Dear Tomas
I was involved in producing the leg ulcer guideline that is listed on the
NZGG website. This project involved adapting 2 seed guidelines (both UK - a
SIGN guideline and a RCN guideline), rather than starting from scratch.
It is worth noting that Arash Rashidian is correct in stating adapting a
guideline is not a cheap option. Our project was not funded by NZGG, but
resourcing was supported through a the positions of those involved (a
university and a hospital). Additionally, we had to find money to support
the printing and dissemination. Overall, I have estimated that the project
cost about NZ$70,000.
At the time (1998) there were no roadmaps to guide us in the process, so I
am sure the process we used could be improved upon. I have still not seen
any articles describing a "good" process for adapting guidelines, but a
paper Paul Shekelle et al outlines a process for updating guidelines that
could be adapted (Shekelle P et al. When should clinical guidelines be
updated? BMJ 2001; 323: 155-157).
Following a suitability screen, we searched and obtained all guidelines for
leg ulcer management; we critically appraised those guidelines and decided
to adapt the 2 evidence based guidelines, as they observed similar processes
to those outlined by NZGG (systematic review of literature, critical
appraisal, grading evidence).
Having decided which guidelines to use (and sought their permission), we
then created a table of the recommendations with the type and grade of
evidence alongside. This revealed two things:
1. The gaps in each of the guidelines, and the gaps in evidence between the
guidelines
2. The fact that the 2 guidelines gave different grades to the same pieces
of evidence.
We resolved therefore to
1. plug the gaps
2. review all the evidence for regrading purposes that had been critically
appraised by the original guidelines
3. update the evidence
To do this we generated clinical questions, with respect to the gaps and
updating the evidence, and searched for new studies, and we obtained all
the studies referenced in the original reviews for regrading. From their we
pretty much followed a normal guideline process.
I am not sure that we saved anything, in terms of time, by adapting rather
than starting afresh as it took us approximately 18 months from the time we
decided to do a guideline to the time it was disseminated.
Feel free to contact me if you want anymore details.
regards
Andrew Jull
HRC Foxley Fellow
Clinical Trials Research Unit Tel: +64 9 373-7599 Ext 84744
Dept of Medicine Mobile: +64 21 173 7755
Private Bag 92019 Fax: +64 9 373-1710
University of Auckland Email: [log in to unmask]
<mailto:[log in to unmask]>
Note - the University of Auckland is changing its extension numbers.
Beginning 29 November, my number will be 84744.
-----Original Message-----
From: Dr Tomas Pantoja [mailto:[log in to unmask]]
Sent: Saturday, 30 November 2002 2:14 AM
To: [log in to unmask]
Subject: Quick & dirty guidelines
Dear list members:
We are a group of Family Doctors in Chile trying to develop Clinical
Practice Guidelines for common conditions in general practice under the
umbrella of our scientific society (Chilean Society of Family & General
Medicine). We have some expertise in methodological issues regarding the
development of CPG but we (as none of other specialty societies) don't have
specific and sufficient resources to allocate to this daunting task. Then,
we have discussed the possibility to accomplish our objectives through the
"adaptation" of guidelines developed by others (such as NZGG, NICE, SIGN,
Clearinghouses,...), with a previous critical appraisal of those guidelines
(using instruments such as AGREE), and the use of formal consensus
techniques such the RAND nominal group technique.
We ask for opinions and thoughs from the list regarding
does anyone know similar experiences of guidelines development in developing
countries?
does anyone know how this "quick and (not so) dirty" guidelines development
process compare with more "formal" processes?
Kind regards
Tomas Pantoja MD MSc
Assistant Professor
Family & Community Medicine Programme
Catholic University of Chile
on behalf of the Chilean Society of Family & General Medicine guidelines
development group
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