Kenneth R. Goldschneider, MD, FAAP Cincinnati Children s Hospital Medical Center Cincinnati, Ohio, USA

Kenneth R. Goldschneider, MD, FAAP Cincinnati Children s Hospital Medical Center Cincinnati, Ohio, USA

Clinical Practice Guidelines The IOM (2011) defined clinical practice guidelines as "statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options." Trustworthy guidelines should be based on a systematic evidence review, developed by panel of multidisciplinary experts, provide a clear explanation of the logical relationships between alternative care options and health outcomes, and provide ratings of both the quality of evidence and the strength of the recommendations. IOM = Institute of Medicine, USA

8 IOM Standards for Trustworthy CPG Establishing transparency; Management of conflict of interest; Guideline development group composition; Clinical practice guideline systematic review intersection; Establishing evidence foundations for and rating strength of recommendations; Articulation of recommendations; External review; and Updating.

Authors Kenneth Goldschneider, MD, FAAP Cincinnati Children s Hospital Cincinnati, Ohio, USA Julie Good, MD Lucille Packard Children s Hospital Stanford, California, USA Emily Harrop MBBS BSc DCH MRCPCH PhD DPM. Helen and Douglas House Hospices, Oxford, UK. Christina Liossi, DPsych Great Ormond Street Hospital for Children NHS Trust London, UK Lynch-Jordan, PhD Cincinnati Children s Hospital Cincinnati, Ohio, USA Anna Martinez, MBBS, MRCP, MRCPCH Great Ormond Street Hospital NHS Trust London, ENGLAND Lynne G. Maxwell, MD, FAAP Children s Hospital of Philadelphia Philadelphia, Pennsylvania, USA Danette Stanko-Lopp, MA, MPH Cincinnati Children s Hospital Cincinnati, Ohio, USA

Contributors Beverly Inge Walti RNC NIC,MSN,CPNP,CNS Kara Malcolm, RN, BSN, MSN(c) Teresa Mingrone, MSN, RN Stacy Shipley, RN Clinician Reviewers Anna L. Bruckner, MD Elizabeth Ely, RN, PhD Kim Hazelbaker,RN Barbara Hoggart, MD Richard F. Howard, BSc, FRCA Anne Lucky, MD Geraldine Mancuso-Kelly, RN Elena Pope, MD Susan Rowe, RN Alexandra Szabova, MD Jean Whalen, RN Patient/family Reviewers Patsy DiGiovanna Michelle Starkey Natasha Starkey *Brett Kopelan *consensus meeting participant

The process, ideally Identify leader Identify co-authors and methodologist Identify advisors (clinician and patient) Make budget

The Process - continued Identify areas of need and interest, goals and overall structure Patient and clinician surveys Stay focused, a general review is not needed for every set of guidelines Follow IOM Standards Analyze evidence (methodologist) Interplay with clinical relevance Begin writing Consider phone/video conference call Revisions x 1,2,3 Reviewers input Consensus conference Further revisions as needed Submit for publication/dissemination

Getting it out there

Options for dissemination Independent publication (e.g. dental, wound care) Journal (dental) Online Combinations

Published in BMC Medicine Open Access Online, downloadable Free to readers Paid for by authors (DEBRA USA) Decent Impact Factor: 7.2 BMJ = 17.4 NEJM = 55.4 Int J Derm = 1.3 Pain = 5.8 Pain Sympt Manage = 2.6

Utilization Pain Guidelines: 8500 accesses to online article since 1/2015. Sounds impressive, but Does not say if they were used or simply looked at

The Guidelines Pain Itch 10 sets of recommendations Evidence-based and consensus-based

How We evaluated the Evidence Journal of Evaluation in Clinical Practice 15 (2009) 1054 1060

How We evaluated the Evidence

A D Recommendation Grades Strength of Evidence Applicability Effect on Care, quality of life Risk : Benefit ratio Feasibility

Only a Minimum! The guidelines provide a place to start If we do not try new things, we will not progress! The next set of guidelines needs to have new information

Thank you!