I recently spoke with Richard M. Rosenfeld, MD, MPH, conference co-chair, chair of Guidelines International Network North America (G-I-N NA), and a G-I-N trustee, regarding the upcoming Evidence-Based Guidelines Affecting Policy, Practice and Stakeholders (E-GAAPS) conference in New York City on December 10–11, 2012.

TG: What prompted G-I-N NA to host this conference?

RR: We created this conference for the same reason G-I-N NA was formed: to help fulfill a pressing need for networking, communication, and exchange of best ideas and practices among individuals and organizations that develop, adapt, disseminate, and implement clinical practice guidelines.

TG: I notice there is a number of high-profile speakers and faculty for this two-day conference. How were these individuals selected?

RR: We began by forming a program committee representing the conference sponsors (G-I-N North America and the New York Academy of Medicine) and then added key individuals to represent additional stakeholders. We set the bar high and sought to identify and engage the best and brightest individuals in the field. The resulting speaker roster is literally a “who’s who” of luminaries in guidelines and related disciplines (e.g., media, communications, health policy, etc.).

TG: Who should attend this conference?

RR: Quite simply anyone who uses, adapts, develops, disseminates, or implements guidelines can benefit from the plenary sessions and numerous workshops. This includes not only clinicians, but also students, the public, consumers, the media, administrators, health policy makers, and staff from professional medical associations.

TG: Will there be opportunities for guideline developers to network or present information about their development and dissemination practices?

RR: Yes, we have set aside space for networking throughout the program. A primary objective of the G-I-N is to promote communication and networking, and this them is reflected the conference.

TG: What are G-I-N NA’s measures of success for this course?

RR: First, we would like to see spirited participation and exchange of ideas in the numerous workshop and breakout sessions that are a highlight of the program. Second, we would like to see increased interest and participation in G-I-N NA and the parent organization, G-I-N, to ensure that future events, webinars, and conferences best fulfill the needs of the North American guideline community. 

I hope to see you at the E-GAAPS conference on December 10–11 in New York City. Visit www.nyam.org/events/2012/evidence-based-guidelines-conference.html for more information on the meeting and registration.

We invite you to share your thoughts on a Medscape article¹ that asserts that a majority of guidelines fails to meet the Institute of Medicine (IOM) standards for development of systematic reviews (SRs)² and clinical practice guidelines (CPGs).³ Did any of you think your respective organizations would be further along in this transition than you are?

Here are some examples of the AAN’s progress to date on meeting the standards.

1. We updated our process manual in November 2011 to be consistent with the standards both for SRs and CPGs.

2. We established a grandfather period for all projects in process, allowing project teams 18 months to produce a guideline draft for review by the AAN Guideline Development Subcommittee (GDS). Now that the period has ended, the GDS will review the drafts from those project teams that produced a draft by the deadline, and will focus on developing IOM-compliant SRs and CPGs.

3. We drastically reduced the number of projects we have in process. At one time we had 70 guidelines in process; now we will be focused on developing four SRs and four CPGs, each of which will be IOM compliant.

What have you and your organizations done to attempt to meet the standards within your processes? Please share your thoughts within the comments.

¹Barclay L., Clinical Practice Guidelines Fail to Meet IOM Standards. Medscape. www.medscape.com/viewarticle/773099?src=nldne. Published October 22, 2012. Accessed October 22, 2012.

²Institute of Medicine of the National Academies. Finding What Works in Health Care: Standards for Systematic Reviews. www.iom.edu/Reports/2011/Finding-What-Works-in-Health-Care-Standards-for-Systematic-Reviews.aspx. Released March 23, 2011. Accessed March 23, 2011.

³Institute of Medicine of the National Academies. Clinical Practice Guidelines We Can Trust: Standards for Developing Trustworthy Clinical Practice Guidelines (CPGs). www.iom.edu/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust.aspx. Released March 23, 2011. Accessed March 23, 2011.

It has been a year and a half since the Institute of Medicine (IOM) published its standards for development of systematic reviews (SRs)¹ and clinical practice guidelines (CPGs).² In that time, the American Academy of Neurology (AAN) has updated its process for developing SRs and CPGs in accordance with the IOM standards. To test this new process, we chose two guideline projects as pilot efforts: immunizations in multiple sclerosis (MS) and disorders of consciousness.

To enable public comment, we worked with our marketing team to put together a strategy to reach AAN members and the public. Here are some ideas we implemented:

·         Email to all AAN members

·         Email to the Neurology Now® group for patients with MS

·         Pitch to public relations teams of major patient advocacy organizations

·         Posting of information on the Facebook page of Neurology Now, the AAN’s publication for patients

·         Posting of information on the largest Facebook groups for patients with MS

·         Posting of links on the AAN Twitter channel (@AANPublic)

·         Posting of links on the Neurology Now Twitter channel (@NeurologyNow)

·         Posting on AAN Google+ pages

The AAN’s first public comment was for the immunization in MS protocol, the project plan draft for the guideline development effort. We posted the protocol on the AAN website in August for 30 days. We had 63 individuals review the protocol and provide comment. Of those reviewers, 10 were AAN members, and 53 were nonmembers. A total of 79 comments were made.

The disorders of consciousness protocol underwent public comment from September to October. We had 18 individuals review the protocol and comment. Of those reviewers, 8 were AAN members, and 10 were nonmembers. A total of 41 comments were made.

After completing two public comment periods, we have found that this process is more complicated than we originally envisioned. It is difficult to coordinate communications with all of the parties we would like to invite for document review. In spite of this challenge, we have found that most of the reviewers have provided valuable comments.

We are excited to be able to incorporate feedback from these stakeholders in our development process. We still have some kinks to work out, but we believe this process will make for a much better product.

¹Institute of Medicine of the National Academies. Finding What Works in Health Care: Standards for Systematic Reviews. www.iom.edu/Reports/2011/Finding-What-Works-in-Health-Care-Standards-for-Systematic-Reviews.aspx. Released March 23, 2011. Accessed March 23, 2011.

²Institute of Medicine of the National Academies. Clinical Practice Guidelines We Can Trust: Standards for Developing Trustworthy Clinical Practice Guidelines (CPGs). www.iom.edu/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust.aspx. Released March 23, 2011. Accessed March 23, 2011.

New AAN Guideline Evaluates Bell Palsy Treatments

Read the new practice guideline

Oral steroids can improve the likelihood of full facial recovery in people with new-onset Bell palsy, according to “Evidence-based Guideline Update:  Steroids and Antivirals for Bell Palsy,” that was published electronically ahead of print on November 7, 2012, and appears in the November 27, 2012, issue of Neurology®. The efficacy of oral steroids is supported by well-designed, high-quality studies.

Efficacy of Antiviral Therapy Questionable

Antiviral therapy alone has not been shown in well-designed studies to increase the likelihood of full facial recovery. Physicians might offer antiviral drugs as an addition to oral steroid treatment, but they should inform their patients that a benefit from this drug combination has not been strongly demonstrated by well-designed studies. Patients also should be informed that if there is an added benefit of combination therapy even in severe cases, it will be marginal at best. 

Read the guideline and access PDF summaries for clinicians and patients, a slide presentation, and a clinical example. For more information, contact Julie Cox at jcox@aan.com or (612) 928-6069.