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GIN conference and Cochrane Colloquium 2018

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GIN conference and Cochrane Colloquium 2018

  1. 1. HOW CAN WE INTEGRATE GRADE AND A FORMAL CONSENSUS METHOD INTO AN INTERNATIONAL GUIDELINE PROJECT? THE EXAMPLE OF AN INTERNATIONAL CONSENSUS CONFERENCE ON PATIENT BLOOD MANAGEMENT (ICC-PBM) HANS VAN REMOORTEL COORDINATING RESEARCHER CENTRE FOR EVIDENCE-BASED PRACTICE (CEBAP) BELGIAN RED CROSS WWW.CEBAP.ORG
  2. 2. Conflicts of interests  Employee of Belgian Red Cross-Flanders, providing safe blood products to hospitals in Flanders and Brussels which did not influence his contribution to ICC-PBM 2018 Frankfurt  No conflicts of interest to declare
  3. 3. Outline 1.Patient Blood Management: 3 topics of interest and 17 PICO questions 2. Using a formal consensus methodology: the Consensus Development Conference 3. Using an evidence-based methodology: the GRADE approach
  4. 4. Patient blood management (PBM) is a patient- focused, evidence-based and systematic approach to optimize the management of patient and transfusion of blood products for quality and effective patient care.
  5. 5. Goodnough 2012
  6. 6. Scientific Committee: formulating 3 topics of interest and 17 PICO questions Scientific Committee Pierre Albaladejo (Grenoble University Hospital, France/ISTH) Shubha Allard (NHS Blood & Transplant/ISBT) Cécile Aubron (Academic Hospital of Brest, France/SFTS) Kari Aranko (European Blood Alliance/EBA) Dana Devine (Canadian Blood Services/CBS) Craig French (Western Health, Melbourne Australia) Kathrine P. Frey (Fairview Health Services and Patient Readiness Institute, Minneapolis MN/AABB) Christian Gabriel (Ludwig Boltzmann Institute for clinical and experimental traumatology, Austria/DGTI) Richard Gammon (One Blood, Orlando/AABB) Andreas Greinacher (Institut für Immunologie und Transfusionsmedizin Greifswald/ICTMG) Marian van Kraaij (Sanquin, the Netherlands/EBA) Jerrold Levy (Duke University School of Medicine, North Carolina/ISTH) Giancarlo Liumbruno (Italian National Institute of Health/EBA) Patrick Meybohm (University Clinics of the Johann Wolfgang Goethe University Frankfurt/Main) Markus Müller (Institute for Transfusion Medicine and Immunohaematology Frankfurt/EBA) Mike Murphy (NHS Blood & Transplant and AABB/EBA) Hans Van Remoortel (Centre for Evidence-Based Practice, Belgian Red Cross) Ben Saxon (Australian Red Cross Blood Service/ARCBS) Erhard Seifried (German Red Cross Blood Transfusion Services/EBA) (chair) Nadine Shehata (Mount Sinai Hospital Toronto/ICTMG) Pierre Tiberghien (French National Blood Service/EBA) Claudio Velati (Società Italiana di Medicina Trasfusionale e Immunoematologia) Erica Wood (Epidemiology and Preventive Medicine at Monash University/ISBT) Face-to-face meeting SciCom February 2017
  7. 7. Topic 1: Preoperative anaemia  Definition and diagnosis (PICO 1 and PICO 2)  Treatment (PICO 3) Topic 2: RBC transfusion triggers  Intensive care and acute interventions (PICO 4-9 & PICO 14)  Haematology and oncology (PICO 10 & PICO 11)  Neurology (PICO 12 & PICO 13) Topic 3: PBM implementation  Effectiveness implementation of ‘comprehensive’ PBM programs (PICO 15)  Effectiveness behavioural interventions (PICO 16)  Effectiveness decision support systems (PICO 17) Face-to-face meeting SciCom February 2017 Scientific Committee: formulating 3 topics of interest and 17 PICO questions Scientific Committee
  8. 8. Outline 1. Patient Blood Management: 3 topics of interest and 17 PICO questions 2.Using a formal consensus methodology: the Consensus Development Conference 3. Using an evidence-based methodology: the GRADE approach
  9. 9. 2-day International Consensus Conference on Patient Blood Management (24 & 25 April, Frankfurt, Germany) - 200 medical experts - From 5 continents - Representing more than 10 disciplines (e.g. transfusion medicine, surgery, anesthesiology and haematology) - Co-sponsors: AABB, ISBT, DGTI, SFTS, SIMTI, EBA - Participation: ARCBS, TBS, ICTMG, ISTH, NBA, ÖGBT, SFAR - Presence: WHO, EU Commission, DGAI, National Health Authority Australia
  10. 10. Scientific Committee Decision- making panelists Speakers (Co-)chairs Audience Rapporteurs Consensus Development Conference (CDC)
  11. 11. Consensus Development Conference (CDC) *Nair R et al., Semin Arthritis Rheum, 2011; Sher G and Devine D, Transfusion, 2007 Major steps in the Consensus Development Conference format? 1) Evidence presented by the SCIENTIFIC COMMITTEE to the conference, CHAIRED in a public (open) session followed by discussion (AUDIENCE) 2) Private (executive) session by DECISION-MAKING panel to further deliberate on the evidence and discussion to reach consensus -> result: draft consensus statement. 3) Presentation of draft consensus statement in a plenary session + review/comment/indicative voting by conference attendees. 4) Final executive session with final consensus statement by DECISION- MAKING PANEL.
  12. 12. Outline 1. Patient Blood Management: 3 topics of interest and 17 PICO questions 2. Using a formal consensus methodology: the Consensus Development Conference 3.Using an evidence-based methodology: the GRADE approach
  13. 13. GRADE approach From evidence to recommendations – transparent and sensible P I C O Outcome Outcome Outcome Outcome Critical Critical Important Not High Moderate Low Very low GradedownGradeup 1. Risk of bias 2. Inconsistency 3. Indirectness 4. Imprecision 5. Publication bias 1. Large effect 2. Dose response 3. Confounders Summary of findings & estimate of effect for each outcome Systematic review Randomization Experimental: High Observational: Low Scientific Committee
  14. 14. GRADE overall quality of the evidence across outcomes based on lowest quality of critical outcomes Guideline development GRADE recommendations Evidence to recommendation • For or against (direction) ↑↓ • Strong or conditional/weak (strength) By considering balance of consequences (evidence to recommendation)  Quality of evidence  Balance benefits/harms  Values and preferences  Resource use (cost(-effectiveness)  Equity – Acceptability - Feasibility • “We recommend using…” • “We recommend against using…” • “We suggest using…” • “We suggest against using…” EtD framework GRADEpro Guideline Formulate recommendations Transparency, clear, actionable Research? Decision-making panelists Audience Rapporteurs (Co-)chairs Panelists GRADE approach From evidence to recommendations – transparent and sensible
  15. 15. CRITERIA JUDGEMENT RESEARCH EVIDENCE ADDITIONAL CONSIDERATIONS 1. DESIRABLE EFFECTS How substantial are the desirable anticipated effects? 2. UNDESIRABLE EFFECTS How substantial are the undesirable anticipated effects? 3. CERTAINTY OF EVIDENCE What is the overall quality of the evidence of effects? 4. VALUES Is there important uncertainty about or variability in how much people value the critical outcomes? 5. BALANCE OF EFFECTS Does the balance between desirable and undesirable effects favor the intervention or the comparison? 6. RESOURCES REQUIRED How large are the resource requirements (costs)? 7. COST EFFECTIVENESS Does the cost-effectiveness of the intervention favor the intervention or the comparison? 8. EQUITY What would be the impact on health equity? 9. ACCEPTABILITY Is the intervention acceptable to key stakeholders? 10. FEASIBILITY Is the intervention feasible to implement? Evidence-to-Decision framework Rapporteurs Rapporteurs Rapporteurs Rapporteurs Rapporteurs Rapporteurs Rapporteurs Rapporteurs Rapporteurs Rapporteurs Audience Audience Audience Audience Audience Audience Audience Audience Audience Audience
  16. 16. Outline 1. Patient Blood Management: 3 topics of interest and 17 PICO questions 2.Using a formal consensus methodology: the Consensus Development Conference 3.Using an evidence-based methodology: the GRADE approach +
  17. 17. 1 year of preparation • Feb 2017: SciCom meeting, Frankfurt (Germany) • June 2017: Sponsors meeting, ISBT Copenhagen (Denmark) • March 2017 – April 2018: 12 SciCom teleconferences • Jan/Feb 2018: two face-to-face meetings with SciSec and chairs, Frankfurt (Germany) • March 2017 – January 2018: systematic reviews 17 PICO questions (+/- 18.000 references screened, 145 studies included) • Dec 2017 – April 2018: • 2 SciCom webinars • 4 panellists webinars • 3 chairs webinars • 1 webinar rapporteurs • 1 tutorial rapporteurs • 2 speakers webinars
  18. 18. Start day 1 (24 April 2018)
  19. 19. 3 Parallel sessions Session 1: Preoperative anaemia  Definition and diagnosis (PICO 1 and PICO 2)  Treatment (PICO 3) Session 2: RBC transfusion triggers  Intensive care and acute interventions (PICO 4-9 & PICO 14)  Haematology and oncology (PICO 10 & PICO 11)  Neurology (PICO 12 & PICO 13) Session 3: PBM implementation  Effectiveness implementation of ‘comprehensive’ PBM programs (PICO 15)  Effectiveness behavioural interventions (PICO 16)  Effectiveness decision support systems (PICO 17) Day 1 (24 April 2018) Part 1: Plenary • Evidence presented by • Based on Evidence-to-Decision (EtD) framework • Discussion with moderated by • Notes recorded by AudienceRapporteurs (Co-)chairs Panelists Speakers
  20. 20. Day 1: 3 parallel/open sessions
  21. 21. Day 1: 3 parallel/open sessions
  22. 22. 3 Parallel sessions Session 1: Preoperative anaemia  Definition and diagnosis (PICO 1 and PICO 2)  Treatment (PICO 3) Session 2: RBC transfusion triggers  Intensive care and acute interventions (PICO 4-9 & PICO 14)  Haematology and oncology (PICO 10 & PICO 11)  Neurology (PICO 12 & PICO 13) Session 3: PBM implementation  Effectiveness implementation of ‘comprehensive’ PBM programs (PICO 15)  Effectiveness behavioural interventions (PICO 16)  Effectiveness decision support systems (PICO 17) Day 1 (24 April 2018) + + + Part 1: Plenary Part 2: Closed (private/executive session) • Evidence presented by • Based on Evidence-to-Decision (EtD) framework • Discussion with moderated by • Notes recorded by • Based on EtD framework • Draft recommendations by • Moderated by • Notes recorded by AudienceRapporteurs (Co-)chairs Panelists Speakers
  23. 23. Day 1: closed session with decision-making panels
  24. 24. Draft conclusions at the end of day 1 TYPE OF RECOMMENDATION Strong recommendation against the intervention Conditional recommendation against the intervention Conditional recommendation for either the intervention or the comparison Conditional recommendation for the intervention Strong recommendation for the intervention RECOMMENDATION Option 1: Formulation of a strong or conditional recommendation Terminology strong recommendation: “we recommend…” – “clinicians should…” – “clinicians shoud not….” – “Do….” – “Don’t…..” Terminology weak/conditional recommendation: “we suggest…” – “clinicians might….” – “we conditionally recommend…” Option 2: No recommendation Option 3: Research recommendation JUSTIFICATION … SUBGROUP CONSIDERATIONS … IMPLEMENTATION CONSIDERATIONS … MONITORING AND EVALUATION … RESEARCH PRIORITIES … Closed session with chairs/decision-making panels/rapporteurs
  25. 25.  Plenary session with the general audience (all 3 topics)  Presentation draft recommendations/justifications by AudienceRapporteurs (Co-)chairs Panelists Day 2 (25 April 2018)
  26. 26.  Plenary session with the general audience (all 3 topics)  Presentation draft recommendations/justifications by  Discussion with/indicative voting by , moderated by the  Notes recorded by AudienceRapporteurs (Co-)chairs Panelists Day 2 (25 April 2018)
  27. 27.  Plenary session with the general audience (all 3 topics)  Presentation draft recommendations/justifications by  Discussion with/indicative voting by , moderated by the  Notes recorded by  Closed sessions with the decision-making panelists and (co-) chairs  Formulation of final recommendations by , moderated by the AudienceRapporteurs (Co-)chairs Panelists Day 2 (25 April 2018)
  28. 28. Day 2: closed session with decision-making panels
  29. 29. Conclusions: 10 evidence-based recommendations  Topic 1: Preoperative anaemia  4 recommendations (1 strong, 3 conditional)  Topic 2: RBC transfusion triggers  4 recommendations (2 strong, 2 conditional)  Topic 3: PBM implementation  2 recommendations (2 conditional)  Research recommendations for all topics
  30. 30. Lessons learned to improve a future guideline project  Preparation: time versus resources  2 face-to-face meetings between methodologists and experts  Beginning: PICO + selection criteria (lumping vs splitting!)  Intermediate: to discuss results systematic review  Improve sense of ownership and knowledge of evidence-based methodology by different groups (panel members, chairs)  More rigorous process to select panel members (COI!) and formal/blind voting system on draft/final recommendations  Organization Consensus conference immediately before/after blood transfusion conference (e.g. ISBT) could increase participation (by general audience).
  31. 31. Acknowledgments Prof. Dr. Erhard Seifried (German Red Cross Blood Transfusion Services/EBA) (chair) Dr. Kari Aranko (European Blood Alliance/EBA) Willemijn Kramer (European Blood Alliance/EBA) Dr. Markus Müller (Institute for Transfusion Medicine and Immunohaematology Frankfurt/EBA) Prof. Dr. Patrick Meybohm (University Clinics of the Johann Wolfgang Goethe University Frankfurt/Main) Chairs of the Plenary Sessions: Prof. Dr. Reinhard Burger, Robert-Koch-Institute, Berlin, Germany Prof. Dr. Klaus Cichutek, Paul-Ehrlich-Institute, Langen, Germany Prof. Dr. Jimmy Volmink, Faculty of Medicine and Health Sciences at Stellenbosch University, South Africa Decision-making panel ‘Preoperative anaemia’ Prof. Dr. Yves Ozier, University Hospital of Brest, France (Chair) Prof Dr. Emmy De Buck, Centre for Evidence Based Practice, Belgian Red Cross-Flanders, Belgium (Co-Chair) Decision-making panel ‘RBC transfusion triggers’ Prof. Dr. Reinhard Burger, Robert-Koch-Institute, Berlin, Germany (Chair) Prof. Dr. Jimmy Volmink, Faculty of Medicine and Health Sciences at Stellenbosch University, South Africa (Co-Chair) Decision-making panel ‘PBM implementation’ Prof. Dr. Jonathan Waters, Magee-Womens Hospital of the University of Pittsburgh Medical Center (Chair) Prof. Dr. Dean Fergusson, Ottawa Hospital Research Institute, University of Ottawa, Canada (Co-Chair) Stefan Holtzem (Photographer)
  32. 32. Acknowledgments Centre for Evidence-Based Practice (CEBaP) Belgian Red Cross www.cebap.org @CEBaP_evidence
  33. 33. Translating evidence into practical tools to teach first aid to children in sub-Saharan Africa Anne-Catherine Vanhove – Researcher Centre for Evidence-Based Practice
  34. 34. Conflict of interest I have no actual or potential conflict of interest in relation to this presentation.
  35. 35. Why? Only 17 and already saved a life thanks to first aid course in school
  36. 36. Why? ✚ First aid training: cost-effective approach to decrease burden of disease & injury in sub-Saharan Africa (World Bank) ✚ African Red Cross National Societies expressed need for first aid materials adapted to African context
  37. 37. Why? ✚ First aid training: cost-effective approach to decrease burden of disease & injury in sub-Saharan Africa (World Bank) ✚ African Red Cross National Societies expressed need for first aid materials adapted to African context ✚ 2009-2011: • Guidelines and materials with up-to-date first aid and prevention advice, specifically directed at the African context • Focus on up-to-date first aid techniques and injury/disease prevention advice ✚ 2016: • Guidelines updated
  38. 38. Methodology First Aid Service & International CooperationCentre for Evidence-Based Practice Panel of external experts
  39. 39. Objectives and research questions ✚ Develop an educational pathway that indicates at which age a child can reach certain objectives concerning first aid ✚ Generate a list of recommended educational methods and materials for educating children in LMICs + = ? First aid + = ? ✚ Develop first aid educational materials for African children
  40. 40. Educational Pathway Experimental and observational studies Identified through database searching 11 446 Screening based on title and abstract 9742 Full text reviews assessed for elegibility 284 Original studies included 57 Duplicates removed: 1704 First aid + = P: children (5-18 years) I: first aid training C: no first aid training O: first aid knowledge, skills and attitude
  41. 41. Educational Pathway Africa 2% Asia 24% Australia/ Oceania 10%Europe 44% North America 16% South America 4% 0 5 10 15 20 25 30 35 40 45 General Four steps in first aid Resuscitation Choking Skin Wounds Burns Bleeding Injuries to bones, muscles or joints Poisoning % of studies per continent number of studies per topic
  42. 42. Educational Pathway
  43. 43. Educational methods and materials Identified through database searching 819 Screening based on title and abstract 697 Full text reviews assessed for elegibility 282 Systematic reviews included 2 Duplicates removed: 122 Excluded: 415 Excluded: 280 + = P: primary & secondary school children in low- and middle-income countries I: instructional materials and/or alternative pedagogical methods C: not providing or using these O: knowledge, skills and attitude Systematic reviews:
  44. 44. Educational methods and materials
  45. 45. Educational methods and materials 1. Provision of instructional materials (e.g. flipcharts, textbooks) 2. Use of alternative pedagogical methods (e.g. problem-solving method of teaching, cooperative teaching, constructivist teaching, guided inquiry teaching, small-group instruction) 3. Structured pedagogy interventions (structured lesson content + teacher training in delivering the new content + instructional materials for students and teachers)
  46. 46. Input experts: educational pathway ✚ Content • Additional topics: e.g. stings and bites, fever, diarrhoea, fits • Additional interventions: e.g. plastic bags instead of gloves ✚ Context • Objective removed due to possible unsafety for the child e.g. touching an unknown person • Objective attained at later age or keep repeating until 18 years of age e.g. seeking help from medical provider, hand washing • Highlight specific dangers at younger age e.g. burns are generally caused by fire or hot water and make children aware of danger https://www.iol.co.za/dailynews/watch-national-epilepsy-week- squashing-the-myths-on-epilepsy-13257039
  47. 47. Input experts: educational methods 5-8 years 9-12 years 13-18 years Story telling Game Song Game Case study Role- play Flip chart Role- play Case study/ video/ manikin
  48. 48. First aid teacher manual: first draft
  49. 49. First aid teacher manual: first draft
  50. 50. Current and future steps ✚ Second expert meeting to collect feedback on the manual and materials ✚ Piloting the materials in several countries including Zimbabwe and Burundi • Train the teachers and collect their feedback • Let the teachers train the children and collect feedback ✚ January 2018: Materials will be available
  51. 51. Acknowledgements www.cebap.org info@cebap.org @CEBaP_evidence www.linkedin.com/company/centre-for-evidence-based-practice-cebap- International Cooperation Belgian Red Cross Lieve Adam – Focal point First Aid An Vanderheyden – Delegate at Tanzania Red Cross
  52. 52. Evidence-based by CEBaP Initiatives to successfully improve the acceptance of Evidence-Based Practice (EBP) in an aid organization: The example of the Belgian Red Cross Bert Avau1,2 , Vere Borra1 , Emmy De Buck1,4 , Philippe Vandekerckhove3,4 1 Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen, Belgium; 2 Cochrane Belgium, Centre for Evidence-Based Medicine (CEBAM), Leuven, Belgium; 3 Belgian Red Cross, Mechelen, Belgium; 4 Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium; More information? Belgian Red Cross, Centre for Evidence-Based Practice, Motstraat 42, B-2800 Mechelen, Belgium. Contact: bert.avau@cebap.org V.u.: Philippe Vandekerckhove, Motstraat 40, 2800 Mechelen | 2018_049 Blended learning improves EBP knowledge, but not attitude @CEBaP_evidence 0 2 4 6 8 10 Pre Post Medianscoreona questionnaire(max9) Measured knowledge regarding EBP 0 2 4 6 Pre Post Asnwerona5-point scale(median) Average attitude score 0 2 4 6 Pre Post Asnwerona6-point scale(median) Average self-perceived knowledge score Activities to implement EBP have increased in the past 5 years 12 evidence-based guidelines and 18 systematic reviews were produced in the past 5 years and are used in practice through manuals, procedures, folders & education Blended learning significantly improves self-perceived knowledge (Wilcoxon test, P = 0.03, n = 8) Blended learning opportunities (1.5 h e-learning + 1.5 h face-to- face) on the use of EBP for employees and volunteers Monthly journal clubs for operational services Foundation of a Centre for Evidence-Based Practice (CEBaP) within Belgian Red Cross EBP uptake incorporated in the long-term strategic vision Uptake of Evidence-Based Practice in all layers of the organization Top-down managerial focus and screening of new employees’ attitude First Aid guidelines First aid educational pathway Reviews supporting blood donor management Review on the effectiveness of WASH interventions Guideline for supporting vulnerable children A significant increase in measured knowledge could not be demonstrated (Wilcoxon test, P = 0.18, n = 8) A significant increase in EBP attitude was not found (Wilcoxon test, P = 0.94, n = 8 Strategy Everyone Helps 0 5 10 15 20 25 2013 2014 2015 2016 2017 Amount Year Markers of EBP implementation within the BRC in the past 5 years Project applications with CEBaP by the operational services Mutual funding proposals between CEBaP and an operational service Questions for methodological support, to be provided by CEBaP Number of journal clubs organised in the organization
  53. 53. How a systematic review and continued stakeholder engagement can lead to a Theory of Change relevant to the aid sector … Anne-Catherine Vanhove1 , Emmy De Buck1,2 , Philippe Vandekerckhove2,3 1 Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen, Belgium; 2 Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium; 3 Belgian Red Cross, Mechelen, Belgium Background The Centre for Evidence-Based Practice provides evidence-based substantiation of the activities of the Belgian Red Cross. One of the activities in international humanitarian assistance is Forecast-based Financing (FbF). Many recent natural disasters had been forecasted before they caused damage, but humanitarian aid mostly still arrives only after the impact of the disaster becomes clear. FbF aims to bridge the gap between forecast and action by releasing funds based on forecast information for ‘early actions’ taking place in the 3-5 days before the disaster hits, to lower the impact of the disaster. Objectives We aimed to establish an evidence base for the identification of early actions for an FbF project in Mozambique by conducting a review of the existing evidence and developing a Theory of Change (ToC). A ToC is a valuable tool for the aid sector which is used to develop a shared understanding of how interventions might work and how change will happen in a programme. Methods While gathering the scientific evidence by conducting a systematic literature search in several databases (phase 1 and 2), methodologists collaborate with several experts and practitioners. Impacts of floods and cyclones and potential early actions during these disasters were for instance identified through expert and stakeholder interviews in Mozambique. Finally,anoverarchingToCisconstructedbythemethodologists (phase 3), which is further refined through stakeholder engagement (FbF experts, policy makers and practitioners/end users in Mozambique from e.g. government agencies, NGOs and the Mozambique Red Cross Society). Research questions for literature search: 1. What is the effectiveness of different potential early actions to reduce the impact of flooding and cyclones in LMIC? 2. What factors influence the implementation of potential early actions to reduce the impact of flooding and cyclones in LMIC? Overview of research approach: Results Evidence for interventions in the humanitarian sector is still limited. No evidence concerning floods and cyclones was identified for many interventions from the existing systematic reviews. If we identified no relevant studies for floods and cyclones, we expanded the setting to systematic reviews concerning all types of natural disasters and ultimately again to the broad international development cooperation setting if needed. Phase 2 is currently ongoing, in which we aim to identify relevant individual studies for potential early actions for which no evidence was identified in systematic reviews. Potential early action Effectiveness Factors influencing implementation Evidence Prevent diarrhea: chlorine tablets Taste and smell Ease of use Education Flood setting in one SR: Yates 2015 Prevent malaria: nets, repellents, spray or larviciding Nets Personal repellent Indoor spray Outdoor spraying ??? Larviciding For nets: Education Free distribution or pay Incentive for use Development cooperation setting in Cochrane SRs: Augustincic Polec 2015, Gamble 2006, Lengeler 2004, Maia 2018, Plues 2010, Tusting 2013 Evacuation: incentives, transport, shelter Phase 2 ongoing Phase 2 ongoing Protect fields: early harvest, dig drainage Phase 2 ongoing Phase 2 ongoing Protect goods/documents/ food Phase 2 ongoing Phase 2 ongoing Protect livestock: vaccination, evacuation Phase 2 ongoing Phase 2 ongoing Reinforce houses/ schools/ hospitals Phase 2 ongoing Phase 2 ongoing Stakeholder meeting: Stakeholders discussed the identified scientific evidence and preliminary ToCs. Their input was used to refine the ToCs regarding issues raised such as taking action at the houses versus in shelters, the need for education at several timepoints and barriers towards the use of chlorine tablets and mosquito nets. Conclusions Conducting a review of the existing evidence provides a solid base for the construction of a ToC,whichcanberefinedbasedonstakeholderinput.Continuousstakeholderengagement ensures the resulting ToC is relevant for practice and creates a sense of ownership and stakeholder buy-in. Current humanitarian response Forecast-based Financing References: Augustincic Polec L, Petkovic J, Welch V, Ueffing E, Tanjong Ghogomu E, Pardo Pardo J, Grabowsky M, Attaran A, Wells GA, Tugwell P. Strategies to increase the ownership and use of insecticide-treated bednets to prevent malaria. Cochrane Database Syst Rev. 2015 (3):CD009186. Gamble CL, Ekwaru JP, ter Kuile FO. Insecticide-treated nets for preventing malaria in pregnancy. Cochrane Database Syst Rev. 2006 (2):CD003755. Lengeler C. Insecticide-treated bed nets and curtains for preventing malaria. Cochrane Database Syst Rev. 2004 (2):CD000363. Maia MF, Kliner M, Richardson M, Lengeler C, Moore SJ. Mosquito repellents for malaria prevention. Cochrane Database Syst Rev. 2018 (2):CD011595. Pluess B, Tanser FC, Lengeler C, Sharp BL. Indoor residual spraying for preventing malaria. Cochrane Database Syst Rev. 2010 (4):CD006657. Tusting LS, Thwing J, Sinclair D, Fillinger U, Gimnig J, Bonner KE, Bottomley C, Lindsay SW. Mosquito larval source management for controlling malaria. Cochrane Database Syst Rev 2013 (8):CD008923. Yates T, Allen J, Joseph ML, Lantagne, D, 2017. Short-term WASH interventions in emergency response: a systematic review. 3ie Systematic Review 33. Floods and cyclones Natural disasters Development cooperation Phase 1: Identify evidence in existing systematic reviews Phase 2: Identify individual studies where evidence gaps exist Phase 3: Integration of scientific evidence and stakeholder input in ToC R.E.:PhilippeVandekerckhove,Motstraat40,2800Mechelen|2018_097 Current humanitarian response Forecast-based Financing Evidence-based by CEBaP More information? Belgian Red Cross, Centre for Evidence-Based Practice, Motstraat 42, B-2800 Mechelen, Belgium. Contact: anne-catherine.vanhove@cebap.org V.u.: Philippe Vandekerckhove, Motstraat 40, 2800 Mechelen | 2018_097 @CEBaP_evidence
  54. 54. Establishment of a methodological Expert Group: a novel approach to optimizing primary care guideline revision and development in Belgium Jorien Laermans1,2, Vere Borra1,2, Saphia Mokrane2,3, Jan Harm Keijzer2, Sam Cordyn2,4, Nicole Dekker2,3, Paul Van Royen2,3 1 Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium, 2 Expert Group, Working Group Development of Primary Care Guidelines, Belgium, 3 Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium, 4 White Yellow Cross Flanders, Brussels, Belgium • The Working Group Development of Primary Care Guidelines is a Belgian consortium responsible for the revision and development of evidence-based guidelines for primary care practitioners • Since its establishment in 2014, several Guideline Development Groups (GDGs) have struggled with the labor-intensive rigorous methodological aspect of guideline development Background & introduction Objectives To revise and redefine the roles and responsibilities of the different GDG members, allowing them to focus on their methodological or content area of expertise Methods Expert Group: focus on methodology & preparation Other GDG members: focus on content & practice • So far, the Expert Group has supported 3 monodisciplinary guideline revisions and 3 multidisciplinary guideline development start-ups • During monthly meetings, they follow up on revisions, optimize processes & procedures and strenghten internal expertise Conclusion & implications for guideline developers • The methodological Expert Group seems to be a promising approach to sustaining high-quality primary care guideline development in Belgium• • Taking full advantage of the individual GDG members’ strengths, whether methodological or substantive, may help guideline developers to optimize the quality and quantity of their guideline output Working Group Development of Primary Care Guidelines Expert Group (7 members) GDG guideline 1 • Helping define clinical questions • Developing search strategies • Screening & critically appraising other guidelines • Preparing GDG & stakeholder meetings Results & discussion • Providing feedback to the Expert Group • Sharing content & practical expertise • Writing the guideline GDG guideline 2 GDG guideline 3

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