline, (2) editorial independence, and (3) the methodology of the updating process. In this article, we present the methodology to develop CheckUp and include as a supplementary file an explanation and elaboration document.
CheckUp can be used to evaluate the completeness of reporting in updated guidelines and as a tool to inform guideline developers about reporting requirements. Editors may request its completion from guideline authors when submitting updated guidelines for publication. Adherence to CheckUp will likely enhance the comprehensiveness and transparency of clinical guideline updating for the benefit of patients and the public, health care professionals, and other relevant stakeholders.

FREE FULL TEXT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5224740/pdf/pmed.1002207.pdf
DOI: http://dx.doi.org/10.1371/journal.pmed.1002207.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=28072838.
PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5224740.

Huddy J. Writing liver function test guidelines: how hard can it be? Br.J.Gen.Pract. 2016 Aug;66(649):426. PMID: 27481972.

[First paragraph, reference html links removed]

I was asked to write local guidelines for our referral management service for GPs to manage asymptomatic abnormal liver function tests (LFTs). ‘I’d be delighted’, I said. ‘How hard can it be?’ I thought. I was only a year off being a consultant in gastroenterology (including having worked at King’s Liver Unit) when I changed to general practice. That was 10 years ago. Now half my week is as a salaried GP, and I spend the other half performing endoscopy at our district general hospital and I have close ties to the gastro department. I’ve got an understanding of the liver and primary care, and secondary care and the referral system. Let’s crack on.

DOI: http://dx.doi.org/10.3399/bjgp16X686353.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=27481972.
PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979947/.