Background:
WHO estimated that only 24% of women and 14% of men with osteoporosis in the Czech Republic were treated, revealing 'care gap' due to lack of care programs for patients after osteoporotic fractures. Therefore, this topic was prioritized by National Institute for Quality and Excellence in Healthcare.
Objective:
Goal was to develop rapid recommendations for clinical osteology, diabetology, geriatrics, neurology, orthopedics, traumatology, and general practice medicine, supporting implementation of coordinated care for patients at risk of or after osteoporotic fractures.
Methods:
Systematic search was conducted focusing on databases for clinical practice guidelines: G-I-N, BIGG, ECRI, Epistemonikos GRADE guideline repository, Guideline Central, MAGICapp, CPG Infobase, TRIP, Guideline Registry, Database of GRADE EtD's and Guidelines. Of the 171 results found, 11 guidelines were deemed the most relevant and forwarded for critical appraisal. Systematic review search was conducted in MEDLINE® ALL (Ovid), Embase (Ovid), and Epistemonikos databases. For the first recommendation regarding the effectiveness of FLS, clinical practice guideline was used. Summary of Findings was necessary to be done to support the evidence for second and third recommendation. Evidence-to-Decision frameworks were created for all questions.
Results:
Four recommendations were created. The first recommendation is linked to quality indicator. Information for patients was developed in form of plain language summary for each recommendation. Recommendation for health policy was created also.
Conclusions:
Rapid recommendation is a step toward implementing FLS coordinator program in the Czech healthcare system. Legislative framework is in place, but funding and collaboration with insurance companies are necessary for full implementation.

Background: Non-small cell lung cancer (NSCLC) remains a highly symptomatic with a rapidly increasing incidence. The treatment options are for most patients limited to adjuvant immunotherapy and best supportive care. Therefore, patient-reported outcomes (PROs) are increasingly becoming an essential component in evaluating healthcare quality from the patient’s perspective.
Objective: We aimed to assess the variability and reporting quality of PROs in NSCLC randomized controlled trial (RCT) study.
Methods: We searched for reports of PROs in NSCLC RCT studies in PubMed, Embase, Web of Science, Scopus, and ClinicalTrials.gov before June 6, 2024. The quality of PRO reporting was assessed using criteria recommended by the International Society for Quality-of-Life Research (ISOQoL). Multivariate linear regression was performed to examine the relationship between reporting quality and influencing factors.
Results: A total of 252 RCTs were included in the analysis. Overall, studies with PROs as primary endpoints demonstrated higher adherence to the reporting checklist (76%). The results of multivariate linear regression indicated a significant improvement in PRO reporting quality over time (β=5.35, 95% CI [1.05, 9.64], P < 0.05). However, substantial shortcomings were identified in PRO reporting, including high rates of missing data and a lack of information on PRO management modes (e.g., telephone, computer, etc.).
Discussion for scientific abstracts: The deficiencies observed in PRO reporting underscore the need for improved design and implementation of PRO endpoints in future NSCLC trials. Enhancing the quality of PRO reporting could improve the relevance and applicability of research findings to clinical practice.

Background: NICE is evolving from a series of separate programmes towards becoming a truly integrated organisation to serve our user’s needs. Building on NICE values of focussing on users first, acting boldly and trusting each other to make decisions, we have developed an approach to empower staff to test new ways of working to improve timeliness whilst maintaining quality in small areas of work before rolling out at pace to the wider programme.
Objective: Building on the successes and lessons learned from the CfG transformation journey so far focusing on:
• Increasing timeliness
• Improving user focus in our work
• Collaboration.
We will pitch how to initiate change within a guidance development context.
Format: We will present a brief overview of learning from the transformation programme discussing pros and cons of how we have approached the required change and share main recommendations for implementation.

Background: Research evidence is often lacking in rare diseases, complicating the development of evidence-based guidelines. Therefore, exploration of innovative methodological strategies is crucial.

Objective: To evaluate the added value of registry data as supplementary evidence in a rare disease guideline.

Methods: to develop this guideline, the GIN-McMaster Guidelines 2.0 was followed. Additionally, registry data was provided to clinical experts for clinical questions in which published evidence was scarce. The perceived effectiveness of the interventions was evaluated by clinical experts using structured observation forms (SOFs).

Results: Adequate supplementary data from the EPSA were available in seven of the twelve clinical questions selected for this guideline (58%). In four out of seven clinical questions (57%), evaluation of supplemental evidence using SOFs contributed to the panel’s decision on a recommendation. Reasons to disregard the supplementary evidence during the formation of a recommendation were uncertainty about the validity of the observations due to small sample sizes, and doubt about the association between the observed outcomes and the intervention due to missing of an intention to treat in the registry data.

Conclusion: This study shows a first evaluation of an innovative methodology for guideline development in rare diseases, highlighting both the challenges and benefits this method has to offer.

Discussion: Although the methodology requires refinement and the dataset used must be optimized, we believe this technique holds significant promise as a tool for developing guidelines for rare diseases.

Introduction
Although the need to integrate sex (as a biological attribute) and gender (as a social construct) into guidelines is widely recognised by scientists, this mandate is often limited to developing recommendations for women for specific diseases.
The lack of sex- and gender-specific evidence will have a negative impact on the advancement of knowledge and the achievement of equity in access to health services.
A sex- and gender-sensitive approach should consider the integration of sex and gender considerations throughout the guideline development process, from the definition of the scope, through the generation of clinical questions and systematic reviews, to the formulation of recommendations. This study aims to provide an overview of the integration of sex and gender-related knowledge into CPGs.
Methods
A systematic mapping review following the PRISMA-ScR guideline will be conducted to assess the frequency and modalities of sex and gender consideration in CPGs. Searches of the main CPG databases and PubMed, Scopus and Embase will be conducted from 2010 onwards.
First, text mining will be used to analyse the guideline texts and identify the use of sex- and gender-specific keywords. Then, two independent reviewers will review selected CPGs according to 1. Presence of an expert in gender medicine; 2. Sex-specific evidence synthesis; 3. Sex- and gender-specific recommendations.
Results (expected)
The review will provide a quantitative and qualitative picture of the gender and gender-sensitive approach to CPG development.
Conclusions
Sex- and gender-specific guidelines are essential to ensure more equitable and efficient health systems.
No conflicts of interest to declare.

Background
Including patient values and preferences(V&Ps) in healthcare decision-making is critical, especially when treatments have uncertain benefits, challenging side-effects, or may impact quality of life, like in tuberculosis(TB) management. Global guideline methodological standards recommend the inclusion of patients and the public into guideline development groups, however, how well this is implemented, practically, is unclear.

Objective
To review TB guidelines to describe their approach for inclusion of patient V&Ps in recommendations.

Methods
We reviewed published TB guidelines from various international and national guideline developers, including WHO and NICE, from the past four years. One reviewer searched the GIN,NICE and WHO databases, as well as specific country guideline websites. We extracted data on inclusion of patient V&Ps in methods sections, evidence-to-decision tables and guideline panel lists. We described findings narratively.

Results
We identified six guidelines published/updated between 2022 and 2025. TB guidelines from Australia and South Africa did not clearly address/include patient and public involvement in their methodology. Other guidelines reported limited patient representation,with some including one to two patient representatives on guideline panels or findings from patient perspective studies,but lacked broader evidence of patient engagement or in-depth qualitative findings of patient perspectives.

Discussion
Although widely accepted that patient and public involvement and patient V&Ps should be included in the guideline development process,methods are not always clear or consistently applied. Different organisations follow varying approaches, and in some cases, no involvement is evident.Further research is needed to understand effective, culturally appropriate ways of including patient V&Ps into guideline development, within different settings.

BACKGROUND
Cardiac rehabilitation is a strongly recommended intervention for patients with coronary artery disease (CAD) and chronic heart failure (CHF). To enhance patient engagement, it is essential to align rehabilitation programs with patient needs. The revision of the Dutch physiotherapy guideline on cardiac rehabilitation aimed to optimize cardiac rehabilitation to improve adherence and completion.
OBJECTIVE
We integrated qualitive and quantitative data to asses how rehabilitation programs could be structured to enhance adherence and completion among patients with CAD and CHF by integrating patient needs into guideline development.
METHODS
Two systematic reviews were performed: (1) a qualitative, meta-ethnographic synthesis to explore the rehabilitation needs of patients with CAD, CHF, or thoracic aortic dissection, using GRADE-CERQual; and (2) a meta-analysis assessing the effectiveness of interventions to enhance adherence and completion of cardiac rehabilitation using GRADE. The integration of both reviews informed the evidence-to-decision process.
RESULTS
The qualitative review identified five lines-of-arguments presenting patient needs: safety without overprotection, involvement of significant others, peer support, personalized care, and meaningful future planning. The integration of qualitative findings influenced the recommendations not only by shaping patient preferences and values within the evidence-to-decision process but also by carrying additional weight due to the nature of the clinical question. This resulted in a stronger emphasis on patient-centered approaches in the guideline recommendations.
DISCUSSION
Our findings suggest that when patient needs are central to guideline development, qualitative research should be considered as crucial evidence. These insights will be used to adapt the methodology for guideline development.

Background: The GRADE approach is the most widely used framework for rating the certainty of evidence and developing guidelines. While GRADE Centers are known for education and training, little is known about their teaching activities.
Objectives: This study aimed to identify structured educational activities, target audiences, and teaching methods used by GRADE Centers.
Methods: Between April and July 2024, an online cross-sectional survey was conducted among leaders of GRADE Centers and networks. The structured questionnaire, based on existing GRADE training frameworks and competency-based education literature, covered organizational capacity, teaching activities, target audiences, content, and delivery formats.
Results: After removing duplicates, responses from 27 of 28 GRADE Centers were analyzed (response rate: 94.4%). Most centers (40.7%) trained up to 50 individuals annually with two centers reporting an annual capacity of 201–250 trainees. The median number of scheduled workshops was three (IQR: 2–4.5). Over time, an estimated 13,850 individuals have received GRADE training, with current annual training capacity of approximately 2,000. Most centers (81.4%) relied on small numbers of trainers (1–5 individuals). English was the primary training language (63%); 44.4% centers offered additional languages. Training was primarily in-person (70.4%), with virtual (51.9%) and hybrid (11.1%) options. All organizations offered GRADE training to address questions of therapy/prevention and five (5/27; 18.5%) for diagnosis.
Conclusions: GRADE training is widely available, with growing online and multilingual offerings, reinforcing its role as a global framework for evidence-based decision-making.

Background: Rare Diseases (RD) affect up to 65 people out of 100,000 individuals. In Brazil, approximately 13 million people have RD. Clinical practice guidelines (CPG) are especially important to guide diagnoses and treatment of RD patients. The National Committee for Health Technology Incorporation (Conitec) advises Brazilian Ministry of Health (MoH) in CPG development.
Objective: To present RD CPG published by MoH and developed in Brazil public health context in the last thirteen years.
Methods: Descriptive qualitative study about RD CPG development and update by Conitec in Brazilian Unified Health System context. Data collection and analyses used Excel 2010 software.
Results: MoH has published 64 RD CPG, such as Cystic Fibrosis and Fabry disease. In 2012-2024 period, 100 RD CPG were published: 31 (31%) new CPG, 75 (75%) updates and 6 (6%) revoked. The annual average for RD CPG was 7.7. The largest number of CPG (n=13) were published in 2013 and 2018 and the smallest number (n=1) in 2023. New CPG were mostly published in 2019 and 2020. CPG revocations occurred in 2018 (n=1), 2021 (n=1) and 2022 (n=4).
Conclusions: Developing and updating CPG, based on the best scientific evidence available, contributes to better health outcomes in this population.
Brazilian Ministry of Health has been investing in production and updating CPG with a view to qualifying the health care provided to people with rare diseases throughout the country. Developing and updating CPG, based on the best scientific evidence available, contributes to better health outcomes in these populations.

Background:
The KNOW ESSENTIALS tool [1] facilitates locally-appropriate, evidence-informed, decision-making, by diverse stakeholders.

Objective:
To describe the KNOW ESSENTIALS tool, its strengths, and its limitations.

Methods and Results:
The tool starts with an analysis of the problem, based on three cardinal criteria viz. (i) KN=Knowledge of need (local epidemiology, consequences, public health significance vis-à-vis other needs, and robustness of local data); (ii) O=Outcome(s) of interest for; and (iii) W=Who is the target of the proposed intervention.

The next four Major criteria include E=Evidence of effectiveness (or efficacy) of the intervention(s); S=Safety (short and long term); S=Social considerations to health-care recipients, providers and/or society; and (iv) E=Economic issues (cost considerations and/or cost-effectiveness analysis).

The other criteria are N=Novelty bias; T=Time to outcome of interest; I=Integration (of the intervention and its delivery with/within the existing services); A=Alternate options (and their limitations); L=Likely impacts of deciding in favour or against the intervention; and S=Sustainability.

Decision-making process: Explore the cardinal criteria. If sufficient information is available, proceed to the Major criteria. If sufficient information is available, consider the Other criteria. Code each green, red, or yellow (indicating the level of confidence in available evidence). Subjective and objective judgements can be added to facilitate decision-making.

Conclusion:
The KNOW ESSENTIALS tool can facilitate evidence-based decision-making starting from analysis of the problem (rather than solution/intervention). It can be used by diverse stakeholders even with limited prior expertise.

References
[1] Mathew JL. Int J Tech Assess Health Care 2011; 27: 139-150.

Background: Chronic spine pain is a common, potentially disabling complaint, for which clinicians often administer interventional procedures. However, clinical practice guidelines provide inconsistent recommendations for their use.

Objective: To develop a clinical practice guideline regarding interventional procedures for chronic spine pain.

Methods: We conducted a systematic review and network meta-analysis of randomised trials and a systematic review of observational studies, summarizing the current body of evidence for benefits and harms of common interventional procedures for axial and radicular, chronic, non-cancer spine pain. An international guideline development panel, including four people living with chronic spine pain, produced recommendations in adherence with standards for trustworthy guidelines using the GRADE approach.

Results: For people living with chronic axial spine pain (≥3 months), the guideline panel issued strong recommendations against: joint radiofrequency ablation with or without joint targeted injection of local anesthetic plus steroid; epidural injection of local anesthetic, steroids, or their combination; joint-targeted injection of local anesthetic, steroids, or their combination; and intramuscular injection of local anesthetic with or without steroids.
For people living with chronic radicular spine pain (≥3 months), the guideline panel issued strong recommendations against: dorsal root ganglion radiofrequency with or without epidural injection of local anesthetic or local anesthetic plus steroids; and epidural injection of local anesthetic, steroids, or their combination.

Discussion for scientific abstracts: These recommendations apply to people living with chronic spine pain that is not associated with cancer or inflammatory arthropathy. Further research is warranted and may alter recommendations in the future.

Background: Ensuring healthcare users have access to reliable and up-to-date information is crucial. The growing prevalence of misinformation underscores the need to build trust in science by making information both accessible and understandable. Nursing Research Foundation (NRF) aims to popularize Clinical Practice Guidelines (CPGs) to plain language to provide information about care policies and their bases for public.
Objective: To describe the development and piloting of NRF guidelines for the general public.
Methods: 1) Essential information from the general public perspective was extracted from NRF-CPGs about exercise during pregnancy and after birth; 2) a layout was formulated to be accessible and comprehensive, based on previously developed criteria compiled from research evidence; 3) two online focus group discussions with the target population were held to collect feedback about text structure and flow, layout and clarity of concepts; 4) the correspondence of the modified text to the original NRF-CPGs was evaluated by the original authors; 5) the finalized document was piloted in collaboration with the health care professionals (n = 4) during patient education situations of the target population; 6) a network meeting was organized with non-governmental organisations, with representatives providing feedback of the document, and co-planned means for distributing the information.
Results: The first NRF’s guidelines for the general public were published in December 2024. Based on the pilot, the concept will be further developed and replicated for other applicable NRF-CPGs, in various nursing areas. All materials will be freely available from NRF webpage in digital and printable format.

Background
Heart failure (HF) is a growing healthcare challenge, especially in aging populations, with rising cases and hospitalizations. Traditional monitoring has accessibility limits, while remote telemedicine offers a promising solution for better patient care and outcomes.
Objective
The primary objective of this guideline was to evaluate whether telemedicine monitoring should be recommended for patients with advanced heart failure (HFrEF phenotype), specifically in terms of reducing rehospitalizations, decreasing mortality rates, and enhancing quality of life.
Methods
The guideline was developed together with the Czech Society of Cardiology based on the best available evidence, following the Czech National Methodology for the Development and Updating of Guidelines and Rapid Recommendations in Healthcare. All steps were carried out according to a standardized process in alignment with the widely adopted GRADE methodology, including a priori protocol registration in the Czech National Guideline Registry.
Results: Recommendations
The guideline panel issued two “strong recommendations FOR” the use of telemedicine in patients with advanced HF: 1. reducing rehospitalizations, and 2. decreasing mortality rates. One “conditional recommendation FOR” was made regarding improving quality of life.
Discussion
This guideline includes three clinical recommendations supporting remote telemonitoring for heart failure patients. The NIKEZ panel also proposes establishing heart failure teams with 24/7 technical support as a practice recommendation and submitting a request for a new remote monitoring procedure to the Czech Ministry of Health as a policy recommendation. Additionally, three quality indicators were defined, and the guideline includes plain language recommendations.

Background:
Appropriate literature searching and processing of the output are crucial to trustworthy evidence synthesis (and therefore evidence-based guidelines).

Objectives:
To examine the trustworthiness of literature searching and screening methods in a sample of systematic reviews.

Methods:
We identified all systematic reviews (SRs) related to child-health published in 2023, and selected a stratified random sample of 10%. From these, we extracted data related to the literature search procedure (number and types of databases searched, searching methods, and presentation of the output). We also examined the citation screening and study selection process, focusing on the number of reviewers who screened studies, and presentation of their outputs.

Results:
We identified 41672 citations, from which 39942 were excluded (being duplicates or not SRs or unrelated to child-health). From the remaining 1730, we selected a random sample of 10%.
Among 173 SRs, 21.4% had searched only two databases (most frequently PubMed and Embase). Less than half had searched >3 databases, and <10% had searched clinical trials registries. Almost 22% reviews stated using Google-Scholar as a ‘database’. Amongst SRs claiming to have searched grey literature, trials registries, and hand-searching, the respective outputs were presented in only 4.6%, 2.3%, and 1.1%.
Only 17.3% SRs reported that literature searching had been done independently by two reviewers, but none showed their outputs separately. Similarly, none of the SRs claiming independent citation screening and selection by two reviewers, reported the data separately.

Discussion/Conclusion:
Literature searching, citation screening, and study selection methods are inappropriate/inadequate in most systematic reviews, impacting trustworthiness.

Background: Ensuring adherence to clinical practice guidelines (CPGs) is critical for building trust in health systems and improving patient outcomes. However, how the impact of guideline adherence on clinical outcomes is studied remains unclear.

Objective: To determine whether and how the impact of adherence to CPGs on clinical outcomes has been assessed. We focused on CPGs addressing the management of major chronic diseases: musculoskeletal diseases, diabetes and hypertension.

Methods: We conducted a methodological review. We searched PubMed on March 3, 2023 (to be updated) for studies published since 2013. We included studies assessing the effect of adherence to CPGs for the pharmacologic management of adult patients. One reviewer screened the titles and abstracts and full-texts and a second reviewer independently screened 10%. Two reviewers independently extracted data using a standardized pilot-tested form. Data were analyzed descriptively.

Results: Of 7952 records retrieved; 16 studies were eligible for inclusion. The studies addressed CPGs for the management of diabetes (n=8), hypertension (n=6), and axial spondyloarthritis (n=2). All studies were observational, but none emulated a target trial. Four studies explicitly reported the recommendations for which adherence was assessed, nine precisely defined adherence and eight studies evaluated only surrogate outcomes. Thirteen studies accounted for confounding factors. There was serious or critical risk of bias in selection of participants in 13 studies.

Discussion: Adherence to CPGs is infrequently and inadequately assessed, limiting their role in strengthening health systems and public trust. More rigorous methodologies are needed to study the impact of guideline adherence on patient outcomes.