Transparent development of the WHO rapid advice guidelines.

Italian National Cancer Institute Regina Elena, Department of Epidemiology, Rome, Italy.
PLoS Medicine (Impact Factor: 14). 06/2007; 4(5):e119. DOI: 10.1371/journal.pmed.0040119
Source: PubMed

ABSTRACT Emerging health problems require rapid advice. We describe the development and pilot testing of a systematic, transparent approach used by the World Health Organization (WHO) to develop rapid advice guidelines in response to requests from member states confronted with uncertainty about the pharmacological management of avian influenza A (H5N1) virus infection. We first searched for systematic reviews of randomized trials of treatment and prevention of seasonal influenza and for non-trial evidence on H5N1 infection, including case reports and animal and in vitro studies. A panel of clinical experts, clinicians with experience in treating patients with H5N1, influenza researchers, and methodologists was convened for a two-day meeting. Panel members reviewed the evidence prior to the meeting and agreed on the process. It took one month to put together a team to prepare the evidence profiles (i.e., summaries of the evidence on important clinical and policy questions), and it took the team only five weeks to prepare and revise the evidence profiles and to prepare draft guidelines prior to the panel meeting. A draft manuscript for publication was prepared within 10 days following the panel meeting. Strengths of the process include its transparency and the short amount of time used to prepare these WHO guidelines. The process could be improved by shortening the time required to commission evidence profiles. Further development is needed to facilitate stakeholder involvement, and evaluate and ensure the guideline's usefulness.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Decision-making based on reliable evidence is more likely to lead to effective and efficient treatments. Evidence-based dentistry was developed, similarly to evidence-based medicine, to help clinicians apply current and valid research findings into their own clinical practice. Interpreting and appraising the literature is fundamental and involves the development of evidence-based dentistry (EBD) skills. Systematic reviews (SRs) of randomized controlled trials (RCTs) are considered to be evidence of the highest level in evaluating the effectiveness of interventions. Furthermore, the assessment of the report of a RCT, as well as a SR, can lead to an estimation of how the study was designed and conducted.
    Progress in orthodontics. 01/2014; 15:58.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group represents an international collaboration of guideline developers, clinicians, health services researchers and methodologists. Many leading organizations, including the World Health Organization (WHO), use the GRADE approach because it has led to progress in the assessment of evidence and in the development of healthcare recommendations. The GRADE system distinguishes the quality of evidence from the strength of a recommendation. The quality of evidence reflects the extent of confidence that an estimate of effect is correct if it is used in the context of single endpoints. In the context of giving guidance, it reflects the extent to which confidence in an estimate of the effect is adequate to support recommendations. The strength of a recommendation, separated into strong and weak or conditional recommendations for or against an intervention, is defined as the extent to which one can be confident that the desirable effects of an intervention outweigh the undesirable effects. A recommendation for action requires consideration for the magnitude of the expected benefit and downsides of an intervention for all patient-important endpoints, the associate values and preferences and resource use. The GRADE system includes a systematic approach to evaluate the generalizability of study results to healthcare practice. Judgments about generalizability, better termed directness, are separated into judgments about the availability of direct comparisons between two alternative management strategies and judgments about differences between the population, intervention, comparator to the intervention, and outcomes (PICO) of interest for a given question, and those included in the relevant studies. In addition to providing an overview of the GRADE system, this article focuses on the approach to assessing directness or generalizability. (As supplied by publisher)
    Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 01/2009; 103(6):391–400.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND:Although several tools to evaluate the credibility of health care guidelines exist, guidance on practical steps for developing guidelines is lacking. We systematically compiled a comprehensive checklist of items linked to relevant resources and tools that guideline developers could consider, without the expectation that every guideline would address each item. METHODS:We searched data sources, including manuals of international guideline developers, literature on guidelines for guidelines (with a focus on methodology reports from international and national agencies, and professional societies) and recent articles providing systematic guidance. We reviewed these sources in duplicate, extracted items for the checklist using a sensitive approach and developed overarching topics relevant to guidelines. In an iterative process, we reviewed items for duplication and omissions and involved experts in guideline development for revisions and suggestions for items to be added. RESULTS:We developed a checklist with 18 topics and 146 items and a webpage to facilitate its use by guideline developers. The topics and included items cover all stages of the guideline enterprise, from the planning and formulation of guidelines, to their implementation and evaluation. The final checklist includes links to training materials as well as resources with suggested methodology for applying the items. INTERPRETATION:The checklist will serve as a resource for guideline developers. Consideration of items on the checklist will support the development, implementation and evaluation of guidelines. We will use crowdsourcing to revise the checklist and keep it up to date.
    Canadian Medical Association Journal 12/2013; · 5.81 Impact Factor

Full-text (2 Sources)

Available from
Jun 1, 2014