How a comparative database is created
Guidelines to be included in the database have been gathered and selected following a systematic methodology, that is, a predefined protocol whose details are available on the general section treating the methodology and in specific methodological sections for each topic.
The contents of the main recommendations, listed per thematic area inside each topic, are summarized in synoptic tabs. The hypertext link to the original document is reported, if available. Some tracts of the selected guidelines, allowing readers an easier evaluation and critical comparison both on methodological aspects and on the content of single recommendations, have been privileged in drawing up the synoptic tabs.
Users can, in the main page of each topic, select only some guidelines, viewing and printing only one synoptic tab, in relation to both methodological characteristics and content of recommendations.
A summary of contents will be available for some particularly relevant topics (diabetes, arterial hypertension, preoperative laboratory tests and osteoporosis), in the form of review and reasoned comparison, allowing a panoramic view of all indications provided by the main international guidelines, along with a discussion of the existing points of agreement and disagreement between the various documents.
Each topic will be provided with an initial section including a general summary and comment, treating the main aspects connected to the contents of recommendations, and to their methodological characteristics. The presence in the documents of a description of the monitoring systems and of the systems to assess the impact (markers), and of the suggested implementation strategy has been considered, among these characteristics, particularly relevant. All these aspects have a crucial role in determining the effects of the recommendations on the clinical effectiveness and appropriateness and on the organizational efficiency. The editorial format has also be considered particularly relevant, as it affects the ability to read and comprehend the guideline. Format can be improved including flow charts, schemes summarizing the main recommendations, etc.
All the main clinical (diagnostic, therapeutic, prognostic, or preventive) recommendations included in all the guidelines that have been analyzed and included in the synoptic comparisons, are available in Italian.
Searching guidelines
Sources to be searched have been chosen identifying the main biomedical databases (MEDLINE and EMBASE) and guideline databases (National Guideline Clearinghouse, Guideline International Network, National Library for Health), national or governmental health agencies' websites, and the websites of the main scientific societies (Italian and foreign) involved in the health issues of interest. A bibliographical search has been carried out using specific strategies for each database, limiting the search to the previous five years (guideline published from 2003 onwards) and to the Italian and English language. The websites of scientific societies and health agencies have been searched manually, maintaining the cited temporal and linguistic limits.Guideline selection
A large number of publications have been gathered, due to the relevance and the proportion of the treated issues. A selection was therefore needed, aimed at merging defined qualitative criteria, guideline's weight in the scientific community and transferability of recommendations to Italian citizens.
A first selection has been carried out on the basis of adherence to the treated topic, inclusion of recommendations for clinical practice (a crucial attribute to define a document as guideline), scientific weight (excluding guidelines drawn up summarizing other international guidelines, or guidelines representing an effort of adaptation to specific environments) and transferability and feasibility of recommendations to Italian population (excluding guidelines focusing on populations with characteristics deeply differing from Italian population, such as Eskimos, native Australians, etc.)
A further selection has been carried out considering the internal validity of the gathered guidelines, assessing the presence of at least one on three essential criteria:
- the guideline should be drown up by a multidisciplinary panel
- a formal grading system should be applied to classify levels of evidence and strength of recommendations
- evidence (primary studies) should be gathered using a systematic methodology.
Evaluation and summary or comparison of guidelines
Guidelines were selected applying the cited criteria and afterwards qualitatively evaluated in an analytic way by three methodologists who independently used the AGREE instrument. The average grade given by the evaluators to each guideline are available in a specific section for each topic. The qualitative characteristics of the selected guidelines are summarized in synoptic tabs, following a specific check-list. The excluded guidelines are listed in separate tabs including the reasons leading to exclusion.The contents of the main recommendations, listed per thematic area inside each topic, are summarized in synoptic tabs. The hypertext link to the original document is reported, if available. Some tracts of the selected guidelines, allowing readers an easier evaluation and critical comparison both on methodological aspects and on the content of single recommendations, have been privileged in drawing up the synoptic tabs.
Users can, in the main page of each topic, select only some guidelines, viewing and printing only one synoptic tab, in relation to both methodological characteristics and content of recommendations.
A summary of contents will be available for some particularly relevant topics (diabetes, arterial hypertension, preoperative laboratory tests and osteoporosis), in the form of review and reasoned comparison, allowing a panoramic view of all indications provided by the main international guidelines, along with a discussion of the existing points of agreement and disagreement between the various documents.
Each topic will be provided with an initial section including a general summary and comment, treating the main aspects connected to the contents of recommendations, and to their methodological characteristics. The presence in the documents of a description of the monitoring systems and of the systems to assess the impact (markers), and of the suggested implementation strategy has been considered, among these characteristics, particularly relevant. All these aspects have a crucial role in determining the effects of the recommendations on the clinical effectiveness and appropriateness and on the organizational efficiency. The editorial format has also be considered particularly relevant, as it affects the ability to read and comprehend the guideline. Format can be improved including flow charts, schemes summarizing the main recommendations, etc.
All the main clinical (diagnostic, therapeutic, prognostic, or preventive) recommendations included in all the guidelines that have been analyzed and included in the synoptic comparisons, are available in Italian.
