Background: Living practice guidelines provide timely, evidence-based recommendations that help improve healthcare practices. The COVID-19 pandemic highlighted their value, but also uncovered their challenges. Since then, substantial experience has been gained in the production, publication, reporting, and appraisal of living guidelines.
Objective: To map the existing literature on the production, reporting, publication, and appraisal of living health practice guidelines.
Methods: We employed standard scoping review methodology. We included conceptual papers and empirical studies related to the production, reporting, publication, and appraisal of living guidelines. We searched MEDLINE and EMBASE. We developed a data abstraction form based on a published framework for the development of living guidelines in health. We extracted data and synthesized the findings based on the pre-defined categories: production, reporting, publication, and appraisal; and produced an evidence map.
Results: Of 52 included studies, (48%) were conceptual papers (e.g., guidance, frameworks) while (52%) were empirical studies (e.g., meta-research, case studies, evaluations, qualitative and survey studies). Twenty-three studies (44%) focused on living guideline experiences, mostly from Australia (65%). Production was the most addressed concept (85%), followed by publication (46%) and reporting (21%). None of the studies addressed appraisal. Production included criteria for adopting the living mode, literature surveillance, updating frequency, decision thresholds, interest-holder engagement, resources, and collaboration. Publication covered formats, platforms, accessibility, and peer review.
Discussion: Our analysis contributes to advancing the production methods of living guidelines and provides a foundation for more comprehensive guidance. More research is needed on the publication, reporting and appraisal of living guidelines.

Background: Africa has increasingly adopted digital tools and innovations in healthcare, such as telemedicine, mobile health applications, and AI-driven diagnostics, to enhance access to care and improve healthcare delivery. The continent also faces challenges in pediatric cancer care, but initiatives like the Texas Children's Global HOPE program demonstrates a commitment to building capacity and improving health outcomes through education and evidence-based guideline implementation. We examined the existing capacities and areas for improvement in the development, adoption, and contextualization of healthcare guidelines in Africa, with a focus on pediatric cancer care and digital health system innovations.
Methods: The study analyzes key innovations, including the Practical Approach to Care Kit (PACK) and the AI Supported Healthcare Assistant (AISHA), as well as the Texas Children's Global HOPE program on the Dissemination and Implementation Science (DIS) Specialist Education Program which includes guideline development, quality improvement, and mentorship. It also reviews initiatives by organizations such as iCODE Abakwa, Africa Evidence Network, and Cochrane Africa.
Results: PACK, developed by the University of Cape Town, has significantly improved clinical care since 2006, while AISHA enhances public health by streamlining guideline development using AI. The Texas Children's Global HOPE program has successfully developed antimicrobial stewardship guidelines and implemented quality improvement initiatives for pediatric cancer care in Africa. Also, digital tools like the digitized Malaria Management Guidelines in Cameroon further highlight Africa's innovation potential.
Discussion: Africa's digital health tools like PACK and AISHA improve clinical care. However, further collaboration and local evidence integration are essential for enhanced healthcare decision-making.

BACKGROUND: In 2022, an update to the NICE Type 2 diabetes (T2DM) clinical guideline recommended that GPs should offer an SGLT-2 inhibitor to T2DM patients with either comorbid cardiovascular disease (ACVD) or chronic heart failure (CHF).

OBJECTIVES: We aimed to evaluate uptake and inequalities in uptake of SGLT-2 inhibitors in these two patient groups in England in September 2023.

METHODS: Data from a representative sample of 25% of UK GP practices was analysed. Patients with prevalent Type 2 diabetes and comorbid ACVD or CHF on 1st September 2023 were identified using patient's GP and hospital records. The percentage of patients with a current SGLT2 inhibitor prescription was calculated according to patient characteristics, and additionally evaluated with logistic regression.

RESULTS: The analysis included 587,826 patients with prevalent T2DM. SGLT-2 inhibitor uptake was 22% in the patients with ACVD, and 30% in those with CHF. In the ACVD subgroup, women had lower odds of a current prescription than men (OR: 0.67 (0.65, 0.69)), and Black and Black British people had lower odds than White British people (OR: 0.78 (0.72, 0.83)). Similar associations were observed in the CHF group.

DISCUSSION: There is an opportunity for increased dissemination of the existing NICE guidance on SGLT-2 inhibitors, and for large increases in use of these cost-effective treatments in the UK. Real-world data is a valuable resource for monitoring uptake and inequalities in uptake of clinical guidelines. To our knowledge, no other studies have previously evaluated uptake of SGLT-2 inhibitors in the UK up to 2023.

Background: Evidence-based clinical practice guidelines (CPGs) are crucial for high-quality patient care. This scoping review is a part of the project Dissolve-E which seeks to enhance the accessibility and usability of CGPs by digitalising the AWMF guideline register and aligning it with digital standards, thus integrating it into a wider digital trustworthy evidence ecosystem .
Objective: To explore tools, methods and experiences with digitalisation of text-formatted CPGs towards executable, computer-interpretable guidelines (CIGs).

Methods: We systematically searched MEDLINE, Web of Science, PMC Europe and Google Scholar on 19 June 2024. We included studies of any design, published from 2014 onwards, focusing on methodological issues and challenges with technical digitalisation processes as well as attitudes and experiences of users of CIGs and knowledge-based clinical decision support systems (CDSS).

Results: The search yielded 14,347 hits. After title/abstract-level, 273 records qualified for full text screening. So far, we included 127 articles for data extraction. Interim analysis indicates that interoperability between different digital guideline formats, databases and applications is crucial. Technically, the implementation of CIG into CDSS was the prominent topic. Medically, the management of conflicting guideline content and avoidance of adverse events in the case of multimorbidity was frequently addressed.

Discussion: Our preliminary results highlight the necessity for multidisciplinary collaboration to address the barriers to digital guideline development and implementation. Our findings will inform stakeholders and point out future directions for the digital transformation of CPG into CIG as well as specific needs for further research.

Background: Skilled birth delivery is vital for improving maternal, neonatal, and child health, particularly in conflict-affected regions like Bali, Cameroon. Integrating artificial intelligence (AI), technology, and digital innovations into healthcare guideline development can significantly enhance health outcomes. This study focuses on merging local health data with global evidence to create clinical practice guidelines tailored to local contexts, addressing district-level knowledge gaps.
Objectives:
• To integrate local health data with global evidence using advanced technologies.
• To develop clinical practice guidelines tailored to local contexts.
• To address disparities in guideline application at the district level.
Methods:
The study utilized the eBASE System’s decision-making process, which integrates local health data, AI algorithms, community preferences, and effective interventions. Methods included collaboration with the Bali District Health Service, the use of DHIS2 data and geotagging for qualitative and quantitative data collection, and stakeholder meetings for data validation and synthesis.
Results:
A 79.3% reduction in unskilled births was observed over 12 months. This was achieved through accurate data extraction, AI-driven data presentation to stakeholders, and community meetings to validate findings and develop evidence-based interventions. Key actions included training health workers, educating communities on skilled birth importance, and targeting high-priority areas like Bossa and Bali Urban.
Discussion:
Integrating AI with local health data significantly improved the development of context-specific clinical guidelines. Community engagement and stakeholder involvement were pivotal to the initiative’s success. Continuous adaptation, stakeholder collaboration, and ongoing investment in AI-driven platforms are essential for sustaining and enhancing maternal health outcomes.

Background:
Systematic reviews and network meta-analyses (NMA) were conducted to update the NICE type 2 diabetes guideline. Statistical knowledge of the healthcare professionals and people with lived experience in NICE committees can vary and ensuring everyone can understand the data is crucial.

Objective:
To summarise the results of complex datasets in an accessible format that provides the most useful information for decision-making.

Methods:
Results from 39 NMAs were imported to Microsoft Power BI. Automated data transformation was conducted to calculate the risk difference and number needed to treat from hazard ratios using control group risks at specified timepoints.

Data dashboards were generated for each outcome of interest including an interactive forest plot; a visual summary of adverse event rates after treatment compared to baseline; a table including the summary statistics and intervention unit costs; and cards with additional metrics to aid decision making. This was accompanied by slicers (interactive filters) for each population model, intervention and class.

Results:
The committee used the dashboard to aid their recommendation writing. This allowed them to focus their considerations of 23 individual interventions for 11 outcomes for four population strata on what matters most to current practice.

Discussion:
The data dashboards improved the clarity of data visualisation and communication to the committee. The process reduced the time needed to produce presentations, while providing an adaptable resource for further investigation. As the program interface is user-friendly, it is easier for developers to implement than software that requires more coding knowledge.