Canadian Clinical Practice Guidelines Research Articles

Antenatal corticosteroids and newborn respiratory outcomes in twins: A regression discontinuity study.

To estimate the effect of antenatal corticosteroids on newborn respiratory morbidity in twins. Regression discontinuity applied to population-based birth registry data. British Columbia, Canada, 2008-2018. Twin pregnancies admitted for birth between 31+0 and 36+6  weeks of gestation. During our study period, Canadian clinical practice guidelines recommended antenatal corticosteroid administration for imminent preterm birth up to 33+6  weeks. We used a logistic model to compare the predicted risks of our outcomes among pregnancies admitted for birth immediately before this clinical cut-point (higher probability of exposure to antenatal corticosteroids) versus immediately after it (lower probability). Our primary outcome was a composite of newborn respiratory distress or in-hospital death. Our secondary outcome was a composite of newborn respiratory intervention or in-hospital death. Among 2524 pregnancies (5035 liveborn twins), 47% of admissions before 34+0  weeks of gestation were exposed to antenatal corticosteroids but only 4.2% of admissions after this cut-point were exposed. The risk of newborn respiratory distress or in-hospital mortality increased abruptly at 34+0  weeks, corresponding to a protective effect of treatment (risk ratio [RR] 0.69, 95% CI 0.53-0.90; risk difference [RD]-12 cases per 100 births, 95% CI -20 to -4.1). There was no clear evidence for or against an effect on newborn respiratory intervention or in-hospital death (RR 0.89, 95% CI 0.70-1.13; RD -4.2 per 100, 95% CI -13 to +4.2). Our findings provide evidence for the effectiveness of antenatal corticosteroids in preventing adverse newborn respiratory outcomes in twins.

'Planning for a healthy baby and a healthy pregnancy': A critical analysis of Canadian clinical practice guidelines for the treatment of opioid dependence during pregnancy.

As opioid fatalities rise in North America, the need to improve the supports available to those who are dependent on opioids and pregnant has become more urgent. This paper discusses the social organisation of drug treatment supports for those who are pregnant, using Canadian clinical practice guidelines (CPGs) for methadone maintenance treatment (MMT) as a case study. Pregnant patients are a priority population for MMT, both in Canada and internationally; the regulatory bodies that oversee MMT in Canada are the provincial Colleges of Physician and Surgeons and Health Canada. The paper analyses MMT CPGs published by these agencies, comparing their general recommendations to those specific to pregnant patients. We demonstrate that the guidelines address few treatment considerations for pregnant patients, other than improved birth outcomes and child welfare, despite acknowledging their more complex needs. Drawing on social science studies of gender and drugs, we argue that MMT CPGs therefore perpetuate the intensified surveillance and foetal prioritisation that have long generated barriers to care for opiate-dependent pregnant patients. We also discuss how and why the CPGs ultimately only reinforced these current limitations in the drug treatment sector.

Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update.

In Canada, more than 2 million people live with osteoporosis, a disease that increases the risk for fractures, which result in excess mortality and morbidity, decreased quality of life and loss of autonomy. This guideline update is intended to assist Canadian health care professionals in the delivery of care to optimize skeletal health and prevent fractures in postmenopausal females and in males aged 50 years and older. This guideline is an update of the 2010 Osteoporosis Canada clinical practice guideline on the diagnosis and management of osteoporosis in Canada. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework and quality assurance as per Appraisal of Guidelines for Research and Evaluation (AGREE II) quality and reporting standards. Primary care physicians and patient partners were represented at all levels of the guideline committees and groups, and participated throughout the entire process to ensure relevance to target users. The process for managing competing interests was developed before and continued throughout the guideline development, informed by the Guideline International Network principles. We considered benefits and harms, patient values and preferences, resources, equity, acceptability and feasibility when developing recommendations; the strength of each recommendation was assigned according to the GRADE framework. The 25 recommendations and 10 good practice statements are grouped under the sections of exercise, nutrition, fracture risk assessment and treatment initiation, pharmacologic interventions, duration and sequence of therapy, and monitoring. The management of osteoporosis should be guided by the patient's risk of fracture, based on clinical assessment and using a validated fracture risk assessment tool. Exercise, nutrition and pharmacotherapy are key elements of the management strategy for fracture prevention and should be individualized. The aim of this guideline is to empower health care professionals and patients to have meaningful discussions on the importance of skeletal health and fracture risk throughout older adulthood. Identification and appropriate management of skeletal fragility can reduce fractures, and preserve mobility, autonomy and quality of life.

Understanding Patient Perspectives on Specialized, Longitudinal, Postpartum, Cardiovascular Risk-Reduction Clinics

BackgroundFemales who experience hypertensive disorders of pregnancy (HDP) have an increased lifelong risk of cardiovascular disease. Thus, Canadian clinical practice guidelines recommend cardiovascular risk reduction follow-up after a patient has HDP. This study examined the experiences of patients with HDP who attended a specialized, longitudinal general internal medicine postpartum cardiovascular risk reduction clinic called PreVASC. PreVASC focuses on comprehensive cardiovascular risk reduction through cardiovascular risk factor screening and management tailored specifically for female patients after they have HDP. MethodsThis multimethod study examined the experiences of female patients with HDP via the following: (i) a quantitative survey (summarized with descriptive statistics); (ii) semistructured qualitative patient phone interviews (results grouped thematically); and (iii) triangulation of qualitative themes with quantitative survey results. ResultsOverall, 37% of eligible clinic patients (42 of 115) participated; 79% of participants (n = 33) reported being “very satisfied” with the PreVASC clinic’s specialized longitudinal model of care, and 95% (n = 40) reported making at least one preventive health behaviour change after receiving individualized counselling on cardiovascular risk reduction. Qualitative results found improvements in patient-reported cardiovascular health knowledge, health behaviours, and health-related anxiety. A preference for in-person vs phone clinic visits was reported by participants. ConclusionsAn in-person, general internal medicine specialist–led, longitudinal model of cardiovascular disease preventive care focused specifically on cardiovascular risk reduction after HDP had positive impacts on patient experience, health knowledge, and preventive health behaviours. This novel knowledge on patient preferences for a longitudinal, specialized model of care advances cardiovascular risk reduction tailored specifically for high-risk people after HDP.

TransitionED: A protocol for Co-designing and implementing Canadian practice guidelines for transitions for youth with eating disorders.

Limited guidelines inform the transition from paediatric to adult healthcare for youth and young adults (YYA) with eating disorders (EDs). This study will develop, implement, and evaluate Canadian Clinical Practice Guidelines for ED transition, including identifying the relevant measurement and evaluation tools for transition readiness and continuity of care. This study consists of three phases. Phase 1 involves conducting a scoping review of the evidence on transition interventions, outcomes, and measurement tools for YYA with EDs, along with guideline development using the modified Delphi method. Phase 2 identifies the contextual/cultural factors relevant to guideline implementation and co-designing an implementation protocol with governance committees and research partners. Phase 3 involves the application and evaluation of the proposed guide lines using the implementation protocol, and assessing the acceptability and feasibility of a prototype transition intervention in two Canadian paediatric ED programs. Results will provide the knowledge needed to enhance the lives of YYA, improve the effectiveness of the ED care system, and support the scale of the transition guidelines across Canada. These guidelines will have international relevance by potentially informing the field on how to support young people with EDs transitioning in similar funding structures and systems of care.

Evaluation and comparison of risk-based and universal prenatal HCV screening programs in Alberta, Canada

Canadian clinical practice guidelines currently recommend risk-based screening for hepatitis C virus (HCV) in pregnant individuals. However, no provinces or territories have ever compared the effectiveness of risk-based versus universal screening for diagnosing prenatal HCV. We aimed to evaluate and compare HCV screening programs after implementing a universal population-level pilot program among prenatal patients in Alberta, Canada. The Alberta Prenatal Screening Program for Select Communicable Diseases was amended to include universal HCV antibody screening. Cohorts of pregnant individuals screened for HCV through risk-based or universal programs were generated over one-year periods. HCV screening rates and prevalence was analyzed and compared between cohorts to evaluate effectiveness of screening methods. Social and demographic risk factors for HCV positive individuals were compared between screening cohorts to identify which populations may be overlooked with risk-based guidelines. HCV antibody screening rates were 11.9% and 99.9% among pregnant individuals in the risk-based and universal cohorts respectively. HCV prevalence among the cohorts was 0.07% and 0.11% (difference=0.04%, p=0.032), with an average of 21 additional HCV positive pregnant individuals identified annually with universal screening. HCV positive prenatal patients diagnosed through universal screening were more likely to engage in high-risk sexual behaviours/sex work compared to those diagnosed through risk-based screening (47.6% versus 12.5%, respectively p=0.035), suggesting risk-based screening is missing these high-risk women. Universal HCV screening diagnoses significantly higher numbers of pregnant individuals infected with HCV compared to risk-based screening. Universal HCV screening or amending risk-based guidelines to incorporate more proxy variables for risk factors should be considered to improve prenatal HCV screening guidelines in Canada and help achieve HCV elimination in the next decade. Hepatitis C virus (HCV) is a bloodborne pathogen that can cause severe liver disease and be vertically transmitted from a mother to her baby during pregnancy. Pregnant individuals in Alberta are currently only tested for HCV if they disclose to their physician engagement in activities that put them at risk for acquiring the infection (risk-based screening). Using a population-wide universal prenatal HCV screening program, our work shows testing based on patient disclosed risk alone significantly underdiagnoses HCV in pregnant individuals and suggests individuals engaging in sex work or risky sexual behaviours are being overlooked with the current risk-based program. Our outcomes represent the first province-wide study to evaluate and compare prenatal HCV risk-based and universal screening programs in Canada and can be used as evidence-based data for updating prenatal HCV screening policies across the country and in similar jurisdictions.

Gender Differences in North American and International Otolaryngology Clinical Practice Guideline Authorship: A 17-Year Analysis.

To analyze gender differences in authorship of North American (Canadian and American) and international published otolaryngology-head and neck surgery (OHNS) clinical practice guidelines (CPG) over a 17-year period. Clinical practice guidelines published between 2005 and 2022 were identified through the Canadian Agency for Drugs and Technology in Health (CADTH) search strategy in MEDLINE and EMBASE. Studies were included if they were original studies, published in the English language, and encompassed Canadian, American, or international OHNS clinical practice guidelines. A total of 145 guidelines were identified, encompassing 661 female authors (27.4%) and 1756 male authors (72.7%). Among OHNS authors, women and men accounted for 21.2% and 78.8% of authors, respectively. Women who were involved in guideline authorship were 31.0% less likely to be an otolaryngologist compared to men. There were no gender differences across first or senior author and by subspeciality. Female otolaryngologist representation was the greatest in rhinology (28.3%) and pediatrics (26.7%). American guidelines had the greatest proportion of female authors per guideline (34.1%) and the greatest number of unique female authors (33.2%). Despite the increasing representation of women in OHNS, gender gaps exist with regards to authorship within clinical practice guidelines. Greater gender diversity and transparency is required within guideline authorship to help achieve equitable gender representation and the development of balanced guidelines with a variety of viewpoints.

Placenta Accreta Spectrum Disorders: A National Survey

ObjectivesDescribe the current practice of Canadian obstetricians-gynaecologists in managing placenta accreta spectrum (PAS) disorders from suspicion of diagnosis to delivery planning and explore the impact of the latest national practice guidelines on this topic. MethodsWe distributed a cross-sectional bilingual electronic survey to Canadian obstetricians-gynaecologists in March–April 2021. Demographic data and information on screening, diagnosis, and management were collected using a 39-item questionnaire. The survey was validated and pretested among a sample population. Descriptive statistics were used to present the results. ResultsWe received 142 responses. Almost 60% of respondents said they had read the latest Society of Obstetricians and Gynaecologists of Canada clinical practice guideline on PAS disorders, published in July 2019. Nearly 1 in 3 respondents changed their practice following this guideline. Respondents highlighted the importance of 4 key points: (1) limiting travel to thereby remain close to a regional care centre, (2) preoperative anemia optimization, (3) performance of cesarean-hysterectomy leaving the placenta in situ (83%), (4) access via midline laparotomy (65%). Most respondents recognized the importance of perioperative blood loss reduction strategies such as tranexamic acid and perioperative thromboprophylaxis via sequential compression devices and low-molecular-weight heparin until full mobilization. ConclusionsThis study demonstrates the impact of the Society of Obstetricians and Gynaecologists of Canada's PAS clinical practice guideline on management choices made by Canadian clinicians. Our study highlights the value of a multidisciplinary approach to reducing maternal morbidity in individuals facing surgery for a PAS disorder and the importance of regionalized care that is resourced to provide maternal-fetal medicine and surgical expertise, transfusion medicine, and critical care support.

Evaluation of the Canadian Clinical Practice Guidelines Risk Prediction Tool for Acute Aortic Syndrome: The RIPP Score.

Acute aortic syndrome (AAS) is a rare clinical syndrome with a high mortality rate. The Canadian clinical practice guideline for the diagnosis of AAS was developed in order to reduce the frequency of misdiagnoses. As part of the guideline, a clinical decision aid was developed to facilitate clinician decision-making (RIPP score). The aim of this study is to validate the diagnostic accuracy of this tool and assess its performance in comparison to other risk prediction tools that have been developed. This was a historical case-control study. Consecutive cases and controls were recruited from three academic emergency departments from 2002-2020. Cases were identified through an admission, discharge, or death certificated diagnosis of acute aortic syndrome. Controls were identified through presenting complaint of chest, abdominal, flank, back pain, and/or perfusion deficit. We compared the clinical decision tools' C statistic and used the DeLong method to test for the significance of these differences and report sensitivity and specificity with 95% confidence intervals. We collected data on 379 cases of acute aortic syndrome and 1340 potential eligible controls; 379 patients were randomly selected from the final population. The RIPP score had a sensitivity of 99.7% (98.54-99.99). This higher sensitivity resulted in a lower specificity (53%) compared to the other clinical decision aids (63-86%). The DeLong comparison of the C statistics found that the RIPP score had a higher C statistic than the ADDRS (-0.0423 (95% confidence interval -0.07-0.02); P < 0.0009) and the AORTAs score (-0.05 (-0.07 to -0.02); P = 0.0002), no difference compared to the Lovy decision tool (0.02 (95% CI -0.01-0.05 P < 0.25)) and decreased compared to the Von Kodolitsch decision tool (0.04 (95% CI 0.01-0.07 P < 0.008)). The Canadian clinical practice guideline's AAS clinical decision aid is a highly sensitive tool that uses readily available clinical information. It has the potential to improve diagnosis of AAS in the emergency department.

Exploring ChatGPT's Potential in Facilitating Adaptation of Clinical Guidelines: A Case Study of Diabetic Ketoacidosis Guidelines.

Background This study aimed to evaluate the efficacy of ChatGPT, an advanced natural language processing model, in adapting and synthesizing clinical guidelines for diabetic ketoacidosis (DKA) by comparing and contrasting different guideline sources. Methodology We employed a comprehensive comparison approach and examined three reputable guideline sources: Diabetes Canada Clinical Practice Guidelines Expert Committee (2018), Emergency Management of Hyperglycaemia in Primary Care, and Joint British Diabetes Societies (JBDS) 02 The Management of Diabetic Ketoacidosis in Adults. Data extraction focused on diagnostic criteria, risk factors, signs and symptoms, investigations, and treatment recommendations. We compared the synthesized guidelines generated by ChatGPT and identified any misreporting or non-reporting errors. Results ChatGPT was capable of generating a comprehensive table comparing the guidelines. However, multiple recurrent errors, including misreporting and non-reporting errors, were identified, rendering the results unreliable. Additionally, inconsistencies were observed in the repeated reporting of data. The study highlights the limitations of using ChatGPT for the adaptation of clinical guidelines without expert human intervention. Conclusions Although ChatGPT demonstrates the potential for the synthesis of clinical guidelines, the presence of multiple recurrent errors and inconsistencies underscores the need for expert human intervention and validation. Future research should focus on improving the accuracy and reliability of ChatGPT, as well as exploring its potential applications in other areas of clinical practice and guideline development.

Cardiovascular Risk Factors and Adherence to Cardiovascular Protection Practice Guidelines in Adults With Type 1 Diabetes: A BETTER Registry Cross-sectional Analysis

ObjectivesCardiovascular disease (CVD) is a major cause of morbidity and mortality in people with type 1 diabetes (PWT1D). We assessed cardiovascular risk factors and pharmacologic treatment in a large Canadian cohort of PWT1D. MethodsThis cross-sectional study used data from adult PWT1D in the BETTER registry (n=974). CVD risk factor status, diabetes complications, and treatments (used as proxy for blood pressure and dyslipidemia) were self-reported through online questionnaires. Objective data were available for a subgroup of PWT1D (23%, n=224). ResultsParticipants were adults (43.9±14.8 years) with a diabetes duration of 23.3±15.2 years; 34.8% reported glycated hemoglobin (A1C) levels of ≤7%, 67.2% reported a very high cardiovascular risk, and 27.2% reported at least 3 CVD risk factors. Most participants received care for CVD in accordance with the Diabetes Canada Clinical Practice Guidelines (DC-CPG), with a median recommended pharmacologic treatment score of 75.0%. However, 3 subgroups of participants with lower adherence (<70%) to DC-CPG were identified: 1) those with microvascular complications and receiving a statin (60.8%, 208 of 342) or renin–angiotensin axis nephroprotective therapy (52.6%, 180 of 342); 2) those aged ≥40 years and receiving statin therapy (67.1%, 369 of 550); and 3) those aged ≥30 years with a diabetes duration of ≥15 years and receiving statin therapy (58.9%, 344 of 584). Among a subgroup of participants with recent laboratory results, only 24.5% of PWT1D (26 of 106) achieved both A1C and low-density lipoprotein cholesterol targets. ConclusionsMost PWT1D received recommended pharmacologic cardiovascular protection, but specific subgroups required special attention. Target achievement for key risk factors remains suboptimal.

Female Sexual Dysfunction: An Appraisal of Canadian Clinical Practice Guidelines Using the AGREE II Instrument

Female sexual dysfunction (FSD) is a prevalent concern among Canadian women. While clinical practice guidelines (CPGs) are commonly relied upon to guide evidence-based decision making, the availability and quality of published Canadian CPGs for FSD is unknown. More broadly, there is also a paucity of literature, which has evaluated documents guiding Canadian CPG development. A search was conducted to identify Canadian documents describing CPG development processes. Eligible documents underwent full-text review to extract content pertaining to scope and target audience. A separate search was conducted to identify Canadian CPGs specific to FSD. Eligible documents underwent quality appraisal using the validated Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Four documents outlining CPG development processes were identified. While there were similarities in the steps for CPG development, discrepancies in scope, target user, and affiliated development group across the Canadian methodologies were noted. One Canadian CPG specific to FSD was identified. Th is CPG scored highly in the domains of Scope and Purpose (79%), and Clarity of Presentation (86%), although it did not reach the same quality threshold for the remaining domains. Our results suggest the need for consistent guidelines that are implementable by Canadian CPG developers across the diverse clinical landscape, including women’s sexual health. Th is is the first study to evaluate the quality of CPGs for FSD using the AGREE II instrument. Our appraisal identifies areas of weakness that should be considered when updating this CPG in the future and in the development of new CPGs in this field.

Obesidad en adultos: guía de práctica clínica adaptada para Chile

The Chilean Society of Bariatric and Metabolic Surgery, together with other scientific societies, led a process for adapting the Canadian clinical practice guideline for obesity in adults for Chile. The aim of the Canadian guideline, among its main objectives, was to propose changes in obesity management using a chronic disease framework and focusing on improving patient-centered health outcomes, rather than focusing on weight loss alone. A group of 58 healthcare professionals applied the GRADE-Adolopment method to analyze and adapt the original recommendations and to create de novo recommendations. New recommendations were developed through a systematic review of the evidence using the Epistemonikos database and based on the GRADE-Evidence to Decision (EtD) framework. Seventy-six (76) of the 80 original recommendations were adopted, one recommendation was adapted, and 12 new recommendations were created. The adaptation process reduced the time needed to develop a Chilean clinical practice guideline for the management of obesity in adults. The change in obesity management approaches towards non-stigmatizing and patient-centered strategies focused on improving health outcomes and not solely on weight reduction is universal and it is possible to apply this approach in different countries and contexts.

Clinical Considerations in the Selection of Preexposure Prophylaxis for HIV Prevention in Canada.

According to the Public Health Agency of Canada, approximately 62,050 people were living with HIV in Canada in 2018, and of those, 13% were undiagnosed. Currently, no single strategy provides complete protection or is universally effective across all demographic groups at risk for HIV. However, HIV preexposure prophylaxis (PrEP) is the newest HIV prevention strategy that shows promise. To date, two products have received an indication for PrEP by Health Canada: emtricitabine/tenofovir disoproxil fumarate (Truvada®; FTC/TDF) and emtricitabine/tenofovir alafenamide (Descovy®; FTC/TAF). Despite the high efficacy of these PrEP intervention methods, access to PrEP in Canada remains low. Identifying and addressing barriers to PrEP access, especially in high-risk groups, are necessary to reduce HIV transmission in Canada. While guidelines published by the Center for Disease Control and Prevention (CDC) include FTC/TAF information, the efficacy of FTC/TAF for PrEP has not yet been considered in Canada's clinical practice guidelines. Thus, the current paper reviews data regarding the use of FTC/TDF and FTC/TAF for PrEP, which may be useful for Canadian healthcare providers when counseling and implementing HIV prevention methods. The authors highlight these data in relation to various at-risk populations and review ongoing clinical trials investigating novel PrEP agents. Overall, FTC/TDF PrEP is effective for many populations, including men who have sex with men, transgender women, heterosexuals with partners living with HIV, and people who use drugs. While there is fewer data reported on the efficacy of FTC/TAF to date, recent clinical trials have demonstrated noninferiority of FTC/TAF in comparison to FTC/TDF. Notably, as studies have shown that FTC/TAF maintains renal function and bone mineral density to a greater extent than FTC/TDF, FTC/TAF may be a safer option for patients experiencing renal and/or bone dysfunction, for those at risk of renal and bone complications, and for those who develop FTC/TDF-related adverse events.

Cross-sectional comparisons of dietary indexes underlying nutrition labels: nutri-score, Canadian 'high in' labels and Diabetes Canada Clinical Practices (DCCP).

To assess the cross-sectional association between dietary indexes (DI) that underlie, respectively, the Nutri-score (NS), the proposed Canadian 'High In' Symbol (CHIL) and the Diabetes Canada Clinical Practice Guidelines (DCCP) with food consumption, nutrient intakes and metabolic markers. 1836 adults (18-74years) participating in the representative ESTEBAN study, conducted in mainland France in 2014-2016, were included in the analysis. Food consumption was assessed with three repeated 24h dietary recalls. Anthropometric measurements and biomarkers of metabolic risk (cholesterol-total, LDL (Low Density Lipoprotein), HDL (High Density Lipoprotein)-triglycerides, glucose) were obtained through a clinical examination and fasting blood draw. The DI were assessed for their association with food consumption, dietary intakes and metabolic biomarkers as quintiles and continuous variables using multi-adjusted linear regression. Heathier diets were assigned to lower scores. Correlations between scores ranged from + 0.62 between CHIL-DI and NS-DI to + 0.75 between NS-DI and DCCP-DI. All DIs discriminated individuals according to the nutritional quality of their diets through food consumption and nutrient intakes (healthier diets were associated with lower intakes of energy, added sugars and saturated fat; and with higher intakes of fiber, vitamins and minerals). NS-DI was associated with blood glucose (adjusted mean in Q1 = 5 vs. Q5 = 5.46mmol/dl, ptrend = 0.001) and DCCP-DI was associated with BMI (Q1 = 24.8kg/m2 vs. Q5 = 25.8kg/m2, ptrend = 0.025), while CHIL showed no significant association with any anthropometric measures or biomarkers. This study provides elements supporting the validity of the nutrient profiling systems underlying front-of-package nutrition labellings (FOPLs) to characterize the healthiness of diets.

Availability, Quality, and Implementability of Canadian Clinical Practice Guidelines for Female Sexual Dysfunction

ABSTRACT Introduction Sexual health problems are common among Canadian women, though they often go unaddressed and untreated in clinical settings. Clinical practice guidelines (CPGs) are systematically developed statements that facilitate structured, evidence-based guidance for specific clinical circumstances. Their potential benefits to patients and practitioners are dependent upon comprehensive guideline development processes that consolidate best available evidence, and guide successful implementation into practice. Little is known about the curation, availability, quality, and implementability of Canadian CPGs for women's sexual health problems and female sexual dysfunction (FSD). Objective i) To determine the availability of protocols guiding the curation of Canadian CPGs ii) To assess the availability, quality, and implementability of Canadian CPGs for women's sexual health concerns and FSD. Methods A systematic search for publicly available documents referencing Canadian CPG development processes was conducted. Websites associated with provincial and national health bodies, in addition to relevant professional medical organizations, and electronic databases PubMed and Google Scholar were searched. A separate search was conducted to retrieve Canadian CPGs specific to women's sexual health and FSD using similar methodology. FSD CPGs that met the criteria of including recommendations on FSD screening, management, and resources went on to subsequent analyses using the AGREE-II and AGREE-REX tools to assess CPG quality and implementability, respectively, and qualitative content analysis to identify the scope and thematic content of the CPGs. Results Two national guidelines for Canadian CPG development were identified. 3/13 Canadian provinces and territories had protocols outlining processes for general CPG development. National and provincial documents varied in their recommended methodologies for CPG curation and updating evidence suggesting a lack of standardization. Two Canadian CPGs specific to FSD and sexual concerns were identified: one from the Canadian Urological Association, and one from the Society of Obstetrics and Gynecology of Canada (SOGC). Only the SOGC guideline contained information regarding screening, management, and resources for FSD, and thus underwent subsequent analysis. The SOGC guideline scored highly with respect to the domains of Scope and Purpose (79%), and Clarity of Presentation (86%), though it did not sufficiently address the remaining AGREE-II domains, scoring lowest in Applicability (44%) and Editorial Independence (13%). AGREE-REX scoring was 58%, suggesting it was moderately implementable. Qualitative analysis revealed a focus on the importance of healthcare providers ensuring they have the necessary skills and knowledge to assess and manage sexual health problems, though the details of these skills and knowledge were not consistently defined. Conclusions There is a lack of standardization of the process of CPG curation in Canada and limited Canadian CPGs guiding best practices for screening and management of FSDs, and provision of additional resources. This study highlights the strengths and deficiencies in the current Canadian CPGs for FSD. Canadian CPG developers should consider FSD a topic of priority and continue to make attempts to curate comprehensive, evidence-based CPGs in this field that are implementable in all local Canadian contexts. The ISSWSH Process of Care for the Identification of Sexual Concerns and Problems in Women may serve as a valuable resource in improving Canadian-specific FSD CPGs. Disclosure No

Implementation of the cardiovascular assessment screening program (CASP) by nurse practitioners-it's time to focus on early identification of cardiovascular risk

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Newfoundland and Labrador Support for Patient-Oriented Research (NL SUPPORT) Background There is inconsistent utilization of clinical practice guidelines (CPGs) for cardiovascular disease (CVD) screening and management by advanced practice nurses/nurses practitioners (NPs) to identify CVD risk factors early and to intervene using current recommendations. To address this clinical practice issue and increase utilization of Canadian CPGs, an exploratory multiphase sequential mixed methods study was conducted and the Cardiovascular Assessment Screening Program (CASP) was developed, implemented, and evaluated. Objective Phase 2 of the mixed methods study, a cluster randomized controlled trial (cRCT), evaluated the implementation of CASP by NPs with individuals aged 40-74 years, without established CVD or vascular disease (VD), in order to identify CVD risk factors early, to determine the level of risk for a CV event, to calculate the Heart Age, and to set heart health priorities and management, according to current CPGs in Canada. Methods In a cRCT, block randomization randomly divided ten NPs into the intervention group clusters (IGCs) and the control group clusters (CGCs). In turn, eight NPs recruited 166 patients in their own communities; the four NP IGCs recruited patients (n=67) and the four NP CGCs recruited patients (n=99). The web-based CASP intervention was implemented with patients in the IGCs, and the CGCs received standard care. The CASP intervention consisted of four components: an electronic CVD Database, an NP toolkit, an educational resource for NPs and patients, and a website containing CPGs. The data on CVD risk factors, Framingham Risk Score (FRS), Heart Age, and priorities for heart health were recorded in the CVD Database utilized by the NP IGCs. Results Utilizing the CVD database, CVD risk factors were consistently identified in patients by NPs in the IGCs compared to the NP CGCs. The patients in the IGCs had a high number of risk factors for CVD documented by NPs, including family history of CVD, hypertension, diabetes, obesity, renal dysfunction, and dyslipidemia, and found that 62 patients (91%) were at moderate to high risk for having a CV event in the next 10 years using the FRS. In comparison, NPs in the CGCs did minimal documentation of risk factors; the level of CVD risk was largely unknown (96%) for control group patients as the FRS was only documented on 7 patients (4%). The Heart Age was calculated in the IGCs (92%); in the CGCs, the Heart Age was not calculated. The recommendations made by IGC NPs matched their patients’ priorities 94% of the time; 75% of the intervention group patients developed personalised goals that matched their top priorities for improving heart health. Conclusion The key benefit of the CASP implementation by NPs was the identification of CVD risk factors earlier in individuals without established CVD or VD. Engaging individuals to participate in screening to learn about their CVD risk encourages priority setting for heart health using a patient-focused approach.

A survey of stakeholders' perceived importance of health indicators and subgroup analyses to inform the Canadian clinical practice guideline for managing paediatric obesity.

To assess stakeholder ratings of health indicators and subgroup analyses in systematic reviews used to update the Canadian Clinical Practice Guideline for Managing Paediatric Obesity. Stakeholders (caregivers of children with obesity and Clinical Practice Guideline Steering Committee members) completed an online survey between April 2020 and March 2021. Participants rated importance of health indicators and subgroup analyses for behavioural and psychological, pharmacotherapeutic, and surgical interventions for managing paediatric obesity from not important to critically important using Grading, Recommendations, Assessment, Development and Evaluation criteria. No health indicators or subgroup analyses were rated not important by the 30 caregivers and 17 Steering Committee members. Across intervention types, stakeholders rated anxiety, depression, health-related quality of life, serious adverse events, plus age and weight status subgroups as critically important. Stakeholder ratings will inform data reporting and interpretation to update Canada's Clinical Practice Guideline for Managing Paediatric Obesity.

Examining Nutrient Intakes of Canadian Adults With Diabetes Using the Diabetes Canada Clinical Practice Guidelines Nutrient Profile Model

ObjectivesThe Diabetes Canada Clinical Practice (DCCP) Guidelines provide dietary recommendations for Canadians at risk and with diabetes to help lower risk and for self-management of diabetes. The DCCP nutrient profile model was developed to classify foods based on their adherence to the DCCP Guidelines. The objective of the study was to examine the nutrient intakes of Canadian adults with diabetes using the DCCP nutrient profile model. MethodsUsing one-day 24-hour dietary recall from the 2015 Canadian Community Health Survey-Nutrition, nutrient intakes of Canadian adults with self-reported status of diabetes were examined. Foods were categorized by the DCCP nutrient profile model as “least”, “partially”, or “most” aligned with the DCCP Guidelines. Mean nutrient intakes were estimated and standard errors were calculated using balanced repeated replication with 500 bootstrap weighted replicates. Mean estimates were adjusted for age, sex, energy intake, and misreporting status using least squares regression. ResultsCanadian adults with diabetes (n = 1,249) consumed 14% (341 kcal/d [95% CI: 254,428]), 54% (1,291 kcal/d [1112,1470]), and 31% (682 kcal/d [613,751]) of total calories from foods that are “least”, “partially”, and “most” aligned with the DCCP Guidelines, respectively. The proportion of total fat, carbohydrate, and protein intakes from foods that are “least”, “partially”, and “most” aligned with the DCCP Guidelines were similar to their caloric contribution. However, 49% of added sugar intakes (24.1 g/d [20.8, 27.4]) were consumed from foods “least” aligned with the DCCP Guidelines. Over 60% sodium (1,746 mg/d [1,578, 1,915]) and saturated fat (18.7 g/d [16.1, 21.4]) intakes were consumed from foods “partially” aligned with the DCCP Guidelines. More than half of the fiber intakes (11.2 g/d [10.2, 12.2]) were consumed from foods “most” aligned with the DCCP Guidelines. ConclusionsDespite the low caloric contribution of foods “least” aligned with the DCCP Guidelines, these foods contributed to disproportionate intakes of added sugar and saturated fat among Canadian adults with diabetes. The use of the DCCP nutrient profile model can help Canadians with diabetes improve their nutrient intakes. Funding SourcesCIHR Project Grant; Sanofi-Pasteur International Collaboration; CIHR-Doctoral Award (JJL).

Update to the Canadian clinical practice guideline for best-practice management of breast cancer-related lymphedema: study protocol.

Background:One of the more frequent complications following treatment for breast cancer, lymphedema is a substantial swelling of the arm, breast and chest wall that occurs on the side where lymph nodes were removed. The aim of this work is to update recommendations on the prevention, diagnosis and management of lymphedema related to breast cancer.Methods:We present the protocol for an update of the 2001 clinical practice guideline on lymphedema from the Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. We will use a patient-oriented research approach with a focus on self-management and the positive health model to inform the updated guideline development. The methods proposed will be undertaken with consideration of the standards outlined in the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. The literature will be appraised by evaluating existing guidelines from other countries, the evidence from systematic reviews and meta-analyses and direct evidence from clinical studies. We will manage competing interests according to Guidelines International Network principles. Recommendations will be presented using an actionable statement format and will be linked to the level of evidence along with any relevant considerations used in formulation. A draft of the guideline will be produced by the steering committee then sent out to international experts and stakeholder groups for feedback.Interpretation:The primary benefit of this clinical guideline will be to improve the quality of care of women with breast cancer–related lymphedema. Findings will be disseminated at national and international conferences and through webinars and educational videos hosted on the websites of the supporting organizations.