Background
Clinical questions frequently represent complex decision-making needs that require assessment across many interventions and comparisons. Under the traditional GRADE Evidence-to-Decision (EtD) framework, these questions can result in many lengthy tables that are difficult for guideline developers and end users to process and interpret.

Objectives
To facilitate and ensure transparent decision-making for complex clinical questions involving multiple interventions within the GRADE-EtD framework.

Methods
In 2020, ACP manually built its first pilot multiple-comparison EtD (MC-EtD) framework to support decision-making for managing acute non-low back pain and has since published using an electronic MC-EtD framework managed via GRADEpro.

Results
The first ACP MC-EtD summarized evidence and judgments across nearly 30 interventions. ACP has published 6 other guidelines addressing complex clinical questions involving multiple interventions, evolving the MC-EtD to incorporate additional EtD criteria for decision-making.

Discussion for scientific abstracts
ACP’s approach to the MC-EtD framework has streamlined the recommendation formulation process for complex clinical questions. It has reduced the number of tables required to present and analyze complex data, showcased flexibility in adapting to various clinical questions’ characteristics, and facilitated the prioritization of options when supported findings.

Objective: To evaluate the current application status of the Population, Intervention, Comparator(s), Attributes, and Recommendation(PICAR) framework—a structured tool designed for systematic reviews of clinical practice guidelines (CPGs)—and compare its utility with the traditional Population, Intervention, Comparison, and Outcome(PICO) framework.
Methods: A systematic search was conducted in PubMed and Web of Science (up to December 2024) using a combination of Medical Subject Headings (MeSH) terms and free-text keywords. Two researchers independently screened studies published after 2019 that explicitly applied the PICAR framework to CPG evaluations, with discrepancies resolved through group discussions. Data on first authors’ countries, journal impact factors, and framework implementation details were extracted using a pre-designed Excel sheet for statistical analysis.
Results: Among 601 CPG systematic reviews, 47 studies (7.8%) utilized the PICAR framework, significantly surpassing the adoption rate of PICO (27 studies, 4.5%). PICAR applications were concentrated in China and Canada (17% combined), likely due to prior dissemination efforts. Most studies employing PICAR were published in mid-tier journals (impact factor 3–6, 47%), with limited representation in high-impact journals (>9, 2%). While PICAR enhanced methodological rigor through structured elements (e.g., CPG attributes, and recommendation characteristics), its adoption was constrained by its novelty and researchers’ persistent reliance on PICO.
Conclusion: The PICAR framework addresses critical limitations of PICO in CPG evaluations but remains underutilized. Broader adoption requires targeted academic promotion, standardization refinement, and interdisciplinary collaboration to strengthen guideline evaluation quality and advance evidence-based decision support.
Keywords: PICAR framework, clinical practice guidelines, systematic review.

Background: The RIGHT Statement is a key tool for evaluating the reporting quality of clinical practice guidelines (CPGs). However, its lack of standardized thresholds to classify reporting quality (e.g., high vs. low) hinders consistent interpretation and cross-study comparisons.

Objective: To analyze how existing studies applying the RIGHT tool define reporting quality thresholds and identify methodological inconsistencies.

Methods: We conducted a systematic review of studies using the RIGHT tool to assess CPG reporting quality. Databases (PubMed, China National Knowledge Infrastructure) were searched up to February 2025. Inclusion criteria: peer-reviewed articles (English/Chinese) applying RIGHT tool for reporting quality evaluation. We extracted data on thresholding and classification methods.

Results: Among 116 studies, only 17 (14.7%) explicitly defined thresholds. Three distinct approaches emerged, but, no study empirically justified thresholds.
1. Based on reporting rates: 6 studies used reporting rates≥70% = high quality, 40-70% = moderate quality, ≤40% = low quality; 5 studies adopted ≥80% = high quality, 50-80% = moderate quality, <50% = low quality; 1 study used 60% as a ‘qualified’ threshold.
2. Total score thresholds: 4 studies scored 35 criteria (1 point/item), defining ≥30 = high quality, 20-29 = moderate quality, ≤19 = low quality.
3. Unilateral thresholds: 1 study classified <50% as low quality.

Conclusion: Substantial variability in threshold definitions undermines the comparability of RIGHT-based evaluations. Standardized criteria are urgently needed. Limitations include incomplete database coverage; future work should expand searches to ensure comprehensiveness.

Acknowledges: The author gratefully acknowledges the support of K.C.Wong Education Foundation, Hong Kong.

Background
Guidelines development handbooks provide guidance on how to create public health/clinical practice guidelines. Despite previous work to identify best practices, currently, there is no published tool to assess equity considerations in guideline development handbooks.

Objective
We undertook two phases of tool development and validation.

Methods
In phase one, we reviewed literature to generate a list of “essential elements” or tasks experts agree are part of guideline development methodology. We mapped “essential elements” to relevant equity concepts, and drafted an equity assessment tool for use in reviewing guideline development handbooks. In phase two, we surveyed experts (previous guideline panel members/researchers) for feedback and pilot tested the tool with experts using the WHO guideline development handbook.

Results
We identified 18 “essential elements” of guideline development. Each item has 5 parts: essential element name, definition, criteria/consideration, where to look, and illustrative quote. Twenty experts responded to the online survey. Based on qualitative coding, most experts either provided no feedback or added language to existing tool criteria. Eight experts participated in pilot testing the revised tool. Among experts some essential elements had higher agreement in their assessments compared to other essential elements. Potential reasons include differing equity frameworks, and different individual’s research interests. We incorporated their feedback and finalized our tool.

Discussion
We propose an equity assessment tool to identify opportunities to further enhance equity in guidelines development handbooks. Future research may include further validation by applying the tool to international and national guideline development handbooks.

The key characteristics of elderly patients is the high prevalence of chronic diseases. To manage multiple disease symptoms, they often take various medications simultaneously, leading to polypharmacy. Polypharmacy increases the risk of adverse drug reactions due to drug-drug interactions and, rather than promoting treatment and health recovery, may accelerate frailty.
In South Korea, patients have unrestricted access to healthcare facilities ranging from primary to tertiary care, which significantly increases the risk of polypharmacy. To address this issue, a guidelines are being developed to manage and regulate polypharmacy.
From the April 2024, the National Evidence-based healthcare Collaborating Agency (NECA) and the Korean Association of Internal Medicine (KAIM) collaborated for trustworthy Korean guideline development. A working committee was formed multidisciplinary with 16 specialists.
To identify the target medications, a list of drugs commonly associated with high polypharmacy use, BEERS criteria and STOPPS, was compiled. Through committee discussions, the following medications were determined to require caution when prescribed for the elderly patients: proton pump inhibitor (PPI), muscle relaxants, NSAIDs, opioids, megestrol, and oral steroids.
The development was carried out using the GRADE-ADOLOPMENT method, following the GRADE approach to assess the certainty of evidence and formulate recommendations. In cases of insufficient evidence, expert consensus recommendations are being considered using formal consensus methodologies (such as the Delphi technique) to establish recommendations that are applicable to the domestic context.
This guideline is currently under development, with evidence review in progress (2024.4. ~2025.12.). Upon finalizing the recommendations, various dissemination tools will be developed to facilitate widespread implementation.

Background
Evidence-to-decision (EtD) frameworks provide a transparent method for guideline panels to consider a range of key factors when formuating recommendations. The WHO-INTEGRATE framework is rooted in WHO norms and values. It addresses the complexity of interventions and delivery systems, making it particularly suitable for public health, health systems, and health policy guidelines. The framework has been used in WHO and AWMF guidelines and elsewhere, covering issues as diverse as wheelchair provision and school measures during the COVID-19 pandemic.
Objectives
To increase awareness of the WHO-INTEGRATE framework and available resources
To gain hands-on experience with the application of the WHO-INTEGRATE framework
To reflect on the added value and challenges in applying the WHO-INTEGRATE framework
To gain feedback on the framework
Format
The workshop, hosted by WHO and the LMU Munich, will combine presentations, hands-on exercises and audience participation.
Part I: Getting to know the framework
PRESENTATION: WHO-INTEGRATE basics: framework, criteria and sub-criteria, resources, uses
INTERACTIVE: Q&A
Part II: Applying the framework
PRESENTATION: WHO-INTEGRATE application: introduction to use case “school guidelines” and guiding questions
INTERACTIVE: Exercise in groups of 5-8 people, each focusing on a selected criterion, its added value and challenges (e.g. selection of sub-criteria)
Part III: Reflecting on the use, added value and challenges of the framework
INTERACTIVE: Fishbowl exercise: series of 2-minute statements from eight seats (“fishbowl”), with an initial set-up of six filled seats and two empty seats with participants (spokespersons from the groups in part II and facilitators moving in and out to make a statement.

Background

Guideline developers are frequently confronted with a diverse range of evidence, ranging from scientific studies including randomized controlled trials, observational and case studies, and qualitative evidence synthesis, to experiential knowledge by various interest holder, evidence retrieved through technological innovations, as well as sustainability and cost efficiency considerations.

While methods for retrieving and assembling diverse types of knowledge have advanced significantly, strategies for meaningfully integrating them remain less standardized and less refined. What alternative approaches exist beyond consensus-building? How can conflicting or opposing evidence be effectively incorporated into guidelines? There is a growing need to explore methods to address this challenge of meaningfully drawing on different types of evidence.

Objective

This session aims to explore best practices for integrating diverse forms of knowledge into guidelines. By learning from real-world examples and engaging with the community of guideline developers, participants will share and gain insights into how different types of evidence, values, ethics, and contextual factors can be incorporated into guideline development in different ways.

Format

The session will begin with a selection of examples showcasing some approaches to integrating diverse evidence. Participants will then engage in small group discussions to share experiences and challenges related to this topic. Finally, the group will reconvene in a plenary session to exchange insights, reflect on different integration strategies, and explore potential new approaches collectively developed during the discussions.

Background
Multimorbidity is an increasing global health challenge with consequences and widening health inequalities in low-and-middle-income countries (LMICs). Addressing multimorbidity in LMICs demands a shift from fragmented models of care to a more comprehensive and integrated patient centred care model, independent of socio-economic circumstances. Proposed strategies include tailored guideline-development models, capacity sharing and collaboration.
Objective
This workshop will equip participants to identify gaps and tailor guideline development strategies to local contexts, fostering effective and sustainable evidence-informed policies for multimorbidity in LMICs.
Description of activities/interaction plan
The workshop focuses on how to approach contextualisation of global evidence for impact in LMIC settings using guideline adolopment case studies. The session offers deliberative dialogue on collaboration, capacity strengthening and infrastructures for planning and implementation of patient-centred approach to management of multimorbidity in LMICs. This will be a knowledge exchange platform and present practical training to those interested in knowledge translation and evidence-informed policies in low-resource contexts.
We will work in five steps:
1. Introduction including overview of workshop objectives, highlights of previous and ongoing research,
2. Applicable adolopment practices for LMICs working through examples in small groups,
3. Deliberative dialogue on effective partnerships, collaboration, equity and ethics
4. Agreeing priorities and commitments, recognising key multisectoral interest-holders,
5. Summary, Q&A, and closing
Planned Outcomes: Action plan for multimorbidity guideline adolopment for LMIC context, draft terms of reference for effective collaboration, a position statement addressing multimorbidity guidelines and evidence-informed policies. Longer-term outcomes include a global multi-institutional partnership and commitment to capacity sharing in this field.

Background: Snakebite accidents are on the World Health Organization's list of neglected tropical diseases. Brazil's vast territory and cultural diversity make addressing snakebites complex, requiring strategies adapted to regional and sociocultural realities.

Objective: Describe the sociodemographic profile and implications for the standardization of practices in snakebite care.

Methods: A qualiquantitative study based on a scoping review that explored the Brazilian reality regarding social aspects, beliefs, and customs related to snakebite accidents. Data from the Ministry of Health (MS), 2001-2022, were analyzed to outline the epidemiological profile of victims, considering year, location, sex, and race/color. Mortality rates were calculated as deaths/population at risk, times 1 million (2010 Census), and trend analysis used Prais-Winsten regression (p<0.05).

Results: A total of 509,275 snakebite cases were reported. The North region shows the highest increase in incidence (4.1%/year) and the highest mortality, despite a stationary trend (TIMA: 4.7%; 95% CI: 1.1-8.4; p=0.013). Cases are more common in men, Black, Brown, and rural workers, while lethality is higher in women, Indigenous, elderly, and socioeconomically vulnerable people. High exposure and barriers to healthcare access in the North worsen the impacts, with cultural factors increasing Indigenous vulnerability. MS data confirm regional differences in snakebites and highlight greater challenges for the North region.

Discussion: Brazil's continental dimension and sociocultural diversity make it difficult to create clinical guidelines, but these initiatives can serve as regional models that promote strategies adapted to local particularities, helping address public health issues in Latin America.

Background: Current guidelines recommend 12 months of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) to reduce the risk of stent thrombosis and ischemic events. However, DAPT increases bleeding risk. The advent of new-generation drug-eluting stents (DES) has reduced stent thrombosis risk, leading to the hypothesis that transitioning from DAPT to monotherapy could lower bleeding risks without increasing ischemic or thrombotic complications. Despite this, the choice of optimal monotherapy (aspirin vs. P2Y12 inhibitors) remains unclear due to limited comparative evidence. Existing systematic reviews have not adequately considered follow-up duration, switching to monotherapy, or the certainty of evidence.

Objective: This study aims to provide a comprehensive analysis of the effectiveness of various antiplatelet regimens, follow-up durations, and a GRADE assessment. The goal is to determine whether aspirin or P2Y12 inhibitor monotherapy is more effective and safer in reducing cardiovascular events in patients with DES.

Methods: We conducted a comprehensive search of Medline (PubMed), Embase, and CENTRAL from inception to the present. Two reviewers independently screened studies, extracted data, and critically appraised them using the newly developed risk of bias tool (ROBUST). Disagreements were resolved by consensus or a third reviewer. Data will be pooled using pairwise and network meta-analyses with a Bayesian approach, and the GRADE methodology will assess the certainty of the evidence.

Future Prospects: This systematic review employs rigorous methods to ensure reliable results. The findings will inform clinical guidelines and provide a basis for personalized treatment strategies for millions of patients globally.