Search

Background: In response to the COVID-19 pandemic, the Ontario-based Centre for Effective Practice (CEP) established the COVID-19 Resource Centre (CRC) in March 2020. This platform rapidly became a critical source of clinical and practice guidance for primary care providers, highlighting the importance of effective information synthesis during public health emergencies., Description: The article discusses the development of the CRC, emphasizing the application of librarianship principles in navigating the challenges posed by the pandemic's information overload and the scarcity of evidence. It outlines the strategies for literature searching, appraisal, and evidence synthesis that were employed to ensure the content's accuracy and utility. The CRC's evolution is presented within the context of its goal to efficiently bridge the gap between evidence and clinical practice, underscoring the collaborative efforts and innovative methodologies that contributed to its success., Outcomes: The CRC has served as an invaluable resource, attracting close to 185,000 visitors from Ontario, across Canada, and internationally. According to survey feedback, 89% of users reported enhanced knowledge of COVID-19 evidence and policies, and 87% stated that the vaccine information directly informed their practice. These statistics underscore the CRC's role in supporting informed decision-making among healthcare providers., Discussion: The CRC marked the CEP's first foray into real-time evidence-based tool development. Facing challenges of expanding information volumes, an unpredictable information landscape, and the need for swift adaptation to new developments, the CRC emerged as a critical resource, enhancing credibility for the CEP, and fostering new partnerships. This journey underscores the importance of librarianship skills-critical appraisal, evidence synthesis, and knowledge translation-in enhancing service delivery., Competing Interests: No competing interests declared., (© Dabrowski, Moore, Bean, Salach, Hagel, Bevan, Scott-Meuser, van Hal, De Longhi, Lang-Robertson, and Tulchinsky.)

Background: Clinical practice guidelines (CPGs) synthesize high-quality information to support evidence-based clinical practice. In primary care, numerous CPGs must be integrated to address the needs of patients with multiple risks and conditions. The BETTER program aims to improve prevention and screening for cancer and chronic disease in primary care by synthesizing CPGs into integrated, actionable recommendations. We describe the process used to harmonize high-quality cancer and chronic disease prevention and screening (CCDPS) CPGs to update the BETTER program., Methods: A review of CPG databases, repositories, and grey literature was conducted to identify international and Canadian (national and provincial) CPGs for CCDPS in adults 40-69 years of age across 19 topic areas: cancers, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, hepatitis C, obesity, osteoporosis, depression, and associated risk factors (i.e., diet, physical activity, alcohol, cannabis, drug, tobacco, and vaping/e-cigarette use). CPGs published in English between 2016 and 2021, applicable to adults, and containing CCDPS recommendations were included. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and a three-step process involving patients, health policy, content experts, primary care providers, and researchers was used to identify and synthesize recommendations., Results: We identified 51 international and Canadian CPGs and 22 guidelines developed by provincial organizations that provided relevant CCDPS recommendations. Clinical recommendations were extracted and reviewed for inclusion using the following criteria: 1) pertinence to primary prevention and screening, 2) relevance to adults ages 40-69, and 3) applicability to diverse primary care settings. Recommendations were synthesized and integrated into the BETTER toolkit alongside resources to support shared decision-making and care paths for the BETTER program., Conclusions: Comprehensive care requires the ability to address a person's overall health. An approach to identify high-quality clinical guidance to comprehensively address CCDPS is described. The process used to synthesize and harmonize implementable clinical recommendations may be useful to others wanting to integrate evidence across broad content areas to provide comprehensive care. The BETTER toolkit provides resources that clearly and succinctly present a breadth of clinical evidence that providers can use to assist with implementing CCDPS guidance in primary care., (© 2024. The Author(s).)

Pyruvate kinase (PK) deficiency is the most common cause of chronic congenital non-spherocytic haemolytic anaemia worldwide, with an estimated prevalence of one in 100 000 to one in 300 000 people. PK deficiency results in chronic haemolytic anaemia, with wide ranging and serious consequences affecting health, quality of life, and mortality. The goal of the International Guidelines for the Diagnosis and Management of Pyruvate Kinase Deficiency was to develop evidence-based guidelines for the clinical care of patients with PK deficiency. These clinical guidelines were developed by use of GRADE methodology and the AGREE II framework. Experts were invited after consideration of area of expertise, scholarly contributions in PK deficiency, and country of practice for global representation. The expert panel included 29 expert physicians (including adult and paediatric haematologists and other subspecialists), geneticists, laboratory specialists, nurses, a guidelines methodologist, patients with PK deficiency, and caregivers from ten countries. Five key topic areas were identified, the panel prioritised key questions, and a systematic literature search was done to generate evidence summaries that were used in the development of draft recommendations. The expert panel then met in person to finalise and vote on recommendations according to a structured consensus procedure. Agreement of greater than or equal to 67% among the expert panel was required for inclusion of a recommendation in the final guideline. The expert panel agreed on 31 total recommendations across five key topics: diagnosis and genetics, monitoring and management of chronic complications, standard management of anaemia, targeted and advanced therapies, and special populations. These new guidelines should facilitate best practices and evidence-based PK deficiency care into clinical practice., Competing Interests: Declaration of interests HA-S reports grants or contracts in research funding to their institution from Agios, Sobi, Vaderis, Novartis, and Amgen and reports consulting fees from Agios, Sobi, Novartis, Argenx, Rigel, Moderna, Forma, and Pharmacosmos. SWE reports receiving support for attending meetings, travel, or both from Agios and is on data safety monitoring boards or advisory boards for Agios. JAR reports grants or contracts from Pfizer, Agios, Novartis, Sanofi, Sobi, and Dova, and is on data safety monitoring boards or advisory boards for Agios, Global Blood Therapeutics, and Novartis. SS reports grants or contracts from Bristol-Myers Squibb/Celgene, Forma, and Agios; reports consulting fees from Agios, Bluebird Bio, Fulcrum, Chiesi, Bristol-Myers Squibb/Celgene, and Vertex); reports honoraria from Plexus, Clinical Care Options, and Physicians' Education Resource; reports receiving support for attending meetings, travel, or both from Agios, Bristol-Myers Squibb/Celgene and Bluebird Bio; and is on data safety monitoring boards or advisory boards for CRISPR/Vertex. KL-R reports funding provided to the Centre for Effective Practice (an independent not for profit corporation) to conduct the systematic literature review in this work. DCR is on data safety monitoring boards or advisory boards for Agios. AW reports receiving support for attending meetings, travel, or both from Agios and reports being in leadership in an advocacy group (the Pyruvate Kinase Deficiency Foundation). CL reports receiving support for attending meetings, travel, or both from Agios and reports being in leadership in an advocacy group (Metabolic Support UK). EJN reports consulting fees from Saliogen, reports receiving support for attending meetings, travel, or both from Agios; reports stock or stock options in Saliogen; and is on data safety monitoring boards or advisory boards for Agios, Imara, Merck/Acceleron, Sobi, and Pfizer. PB reports grants or contracts from Agios; reports honoraria from Rocket; reports support for attending meetings, travel, or both from Agios; and is on data safety monitoring boards or advisory boards for Agios. RFG reports grants or contracts from Agios, Novartis, and Sobi; reports consulting fees from Agios; is on data safety monitoring boards or advisory boards (Sanofi); and reports being in leadership in other boards, societies, committees, or advocacy groups (PK Deficiency Advocacy Advisory Council, Thrive with PK Deficiency, and Rare Anemias International Network). DPe reports receiving support for attending meetings, travel, or both from Eurobloodnet; is on data safety monitoring boards or advisory boards for Eurobloodnet; and reports being in a leadership role in an advocacy group (Stichting Zeldzame Bloedziekten). WB reports consulting fees from Alexion, Agios, Novartis, Sobi, and Sanofi; reports honoraria from Agios, Novartis, and Sanofi; reports receiving support for attending meetings, travel, or both from Sanofi; and is on data safety monitoring boards or advisory boards for Novartis. AJS is on data safety monitoring boards or advisory boards for Vertex and Bluebird Bio. NS reports receiving support for attending meetings, travel, or both from Agios. OA reports grants or contracts from Agios; reports honoraria from Agios; reports receiving support for attending meetings, travel, or both from the German, Austrian, and Swiss Society for Pediatric Oncology and Hematology, the German Society for Neonatology and Pediatric Intensive Care, and Agios; and is on data safety monitoring boards or advisory boards for Agios. AG reports grants or contracts from Agios, Bristol-Myers Squibb, Novo Nordisk, Saniona, and Sanofi; reports consulting fees from Agios, Novo Nordisk, Pharmacosmos, and Vertex; and reports receiving support for attending meetings, travel, or both from AbbVie. MDMMP reports grants or contracts from Agios and is on data safety monitoring boards or advisory boards for Agios. SC reports grants or contracts in research funding to their institution from Agios; reports consulting fees from Agios; and is on data safety monitoring boards or advisory boards for Agios. EJvB reports grants or contracts in research funding to their institution from Agios and Horizon Europe; reports consulting fees from Bristol-Myers Squibb and Agios; is on data safety monitoring boards or advisory boards for Imara Pharmaceuticals; and reports being in a leadership role in other boards (Sickle Cell Outcome Registry Research The Netherlands and Eurobloodnet). JLK reports consulting fees from Forma, Agios, and Chiesi and is on data safety monitoring boards or advisory boards for Agios. TAK reports grants to contracts in research funding to their institution from Agios, Forma, and Novo Nordisk); reports consulting fees from Forma and Novo Nordisk; and is on data safety monitoring boards or advisory boards for Agios, Forma, and Novo Nordisk). FG is on data safety monitoring boards or advisory boards for Addmedica, Vertex, Agios, Global Blood Therapeutics, and Novartis. KHMK reports grants or contracts from Agios and Pfizer; reports consulting fees from Alexion, Agios, Bristol-Myers Squibb, Forma, Pfizer, Novo Nordisk, and Vertex); reports honoraria from Agios and Bristol-Myers Squibb; and is on data safety monitoring boards or advisory boards for Bioverativ, Sanofi, and Sangamo. All other authors report no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Description: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease with an estimated prevalence of 1 in 5000 that is characterized by the presence of vascular malformations (VMs). These result in chronic bleeding, acute hemorrhage, and complications from shunting through VMs. The goal of the Second International HHT Guidelines process was to develop evidence-based consensus guidelines for the management and prevention of HHT-related symptoms and complications., Methods: The guidelines were developed using the AGREE II (Appraisal of Guidelines for Research and Evaluation II) framework and GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. The guidelines expert panel included expert physicians (clinical and genetic) in HHT from 15 countries, guidelines methodologists, health care workers, health care administrators, patient advocacy representatives, and persons with HHT. During the preconference process, the expert panel generated clinically relevant questions in 6 priority topic areas. A systematic literature search was done in June 2019, and articles meeting a priori criteria were included to generate evidence tables, which were used as the basis for recommendation development. The expert panel subsequently convened during a guidelines conference to conduct a structured consensus process, during which recommendations reaching at least 80% consensus were discussed and approved., Recommendations: The expert panel generated and approved 6 new recommendations for each of the following 6 priority topic areas: epistaxis, gastrointestinal bleeding, anemia and iron deficiency, liver VMs, pediatric care, and pregnancy and delivery (36 total). The recommendations highlight new evidence in existing topics from the first International HHT Guidelines and provide guidance in 3 new areas: anemia, pediatrics, and pregnancy and delivery. These recommendations should facilitate implementation of key components of HHT care into clinical practice.

This is an update to the 2014 Canadian Hereditary Angioedema Guideline with an expanded scope to include the management of hereditary angioedema (HAE) patients worldwide. It is a collaboration of Canadian and international HAE experts and patient groups led by the Canadian Hereditary Angioedema Network. The objective of this guideline is to provide evidence-based recommendations, using the GRADE system, for the management of patients with HAE. This includes the treatment of attacks, short-term prophylaxis, long-term prophylaxis, and recommendations for self-administration, individualized therapy, quality of life, and comprehensive care. New to the 2019 version of this guideline are sections covering the diagnosis and recommended therapies for acute treatment in HAE patients with normal C1-INH, as well as sections on pregnant and paediatric patients, patient associations and an HAE registry. Hereditary angioedema results in random and often unpredictable attacks of painful swelling typically affecting the extremities, bowel mucosa, genitals, face and upper airway. Attacks are associated with significant functional impairment, decreased health-related quality of life, and mortality in the case of laryngeal attacks. Caring for patients with HAE can be challenging due to the complexity of this disease. The care of patients with HAE in Canada, as in many countries, continues to be neither optimal nor uniform. It lags behind some other countries where there are more organized models for HAE management, and greater availability of additional licensed therapeutic options. It is anticipated that providing this guideline to caregivers, policy makers, patients, and advocates will not only optimize the management of HAE, but also promote the importance of individualized care. The primary target users of this guideline are healthcare providers who are managing patients with HAE. Other healthcare providers who may use this guideline are emergency and intensive care physicians, primary care physicians, gastroenterologists, dentists, otolaryngologists, paediatricians, and gynaecologists who will encounter patients with HAE and need to be aware of this condition. Hospital administrators, insurers and policy makers may also find this guideline helpful., Competing Interests: Competing interestsDetails of potential conflicts of interest (COI) were elicited using the standardized “International Committee of Medical Journal Editors Form for Disclosure of Potential Conflicts of Interest”. COI forms were distributed to attendees prior to their review of the manuscript, and were mandatory for all contributing authors., (© The Author(s) 2019.)

Objective: To develop and encourage the adoption of clinical practice guidelines (CPGs) for smoking cessation in Canada by engaging stakeholders in the adaptation of existing high-quality CPGs using principles of the ADAPTE framework., Methods: An independent expert body in guideline review conducted a review and identified six existing CPGs, which met a priori criteria for quality and potential applicability to the local context. Summary statements were extracted and assigned a grade of recommendation and level of evidence by a second expert panel. Regional knowledge exchange brokers recruited additional stakeholders to build a multidisciplinary network of over 800 clinicians, researchers and decision-makers from across Canada. This interprofessional network and other stakeholders were offered various opportunities to provide input on the guideline both online and in person. We actively encouraged end-user input into the development and adaptation of the guidelines to ensure applicability to various practice settings and to promote adoption., Results: The final guideline contained 24 summary statements along with supporting clinical considerations, across six topic area sections. The guideline was adopted by various provincial/territorial and national government and non-governmental organisations., Conclusions: This method can be applied in other jurisdictions to adapt existing high-quality smoking cessation CPGs to the local context and to facilitate subsequent adoption by various stakeholders., Competing Interests: Competing interests: No pharmaceutical or tobacco industry funds were used or received in the development of these guidelines. During the course of the grant, PS received funding for ad hoc consulting for advisory boards, education and unrestricted research grants from manufacturers of smoking cessation medications including Pfizer, Johnson and Johnson, Nabi Pharmaceuticals via an arm’s length Data Safety and Monitoring Board, Novartis and Biovail. PS also received consulting fees from manufacturers of anti-addiction medications including Prempharm, Lundbeck and Sanofi Synthélabo. No funds for entertainment were accepted. VC reports grants from Drugs and Tobacco Initiatives Program, Health Canada, during the conduct of the study. LZ reports grants from Global Research Awards for Nicotine Dependence, and a grant from Pfizer Canada, outside the submitted work. The remaining authors have nothing to disclose., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Hereditary angioedema (HAE) is a disease which is associated with random and often unpredictable attacks of painful swelling typically affecting the extremities, bowel mucosa, genitals, face and upper airway. Attacks are associated with significant functional impairment, decreased Health Related Quality of Life, and mortality in the case of laryngeal attacks. Caring for patients with HAE can be challenging due to the complexity of this disease. The care of patients with HAE in Canada is neither optimal nor uniform across the country. It lags behind other countries where there are more organized models for HAE management, and where additional therapeutic options are licensed and available for use. The objective of this guideline is to provide graded recommendations for the management of patients in Canada with HAE. This includes the treatment of attacks, short-term prophylaxis, long-term prophylaxis, and recommendations for self-administration, individualized therapy, quality of life, and comprehensive care. It is anticipated that by providing this guideline to caregivers, policy makers, patients and their advocates, that there will be an improved understanding of the current recommendations regarding management of HAE and the factors that need to be considered when choosing therapies and treatment plans for individual patients. The primary target users of this guideline are healthcare providers who are managing patients with HAE. Other healthcare providers who may use this guideline are emergency physicians, gastroenterologists, dentists and otolaryngologists, who will encounter patients with HAE and need to be aware of this condition. Hospital administrators, insurers and policy makers may also find this guideline helpful.