Methods for living guidelines: early guidance based on practical experience. Paper 4: search methods and approaches for living guidelines

McDonald, Steve; Sharp, Steve; Murad, M Hassan; Navarro, David Fraile

doi:10.1016/j.jclinepi.2022.12.023

Cited by 13 publications

(4 citation statements)

References 27 publications

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“…Although the urgency of COVID‐19 was unique, several principles that guided our surveillance are applicable to living guidelines more generally [32]. Understanding what is appropriate in terms of timeliness (frequency), coverage (range and type of sources) and approach (manual vs. automation), and what is feasible given resource constraints (time and personnel) are key considerations.…”

Section: Discussionmentioning

confidence: 99%

Designing, refining and reflecting on 3 years of daily evidence surveillance for Australia's living national COVID‐19 guidelines

McDonald,

Turner

2024

Cochrane Evidence Synthesis and Methods

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Australia's national living guidelines for COVID‐19 were launched in April 2020 and include over 200 recommendations to guide the clinical care of patients with COVID‐19. Until the guidelines were retired in August 2023, new evidence was continually monitored through daily surveillance. This paper describes the initial design for evidence surveillance (at a time when efforts to collate information on the novel coronavirus were in their infancy and often duplicative) and how it was refined throughout the pandemic. Among the wide range of sources monitored, the collections of COVID‐19 research from leading medical journals, medRxiv preprints and PubMed auto alerts proved the most enduring in identifying time‐critical and impactful evidence. The paper also explores how evidence was tracked and surveillance integrated into the overall evidence workflow by using messaging apps and communication platforms. Finally, we consider the implications for living guidelines and reflect on factors that contributed to the feasibility of daily surveillance: the clearly defined scope of the guidelines; focusing efforts on maximum impact; minimizing duplication by partnering with others; setting up simple but effective processes for managing evidence; and the value of continuous involvement of personnel from the outset. Australia's living COVID‐19 guidelines were underpinned by a novel approach to evidence surveillance that was feasible and essential in maintaining COVID‐19 living guidelines for over 3 years.

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Section: Discussionmentioning

confidence: 99%

Designing, refining and reflecting on 3 years of daily evidence surveillance for Australia's living national COVID‐19 guidelines

McDonald,

Turner

2024

Cochrane Evidence Synthesis and Methods

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“…The core methods for literature searching, evidence appraisal and synthesis are similar for living and partial updating of traditional (static) guidelines, but living guidelines involve a frequent and explicit approach to keeping the guidelines up-to-date. This approach includes frequent surveillance for newly published clinical studies, the prospective, ongoing incorporation of those studies into the evidence base, and the use of pre-agreed triggers for updating the corresponding evidence-based recommendations ( Akl et al, 2017 ; Cheyne et al, 2023a ; Cheyne et al, 2023b ; Fraile Navarro et al, 2023 ; McDonald et al, 2023 ; Synnot et al, 2023 ) The criteria for selecting living topics are: clinical or policy priority of the question, important uncertainty in the existing evidence, and high likelihood of emergence of new evidence where the clinical/policy context is likely to change ( Akl et al, 2017 ; Cheyne et al, 2023a ). The frequency of updating a living topic is determined by the nature of the health problem, the flow of emerging evidence, the capacity of the evidence review team to search, screen and appraise new evidence, and the capacity of the Guideline Development Panel to meet and determine the implications of the new evidence ( Cheyne et al, 2023b ; McDonald et al, 2023 ) For example, searches for living COVID-19 guidelines were conducted on a daily basis during the height of the pandemic, whereas searches for living stroke guidelines are conducted every 3 months ( Tendal et al, 2021 ; Hill et al, 2022 ).…”

Section: Static Versus Living Guidelinesmentioning

confidence: 99%

What could health technology assessment learn from living clinical practice guidelines?

Cheyne,

Chakraborty,

Lewis

et al. 2023

Front. Pharmacol.

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A “living” approach to clinical practice guidelines is when the identification, appraisal and synthesis of evidence is maintained and repeated at an agreed frequency, with a clear process for when and how new evidence is to be incorporated. The value of a living approach to guidelines was emphasised during the COVID-19 pandemic when health professionals and policymakers needed to make decisions regarding patient care in the context of a nascent but rapidly evolving evidence base. In this perspective, we draw on our recent experience developing Australian and international living guidelines and reflect on the feasibility of applying living guideline methods and processes to a lifecycle approach to health technology assessment (HTA). We believe the opportunities and challenges of adopting a living approach in HTA fall into five key themes: identification, appraisal and synthesis of evidence; optimising the frequency of updates; embedding ongoing multi-stakeholder engagement; linking the emergence of new evidence to reimbursement; and system capacity to support a living approach. We acknowledge that the suitability of specific living approaches to HTA will be heavily influenced by the type of health technology, its intended use in the health system, local reimbursement pathways, and other policy settings. But we believe that the methods and processes applied successfully to guideline development to manage evidentiary uncertainty could be applied in the context of HTA and reimbursement decision-making to help manage similar sources of uncertainty.

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“…Se deben establecer, también, los lineamientos para la actualización de las directrices. Para ello, se deben elaborar estrategias que permitan conocer cuáles directrices se deben actualizar, el tiempo de vigencia, la inclusión de intervenciones nuevas y el desarrollo de revisiones "vivas" para condiciones en las cuales se necesita contar con evidencia actualizada (42).…”

Section: Definición De Los Métodos Para La Elaboración De Las Directr...unclassified

Guía para adaptar y aplicar directrices informadas por la evidencia. Segunda edición

2023

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La Organización Panamericana de la Salud presenta esta guía dirigida a entes gubernamentales, autoridades de salud pública, profesionales de la salud, pacientes y otras personas e instituciones interesadas en la elaboración de directrices informadas por la evidencia. Tiene por objetivo presentar las estrategias políticas y metodológicas para la creación y el fortalecimiento de los programas nacionales de elaboración de directrices en la Región de las Américas. En esta segunda edición se revisa el proceso de elaboración de directrices de acuerdo con la última versión del método de clasificación de la valoración, elaboración y evaluación de las recomendaciones (conocido como GRADE, por su sigla en inglés). Se abordan la formulación de las recomendaciones, la construcción de los perfiles de evidencia y la creación de los marcos para pasar de la evidencia a las decisiones; se presentan marcos conceptuales nuevos para la creación o fortalecimiento de los programas de directrices (modelo lógico del funcionamiento del programa, pasos para su institucionalización y retos para los entes gubernamentales), y se actualizan los aspectos clave del proceso de aplicación de las directrices elaboradas por los países o instituciones de salud de la Región (barreras, estrategias y facilitadores de la aplicación, e indicadores).

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Methods for living guidelines: early guidance based on practical experience. Paper 4: search methods and approaches for living guidelines

Cited by 13 publications

References 27 publications

Designing, refining and reflecting on 3 years of daily evidence surveillance for Australia's living national COVID‐19 guidelines

Designing, refining and reflecting on 3 years of daily evidence surveillance for Australia's living national COVID‐19 guidelines

What could health technology assessment learn from living clinical practice guidelines?

Guía para adaptar y aplicar directrices informadas por la evidencia. Segunda edición

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