Development Of Medical Guidelines Research Articles

Machine learning to optimize literature screening in medical guideline development

ObjectivesIn a time of exponential growth of new evidence supporting clinical decision-making, combined with a labor-intensive process of selecting this evidence, methods are needed to speed up current processes to keep medical guidelines up-to-date. This study evaluated the performance and feasibility of active learning to support the selection of relevant publications within medical guideline development and to study the role of noisy labels.DesignWe used a mixed-methods design. Two independent clinicians’ manual process of literature selection was evaluated for 14 searches. This was followed by a series of simulations investigating the performance of random reading versus using screening prioritization based on active learning. We identified hard-to-find papers and checked the labels in a reflective dialogue.Main outcome measuresInter-rater reliability was assessed using Cohen’s Kappa (ĸ). To evaluate the performance of active learning, we used the Work Saved over Sampling at 95% recall (WSS@95) and percentage Relevant Records Found at reading only 10% of the total number of records (RRF@10). We used the average time to discovery (ATD) to detect records with potentially noisy labels. Finally, the accuracy of labeling was discussed in a reflective dialogue with guideline developers.ResultsMean ĸ for manual title-abstract selection by clinicians was 0.50 and varied between − 0.01 and 0.87 based on 5.021 abstracts. WSS@95 ranged from 50.15% (SD = 17.7) based on selection by clinicians to 69.24% (SD = 11.5) based on the selection by research methodologist up to 75.76% (SD = 12.2) based on the final full-text inclusion. A similar pattern was seen for RRF@10, ranging from 48.31% (SD = 23.3) to 62.8% (SD = 21.20) and 65.58% (SD = 23.25). The performance of active learning deteriorates with higher noise. Compared with the final full-text selection, the selection made by clinicians or research methodologists deteriorated WSS@95 by 25.61% and 6.25%, respectively.ConclusionWhile active machine learning tools can accelerate the process of literature screening within guideline development, they can only work as well as the input given by human raters. Noisy labels make noisy machine learning.

Gender disparities in the pediatric allergy-related guidelines in Japan.

Inclusion of female authors has been noted as potentially beneficial in the development of medical guidelines. Japanese professional committees representing allergic subspecialties develop practical guidelines with recommendations to caregivers, but these committees may be influenced by their gender composition. The objective of our study was to examine the influence of gender in developing pediatric allergic disease guidelines in Japan from 1999 to 2020. We examined the gender parities among the guideline committee members in allergic rhinitis, atopic dermatitis, bronchial asthma, and food allergy guidelines in Japan. We examined the gender composition of the committees, annual trends, and differences in guideline content. The median proportion of women members among the 22 guidelines committees was 6.6% (range: 0%-27.3%). The analysis of the quadrant period did not show a significant increase in the proportion of female members. The food allergy group had a significantly higher proportion of female members than other guidelines (P < 0.01), but the proportion decreased from 25% to 14.3% during the observation period. For the pediatric asthma guidelines, the proportion of female committee members decreased from 5.3% in the 2000 version to 0% in the most recent revision in 2017. The proportion of women on the committees that develop pediatric guidelines continues to be low and has not improved over the past 20 years.

Extent of patients' satisfaction in the external services department of Al-Iman General Hospital: مدى رضا المرضى في قسم الخدمات الخارجية بمستشفى الإيمان العام بالرياض

The study aimed to identify the extent of patient satisfaction in the external services section of the General Eman Hospital, and the problem of the study is summarized in the following question, which is the extent of the patients ’satisfaction in the external services section of the general faith hospital from the viewpoint of auditors of the general faith hospital in Riyadh, and the study has significance as the study is a step to identify On the level of quality of medical services aimed at patient satisfaction in the External Services Department of Al-Iman General Hospital. Likewise, this study came to know the level of quality of services provided to patients in the external services department of Al-Iman General Hospital in order to put it and put officials in the picture of the matter, and the study identified hypotheses and there are no statistically significant differences at the level of significance (5 = 0.05) towards the level of patient satisfaction, and the quality Actual services in the External Services Department of Al-Iman General Hospital, depending on gender, age and educational qualification. The descriptive analytical approach was used to achieve the goals of the study, and the questionnaire was used as a tool to collect data, and the study community consisted of auditors of Al Iman General Hospital in Riyadh, and the study sample consisted of (110) male and female auditors from Al Iman Hospital, and a set of statistical methods were used to process the study data By using the SPSS program. In light of this, a number of results were reached, the most important of which are: Health care services, such as the dimensions of service quality, tangibility: (tangible physical aspects), response, safety, and sympathy for patients, to satisfy patients in the external services department of Iman Hospital, have a significant and positive impact on patient satisfaction. Likewise, the degree of satisfaction was satisfactory with regard to the dimensions of quality of service, tangibility: (tangible physical aspects), response, safety, and sympathy for patients, to satisfy patients in the external services department of Iman Hospital. In light of the results, the study recommends the following: - Doctors and nurses should pay attention to the auditors, pay attention to the problems and inquiries of patients, and urge to provide services on time without delay, to meet the requests of patients immediately. - The hospital administration should work on everything that improves the level of satisfaction of the auditors with the provision of modern devices that contribute to providing good medical services, attention to the problems and inquiries of patients, attention to the cleanliness of hospital facilities and the development of medical guidelines, and provide waiting places for auditors.

Implications of the COVID-19 Pandemic for the Development and Update of Clinical Practice Guidelines: Viewpoint.

Following the rapid spread of a new type of coronavirus (SARS-CoV-2), nearly all countries have introduced temporary restrictions affecting daily life, with “social distancing” as a key intervention for slowing the spread of the virus. Despite the pandemic, the development or actualization of medical guidelines, especially in the rapidly changing field of oncology, needs to be continued to provide up-to-date evidence- and consensus-based recommendations for shared decision making and maintaining the treatment quality for patients. In this viewpoint, we describe the potential strengths and limitations of online conferences for medical guideline development. This viewpoint will assist guideline developers in evaluating whether online conferences are an appropriate tool for their guideline conference and audience.

Unzureichende Patientenbeteiligung an der Leitlinienentwicklung in Deutschland – eine Analyse der von der AWMF verbreiteten ärztlichen Empfehlungen

BackgroundAs early as 1997, the German Guideline for Guidelines laid down patient participation in guideline development as the cornerstone of good, trustworthy medical guidelines. The German Guideline Assessment Tool (DELBI) published in 2005 requires patients or relatives to be involved in the development of medical guidelines. Ideally, this should be effected through membership in the author group. The Association of the Scientific Medical Societies in Germany (AWMF) recommends this approach for the so-called S3 guidelines (systematically developed guidelines) and S2k guidelines (consensus-based guidelines). The present study addresses the question of whether and to what extent German guideline publishers adhere to these principles of patient orientation. MethodsFor this purpose, a descriptive analysis of the guidelines valid at the beginning of November 2017 was carried out. All guidelines (n=520) of the AWMF member societies were assessed. We evaluated S3- and S2k guidelines only, as these are of particular importance for patient involvement due to the requirement of an interdisciplinary guideline group.Data were reported on the involvement of patients (as co-authors of medical guidelines) and on the existence of guidance documents addressing patients and the public (so-called patient information and patient guidelines). ResultsRegarding the 105 (165) S3 (S2k) guidelines, we found evidence on patient involvement in guideline development in 99 (134) cases (94 % of S3 / 81 % of S2k guidelines). In 61 (87) guidelines, authors had contributed to the authors group (58 % / 53 %) and 59 (80) guidelines with voting rights (56 % / 48 %). For 50 (15) S3 (S2k) guidelines (48 % / 9 %), the guideline report provided information on the existence or planned development of guidance documents for patients and the public (patient guidelines or patient information). Guidance-related patient information was available on the internet for only 37 (2) S3 (S2k) guidelines (35 % / 2 %). ConclusionA substantial gap remains between patient / public involvement standards for guideline development and practice in Germany, even 12 years after the publication of national guideline standards. This is a missed opportunity since guidelines without adequate participation of those affected by the recommendations have a problem of legitimacy and transparency. Only guidelines where patients were involved in all voting processes during development build and strengthen trust between patients and the medical profession. And only those who present the rationale for medical recommendations in a generally understandable and comprehensible manner let affected individuals make individual decisions.

Revealing oral medication patterns from reconstructed long-term medication history of type 2 diabetes.

With the growing attention to evidence-based medical guideline development, longitudinal analysis of Electronic Medical Records (EMR) has become a good tool for providing insight into and new knowledge on the existing therapy. For chronic diseases, longitudinal analysis of medication history plays a key role in reaching this goal. However, raw medication data in EMR are not suitable for longitudinal analysis for several reasons. First, many prescriptions have a short duration. Second, the prescription duration may have a gap or overlap with other prescription durations. Additionally, for diabetes cases, physicians must wait for a certain period to observe the effectiveness of the medication. However, the existing methods do not address these conditions. To tackle these issues, we propose a set of rules for medication episode reconstruction. We then apply the rules for longitudinal analysis on anonymous Type 2 diabetes patients' EMR provided by Kyoto University Hospital. The EMR span from 2000 to 2015. Two of our significant results are as follows: (1) our proposed medication episode reconstruction method is able to compress the search space into 23.83% compared to the raw data, and (2) the preliminary results show the benefits of the method in revealing the existing medication patterns over the years and unfamiliar therapy transition.

A joint model of persistent human papillomavirus infection and cervical cancer risk: Implications for cervical cancer screening.

New cervical cancer screening guidelines in the US and many European countries recommend that women get tested for human papillomavirus (HPV). To inform decisions about screening intervals, we calculate the increase in precancer/cancer risk per year of continued HPV infection. However, both time to onset of precancer/cancer and time to HPV clearance are interval-censored, and onset of precancer/cancer strongly informatively censors HPV clearance. We analyze this bivariate informatively interval-censored data by developing a novel joint model for time to clearance of HPV and time to precancer/cancer using shared random-effects, where the estimated mean duration of each woman's HPV infection is a covariate in the submodel for time to precancer/cancer. The model was fit to data on 9,553 HPV-positive/Pap-negative women undergoing cervical cancer screening at Kaiser Permanente Northern California, data that were pivotal to the development of US screening guidelines. We compare the implications for screening intervals of this joint model to those from population-average marginal models of precancer/cancer risk. In particular, after 2 years the marginal population-average precancer/cancer risk was 5%, suggesting a 2-year interval to control population-average risk at 5%. In contrast, the joint model reveals that almost all women exceeding 5% individual risk in 2 years also exceeded 5% in 1 year, suggesting that a 1-year interval is better to control individual risk at 5%. The example suggests that sophisticated risk models capable of predicting individual risk may have different implications than population-average risk models that are currently used for informing medical guideline development.

Supporting quality improvement in the development of medical guidelines in Austria

PurposeUntil today a central register for medical guidelines has not been established in Austria. Hence, the study at hand aims to identify important success factors for medical guidelines in Austria in order to fully support the future activities of organisations developing these guidelines.Design/methodology/approachUsing a specially‐developed questionnaire, 137 potential Austrian guideline developers were asked about the anticipated benefits of a common guideline register and a standardised method for guideline development by means of a complete inventory count for Austria.FindingsApproximately 73 per cent of Austrian guideline developers know of existing online guideline registers. Nearly 77 per cent know neither of an instrument to evaluate the guidelines in a methodical way, nor of the Council of Europe's recommendation. Around 63 per cent expect an improvement in the quality of the guidelines by implementing a standardised method.Research limitations/implicationsThe present study provides the results of the first complete inventory count of guideline developers in Austria and can be used as an orientation for future activities.Practical implicationsThe realisation of the success factors would increase the quality of national guidelines and would boost the implementation of best practices such as evidence‐based‐medicine into the Austrian health care system.Originality/valueThe study shows for the first time the necessity of support in order to improve the quality of Austrian guidelines from the point of view of potential developers.

E‐SPC – delivering drug information in the 21st century: developing new approaches to deliver drug information to prescribers

e‐SPC – delivering drug information in the 21st century: developing new approaches to deliver drug information to prescribers

Consensus Report: Diabetes Performance Measures: Current Status and Future Directions

OVERVIEW : Just as treatment guidelines for diabetes care were at the forefront of medical guideline development,1 diabetes has been a prominent focus of performance measurement and quality improvement initiatives for well over a decade. However, the constraints of pre-electronic health records (EHRs) data systems have consistently limited the clinical scope and sophistication of current diabetes quality measures. The U.S. health care system is nearing a tipping point in the use of more sophisticated EHR-based information systems, and widespread use of these systems will usher in a new era for diabetes quality measurement. New information system capabilities will enable improvements to existing measures and enable development of much more sophisticated measures that can accommodate personalization of clinical goals, patient preferences, and patient-reported data, thus moving both guidelines and measures toward personalization based on sophisticated assessment of the risks and benefits of certain clinical actions for a given patient at a given clinical encounter. To facilitate discussion of the future of performance measurement in diabetes in this era of rapid transition to EHRs, the American Diabetes Association (ADA) convened a consensus development conference in December 2010. Participating experts identified and discussed the following questions: 1. What is the evidence that measuring quality, benchmarking, and providing feedback or incentives improve diabetes care? 2. What are the limitations, burdens, and consequences (intended or unintended) of diabetes quality measures as currently structured? 3. What should be the role of shared decision making, patient preferences, and patient-reported data in quality measures? 4. What is the future of quality measurement in diabetes? 5. How can quality monitoring be integrated into population surveillance efforts? This report summarizes the consensus meeting and represents the expert opinion of its authors and not the official position of the ADA or any other participating organization. The first national effort to develop a set of performance …

Diabetes Performance Measures: Current Status and Future Directions

Just as treatment guidelines for diabetes care were at the forefront of medical guideline development (1), diabetes has been a prominent focus of performance measurement and quality improvement initiatives for well over a decade. However, the constraints of pre-electronic health records (EHRs) data systems have consistently limited the clinical scope and sophistication of current diabetes quality measures. The U.S. health care system is nearing a tipping point in the use of more sophisticated EHR-based information systems, and widespread use of these systems will usher in a new era for diabetes quality measurement. New information system capabilities will enable improvements to existing measures and enable development of much more sophisticated measures that can accommodate personalization of clinical goals, patient preferences, and patient-reported data, thus moving both guidelines and measures toward personalization based on sophisticated assessment of the risks and benefits of certain clinical actions for a given patient at a given clinical encounter. To facilitate discussion of the future of performance measurement in diabetes in this era of rapid transition to EHRs, the American Diabetes Association (ADA) convened a consensus development conference in December 2010. Participating experts identified and discussed the following questions: 1. 1. What is the evidence that measuring quality, benchmarking, and providing feedback or incentives improve diabetes care? 2. 2. What are the limitations, burdens, and consequences (intended or unintended) of diabetes quality measures as currently structured? 3. 3. What should be the role of shared decision making, patient preferences, and patient-reported data in quality measures? 4. 4. What is the future of quality measurement in diabetes? 5. 5. How can quality monitoring be integrated into population surveillance efforts? This report summarizes the consensus meeting, and represents the expert opinion of its authors and not the official position of the ADA or any other participating organization. ### 1. What is the evidence that measuring quality, benchmarking, and providing feedback or incentives improve diabetes care? The first national effort to develop a …

Guidelines in dermatology— Quo vadis?: Facts and controversies

Since their introduction in 1980s, medical guidelines have become a milestone in the modern medical practice and science. Being a key feature of modern evidence-based medicine, guidelines offer the opportunity for unification and standardization of diagnostic procedures, their use guarantees the equal access of patients to medical service, and they represent a scaffold for inexperienced physicians. The implementation of guidelines also can serve as a basis in malpractice issues and can contribute to the formation of national and international health care policies. In past decades, the process of development, update, and practical application of clinical guidelines has been seriously improved; however, certain limitations still exist, namely cost-effectiveness issues, editorial independence, applicability, accessibility, and external validity. This contribution discusses the advantages and the drawbacks in the use and the development of medical guidelines, emphasizing future perspectives and challenges in the development of clinical guidelines.

Integration of CAM in medical guidelines

Medical guidelines aim to provide all professions involved in the treatment of a disease a systematically developed basis for the diagnosis and therapy. They have growing impact on political, juristic and educational issues in Medicine. In Germany, the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften) is responsible for the coordination of the development of medical guidelines. In June 2009 a total of 154 scientific-medical societies constitute the group of members of the AWMF. The German Society for Natural Medicine (Deutsche Gesellschaft für Naturheilkunde) is currently not a member. What is necessary to integrate CAM into medical guidelines? To clarify problems and potential of CAM in medical guidelines, the field of gastroenterology was chosen. In Gastroenterology there are at present 10 S3 guidelines published. Especially inflammatory bowel diseases (IBD) and irritable bowel syndrome (IBS) are diseases that can be very well treated with an integrative medical approach including complementary treatment options. Our work will focus on the experience to integrate CAM made in the development of the recently published guidelines for Crohn's disease as well as the guidelines for ulcerative colitis and irritable bowel syndrome which are presently under development. For the integration of CAM in medical guidelines, more high-quality research in CAM is needed. Furthermore, for the future of Integrative Medicine, it is urgently needed for the German Society for Natural Medicine to become a full member in the AWMF. This will be one major step to ensure and facilitate the inclusion of CAM in medical guidelines in the future, which can be estimated as one important step to further develop Integrative Medicine.

Applying Bayesian ideas to the development of medical guidelines.

Measurements of the quality of health care, in particular the underuse and overuse of medical therapies and diagnostic tests, often involve employment of medical practice guidelines to assess the appropriateness of treatments. This paper presents a case study of a Bayesian analysis for the development of medical guidelines based on expert opinion, using ordinal categorical rater data. We develop guidelines for the use of coronary angiography following an acute myocardial infarction (AMI) for 890 clinical indications using statistical models fit to appropriateness ratings obtained from a nine-member expert panel. The main foci of our analyses were on the estimation of an appropriateness score for each of the clinical indications, an associated measure of precision, and functions of the underlying score. We considered two classes of models that assume the ratings are either in the form of grouped normal data or are ungrouped variables arising from a normal distribution, while permitting rater effects and indication heterogeneity in both. We estimated models using Markov chain Monte Carlo methods and constructed indices quantifying appropriateness based on posterior probabilities of selected model parameters. We compared our model-based approach to the standard approach currently employed in medical guideline development and found that the standard approach correctly identified 99 per cent of the appropriate indications while overestimating appropriateness 18 per cent of the time compared to our model-based approach.

Decisions to Treat Critically Ill Patients: A Comparison of Social versus Medical Considerations

A questionnaire survey shows that physicians in four medical specialties evaluate chronically and terminally ill patients not only in terms of the physiological aspects of illness but also in terms of the extent to which they are capable of interacting with others. A patient's potential capacity to perform his social roles depends upon his "salvageability," i;e., the likelihood that he will be able to resume his roles and the degree of irreversible physical or mental damage which indicates his capacity for resuming them. The priorities in terms of treatment are the following: (1) salvageable patients with physical damage; (2) salvageable patients with mental damage and unsalvageable patients with physical damage; (3) unsalvageable patients with mental damage. Within these catagories variables such as patient attitude, family attitude, age, and social class, which define the social environment of the patient, also influence the physician's decision to treat him. Studies of hospital records of cases in two of the specialties were consistent with they survey findings. The findings suggest that there is a disparity between the traditional ethic concerning the treatment of such patients and the actual behavior of many physicians. As a solution to the inconsistencies between ideal and actual behavior, the development of medical guidelines for the withdrawal of treatment with respect ot certain specifically defined conditions is recommended.