Background
Time of validity
Updating strategy
Living clinical guidelines
Objectives
Methods
Living strategy
Process | Description | Participants |
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1. Recruitment of members for the CG Updating Working Group | − Contact the CG Development Group to invite them to participate in the implementation of the strategy. − Replace non-respondents or those who declined with new members. | − Technical team |
2. Mapping of the CG | − Identify clinical questions, recommendations, and references in the CG. − Compile original documentation (searches, references, evidence syntheses, and GRADE evidence profiles). | − Technical team |
3. Identification of evidence from the CG Updating Working Group | − Distribute a questionnaire via email among the CG Updating Working Group for identifying new evidence. | − Clinical team − Patients and carers team |
4. Design of restricted literature search strategy | − Design and validate restricted search strategies per clinical question. − Design search strategy for costs and resources use and for patients’ values and preferences. | − Technical team |
5. Running of restricted literature searches | − Conduct restricted searches in MEDLINE (through PubMed). | − Technical team |
6. Review of alerts for drugs and medical devices | − Identify alerts for drugs and medical devices issued by the Spanish Agency for Medicines and Health Products. | − Technical team |
7. Development of references database | − Develop references database and identify duplicates among the different information sources and between the original and updated CGs. | − Technical team |
8. First reference screening | − Identify pertinent references (topic-related references with a fitting study design). | − Technical team |
9. Second reference screening (assessment of new evidence impact) | − Develop a questionnaire to identify: (1) relevant references: references that are pertinent for updating a recommendation but that actually do not trigger an update and (2) potential key references: references that could potentially trigger an update of a recommendation. | − Clinical team − Technical team |
10. Development of a clinical questions database | − Select clinical questions with pertinent, relevant, and key references. | − Technical team |
11. Classification of clinical questions | − Analyse clinical questions database to identify: (1) clinical questions to be reviewed: with potential key references and with different relevant references or important pharmacological alerts, (2) valid clinical questions: without potential key references associated and (3) new clinical questions. | − Technical team |
12. Review and, if necessary, modification of clinical questions and recommendations | − Assessment of the potential key references. − Update recommendations if necessary. − Identify key references (references that have triggered changes in one or more recommendations). − Reach a consensus with the CG Updating Working Group on the suggested updates. | − Clinical team − Patients and carers team − Technical team |
13. Update of the CG manuscript | − Incorporate updates in the previous version of the CG manuscript. | − Technical team |
Identification of new evidence
Reference screening
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Pertinent references: topic-related references that met the study design criteria
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Relevant references: pertinent references that could be used when considering an update to a recommendation, but that would not necessarily trigger a potential update
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Potential key references: relevant references that could potentially trigger an update
Classification of clinical questions
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Clinical question to be reviewed: question with potential key references or with alerts
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Valid clinical question: question without potential key references or without alerts
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New clinical question
Update cycle
Data analysis
Results
Clinical Guideline Updating Working Group
Mapping process
Continuous surveillance process
First update cycle | Second update cycle | Third update cycle | |
---|---|---|---|
Literature search | |||
–Search dates | 01/01/2012 31/08/2014 | 01/09/2014 28/02/2015 | 01/03/2015 31/08/2015 |
–Time period included (months) | 32 | 6 | 6 |
Results of the literature search | |||
–Evidence identified from the CG Updating Working Group | 19 | NC | NC |
–References on efficacy | 9191 | 2089 | 1946 |
–References on costs and resource use | 116 | 51 | 19 |
–References on patients’ values and preferences | 384 | 10 | 39 |
–Drug alerts | NA | 10 | 6 |
Total | 9710 | 2160 | 2010 |
Results of reference screening | |||
–Pertinent references | 318 | NC | NC |
–Relevant references | 289 | NC | NC |
–Potential key references (≥1 participants) | 184 | NC | NC |
–Potential key references (≥2 participants) | 31 | NC | NC |
–Potential key references (CG methodology experts) | 55 | NC | NC |