Background: Clinical practice guidelines (CPGs) are typically updated every three to five years, often on irregular schedules with poorly defined processes. Living guidelines, however, are continuously updated as new evidence emerges, offering a unique opportunity to examine how recommendations evolve over time. 

Objectives: To map changes in the strength and direction of living COVID-19 treatment recommendations over time and analyze the justification for these changes.
 
Methods: This project is ongoing. We will include all recommendation for both non-severe and severe/critical COVID-19 of the WHO living guidelines on COVID-19 drug treatments. We will extract reasons for the update as described in the guidelines, and data on the direction, strength, and characteristics of recommendations across updates. Extracted characteristics will include treatment type, number of included studies, certainty of the evidence, and factors influencing changes in strength or direction. 

Results: This work is in progress. To date, there have been 14 versions of the guidelines on COVID-19 drug treatments. We will quantify the frequency of changes in strength and direction per treatment and overall. For conditional and strong recommendations, we will assess the frequency and timing of changes. We will also summarize the justifications for these changes across treatments and populations.  

Conclusions: This study will quantify changes in the strength and direction of COVID-19 treatment recommendations and identify factors influencing these changes. Our findings may help determine triggers for updating CPGs by analyzing the reasons for updates described in the guidelines, improving the understanding of how recommendations evolve in a living guideline framework.

Background: Understanding public perspectives is essential for informed public health decision-making. This study is part of the Pandemic Evidence Collaboration, a three-year program aiming to identify, develop and implement strategies to generate high-quality evidence for non-pharmacological interventions (NPIs) during pandemics.
Objectives: This study explores how the public values and perceives the benefits and harms of NPIs for pandemic control.
Methods: We will conduct a comprehensive literature search in Medline, Embase, PsycINFO, and CINAHL, using key terms related to pandemics, NPIs, and public values. The review team will also manually review grey literature. Two independent reviewers will screen studies, resolving conflicts through discussion or adjudication. We will extract data on study characteristics, methods, and value elicitation and assess bias using the ROBVALU tool.
Results: The review is ongoing, and we expect to identify diverse studies assessing public values toward NPIs. The review team will categorize results based on perceived benefits and harms of interventions like physical distancing and school closures.
Discussion: Defining the benefits and harms of NPIs presents challenges due to their complex and varied impacts across populations. While transmission reduction is quantifiable, harms such as mental health strain, economic losses, and educational disruptions depend on social and cultural contexts. Public values shift over time, further complicating their integration into policy-making. The lack of standardized methods for measuring these values adds to the complexity.
This review will offer insights into public perspectives on NPIs, helping policymakers integrate public values into health decisions to improve acceptance and effectiveness.

Aim: To analyze implementation and characteristics of guideline-based, oncological quality indicators (QI) in Germany

Background: The German Guideline Program in Oncology (GGPO) established a methodology to generate and implement QI based on GGPO guidelines.

Methods: QI stratified by guideline topic, numbers of QI calculable based on cancer registries or certification system, Donabedian-type, and evidence base of underlying recommendations are reported. Further, analysis results of the updating process are presented per tumor entity.

Results: Of the 6,016 (76-442) recommendations from 34 guidelines 2,417 (18-212) were strong, representing the foundation for potential QI. In total, 276 (1-15) QI have been developed, 245 being process indicators. Outcome and structural indicators are infrequent (27 and 4, respectively). 140 of the underlying recommendations are evidence-based. 175 of the QI can be calculated with the oncological base documentation set. 130 QI (186 entities) can be covered by the certification system. The most frequent QI type is therapy (102), followed by diagnosis (54), classification/histology (30), and “other” (61). Of the 180 QI undergoing updates, 66 were modified, 47 were dropped, and 67 new QI were added. On average, QI were modified after 6.3 years and dropped after 7.3 years.

Conclusion: The implementation of guideline-based QI is feasible, yielding important information on guideline adherence and serving as the foundation of certification. Guideline groups should integrate the QI results of cancer registries in their guideline- / QI-update. Regular and flexible QI update processes are necessary to reflect changes in guideline recommendations and to react on changes in healthcare.

Background: Public trust in science and policy requires transparency, collaboration, and accessible communication. At present, members of the public and healthcare professionals may not be familiar with clinical guidelines, what they are, how they are created, and how to get involved in their development. This can lead to a mistrust in health policy and decision-making, as well as a lost opportunity to ensure that recommendations are based on real clinical practice and address outcomes that matter most to people.
Objective: Based at the Centre in Ireland for Clinical guideline support and Evidence Reviews (CICER), the STAKEholder project seeks to: partner meaningfully with people with lived healthcare experience and healthcare professionals; enhance general awareness and transparency regarding clinical guideline development in Ireland; and prepare those with lived experience and healthcare professionals to be actively involved in guideline development groups.
Methods: In partnership with people with lived experience and healthcare professionals, we will apply co-production and knowledge exchange methods to develop accessible micro-learning videos and e-learning courses. We will use an iterative approach, featuring formative involvement in course content, storyboard workshops, user testing, and summative evaluation.
Results: We will present on our approach to co-production of digital learning materials on guideline development, key outcomes, and lessons learned.
Discussion: Our iterative, participatory approach is intended to foster meaningful stakeholder collaboration throughout the co-production process. This project will build transparency and partnership both during development and through our outputs, to help strengthen public trust in science, health systems, and clinical guidelines.

Background: Transparent, standardised processes for retiring clinical guidelines (CGs) are essential for maintaining trustworthiness and ensuring healthcare professionals have access to current recommendations. A 2022 systematic review published by CICER on international practices for updating CGs identified nine handbooks that described retirement processes. In 2025, we were requested by the Irish Department of Health to compile an update on international guidance around retiring CGs.
Objective: To summarise international guidance on criteria and processes for retiring CGs.
Methods: We conducted a rapid scoping review updating the grey literature and web searches of the 2022 review to locate newly published guidance. Our data extraction focused on: criteria guideline organisations use for retirement; methods for communicating retirement to guideline development groups, users, and members of the public; and procedures for storing, labelling, accessing, or removing outdated CGs from publicly accessible websites.
Results: We included five previously identified handbooks, two updates to previously identified handbooks, and nine newly identified or newly published handbooks. Fifteen handbooks refer to criteria for retiring a guideline, most often that the expiration date has passed or a more recent or more comprehensive guideline has been published. Eight handbooks refer to methods for communicating, tagging, and or archiving retired guidelines.
Discussion: This review synthesises international practices for retiring guidelines, with a focus on criteria, communication, and storage procedures. Our findings will support guideline organisations in developing transparent, standardised retirement processes, which are crucial for maintaining guideline legitimacy and preserving trust among users of guidelines.

Background
As the national independent public scientific agency, the French National Authority for Health (HAS) is tasked to provide evidence-based and trustworthy guidelines. HAS adopted new methods, especially facilitating collaborations to ensure implementation and building trust.
Objectives
To implement a recent collaborative method.
Methods
A process is performed including use of new tools, a specific scoping period and regular meetings with medical societies and stakeholders.
Results
Guidelines department established a specific updating and collaboration unit and adopted new processes characterized by stronger collaborations and more agility. Training and outsourcing by learned societies are significant elements.
A specific guide and training tools were designed and set out all the conflict-of-interest management, methodological and scientific elements that make up the HAS specifications and can award the HAS label. The most recurrent demand from HAS are increasing the multidisciplinary of working group and including perspectives of patients, even in case of highly technical topics.
All along the process and at every crucial point of elaboration, regular "stop and go" meetings and exchanges are planned to adapt our process and building trust.
In 2 years-pilot phase, more than 17 GL were engaged in different fields (anesthetics and intensive care, gynaecology and childbirth, antimicrobial resistance, urology, etc).
Conclusions
Guideline developers must regularly adapt their methods to build trust in science. HAS established one to improve collaboration and implementation. A quantitative and qualitative report is on progress to assess the impact of this strategy and will share with the related GIN working groups (updating and collaboration).

Background: Antimicrobial resistance (AMR) is a recognized threat to global health. This is mainly driven by the inappropriate use of antimicrobials. Recommendations from evidence-based practice guidelines (EBPGs) can promote appropriate antimicrobial usage. Currently, no guidance exists for considering AMR in EBPGs.

Objective: To (1) assess whether and how EBPGs address AMR considerations, using a checklist developed in collaboration with stakeholders; and (2) promote appropriate interpretation and use of these guidelines, through the presentation of critical appraisal assessments.

Methods: We will conduct a two-stage Delphi process with four stakeholder groups to develop and conduct face validity for a checklist of AMR considerations for EBPGs. To assess guidelines, we will search various databases for EBPGs on four prioritized syndromes (e.g., community-acquired pneumonia). Pairs of reviewers will screen articles to include EBPGs and will use piloted data extraction forms to extract characteristics of the EBPGs (e.g., guideline topic, AMR considerations). For each EBPG, they will evaluate whether and how AMR was considered (using the developed checklist), methodological quality (using the modification of the National Guideline Clearinghouse Extent of Adherence to Trustworthy Standards instrument), and adaptability (using items from existing adaptability frameworks). Following user-testing and collaboration with knowledge users, results will be presented in an open-access database.

Results: This work is ongoing. We will present the details of our methodological approach for developing each of our three expected outputs.

Discussion: Our findings will help decision-makers contextualize the literature regarding AMR considerations, trustworthiness, and adaptability. Checklist development will be limited to content validation.