Guideline registries and libraries: a mixed-methods approach identified issues to be addressed with content.

Objective: To establish what GIN guideline community members see as the desirable features of a guidelines library and registry of guidelines in development STUDY DESIGN AND SETTING: An explorative mixed-methods study was undertaken, including scoping activity and semi-structured interviews with guideline developers and endorsers from nine member organizations of the Guidelines International Network.

Results: A small number of desirable features of a guideline library were identified: comprehensiveness; single source of information to avoid searching multiple sites; inclusion of related materials; being up to date; searchability and ease of use. No existing library of guidelines was considered to have all of these features.

Developing Guidelines Before, During, and After the COVID-19 Pandemic.

These authors discuss several challenges and solutions for developers of COVID-19–related guidelines and recommendations.

Scottish Intercollegiate Guidelines Network: the first 15 years (1993-2008).

The Scottish Intercollegiate Guidelines Network (SIGN) was established in 1993. One of the first national programmes of evidence-based clinical practice guidelines, it has played a lead role internationally in many of the developments in guideline methodology. The challenges faced from the beginning of the organisation up to its integration into the National Health Service and how they were addressed are set out and related to SIGN's contribution to the Scottish tradition of medical education.

Sharing hard labour: developing a standard template for data summaries in guideline development.

Background: A key objective of the Guidelines International Network (GIN) is to reduce duplication of effort. To address this objective, a working group was established to define a minimum dataset for inclusion in all evidence tables.

Methods: A literature review was conducted to identify existing evidence tables, and GIN member organisations were asked to provide the tables they use.

Uterine-artery embolization versus surgery for symptomatic uterine fibroids.

Background: The efficacy and safety of uterine-artery embolization, as compared with standard surgical methods, for the treatment of symptomatic uterine fibroids remain uncertain.

Methods: We conducted a randomized trial comparing uterine-artery embolization and surgery in women with symptomatic uterine fibroids. The primary outcome was quality of life at 1 year of follow-up, as measured by the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36).

Comparison of CPAP titration at home or the sleep laboratory in the sleep apnea hypopnea syndrome.

Study Objectives: Continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) is conventionally started after in-laboratory overnight titration. This use of sleep laboratory space is both costly and limits access for diagnostic studies. This study aimed to evaluate whether automated CPAP titration in the home produced patient outcomes equal to those following laboratory-based automated CPAP titration.

How to formulate research recommendations.

“More research is needed” is a conclusion that fits most systematic reviews. But authors need to be more specific about what exactly is required

Screening for thrombophilia in high-risk situations: systematic review and cost-effectiveness analysis. The Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) study.

Objectives: To assess the risk of clinical complications associated with thrombophilia in three high-risk patient groups: women using oral oestrogen preparations, women during pregnancy and patients undergoing major orthopaedic surgery. To assess the effectiveness of prophylactic treatments in preventing venous thromboembolism (VTE) and adverse pregnancy outcomes in women with thrombophilia during pregnancy and VTE in patients with thrombophilia, undergoing major orthopaedic surgery. To evaluate the relative cost-effectiveness of universal and selective VTE history-based screening for thrombophilia compared with no screening in the three high-risk patient groups.

Thrombophilia in pregnancy: a systematic review.

Growing evidence suggests that thrombophilia is associated with venous thromboembolism (VTE) and adverse pregnancy outcomes. However, methodological limitations have made it difficult to obtain a clear overview of the overall risks. We conducted a systematic review to determine the risk of VTE and adverse pregnancy outcomes associated with thrombophilia in pregnancy.

Clinical practice guidelines.

This paper introduces the concepts of evidence-based clinical practice guidelines. It describes the key elements of guideline development, using examples from the Scottish Intercollegiate Guidelines Network (SIGN), and then goes on to discuss how practitioners in Singapore and other countries can find and use guidelines from other areas of the world. It concludes with a short section on the future direction of guideline development.

Screening for thrombophilia in high-risk situations: a meta-analysis and cost-effectiveness analysis.

Laboratory testing for the identification of heritable thrombophilia in high-risk patient groups have become common practice; however, indiscriminate testing of all patients is unjustified. The objective of this study was to evaluate the cost-effectiveness of universal and selective history-based thrombophilia screening relative to no screening, from the perspective of the UK National Health Service, in women prior to prescribing combined oral contraceptives and hormone replacement therapy, women during pregnancy and patients prior to major orthopaedic surgery. A decision analysis model was developed, and data from meta-analysis, the literature and two Delphi studies were incorporated in the model.

Oral contraceptives, hormone replacement therapy, thrombophilias and risk of venous thromboembolism: a systematic review. The Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) Study.

Combined oral contraceptives, oral hormone replacement therapy and thrombophilias are recognised risk factors for venous thromboembolism in women. The objective of this study was to assess the risk of thromboembolism among women with thrombophilia who are taking oral contraceptives or hormone replacement therapy, conducting a systematic review and metaanalysis. Of 201 studies identified, only nine met the inclusion criteria.

An evaluation of economics and acceptability of screening for Chlamydia trachomatis infection, in women attending antenatal, abortion, colposcopy and family planning clinics in Scotland, UK.

Objective: The aims of this study were to determine cost effectiveness of screening for Chlamydia trachomatis in hospital-based antenatal and gynaecology clinics, and community-based family planning clinics. Additionally, women's views of screening were determined in the hospital-based clinics.

Design: Cost effectiveness based on decision model.

Opportunistic screening for genital Chlamydia trachomatis infection and partner follow-up in family planning clinics in three Scottish cities.

Three large urban family planning clinics (FPCs) in Scotland participated in a study to examine the implications of opportunistically offering urine testing for genital Chlamydia trachomatis infection and FPC follow-up of positive women and of their male partners. Ninety-eight percent (3029) of women accepted the test. The prevalence of infection was 5.

Stepping down inhaled corticosteroids in asthma: randomised controlled trial.

Objectives: To determine whether the dose of inhaled corticosteroids can be stepped down in patients with chronic stable asthma while maintaining control.

Design: One year, randomised controlled, double blind, parallel group trial.

Setting: General practices throughout western and central Scotland.

Cost-effectiveness of screening for the factor V Leiden mutation in pregnant women.

The factor V Leiden (FVL) mutation is associated with vascular complications in pregnancy, and routine screening of all pregnant women has been suggested. We did a prospective, unselected study in 967 pregnant women to evaluate the cost-effectiveness of screening all women, or only those with a personal or family history of venous thrombosis (n=113). When anticoagulant prophylaxis was assumed to effect a 50% reduction in vascular complications, we recorded an additional management cost of 3768 pounds sterling with selective screening and 39,841 pounds sterling with universal screening.

An economic analysis of surgical wound infection.

Audit of surgical wound infection is not only an outcome indicator, but also an important aspect of infection control. The literature suggests an expensive 'gold standard' involving a full-time audit nurse collecting prospective data, including a 30-day follow-up into the community.Our study indicates that the cost of surgical wound infection is three-fold: cost to the hospital, the community services and the patient.