Power point presented during the Panel session: Guideline Adaptation: different methods, different experiences, mapping a way forward; 9th G-I-N International Conference, Berlin, Germany 22nd-25th August 2012 by Dr Yasser Sami Abdel Dayem Amer representing the Alexandria CEBCPGs and Healthcare Quality Directorate of Alexandria University Hospitals with Prof. Dr. Tarek Omar, Professor of Pediatrics, Alexandria Faculty of Medicine

2. Alexandria University Hospitals
Healthcare Quality Directorate
Center for Evidence-Based Clinical Practice Guidelines
(AUH – HCQD, CEBCPGs)
(Founded Nov. 2008)
Member of Guidelines International Network (G-I-N)
(Since May 2009)

3. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines

4. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines

5. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
First Workshop in Egypt
Adaptation of CPGs - 2009 (AFM-GIN-ADAPTE)

6. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
Develop
Adapt
Adopt
Read

7. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
*12 M.Sc. Theses plus 1 Ph.D. thesis to produce 13 Adapted EBCPGs
4 Finalized Adapted CPGs by CEBCPGs, HCQD-AUHs through MSc Theses
(till 3/2012) in PEDIATRICS DEPT.:
1- Treatment of Acute Childhood Asthma in ER - AUCH: Dr. Yasser Sami Amer (Finalized, Approved ,
Disseminated & Implemented).
2- Treatment of Positioning & Attachment Breast Feeding Problems in BFCC - AUCH: Dr. Georgina
Ramsis (Finalized & Approved).
3- Triage and Acuity Scale in A & E Dept., AMUH: Dr. Mary Christeen Nabiel Sharobeem (Finalized,
Approved & Disseminated ) – the only thesis outside the Pediatrics Dept.
4- Treatment of HIE in Neonates in NICU: Dr. Walid Gamal AbdelKhaliq
(Finalized & Approved).
9 Adapted CPGs in progress by Pediatrics Dept. & CEBCPGs, HCQD-AUHs through
MSc/PhD Theses (till 8/2012):
1. Treatment of ADHD in children in AUCH: Dr. Mariana Iskander Amin (Finalization Phase).
2. Diagnosis of acute attack of seizures in AUCH: Dr. Soheir Farouk AbdelSalam (Set Up Phase).
3. Treatment of acute attack of seizures in AUCH : Dr. Islam Yousry A.Moneium (Set Up Phase).
4. Management of Epilepsy in children in AUCH: Dr. Shimaa Anwar (Set Up Phase)
5. Treatment of Childhood Autism in AUCH: Dr. Farioz Ibrahim (Set Up Phase).
6. Management of Acute Bacterial Meningitis in AUCH: Dr Mariam Adly (Set Up Phase).
7. Treatment of Chronic Asthma in AUCH: Dr. Reem Galal Ghazal (Set Up Phase).
8. Treatment of Community Acquired Pneumonia in AUCH: Dr. Zobaida Eltazmany (Set Up Phase).
9. Treatment of Allergic Rhinitis in AUCH: Dr. Shahinaz (Set Up Phase).

8. 4 Finalized Adapted CPGs

9. Alexandria University Hospitals
HCQD - CEBCPGs'
Adapted ADAPTE Methodology
for EBCPGs Adaptation
Proposed by YASSER AMER
Supervised & Approved by MAHMOUD ELZALABANY, TAREK OMAR
& AFAF IBRAHIM
TheIs Adaptablemethods are adapted from the
proposed
original ADAPTE Process (The ADAPTE
according to
local settings
Collaboration's (2009); The ADAPTE Process:
NMC 2009
Resource Toolkit for Guideline Adaptation.
(Version 2.0)

10. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
These CEBCPGs' Methods consist
of two main parts;
Part One:
Cross-sectional/ or retrospective study survey via self-
administered Questionnaire &/or Interview of the target
healthcare Professionals & Medical Records of target
Population (patients) for Assessment of the current
situation of practice in the selected healthcare context;
 to identify/select high priority health topic(s) for CPG
Adaptation
 & to justify the need for producing an CPG for this
selected topic and expected benefit and outcome for
disseminating and implementing this adapted CPG.

11. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
Part Two
The Adapted ADAPTE Methodology
©Copyright ADAPTE 2007

12. Adaptation Phase
Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
We identified 3 main ADAPTE steps:-
Health Questions
(PIPOH)
AGREE Instrument (I, II, III)
Assess source CPGs quality
External Review
(Consensus)

13. Adaptation Phase
Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
ADAPTE Tools Alternatives to:-

14. Adaptation Phase
Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
Original ADAPTE Tool Adapted ADAPTE
(Alternative)
Assess the source CPGs AGREE II Instrument
consistency: Evaluation of Domain 3. Rigour of
Search/selection of evidence & Development scores
Scientific Validity of CPGs/
Consistency between evidence, its Consider
interpretation and recommendations incorporating
Assess Acceptability/ AGREE II Instrument
Applicability of Domain 5. Applicability scores
recommendations & Domain 2. Stakeholder
Involvement scores;

15. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
Solutions
If CPGs retrieved were low-quality (No clear methodology, levels of
evidence and grades of recommendations & the developers did not reply to
any of our emails to receive them; The panel can do Critical Appraisal
of the reference studies (articles) and classify their evidence
according to type of study (e.g. Systematic reviews, MAs, RCTs,…etc.)
and /or create Evidence-tables (e.g. like what the panel did in Triage &
HIE CPG Adaptation). Then the panel can decide at this point here
whether to pursuit for CPG development or adaptation.
(? may also consider concept)

16. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
Lessons for CPGs
Developers, Adapters,
Implementers and
7 Users

17. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
Lessons learned
1) Health Topics for CPG Adaptation &
Implementation should be selected based on Cross-
sectional study surveys for local Healthcare
Professionals (e.g. Needs Assessment, Review of Medical
Records, Self-administered Questionnaires and Interviews)
.

18. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
Lessons learned (cont’d)
2) Adaptation of CPGs as a valid alternative to de
novo development has the benefit of reduction of
the costs/ time, avoid practice variations, consider
availability of resources, respect difference between
patient populations, local policies, and practice
patterns and promote the sense of ownership among
target users.

19. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
Lessons learned (cont’d)
3) Examples of Successful CPGs Implementation
Strategies; i) For Practitioners: Tools designed to
facilitate behavioral/practice changes (e.g. Posters &
Brochures of Clinical algorithms & Flow charts),
Educational material (printed/ electronic),
Educational meetings (e.g. conferences, lectures &
workshops) & Local Clinical Champions; and
ii) For Patients/ Parents/Carers: Education materials
(printed and electronic) & meetings.

20. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
Official website:
http://www.alexmed.edu.eg/?page_id=1278
Last accessed 8/2012

21. https://www.facebook.com/pages/Alexandria-Center-for-Evidence-Based-Clinical-
Practice-Guidelines/124300224291530?ref=hl

22. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
The Final Adapted CPG document
The Final
Adapted
CPG
document
FIRST OF ITS KIND IN EGYPT
AUCH, AFM & AUHs

23. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
The Final Adapted CPG document
47 pages
document (with
added tools).
Reviewed by
Pediatric
Repir., Allergy &
Immuno.
Unit, AFM Staff
members.
Approved by
Pediatrics Dept.
& AFM Councils

24. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
Implementations Tools
for the Adapted CPG

25. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
I-1. Clinical algorithms (for <
2 yrs)

26. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
I-2. Clinical algorithms (for 2-
5 yrs)

27. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
I-3. Clinical algorithms (for
> 5 yrs)

28. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
II-1. Asthma Action Plan
(English)

29. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
II-2. Asthma Action Plan
(Arabic)

30. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
III- Patient Guide-Inhalers (Poster-
Arabic)

31. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
IV- Patient information
(Arabic)

32. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
Lessons learned (cont’d)
4) The Finalized Adapted CPGs should be included in
the Training Curricula of both
Undergraduate and Postgraduate Medical Students
and as a part of any Healthcare Facility’s Policy for
Residency Training.

33. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
Lessons learned (cont’d)
5) Follow up of the implementation,
dissemination and updating of the CPG as a
vital step in the process of Adaptation (the
living CPG concept).

34. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
Lessons learned (cont’d)
6) Promote and Improve National (e.g. through local
different HCFs/ sectors) and International (e.g.
through G-I-N) Collaboration in CPGs
activities.

35. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
Lessons learned (cont’d)
7) Coordinate, organize and promote Establishment &
Activation of; ‘Multidisciplinary’ CPGs
Committees/ Adaptation Working groups from the
Staff of all Clinical Departments of selected HCFs
(to involve practitioners & patients); and of a
National CPGs Database(s), enabling the systematic
search, comparison and dissemination of CPGs
from all members of Committees/ WGs.

36. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
Prof. Dr. Nabil Dowidar
Professor of General Surgery , MRI
Head, Alexandria Center for EBM, MRI
Founding Member, Health Governance Unit, MRI
Former Dean, MRI
Medical Research Institute (MRI)
Prof. Dr. Afaf Ibrahim
Professor of Public Health, Social & Preventive Medicine, AFM
Head, Community Medicine Dept.
Director, CEBCPGs , HCQD-AUHs

37. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
Dr. Yasser Sami Amer
M.Sc. Pediatrics, M.Sc. Healthcare Informatics
Hospital Clinical Guidelines & Pathway General
Coordinator, CEBCPGs, HCQD-AUHs, Primary Contact Person for G-I-N
Dr. Hossam Dhorgham
M.Sc. Pediatrics, M.Sc. Healthcare Management
Former Healthcare Quality Coordinator, HCQD-AUHs
Former Head, Accreditation & Licensure Directorate, HCQD-AUHs
Eng. Ahmed Mourady
Communication & Electronics Engineer
E-Learning Consultant,
Former Local Project Manager, Modernization of AUHs in Smouha

38. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
Prof. Dr. Tarek Omar
Professor of Pediatrics & Ped. Neurology, AFM
General Supervisor CEBCPGs & HCQD-AUHs.
Former Head, AUHs Sector

39. Healthcare Quality Directorate - Alexandria University Hospitals
Center for Evidence-Based Clinical Practice Guidelines
Prof. Dr. Mahmoud El-Zalabany
Professor of Pediatrics & Ped. Respiratory, Allergy & Immunology
Former Dean, AFM
Former Chairman, AUHs Board

40. Healthcare Quality Directorate - Alexandria University Hospitals
Bernard
Center for Evidence-Based Clinical Practice Guidelines
Magali Bernand Virginia
Remy- Moyer
Stockinger
Acknowledgement & due gratitude to all members of G-I-N &
ADAPTE for their continuous support & sincere guidance
Najoua
throughout this work especially ….
Rachel
Beatrice Mlika- Voellinger
Fervers Cabanne
Ali El-
Sara Ghorr
Twadle
Philip van
der Wees

41. Dr. Yasser Sami Amer
MSc Pediatrics, MSc HC Informatics
Founding Member, G. Coordinator,
CEBCPGs, HCQD-AUHs