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Background
Healthcare decision makers face challenges when using guidelines, including understanding the quality of the evidence or the values and preferences upon which recommendations are made, which are often not clear.
Methods
GRADE is a systematic approach towards assessing the quality of evidence and the strength of recommendations in health...
Context in source publication
Citations
... We obtained ethical and data privacy approvals in all countries and legal contracts regulating data sharing were signed by all centres. Informed by previous research and innovation projects within digital health [21,[32][33][34][35][36], we applied a user centred design, in an iterative development process (figure 1). We adhered to the Standards for Reporting Qualitative Research (SRQR) [37]. ...
... Primary Care/services (PC), Secondary Care/services (SC), Child Welfare (CW), Schools (S) and Kindergarten (KG). ERIC expert recommendations for implementing change (Powell et al., 2015), CFIR consolidated framework for implementation research (Damschroder et al., 2009), LoU levels-of-use (Hall et al., 2006), AIF active implementation framework (Fixsen & Blase, 2020), EtD evidence-to-decision (Treweek et al., 2013), KTA knowledge-to-action (Graham & Tetroe, 2010), NPT normalization process theory ( Content courtesy of Springer Nature, terms of use apply. Rights reserved. ...
The third annual conference of the Norwegian Network for Implementation Research (NIMP) was held on November 28th, 2022, in Oslo, Norway. This event drew 98 participants from diverse sectors and disciplines such as health care, welfare, education, and government, with increased interest from non-research practitioners and policymakers (32% of attendees) compared to prior NIMP conferences. The conference featured a keynote presentation from Professor Per Nilsen, two plenary presentations, eleven parallel session presentations, and five poster presentations. The majority of presentations focused on applied implementation research (72%). However, 28% were from non-research implementation practice and policy work, indicating an increased awareness and use of implementation science outside of academia. The presentations were focused on implementation determinants and strategies, the use of theories, models, and frameworks, and research-to-practice partnerships. The conference saw limited rigorous evaluation of implementation, and more robust evaluation methods with strong measures of implementation outcomes may be needed to enhance implementation evidence in Norway. To sustain engagement in the conference, NIMP should continue integrating implementation research and practice, and consider interactive cross-professional sessions to foster knowledge exchange and collaboration. The conference’s increasing influence reflects the growing awareness and relevance of implementation science in Norway, and the conference may facilitate beneficial feedback loops between implementation research and practice to advance the science and practice of implementation in Norway.
... Implementation is defined as "the processes or methods, techniques, activities, and resources that support the adoption, integration, and sustainment of evidence-based interventions into usual settings-sample indicators and outcomes include acceptability, adoption, appropriateness, cost, feasibility, penetration and sustainability" (21). Significant progress has been made developing frameworks to build and disseminate evidence that underpins implementation (21,22) User-centered design can contribute greatly to evidence-based practice and driving successful implementation (23). The authors observe that test developers do not engage early enough with stakeholders who play a key role in influencing the implementation process. ...
The purpose of this mixed methods feasibility study was to gain insights into unmet clinical needs, stakeholder preferences and potential barriers and enablers to adoption for planning the implementation of point-of-care testing for earlier detection and guided treatment of chronic obstructive pulmonary disease (COPD) acute exacerbation in the NHS in England. Exacerbations of COPD cause considerable mortality and morbidity. Earlier identification of exacerbations and guided treatment would lead to reduced exacerbation duration, reduced hospitalizations and mortality, improve health-related quality of life, reduce unnecessary treatments (including inappropriate antibiotic prescribing) which could save the NHS over £400 per patient. During the early stages of product design, we took a multi-disciplinary approach to evidence generation, gaining insights from key stakeholders to test the product concept and inform evidence-based implementation planning. Primary data was collected from 11 health care and service professionals involved in the management of acute COPD exacerbations. Overall, participants agreed that by earlier differentiation of acute exacerbation from stable COPD, patients could be started on appropriate treatment. To implement point-of-care testing into clinical practice, evidence is required to demonstrate the accuracy of differentiating between exacerbation etiologies and to provide information on the beneficial impact to the system in terms of optimized management, reduced long-term side effects, admission avoidance, and cost-effectiveness. This research provides an evidence base for future implementation planning of point-of-care testing for earlier detection and guided treatment of COPD acute exacerbation. Moreover, the technology developers can decide whether to refine the product design and value proposition thereby de-risking product development.
... 1) Clinical guidelines are defined as a convenient document that "develops and evaluates the communication strategies to support informed decisions and practice based on evidence" [20] and the consumer makes the final decision in the clinical practice stage. Consequently, developing "ASDfriendly" guidelines will optimize its use. ...
Under the Ministry of Health and Welfare of the Republic of Korea, the National Autism and Developmental Disorder Centers for people with developmental disabilities are gradually expanding. The headquarters of the National Autism and Developmental Disorder Center provides support for education, training, and research, and several centers have been effectively operating since 2020. This study aimed to provide practical recommendations and guidelines for specialists such as clinical psychologists, child psychiatrists, allied professionals, community workers, and related administrators. It was developed as a guideline to promote early diagnosis, provide important information on integrated treatment, and assist people with developmental disabilities in Korea to make the best decisions for their quality of life.
... Feasibility, quality of the evidence, how those affected value the outcomes, and resource use are all considered with equal weight when compared to the expected benefits of the technology (Figure 1). 31,33 The value of the HTA rests on its implementation, and therefore a TISP process that explicitly prioritizes both the feasibility of financing and feasibility of delivery should occur at the beginning of any TISP process, supporting effective policy implementation. ...
Producing a Health Technology Assessment (HTA) is resource intensive, therefore, an explicit process for Topic Identification, Selection, and Prioritization (TISP) can optimize the use of limited resources to those HTA topics of national importance. TISP does not have to be complicated, however, a formalized process facilitates HTA recommendations that better align with local priorities. The comprehensiveness of TISP processes varies according to countries’ needs and to the types of decisions HTA supports. There may be many relevant considerations for TISP, such as the resources available for allocation within the health system, the number of dedicated personnel to complete HTA, and the number of stakeholders and institutions involved in the decision-making process. In countries where HTA-supported decision-making is well-established, the process for TISP is usually formalized. In settings where HTA is emerging, relatively new, or where there may not be the necessary supporting institutional mechanisms, there is limited normative guidance on how to implement TISP. We argue that developing a clear process for TISP is key when institutionalizing HTA. Moreover, insights and experiences from more formalized HTA systems can provide valuable lessons. In this commentary we discuss three institutional aspects that we believe are vital to TISP: 1) Begin topic selection with a clear link to health system feasibility, 2) Ensure legitimacy and impact through transparent TISP processes, and 3) Include the public from the start to embed patient and public engagement throughout HTA.
... The strength of the recommendation is communicated by colour coding, and a header describes the population to which the recommendation applies. A 'user-friendly' multilayer software tool for guideline presentation was issued by DECIDE consortium [74] and is available at http://www.decide-collaboration.eu/ (accessed on 20 March 2023). ...
The increasing attendance of paediatric emergency departments has become a serious health issue. To reduce an elevated burden of medical errors, inevitably caused by a high level of stress exerted on emergency physicians, we propose potential areas for improvement in regular paediatric emergency departments. In an effort to guarantee the demanded quality of care to all incoming patients, the workflow in paediatric emergency departments should be sufficiently optimised. The key component remains to implement one of the validated paediatric triage systems upon the patient’s arrival at the emergency department and fast-tracking patients with a low level of risk according to the triage system. To ensure the patient’s safety, emergency physicians should follow issued guidelines. Cognitive aids, such as well-designed checklists, posters or flow charts, generally improve physicians’ adherence to guidelines and should be available in every paediatric emergency department. To sharpen diagnostic accuracy, the use of ultrasound in a paediatric emergency department, according to ultrasound protocols, should be targeted to answer specific clinical questions. Combining all mentioned improvements might reduce the number of errors linked to overcrowding. The review serves not only as a blueprint for modernising paediatric emergency departments but also as a bin of useful literature which can be suitable in the paediatric emergency field.
... The strength of the recommendation is communicated by use of text and color coding, and a header describes the population for which the recommendation applies. An 'user-friendly' multilayer software tool for guideline presentation was issued by DECIDE consortium [74] and is available on http://www.decide-collaboration.eu/. Rather than preparing new guideline, the local health authorities more often face up to excess of guidelines on the same subject. ...
The increasing attendance of paediatric emergency departments becomes a serious health issue. To reduce an elevated burden of medical errors, inevitably caused by high level of stress exerted on emergency physicians, we propose potential areas for improvement in regular paediatric emergency departments. In effort to guarantee demanded quality of care to all incoming patients, the workflow in paediatric emergency departments should be sufficiently optimized. The key component remains implementing one of the validated paediatric triage systems upon patient's arrival at emergency department and fast-tracking patients with low level of risk according to the triage system. To ensure the patient's safety, emergency physicians should follow issued guidelines. Cognitive aids, such as well-designed checklists, posters or flow charts, generally improve physicians' adherence to guidelines and should be therefore available in every paediatric emergency department. To sharpen diagnostic accuracy, the use of ultrasound in paediatric emergency department, according to ultrasound protocols, should be targeted to answer specific clinical questions. Combining all mentioned improvements might reduce number of errors linked with overcrowding. The review serves not only as a blueprint for modernizing paediatric emergency departments, but also as a bin of useful literature which can be suitable in the paediatric emergency field.
... 45 According to Treweek et al. "guidelines are a convenient way of packaging evidence and presenting recommendations to healthcare decision-makers". 46 However, international guidelines may not reflect local epidemiology, healthcare contents, available treatments or their safe administration, local culture, or capacity to implement care. 47 Apart from organizational barriers to implementing guidelines such as inadequate resources or inappropriate policies, there also exist physician-level barriers like lack of awareness or familiarity, lack of agreement, self-efficacy outcome expectancy, inertia in overcoming previous practice patterns, and external influences. ...
South Asians are estimated to have a 40% increased risk for coronary artery disease as compared to populations from other regions. Nepal, as a South Asian country, should also analyze the burden of coronary artery disease and its risk factors to minimize cardiovascular morbidity and mortality. We reviewed the barriers to cardiovascular care and its services in low- and middle-income countries, including Nepal. The identified barriers included coronary artery disease risk factors, access, cost, adherence to cardiovascular care, awareness, knowledge gaps, and socioeconomic and health system challenges. The possible strategies to reduce coronary artery disease included national, regional, and local perspectives. It also highlighted the involvement of community workers and local leaders, education, patient-centered intervention, easy access to drugs and treatments, rehabilitation and public health measures, innovation within the health care system, and multi-sectoral involvement. This review provides insights into the current situation of coronary artery disease and its possible solutions.
... Decision support is of course far from new in clinical decision-making. For decades, efforts have intensified to systematically consider and operationalize available evidence into clinical practice guidelines (8), hereby "packaging evidence and present recommendations to healthcare decision makers" (9). A novel, distinctive challenge raised by AI-DSS is the proliferation of available data points and the increasing computational complexity of available applications to process them. ...
Introduction
Artificial intelligence–driven decision support systems (AI–DSS) have the potential to help physicians analyze data and facilitate the search for a correct diagnosis or suitable intervention. The potential of such systems is often emphasized. However, implementation in clinical practice deserves continuous attention. This article aims to shed light on the needs and challenges arising from the use of AI-DSS from physicians’ perspectives.
Methods
The basis for this study is a qualitative content analysis of expert interviews with experienced nephrologists after testing an AI-DSS in a straightforward usage scenario.
Results
The results provide insights on the basics of clinical decision-making, expected challenges when using AI-DSS as well as a reflection on the test run.
Discussion
While we can confirm the somewhat expectable demand for better explainability and control, other insights highlight the need to uphold classical strengths of the medical profession when using AI-DSS as well as the importance of broadening the view of AI-related challenges to the clinical environment, especially during treatment. Our results stress the necessity for adjusting AI-DSS to shared decision-making. We conclude that explainability must be context-specific while fostering meaningful interaction with the systems available.
... Recommendations should be based not only on the best currently available research evidence (systematic reviews), but also on a comprehensive consideration of factors such as resource utilization, patient values and preferences, equity and accessibility. [31] The evidence to decisions (EtD) developed by the GRADE working group provides a theoretical framework for how to generate optimal recommendations. [32,33] The GRADE grid proposed by the GRADE working group, along with the classical Delphi method and the nominal group method, provides a way to reach consensus on recommendations. ...
Transparency Ecosystem for Research and Journals in Medicine (TERM) Working Group summarized the essential recommendations that should be considered to review and publish a high-quality guideline. These recommendations from editors and reviewers included the 10 components of essential requirements: systematic review of existing relevant guidelines, guideline registration, guideline protocol, stakeholders, conflicts of interest, clinical questions, systematic reviews, recommendation consensus, guideline reporting, and external review. TERM Working Group abbreviates them as PAGE (essential requirements for Publishing clinical prActice GuidelinEs), recommends guideline authors, editors, and peer reviewers use them for high-quality guidelines.
