Barrett's esophagus (BE), a common condition, is the only known precursor to esophageal adenocarcinoma (EAC). There is uncertainty about the best way to manage BE as most people with BE never develop EAC and most patients diagnosed with EAC have no preceding diagnosis of BE. Moreover, there have been recent advances in knowledge and practice about the management of BE and early EAC. To aid clinical decision making in this rapidly moving field, Cancer Council Australia convened an expert working party to identify pertinent clinical questions. The questions covered a wide range of topics including endoscopic and histological definitions of BE and early EAC; prevalence, incidence, natural history, and risk factors for BE; and methods for managing BE and early EAC. The latter considered modification of lifestyle factors; screening and surveillance strategies; and medical, endoscopic, and surgical interventions. To answer each question, the working party systematically reviewed the literature and developed a set of recommendations through consensus. Evidence underpinning each recommendation was rated according to quality and applicability.

Using a wiki platform for guideline development and dissemination is a successful method for producing high-quality resources that can undergo wide international stakeholder review and include open public consultation. This can replace conventional methods whereby guidelines can quickly become outdated.

In 2013 Australia introduced Wiki-based Clinical Practice Guidelines for the Management of Adult Onset Sarcoma. These guidelines utilized a customized MediaWiki software application for guideline development and are the first evidence-based guidelines for clinical management of sarcoma. This paper presents our experience with developing and implementing web-based interactive guidelines and reviews some of the challenges and lessons from adopting an evidence-based (rather than consensus-based) approach to clinical sarcoma guidelines. Digital guidelines can be easily updated with new evidence, continuously reviewed and widely disseminated. They provide an accessible method of enabling clinicians and consumers to access evidence-based clinical practice recommendations and, as evidenced by over 2000 views in the first four months after release, with 49% of those visits being from countries outside of Australia. The lessons learned have relevance to other rare cancers in addition to the international sarcoma community.

AimTo develop clinical practice guidelines for screening, assessing and managing cancer pain in Australian adults. MethodsThis three phase project utilised the ADAPTE approach to adapt international cancer pain guidelines for the Australian setting. A Working Party was established to define scope, screen guidelines for adaptation, and develop recommendations to support better cancer pain control through screening, assessment, pharmacological and non-pharmacological management, and patient education.Recommendations with limited evidence were referred to Expert Panels for advice before the draft guidelines were opened for public consultation via the Cancer Council Australia Cancer Guidelines Wiki platform in late 2012. All comments were reviewed by the Working Party and the guidelines revised accordingly. ResultsScreening resulted in six international guidelines being included for adaptation -those developed by the

large network of private practices affiliated with Boston Children's Hospital. The SE game consisted of 15 validated multiple-choice questions and explanations on constipation clinical guidelines. All PCPs were sent two questions every week via an automated e-mail system (Qstream, Inc., Burlington, MA, USA). Adaptive game mechanics re-sent the questions answered incorrectly and correctly at 8 days and 16 days, respectively. Points were awarded based on performance. Physicians retired questions by answering them correctly twice in a row (progression dynamic). Each PCP was assigned to one of 10 teams based on geographic location (e.g. North of the Charles River, Coast & Cape, etc.). Competition was fostered by posting scores on individual and team leaderboards. To protect participants' identities on the leaderboards, each was assigned an alias in the form of an adjective and an animal (e.g. Striking Penguin, Itchy Eagle, Jazzy Chicken, etc.). Main outcome measures were baseline scores (percentage of questions answered correctly upon initial presentation) and final scores (percentage of questions answered correctly upon final presentation). A post-game survey was administered online.Of 266 network PCPs, 120 (45%) enrolled; 117 enrollees (98%) participated in the game and 103 (86%) completed it over the allotted 13 weeks. The Cronbach's a-value for the reliability of the aggregated SE questions on initial presentation was 0.74. Mean AE standard deviation baseline and final scores were 58 AE 19% and 88 AE 20%, respectively (p < 0.001, Cohen's d = 1.5). Scores did not vary significantly by gender, provider type (nurse or physician) or years in practice. Among the 99 survey respondents (83% of enrollees), 96 (97%) agreed that the SE game was easy to incorporate into their schedules, 89 (90%) agreed that they were likely to implement new ways of managing constipation into their practice, and all (100%) reported that they would like more continuing medical education using SE games. What lessons were learned? Our results demonstrate that a team-based SE game is an effective and very acceptable educational methodology to improve constipation management among private practice, paediatric PCPs. Although baseline scores among PCPs were low, the SE game generated strong gains in knowledge of constipation management guidelines. Notwithstanding the inherent limitations of self-report survey data, almost all paediatric PCPs reported that the SE game made them more likely to implement improved methods of constipation management into their practice. Future studies will investigate actual clinical adher-ence to management guidelines among paediatric PCPs. REFERENCE 1 Kerfoot BP, Lawler EV, Sokolovskaya G, Gagnon D, Conlin PR. Durable improvements in prostate cancer screening from online spaced education: a randomised controlled trial. Am J Prev Med 2010;39 (5):472-8.