This document provides evidence-based recommendations for point-of-care lung ultrasound from an international panel of 28 experts. The panel reviewed literature from 1966 to 2011 using the GRADE method to determine evidence quality and develop recommendations. They discussed 73 proposed statements over three conferences using a modified Delphi technique and anonymous voting. Strong recommendations were made for 65 statements, and weak recommendations for 2 statements. The recommendations aim to standardize the application of lung ultrasound in clinical settings and provide a framework to guide its future use and research.
CHC15 - EHR adoption in a european environment and public management hospital...Carlos Sousa
SOURCE:
Invited speaker for CERNER HEALTH CONFERENCE, Educational Session, held during Oct 11-14 in Kansas City (MO) - US.
ABSTRACT:
After 13 years under private management, Hospital Prof. Fernando da Fonseca (HFF) committed to invest a solid EHR strategic approach aligned with best practices, due to management shift as public management hospital within the NHS network. HFF focused on creating a Clinical Commission for information that could support and lead the change on workflow and mindset of the hospital culture. This team combines the knowledge and experience of multidisciplinary roles, designing a EHR model that fully responds to the needs. Thus ensuring a successful phased implementation which started in the emergency department and was then deployed throughout the rest of the hospital. After three years of project, the hospital has achieved a high level (superior to 85%) of EHR adoption and has proven outcomes in the delivery of quality of care and Social ROI (e.g. direct data interoperability with medical emergency before hospital admission, algorithm implementation to improve organ donor and collection, integration with private clinics for outsourcing auxiliary services, including Lab and radiology prescriptions and results/reports). HFF continues to strongly work on this project and are dedicated to implementing their roadmap with the short term aim of achieving HIMSS Stage 6.
This document discusses maximizing patient outcomes in respiratory care. It outlines the founding principles of the Respiratory Effectiveness Group (REG), which aims to better integrate real-world evidence from sources like observational studies and pragmatic trials into clinical practice guidelines. Currently, guidelines are often based primarily on randomized controlled trials, which have limitations and may not generalize to most patients. The document calls for considering a diversity of evidence and tailoring care to individual patient needs and characteristics. It also discusses how databases could help achieve more personalized care by providing real-world data on topics like disease prevalence, treatments, and outcomes across different healthcare systems.
The document discusses the adaptation and implementation of clinical practice guidelines (CPGs) at hospitals of two universities in the Middle East and North Africa region. It provides an overview of the CPG adaptation and implementation program launched at Alexandria University Hospitals in Egypt and King Saud University in Saudi Arabia. It describes how over a dozen CPGs have been adapted through various theses projects at Alexandria University Hospitals, and outlines the current status of the CPG program established at King Saud University Medical City, which has adapted over 30 CPGs across various clinical departments.
An introduction on Evidence-Based Clinical Practice Guidelines in Health Care Organizations
Brief on Alexandria Center for EBCPGs in Alexandria University Hospitals, Egypt
By Dr. Yasser Sami Abdel Dayem Amer, MBBCh, MS 2013
Special Thanks to
Prof Dr Mahmoud Elzalabany
Prof Dr Tarek Omar
Prof Dr Nabil Dowidar
Prof Dr Afaf Gaber
Part 1. An overview on implementation of CPGs
Part 2. CPGs & HTAs
Presented during the 2nd Regional Workshop for CPG Adaptation, Tunis, Tunisia May 24-26 2016
A collaborative between INA Sante, WHO-EMRO, KSU
REG PCORI Grant Planning Meeting 26/09/15Zoe Mitchell
The document outlines an agenda for a planning meeting between the Respiratory Effectiveness Group (REG) and the Patient-Centered Outcomes Research Institute (PCORI) to discuss potential comparative effectiveness research collaborations. Key items on the agenda include aligning the missions of REG and PCORI, discussing what comparative effectiveness research entails, engaging stakeholders, and generating ideas for potential research topics that could be funded through PCORI. The meeting aims to identify topics of interest to both organizations that incorporate patient-centered outcomes research.
This document provides evidence-based recommendations for point-of-care lung ultrasound from an international panel of 28 experts. The panel reviewed literature from 1966 to 2011 using the GRADE method to determine evidence quality and develop recommendations. They discussed 73 proposed statements over three conferences using a modified Delphi technique and anonymous voting. Strong recommendations were made for 65 statements, and weak recommendations for 2 statements. The recommendations aim to standardize the application of lung ultrasound in clinical settings and provide a framework to guide its future use and research.
CHC15 - EHR adoption in a european environment and public management hospital...Carlos Sousa
SOURCE:
Invited speaker for CERNER HEALTH CONFERENCE, Educational Session, held during Oct 11-14 in Kansas City (MO) - US.
ABSTRACT:
After 13 years under private management, Hospital Prof. Fernando da Fonseca (HFF) committed to invest a solid EHR strategic approach aligned with best practices, due to management shift as public management hospital within the NHS network. HFF focused on creating a Clinical Commission for information that could support and lead the change on workflow and mindset of the hospital culture. This team combines the knowledge and experience of multidisciplinary roles, designing a EHR model that fully responds to the needs. Thus ensuring a successful phased implementation which started in the emergency department and was then deployed throughout the rest of the hospital. After three years of project, the hospital has achieved a high level (superior to 85%) of EHR adoption and has proven outcomes in the delivery of quality of care and Social ROI (e.g. direct data interoperability with medical emergency before hospital admission, algorithm implementation to improve organ donor and collection, integration with private clinics for outsourcing auxiliary services, including Lab and radiology prescriptions and results/reports). HFF continues to strongly work on this project and are dedicated to implementing their roadmap with the short term aim of achieving HIMSS Stage 6.
This document discusses maximizing patient outcomes in respiratory care. It outlines the founding principles of the Respiratory Effectiveness Group (REG), which aims to better integrate real-world evidence from sources like observational studies and pragmatic trials into clinical practice guidelines. Currently, guidelines are often based primarily on randomized controlled trials, which have limitations and may not generalize to most patients. The document calls for considering a diversity of evidence and tailoring care to individual patient needs and characteristics. It also discusses how databases could help achieve more personalized care by providing real-world data on topics like disease prevalence, treatments, and outcomes across different healthcare systems.
The document discusses the adaptation and implementation of clinical practice guidelines (CPGs) at hospitals of two universities in the Middle East and North Africa region. It provides an overview of the CPG adaptation and implementation program launched at Alexandria University Hospitals in Egypt and King Saud University in Saudi Arabia. It describes how over a dozen CPGs have been adapted through various theses projects at Alexandria University Hospitals, and outlines the current status of the CPG program established at King Saud University Medical City, which has adapted over 30 CPGs across various clinical departments.
An introduction on Evidence-Based Clinical Practice Guidelines in Health Care Organizations
Brief on Alexandria Center for EBCPGs in Alexandria University Hospitals, Egypt
By Dr. Yasser Sami Abdel Dayem Amer, MBBCh, MS 2013
Special Thanks to
Prof Dr Mahmoud Elzalabany
Prof Dr Tarek Omar
Prof Dr Nabil Dowidar
Prof Dr Afaf Gaber
Part 1. An overview on implementation of CPGs
Part 2. CPGs & HTAs
Presented during the 2nd Regional Workshop for CPG Adaptation, Tunis, Tunisia May 24-26 2016
A collaborative between INA Sante, WHO-EMRO, KSU
REG PCORI Grant Planning Meeting 26/09/15Zoe Mitchell
The document outlines an agenda for a planning meeting between the Respiratory Effectiveness Group (REG) and the Patient-Centered Outcomes Research Institute (PCORI) to discuss potential comparative effectiveness research collaborations. Key items on the agenda include aligning the missions of REG and PCORI, discussing what comparative effectiveness research entails, engaging stakeholders, and generating ideas for potential research topics that could be funded through PCORI. The meeting aims to identify topics of interest to both organizations that incorporate patient-centered outcomes research.
The document provides details about an upcoming annual general meeting for the Respiratory Effectiveness Group (REG). The meeting will take place on September 26th at the Wyndham Apollo Hotel in Amsterdam. David Price will chair the meeting, which will review REG's activities from 2013 to 2015 and look ahead to future opportunities. Some of the key accomplishments highlighted include establishing a global network of over 270 collaborators across 38 countries, running numerous research studies and task forces, publishing several papers and abstracts, and hosting successful summits in 2014 and 2015. The meeting aims to further develop REG's working groups and collaborative activities to generate real-world evidence that can guide clinical practice and policy.
During the workshop, the Trillium II project was presented to the audience as well as the state of patient summaries in Denmark and the US. Furthermore, the results of a survey on use of patient summaries in disaster and relief situations were presented.
The purpose of the workshop was to promote the project and the Global Community for Digital Health Innovation and collect feedback on the participants’ attitude towards patient summaries.
The workshop participants were invited to discuss which patient summary use cases they considered most relevant for the Trillium II project to focus on and how an international patient summary should be governed.
This session was conducted as a part of the 6th Resident Professional Development Course titled "Evidence-Based Medicine" in 9th SEPT 2015 at College of Medicine, King Saud University
This document summarizes a study that used multi-criteria decision analysis (MCDA) to understand stakeholders' preferences on decision criteria for the treatment obinutuzumab for indolent non-Hodgkin lymphoma in Italy. Stakeholders including patients, clinicians, and payers participated in an online survey and meetings to provide weights and scores on criteria such as disease severity and cost. The results showed similarity between patients and clinicians prioritizing criteria related to disease impact, while payers distributed weights more evenly. Obinutuzumab scored highly on disease severity and therapeutic benefit but lower on economic criteria. The overall value score can help inform coverage decisions by identifying priority outcomes and consensus views.
Multifactorial Approach in Clinical Research Concept and Practice in HungaryTristan Azbej, PhD
Hungary provides an attractive environment for clinical trials due to its:
1) Strong patient access programs that support high enrollment rates. These include a centralized patient database and satellite GP networks.
2) Supportive regulatory environment with efficient approval timelines under 60 days on average.
3) Established academic research centers that offer therapeutic expertise, trained personnel, and access to facilities like central laboratories and imaging. These support both early and late phase trials across therapeutic areas.
Xylem Clinical Research Pvt. Ltd. is an Indian Site Management Organization (SMO) that provides support for clinical trials from Phase I-IV. It aims to facilitate smooth execution of trials through services like SMO support, site coordination, regulatory writing, and ensuring sites are audit-ready. Xylem has experience managing sites in diseases like oncology, infectious diseases, and more. It has a team with over 50 years of combined clinical research experience to help sponsors and CROs conduct trials in India on time and to high quality standards.
The document summarizes discussions from an IPF/ILD Working Group meeting. It provides updates on several studies, including one characterizing the clinical features and healthcare utilization of IPF patients in the years before diagnosis. The study found increased healthcare resource use in the 2 years prior to an IPF diagnosis. Another study aims to evaluate diagnostic agreement across global sites. The working group discussed priorities for future research, including a Phase II study using digitized patient cases to assess diagnostic accuracy across different healthcare settings.
The document summarizes a study that evaluated methods for selecting pregnant or postpartum women with suspected pulmonary embolism (PE) for diagnostic imaging. The study aimed to estimate the accuracy, effectiveness and cost-effectiveness of using clinical features, decision rules and biomarkers to identify which patients need imaging. The study developed a diagnostic model to analyze the performance of these selection methods and assess their ability to safely reduce imaging while maintaining appropriate patient care.
An overview of the work and initial results of the REG-EAACI Taskforce assessing the quality of literature in the field of real-world respiratory medicine.
The External Review Committee evaluated CAPHRI School for Public Health and Primary Care for the period 2004-2009. Some key findings:
- CAPHRI has an international leading position in extramural research as evidenced by top publications in journals like Nature and The Lancet.
- The number of articles in top international journals is an astonishing achievement given CAPHRI's research topics in public health and primary care.
- CAPHRI demonstrates strong societal impact through dissemination of knowledge, stakeholder interest, and contributions to societal sectors.
- Overall CAPHRI receives a positive review with high ratings for quality, productivity, relevance and vitality. The committee concludes CAPHRI performs at an
The editorial discusses the publication of results from the REVIVE clinical trials that tested the drug levosimendan for acute decompensated heart failure. The trials were completed over 7 years ago but results were only recently published. The editorial argues that this late publication fulfills critical obligations to study participants who consented to the trials, and to clinical colleagues who need complete trial results to inform decisions. While levosimendan provided some benefits like reduced need for rescue interventions, it also increased risks like hypotension and arrhythmias. The editorial maintains researchers and sponsors have a duty to publish full trial results in a timely manner.
This document summarizes Professor Adrian Towse's presentation on assessing the value of new antibiotics. It discusses the challenges of developing new antibiotics due to scientific and economic hurdles. Current health technology assessment frameworks may not fully capture antibiotics' value in addressing antimicrobial resistance. Additional elements of value for antibiotics are proposed, including insurance value, diversity value, and enablement value. Evidence requirements for assessing these new elements were discussed. While not unique to antibiotics, these elements provide a more comprehensive evaluation. Further refinement is needed to incorporate these elements into health technology assessments.
REG Technologies Working Group Meeting 26/09/15Zoe Mitchell
This document provides an agenda and notes from a meeting of the Technologies Working Group of the Respiratory Effectiveness Group (REG). The meeting objectives were to agree terms of reference for the group, discuss initial seed projects, and identify 1-2 longer term projects. Under terms of reference, the group will focus on technology-based solutions for chronic respiratory conditions, with a focus on monitoring and behavioral change. Initial seed project ideas discussed included evaluating practices for developing technology solutions, a literature review on using health information to change patient behavior, and optimizing technology interfaces for older patients. Preliminary data from a PhD student's survey of stakeholder attitudes towards smart inhalers was also presented. The group discussed potential future projects and grant opportunities.
Koonal's slides from a short presentation (vignette) he gave at HTAi Annual Meeting 2018 summarising two study being undertaken in parallel to value health in children and adolescents. The audience comprised attendees at a conference focused on HTA.
This document discusses Denmark's national health registries and their use for epidemiological research. It notes that Denmark assigns unique personal identification numbers to all citizens, allowing accurate linkage between various health registries. This enables large population-based cohort studies with long-term follow up. The registries contain information on healthcare utilization, prescriptions, and diagnoses. Several studies are described that use the registries to study topics like MMR vaccination and autism, quality of diabetes care, and blood pressure control. Challenges with using registry data include ensuring validity of diagnoses and missing data. However, strengths include no selection bias, large sample sizes, and prospectively collected data.
Does society wish to prioritise end-of-life treatments over other types of tr...Office of Health Economics
Koonal Shah presented research on whether society prioritizes end-of-life treatments over other types of treatments. Seventeen studies were reviewed that examined public preferences on giving greater priority to health gains for end-of-life patients. The evidence was mixed, with some studies consistent with an end-of-life premium and others not finding clear support. Few studies compared preferences for quality of life improvements versus life extensions for end-of-life patients. Shah discussed factors like indifference options, visual aids, and accounting for age and time preferences that affected study findings. Further research was recommended to better understand preferences in this area.
This document discusses biobanks and registries, their value for research, and opportunities for patient involvement. It describes how biobanks store biological samples and associated data to support research. Registries collect standardized clinical data on patient populations over time. Both require governance and quality management. The document presents two cases where patient organizations were involved in biobank and registry co-creation and governance to help advance research.
PROMISE ethics panel final report, October 17, 2012erikanature
Final report of a specially commissioned panel tasked with examining the ethics of the PROMISE trials, which study different drug regimens to prevent mother to child transmission of HIV. The trials are sponsored by the US National Institute of Allergy and Infectious Disease, which commissioned the ethics review.
Audio video consenting process and role of CRC or PI during av consentingJagriti Bansal
The document outlines the requirements and process for audio-visual (AV) recording of informed consent for clinical trials in India. Key points include:
1. AV recording of informed consent is now mandatory per a 2013 order from the Drug Controller General of India, following a Supreme Court ruling.
2. The requirements for AV consenting include an approved protocol and consent form, the subject and principal investigator on camera, a private room, and storage of recordings.
3. The process involves introducing all parties, explaining the study and consent form verbally, having the subject sign, and answering questions to ensure understanding before signing.
4. Clinical research coordinators are responsible for assisting with the process, ensuring privacy,
Presentation_Thesis defense _Thi Ha VO. 16.12.2015HA VO THI
The document describes the development and validation of a new multidimensional tool called CLEO for assessing the potential impact of pharmacist interventions (PIs). It involved:
1. Conducting a systematic review of existing models and tools which identified limitations and informed the development of the optimal SP(ECH)O-P model.
2. Developing the CLEO tool based on the model, with 3 dimensions (clinical, economic, organizational) and defined scoring criteria.
3. Validating the CLEO tool by testing inter-rater and intra-rater reliability on samples of PIs, which showed moderate to substantial agreement, demonstrating the tool is reliable for assessing impacts of PIs
The document provides details about an upcoming annual general meeting for the Respiratory Effectiveness Group (REG). The meeting will take place on September 26th at the Wyndham Apollo Hotel in Amsterdam. David Price will chair the meeting, which will review REG's activities from 2013 to 2015 and look ahead to future opportunities. Some of the key accomplishments highlighted include establishing a global network of over 270 collaborators across 38 countries, running numerous research studies and task forces, publishing several papers and abstracts, and hosting successful summits in 2014 and 2015. The meeting aims to further develop REG's working groups and collaborative activities to generate real-world evidence that can guide clinical practice and policy.
During the workshop, the Trillium II project was presented to the audience as well as the state of patient summaries in Denmark and the US. Furthermore, the results of a survey on use of patient summaries in disaster and relief situations were presented.
The purpose of the workshop was to promote the project and the Global Community for Digital Health Innovation and collect feedback on the participants’ attitude towards patient summaries.
The workshop participants were invited to discuss which patient summary use cases they considered most relevant for the Trillium II project to focus on and how an international patient summary should be governed.
This session was conducted as a part of the 6th Resident Professional Development Course titled "Evidence-Based Medicine" in 9th SEPT 2015 at College of Medicine, King Saud University
This document summarizes a study that used multi-criteria decision analysis (MCDA) to understand stakeholders' preferences on decision criteria for the treatment obinutuzumab for indolent non-Hodgkin lymphoma in Italy. Stakeholders including patients, clinicians, and payers participated in an online survey and meetings to provide weights and scores on criteria such as disease severity and cost. The results showed similarity between patients and clinicians prioritizing criteria related to disease impact, while payers distributed weights more evenly. Obinutuzumab scored highly on disease severity and therapeutic benefit but lower on economic criteria. The overall value score can help inform coverage decisions by identifying priority outcomes and consensus views.
Multifactorial Approach in Clinical Research Concept and Practice in HungaryTristan Azbej, PhD
Hungary provides an attractive environment for clinical trials due to its:
1) Strong patient access programs that support high enrollment rates. These include a centralized patient database and satellite GP networks.
2) Supportive regulatory environment with efficient approval timelines under 60 days on average.
3) Established academic research centers that offer therapeutic expertise, trained personnel, and access to facilities like central laboratories and imaging. These support both early and late phase trials across therapeutic areas.
Xylem Clinical Research Pvt. Ltd. is an Indian Site Management Organization (SMO) that provides support for clinical trials from Phase I-IV. It aims to facilitate smooth execution of trials through services like SMO support, site coordination, regulatory writing, and ensuring sites are audit-ready. Xylem has experience managing sites in diseases like oncology, infectious diseases, and more. It has a team with over 50 years of combined clinical research experience to help sponsors and CROs conduct trials in India on time and to high quality standards.
The document summarizes discussions from an IPF/ILD Working Group meeting. It provides updates on several studies, including one characterizing the clinical features and healthcare utilization of IPF patients in the years before diagnosis. The study found increased healthcare resource use in the 2 years prior to an IPF diagnosis. Another study aims to evaluate diagnostic agreement across global sites. The working group discussed priorities for future research, including a Phase II study using digitized patient cases to assess diagnostic accuracy across different healthcare settings.
The document summarizes a study that evaluated methods for selecting pregnant or postpartum women with suspected pulmonary embolism (PE) for diagnostic imaging. The study aimed to estimate the accuracy, effectiveness and cost-effectiveness of using clinical features, decision rules and biomarkers to identify which patients need imaging. The study developed a diagnostic model to analyze the performance of these selection methods and assess their ability to safely reduce imaging while maintaining appropriate patient care.
An overview of the work and initial results of the REG-EAACI Taskforce assessing the quality of literature in the field of real-world respiratory medicine.
The External Review Committee evaluated CAPHRI School for Public Health and Primary Care for the period 2004-2009. Some key findings:
- CAPHRI has an international leading position in extramural research as evidenced by top publications in journals like Nature and The Lancet.
- The number of articles in top international journals is an astonishing achievement given CAPHRI's research topics in public health and primary care.
- CAPHRI demonstrates strong societal impact through dissemination of knowledge, stakeholder interest, and contributions to societal sectors.
- Overall CAPHRI receives a positive review with high ratings for quality, productivity, relevance and vitality. The committee concludes CAPHRI performs at an
The editorial discusses the publication of results from the REVIVE clinical trials that tested the drug levosimendan for acute decompensated heart failure. The trials were completed over 7 years ago but results were only recently published. The editorial argues that this late publication fulfills critical obligations to study participants who consented to the trials, and to clinical colleagues who need complete trial results to inform decisions. While levosimendan provided some benefits like reduced need for rescue interventions, it also increased risks like hypotension and arrhythmias. The editorial maintains researchers and sponsors have a duty to publish full trial results in a timely manner.
This document summarizes Professor Adrian Towse's presentation on assessing the value of new antibiotics. It discusses the challenges of developing new antibiotics due to scientific and economic hurdles. Current health technology assessment frameworks may not fully capture antibiotics' value in addressing antimicrobial resistance. Additional elements of value for antibiotics are proposed, including insurance value, diversity value, and enablement value. Evidence requirements for assessing these new elements were discussed. While not unique to antibiotics, these elements provide a more comprehensive evaluation. Further refinement is needed to incorporate these elements into health technology assessments.
REG Technologies Working Group Meeting 26/09/15Zoe Mitchell
This document provides an agenda and notes from a meeting of the Technologies Working Group of the Respiratory Effectiveness Group (REG). The meeting objectives were to agree terms of reference for the group, discuss initial seed projects, and identify 1-2 longer term projects. Under terms of reference, the group will focus on technology-based solutions for chronic respiratory conditions, with a focus on monitoring and behavioral change. Initial seed project ideas discussed included evaluating practices for developing technology solutions, a literature review on using health information to change patient behavior, and optimizing technology interfaces for older patients. Preliminary data from a PhD student's survey of stakeholder attitudes towards smart inhalers was also presented. The group discussed potential future projects and grant opportunities.
Koonal's slides from a short presentation (vignette) he gave at HTAi Annual Meeting 2018 summarising two study being undertaken in parallel to value health in children and adolescents. The audience comprised attendees at a conference focused on HTA.
This document discusses Denmark's national health registries and their use for epidemiological research. It notes that Denmark assigns unique personal identification numbers to all citizens, allowing accurate linkage between various health registries. This enables large population-based cohort studies with long-term follow up. The registries contain information on healthcare utilization, prescriptions, and diagnoses. Several studies are described that use the registries to study topics like MMR vaccination and autism, quality of diabetes care, and blood pressure control. Challenges with using registry data include ensuring validity of diagnoses and missing data. However, strengths include no selection bias, large sample sizes, and prospectively collected data.
Does society wish to prioritise end-of-life treatments over other types of tr...Office of Health Economics
Koonal Shah presented research on whether society prioritizes end-of-life treatments over other types of treatments. Seventeen studies were reviewed that examined public preferences on giving greater priority to health gains for end-of-life patients. The evidence was mixed, with some studies consistent with an end-of-life premium and others not finding clear support. Few studies compared preferences for quality of life improvements versus life extensions for end-of-life patients. Shah discussed factors like indifference options, visual aids, and accounting for age and time preferences that affected study findings. Further research was recommended to better understand preferences in this area.
This document discusses biobanks and registries, their value for research, and opportunities for patient involvement. It describes how biobanks store biological samples and associated data to support research. Registries collect standardized clinical data on patient populations over time. Both require governance and quality management. The document presents two cases where patient organizations were involved in biobank and registry co-creation and governance to help advance research.
PROMISE ethics panel final report, October 17, 2012erikanature
Final report of a specially commissioned panel tasked with examining the ethics of the PROMISE trials, which study different drug regimens to prevent mother to child transmission of HIV. The trials are sponsored by the US National Institute of Allergy and Infectious Disease, which commissioned the ethics review.
Audio video consenting process and role of CRC or PI during av consentingJagriti Bansal
The document outlines the requirements and process for audio-visual (AV) recording of informed consent for clinical trials in India. Key points include:
1. AV recording of informed consent is now mandatory per a 2013 order from the Drug Controller General of India, following a Supreme Court ruling.
2. The requirements for AV consenting include an approved protocol and consent form, the subject and principal investigator on camera, a private room, and storage of recordings.
3. The process involves introducing all parties, explaining the study and consent form verbally, having the subject sign, and answering questions to ensure understanding before signing.
4. Clinical research coordinators are responsible for assisting with the process, ensuring privacy,
Presentation_Thesis defense _Thi Ha VO. 16.12.2015HA VO THI
The document describes the development and validation of a new multidimensional tool called CLEO for assessing the potential impact of pharmacist interventions (PIs). It involved:
1. Conducting a systematic review of existing models and tools which identified limitations and informed the development of the optimal SP(ECH)O-P model.
2. Developing the CLEO tool based on the model, with 3 dimensions (clinical, economic, organizational) and defined scoring criteria.
3. Validating the CLEO tool by testing inter-rater and intra-rater reliability on samples of PIs, which showed moderate to substantial agreement, demonstrating the tool is reliable for assessing impacts of PIs
European clinical practice guideline on diagnosis hiponatremiaJaime dehais
1. Hyponatraemia, defined as a serum sodium concentration less than 135 mmol/l, is common in clinical practice and associated with increased mortality, morbidity, and length of hospital stay.
2. Despite this, management of patients with hyponatraemia remains problematic due to diverse approaches across institutions and specialties.
3. The European Society of Intensive Care Medicine, European Society of Endocrinology, and European Renal Association developed this joint clinical practice guideline to provide a standardized approach to diagnosis and treatment of hyponatraemia.
PanCareSurPass @SIOP Europe/CCI Europe Meeting 2021, Riccardo HauptKylieOBrien10
Research Manager Dr. Riccardo Haupt presented the PanCareSurPass project at the ‘PanCare and ELTEC – Late effects’ session of the SIOP Europe/CCI Europe Meeting 2021 on 28th April 2021.
PanCareSurPass has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 89999. The material presented and views expressed here are the responsibilities of the author(s) only. The EU Commission takes no responsibility for any use made of the information set out.
2nd European Conference on Clinical ResearchMarket iT
The document provides information on the organizers, program committee, and agenda for the 2nd European Conference on Clinical Research being held from February 2-4, 2015 in Paris, France. The pre-conference on February 2nd will focus on how clinical procurement can provide strategic value beyond cost reductions. The main conference on February 3rd-4th will involve presentations and debates on key issues in clinical research regulation, new technologies, risk management, and the patient's role. Topics will include the impacts and challenges of the new EU Clinical Trials Regulation and new operational practices in clinical trials.
The NIHR Research Design Service provides support to NHS staff and academics preparing research proposals for submission to peer-reviewed funding competitions for applied health or social care research.
This presentation shows how the Belgian Red Cross uses the principles of Evidence-Based Practice to support its humanitarian and development aid activities.
Aysun Karatas MedicReS World Congress 2015 MedicReS
A Non-Profit Sponsor Organisation for Investigator Initiated Oncologic Trials in Germany and Europe Presentation to MedicReS 5th World Congress on October 19,25,2015 in New York by Dr. Aysun Karatas
This document discusses patient involvement at the Medicines Evaluation Board (MEB) in the Netherlands. It makes three key points:
1. The MEB focuses on involving patients throughout the entire life cycle of a medicinal product to ensure the patient perspective is considered. Meetings are held 3-4 times per year and minutes are published online.
2. Strategies for patient involvement at the MEB include having a board member represent the patient perspective, consulting patient organizations on regulatory decisions and guidelines, and creating an online portal for patients.
3. Eliciting individual patient preferences could help identify subgroups with similar preferences to better tailor regulatory decisions and highlight situations where regulator and patient values differ requiring improved communication.
Brendan Delany – Chair in Medical Informatics and Decision Making, Imperial...HIMSS UK
The document discusses the EU-funded TRANSFoRm project, which aimed to develop methods and validated architectures to support a learning health system. The project involved 21 partners from 10 EU member states. It sought to enable real-time clinical diagnosis and trials using data from electronic health records. It developed ontologies and standards to maintain meaning across the learning health system. A prototype clinical decision support system integrated into a primary care electronic health record was evaluated in a simulation and found to improve diagnostic accuracy and management without increasing consultation time or test ordering.
The eumusc.net project was a panEuropean project on musculoskeletal (MSK) health. It developed an atlas of MSK health and tools to vigil it, standards of care for rheumatoid arthritis (RA) and osteoarthritis, quality indicators for RA, and tips for implementing all them.
El proyecto eumusc.net fue un proyecto paneuropeo sobre salud musculoesquelética (ME). Se desarrolló un atlas de y herramientas de vigilancia de la salud ME, estándares de cuidado para la artritis reumatoide (AR) y la artrosis, indicadores de calidad para la AR, y consejos para la implementación de todos ellos.
Ομιλία-Παρουσίαση: Edith Frénoy, Director of Market Access/HTA, European Federation of Pharmaceutical Industries Associations (EFPIA)
Τίτλος Ομιλίας: «HTA cooperation in Europe: can it support the Greek debate?»
The document summarizes guidelines from a consensus conference on the diagnosis and treatment of acute appendicitis (AA). Regarding diagnostic efficiency of clinical scoring systems:
- Several scoring systems have been developed to predict AA based on history, exam, and labs, including the Alvarado score and Appendicitis Inflammatory Response (AIR) score.
- The Alvarado score has been most extensively studied but performance depends on cutoff; an AIR score below 4 or above 8 can help rule out or rule in AA.
- Scoring systems can help structure management but none is sufficiently accurate alone to rule in or out surgery.
ECRIN provides support for multinational clinical trials across Europe. It offers diverse activities including trial preparation, protocol review, quality assurance, and capacity building projects. ECRIN develops tools to help with regulatory and ethical requirements. It also promotes quality through a data centre certification program. Patients are involved in ECRIN's scientific evaluation, international collaboration efforts, and some are active participants in supported clinical trials. Communication and public awareness activities help stimulate discussion about challenges in multinational clinical research.
Purpose of the call:
•Review current data and state of the SSCL
•Discuss the role of communications and team work in patient safety
•Discuss and define how we can measure the effectiveness of the SSCL.
Read more and watch the webinar recording: http://bit.ly/1sXDqaZ
This document provides guidelines for the use of topical antiseptic and antimicrobial agents in wound management. It was developed by a multidisciplinary group of experts and is intended to help clinicians determine when, why, and how to appropriately use these agents. The document discusses the need to use antimicrobials in a targeted manner for short durations based on clinical signs of infection rather than arbitrary timelines. It also addresses issues like antibiotic resistance and the role of antiseptics in wound healing.
The document discusses a seminar on assessing eHealth and telemedicine services with a focus on patient outcomes and involvement. It describes several frameworks for assessment, including MAST, a multidimensional framework adopted in several European countries. MAST suggests a three stage assessment process including pre-assessment, multidisciplinary assessment of domains like clinical effectiveness and patient perspective, and assessing transferability. Effective involvement of patients is highlighted, noting they can provide information on outcomes and expectations through methods like interviews, questionnaires and diaries. Their views are influenced by factors like comfort with technology and interaction with professionals.
Similar to GIN conference and Cochrane Colloquium 2018 (20)
Poster Methodological expert group @G-I-N conference Manchester (UK) 2018CEBaP_rkv
The document describes the establishment of a methodological Expert Group in Belgium to help optimize primary care guideline development. The Expert Group, consisting of 7 members, focuses on methodology and preparation to support Guideline Development Groups working on specific guidelines. This allows each group to focus on either methodological aspects or guideline content and clinical expertise. So far the Expert Group has supported 3 single-topic and 3 multi-topic guideline revisions and start-ups. Monthly meetings are held to follow guideline progress, improve processes, and strengthen methodological expertise. The Expert Group approach seems promising for sustaining high-quality primary care guideline development in Belgium by leveraging the strengths of individual group members.
Oral presentation ICC-PBM 2018 @ G-I-N conference Manchester (UK) 2018CEBaP_rkv
The document describes how an international consensus conference on patient blood management (ICC-PBM) integrated the GRADE approach and a formal consensus methodology. A scientific committee formulated 17 questions to guide 3 topics of interest. A 2-day conference included 200 medical experts from 10 disciplines who reviewed evidence using GRADE. It included open sessions for evidence presentation, discussion, and closed executive sessions where decision-making panels drafted recommendations. The process aimed to develop transparent, evidence-based consensus guidelines for optimizing patient blood management.
An evidence-based guideline to assist volunteers in working with at-risk chil...CEBaP_rkv
This document describes the development of an evidence-based guideline to assist volunteers in selecting effective activities for at-risk children in preschool and primary school. The authors conducted a systematic review which identified 8 reviews and 37 studies. They developed recommendations for activities based on the evidence quality and practical considerations. Seven activities were recommended for preschoolers, including book reading, road safety games, number games, and playing with blocks. Two activities were recommended for primary school children: reading books and poetry. The guideline aims to help volunteers choose interventions that provide maximum benefits to at-risk children.
Standard wording for formulating evidence conclusions and implications for re...CEBaP_rkv
There is a document outlining guidelines for standardizing the wording used in evidence conclusions and recommendations in evidence-based reviews developed by the Centre for Evidence-Based Practice of Belgian Red Cross-Flanders. The document provides criteria for evidence conclusions, including specifying the number and type of studies, intervention, comparison, outcome, level of evidence, and direction of effect. It establishes standard wording for different categories of evidence conclusions based on statistical significance, level of evidence, and precision of results. The implications for drafting recommendations based on the evidence conclusions are also discussed.
Implementation of evidence-based African First Aid Materials (AFAM) in Sub-Sa...CEBaP_rkv
1. The document discusses the development and implementation of African First Aid Materials (AFAM) to provide evidence-based first aid guidelines adapted for contexts in Sub-Saharan Africa.
2. AFAM materials have been implemented in several Red Cross national societies across Africa. Feedback indicates that the flexible materials allow for adaptation while maintaining an evidence-based approach.
3. The presentation provides specific examples of AFAM's impact through the Uganda Red Cross Society, such as training over 3,000 people in evidence-based first aid and conducting several first aid simulations for communities. Areas for further improvement are also discussed.
The document discusses the development of the Indian First Aid Guidelines (IFAG) through an international partnership between the Indian Red Cross Society and Belgian Red Cross-Flanders. It describes the IFAG as evidence-based first aid guidelines developed using an expert panel and aimed at training Indian laypeople. The guidelines were created through a multi-step process including defining topics, searching multiple databases, assessing evidence quality, drafting recommendations, and reviews by experts and peers to ensure the guidelines are appropriate for the Indian context.
Are individuals presenting with hypotension eligible as whole blood donors? A...CEBaP_rkv
1) A systematic review was conducted to determine if hypotension increases the risk of adverse donor events compared to normotension in whole blood donors.
2) The review identified 10 observational studies including over 1.4 million donations.
3) Five high quality studies that controlled for confounding factors found no evidence that hypotension independently predicts donor complications.
4) Based on the current evidence, hypotension alone has not been shown to increase health risks for blood donors.
Poster Presentation meta-analysis bed nets (22nd Cochrane Colloquium, Hyderab...CEBaP_rkv
From 21-26 september 2014, the 22nd Cochrane Colloquium was held in Hyderabad (India). CEBaP presented the results of a meta-analysis regarding the effectiveness of bed nets to prevent malaria in India. We concluded that bed nets were considered as an effective intervention to prevent malaria in Indian laypeople. This analysis was part of the IFAG project (Indian First Aid Guidelines), a collaborative project of the Indian Red Cross Society and Red Cross-Flanders.
Van 21 tot en met 26 september 2014 vond in Hyderabad (India) het 22e Cochrane Colloquium plaats. CEBaP presenteerde er de resultaten van een meta-analyse betreffende de effectiviteit van bed netten ter preventie van malaria in India. We concludeerden dat bed netten als een effectieve interventie kunnen beschouwd worden ter preventie van malaria voor de Indische bevolking. Deze analyse was een onderdeel van het IFAG project (Indian First Aid Guidelines), een gezamenlijk project van het Indische Rode Kruis en Rode Kruis-Vlaanderen.
1) A systematic review was conducted to determine if hypotension increases the risk of adverse donor events compared to normotension in whole blood donors.
2) Ten observational studies including over 1.48 million donations were identified that addressed this question.
3) Five high-quality studies found that hypotension had not been shown to independently predict donor complications.
4) The overall quality of evidence was determined to be low, indicating further research is needed.
European conference on donor health & managementCEBaP_rkv
We conducted a systematic review to determine whether people with low blood pressure can safely donate blood. Be sure to check our presentation, which we delivered at the European Conference on Donor Health & Management in The Hague. + link naar de presentatie via Slideshare.
ESPP presentation to EU Waste Water Network, 4th June 2024 “EU policies driving nutrient removal and recycling
and the revised UWWTD (Urban Waste Water Treatment Directive)”
ESR spectroscopy in liquid food and beverages.pptxPRIYANKA PATEL
With increasing population, people need to rely on packaged food stuffs. Packaging of food materials requires the preservation of food. There are various methods for the treatment of food to preserve them and irradiation treatment of food is one of them. It is the most common and the most harmless method for the food preservation as it does not alter the necessary micronutrients of food materials. Although irradiated food doesn’t cause any harm to the human health but still the quality assessment of food is required to provide consumers with necessary information about the food. ESR spectroscopy is the most sophisticated way to investigate the quality of the food and the free radicals induced during the processing of the food. ESR spin trapping technique is useful for the detection of highly unstable radicals in the food. The antioxidant capability of liquid food and beverages in mainly performed by spin trapping technique.
When I was asked to give a companion lecture in support of ‘The Philosophy of Science’ (https://shorturl.at/4pUXz) I decided not to walk through the detail of the many methodologies in order of use. Instead, I chose to employ a long standing, and ongoing, scientific development as an exemplar. And so, I chose the ever evolving story of Thermodynamics as a scientific investigation at its best.
Conducted over a period of >200 years, Thermodynamics R&D, and application, benefitted from the highest levels of professionalism, collaboration, and technical thoroughness. New layers of application, methodology, and practice were made possible by the progressive advance of technology. In turn, this has seen measurement and modelling accuracy continually improved at a micro and macro level.
Perhaps most importantly, Thermodynamics rapidly became a primary tool in the advance of applied science/engineering/technology, spanning micro-tech, to aerospace and cosmology. I can think of no better a story to illustrate the breadth of scientific methodologies and applications at their best.
This presentation explores a brief idea about the structural and functional attributes of nucleotides, the structure and function of genetic materials along with the impact of UV rays and pH upon them.
EWOCS-I: The catalog of X-ray sources in Westerlund 1 from the Extended Weste...Sérgio Sacani
Context. With a mass exceeding several 104 M⊙ and a rich and dense population of massive stars, supermassive young star clusters
represent the most massive star-forming environment that is dominated by the feedback from massive stars and gravitational interactions
among stars.
Aims. In this paper we present the Extended Westerlund 1 and 2 Open Clusters Survey (EWOCS) project, which aims to investigate
the influence of the starburst environment on the formation of stars and planets, and on the evolution of both low and high mass stars.
The primary targets of this project are Westerlund 1 and 2, the closest supermassive star clusters to the Sun.
Methods. The project is based primarily on recent observations conducted with the Chandra and JWST observatories. Specifically,
the Chandra survey of Westerlund 1 consists of 36 new ACIS-I observations, nearly co-pointed, for a total exposure time of 1 Msec.
Additionally, we included 8 archival Chandra/ACIS-S observations. This paper presents the resulting catalog of X-ray sources within
and around Westerlund 1. Sources were detected by combining various existing methods, and photon extraction and source validation
were carried out using the ACIS-Extract software.
Results. The EWOCS X-ray catalog comprises 5963 validated sources out of the 9420 initially provided to ACIS-Extract, reaching a
photon flux threshold of approximately 2 × 10−8 photons cm−2
s
−1
. The X-ray sources exhibit a highly concentrated spatial distribution,
with 1075 sources located within the central 1 arcmin. We have successfully detected X-ray emissions from 126 out of the 166 known
massive stars of the cluster, and we have collected over 71 000 photons from the magnetar CXO J164710.20-455217.
BREEDING METHODS FOR DISEASE RESISTANCE.pptxRASHMI M G
Plant breeding for disease resistance is a strategy to reduce crop losses caused by disease. Plants have an innate immune system that allows them to recognize pathogens and provide resistance. However, breeding for long-lasting resistance often involves combining multiple resistance genes
What is greenhouse gasses and how many gasses are there to affect the Earth.moosaasad1975
What are greenhouse gasses how they affect the earth and its environment what is the future of the environment and earth how the weather and the climate effects.
The binding of cosmological structures by massless topological defectsSérgio Sacani
Assuming spherical symmetry and weak field, it is shown that if one solves the Poisson equation or the Einstein field
equations sourced by a topological defect, i.e. a singularity of a very specific form, the result is a localized gravitational
field capable of driving flat rotation (i.e. Keplerian circular orbits at a constant speed for all radii) of test masses on a thin
spherical shell without any underlying mass. Moreover, a large-scale structure which exploits this solution by assembling
concentrically a number of such topological defects can establish a flat stellar or galactic rotation curve, and can also deflect
light in the same manner as an equipotential (isothermal) sphere. Thus, the need for dark matter or modified gravity theory is
mitigated, at least in part.
Current Ms word generated power point presentation covers major details about the micronuclei test. It's significance and assays to conduct it. It is used to detect the micronuclei formation inside the cells of nearly every multicellular organism. It's formation takes place during chromosomal sepration at metaphase.
Phenomics assisted breeding in crop improvementIshaGoswami9
As the population is increasing and will reach about 9 billion upto 2050. Also due to climate change, it is difficult to meet the food requirement of such a large population. Facing the challenges presented by resource shortages, climate
change, and increasing global population, crop yield and quality need to be improved in a sustainable way over the coming decades. Genetic improvement by breeding is the best way to increase crop productivity. With the rapid progression of functional
genomics, an increasing number of crop genomes have been sequenced and dozens of genes influencing key agronomic traits have been identified. However, current genome sequence information has not been adequately exploited for understanding
the complex characteristics of multiple gene, owing to a lack of crop phenotypic data. Efficient, automatic, and accurate technologies and platforms that can capture phenotypic data that can
be linked to genomics information for crop improvement at all growth stages have become as important as genotyping. Thus,
high-throughput phenotyping has become the major bottleneck restricting crop breeding. Plant phenomics has been defined as the high-throughput, accurate acquisition and analysis of multi-dimensional phenotypes
during crop growing stages at the organism level, including the cell, tissue, organ, individual plant, plot, and field levels. With the rapid development of novel sensors, imaging technology,
and analysis methods, numerous infrastructure platforms have been developed for phenotyping.
Nucleophilic Addition of carbonyl compounds.pptxSSR02
Nucleophilic addition is the most important reaction of carbonyls. Not just aldehydes and ketones, but also carboxylic acid derivatives in general.
Carbonyls undergo addition reactions with a large range of nucleophiles.
Comparing the relative basicity of the nucleophile and the product is extremely helpful in determining how reversible the addition reaction is. Reactions with Grignards and hydrides are irreversible. Reactions with weak bases like halides and carboxylates generally don’t happen.
Electronic effects (inductive effects, electron donation) have a large impact on reactivity.
Large groups adjacent to the carbonyl will slow the rate of reaction.
Neutral nucleophiles can also add to carbonyls, although their additions are generally slower and more reversible. Acid catalysis is sometimes employed to increase the rate of addition.
8.Isolation of pure cultures and preservation of cultures.pdf
GIN conference and Cochrane Colloquium 2018
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. 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. 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. 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.
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. 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. 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. 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
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. 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. 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. 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.
16. 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
17. 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
+
18. 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
25. 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
26. Plenary session with the general audience (all 3 topics)
Presentation draft recommendations/justifications by
AudienceRapporteurs
(Co-)chairs Panelists
Day 2 (25 April 2018)
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
AudienceRapporteurs
(Co-)chairs Panelists
Day 2 (25 April 2018)
28. 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)
31. 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).
32. 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)
34. Translating evidence into practical tools
to teach first aid to children
in sub-Saharan Africa
Anne-Catherine Vanhove – Researcher Centre for Evidence-Based Practice
35. Conflict of interest
I have no actual or potential conflict of interest in relation to this presentation.
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
38. 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
39. Methodology
First Aid Service &
International CooperationCentre for
Evidence-Based Practice
Panel of external experts
40. 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
41. 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
44. 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:
46. 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)
47. 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
48. 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
51. 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
53. 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
54. 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
55. 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