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Palmer, Claire. "Clinical practice guidelines: the priorities." Psychiatric Bulletin 20, no. 1 (January 1996): 40–42. http://dx.doi.org/10.1192/pb.20.1.40.
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The Clinical Practice Guidelines (CPG) Steering Group commissioned a survey to find out which areas of clinical practice the mental health community view as priority for the development of clinical practice guidelines (CPGs). Fifty per cent of all professionals and service users surveyed considered the assessment of risk and management of deliberate self-harm and dangerousness' a priority area for guideline development. These findings provided the basis for a successful bid to the Department of Health for the development of The Royal College of Psychiatrists' first CPG.
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Society of Neurosciences, Malaysian. "Clinical Practice Guidelines." Journal Of Cardiovascular, Neurovascular & Stroke 3, no. 1 (March 30, 2021): 1–155. http://dx.doi.org/10.32896/cvns.v3n1.1-155.
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The 1st Clinical Practice Guideline (CPG) on the management of ischaemic stroke was published in 2006 and the second edition was published in 2012. Since then, there was a rapid development in the management of acute stroke, mainly with the improvement and advancement of reperfusion therapy, encompassing both medical thrombolysis and mechanical thrombectomy. Furthermore, the importance of timely intervention, especially in the emergency department, had significantly improved the outcome in stroke patients. Therefore, this current CPG emphasizes the hyperacute management and has introduced new chapters, for example, emergency medical services. With the growing numbers of elderly population in Malaysia, we have also included a new chapter on stroke in the older person. This 3rd edition was developed to provide a clear and concise approach based on current evidence with the focus being on the efforts to reduce time and improve pre-hospital care. We have summarised and adapted relevant clinical trials data and published literatures to our local practice.
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Kim, Soo Young. "Recent Advance in Clinical Practice Guideline Development Methodology." Korean Journal of Family Medicine 43, no. 6 (November 20, 2022): 347–52. http://dx.doi.org/10.4082/kjfm.22.0178.
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Clinical practice guidelines (CPG) can be defined as systematically developed recommendations and related content obtained by reviewing scientific evidence, which help healthcare providers make decisions. CPG is one of the most powerful tools that helps clinicians make evidence-based decisions in practice. Methodologies in areas essential for CPG development, such as for systematic review, risk of bias (ROB) assessment, adaptation, and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations, are rapidly developing. Therefore, they must be well-understood and applied to evidence-based CPG development. In this regard, it is necessary to learn about the updates and changed in the methodologies for CPG development. This manuscript covers the following CPG development methodologies: (1) main principles of CPG, (2) managing conflict of interest, (3) considering patient value and preference, (4) determination of key questions, (5) ROB assessment, (6) adaptation, (7) rapid guideline development, (8) living guideline development, and (9) GIN-McMaster Guideline Development Checklist.
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Vachhrajani, Shobhan, Abhaya V. Kulkarni, and John R. W. Kestle. "Clinical practice guidelines." Journal of Neurosurgery: Pediatrics 3, no. 4 (April 2009): 249–56. http://dx.doi.org/10.3171/2008.12.peds08278.
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In the era of evidence-based medicine, clinical practice guidelines (CPGs) have become an integral part of many aspects of medical practice. Because practicing neurosurgeons rarely have the time or, in some cases, the methodological expertise, to assess and assimilate the totality of primary research, CPGs can in theory provide a vehicle through which neurosurgeons could more efficiently integrate the most current evidence into patient management. Clinical practice guidelines have been met with some skepticism, however, particularly within the neurosurgical community. Some have expressed concerns that the promise of CPGs has not been matched by the reality. Others who oppose CPGs fear that they hinder the art of medicine, and limit physician and patient autonomy. The purpose of this paper is to provide the practicing neurosurgeon with an up-to-date review of CPGs. The authors discuss some of the complexities and recent advancements in CPG development, appraisal, and publication. An overview of the various systems for grading medical evidence and issuing CPG recommendations, each of which has its advantages and disadvantages, is included, and the current knowledge on the impact of CPGs in 2 important realms, patient care and medicolegal issues, is discussed. The purpose of this review is to provide a balanced, current synopsis of what CPGs are, how they are developed, and what they can and cannot do. The authors hope that this will allow neurosurgeons to make more informed decisions about the many CPGs that will inevitably become an essential component of medical practice in the years to come.
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Torcivia, Peter, Ifeoma Nkemakolam, and M. Danet Lapiz-Bluhm. "Critical Appraisal of Clinical Practice Guidelines (CPG) Training for Graduate Student Nurses: Exemplar of a CPG for the Management of Post-Traumatic Stress Disorder (PTSD)." Journal of the American Nurses Association - New York 2, no. 2 (August 23, 2022): 28–34. http://dx.doi.org/10.47988/janany.33648481.2.2.
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Background: Clinical practice guidelines serve as a framework for clinical decisions supporting best practices to optimize patient care. Critical appraisal of a clinical practice guideline is an important clinical skill for advanced practice nurses and other advanced healthcare professionals. Hence, advanced practice nursing students should receive appraisal training of clinical practice guidelines to develop their critical skills in determining their quality and potential incorporation into evidence-based clinical practice. Objective: This paper describes the incorporation of a critical appraisal of a clinical practice guideline in a graduate nursing program for advanced nursing practice. As an exemplar of the appraisal process, the clinical practice guideline from the United States (US) Department of Veterans Affairs and the Department of Defense (VA/DoD) on the management of post-traumatic stress disorder and acute stress disorder was critically appraised. Methodology: Students enrolled in a graduate nursing course were formed into groups of 3-4, and selected a clinical practice guideline according to their specialty. A group of four students enrolled in the Psychiatric and Mental Health Nurse Practitioner program critically appraised the VA/DoD clinical practice related to the management of posttraumatic stress disorder and acute stress disorder using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument. Students’ performance and feedback were evaluated. Results: The students viewed the course activity positively and appreciated learning the CPG appraisal process and its use in practice. The VA/DoD clinical practice guideline was deemed of high quality and user-friendly for practitioners’ use in clinical decision-making despite minor limitations. Conclusion and recommendations: Incorporation of clinical practice guideline assessment using the AGREE II Instrument in the advanced practice nursing curriculum should be considered. Participating graduate students considered the skill needed for their future advanced practice. Regular updates of clinical practice guidelines and their appraisals are also recommended.
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Tobin, Margaret, Andrew Wilson, David Codyre, Alan Rosen, and David Barton. "Clinical Practice Guidelines: A Tool to Measure Variance." Australasian Psychiatry 11, no. 1 (March 2003): 26–28. http://dx.doi.org/10.1046/j.1440-1665.2003.00522.x.
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Objective: To outline plans of the RANZCP Quality Improvement Committee (QIC) for the implementation of the Clinical Practice Guidelines (CPG) into clinical practice in Australia and New Zealand, and provide views of the QIC on the role of CPG as a quality improvement tool. Conclusions: Clinical Practice Guidelines are of limited utility unless there is clinician buy-in and they are used as a tool to measure variance as part of a continuous quality improvement cycle. The QIC actively encourages debate regarding the content and development process of the CPG as well as methods for their use in routine clinical practice.
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Gholami, Reza, Rishad Khan, Anushka Ramkissoon, Abdulrahman Alabdulqader, Nikko Gimpaya, Rishi Bansal, Michael A. Scaffidi, et al. "Recommendation Reversals in Gastroenterology Clinical Practice Guidelines." Journal of the Canadian Association of Gastroenterology 5, no. 2 (October 21, 2021): 98–99. http://dx.doi.org/10.1093/jcag/gwab040.
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Abstract Background Recommendations in clinical practice guidelines (CPGs) may be reversed when evidence emerges to show they are futile or unsafe. In this study, we identified and characterized recommendation reversals in gastroenterology CPGs. Methods We searched CPGs published by 20 gastroenterology societies from January 1990 to December 2019. We included guidelines which had at least two iterations of the same topic. We defined reversals as when (a) the more recent iteration of a CPG recommends against a specific practice that was previously recommend in an earlier iteration of a CPG from the same body, and (b) the recommendation in the previous iteration of the CPG is not replaced by a new diagnostic or therapeutic recommendation in the more recent iteration of the CPG. The primary outcome was the number of recommendation reversals. Secondary outcomes included the strength of recommendations and quality of evidence cited for reversals. Results Twenty societies published 1022 CPGs from 1990 to 2019. Our sample for analysis included 129 unique CPGs. There were 11 recommendation reversals from 10 guidelines. New evidence was presented for 10 recommendation reversals. Meta-analyses were cited for two reversals, and randomized controlled trials (RCTs) for seven reversals. Recommendations were stronger after the reversal for three cases, weaker in two cases, and of similar strength in three cases. We were unable to compare recommendation strengths for three reversals. Conclusion Recommendation reversals in gastroenterology CPGs are uncommon but highlight low value or harmful practices.
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Marriott, Sarah. "Clinical Practice Guidelines: who needs them?" Psychiatric Bulletin 19, no. 7 (July 1995): 403–6. http://dx.doi.org/10.1192/pb.19.7.403.
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Clinical Practice Guidelines (CPGs) are systematically developed statements to assist practitioner and patient in clinical decisions about appropriate health care for specific clinical circumstances. The Royal College of Psychiatrists CPG Programme aims to develop clinical guidelines which are scientifically valid and acceptable to those affected by them. At the same time, CPGs must be responsive to advances in knowledge, and versatile enough for the demands of routine practice. Their development involves a number of stages and a variety of methods, built into a cycle of evaluation and review. The Programme has established priorities for clinical topics for CPG development through consultation with the mental health community. Well-developed CPGs would benefit clinicians, patients and purchasers of care. It Is now important to appraise their ability to change clinical practice, the associated direct and indirect costs, and their value as a medical technology. The clinical professions are in the strongest position to co-ordinate their development, and guide their evaluation.
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KLIGER, ALAN S., and WILLIAM E. HALEY. "Clinical Practice Guidelines in End-Stage Renal Disease." Journal of the American Society of Nephrology 10, no. 4 (April 1999): 872–77. http://dx.doi.org/10.1681/asn.v104872.
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Abstract. Clinical practice guidelines (CPGs) for end-stage renal failure (ESRD) were recently published, and represent a comprehensive review of available literature and the considered judgment of experts in ESRD. To prioritize and implement these guidelines, the evidence underlying each guideline should be ranked and the attributes of each should be defined. Strategies to improve practice patterns should be tested. Focused information for each high priority guideline should be disseminated, including a synopsis and assessment of the underlying evidence, the evidence model used to develop that guideline, and suggested strategies for CPG implementation. Clinical performance measures should be developed and used to measure current practice, and the success of changing practice patterns on clinical outcomes. Individual practitioners and dialysis facilities should be encouraged to utilize continuous quality improvement techniques to put the guidelines into effect. Local implementation should proceed at the same time as a national project to convert high priority CPGs into clinical performance measures proceeds. Patients and patient care organizations should participate in this process, and professional organizations must make a strong commitment to educate clinicians in the methodology of CPG and performance measure development and the techniques of continuous quality improvement. Health care regulators should understand that CPGs are not standards, but are statements that assist practitioners and patients in making decisions.
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Lim, Kyeong-Tae, Hyun-Tae Kim, Eui-Hyoung Hwang, Man-Suk Hwang, In Heo, Sun-Young Park, Jae-Heung Cho, et al. "Adaptation and Dissemination of Korean Medicine Clinical Practice Guidelines for Traffic Injuries." Healthcare 10, no. 7 (June 22, 2022): 1166. http://dx.doi.org/10.3390/healthcare10071166.
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In South Korea, car insurance that includes medical coverage of traditional Korean medicine (TKM) has increased exponentially. Clinical practice guidelines (CPG) for traffic injuries were established in 2016. We aimed to revise and update de novo CPG and distribute the adapted CPG to TKM practitioners and patients. Clinical key questions from previous CPG were identified and updated regarding the grade of recommendation and level of evidence using additional evidence from the literature obtained through a systematic search and the use of the Grading of Recommendations Assessment, Development, and Evaluation methodology. The dissemination and implementation of the updated CPG were conducted at the CPG Center of Korean Medicine. Ultimately, 25 recommendations based on 13 clinical key questions were developed: 2 for diagnosis, 22 for TKM treatments, and 1 for prognosis. After recognition by professional societies and certification by the CPG Center of Korean Medicine, leaflets, card news, and infographics for TKM doctors in South Korea were produced and distributed. These are the only TKM CPG for patients who have experienced traffic injuries. They are expected to contribute to standardized and evidence-based treatment using TKM and similar interventions. Moreover, disseminating the adapted CPG will promote treatment reliability and strengthen insurance coverage.
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Bautista-Molano, W., E. Jauregui, L. Saldarriaga, M. X. Rojas, and J. R. Pieschacón. "THU0557 QUALITY ASSESSMENT OF CLINICAL PRACTICE GUIDELINES IN AXIAL AND PERIPHERAL SPONDYLOARTHRITIS: A SYSTEMATIC APPRAISAL." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 519.2–520. http://dx.doi.org/10.1136/annrheumdis-2020-eular.5520.
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Background:Clinical practice guidelines (CPG) in spondyloarthritis (SpA) serves as a tool for rheumatologists, health-care providers and patients in the selection of appropriate treatment framework in common clinical scenarios guiding decision-making processes. However, the quality of these guidelines has not yet been evaluated systematically in the field.Objectives:The aim of the study was to evaluate the quality of the CPG available for the treatment of axial and peripheral SpA.Methods:A systematic and scientific literature search between 2014 and 2019 was performed in order to identify and select CPG focused on the treatment of axial and peripheral SpA. The authors systematically searched the main guideline databases and guideline developer websites completing the search in PUBMED/MEDLINE and EMBASE. Four independent reviewers with methodological and clinical expertise in the field of SpA, assessed the eligible guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Their degree of agreement was evaluated with the intra-class correlation coefficient (ICC). The statistical analyses as done using the R psych package.Results:Twelve CPG were selected for evaluation. The scores for each of the AGREE II domains were: scope and purpose 86% (range: 67–99%); stakeholder involvement 71% (range: 22–93%); rigour of development 61% (range: 29–82%); clarity and presentation 79% (range: 68–86%); applicability 48% (range: 21–71%); and editorial independence 72% (range: 19–92%). Most of the appraised guidelines could be recommended (n=12) or recommended with limitations (n=12) for use in clinical practice. The overall agreement among reviewers was moderate (ICC: 0.40; 95% CI 0.16 to 0.82). The CPG with the best quality assessment using the AGREE II instrument was the NICE guideline developed by the National Institute for Health and Care Excellence. A slightly higher quality assessment of CPG developed by research agencies or guideline developers was observed, in comparison to those developed by scientific societies. Figure 1..ssessment cientific societies.eld of ocieties and XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXConclusion:Quality assessment of guidelines for the treatment of axial and peripheral SpA is good with an average of 69%. However, a cut-off point has not been clearly established. Measures should be taken to assure that CPGs are based on the best available evidence and rigorously developed and reported. Additional efforts are needed to provide high-quality guidelines that serve as a useful and reliable instrument for clinical decision-making process in the field of SpA.Disclosure of Interests:None declared
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Scott, Ann, Carmen Moga, and Christa Harstall. "OP144 Health Economics In Clinical Practice Guidelines: The Know-Do Gap." International Journal of Technology Assessment in Health Care 34, S1 (2018): 53. http://dx.doi.org/10.1017/s0266462318001575.
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Introduction:Clinical practice guidelines (CPGs) are an ideal implementation mechanism for promoting effective clinical practice, but without due consideration of costs they may do more harm than good and become a source of inefficiency. The Alberta Guideline Adaptation Program sought current best practice for incorporating economic information into CPGs to better leverage health technology assessment (HTA) and health economic expertise in its guideline development program.Methods:A comprehensive, systematic review of published and grey literature was undertaken to: (i) catalogue theoretical frameworks and practical methods for incorporating economic information into CPGs and forecasting the post-implementation economic impact of CPGs; (ii) summarize current methods for evaluating the economic impact of CPGs; and, (iii) identify barriers and facilitators to incorporating economic information into CPGs.Results:Rigorous economic analyses were infrequently incorporated in CPG development. While a selection of guidance documents and CPG manuals published between 2001 and 2017 by leading CPG developers emphasized the health economist's role and the importance of incorporating economic evidence into CPGs, few provided adequate guidance on the best way to do this. There is no agreement on how best to monitor the economic impact of CPGs. Analysis of a sample of over 100 studies published between 2005 and 2013 identified the three main methods currently used to assess the post-implementation economic impact of CPGs: pre-test/post-test cost analyses, mapping studies, and modelled cost-effectiveness studies. The key elements of each study type were summarized and compared.Conclusions:The review highlighted the under-recognized know-do gap among developers with respect to using health economics information and expertise in CPG development. It identified the advantages and potential limitations of applying health economics to CPG development, as well as areas where developers can better utilize HTA researchers and health economists to improve the quality of guidelines and better document the resource implications and feasibility of the interventions they recommend.
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McCaul, Michael, Dawn Ernstzen, Henk Temmingh, Beverly Draper, Michelle Galloway, and Tamara Kredo. "Clinical practice guideline adaptation methods in resource-constrained settings: four case studies from South Africa." BMJ Evidence-Based Medicine 25, no. 6 (July 10, 2019): 193–98. http://dx.doi.org/10.1136/bmjebm-2019-111192.
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Developing a clinical practice guideline (CPG) is expensive and time-consuming and therefore often unrealistic in settings with limited funding or resources. Although CPGs form the cornerstone of providing synthesised, systematic, evidence-based guidance to patients, healthcare practitioners and managers, there is no added benefit in developing new CPGs when there are accessible, good-quality, up-to-date CPGs available that can be adapted to fit local needs. Different approaches to CPG development have been proposed, including adopting, adapting or contextualising existing high-quality CPGs to make recommendations relevant to local contexts. These approaches are attractive where technical and financial resources are limited and high-quality guidance already exists. However, few examples exist to showcase such alternative approaches to CPG development. The South African Guidelines Excellence project held a workshop in 2017 to provide an opportunity for dialogue regarding different approaches to guideline development with key examples and case studies from the South African setting. Four CPGs represented the topics: mental health, health promotion, chronic musculoskeletal pain and prehospital emergency care. Each CPG used a different approach, however, using transparent, reportable methods. They included advisory groups with representation from content experts, CPG users and methodologists. They assessed CPGs and systematic reviews for adopting or adapting. Each team considered local context issues through qualitative research or stakeholder engagement. Lessons learnt include that South Africa needs fit-for-purpose guidelines and that existing appropriate, high-quality guidelines must be taken into account. Approaches for adapting guidelines are not clear globally and there are lessons to be learnt from existing descriptions of approaches from South Africa.
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de Vasconcelos, Luciana Pereira, Luiza de Oliveira Rodrigues, and Moacyr Roberto Cuce Nobre. "Clinical guidelines and patient related outcomes: summary of evidence and recommendations." International Journal of Health Governance 24, no. 3 (August 21, 2019): 230–38. http://dx.doi.org/10.1108/ijhg-12-2018-0073.
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Purpose Good medical practice, evidence-based medicine (EBM) and clinical practice guidelines (CPG) have been recurring subjects in the scientific literature. EBM advocates argue that good medical practice should be guided by evidence-based CPG. On the other hand, critical authors of EBM methodology argue that various interests undermine the quality of evidence and reliability of CPG recommendations. The purpose of this paper is to evaluate patient related outcomes of CPG implementation, in light of EBM critics. Design/methodology/approach The authors opted for a rapid literature review. Findings There are few studies evaluating the effectiveness of CPG in patient-related outcomes. The systematic reviews found are not conclusive, although they suggest a positive impact of CPGs in relevant outcomes. Research limitations/implications This work was not a systematic review of literature, which is its main limitation. On the other hand, arguments from EBM and CPG critics were considered, and thus it can enlighten health institutions to recognize the caveats and to establish policies toward care improvement. Originality/value The paper is the first of its kind to discuss, based on the published literature, next steps toward better health practice, while acknowledging the caveats of this process.
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Angel, Gustavo, Cristian Trujillo, Mario Mallama, Pablo Alonso-Coello, Markus Klimek, and Jose A. Calvache. "Methodological transparency of preoperative clinical practice guidelines for elective surgery. Systematic review." PLOS ONE 18, no. 2 (February 24, 2023): e0272756. http://dx.doi.org/10.1371/journal.pone.0272756.
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Background Clinical practice guidelines (CPG) are statements that provide recommendations regarding the approach to different diseases and aim to increase quality while decreasing the risk of complications in health care. Numerous guidelines in the field of perioperative care have been published in the previous decade but their methodological quality and transparency are relatively unknown. Objective To critically evaluate the transparency and methodological quality of published CPG in the preoperative assessment and management of adult patients undergoing elective surgery. Design Systematic review and methodological appraisal study. Data sources We searched for eligible CPG published in English or Spanish between January 1, 2010, and June 30, 2022, in Pubmed MEDLINE, TRIP Database, Embase, the Cochrane Library, as well as in representatives’ medical societies of Anaesthesiology and developers of CPG. Eligibility criteria CPG dedicated on preoperative fasting, cardiac assessment for non-cardiac surgery, and the use of routine preoperative tests were included. Methodological quality and transparency of CPG were assessed by 3 evaluators using the 6 domains of the AGREE-II tool. Results We included 20 CPG of which 14 were classified as recommended guidelines. The domain of "applicability" scored the lowest (44%), while the domains "scope and objective" and "editorial interdependence" received the highest median scores of 93% and 97% respectively. The remaining domains received scores ranging from 44% to 84%. The top mean scored CPG in preoperative fasting was ASA 2017 (93%); among cardiac evaluation, CPG for non-cardiac surgery were CCS 2017 (91%), ESC-ESA 2014 (90%), and AHA-ACC 2014 (89%); in preoperative testing ICSI 2020 (97%). Conclusions In the last ten years, most published CPG in the preoperative assessment or management of adult patients undergoing elective surgery focused on preoperative fasting, cardiac assessment for non-cardiac surgery, and use of routine preoperative tests, present moderate to high methodological quality and can be recommended for their use or adaptation. Applicability and stakeholder involvement domains must be improved in the development of future guidelines.
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Wu, Annie M., Connie M. Wu, Benjamin K. Young, Dominic J. Wu, Curtis E. Margo, and Paul B. Greenberg. "Critical Appraisal of Clinical Practice Guidelines for Age-Related Macular Degeneration." Journal of Ophthalmology 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/710324.
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Purpose. To evaluate the methodological quality of age-related macular degeneration (AMD) clinical practice guidelines (CPGs).Methods. AMD CPGs published by the American Academy of Ophthalmology (AAO) and Royal College of Ophthalmologists (RCO) were appraised by independent reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, which comprises six domains (Scope and Purpose, Stakeholder Involvement, Rigor of Development, Clarity of Presentation, Applicability, and Editorial Independence), and an Overall Assessment score summarizing methodological quality across all domains.Results. Average domain scores ranged from 35% to 83% for the AAO CPG and from 17% to 83% for the RCO CPG. Intraclass correlation coefficients for the reliability of mean scores for the AAO and RCO CPGs were 0.74 and 0.88, respectively. The strongest domains were Scope and Purpose and Clarity of Presentation. The weakest were Stakeholder Involvement (AAO) and Editorial Independence (RCO).Conclusions. Future AMD CPGs can be improved by involving all relevant stakeholders in guideline development, ensuring transparency of guideline development and review methodology, improving guideline applicability with respect to economic considerations, and addressing potential conflict of interests within the development group.
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Lepkowski, Angela M., Robin Adair Shannon, and Erin D. Maughan. "Validation of a Model for Developing Evidence-Based Clinical Practice Guidelines for School Nursing." Journal of School Nursing 36, no. 6 (October 20, 2019): 410–14. http://dx.doi.org/10.1177/1059840519881771.
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The paucity of scientifically rigorous school nursing clinical practice guidelines (CPGs) presents barriers to evidence-based care of students with special health-care needs. A Model for Developing Evidence-Based Clinical Practice Guidelines for School Nursing (School Nursing CPG Model) was developed under the auspices of the National Association of School Nurses (NASN) to address this need. To test and validate this School Nursing CPG Model, a trial CPG development project was conducted to (1) identify structure and process gaps and areas for improvement within the School Nursing CPG Model and (2) develop an evidence-based CPG for school nursing practice that addresses a priority student health condition: seizures and epilepsy. The School Nursing CPG Model was validated through a trial CPG project which followed the systematic, standardized process of the School Nursing CPG Model while responsively implementing quality improvement measures through the Plan–Do–Study–Act cycle. Both specific aims were accomplished.
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Kumar Tyagi, N., and S. Dhesy-Thind. "Clinical practice guidelines in breast cancer." Current Oncology 25 (June 14, 2018): 151. http://dx.doi.org/10.3747/co.25.3729.
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Background A number of clinical practice guidelines (cpgs) concerning breast cancer (bca) screening and management are available. Here, we review the strengths and weaknesses of cpgs from various professional organizations and consensus groups with respect to their methodologic quality, recommendations, and implementability.Methods Guidelines from four groups were reviewed with respect to two clinical scenarios: adjuvant ovarian function suppression (ofs) in premenopausal women with early-stage estrogen receptor–positive bca, and use of sentinel lymph node biopsy (slnb) after neoadjuvant chemotherapy (nac) for locally advanced bca. Guidelines from the American Society of Clinical Oncology (asco); Cancer Care Ontario’s Program in Evidence Based Care (cco’s pebc); the U.S. National Comprehensive Cancer Network (nccn); and the St. Gallen International Breast Cancer Consensus Conference were reviewed by two independent assessors. Guideline methodology and applicability were evaluated using the agree ii tool.Results The quality of the cpgs was greatest for the guidelines developed by asco and cco’s pebc. The nccn and St. Gallen guidelines were found to have lower scores for methodologic rigour. All guidelines scored poorly for applicability. The recommendations for ofs were similar in three guidelines. Recommendations by the various organizations for the use of slnb after nac were contradictory.Conclusions Our review demonstrated that cpgs can be heterogeneous in methodologic quality. Low-quality cpg implementation strategies contribute to low uptake of, and adherence to, bca cpgs. Further research examining the barriers to recommendations—such as intrinsic guideline characteristics and the needs of end users—is required. The use of bca cpgs can improve the knowledge-to-practice gap and patient outcomes.
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Shannon, Robin Adair, and Erin D. Maughan. "A Model for Developing Evidence-Based Clinical Practice Guidelines for School Nursing." Journal of School Nursing 36, no. 6 (October 16, 2019): 415–22. http://dx.doi.org/10.1177/1059840519880938.
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School nurses need evidence-based clinical practice guidelines (CPGs) to provide quality care for students with special health-care needs. However, a gap analysis revealed a paucity of rigorous school nursing CPGs. To fill this gap, a Model for Developing Evidence-based Clinical Practice Guidelines for School Nursing (School Nursing CPG Model) was designed under the auspices of the National Association of School Nurses to offer school nurse scholars, school health leaders, and pediatric clinical experts a standardized structure and systematic process to create rigorous evidence-based CPGs. The aim is to employ the School Nursing CPG Model to build a repository of CPGs that are projected to improve the quality of school nursing practice, thereby improving health and educational outcomes for students with special health-care needs. The School Nursing CPG Model is anticipated to apply to CPG development for other nursing specialties.
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Reames, Bradley N., Robert W. Krell, Sarah N. Ponto, and Sandra L. Wong. "Critical Evaluation of Oncology Clinical Practice Guidelines." Journal of Clinical Oncology 31, no. 20 (July 10, 2013): 2563–68. http://dx.doi.org/10.1200/jco.2012.46.8371.
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Purpose Significant concerns exist regarding the content and reliability of oncology clinical practice guidelines (CPGs). The Institute of Medicine (IOM) report “Clinical Practice Guidelines We Can Trust” established standards for developing trustworthy CPGs. By using these standards as a benchmark, we sought to evaluate recent oncology guidelines. Methods CPGs and consensus statements addressing the screening, evaluation, or management of the four leading causes of cancer-related mortality in the United States (lung, breast, prostate, and colorectal cancers) published between January 2005 and December 2010 were identified. A standardized scoring system based on the eight IOM standards was used to critically evaluate the methodology, content, and disclosure policies of CPGs. All CPGs were given two scores; points were awarded for eight standards and 20 subcriteria. Results No CPG fully met all the IOM standards. The average overall scores were 2.75 of 8 possible standards and 8.24 of 20 possible subcriteria. Less than half the CPGs were based on a systematic review. Only half the CPG panels addressed conflicts of interest. Most did not comply with standards for inclusion of patient and public involvement in the development or review process, nor did they specify their process for updating. CPGs were most consistent with IOM standards for transparency, articulation of recommendations, and use of external review. Conclusion The vast majority of oncology CPGs fail to meet the IOM standards for trustworthy guidelines. On the basis of these results, there is still much to be done to make guidelines as methodologically sound and evidence-based as possible.
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de la Maza Krzeptowsky, Lilia. "41. Clinical Practice Guidelines (CPG) to Intraoperative Neurophysiological Monitoring (IONM)." Clinical Neurophysiology 127, no. 9 (September 2016): e312. http://dx.doi.org/10.1016/j.clinph.2016.05.316.
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Jeong, Eunhye, Jinkyung Park, and Sung Ok Chang. "Development and Evaluation of Clinical Practice Guideline for Delirium in Long-Term Care." International Journal of Environmental Research and Public Health 17, no. 21 (November 9, 2020): 8255. http://dx.doi.org/10.3390/ijerph17218255.
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Delirium is highly prevalent and leads to several bad outcomes for older long-term care (LTC) residents. For a more successful translation of delirium knowledge, Clinical Practice Guidelines (CPGs) tailored to LTC should be developed and applied based on the understanding of the barriers to implementation. This study was conducted to develop a CPG for delirium in LTC and to determine the barriers perceived by healthcare professionals related to the implementation of the CPG. We followed a structured, evidence- and theory-based procedure during the development process. After a systematic search, quality appraisal, and selection for eligible up-to-date CPGs for delirium, the recommendations applicable to the LTC were drafted, evaluated, and confirmed by an external group of experts. To evaluate the barriers to guideline uptake from the users’ perspectives, semi-structured interviews were conducted which resulted in four major themes: (1) a lack of resources, (2) a tendency to follow mindlines rather than guidelines, (3) passive attitudes, and (4) misunderstanding delirium care in LTC. To minimize adverse prognoses through prompt delirium care, the implementation of a CPG with an approach that comprehensively considers various barriers at the system, practice, healthcare professional, and patients/family levels is necessary.
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Savoie, Isabelle, Arminée Kazanjian, and Ken Bassett. "Do Clinical Practice Guidelines Reflect Research Evidence?" Journal of Health Services Research & Policy 5, no. 2 (April 2000): 76–82. http://dx.doi.org/10.1177/135581960000500204.
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Objectives: To examine whether existing clinical practice guidelines (CPGs) for cholesterol testing reflect research evidence and hence may control or reduce costs while maintaining or improving the quality of care. Methods: A systematic search for published and unpublished cholesterol testing CPGs and independent critical appraisal of the CPGs by two researchers using a standard checklist. Results: In four of the five CPGs analysed, the link between the research evidence and the recommendations was not maintained. The appraisal, local experience and the literature all suggest that panel composition is an important explanation, in that the greater the involvement of clinical experts in the development process of the CPGs, the less the recommendations reflected the research evidence. Even though their participation is important for CPG uptake, clinical expert panels appear to have difficulty limiting CPGs to research-based recommendations. Conclusions: Existing cholesterol testing CPGs are unlikely to improve the quality of care while controlling or reducing costs. The problem lies not with guideline implementation but with the guidelines themselves. It is unclear how best to ensure that recommendations reflect research evidence but this is likely to require significant and progressive changes to the current guideline development process, including a redefinition of the clinical experts' role.
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Jatchavala, Chonnakarn, and Stella W. Y. Chan. "Thai Adolescent Depression: Recurrence Prevention in Practice." Journal of Health Science and Medical Research 36, no. 2 (May 24, 2018): 147. http://dx.doi.org/10.31584/jhsmr.2018.36.2.8.
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This article aims to review the current practice of recurrence prevention and intervention of adolescent depressive disorder in Thailand. In particular, we assess the Clinical Practice Guideline of Major Depressive Disorder for General Practitioners (CPG-MDD-GP) for Thailand, which is now the official guideline for all depressive patients who are children, adolescents, and adults in Thailand. Although this current Thai clinical guideline was developed and derived from the National Institute for Health and Care Excellence (NICE) of the United Kingdom and the recommendations and the practice parameters of the American Academy of Child and Adolescent Psychiatry (AACAP), it differs from these guidelines in a number of ways. Specifically, the main tool for the primary assessment of the Thai CPG-MDD-GP is called 9Q which categorizes the severity and follow-up of depressive symptoms by health care providers in a hospital setting, whereas the NICE guideline for depression in children and adolescents is based mainly on the community setting, and the AACAP parameter assesses patients by a direct interview method. Additionally, the Thai CPG-MDD-GP has no premise intervention for recurrence prevention of depression and lacks details regarding the importance of treatment engagement by family and community.
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Jatchavala, Chonnakarn, and Stella W. Y. Chan. "Thai Adolescent Depression: Recurrence Prevention in Practice." Journal of Health Science and Medical Research 36, no. 2 (May 24, 2018): 147. http://dx.doi.org/10.31584/jhsmr.v36i2.8.
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This article aims to review the current practice of recurrence prevention and intervention of adolescent depressive disorder in Thailand. In particular, we assess the Clinical Practice Guideline of Major Depressive Disorder for General Practitioners (CPG-MDD-GP) for Thailand, which is now the official guideline for all depressive patients who are children, adolescents, and adults in Thailand. Although this current Thai clinical guideline was developed and derived from the National Institute for Health and Care Excellence (NICE) of the United Kingdom and the recommendations and the practice parameters of the American Academy of Child and Adolescent Psychiatry (AACAP), it differs from these guidelines in a number of ways. Specifically, the main tool for the primary assessment of the Thai CPG-MDD-GP is called 9Q which categorizes the severity and follow-up of depressive symptoms by health care providers in a hospital setting, whereas the NICE guideline for depression in children and adolescents is based mainly on the community setting, and the AACAP parameter assesses patients by a direct interview method. Additionally, the Thai CPG-MDD-GP has no premise intervention for recurrence prevention of depression and lacks details regarding the importance of treatment engagement by family and community.
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Gärtner, Fania R., Johanneke E. Portielje, Miranda Langendam, Desiree Hairwassers, Thomas Agoritsas, Brigitte Gijsen, Gerrit-Jan Liefers, Arwen H. Pieterse, and Anne M. Stiggelbout. "Role of patient preferences in clinical practice guidelines: a multiple methods study using guidelines from oncology as a case." BMJ Open 9, no. 12 (December 2019): e032483. http://dx.doi.org/10.1136/bmjopen-2019-032483.
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ObjectiveMany treatment decisions are preference-sensitive and call for shared decision-making, notably when benefits are limited or uncertain, and harms impact quality of life. We explored if clinical practice guidelines (CPGs) acknowledge preference-sensitive decisions in how they motivate and phrase their recommendations.DesignWe performed a qualitative analysis of the content of CPGs and verified the results in semistructured interviews with CPG panel members.SettingDutch oncology CPGs issued in 2010 or later, concerning primary treatment with curative intent.Participants14 CPG panel members.Main outcomesFor treatment recommendations from six CPG modules, two researchers extracted the following: strength of recommendation in terms of the Grading of Recommendations Assessment, Development and Evaluation and its consistency with the CPG text; completeness of presentation of benefits and harms; incorporation of patient preferences; statements on the panel’s benefits–harm trade-off underlying recommendation; and advice on patient involvement in decision-making.ResultsWe identified 32 recommendations, 18 were acknowledged preference-sensitive decisions. Three of 14 strong recommendations should have been weak based on the module text. The reporting of benefits and harms, and their probabilities, was sufficiently complete and clear to inform the strength of the recommendation in one of the six modules only. Numerical probabilities were seldom presented. None of the modules presented information on patient preferences. CPG panel’s preferences were not made explicit, but appeared to have impacted 15 of 32 recommendations. Advice to involve patients and their preferences in decision-making was given for 20 recommendations (14 weak). Interviewees confirmed these findings. Explanations for lack of information were, for example, that clinicians know the information and that CPGs must be short. Explanations for trade-offs made were cultural-historical preferences, compliance with daily care, presumed role of CPGs and lack of time.ConclusionsThe motivation and phrasing of CPG recommendations do not stimulate choice awareness and a neutral presentation of options, thus hindering shared decision-making.
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Elit, L. M., M. Johnston, M. Brouwers, M. Fung- Kee-Fung, G. Browman, and I. D. Graham. "Promoting Best Gynecologic Oncology Practice: A Role For The Society of Gynecologic Oncologists of Canada." Current Oncology 13, no. 3 (June 1, 2006): 94–98. http://dx.doi.org/10.3390/curroncol13030009.
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During March 30–April 1, 2005, the Society of Gynecologic Oncologists of Canada (GOC) and the Canadian Strategy for Cancer Control (CSCC) Clinical Practice Guidelines Action Group (CPG-AG) met to • determine how GOC would like to influence practice in the care of women with gynecologic cancer. • explore a collaborative model for developing and implementing evidence-based practice guidelines. • investigate the utility of the CPG evaluation and adaptation cycle as a tool for selecting, adapting, and adopting guidelines. At the workshop meeting, 21 members of the GOC and the CPG-AG heard presentations from various Canadian guideline initiatives. As an example of adaptation and adoption processes, the AGREE (Appraisal of Guidelines for Research and Evaluation) tool was applied to guidelines in recurrent ovarian cancer, and the group explored their opportunity to use knowledge translation to influence the care of women with gynecologic cancer. The themes influencing practice are consistent with GOC’s mandate. The future is expected to involve partnering with other groups to maximize scarce resources. Resources should be directed to facilitating implementation of existing guidelines rather than to developing new documents. The full spectrum of cancer care includes prevention, screening, diagnosis, primary treatment, follow-up, treatment of recurrent disease, and palliation. High-quality evidence is available in some areas, but gaps exist where guideline panels could provide guidance. Development of a pan-Canadian gynecologic oncology process could provide an opportunity to influence access to care at the political and policy levels. The GOC will develop linkages such that the toolbox available through CSCC-CPG-AG can be incorporated into future collaboration.
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Oliveira, Margarida, Sergio Palacios-Fernandez, Ricard Cervera, and Gerard Espinosa. "Clinical practice guidelines and recommendations for the management of patients with systemic lupus erythematosus: a critical comparison." Rheumatology 59, no. 12 (May 6, 2020): 3690–99. http://dx.doi.org/10.1093/rheumatology/keaa142.
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Abstract Objective SLE has a great clinical heterogeneity and low prevalence, thus making the development of recommendations or clinical practice guidelines (CPG) based on high-quality evidence difficult. In the last few years, several CPG appeared addressing the management of the disease. The aim of this review is to critically compare the recommendations made in the most recent CPG and to analyse and compare their methodological quality. Methods The Appraisal of Guidelines for Research and Evaluation (AGREE) II tool was used to compare the methodological quality of each of the CPG. Results Most CPG agreed in the general management and first-line treatment recommendations where there is higher quality evidence and disagreed in refractory disease treatment where there is lack of quality evidence. Also, the CPG are agreed in whether a patient should be treated regarding the most severe clinical manifestation or taking into account the treatment that best serves all clinical manifestations. The majority of the appraised CPG scored high-quality ratings, especially for scope and purpose and clarity of presentation, while they were of less quality when assessing applicability of each CPG. Conclusion CPG should aid, but not replace, the health professional’s clinical judgment in daily clinical patient management.
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Légaré, France, Antoine Boivin, Trudy van der Weijden, Christine Pakenham, Jako Burgers, Jean Légaré, Sylvie St-Jacques, and Susie Gagnon. "Patient and Public Involvement in Clinical Practice Guidelines." Medical Decision Making 31, no. 6 (September 29, 2011): E45—E74. http://dx.doi.org/10.1177/0272989x11424401.
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Background. The role of patient and public involvement programs (PPIPs) in developing and implementing clinical practice guidelines (CPGs) has generated great interest. Purpose. The authors sought to identify key components of PPIPs used in developing and implementing CPGs. Data sources. The authors searched bibliographic databases and contacted relevant organizations. Study selection. In total, 2161 articles and reports were retrieved on PPIPs in the development and implementation of CPGs. Of these, 71 qualified for inclusion in the review. Data extraction. Reviewers independently extracted data on key components of PPIPs and barriers and facilitators to their operation. Data synthesis. Over half of the studies were published after 2002, and more than half originated from the United States, the United Kingdom, Australia, and Germany. CPGs that involved patients and the public addressed a variety of health problems, especially mental health and cancer. The most frequently cited objective for using PPIPs in developing CPGs was to incorporate patients’ values or perspectives in CPG recommendations. Patients and their families and caregivers were the parties most often involved. Methods used to recruit PPIP participants included soliciting through patient/public organizations, sending invitations, and receiving referrals and recruits from clinicians. Patients and the public most often participated by taking part in a CPG working group, workshop, meeting, seminar, literature review, or consultation such as a focus group, individual interview, or survey. Patients and the public principally helped formulate recommendations and revise drafts. Limitations. The authors did not contact the authors of the studies. Conclusion. This literature review provides an extensive knowledge base for making PPIPs more effective when developing and implementing CPGs. More research is needed to assess the impact of PPIPs and resources they require.
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McCartney, Christopher R., and Clifford J. Rosen. "Conflicts of Interest in Clinical Practice Guidelines: Accelerating an Evolution. An Endocrine Society Consensus Statement*." Journal of Clinical Endocrinology & Metabolism 103, no. 12 (October 19, 2018): 4339–42. http://dx.doi.org/10.1210/jc.2018-01878.
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Abstract An analysis of the Endocrine Society’s clinical practice guidelines (CPGs) published from 2010 to 2017—presented by Irwig et al. in the current issue of The Journal of Endocrinology and Metabolism—suggested that the Endocrine Society met five of seven National Academy of Medicine (NAM) standards concerning financial conflicts of interest in CPGs. As current contributors to the Endocrine Society’s CPG efforts, we offer additional context related to the 2011 NAM standards and the current environment concerning industry support in medicine, and we comment on the nature of industry support received by the Society’s CPG authors according to Irwig and colleagues’ analysis of the Centers for Medicare and Medicaid Services’ Open Payments database. Perhaps most importantly, we outline the Society’s recent and ongoing efforts to enhance the value of its CPGs. Such efforts include a 2016 revision of CPG author conflict of interest rules—a change that was invisible to the investigatory methods used by Irwig et al.—in addition to other processes designed to enhance CPG objectivity. We conclude our commentary by recognizing that good-faith attempts to enhance transparency and to reduce conflicts of interest (real or apparent) in CPGs will ultimately serve the best interests of patients and providers; we confirm the Endocrine Society’s resolute commitment to providing high-quality, evidence-based clinical guidance via a CPG development process that faithfully accords with current CPG best practices.
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Brems, J. Henry, Andrea E. Davis, and Ellen Wright Clayton. "Analysis of conflict of interest policies among organizations producing clinical practice guidelines." PLOS ONE 16, no. 4 (April 30, 2021): e0249267. http://dx.doi.org/10.1371/journal.pone.0249267.
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Background Conflicts of interest (COI) jeopardize the validity of Clinical Practice Guidelines (CPGs). When the Institute of Medicine promulgated COI policies in 2011, few organizations met these requirements, but it is unknown if organizations have improved their policies since that time. We sought to evaluate current adherence to IOM standards of COI policies. Methods and findings We conducted a retrospective document review of COI policies and CPGs from organizations that published five or more CPGs between January 1, 2018 and December 31, 2019. Organizations were identified via CPG databases. COI policies were obtained from an internet search. We collected data on i) the number of organizations that have COI policies specific to CPG development, ii) the number of policies meeting each IOM standard and iii) the number of IOM standards met by each policy. COI disclosures from five CPGs of each organization were assessed for adherence to IOM standards. Among the 46 organizations that published 5 or more CPGs, 36 (78%) had a COI policy. Standard 2.2b (requiring divestment of financial COI) was met least frequently, by 2 of 36 (6%) organizations. Standard 2.1 (requiring disclosure of COI) was met most frequently, by 33 of 36 (92%) organizations. A total of 31 of 36 (86%) organizations met 4 or fewer of the 7 IOM standards. Among the 16 organizations limiting COI to a minority of the CPG panel (standard 2.4c) and the 15 organizations prohibiting COI among chairs or co-chairs (standard 2.4d), 12 (75%) and 10 (67%) organizations violated the respective standard in at least one CPG. The main limitations of our study are the exclusion of organizations producing fewer CPGs and ability to assess only publicly available policies. Conclusion Among organizations producing CPGs, COI policies frequently do not meet IOM standards, and organizations often violate their own policies. These shortcomings may undermine the public trust in and thus the utility of CPGs. CPG-producing organizations should improve their COI policies and their strategies to manage COI to increase the trustworthiness of CPGs.
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Ciocson, Maria Ana Flor Rasonabe, Maranda G. Hernandez, Mohammad Atallah, and Yasser S. Amer. "Central Vascular Access Device: An Adapted Evidence-Based Clinical Practice Guideline." Journal of the Association for Vascular Access 19, no. 4 (December 1, 2014): 221–37. http://dx.doi.org/10.1016/j.java.2014.09.002.
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Abstract Background: Our aim was to adapt recommendations from high-quality, evidence-based clinical practice guidelines (CPGs) for central vascular access device (CVAD) insertion, management, and removal in King Saud University Medical City. Currently, the hospital has a policy and procedure for CVAD insertion; however, the methodology of creating the policy document was not evidence-based, and the clinical content was not up to date. A new CPG will guide the revision of CVAD policies and procedures and eliminate variation in clinician practices. Methods: The King Saud University Medical City CPG Committee introduced the modified ADAPTE process methodology for adaptation and implementation of CPGs originally developed by the ADAPTE Collaboration. Results: The final decision of the panel after full assessment of 2 selected source CPGs was to adopt all Centers for Disease Control and Prevention CPG recommendations and some essential sections from the Infusion Nurses Society CPG recommendations. In addition, the team developed new implementation tools. Conclusions: The ADAPTE process is an excellent scientific and rigorous process for CPG adaptation and clinical performance improvement. It can be further adapted according to the local context and resources to promote a sense of ownership of the adapted CPG. Furthermore, new CPGs will have a positive effect on hospital-wide accreditation processes and local benchmarking of health care quality outcomes.
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Hussain, Musarrat, Jamil Hussain, Taqdir Ali, Syed Imran Ali, Hafiz Syed Muhammad Bilal, Sungyoung Lee, and Taechoong Chung. "Text Classification in Clinical Practice Guidelines Using Machine-Learning Assisted Pattern-Based Approach." Applied Sciences 11, no. 8 (April 7, 2021): 3296. http://dx.doi.org/10.3390/app11083296.
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Clinical Practice Guidelines (CPGs) aim to optimize patient care by assisting physicians during the decision-making process. However, guideline adherence is highly affected by its unstructured format and aggregation of background information with disease-specific information. The objective of our study is to extract disease-specific information from CPG for enhancing its adherence ratio. In this research, we propose a semi-automatic mechanism for extracting disease-specific information from CPGs using pattern-matching techniques. We apply supervised and unsupervised machine-learning algorithms on CPG to extract a list of salient terms contributing to distinguishing recommendation sentences (RS) from non-recommendation sentences (NRS). Simultaneously, a group of experts also analyzes the same CPG and extract the initial patterns “Heuristic Patterns” using a group decision-making method, nominal group technique (NGT). We provide the list of salient terms to the experts and ask them to refine their extracted patterns. The experts refine patterns considering the provided salient terms. The extracted heuristic patterns depend on specific terms and suffer from the specialization problem due to synonymy and polysemy. Therefore, we generalize the heuristic patterns to part-of-speech (POS) patterns and unified medical language system (UMLS) patterns, which make the proposed method generalize for all types of CPGs. We evaluated the initial extracted patterns on asthma, rhinosinusitis, and hypertension guidelines with the accuracy of 76.92%, 84.63%, and 89.16%, respectively. The accuracy increased to 78.89%, 85.32%, and 92.07% with refined machine-learning assistive patterns, respectively. Our system assists physicians by locating disease-specific information in the CPGs, which enhances the physicians’ performance and reduces CPG processing time. Additionally, it is beneficial in CPGs content annotation.
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Jones, Jordan, Aditya Pradhan, Morgan E. Pizzuti, Christopher M. Bland, and P. Brandon Bookstaver. "Is Three Company or a Crowd? Comparing and Contrasting U.S. and European Clostridioidesdifficile Clinical Practice Guidelines." Antibiotics 11, no. 9 (September 14, 2022): 1247. http://dx.doi.org/10.3390/antibiotics11091247.
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In 2021, the American College of Gastroenterology (ACG), the Infectious Diseases Society of America in conjunction with the Society for Healthcare Epidemiology of America (IDSA/SHEA), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) published updated clinical practice guidelines (CPGs) for the management of Clostridioides difficile infections. The differences, sometimes subtle, between these guideline recommendations have caused some debate among clinicians. This paper delves into select key recommendations from each respective CPG and analyzes the differences and evidence associated with each. One primary difference between the CPGs is the preference given to fidaxomicin over vancomycin for initial treatment in non-severe and severe disease endorsed by IDSA/SHEA and ESCMID guidelines, while the ACG-sponsored CPGs do not offer a preference. The emphasis on cost effective data was also a noticeable difference between the CPGs and thus interpretation of the available evidence. When using guidelines to help support local practice or institutional treatment pathways, clinicians should carefully balance CPG recommendations with local patient populations and feasibility of implementation, especially when multiple guidelines for the same disease state exist.
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Gholami, R., N. Gimpaya, R. Khan, M. A. Scaffidi, R. Bansal, A. Ramkissoon, A. Alabdulqader, and S. C. Grover. "A71 RECOMMENDATION REVERSALS IN GASTROENTEROLOGY CLINICAL PRACTICE GUIDELINES." Journal of the Canadian Association of Gastroenterology 4, Supplement_1 (March 1, 2021): 34–37. http://dx.doi.org/10.1093/jcag/gwab002.069.
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Abstract Background Clinical practice guidelines are evidence-based resources designed to inform clinical decision making. Often, superior evidence will support the inclusion of novel procedures and practices to replace older recommendations. Recommendation reversals occur when (a) superior quality evidence emerges to suggest the harm or non-beneficence of prior recommendations, and (b) that recommendation is not supplanted by a newer one. Aims The primary objective of this study was to describe the content, frequency and rationale for recommendation reversals in CPGs published by gastroenterological societies. Methods For this meta-epidemiologic study, we considered two criteria to define a recommendation reversal: (a) the more recent CPG makes a recommendation that contradicts a previously accepted practice; and (b) the prior recommendation is not replaced by any novel intervention. We searched CPGs published by 20 major GI societies from 1991- 2019. Guidelines were included if had at least two iterations with the same title and used a valid evidence rating system (such as GRADE). Explicit recommendations which reported definite levels of evidence and strength of recommendation were extracted. Results We identified 1022 clinical guidelines from GI societies over 28 years. 292 CPGs were included for data synthesis. 5985 explicit statements were extracted. 12 reversals were confirmed and are summarized in the Table. Six reversals (50.0%) occurred due to studies reporting non-beneficence and 3 (25.0%) occrred due to studies reporting harm. Three recommendations (25.0%) were reversed due to new clinical trials; 3 (25.0%) due to systematic reviews or meta-analyses; and 2 to conform with CPGs of other societies (16.7%). Conclusions We describe recommendation reversals made in gastroenterology CPGs, and the reasons thereof. Investigation of recommendation reversals allows for the identification of low-value medical practices. This reinforces the need for GI CPG committees to (1) iteratively review guidelines to re-evaluate recommendations made on low-quality evidence and; (2) refrain from making recommendations when evidence for the same is weak. Funding Agencies None
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Hopwood, M. "Update and Revision of the RANZCP Clinical Practice Guidelines for Mood Disorders." European Psychiatry 41, S1 (April 2017): S138. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1966.
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In 2015, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) published its new Clinical Practice Guidelines (CPGs) for Mood Disorders. The Mood Disorder CPG focuses on ‘real world’ clinical management of depressive and bipolar disorders, addressing mood disorders as a whole to recognise the overlap between distinct diagnoses and changes in diagnoses along the mood disorder spectrum. This presentation will provide an overview of the process and methodology used in the development of the guidelines, as well as the key principles established in the new CPG for the assessment and management of depressive and bipolar disorders.Disclosure of interestThe author has not supplied his/her declaration of competing interest.
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Brushwood, David B. "Liability Implications of Innovative Drug Therapy: The Significance of Clinical Guidelines in Establishing the Legal Standard of Care." Journal of Pharmacy Practice 15, no. 3 (June 2002): 279–89. http://dx.doi.org/10.1106/vexn-y15m-ru3u.
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The use of the clinical practice guideline (CPG) has become widespread in contemporary health care. For some health care providers, there may be a perceived “safe haven” from liability for strict compliance with a relevant CPG. Pointing to an objective standard, such as a CPG, the health care provider may feel secure in defending care that was provided to a patient, when called to account for a bad outcome. The benefit of any CPG is that it standardizes practice at an acceptably high level. The complimentary risk of a CPG is that it may stifle innovation based on newly discovered or newly appreciated data that were not considered when the CPG was developed. The trend in malpractice law is to recognize a CPG as relevant to the applicable standard of care, but not to equate a CPG with the standard of care. In fact, an outdated CPG may fail to reflect the standard of care, if new scientific or medical knowledge has been validated. The health care provider who adheres to an outdated CPG is at greater risk of liability than the health care provider who spurns the outdated CPG in favor of innovative practice based on valid new information. Innovation, as opposed to experimentation, is recognized as a necessary component of competent health care. The health care provider who adheres to outdated traditional medicine, spurning new developments validated by evidence, has clearly expanded exposure to liability.
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Reames, Bradley Norman, Robert Wallace Krell, Sarah Nicks Ponto, and Sandra L. Wong. "A critical evaluation of oncology clinical practice guidelines." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 6020. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.6020.
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6020 Background: Clinical Practice Guidelines (CPGs) play an essential role in cancer care today, but there are significant concerns regarding their content and reliability. In 2011, the Institute of Medicine (IOM) report “Clinical Practice Guidelines We Can Trust” created standards for developing trustworthy CPGs. Using these standards as a benchmark, we sought to evaluate recent oncology guidelines. Methods: CPGs and consensus statements addressing the screening, evaluation or management of the four leading causes of cancer-related mortality in the US (non-small cell lung, breast, prostate and colorectal cancers) published between January 2005 and December 2010 were identified using MEDLINE. A standardized scoring system based on the eight standards set forth by the IOM was devised, and the methodology, content and disclosure policies of CPGs were critically evaluated by four independent reviewers. All CPGs were given two scores; points were awarded out of a possible 8 major criteria and 20 sub-criteria. Results: We identified 168 CPGs for inclusion in the study; 45% were from US groups. None of the CPGs fully met all the IOM standards. On average, CPGs only met 2.8 of 8 standards set forth by the IOM (mean 2.8 points out of 8, SD 1.7; 8.3 out of 20, SD 4.3). Less than half of CPGs were based on a systematic review. Only half of CPG panels addressed conflicts of interest. Overall, the CPGs were most consistent with IOM standards for transparency regarding the development process, articulation of recommendations, and use of external review. Most did not comply with standards for inclusion of patient and public involvement in the development or review process, nor did they specify their process for updating. CPGs from the US had higher overall scores than CPGs from international groups. CPGs addressing non-small cell lung cancer had higher overall scores (mean 3.9) than those for other cancers. Conclusions: The vast majority of oncology CPGs fails to meet the IOM standards for trustworthy guidelines. Notably, most CPGs are not based on systematic reviews, lack full disclosure, and do not include all relevant stakeholders in the guideline process. This highlights the need for improved CPG development processes.
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Hagerty, C. G., and F. A. Sonnenberg. "Computer-Interpretable Clinical Practice Guidelines." Yearbook of Medical Informatics 15, no. 01 (August 2006): 145–58. http://dx.doi.org/10.1055/s-0038-1638486.
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SummaryTo provide a comprehensive overview of computerinterpretable guideline (CIG) systems aimed at non-experts. The overview includes the history of efforts to develop CIGs, features of and relationships among current major CIG systems, current status of standards developments pertinent to CIGs and identification of unsolved problems and needs for future researchLiterature re view based on PubMed, AMIA conference proceedings and key references from publications identified. Search terms included practice guidelines, decision support, controlled vocabulary and medical record systems. Papers were reviewed by both authors and summarized narratively.There is a consensus that guideline delivery systems must be integrated with electronic health records (EHRs) to be most effective. Several evolving CIG formalisms have in common, use of a task network model. There is currently no dominant CIG system. The major challenge in development of interoperable CIGs, is agreement on a standard controlled vocabulary. Such standards are under development, but not widely used, particularly in commercial EHR systems. The Virtual Medical Record (VMR) concept has been proposed as a standard that would serve as an intermediary between guideline vocabulary and that used in EHR implementation.CIG systems are in a state of evolution. Standards efforts promise to improve interoperability without compromising innovation. The VMR concept can assist guideline development even before clinical systems routinely adhere to standards. Frontiers for future work include using the principles learned by computer implementation of guidelines to improve the guideline development process and evaluation methods that isolate the effects of specific CIG features.
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Desai, Aakash, Madhuri Chengappa, Ronald S. Go, and Thejaswi Poonacha. "Financial conflicts of interest among the National Comprehensive Cancer Network (NCCN) Clinical Practice Guideline (CPG) Panelists in 2019." Journal of Clinical Oncology 37, no. 27_suppl (September 20, 2019): 15. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.15.
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15 Background: CPG are evidence-based guidelines, which serve as a standard of care in practice, quality improvement, and reimbursement. The extent of financial conflicts of Interest (FCOI) in NCCN guidelines has not been recently evaluated. Our study evaluated the extent of FCOI in the NCCN CPG among the 10 most common malignancies in the US. Methods: We examined the latest 2019 version of the NCCN CPG for the 10 most common cancers by incidence in the US. Using disclosure lists, we catalogued the FCOIs for the panelists under various categories outlined in the CPG. We also tabulated the companies/institutions involved in each disclosure. An “episode” describes 1 instance of participation of a panelist in 1 company in 1 category of each guideline. “Affiliation” describes a commercial, industry, or institute affiliation reported by a panelist in each episode. Results: Of the 491 panelists on the CPG, 483 (98.3%) completed FCOI disclosures. 224 (46.38%) reported at least 1 FCOI. A total of 1,103 episodes were disclosed with an average of 4.9 episodes per panelist with FCOI. Being a part of scientific advisory boards, consultant, or expert witness was the most common FCOI category (19.9%). A total of 191 companies were associated with 1,103 episodes of FCOI. The top companies were Bristol Myers Squibb, Merck, Genentech and AstraZeneca. Among the top 10 cancers, the prevalence of FCOI were lung (56%), bladder (52%), pancreatic (52%), non-Hodgkin lymphoma (50%), kidney (49%), colorectal (43%), breast (42%), melanoma (40%), prostate (38%), and uterine (32%). Among the panelists with FCOI, 26%, 17%, and 57% reported 1, 2, and > 3 episodes, respectively. There were 127 episodes among the CPG chairs/vice chairs who reported FCOI (mean 6.4). The chairs/vice chairs of uterine, pancreatic, melanoma, and prostate cancer CPG did not have any FCOI. Conclusions: FCOI are very prevalent among the top 10 NCCN CPG panelists. In almost half of the CPG, the majority of the panelists had at least 1 FCOI. Over half of the CPG chairs/vice chairs reported multiple FCOI. Further studies are necessary to determine the impact of these FCOI.
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Tan, Kia Hau Matthew, Safa Salim, Matthew Machin, Aurélien Geroult, Sarah Onida, Tristan Lane, and A. H. Davies. "Abdominal aortic aneurysm clinical practice guidelines: a methodological assessment using the AGREE II instrument." BMJ Open 12, no. 1 (January 2022): e056750. http://dx.doi.org/10.1136/bmjopen-2021-056750.
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ObjectivesAbdominal aortic aneurysm (AAA) clinical practice guidelines (CPGs) provide evidence-based information on patient management; however, methodological differences exist in the development of CPGs. This study examines the methodological quality of AAA CPGs using a validated assessment tool.MethodsMedline, EMBASE and online CPG databases were searched from 1946 to 31 October 2021. Full-text, English language, evidence-based AAA CPGs were included. Consensus-based CPGs, summaries of CPGs or CPGs which were only available on purchase were excluded. Five reviewers assessed their quality using the Appraisal of Guidelines for Research and Evaluation II instrument. An overall guideline assessment scaled score of ≥80% was considered as the threshold to recommend CPG use in clinical practice.ResultsSeven CPGs were identified. Scores showed good inter-reviewer reliability (intraclass correlation coefficient 0.943, 95% CI 0.915 to 0.964). On average, CPGs performed adequately with mean scaled scores of over 50% in all domains. However, between CPGs, significant methodological heterogeneity was observed in all domains. Four CPGs scored ≥80% (European Society of Cardiology, the Society of Vascular Surgery, the European Society of Vascular Surgery and the National Institute of Health and Care Excellence), supporting their use in clinical practice.ConclusionsFour CPGs were considered of adequate methodological quality to recommend their use in clinical practice; nonetheless, these still showed areas for improvement, potentially through performing economic analysis and trial application of recommendations. A structured approach employing validated CPG creation tools should be used to improve rigour of AAA CPGs. Future work should also evaluate recommendation accuracy using validated appraisal tools.
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Teckie, Sewit, Lucille Lee, Henry Chou, Petrina Zuvic, and Louis Potters. "Implementation of clinical practice guidelines in a multicenter radiation oncology department." Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 117. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.117.
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117 Background: Recent reports suggest that less than 20% of cancer care is based upon level I evidence. As a result, the majority of cancer care tends to be ad-hoc. Furthermore, deviations from established standards-of-care are associated with worse clinical outcomes. Systematic and evidence-based approaches to cancer care are widely regarded as an effective way of improving quality and value in oncology, yet their implementation remains broadly circumspect. In our multicenter radiation medicine department, we developed clinical practice guidelines (CPGs) that encourage consistent care in order to minimize variations in patient treatment, outcome, and experience. We hypothesized that CPGs would also improve efficiency, performance, and cost. Methods: We developed a system for prioritizing value in radiation oncology (Smarter Radiation Oncology) comprising three pillars – quality, evidence-based care, and patient experience. We created 87 unique, evidence-based and consensus-driven electronic CPGs that apply to the majority of patients undergoing radiation therapy in our department. Each CPG delineates an evidence-based treatment approach for a specific cancer site and stage, as well as many technical components such as simulation, treatment planning, quality assurance, clinical care requirements and survivorship. Results: Overall compliance to CPGs was >88%. Six-sigma Z-scores indicated improvement in efficiency and compliance. Treatment delays decreased and patients reported more favorable ratings on a variety of measures, including likelihood to recommend, wait times, understanding of treatment, and physician sensitivity. For breast and prostate cancer, adherence to CPG treatment resulted in 20% and 15% average lower costs than standard, non-CPG treatment. Conclusions: We demonstrate that consensus- and evidence-based CPGs can be successfully implemented in a multicenter department, with high adherence rates. CPGs improve safety and reduce costs by minimizing variation and deviations from standards-of-care. In an era of rising cancer spending, CPGs can be expanded beyond radiation oncology to the entire oncologic care process, thereby improving value for all cancer patients.
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Kovaleva, Maria Yuryevna, and Vlada Konstantinovna Fediaeva. "The Assessment of Potential Benefit and Risk Balance in the Process of Clinical Practice Guidelines Development and Grading the Evidence." Medical Technologies. Assessment and Choice (Медицинские технологии. Оценка и выбор), no. 4 (38) (December 1, 2019): 8–17. http://dx.doi.org/10.31556/2219-0678.2019.38.4.008-017.
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Aim of the study. A review of international practice of “benefit-risk” ratio assessment in the process of clinical practice guidelines (CPG) development; assessment of its acceptability for Russian Federation. Material and methods. We analyzed official methodological guides of the GRADE working group and information from the websites of the professional associations, indicated on the official GRADE website. Additionally, the review of methods of quantitative assessment of risk-benefit ratio was conducted. The search was performed in Pubmed and Embase in April 2019, according to the queries “benefit-risk guidelines”, “balance of benefits and harm”, “risk-benefit guidelines”. Results. The “benefit-risk” ratio assessment is an important component in the development of CPG, however, there were no universal transparent methods for it: in foreign CPG, the “benefit-risk” ratio for medical interventions is determined by the expert group consensus. There were also identified quantitative methods for assessing this ratio, currently not used in the process of the CPG development. Conclusion. We have not identified universal transparent validated quantitative methods for assessing the “benefit-risk” ratio for medical interventions in CPG. Still many quantitative, semi-quantitative and qualitative methods for analyzing this ratio were found in the literature. Thus it seems appropriate to analyze international experience further, to evaluate the advantages and disadvantages of all assessment systems and to test their acceptability for the development of CPG in the Russian Federation.
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Choi, Sukgi, and Lorraine Nnacheta. "Clinical Practice Guidelines: AAO-HNSF Process for CPG Development and Topic Selection." Otolaryngology–Head and Neck Surgery 158, no. 2 (October 24, 2017): 219–21. http://dx.doi.org/10.1177/0194599817738526.
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The American Academy of Otolaryngology–Head and Neck Surgery has been developing clinical practice guidelines (CPGs) for use by its members and the public. The process of CPG development and the selection of topics for CPGs can be confusing. This commentary attempts to clarify this process and delineate the issues that are considered in topic selection.
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Flynn, John P., Jennifer A. Villwock, Alexander G. Chiu, and Kevin J. Sykes. "Appraising Otolaryngology–Head and Neck Surgery Clinical Practice Guidelines for Effective Dissemination and Implementation Design." Otolaryngology–Head and Neck Surgery 163, no. 2 (March 3, 2020): 209–15. http://dx.doi.org/10.1177/0194599820910126.
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Objectives Dissemination and implementation (D&I) science analyzes interventional strategies that aid in spreading scientific knowledge, adopting evidence into practice, and identifying barriers to maximize successful integration of science into practice. This study set out to critically appraise the published D&I strategies of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) Clinical Practice Guidelines (CPGs) and to introduce the theories of D&I science. Methods The 15 AAO-HNSF CPGs underwent appraisal by 2 independent reviewers using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. CPGs were rated over 23 key items in 6 domains. Each item was rated on a 7-point scale from 1 ( strongly disagree) to 7 ( strongly agree). CPGs were rated and quality assessments were performed. Intrarater reliability was assessed. Results The overall mean score of the CPGs was 85.2% (95% confidence interval, 83.4%-86.9%). Individual CPG mean scores ranged from 80.4% to 90.9%. Mean interrater reliability was strong. All domains of the AGREE II instrument, except the Applicability domain, scored a mean of 90.7% or better. D&I strategies within the CPGs, as calculated by the Applicability domain score, ranged from 22.9% to 77.1%. Discussion There is a paucity of published D&I strategies within the AAO-HNSF CPGs. Nesting a D&I framework, such as the Quality Improvement Framework, within CPGs would allow for identification of barriers to CPG adoption and evaluation of CPG-directed interventions. Implications for Practice A D&I framework within the AAO-HNSF CPGs would allow for objective measurement of the overall impact of CPGs on otolaryngology practices.
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Greiner, Benjamin, Ryan Essex, and Denna Wheeler. "An analysis of research quality underlying IDSA clinical practice guidelines: a cross-sectional study." Journal of Osteopathic Medicine 121, no. 3 (January 26, 2021): 319–23. http://dx.doi.org/10.1515/jom-2020-0081.
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Abstract Context As a result of new developments in medicine, the need for evidence-based clinical practice guidelines (CPG) is of utmost importance. However, studies have shown that many medical societies are using low quality research to develop CPGs. Objectives To evaluate the quality of research underlying the CPGs issued by the Infectious Diseases Society of America (IDSA). Methods We examined 29 CPGs issued between January 1, 2012 and December 31, 2019 and classified each by research quality according to levels reported by the CPG authors and previously specified by the IDSA: Levels I through III, corresponding to high, moderate, and low quality of evidence, respectively. Each ranking was cross-checked with a second researcher to improve inter-rater reliability. To analyze evolution of research quality over time, three updated CPGs were randomly selected and compared to their original versions. Chi-square analysis was then performed to determine statistical significance. Results We evaluated the quality of research for 2,920 recommendations within the 29 CPGs that met our criteria and found that 418 (14%) were developed using high-quality (Level I) research from randomized, controlled trials. Of the remaining recommendations, 928 (32%) were based on moderate quality research (observational studies) and 1574 (54%) on low quality research (expert opinion). A Pearson chi-squared analysis indicated no-statistically significant difference between original guidelines or their subsequent updates for Clostridium difficile (χ2=0.323; n=85; degrees of freedom [df]=2; p=0.851), candidiasis (χ2=4.133; n=195; df=2; p=0.127), or coccidiomycosis (χ2=0.531; n=95; df=1; p=0.466). Conclusions The proportion of high-quality research underlying guideline recommendations is remarkably low, indicating that moderate and low quality evidence is still influencing infectious disease guidelines despite IDSA standards. Moreover, the quality of research has not significantly changed over time. IDSA CPGs are a formidable source of information for clinicians, but an increased number of quality studies should be utilized to further guide CPG development.
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Diaz del Campo, Petra, Javier Gracia, Raquel Luengo, Beatriz Nieto, and Juan Antonio Blasco. "S74– Patient perspectives in clinical practice guideline (CPG)." Otolaryngology–Head and Neck Surgery 143, no. 1_suppl (July 2010): 50–51. http://dx.doi.org/10.1016/j.otohns.2010.04.196.
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Romero, Jose Antonio Vinagre, and Carmen De Pablos Heredero. "The Strategic Impact of Clinical Practice Guidelines in Nursing on the Managerial Function of Supervision." Revista da Escola de Enfermagem da USP 47, no. 5 (October 2013): 1233–38. http://dx.doi.org/10.1590/s0080-623420130000500031.
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Clinical practice guidelines in nursing (CPG-N) are tools that allow the necessary knowledge that frequently remains specialist-internalised to be made explicit. These tools are a complement to risk adjustment systems (RAS), reinforcing their effectiveness and permitting a rationalisation of healthcare costs. This theoretical study defends the importance of building and using CPG-Ns as instruments to support the figure of the nursing supervisor in order to optimise the implementation of R&D and hospital quality strategies, enabling clinical excellence in nursing processes and cost-efficient reallocation of economic resources through their linear integration with SARs.
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Rech, Matheus Machado, Yan De Assunção Bicca, Miguel Bertelli Ramos, Murillo Cesar Gionedis, Arthur Aguzzoli, and Asdrubal Falavigna. "Knowledge, attitudes, and behaviors regarding the use of clinical practice guidelines among spine surgeons in Latin America." Surgical Neurology International 13 (April 15, 2022): 144. http://dx.doi.org/10.25259/sni_220_2022.
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Background: Clinical Practice Guidelines (CPGs) are invaluable tools to assure evidence-based spine surgery care. In this study, we aimed to identify perceptions, barriers, and potential determinants for the use of CPG among Latin American spine surgeons. Methods: A 28-item questionnaire regarding the use of CPGs was sent to the members of AO Spine Latin America. The questionnaire was subdivided into three sections: (1) demographic data; (2) perceptions and awareness of CPGs; (3) and potential barriers to CPG use. Multivariate logistic regression was performed to assess potential associations with CPG use. Results: A total of 304 spine surgeons answered the questionnaire. Most of the participants were male (91.8%) and orthopedic spine surgeons (52.3%) who averaged 45–65 years of age. Most respondents were aware of some CPGs for spine care (68.8%) and reported using them (70.4%); lack of awareness about CPGs was the most frequent barrier to their use (65.1%). Conclusion: Awareness of CPGs in spine surgery is of paramount importance for their use. Educational programs explaining the importance and benefits of spine care CPG surgical and clinical practice would increase the adherence of physicians to the guidelines.
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Bryant, Elizabeth Ann, Anna Mae Scott, and Rae Thomas. "Patient and public involvement in the development of clinical practice guidelines: a scoping review protocol." BMJ Open 10, no. 10 (October 2020): e037327. http://dx.doi.org/10.1136/bmjopen-2020-037327.
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IntroductionClinical practice guidelines (CPGs) are intended to optimise patient care by recommending care pathways based on the best available research evidence and practice experience. Patient and public involvement (PPI) in healthcare is recommended based on the expectation that it will improve the quality and relevance of outcomes. There is no consensus on what constitutes meaningful and effective PPI in CPG. We will conduct a scoping review to identify and synthesise knowledge in four key areas: who have been the patients and public previously involved in CPG development, how were they recruited, at what stage in the CPG process were they involved and how were they involved. This knowledge will inform a general model of PPI in CPG to inform CPGs development.Methods and analysisWe will conduct a scoping review using the Methodology for Scoping Reviews refined by the Joanna Briggs Institute. Searches will be conducted in electronic databases (PubMed, Embase, CINAHL and PsycINFO). National standards for developing CPGs from Australia, UK, Canada and the USA will also be identified. A forward and backward citation search will be conducted on the included studies and national standards. Abstracts and full-text studies will be independently screened by two researchers. Extracted data will include study details, type of clinical guideline and the four key areas, which patients and public were involved, how were they recruited, at what stage were they included and how they were involved. Data will be narratively synthesised.Ethics and disseminationAs a scoping review, this study does not require ethics approval. We intend to disseminate the results through publication in a peer-reviewed journal and conference presentations. Furthermore, we will use the findings from our scoping review to inform future research to fill key evidence gaps identified by this review.