Article type
Abstract
"Background
Evidence-based guideline development requires the investment of considerable resources in terms of skilled personnel, finances, and time. This makes it particularly challenging to undertake in resource-constrained settings of developing countries. Consequently, many guidelines developed in such healthcare systems do not meet the criteria for trustworthiness.
Objective
This presentation summarizes a unique experiment of developing evidence-based guidelines, by personnel with no prior experience/training, and without external funding.
Methods
The Indian Academy of Pediatrics (IAP) National Respiratory Chapter desired to develop clinical practice guidelines for pediatricians caring for children with respiratory problems. Fifty pediatricians (content experts), with no prior experience in evidence-based guideline development, volunteered. An online training workshop was conducted over a series of weekends to build concepts and skills in guideline methodology. Thereafter, a learning-by-doing approach was adopted under the mentorship of the Chairperson. Twenty-four pediatricians volunteered to develop the guideline and submitted formal DoI statements, that were vetted for conflicts.
Contemporary guideline methodology steps were followed with additional in-built efficiency tweaks. These included searching for existing guidelines (whose recommendations could be adopted adapted, or adoloped to the local setting). If unavailable, current, high-quality systemic reviews addressing the PICOT questions were searched. If even these were unavailable, de novo systematic reviews were undertaken. The evidence base for each question was critically appraised and GRADEd. Formal evidence-to-decision framework were used to translate the evidence to recommendations implementable in the local setting.
Results
The experiment yielded the world’s first methodologically-robust, evidence-based guideline for the management of Allergic BronchoPulmonary Aspergillosis in children. Other salient outcomes included capacity-building of 24 pediatricians (who are able to teach the methodology, and also participate in the next guideline on empyema management), saving a large amount of financial resources, and enthusing stakeholders about the feasibility of evidence-based guideline development. The downsides of the experiment were the immense drain of personal time of the Chairperson (approximately 600 hours over 15 months), variable levels of commitment of the 24 volunteers, and unproven sustainability in the long-term without funding support.
Conclusion
This unique guideline development model emphasizes efficiency, economy, and excellence; and can be emulated in diverse resource-constrained settings.
"
Evidence-based guideline development requires the investment of considerable resources in terms of skilled personnel, finances, and time. This makes it particularly challenging to undertake in resource-constrained settings of developing countries. Consequently, many guidelines developed in such healthcare systems do not meet the criteria for trustworthiness.
Objective
This presentation summarizes a unique experiment of developing evidence-based guidelines, by personnel with no prior experience/training, and without external funding.
Methods
The Indian Academy of Pediatrics (IAP) National Respiratory Chapter desired to develop clinical practice guidelines for pediatricians caring for children with respiratory problems. Fifty pediatricians (content experts), with no prior experience in evidence-based guideline development, volunteered. An online training workshop was conducted over a series of weekends to build concepts and skills in guideline methodology. Thereafter, a learning-by-doing approach was adopted under the mentorship of the Chairperson. Twenty-four pediatricians volunteered to develop the guideline and submitted formal DoI statements, that were vetted for conflicts.
Contemporary guideline methodology steps were followed with additional in-built efficiency tweaks. These included searching for existing guidelines (whose recommendations could be adopted adapted, or adoloped to the local setting). If unavailable, current, high-quality systemic reviews addressing the PICOT questions were searched. If even these were unavailable, de novo systematic reviews were undertaken. The evidence base for each question was critically appraised and GRADEd. Formal evidence-to-decision framework were used to translate the evidence to recommendations implementable in the local setting.
Results
The experiment yielded the world’s first methodologically-robust, evidence-based guideline for the management of Allergic BronchoPulmonary Aspergillosis in children. Other salient outcomes included capacity-building of 24 pediatricians (who are able to teach the methodology, and also participate in the next guideline on empyema management), saving a large amount of financial resources, and enthusing stakeholders about the feasibility of evidence-based guideline development. The downsides of the experiment were the immense drain of personal time of the Chairperson (approximately 600 hours over 15 months), variable levels of commitment of the 24 volunteers, and unproven sustainability in the long-term without funding support.
Conclusion
This unique guideline development model emphasizes efficiency, economy, and excellence; and can be emulated in diverse resource-constrained settings.
"