Table 2 Stages of the strategies*
From: Strategies for monitoring and updating clinical practice guidelines: a systematic review
Author and year | Assessing the need to update | Scope definition | Update group (number of participants) | Evidence search strategy | Evidence selection, assessment and synthesis | Update recommendations | Presentation of updates |
|---|---|---|---|---|---|---|---|
Shekelle 2001[3] | Within specific timeframe | Identification of main recommendations | Reviewers (2) Chairs of the original CPG expert panel (15) Members related with original CPGs (2) Members of the original CPG expert panel (121) Nonpanel experts (8) | Restricted search 5 key medical journals and key specialty journals Reviews, editorials, commentaries Additional search in NGC and web sites of CPGs publishing organizations Surveyed experts by mail | Reviewed references (title, abstract and articles) Reviewed the relevance of selected references Based on new evidence and judgment guidelines were classified in to: major update, minor update or still valid | NA | NA |
Bosquet 2003[9]‡ | Monitoring | Discussion about priority of topics to be updated | Methodologist (NS) Original working group (NS) | Exhaustive search MEDLINE, EMBASE, SBU and APM web sites | Selection of references Evaluation the impact of reference on existing guideline: consistent with existing guidelines, inconsistent or concern new topics | NA | NA |
Gartlehner 2004[7] | Within specific timeframe | Developed analytic framework, critical key questions and eligibility criteria Survey to national/ international experts | Clinicians (4) Health services researchers (2) Reviewers (4) Librarians (NS) National or international experts (13) | Modified Shekelle et al. [Shekelle2001] search AIM journals and non-AIM speciality journals Reviews, editorials, commentaries, guidelines Additional search in PreMedline, HSTAT, The Cochrane Library and selected NIH websites Surveyed to national or international experts Exhaustive search MEDLINE, The Cochrane Library Reviews, meta-analysis, RCTs Surveyed to national or international experts | Assessed the relevance of abstracts, full-text articles and original studies Used of update memos with studies that judged as eligible and addressed a critical key question | NA | NA |
Nunes 2009[15]‡§** | Within specific timeframe | NS | Methodologist (3) Clinicians (3) | Restricted search Guidelines | Selection and assessment guidelines with AGREE Narrative summary of the methodological aspects and major findings of each guideline | NA | NA |
Eccles 2002[10] | Within specific timeframe | NS | General practitioners (8) Consultants (2) Nurses (2) Health economists (2) Guideline methodologist (2) | Exhaustive search MEDLINE, EMBASE, The Cochrane Library | Systematic review Evidence tables or text summaries | 3 situations: new recommendations; refinement recommendations; and unchanged recommendations | NS |
Newton 2006[14]ठ| NS | Additional research questions | Methodologist (9) Clinicians (6) | Exhaustive search NS | Verification of results and study quality from the original review | Integrating a qualitative and quantitative data on the prior review and developing recommendations | NS |
Parmelli 2010[16] | Within specific timeframe | Mail consultation to experts from development group Relevant evidence | Coordinating group (10) 3 multidisciplinary panels (NS) External methodological group (NS) | Exhaustive search MEDLINE, EMABASE, central and databases for conference (ASCO) SRs, meta-analysis, RCTs | Evidence selection Application GRADE methodology Evidence tables Informed and discussed with panellist in meetings | Classified strength of recommendation in 4 levels: strong positive, weak positive, weak negative and strong negative Voted by experts in meeting | NS |
Johnston 2003[8] | Monitoring | NS | Health information specialist (3) Lead author of the original guideline (NS) DSG who developed guideline: chair, members and research assistant (NS) | Exhaustive search MEDLINE (monthly), CancerList (monthly), HealthStar (monthly), The Cochrane Library (quarterly) Guidelines, SRs, RCTs Additional search in key journals and proceedings meeting Notifications by DSG members | Identified potentially relevant new trials, meta-analyses an evidence-based guidelines or update results from trials included in original guideline Reviewed abstracts and articles Considered relevance of each reference to original guideline question Interpreted new evidence in the context of original guideline Descriptive and summaries of new evidence | DSG choose implications of new evidence on clinical recommendations: unchanged recommendation, strength recommendation, change recommendation | Notice linked to each guideline to keep practitioners aware that regular update search conduced Update bulletin with new evidence emerged Notice at the top of the guideline to alert practitioners that guideline was review Removed obsolete guidelines Integrated evidence update into original report (dynamic ‘living’ practice guidelines) |