Integrating guideline development and implementation: analysis of guideline development manual instructions for generating implementation advice.

Background: Guidelines are important tools that inform healthcare delivery based on best available research evidence. Guideline use is in part based on quality of the guidelines, which includes advice for implementation and has been shown to vary. Others hypothesized this is due to limited instructions in guideline development manuals.

American Society of Clinical Oncology Clinical Practice Guidelines: formal systematic review-based consensus methodology.

The American Society of Clinical Oncology (ASCO) guidelines program employs a systematic review-based methodology to produce evidence-based guidelines. This is consistent with the stance of the Institute of Medicine on guideline development, which is that high-quality evidence syntheses form the basis for recommendation development. In the absence of high-quality evidence, recommendation development becomes more complex.

The systematic review and bibliometric network analysis (SeBriNA) is a new method to contextualize evidence. Part 1: description.

Objective: We describe a new methodology, the systematic review and bibliometric network analysis (SeBriNA), to contextualize the quality and quantity of patient-centered outcomes evidence relative to complementary documents such as reviews, practice guidelines, editorials, and media reports.

Study Design And Setting: The SeBriNA is informed by systematic review and bibliometric analysis methodologies. It focuses on two key concepts: 1) quality of evidence for patient-centered outcomes using cumulative meta-analysis and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) appraisal approach; 2) quantity of original research and its citation relationships to related documents.

Application of the systematic review and bibliometric network analysis (SeBriNA) methodology contextualizes evidence. Part 2: rituximab for non-Hodgkin's lymphoma.

Objective: We conducted a systematic review and bibliometric network analysis (SeBriNA) of rituximab for non-Hodgkin's lymphoma.

Study Design And Setting: We searched three primary data sources (1997-2003) for five document types: original research, reviews, guidelines, editorials, and media reports. We conducted cumulative meta-analysis on three outcomes (mortality, tumor response, safety) and used GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) to classify evidence quality.

Resection of liver metastases in patients with breast cancer: survival and prognostic factors.

Aims: Patients with breast cancer metastasized to the liver have a median survival of 4-33 months and treatment options are usually restricted to palliative systemic therapy. The aim of this observational study was to evaluate the effectiveness and safety of resection of liver metastases from breast cancer and to identify prognostic factors for overall survival.

Methods: Patients were identified using the national registry of histo- and cytopathology in the Netherlands (PALGA).

What is the Best Way to Produce Consensus and Buy in to Guidelines for Rectal Cancer?

Evidence-based guidelines are important tools and common pathways for translating evidence into clinical practice. It is most urgently needed when significant heterogeneity in practice exist. Actively engaging opinion leaders in the process of evidence-based guidelines development is important for several reasons.

Information seeking for making evidence-informed decisions: a social network analysis on the staff of a public health department in Canada.

Background: Social network analysis is an approach to study the interactions and exchange of resources among people. It can help understanding the underlying structural and behavioral complexities that influence the process of capacity building towards evidence-informed decision making. A social network analysis was conducted to understand if and how the staff of a public health department in Ontario turn to peers to get help incorporating research evidence into practice.

Comparison of gaseous cryotherapy with more traditional forms of cryotherapy following total knee arthroplasty.

Objective: The aim of this study was to assess the efficacy of gaseous cryotherapy following total knee arthroplasty (TKA) and to compare it to routinely used strategies for applying cold therapy.

Patients And Methods: Sixty-six patients undergoing primary unilateral TKA were randomized into three groups and received "gaseous cryotherapy (GC)", "cold pack" and "cryocuff" applications, respectively throughout the hospital stay. Primary outcomes (knee pain intensity, mobility and girth measurements) were recorded on preoperative day 1 as well as on postoperative day (POD) 7.

The guideline implementability research and application network (GIRAnet): an international collaborative to support knowledge exchange: study protocol.

Background: Modifying the format and content of guidelines may facilitate their use and lead to improved quality of care. We reviewed the medical literature to identify features desired by different users and associated with guideline use to develop a framework of implementability and found that most guidelines do not contain these elements. Further research is needed to develop and evaluate implementability tools.

Teaching and training in breaking bad news at the Dutch medical schools: a comparison.

Background: Physicians consider breaking bad news (BBN) a difficult task, and training is therefore necessary. There is much variety in what schools consider to be best practice and best timing for such training. This article discusses BBN-programmes at the Dutch medical schools.

The genetics of familial combined hyperlipidaemia.

Almost 40 years after the first description of familial combined hyperlipidaemia (FCHL) as a discrete entity, the genetic and metabolic basis of this prevalent disease has yet to be fully unveiled. In general, two strategies have been applied to elucidate its complex genetic background, the candidate-gene and the linkage approach, which have yielded an extensive list of genes associated with FCHL or its related traits, with a variable degree of scientific evidence. Some genes influence the FCHL phenotype in many pedigrees, whereas others are responsible for the affected state in only one kindred, thereby adding to the genetic and phenotypic heterogeneity of FCHL.

Physician self-audit: a scoping review.

Introduction: Self-audit involves self-collection of personal performance data, reflection on gaps between performance and standards, and development and implementation of learning or quality improvement plans by individual care providers. It appears to stimulate learning and quality improvement, but few physicians engage in self-audit. The purpose of this study was to identify how self-audit has been operationalized; factors influencing self-audit conduct and outcomes, including program design; and issues warranting further research.

The Global Rating Scale complements the AGREE II in advancing the quality of practice guidelines.

Objective: To explore the role of a four-item Global Rating Scale (GRS) that could be used in place of the Appraisal of Guidelines, Research and Evaluation II (AGREE II).

Study Design And Setting: A mixed four-factor design was used (User Type, Evaluation Type, Clinical Topic, Guideline). Participants were asked to read and evaluate a guideline using both the AGREE II draft and GRS or GRS only and to complete a series of questions regarding overall guideline quality, adoption, utility, and acceptability.

The landscape of knowledge translation interventions in cancer control: what do we know and where to next? A review of systematic reviews.

Background: Effective implementation strategies are needed to optimize advancements in the fields of cancer diagnosis, treatment, survivorship, and end-of-life care. We conducted a review of systematic reviews to better understand the evidentiary base of implementation strategies in cancer control.

Methods: Using three databases, we conducted a search and identified English-language systematic reviews published between 2005 and 2010 that targeted consumer, professional, organizational, regulatory, or financial interventions, tested exclusively or partially in a cancer context (primary focus); generic or non-cancer-specific reviews were also considered.

Core competencies in the science and practice of knowledge translation: description of a Canadian strategic training initiative.

Background: Globally, healthcare systems are attempting to optimize quality of care. This challenge has resulted in the development of implementation science or knowledge translation (KT) and the resulting need to build capacity in both the science and practice of KT.

Findings: We are attempting to meet these challenges through the creation of a national training initiative in KT.

Effective interventions to facilitate the uptake of breast, cervical and colorectal cancer screening: an implementation guideline.

Background: Appropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. Several high-quality systematic reviews and practice guidelines exist to inform the most effective screening options. However, effective implementation strategies are warranted if the full benefits of screening are to be realized.

What implementation interventions increase cancer screening rates? a systematic review.

Background: Appropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. However, effective implementation strategies are warranted if the full benefits of screening are to be realized. As part of a larger agenda to create an implementation guideline, we conducted a systematic review to evaluate interventions designed to increase the rate of breast, cervical, and colorectal cancer (CRC) screening.

Metformin-associated lactic acidosis in a patient with normal kidney function.

The existence of metformin-induced lactic acidosis has been questioned, in particular in the absence of specific risk factors such as impaired renal function. This report describes the presence of lactic acidosis in a patient with normal kidney function and normal doses of metformin. Subsequent positive rechallenge with metformin confirms causality.

E-learning interventions are comparable to user's manual in a randomized trial of training strategies for the AGREE II.

Background: Practice guidelines (PGs) are systematically developed statements intended to assist in patient and practitioner decisions. The AGREE II is the revised tool for PG development, reporting, and evaluation, comprised of 23 items, two global rating scores, and a new User's Manual. In this study, we sought to develop, execute, and evaluate the impact of two internet interventions designed to accelerate the capacity of stakeholders to use the AGREE II.

Developing a decision aid to guide public sector health policy decisions: a study protocol.

Background: Decision aids have been developed in a number of health disciplines to support evidence-informed decision making, including patient decision aids and clinical practice guidelines. However, policy contexts differ from clinical contexts in terms of complexity and uncertainty, requiring different approaches for identifying, interpreting, and applying many different types of evidence to support decisions. With few studies in the literature offering decision guidance specifically to health policymakers, the present study aims to facilitate the structured and systematic incorporation of research evidence and, where there is currently very little guidance, values and other non-research-based evidence, into the policy making process.

Plasma proprotein convertase subtilisin kexin type 9 is a heritable trait of familial combined hyperlipidaemia.

The aim of the present study was to investigate the relationship between circulating PCSK9 (proprotein convertase subtilisin kexin type 9) and FCHL (familial combined hyperlipidaemia) and, when positive, to determine the strength of its heritability. Plasma PCSK9 levels were measured in FCHL patients (n=45), NL (normolipidaemic) relatives (n=139) and their spouses (n=72). In addition, 11 FCHL patients were treated with atorvastatin to study the response in PCSK9 levels.

Improving cancer control in Canada one case at a time: the "Knowledge Translation in Cancer" casebook.

Purpose: In-the-field projects aiming to improve quality in cancer control provide a valuable complement to health services and knowledge translation (kt) research studies. The present paper describes the methods used to develop the Knowledge Translation for Cancer Control in Canada: A Casebook and its results.

Methods: Nominations for in-the-field projects were accepted from individuals and organizations across Canada.