Background
Previous systematic reviews have examined the impact of smoking on asthma incidence and asthma-related outcomes. However, most of them relied on evidence from cross-sectional studies, did not consider e-cigarette smoking, and did not apply state-of-the-art methods to assess the level of certainty.
Objective
To inform recommendations from the European Academy of Allergy and Clinical Immunology Clinical Practice Guidelines, we conducted three systematic reviews to assess the impact of smoking on asthma-related outcomes.
Methods
We searched Medline and EMBASE (inception to July 2022) for longitudinal studies that assessed the effect of exposure to smoking on asthma incidence and asthma-related outcomes. We pooled effect estimates using random-effects meta-analysis and used GRADE to assess the certainty of evidence.
Results
In the first systematic review, we identified 69 studies suggesting that exposure to second-hand smoke was associated with an increased risk of developing asthma and recurrent wheezing. The second review (26 studies) suggested that second-hand smoking was associated with severe and moderate asthma exacerbation, poorer asthma control, and lower lung function. The third review (25 studies) suggested that active smoking was associated with moderate asthma exacerbations, poorer asthma control, quality of life, and lung function. Only one study examined the impact of electronic cigarettes. In general, the level of certainty was moderate to very low.
Discussion
We updated the available evidence concerning the impact of smoking on asthma. Although the effect estimates are consistent with previous reviews, the use of GRADE allowed us to identify important gaps in the available evidence.

Background: Based on evidence from high-dependency settings, international guidelines recommend 100% single patient rooms (SPRs) for all newly built hospitals.
Aim: To inform National Clinical Guidelines in Ireland, we evaluated the clinical and cost-effectiveness of 100% SPR accommodation, compared to mixed/multi-bed room (MBR) accommodation, on reducing the incidence of hospital-acquired infection (HAI) in general acute settings.
Method: Systematic searches of nine databases (31 May 2022) were conducted. Screening, data extraction and quality appraisal were performed independently by two researchers. Primary outcomes were assessed using GRADE.
Results: Eight studies were eligible for inclusion. Four studies examined rates of HAI with no significant difference reported for most of the outcomes investigated. Compared to MBR accommodation, one study reported an increase for Clostridioides difficile in SPR accommodation; one study reported an immediate decrease for vancomycin-resistant Enterococcus (incidence rate ratio 0.30, 95%CI: 0.12 to 0.75) following a move to a 100% SPR hospital; and one study reported infection with any HAI occurred later in SPR accommodation (adjusted hazard ratio 0.65, 95%CI: 0.45 to 0.95; p=0.03).
Six studies examined the rates of adverse events. Compared to MBR accommodation, an increase in falls was reported for SPR accommodation in two studies and a decrease in the risk of developing delirium in one study.
While costs were estimated to be higher for 100% SPR hospitals, the cost-effectiveness in reducing HAI was not reported.
Conclusion: Overall, evidence regarding the clinical and cost-effectiveness of SPR accommodation for reducing HAI is limited, inconsistent and does not permit clear guideline recommendations.

Background:
The European Respiratory Society (ERS) is committed to provide clinicians with Clinical Practice Guidelines (CPGs) focused on respiratory health and developed according to the highest standards. However, methodological requirements to produce CPGs are time-consuming and labour-intensive. Offering panels adequate support and training early-career members (ECMs) in the GRADE approach became a priority for ERS. The Methodology Network was created to answer this need.

Method and objectives:
The Methodology Network is made up of ECMs selected upon application. Once accepted, members complete an online training, before being assigned to an ERS CPG in which they are responsible for 2 PICO questions under the supervision of an ERS methodologist. After completion of 2 CPGs, members of the Network will have the ability to supervise newer members.

Beyond the support provided to CPG teams, the Network enables to:
- Build a sustainable group of scientists trained in methodology and foster their long-term involvement in guideline activities.
- Ensure that members performing methodological tasks have adequate knowledge.
- Reduce the costs linked to third parties’ involvement in CPG development
- Give to ECMs authorship on highly cited publications and networking opportunities.

The first call demonstrated a high interest with 72 applications received. 10 candidates were selected, completed the training, and are now involved in CPGs. Based on this success, a second call took place in 2023. Applications are currently under review.

Future prospects for project presentations:
We will share our experience with the network and discuss with delegates potential improvement.

Background: Diabetes mellitus (DM) is among the most prevalent diseases in the world. In Brazil, there are about 16.8 million people with DM. Recently, in Brazil, the dapagliflozin (an iSGLT2) was included for patients with DM2, age ≥65 years old and having established cardiovascular disease (CVD). The implementation of the PCDT for DM2 occurs in a non-systematic way, due to the inequities in health among the country. Objective: Describe the educational strategy adopted to stimulate the implementation of the new DM2 protocol in Brazil. Methods: The National Institute of Pharmaceutical Care and Pharmacoeconomics (INAFF) developed an educational strategy for the implementation of such protocol with a focus on the incorporation of dapagliflozin. Multidisciplinary panels, including medical specialists, pharmacists, nurses, health managers and representatives of patient associations, from all five regions of Brazil, have been held, debating about the disease, the PCDT, and strategies for their implementation in the Brazilian Public Health System. Results: The main strategies discussed were: (a) improved communication between reference centers and management, (b) overcoming the barriers identified for access to technology and implementation of the PCDT (age restriction of access; positioning after sulfonylureas in the treatment flow, restriction for GFR < 45, restriction for people with established CVD and insufficient medical specialists) and (c) acquisition of dapaglifozin by the Federal Government. Future prospects for project presentations: In general, panel participants noted that modifying the restriction criteria would favor other patients with DM2 to have access to dapaglifozin, resulting in fewer complications of the disease.

Background
Applicability is an important aspect of guideline quality, but most guidelines score poorly on applicability (Gagliardi et al., 2011). Guidelines commissioned within the Belgian EBP Network (Evikey) are mandated to include a focus on applicability and include an implementation plan. However, limited background in implementation science may hinder the development of high-quality implementation plans.
Objective
To develop a tool to enable guideline developers to consider applicability during guideline development and capture the core information needed to deliver a preliminary implementation plan.
Methods
The tool capitalizes on planned stakeholder meetings and ongoing discussion with stakeholders during the guideline development process and helps to make explicit the discussion on implementation determinants and interventions. Based on the assumption that stakeholders’ statements on determinants and interventions are highly relevant to the context, the tool aims at coordinating an implementation process model of Peters et al. with local guidance on the development of clinical practice guidelines (Peters et al., 2020 ; Dekker et al., 2021). Worksheets, based on the TICD checklist from Flottorp et al. help to capture and summarize those information and reduce the burden and complexity of implementation planning during guideline development (Flottorp et al., 2013).
Future prospects
We are currently piloting the tool to support two guideline development groups in designing an implementation plan. Based on this pilot, we plan to further adapt the tool and incorporate guidance on its use within the guideline development process of clinical practice guidelines commissioned by Evikey.

The objective of this assessment is to determine the safety and effectiveness of the test.
This test is not mentioned in medical textbooks and guidelines, and there is no wheelchair skill assessment tool currently used in clinical practice, the assessment was performed via a systematic review. Effectiveness was assessed based on reliability, validity, and validity of Korean translation. A literature search was conducted in five Korean databases, Ovid-MEDLINE, Ovid-EMBASE, Cochrane Library, and COSMIN database, was performed independently by the subcommittee and two assessors. The quality of each study was assessed using the SIGN, and the assessment results were described based on the quality appraisal results and level of evidence.
The effectiveness of the test was to be assessed based on reliability, validity, and translation validity without limiting the version of the intervention test, but none of the studies used a Korean version of the scale and analyzed translation validity.
Given that the test is performed using a self-report questionnaire, the subcommittee determined that the test has an acceptable reliability and validity. However, because the observer-rated WST, which was used as the comparator in most studies, is the original test from which the WST-Qwas derived, these results are expected. Since WST is currently not mentioned in textbooks or guidelines and their reliability and validity have not been discussed, the subcommittee stated that the interpretation of the results is limited, and the reliability and validity reported in the studies cannot be generalized, as some of the included studies report low capacity scores.

Background
Research gaps (RGs) are areas or topics in which insufficient evidence prevents drawing a conclusion for a given question. RGs in guidelines are one of the extrinsic factors hampering their effective implementation in clinical practice. Identifying RGs plays a significant role in health care, as it relates to the level of adherence by clinicians and provides a basis for hypothesis generation towards improved patient care.

Objectives
To systematically identify RGs in (inter)national Acute Ischemic Stroke (AIS) guidelines and assess the adherence rate of German clinicians to these guidelines.

Method
The German Stroke Registry (GSR) provides treatment information for approximately 13000 patients affected by AIS. We are developing Computer-Interpretable Guidelines (CIGs) based on the official and current German, European Stroke Organisation (ESO), Australian Stroke Foundation, and American Stroke Association (ASA) AIS guidelines. We will use the GSR data coupled with our developed CIGs to identify gaps in AIS guidelines. A by-product of this analysis is the assessment of the adherence rate of German clinicians to AIS guidelines. Technically, we will query the CIGs using GSR data to obtain recommendations for the respective patients. The resulting proposed recommendations will be compared to the actual implemented treatments/therapies as registered in the GSR using appropriate statistical methods. As a result, treatment deviations (e.g., treatment options not covered by the guidelines) can be detected and further investigated by clinicians for relevance and accuracy. Detected deviations serve as a basis for formulating hypotheses on RGs in AIS guidelines.

Results
Ongoing.

Discussion
Ongoing

Asthma is a chronic inflammatory disease of the lower airways that is clinically characterized by increased responsiveness of these airways to different stimuli, with consequent recurrent airflow obstruction. The level of asthma control is low and morbidity is high, regardless of the country evaluated. In Brazil, hospitalizations and mortality are decreasing, in parallel with greater access to treatments and follow-up. A survey showed that 12.3% of asthmatics are controlled and only 32% adhere to the prescribed treatment in Brazil.
To describe the history of the CPG of asthma in the Unified Health System in Brazil.
Descriptive study about the elaboration of the Asthma CPG and its updates published by the Brazilian Ministry of Health. The study included data about the number of contributions received in the public consultation in the last update of the Asthma CPG.
The first Asthma CPG was published by the Brazilian Ministry of Health in 2002 and included clinical, laboratory and differential diagnosis, treatment and monitoring of patients with asthma. Over the years, this CPG has been updated four times. The current version was published in 2021 and included new drugs - omalizumab and mepolizumab - for the treatment of severe asthma. In this update, more than 1,000 public contributions from civil society were received.
The main treatment for Asthma patients is available in SUS. The use of some drugs is conditioned to evidence-based criteria. Asthma CPG promote access and the proper use of technologies and CPG development process expands the participation of Brazilian citizens.

Brazilian Ministry of Health (MS) is assisted by the National Committee for Health Technology Incorporation (Conitec), in its attributions of elaborating or updating Clinical Practice Guidelines. CPG are an important tool for managing and regulating the use of drugs, products and procedures.
To present the CPG developed and updated by Conitec in the context of Brazilian public health system in 2022.
Descriptive qualitative study on the CPG developed and updated by Conitec in 2022. Data collection and analysis was performed using Excel, 2010 software.
In 2022, 30 guidelines were developed and published by Conitec, of which 09 (30%) were new CPG and 08 (27%) were intended for rare diseases. In accordance with the 10th version of International Classification of Diseases, the CPG were related to: certain infectious and parasitic diseases (6; 20.0%), neoplasms (6; 20.0%), nervous system diseases (5; 16.7%), eye diseases and adnexa (3; 10.0%), endocrine, nutritional and metabolic diseases (2; 6.7%), mental and behavioral disorders (2; 6.7%), diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (1; 3.3%), genitourinary system diseases (1; 3.3%), musculoskeletal system and connective tissue diseases (1; 3.3%) and skin and subcutaneous tissue diseases (1; 3.3%).
The CPG developed by Conitec and published by the Ministry of Health are used throughout the national territory. The elaboration of guidelines based on the best available scientific evidence contributes to obtaining better health outcomes in the Brazilian population.

Background:
Infective endocarditis (IE) is a rare but serious disease, with a mortality rate in the first year of around 30%. Nowadays, the evidence supporting the use of antibiotics to prevent IE is based on heterogeneous studies and of low methodological quality. Since this recommendation is currently controversial, updating the evidence about this question is deemed crucial.

Objective:
To describe the methodology used to update the current recommendations on the use of antibiotics in IE prophylaxis in the context of dental procedures, in the framework of the National Antimicrobial Therapeutic Guide published in 2018.

Methods:
The research question was framed in PICO format, a comprehensive search strategy was developed, reviewed the results, and assessed the quality of the selected studies. Subsequently, an EtD framework using the GRADE-ADOLOPMENT methodology was created and the current recommendations were presented.

Results:
A CPG (KCE REPORT 332) published by the Belgian Health Care Knowledge Centre-KCE was identified as key reference. The GDG considered it to adopt its recommendation on IE prophylaxis. Four additional systematic reviews were also considered to complete EtD framework´s background information. According to the new retrieved evidence, the specific recommendation for patients at high risk of IE was updated.

Discussion:
There is currently no consensus about the recommendations for IE prophylaxis among the medical scientific societies. This illustrates the complexity in the management of this condition. Determining the baseline risk of patients and deciding whether they should receive antibiotic prophylaxis or not are the main points of contention.

Background
Oncological patients have high information needs, which are often unmet. Patient versions of guidelines (PVoGs) provide recommendations from clinical guidelines in laypersons’ language. So far, there are only few results on experiences with PVoGs.

Objective
The aim of the project is to analyse the use and applicability of oncological PVoGs in Germany and to identify opportunities for improvement from the perspective of patients, health care providers (HCP) and stakeholders.

Methods
The project is composed of two modules, each with two sub-modules and a final workshop. In Module 1, the development of PVoGs was analysed by systematically searching Pubmed and Medline (Ovid) and screening the websites of guideline organisations for methods of developing, disseminating and implementing PVoGs (Module 1a). Furthermore, semi-structured telephone interviews were conducted with (inter-)national experts with experience in the development of PVoGs (Module 1b). The use of PVoGs was analysed in Module 2. First, semi-structured telephone interviews were conducted with patients and HCP (Module 2a). Their results were discussed with patients and HCP in mixed focus groups via Zoom or in presence (Module 2b). The aggregated results were translated into recommendations, which will be discussed and agreed upon in a workshop with stakeholders in April 2023.

Future prospects
The project identified fields for improving PVoGs by formulating recommendations on areas of dissemination, design and format, forwarding/linking, digitalisation, up-to-dateness and joint work with the PVoG. Accordingly, it might help to improve health care, communication between patients and HCP and informed decision-making.

The Clinical Practice Guidelines Programme in the Spanish National Health System has adopted a continuous surveillance and updating strategy for keeping guidelines up-to-date.
Since 2021, each CPG includes a plan for updating, with the composition of the updating working group, the clinical questions prioritised for updating, and the sources of information to perform the searches, as well as the frequency for updating each clinical question.
A small group of the original guideline development group (five to six people covering technical and clinical expertise) is responsible for identifying and assessing the new evidence. The participation of the entire working group only occur when new evidence suggests the need for modification of a recommendation.
Per protocol, literature scans for new evidence are conducted 6-monthly. Literature search strategies utilise a restrictive approach that prioritise precision over sensitivity. Searches are completed by sending a questionnaire to the updating working group for identifying new potential aspects not included in the original version.
The next step consist of evaluating the impact of the new references on the recommendations in relation to the PICO question, quality of evidence, or direction and strength of the recommendations. The potential impact may be assessed qualitatively, by achieving consensus within the updating working group on the potential impact of the new evidence on the recommendations.
We present the first results of the continuous updating of the CPG about palliative care of the adult in the last days of life.

Background: in 2018 28 Dutch palliative care guidelines were in need of revision to update them with the latest (scientific) insights and current quality standards. Accomplishing this in a short time is challenging, not only for guideline developers, but also for the scientific and professional associations to find sufficient experts for the guideline committees. By combining the revision of three guidelines, we aimed to improve efficiency and harmonization among guidelines.

Objective: Analyze this trajectory to learn for future projects.

Methods: The guidelines Hiccup, Pruritus (Itching) and Hyperhidrosis were revised simultaneously. We chose these guidelines because these are uncommon symptoms involving overlapping disciplines. Efficiency was achieved by:
- combining a survey to identify issues experienced by healthcare providers;
- partially overlapping guideline committees with one chairman,
- combining the committee meetings; and
- combining the activities to disseminate the guidelines.
After revision of the guidelines, we assessed advantages and disadvantages with the committee.

Results:. We revised three revised guidelines in a time frame in which normally one guideline is delivered and needed fewer healthcare providers and guideline developers. Overlapping guideline committees and having one chairman ensured harmonization between the guidelines. A minor disadvantage was that focusing on one topic was experienced as challenging, as some healthcare providers were involved in two or three committees.

Discussion: The combined revision resulted in efficient use of time, manpower and resources The advantages outweighed the disadvantages. Therefore, we are currently doing a similar track, by combining the revisions of the guidelines Ascites, Hypercalcemia and Fever.