Living systematic reviews: 4. Living guideline recommendations.

While it is important for the evidence supporting practice guidelines to be current, that is often not the case. The advent of living systematic reviews has made the concept of "living guidelines" realistic, with the promise to provide timely, up-to-date and high-quality guidance to target users. We define living guidelines as an optimization of the guideline development process to allow updating individual recommendations as soon as new relevant evidence becomes available. A major implication of that definition is that the unit of update is the individual recommendation and not the whole guideline. We then discuss when living guidelines are appropriate, the workflows required to support them, the collaboration between living systematic reviews and living guideline teams, the thresholds for changing recommendations, and potential approaches to publication and dissemination. The success and sustainability of the concept of living guideline will depend on those of its major pillar, the living systematic review. We conclude that guideline developers should both experiment with and research the process of living guidelines.

[1]  E. Akl,et al.  Knowledge, attitudes, beliefs, values, preferences, and feasibility in relation to the use of injection safety devices in healthcare settings: a systematic review , 2016, Health and Quality of Life Outcomes.

[2]  Elie A Akl,et al.  [A reporting tool for practice guidelines in health care: the RIGHT statement]. , 2017, Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen.

[3]  Pablo Alonso-Coello,et al.  Guidance for updating clinical practice guidelines: a systematic review of methodological handbooks , 2014, Implementation Science.

[4]  Lara A. Kahale,et al.  Parenteral anticoagulation in ambulatory patients with cancer. , 2014, The Cochrane database of systematic reviews.

[5]  M. Trujillo-martín,et al.  Continuous surveillance of a pregnancy clinical guideline: an early experience , 2017, Systematic Reviews.

[6]  R. Haynes,et al.  The validity of recommendations from clinical guidelines: a survival analysis , 2017, Canadian Medical Association Journal.

[7]  Gordon H Guyatt,et al.  GRADE guidelines: 12. Preparing summary of findings tables-binary outcomes. , 2013, Journal of clinical epidemiology.

[8]  J. Stockman How Quickly Do Systematic Reviews Go Out of Date? A Survival Analysis , 2009 .

[9]  H. Schünemann,et al.  [GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines.] , 2018, Recenti progressi in medicina.

[10]  Ethan M Balk,et al.  Two methods provide similar signals for the need to update systematic reviews. , 2012, Journal of clinical epidemiology.

[11]  P. Alonso-Coello,et al.  Methodological systematic review identifies major limitations in prioritization processes for updating. , 2017, Journal of clinical epidemiology.

[12]  Laura A. Slaughter,et al.  Enabling Living Systematic Reviews and Clinical Guidelines through Semantic Technologies , 2015, D Lib Mag..

[13]  M. Brouwers,et al.  Reporting Items for Updated Clinical Guidelines: Checklist for the Reporting of Updated Guidelines (CheckUp) , 2017, PLoS medicine.

[14]  Katharina Kaiser,et al.  Versioning computer-interpretable guidelines: Semi-automatic modeling of 'Living Guidelines' using an information extraction method , 2009, Artif. Intell. Medicine.

[15]  Romina Brignardello-Petersen,et al.  [Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise]. , 2014, Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen.

[16]  J. M. Carrasco,et al.  The updating of clinical practice guidelines: insights from an international survey , 2011, Implementation science : IS.

[17]  Gordon H Guyatt,et al.  GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction , 2016, British Medical Journal.

[18]  Melissa C Brouwers,et al.  KEEPING CANCER GUIDELINES CURRENT: RESULTS OF A COMPREHENSIVE PROSPECTIVE LITERATURE MONITORING STRATEGY FOR TWENTY CLINICAL PRACTICE GUIDELINES , 2003, International Journal of Technology Assessment in Health Care.

[19]  Pablo Alonso-Coello,et al.  Updated recommendations: an assessment of NICE clinical guidelines , 2014, Implementation Science.

[20]  Paul G Shekelle,et al.  Assessment of a method to detect signals for updating systematic reviews , 2014, Systematic Reviews.

[21]  G. Guyatt,et al.  Patient values and preferences in decision making for antithrombotic therapy: a systematic review: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. , 2012, Chest.

[22]  Toni Tan,et al.  Median life span of a cohort of National Institute for Health and Care Excellence clinical guidelines was about 60 months. , 2014, Journal of clinical epidemiology.

[23]  Mark D Neuman,et al.  Durability of class I American College of Cardiology/American Heart Association clinical practice guideline recommendations. , 2014, JAMA.

[24]  Elie A Akl,et al.  GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. , 2013, Journal of clinical epidemiology.