Antimicrobial prescribing behaviour in dogs and cats by Belgian veterinarians

2017 ◽  
Vol 182 (11) ◽  
pp. 324-324 ◽  
Author(s):  
Alexia Van Cleven ◽  
Steven Sarrazin ◽  
Hilde de Rooster ◽  
Dominique Paepe ◽  
Sofie Van der Meeren ◽  
...  
Keyword(s):  
Primary Care ◽  
Online Survey ◽  
Treatment Guidelines ◽  
Current Treatment ◽  
Antimicrobial Treatment ◽  
Fourth Generation ◽  
National Guidelines ◽  
First Line ◽  
Clinical Scenarios ◽  
Prescribing Behaviour

The objective of this study is to survey general prescribing behaviour by Belgian companion animal veterinarians and to assess agreement of these practices with current treatment guidelines. Therefore an online survey was administered with five realistic and frequently occurring first-line cases to primary-care veterinary practitioners. For each case a predefined pattern of questions were asked about whether or not they would prescribe antimicrobials, if they would prescribe a non-antimicrobial treatment and if they would perform additional diagnostic steps. The responses were compared with recommendations in national guidelines and recent literature. The overall most prescribed antimicrobials were potentiated amoxicillin (43.0 per cent), fluoroquinolones (14.7 per cent), third-generation and fourth-generation cephalosporins (10.9 per cent) and tetracyclines (10.9 per cent). Only 48.3 per cent of the veterinarians complied with the guidelines in nearly all of the clinical scenarios (ie, prescribing antimicrobials when indicated, not prescribing antimicrobials when it is not indicated). Moreover, when prescribing highest priority critically important antimicrobials, susceptibility testing on bacterial cultures was performed in only 12.4 per cent of the prescriptions. The results showed that the prescribing behaviour of antimicrobial compounds by primary-care veterinary practitioners in dogs and cats is often not in agreement with national guidelines. Focus in improvement of this prescribing behaviour should be on performing the appropriate diagnostic steps and decreasing the use of highest priority critically important antimicrobials.

scholarly journals Antimicrobial resistance in Neisseria gonorrhoeae isolates and gonorrhoea treatment in the Republic of Belarus, Eastern Europe, 2009–2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aliaksandra Aniskevich ◽  
Iryna Shimanskaya ◽  
Iryna Boiko ◽  
Tatyana Golubovskaya ◽  
Daniel Golparian ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Neisseria Gonorrhoeae ◽  
Eastern Europe ◽  
Treatment Guidelines ◽  
Statistical Significance ◽  
Antimicrobial Treatment ◽  
National Guidelines ◽  
First Line ◽  
Exact Test ◽  
The Republic

Abstract Background Limited antimicrobial resistance (AMR) data for Neisseria gonorrhoeae are available in Eastern Europe. We investigated AMR in N. gonorrhoeae isolates in the Republic of Belarus from 2009 to 2019, antimicrobial treatment recommended nationally, and treatment given to patients with gonorrhoea. Methods N. gonorrhoeae isolates (n = 522) cultured in three regions of Belarus in 2009–2019 were examined. Determination of minimum inhibitory concentrations (MICs) of eight antimicrobials was performed using Etest. Resistance breakpoints from the European Committee on Antimicrobial Susceptibility Testing were applied where available. A Nitrocefin test identified β-lactamase production. Gonorrhoea treatment for 1652 patients was also analysed. Statistical significance was determined by the Z-test, Fisher’s exact test, or Mann-Whitney U test with p-values of < 0.05 indicating significance. Results In total, 27.8% of the N. gonorrhoeae isolates were resistant to tetracycline, 24.7% to ciprofloxacin, 7.0% to benzylpenicillin, 2.7% to cefixime, and 0.8% to azithromycin. No isolates were resistant to ceftriaxone, spectinomycin, or gentamicin. However, 14 (2.7%) isolates had a ceftriaxone MIC of 0.125 mg/L, exactly at the resistance breakpoint (MIC > 0.125 mg/L). Only one (0.2%) isolate, from 2013, produced β-lactamase. From 2009 to 2019, the levels of resistance to ciprofloxacin and tetracycline were relatively high and stable. Resistance to cefixime was not identified before 2013 but peaked at 22.2% in 2017. Only sporadic isolates with resistance to azithromycin were found in 2009 (n = 1), 2012 (n = 1), and 2018–2019 (n = 2). Overall, 862 (52.2%) patients received first-line treatment according to national guidelines (ceftriaxone 1 g). However, 154 (9.3%) patients received a nationally recommended alternative treatment (cefixime 400 mg or ofloxacin 400 mg), and 636 (38.5%) were given non-recommended treatment. Conclusions The gonococcal resistance to ciprofloxacin and tetracycline was high, however, the resistance to azithromycin was low and no resistance to ceftriaxone was identified. Ceftriaxone 1 g can continuously be recommended as empiric first-line gonorrhoea therapy in Belarus. Fluoroquinolones should not be prescribed for treatment if susceptibility has not been confirmed by testing. Timely updating and high compliance with national evidence-based gonorrhoea treatment guidelines based on quality-assured AMR data are imperative. The need for continued, improved and enhanced surveillance of gonococcal AMR in Belarus is evident.

scholarly journals Trends and variation in antidepressant prescribing in English primary care

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0020
Author(s):  
Paul Bogowicz ◽  
Helen J Curtis ◽  
Alex J Walker ◽  
Philip Cowen ◽  
John Geddes ◽  
...  
Keyword(s):  
Primary Care ◽  
Regression Analysis ◽  
Mixed Methods Research ◽  
Descriptive Statistics ◽  
Marked Variation ◽  
Substantial Variation ◽  
National Guidelines ◽  
Level Data ◽  
Prescribing Behaviour ◽  
Treatment Sequencing

BackgroundAntidepressants are commonly prescribed. There are clear national guidelines in relation to treatment sequencing. The study examined trends and variation in antidepressant prescribing across English primary care.AimTo examine trends and variation in antidepressant prescribing in England, with a focus on: monoamine oxidase inhibitors (MAOIs); paroxetine; and dosulepin and trimipramine.Design & settingRetrospective longitudinal study using national and practice level data on antidepressant items prescribed per year (1998–2018) and per month (2010–2019).MethodClass- and drug-specific proportions were calculated at national and practice levels. Descriptive statistics were generated, percentile charts and maps were plotted, and conducted logistic regression analysis was conducted.ResultsAntidepressant prescriptions more than tripled between 1998 and 2018, from 377 items per 1000 population to 1266 per 1000. MAOI prescribing fell substantially, from 0.7% of all antidepressant items in 1998 to 0.1% in 2018. There was marked variation between practices in past year prescribing of paroxetine (median practice proportion [MPP] = 1.7%, interdecile range [IDR] = 0.7% to 3.3%) and dosulepin (MPP = 0.7%, IDR = 0% to 1.9%), but less for trimipramine (MPP = 0%, IDR = 0% to 0.2%).ConclusionRapid growth and substantial variation in antidepressant prescribing behaviour was found between practices. The causes could be explored using mixed-methods research. Interventions to reduce prescribing of specific antidepressants, such as dosulepin, could include review prompts, alerts at the time of prescribing, and clinician feedback through tools like OpenPrescribing.net.

scholarly journals A Review of the Management of Gastric Acid-Related Diseases: Focus on Rabeprazole

2011 ◽  
Vol 4 ◽  
pp. CGast.S5133
Author(s):  
Motoyasu Kusano ◽  
Shikou Kuribayashi ◽  
Osamu Kawamura ◽  
Yasuyuki Shimoyama ◽  
Hiroko Hosaka ◽  
...  
Keyword(s):  
Gastric Acid ◽  
Reflux Disease ◽  
Clinical Utility ◽  
Treatment Guidelines ◽  
Eradication Therapy ◽  
Rapid Onset ◽  
Current Treatment ◽  
Ulcer Bleeding ◽  
First Line ◽  
Helicobacter Pylori Eradication

Current treatment guidelines for acid-related diseases (ARDs) recommend first-line treatment with a proton pump inhibitor (PPI) to reduce gastric acid production. PPIs are indicated in the management of gastroesophageal reflux disease (reflux esophagitis, nonerosive reflux disease), peptic ulcer (gastric and duodenal ulcer, non-steroidal anti-inflammatory drug (NSAID)-associated ulcer, bleeding ulcer), functional dyspepsia, and in association with Helicobacter pylori eradication therapy when needed. Currently, PPIs (omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole) are widely used for the treatment of ARDs. All 5 PPIs are effective. However, there are differences in PPI pharmacokinetic and pharmacodynamic profiles that might influence their clinical utility. Rabeprazole is a useful option for the treatment of acid-related diseases due to its rapid onset of acid inhibition and few drug interactions.

scholarly journals Thai national guidelines for the use of antiretroviral therapy in pediatric HIV infection in 2010

2010 ◽  
Vol 4 (4) ◽  
pp. 505-513 ◽  
Author(s):  
Thanyawee Puthanakit ◽  
Auchara Tangsathapornpong ◽  
Jintanat Ananworanich ◽  
Jurai Wongsawat ◽  
Piyarat Suntrattiwong ◽  
...  
Keyword(s):  
Viral Load ◽  
Treatment Guidelines ◽  
Complete Blood Count ◽  
Clinical Stage ◽  
Liver Function Tests ◽  
Pediatric Hiv ◽  
Therapeutic Drug ◽  
National Guidelines ◽  
First Line ◽  
Function Tests

Abstract With better knowledge and availability of antiretroviral treatments, the Thai National HIV Guidelines Working Group has issued treatment guidelines for children in Thailand in March 2010. The most important aspects of these new guidelines are detailed below. ART should be initiated in infants less than 12 months of age at any CD4 level regardless of symptoms and in all children at CDC clinical stage B and C or WHO clinical stages 3 and 4. For children with no or mild symptoms consider CD4-guided thresholds of CD4 <25% (children aged one to five years) or CD4 <350 cells/mm3 (children 5 years or older). The preferred first-line regimen in children aged < 3 years is AZT+3TC+NVP. For children >3 years of age the preferred regimen is AZT+3TC+EFV. If an infant has previously been exposed to NVP perinatally, use AZT+3TC+LPV/r as empirical first regimen. In adolescents, consider TDF+3TC+EFV. The preferred ARV treatment in children who failed first line regimens of 2NRTI+NNRTI (Salvage treatment) comprises 2NRTI (guided by genotype) +LPV/r, and an alternative regimen is 2NRTI (guided by genotype) +ATV/ r (use in cases with dyslipidemia who are six years or older). In cases with extensive NRTI resistance with no effective NRTI option available, double boosted PI with LPV/r+SQV or LPV/r+IDV can be considered. Consultation with an expert is recommended. Laboratory monitoring is recommended for CD4 and every six months. Viral load at least at 6 and 12 months after initiation or change of regimen, then yearly thereafter. More frequent viral load monitoring is advised for cases with unsuccessful virologic response, infants, children with imperfect adherence, or those using of third line regimens. Toxicity monitoring depends on the drug received, at least every six months, and more often as clinically indicated. These include, but are not limited to, complete blood count, renal function tests, liver function tests, urinanalysis, and lipid profiles. Therapeutic drug monitoring is recommended in cases that have ARV-related toxicity, receiving non-standard dosing or regimens, using double boosted PI, and in those with renal or hepatic impairment.

scholarly journals Why did some practices not implement new antibiotic prescribing guidelines on urinary tract infection? A cohort study and survey in NHS England primary care

2018 ◽  
Author(s):  
Richard Croker ◽  
Alex J Walker ◽  
Ben Goldacre
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Interrupted Time Series ◽  
Freedom Of Information ◽  
Antibiotic Prescribing ◽  
Incentive Scheme ◽  
Line Treatment ◽  
First Line ◽  
Prescribing Behaviour ◽  
First Line Treatment

AbstractObjectivesTo describe prescribing trends and geographic variation for trimethoprim and nitrofurantoin; to describe variation in implementing guideline change; and to compare actions taken to reduce trimethoprim use in high- and low-using Clinical Commissioning Groups (CCGs).DesignA retrospective cohort study and interrupted time series analysis in English NHS primary care prescribing data; complemented by information obtained through Freedom of Information Act requests to CCGs. The main outcome measures were: variation in practice and CCG prescribing ratios geographically and over time, including an interrupted time-series; and responses to Freedom of Information requests.ResultsThe amount of trimethoprim prescribed, as a proportion of nitrofurantoin and trimethoprim combined, remained stable and high until 2014, then fell gradually to below 50% in 2017; this reduction was more rapid following the introduction of the Quality Premium. There was substantial variation in the speed of change between CCGs. As of April 2017, for the 10 worst CCGs (with the highest trimethoprim ratios): 9 still had trimethoprim as first line treatment for uncomplicated UTI (one CCG had no formulary); none had active work plans to facilitate change in prescribing behaviour away from trimethoprim; and none had implemented an incentive scheme for change in prescribing behaviour. For the 10 best CCGs: 2 still had trimethoprim as first line treatment (all CCGs had a formulary); 5 (out of 7 who answered this question) had active work plans to facilitate change in prescribing behaviour away from trimethoprim; and 5 (out of 10 responding) had implemented an incentive scheme for change in prescribing behaviour. 9 of the best 10 CCGs reported at least one of: formulary change, work plan, or incentive scheme. None of the worst 10 CCGs did so.ConclusionsMany CCGs failed to implement an important change in antibiotic prescribing guidance; and report strong evidence suggesting that CCGs with minimal prescribing change did little to implement the new guidance. We strongly recommend a national programme of training and accreditation for medicines optimisation pharmacists; and remedial action for CCGs that fail to implement guidance; with all materials and data shared publicly for both such activities.

An evaluation of RAS testing and survival among mCRC patients in the United States.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15144-e15144
Author(s):  
Enko Kiprilov ◽  
Laura Sangaré ◽  
Kimberly Lowe ◽  
Alexandra Christodoulopoulou
Keyword(s):  
Median Survival ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
The United States ◽  
Current Treatment ◽  
First Line ◽  
Treatment Groups ◽  
The Status ◽  
Ras Family ◽  
Third Line

e15144 Background: The status of mutations in the rat sarcoma viral oncogene homolog ( RAS) family of genes, which includes Kirsten RAS ( KRAS) and Neuroblastoma RAS ( NRAS) predicts response to anti-EGFR therapies in metastatic colorectal cancer (mCRC) patients. Current treatment guidelines recommend all mCRC patients to receive RAS testing prior to initiating treatment with an anti-EGFR agent. This study sought to establish estimates of RAS testing among mCRC patients in the US prior to initiation of first and third lines of treatment, and to describe median survival by treatment groups. Methods: Data from the Oncology Services Comprehensive Electronic Records (OSCER) 2.0 dataset were utilized. Patients diagnosed with mCRC between January 1, 2011 and July 31, 2017 were eligible. Patients were followed for up to 1 year, or until death, following their mCRC diagnosis. Results: A total of 17,387 mCRC patients were included in the analysis, among which 69% were RAS tested and 31% were never tested. Among the RAS tested patients, 23% were tested prior to their mCRC diagnosis 60% received RAS testing following mCRC diagnosis but prior to first line of treatment, 3% were tested following first line treatment but prior to third line, and the remaining 14% were tested following third line. Demographic variables did not differ between tested and untested groups, overall and by line of treatment. The overall median survival of RAS WT patients was 31.1 months (95% CI: 30.0, 32.4). MCRC patients who were not RAS tested had a lower median survival of 20.7 months (95% CI: 19.1, 22.5). Conclusions: The timing of when patients are being tested varies greatly. While nearly 70% of patients had a RAS test, approximately 30% failed to be tested, identifying a large gap in testing practices. Universal RAS testing provides patients and their physicians with knowledge of their anti-EGFR treatment options and may result in improved survival.

Use Of Nilotinib As a First Line Treatment In Adult Patients With Philadelphia Chromosome-Positive and Chronic Phase Myeloid Leukemia

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2742-2742
Author(s):  
Guray Saydam ◽  
Ibrahim C. Haznedaroglu ◽  
Leylagul Kaynar ◽  
Akif S. Yavuz ◽  
Ridvan Ali ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Treatment Guidelines ◽  
Philadelphia Chromosome ◽  
Chronic Phase ◽  
Turkish Population ◽  
Current Treatment ◽  
First Year ◽  
Newly Diagnosed ◽  
First Line ◽  
Advisory Committees

Abstract Introduction Nilotinib, a more potent and selective drug than imatinib, was approved by the FDA and EMA initially for the treatment of chronic and accelerated phase Philadelphia chromosome positive (Ph+) chronic myelogenous leukemia (CML) patients resistant or intolerant to prior therapy including imatinib and subsequently for the treatment of newly-diagnosed Ph+ CML patients in the chronic phase (CML-CP). The aim of the present study was to investigate efficacy and safety profile of nilotinib in a Turkish population of newly-diagnosed Ph+ CML-CP patients and to evaluate the effects of these results on prognosis according to current treatment guidelines. Methods The study was planned as a multicenter, open-label, one-arm phase II clinical trial. All patients were planned to be treated with nilotinib (AMN107, Tasigna®) 300 mg BID for 24 months. Herein, efficacy results of the patients who completed the first year of the study are presented. Results Of the 112 patients included in the study, data for 94 patients who completed 12 months of the study up to April 29, 2013 were analyzed. Of these 94 patients, 16 were excluded within this period and 78 completed the first year of the study within the median 371 days (range, 339-401 days) or median 12.4 months (range, 11.3-13.4 months). General characteristics of the patients are presented in Table 1. Treatment-related characteristics of the patients are presented in Table 2. Data are presented as mean±standard deviation or number (%), where appropriate. MMR (Major molecular rate): BCR-ABL/control gene ratio of ≤%0.1 measured by RQ-PCR as % CCyR (Complete cytogenetic response): Patients with 0% Ph+ metaphases Cumulative MMR rates at 3rd, 6th 9th, and 12th months of the patients are shown in Figure 1. Conclusions According to the results of interim analysis of this first prospective CML study conducted on Turkish population, the cumulative MMR rate by 12th month (primary endpoint) (61.7%) appears to be similar to that of the ENESTnd study. From the 3rd month, rapid and increasing MMR rates were reported and median time to MMR was 6.5 months. At both 6th and 12th month, high CCyR rates (both 90.5%) were also established. At all landmark evaluations, most of the patients rapidly achieved high rates of cytogenetic and molecular responses to nilotinib assessed by both 2009 and 2013 ELN optimal response criteria, and only one patient had disease progression. These results suggest that more rapid and greater efficacy was achieved with nilotinib during the 1st year of the study in comparison to historical data with imatinib and that nilotinib might improve short-term responses when started in the first-line setting. The rate of patients with BCR-ABL ≤10% at 3rd month, which is very important according to the current treatment guidelines, was 86.2%.The results of the present study revealed that efficacy of nilotinib, which is a licensed alternative for the treatment of newly diagnosed Ph+ CML-CP in Turkey, might provide a new standard of treatment. Disclosures: Saydam: Bristol-Myers Squibb: Membership on an entity’s Board of Directors or advisory committees; Novartis Pharmaceuticals Corporation, Turkey: Consultancy, Membership on an entity’s Board of Directors or advisory committees. Haznedaroglu:Novartis Pharmaceuticals Corporation, Turkey: Honoraria, Research Funding. Yavuz:Novartis Pharmaceuticals Corporation, Turkey: Membership on an entity’s Board of Directors or advisory committees. Ali:Novartis Pharmaceuticals Corporation, Turkey: Membership on an entity’s Board of Directors or advisory committees. Guvenc:Novartis Pharmaceuticals Corporation, Turkey: Membership on an entity’s Board of Directors or advisory committees. Sonmez:Novartis Pharmaceuticals Corporation, Turkey: Membership on an entity’s Board of Directors or advisory committees. Akkaynak:Novartis Pharmaceuticals Corporation, Turkey: Employment. Dag:Novartis Pharmaceuticals Corporation, Turkey: Employment.

scholarly journals Initial vancomycin for first episode non-severe Clostridium difficile infection

2020 ◽  
Author(s):  
Kevin Zhang ◽  
Patricia Beckett ◽  
Salaheddin Abouanaser ◽  
Marek Smieja
Keyword(s):  
Clostridium Difficile ◽  
Treatment Guidelines ◽  
Multivariable Analysis ◽  
Severe Infection ◽  
Current Treatment ◽  
First Episode ◽  
First Line ◽  
Nosocomial Diarrhea ◽  
Severe Clostridium Difficile Infection ◽  
The Impact

AbstractBackgroundClostridium difficile infection (CDI) is an important cause of nosocomial diarrhea. Given the discrepancy in current treatment guidelines for mild CDI, we sought to evaluate the use of first-line vancomycin for the treatment of non-severe infection.MethodsWe conducted a retrospective cohort study of all adult inpatients with first episode CDI at our institution from January 2013 to May 2018. CDI was defined as a positive C. difficile loop-mediated isothermal amplification assay, in conjunction with ≥3 type 5–7 stools on the Bristol stool scale. To evaluate the impact of first-line vancomycin treatment on adverse clinical outcomes in patients with first episode non-severe CDI, the initial vancomycin vs. initial metronidazole cohorts were first examined in an unadjusted logistic regression analysis for any combination of relapse, recurrence, and all-cause 30-day mortality, followed by an adjusted multivariable analysis.ResultsA total of 737 cases were included. Patients had a median age of 72.3 years (Q1: 61.2, Q3: 83.3) and 628 (85.2%) were classified as non-severe CDI. Among patients with non-severe CDI (n = 628), relapse, recurrence, and mortality rates were 17.4%, 7.0%, and 11.4%, respectively, when treated with initial metronidazole, compared to 18.6%, 3.1%, and 7.8%, respectively, when treated with initial vancomycin. In an adjusted multivariable analysis, the use of first-line vancomycin for the treatment of non-severe CDI was associated with a reduction in recurrence or 30-day mortality (ORadj: 0.51; 95%CI: 0.28–0.94; P=0.03).ConclusionsInitial vancomycin was associated with reduced recurrence or all-cause 30-day mortality in the treatment of adult inpatients with first episode non-severe CDI. Our findings support the use of initial vancomycin for all C. difficile inpatients, irrespective of disease severity, as recommended by Infectious Diseases Society of America guidelines.

scholarly journals The Australian living guidelines for the clinical care of people with COVID-19: What worked, what didn’t and why, a mixed methods process evaluation

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261479
Author(s):  
Tari Turner ◽  
Julian Elliott ◽  
Britta Tendal ◽  
Joshua P. Vogel ◽  
Sarah Norris ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Process Evaluation ◽  
Online Survey ◽  
Clinical Evidence ◽  
Treatment Guidelines ◽  
Guideline Development ◽  
Clinical Care ◽  
Evidence Based ◽  
National Guidelines ◽  
Concurrent Process

Introduction The Australian National COVID-19 Clinical Evidence Taskforce is producing living, evidence-based, national guidelines for treatment of people with COVID-19 which are updated each week. To continually improve the process and outputs of the Taskforce, and inform future living guideline development, we undertook a concurrent process evaluation examining Taskforce activities and experience of team members and stakeholders during the first 5 months of the project. Methods The mixed-methods process evaluation consisted of activity and progress audits, an online survey of all Taskforce participants; and semi-structured interviews with key contributors. Data were collected through five, prospective 4-weekly timepoints (beginning first week of May 2020) and three, fortnightly retrospective timepoints (March 23, April 6 and 20). We collected and analysed quantitative and qualitative data. Results An updated version of the guidelines was successfully published every week during the process evaluation. The Taskforce formed in March 2020, with a nominal start date of March 23. The first version of the guideline was published two weeks later and included 10 recommendations. By August 24, in the final round of the process evaluation, the team of 11 staff, working with seven guideline panels and over 200 health decision-makers, had developed 66 recommendations addressing 58 topics. The Taskforce website had received over 200,000 page views. Satisfaction with the work of the Taskforce remained very high (>90% extremely or somewhat satisfied) throughout. Several key strengths, challenges and methods questions for the work of the Taskforce were identified. Conclusions In just over 5 months of activity, the National COVID-19 Clinical Evidence Taskforce published 20 weekly updates to the evidence-based national treatment guidelines for COVID-19. This process evaluation identified several factors that enabled this achievement (e.g. an extant skill base in evidence review and convening), along with challenges that needed to be overcome (e.g. managing workloads, structure and governance) and methods questions (pace of updating, and thresholds for inclusion of evidence) which may be useful considerations for other living guidelines projects. An impact evaluation is also being conducted separately to examine awareness, acceptance and use of the guidelines.

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