Article type
Year
Abstract
Background: The Danish Health Authorities have a desire to adapt high quality and clinically important international guidelines into a Danish context to achieve national guidelines in an accelerated time course. The BMJ has developed the concept “Rapid Recommendations” where new potential practice changing evidence is transformed into clinical guideline recommendations using the GRADE-approach. The Rapid Recommendation team conducts systematic reviews to inform their guideline panel. We selected the BMJ guidelines and the underlying systematic reviews for adaption, since their methods fulfill our demands for transparency and quality.
Objetives: To develop a new clinical guideline based on adaption of a Rapid Recommendation guideline into a Danish context using the GRADE-method without updating the underlying “body of evidence”.
Methods: In a pilot project the Rapid Recommendation for oxygen therapy (1) was adapted to a Danish context. A guideline panel representing relevant medical specialties and methods specialists assessed the “body of evidence” from the systematic review underlying the rapid recommendation (2). The panel rated the importance of each outcome. The risk of bias assessments of the included trials and meta-analysis were reviewed, but only critical changes were allowed. Finally the quality of evidence for each outcome were rated and the panel formulated their own recommendations.
Results: After public hearing and external peer review the new guideline was published, the process was completed with-in 7 month. The adaption process revealed a need to clarify to the guideline panel, that the adaption was not a translation of recommendations, but a process of formulating new recommendations based upon their own assessments of the “body of evidence”. The working group did not always agree with the risk of bias assessment or study inclusion in the underlying review, which led to rating down the quality of evidence.
Conclusion: Adaption of the BMJ rapid recommendation was feasible and enabled the development of a new guideline in an accelerated time course. Challenges in the adaption process were revealed but could be handled by information of the process, emphasizing that the adaption method implies independent assessment of the “body of evidence” and formulation of own recommendations.
Perspectives: New clinical recommendations and guidelines can be developed based on new high quality systematic reviews and guidelines, leading to a time timesaving process.
Patient or healthcare consumer involvement: People with lived experience of hospitalization for acute medical conditions were members of the original guideline panel (1). Patient organizations were invited to the public hearing of the Danish guideline.
1. BMJ 2018;363:k4169.
2. Chu DK, Kim LH, Young PJ, Zamiri N., Almenawer SA, Jaeschke R., Szczeklik W., Schunemann HJ, Neary JD, Alhazzani W. : Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis.
Objetives: To develop a new clinical guideline based on adaption of a Rapid Recommendation guideline into a Danish context using the GRADE-method without updating the underlying “body of evidence”.
Methods: In a pilot project the Rapid Recommendation for oxygen therapy (1) was adapted to a Danish context. A guideline panel representing relevant medical specialties and methods specialists assessed the “body of evidence” from the systematic review underlying the rapid recommendation (2). The panel rated the importance of each outcome. The risk of bias assessments of the included trials and meta-analysis were reviewed, but only critical changes were allowed. Finally the quality of evidence for each outcome were rated and the panel formulated their own recommendations.
Results: After public hearing and external peer review the new guideline was published, the process was completed with-in 7 month. The adaption process revealed a need to clarify to the guideline panel, that the adaption was not a translation of recommendations, but a process of formulating new recommendations based upon their own assessments of the “body of evidence”. The working group did not always agree with the risk of bias assessment or study inclusion in the underlying review, which led to rating down the quality of evidence.
Conclusion: Adaption of the BMJ rapid recommendation was feasible and enabled the development of a new guideline in an accelerated time course. Challenges in the adaption process were revealed but could be handled by information of the process, emphasizing that the adaption method implies independent assessment of the “body of evidence” and formulation of own recommendations.
Perspectives: New clinical recommendations and guidelines can be developed based on new high quality systematic reviews and guidelines, leading to a time timesaving process.
Patient or healthcare consumer involvement: People with lived experience of hospitalization for acute medical conditions were members of the original guideline panel (1). Patient organizations were invited to the public hearing of the Danish guideline.
1. BMJ 2018;363:k4169.
2. Chu DK, Kim LH, Young PJ, Zamiri N., Almenawer SA, Jaeschke R., Szczeklik W., Schunemann HJ, Neary JD, Alhazzani W. : Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis.