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      WSES guidelines updates

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          The World Society of Emergency Surgery promotes training and continuing medical education in the field of emergency surgery and trauma. One of the most important activities of the society is the development of guidelines. The debate about the process of developing and updating guidelines is very active with no clear consensus and different policies among scientific societies. The present commentary provides the position of the World Society of Emergency Surgery on guideline development process and their update.

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          Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: how quickly do guidelines become outdated?

          Practice guidelines need to be up-to-date to be useful to clinicians. No published methods are available for assessing whether existing practice guidelines are still valid, nor does any empirical information exist regarding how often such assessments need to be made. To assess the current validity of 17 clinical practice guidelines published by the US Agency for Healthcare Research and Quality (AHRQ) that are still in circulation, and to use this information to estimate how quickly guidelines become obsolete. We developed criteria for defining when a guideline needs updating, mailed surveys to members of the original AHRQ guideline panels (n = 170; response rate, 71%), and searched the literature for evidence through March 2000 (n = 6994 titles yielding 173 articles plus 159 new guidelines on the same topics). Identification of new evidence calling for a major, minor, or no update of the 17 guidelines; survival analysis of the rate at which guidelines became outdated. For 7 guidelines, new evidence and expert judgment indicated that a major update is required; 6 were found to be in need of a minor update; 3 were judged as still valid; and for 1 guideline, we could reach no conclusion. Survival analysis indicated that about half the guidelines were outdated in 5.8 years (95% confidence interval [CI], 5.0-6.6 years). The point at which no more than 90% of the guidelines were still valid was 3.6 years (95% CI, 2.6-4.6 years). More than three quarters of the AHRQ guidelines need updating. As a general rule, guidelines should be reassessed for validity every 3 years.
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            Assessing the need to update prevention guidelines: a comparison of two methods.

            An important concern for developers of clinical practice guidelines is how best to determine when guidelines require updating to ensure they remain current and evidence based. Because of the high costs associated with updating guidelines, recent attention has focused on approaches that can reliably assess the extent of updating required. Recently, Shekelle and colleagues proposed a model of limited literature searches with modest expert involvement as a way to reduce the cost and time requirements for assessing whether a guideline needs updating. The main objective of this study was to compare the Shekelle et al. assessment model (review approach) and a conventional process using typical systematic review methods (traditional approach) in terms of comprehensiveness and effort. We modeled the review approach on that by Shekelle and colleagues but refined it iteratively over three phases to achieve greater efficiency. Using both methods independently, we assessed the need to update six topics from the 1996 Guide to Clinical Preventive Services from the US Preventive Services Task Force. Main outcomes included completeness of study identification, importance of missed studies and the effort involved. Although the review approach identified fewer eligible studies than the traditional approach, none of the studies missed was rated as important by task force members acting as liaisons to the project with respect to whether the topic required an update. On average, the review approach produced substantially fewer citations to review than the traditional approach. The effort involved and potential time saving depended largely on the scope of the topic. The revised review approach provides an efficient and acceptable method for judging whether a guideline requires updating.
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              From outdated to updated, keeping clinical guidelines valid.


                Author and article information

                World J Emerg Surg
                World J Emerg Surg
                World Journal of Emergency Surgery : WJES
                BioMed Central (London )
                10 June 2020
                10 June 2020
                : 15
                [1 ]GRID grid.7563.7, ISNI 0000 0001 2174 1754, General and Emergency Surgery Department, School of Medicine and Surgery, , Milano-Bicocca University, ; Monza, Italy
                [2 ]GRID grid.144189.1, ISNI 0000 0004 1756 8209, General, Emergency and Trauma Surgery Department, , Pisa University Hospital, ; Pisa, Italy
                [3 ]GRID grid.415402.6, ISNI 0000 0004 0449 3295, Trauma Surgery Department, , Scripps Memorial Hospital La Jolla, ; San Diego, CA USA
                [4 ]General and Emergency Surgery, Macerata Hospital, Macerata, Italy
                [5 ]GRID grid.414682.d, ISNI 0000 0004 1758 8744, General, Emergency and Trauma Surgery Department, , Bufalini Hospital, ; Cesena, Italy
                [6 ]GRID grid.239638.5, ISNI 0000 0001 0369 638X, Trauma Surgery, , Denver Health, ; Denver, CO USA
                [7 ]GRID grid.18147.3b, ISNI 0000000121724807, Department of General Surgery, University Hospital of Varese, , University of Insubria, ; Varese, Italy
                [8 ]GRID grid.413731.3, ISNI 0000 0000 9950 8111, Division of General Surgery, , Rambam Health Care Center, ; Haifa, Israel
                [9 ]Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
                © The Author(s) 2020

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                guidelines, evidence-based medicine, guideline development, guideline update, wses


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