Co-creation of a step-by-step guide for specifying the test-management pathway to formulate focused guideline questions about healthcare related tests.

Background: Guideline development on testing is known to be difficult for guideline developers. It requires consideration of various aspects, such as accuracy, purpose of testing, and consequences on management and people-important outcomes. This can be outlined in a test-management pathway.

Required knowledge for guideline panel members to develop healthcare related testing recommendations: a developmental study.

Objectives: To define the minimum knowledge required for guideline panel members (healthcare professionals and consumers) involved in developing recommendations about healthcare related testing.

Study Design And Setting: A developmental study with a multistaged approach. We derived a first set of knowledge components from literature and subsequently performed semistructured interviews with 9 experts.

Do clinical practice guidelines consider evidence about diagnostic test consequences on patient-relevant outcomes? A critical document analysis.

Rationale, Aims And Objectives: Supporting evidence for diagnostic test recommendations in clinical practice guidelines (CPGs) should not only include diagnostic accuracy, but also downstream consequences of the test result on patient-relevant outcomes. The aim of this study is to assess the extent to which evidence-based CPGs about diagnostic tests cover all relevant test-treatment pathway components.

Methods: We performed a systematic document analysis and quality assessment of publicly accessible CPGs about three common diagnostic tests: C-reactive protein, colonoscopy and fractional exhaled nitric oxide.

Applying GRADE for diagnosis revealed methodological challenges: an illustrative example for guideline developers.

Objective: To identify challenges in the application of GRADE for diagnosis when assessing the certainty of evidence in the test-treatment strategy (diagnostic accuracy, test burden, management effectiveness, natural course, linked evidence) in an illustrative example and to propose solutions to these challenges.

Study Design And Setting: A case study in applying GRADE for diagnosis that looked at the added value of IgE for diagnosing allergic rhinitis.

Results: Evaluation of the full test-treatment strategy showed a lack of (high-quality) evidence for all elements.

[Chronic kidney damage guidelines revision].

Age has no effect on the diagnosis of 'chronic kidney damage'. Estimated glomerular filtration rate (eGFR) < 60 ml/min per 1.73 m2 is to be considered 'abnormal' for patients of all ages.

Applicability of evidence from previous systematic reviews on immunotherapy in current practice of childhood asthma treatment: a GRADE (Grading of Recommendations Assessment, Development and Evaluation) systematic review.

Objective: Because most children with asthma now use inhaled corticosteroids (ICS), the added benefit of immunotherapy in asthmatic children needs to be examined. We re-assessed the effectiveness of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) in childhood asthma treatment focusing on studies with patient-relevant outcome measures and children using ICS.

Methods: We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to systematically search and appraise the evidence using predefined critical patient-relevant outcomes (asthma symptoms, asthma control and exacerbations).

[The NHG guidelines 'Adult asthma' and 'COPD'].

The Dutch College of General Practitioners (NHG) guidelines 'Adult asthma' and 'COPD' have been revised. New spirometry reference values from the Global Lung Function Initiative are recommended. Airway obstruction is defined as a FEV1/FVC ratio below the 5th percentile for the reference population.

[Dutch College of General Practitioners' practice guideline 'Asthma in children'].

In children < 6 years characteristic asthma patterns are often lacking and the diagnosis cannot be objectified. For this reason 'episodic expiratory wheezing' is the preferred diagnosis. In children ≥ 6 years asthma is diagnosed on the basis of symptoms; if there is doubt spirometry may be helpful.

Prospective comparison of three guideline development methods for treatment of actinic keratosis.

Objective: To compare three methods of guideline development, to see whether using alternative evidence-based methods resulted in variation of recommendations for treating actinic keratosis.

Methods: Method 1 followed a standard multiple session evidence-based approach with a working group. In method 2 recommendations were formulated by a working group during a 2-day conference.

[Advice on guidelines: planning for guideline development in the Netherlands].

There is a lack of shared responsibility and national steering in guideline development. The 'Regieraad' (advisory board on guideline development, established by the Dutch Health Secretary) hopes to facilitate the coordination of guideline development. Therefore, the board developed a shortlist of the 100 most important diseases and 25 important care processes, based on several accepted criteria.

Quality of primary care guidelines for acute low back pain.

Study Design: Systematic review of clinical guidelines.

Objectives: To assess the methodologic quality of existing guidelines for the management of acute low back pain.

Summary Of Background Data: Guidelines are playing an increasingly important role in evidence-based practice.