39 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 During the guideline production process we also send the teams regular evidence updates from Medline/Pubmed and EMBASE of articles that have met our criteria that month. We continue to do this after the ‘opening’ of the guideline. – team members are informed of the most recent developments. A further service – both for our teams and also for colleagues worldwide is our graded evidence service. Searches are done every quarter and results are evaluated so that colleagues have immediate access to key articles and we have built this in as an extra security – guideline team members can raise the ‘alarm’ if new evidence becomes available that might require us to edit our existing text. We can claim our publication is a ‘living document’ because we do make (small) adjustments when necessary. Cascades – powerful tool in WGO Guidelines There is a real gap between what is known and what is done. The WGO guideline project aims to close this gap. From the medical scientific literature, we can learn what is known. From experts and their global networks we can learn what is done and then design guidelines that take account of this. A standardized, global approach of the diagnosis and management may not be feasible since neither the epidemiology nor clinical setting, nor the availability of resources for the diagnosis and management are sufficiently uniform through-out the world to support the provision of a single, gold standard approach. The WGO’s goal is to make ‘global’ guidelines and resource limitations matter. A gastroenterologist in, for instance, the Sudan or mainland China or in remote corners in Europe, may not always have easy access to ‘the state of the art’ tools and technologies assumed by the large international guidelines. Through the WGO Cascades, each guideline offers different treatment options for diagnosis and treatment depending on the context and resources available within the target region Challenges & future plans WGO sees opportunities to invest further in the integration with other WGO activities, such as synchronization with World Digestive Health Day topics – our GERD and Celiac Disease guidelines, the curriculum of the WGO Training Centers and Train the Trainer (TTT) initiatives, spinoffs for pharmaceutical industry public programs, and local and global meeting programs, such as our participation in the scientific program at the GASTRO 2015 and 2016 meetings. WGO represents over 50,000 gastroenterologists worldwide, and we should activate the membership from countries/ regions that benefit from our Cascades, join forces and make the concept stronger in a systematic way. Our goal for 2017 is to further develop our relationship with our ‘Cascade Faculty’, i.e. current and past Review Team and WGO Guideline Committee members, and to further investigate what our Guideline users need and how to help optimize implementation of our global WGO Guidelines and Cascades. We invite our users and readers to share with us their views and ideas to improve a diverse regional representation in our Guideline Development Review Teams and their suggestions for a better use of the clinical knowledge and expertise available. Further reading and references For more information about what Cascades-based guidelines aim to achieve, please refer to the article by Michael Fried and Justus Krabshuis (2): “Can ‘Cascades’ make guidelines global?” and articles by Benjamin Anderson from Washington about his resource based approach to breast cancer (3,4)000 breast cancer deaths around the world in 2002, 221,000 (54% and by Sidney Winawer from the Memorial Sloan-Kettering Cancer Center in New York about Cascades for colon cancer screening (5). 1. Perl D, Leddin D, Bizos D, Veitch A, N’Dow J, Bush-Goddard S, et al. Endoscopic capacity in West Africa. Afr Health Sci. 2016 Mar;16(1):329–38. 2. Fried M, Krabshuis J. Can “Cascades” make guidelines global? J Eval Clin Pract. 2008 Oct;14(5):874–9. 3. Anderson BO, Jakesz R. Breast cancer issues in developing countries: an overview of the Breast Health Global Initia-tive. World J Surg. 2008 Dec;32(12):2578–85. 4. Anderson BO, Shyyan R, Eniu A, Smith RA, Yip C-H, Bese NS, et al. Breast cancer in limited-resource countries: an overview of the Breast Health Global Initiative 2005 guidelines. Breast J. 2006 Feb;12 Suppl 1:S3–15. 5. Winawer SJ, Krabshuis J, Lambert R, O’Brien M, Fried M, World Gastroenterology Organization Guidelines Committee. Cascade colorectal cancer screening guidelines: a global conceptual model. J Clin Gastroenterol. 2011 Apr;45(4):297–300.
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