38 WORLD GASTROENTEROLOGY NEWS NOVEMBER 2016 Editorial | Expert Point of View | Gastro 2016: EGHS-WGO | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events The systematic approach to literature research, team formation, review of evidence and knowledge, and a balanced regional involvement and participation of local health care experts are essential to the guideline-making process and the quality of the resulting clinical practice guidelines. The following WGO Guidelines goals and quality levels are actively monitored during the development and update processes. – Transparent and traceable ‘translation’ of professional and scientific knowledge into clinical practice statements, and an independent and unbiased editorial process. – Delivery of clear and concise clinical practice guidelines. – Development of Cascades of resource sensitive alternatives for diagnosis and management to maximize global applica-bility and impact on health care and health policy. – Publishing of Guidelines developed by a global team of clinically active, leading content experts. Evidence – what we do and what we do not do Each guideline must include an evidence summary from the key medical articles and existing (gold standard) guidelines, if available and if current. Evidence is collected and selected by searching Medline/Pubmed, EMBASE, and other sources if applicable and rel-evant, such as the Cochrane library, Cinahl, and the guideline Clearinghouse databases. So-called ‘Level 1’ Evidence is collected from the databases (Level 1 evidence is generally defined as a systematic review of Level 2 evidence which includes groups of randomized controlled studies for intervention and diagnostic accuracy, and prospective cohort studies for prognosis and etiology, and other evidence-based practice guidelines). The Review Team will be kept up to date with all current and new evidence through the Evidence Alert update services based on monthly high level evidence searches in EMBASE/Medline. The evidence is assessed and recommendations are formulated by expert consensus, and include references to relevant sources: published articles and other (‘gold-standard’) guidelines. We do not perform our own Systematic Reviews (which would require the gathering of relevant randomized controlled trials (RCTs) with carefully designed inclusion and exclusion protocols), or new evidence analysis (requiring and then building strictly structured evidence tables from where to start the synthesis and then the recommendations and grading). Instead, we identify the best available evidence from a variety of sources including existing systematic reviews and guidelines from the most authoritative and influential societies and we then try to summarize this in a new way taking account of available resources – that is to say, we built Cascades – as a Global society we believe guidelines must not be resource-blind but instead sensitive to available resources and local culture and circumstances. WGO Guidelines’ evidence base Gathering evidence is a paramount concern, however very often there is very little evidence, if any, about diagnostic and treatment options that take account of limited resources and other ‘Cascade’ factors. After all, when trials are designed they tend to compare new treatment options with existing options (more often against placebo) rather than older solu-tions or solutions based on locally available materials or resources. There is another aspect here also. Whilst we collect the evidence we leave it to the team to process this as they see fit. We do not work with extraction tables for them to build evidence base elements: chances are a member from, for instance, China would look at this differently than a member from the US – both would know the gold standard – what they would look for is evidence (and ideas) how other ap-proaches might work for them, given their experience and knowledge and available resources. We are really practicing a sort of ‘Comparative Gastroenterology’ here. We identify published ‘gold standards’ – it is extremely important but it is the easy part and usually it means citing the relevant parts of an existing guideline from one of the top societies or perhaps a Cochrane review. Often, one or more gold standard guideline authors are also on the Review Team for our WGO Guideline and we are happy to refer to these leading society guidelines if we talk about a gold standard for diagnosis and treatment. To have world experts supporting our approach is a great honor and not a little encouraging. For our Cascades, we identify options available to those regions which do not have access to the resources needed when applying the gold standard. Or when other ‘Cascade relevant’ factors influence the usefulness of gold standard recom-mendations. So we write for areas with fewer or even very few resources, and where global aspect data (prevalence and incidence worldwide if available), and cultural and patient preferences require an alternative approach in diagnosis and management.
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