Background: The aim of this paper was to create an updated Australian guideline on footwear for people with diabetes. Methods: We reviewed new footwear publications, (international guidelines, and consensus expert opinion alongside the 2013 Australian footwear guideline to formulate updated recommendations. Result: We recommend health professionals managing people with diabetes should: (1) Advise people with diabetes to wear footwear that fits, protects and accommodates the shape of their feet. (2) Advise people with diabetes to always wear socks within their footwear, in order to reduce shear and friction. (3) Educate people with diabetes, their relatives and caregivers on the importance of wearing appropriate footwear to prevent foot ulceration. (4) Instruct people with diabetes at intermediate-or high-risk of foot ulceration to obtain footwear from an appropriately trained professional to ensure it fits, protects and accommodates the shape of their feet. (5) Motivate people with diabetes at intermediate-or high-risk of foot ulceration to wear their footwear at all times, both indoors and outdoors. (6) Motivate people with diabetes at intermediate-or high-risk of foot ulceration (or their relatives and caregivers) to check their footwear, each time before wearing, to ensure that there are no foreign objects in, or penetrating, the footwear; and check their feet, each time their footwear is removed, to ensure there are no signs of abnormal pressure, trauma or ulceration. (7) For people with a foot deformity or pre-ulcerative lesion, consider prescribing medical grade footwear, which may include custom-made in-shoe orthoses or insoles. (8) For people with a healed plantar foot ulcer, prescribe medical grade footwear with custom-made in-shoe orthoses or insoles with a demonstrated plantar pressure relieving effect at high-risk areas. (9) Review prescribed footwear every three months to ensure it still fits adequately, protects, and supports the foot. (10) For people with a plantar diabetic foot ulcer, footwear is not specifically recommended for treatment; prescribe appropriate offloading devices to heal these ulcers. Conclusions: This guideline contains 10 key recommendations to guide health professionals in selecting the most appropriate footwear to meet the specific foot risk needs of an individual with diabetes.

Background: Heart failure is a clinical syndrome occurring from the heart’s inability to effectively fill and or pump blood, it is the most common reason for admission in elderly patients. Guideline directed medical therapy refers to implementation of all class I agents to reduce patient morbidity and mortality, unless there is an appropriate contraindication. Appropriate beta blocker (BB), angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), and aldosterone antagonist (AA) are recommended to be prescribed together prior to discharge for a hospital admission for decompensated heart failure with reduced ejection fraction (HFrEF). Get With The Guidelines – Heart Failure (GWTG- HF) is an online quality improvement project that assists hospitals in providing guideline directed care. Objective: The purpose of this study was to determine if implementation of the GWTG-HF program, increases provider adherence to guideline directed medical therapy (GDMT) for patients admitted with a primary diagnosis of decompensated HFrEF at Banner University Medical Center Tucson (BUMCT). Design: This is a quality improvement project with a pre and post test descriptive design. Setting: BUMCT from 10/04/17 – 11/08/17 Participants: Fifty-five patients discharged with the primary diagnosis of decompensated HFrEF Measurements: Baseline guideline adherence for a 30-day period was compared to guideline adherence after the initiation of the GWTG-HF program. Results: The 24 patients pre intervention were compared to 31 patients post intervention. The following results were found when comparing pre and post adherence rates: BB adherence 92% versus 100%, ACEI/ARB adherence 100% versus 94%, AA adherence 67% versus 84%, and guideline directed medical therapy 58% versus 81%. There were no statistically significant differences for the pre and post adherence rates. Conclusion: Although, there were no statistically significant differences found to support that implementation of the GWTG-HF program, increases providers adherence to GDMT for patients admitted with a primary diagnosis of decompensated HFrEF, the trends were clear. In three out of four class I agents, there was an increase in appropriate provider prescribing per the guidelines.

Benzodiazepine dependence is a significant national problem. Although benzodiazepines — a class of drugs that includes drugs such as alprazolam, lorazepam, temazepam, clonazepam, and diazepam—have a wide range of uses including the treatment of insomnia, anxiety, and seizures; they are addictive. Individuals taking these drugs can quickly develop dangerous tolerances. Therefore, these drugs should not be selected as first choice nor used for more than short periods, yet a significant portion of the population uses benzodiazepines for long periods. This problem is significantly more pronounced in the elderly, a population that scholars have agreed should not use these drugs outside of extreme circumstances. Because benzodiazepines may be wrongfully perceived as an easy treatment for so many common afflictions, providers continue to prescribe them, and patients may be reluctant to discontinue use due to the symptoms associated with withdrawal (i.e., insomnia and anxiety). To avoid these symptoms, the standard discontinuation approach seen in an outpatient setting is a long-term taper that may take eight to 12 weeks of gradual reduction. However, in an inpatient setting, this long-term approach is unfeasible due to the short length of patient stays. The literature has given little consideration to this problem. Thus, it was necessary to review evidence and develop a guideline for benzodiazepine tapering in elderly patients receiving inpatient psychiatric care. The purpose of this project was to develop a guideline to taper benzodiazepines in the elderly using the Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP). The guideline was validated by expert peer reviewers using the AGREE II instrument. The completed guidelines offer recommendations on the tapering of benzodiazepines in an inpatient geropsych unit and best practices for interventions to increase the success rate of discontinuation.

Cílem této práce je vytvoření komplexního pohledu na tvorbu aplikací v Microsoft Office s využitím VBA. Především potom najít způsob jak jednoduše a především levně a rychle vytvářet tento typ aplikací. V úvodní části práce jsou stručně popsány aplikace sady MSO, které jsou při tvorbě MSO řešení nejvíce používány. Dále je zde popsán postup vývoje v jazyce VBA současně s ním i způsob vývoje aplikací ve Visual Studiu. Jsou zde stručně popsány některé základní metodiky a vůbec historie softwarového inženýrství. V kapitole Guideline pro tvorbu aplikací v MSO, která vytváří největší přínos této práce je popsán vývojový cyklus tvorby aplikací v MSO, který jsem během své praxe vytvořil. Praktická úloha potom popisuje postup tvorby jednoduché aplikace v Ms Access. Práce je určena dvěma základním skupinám osob. Jsou to především ti, kteří jsou v roli analytiku a manažerů pracovišť, kde mají pocit, že neustále mechanicky opakují věci, které by bylo možné zautomatizovat. Dále jsou to potom programátoři, analytici a konzultanti, kteří by chtěli začít vyvíjet řešení postavená na MSO. Hlavním přínosem práce je poskytnutí obecného náhledu na tvorbu tohoto typu aplikací, společně s návodem, jak to činit co nejefektivněji.

OBJECTIVES: During health guideline development, panel members often have implicit, different definitions of health outcomes that can lead to variability in evidence synthesis and recommendations. McMaster GRADE Centre researchers developed a standardized description of health outcomes using the health marker state format. We aimed to determine which aspects of the development, content, and use of marker states were valuable to guideline developers. STUDY DESIGN & SETTING: We conducted a case study of marker state development with the European Commission Initiative on Breast Cancer (ECIBC) Guidelines Development Group (GDG). Eighteen GDG members provided written and interview feedback on the process. Using the health marker states, 2 health utility rating surveys were conducted near the beginning and end of development respectively. RESULTS: We developed 24 marker states for outcomes related to breast cancer screening and diagnosis. Feedback from GDG members revealed that marker states could be useful for developing recommendations and improving transparency of guideline methods. Comparison of the two health utility surveys showed a decrease in standard deviation in the second survey across 21 (88%) of the outcomes. CONCLUSIONS: Health marker states are a promising method, satisfying the pre-requisite of being feasible, acceptable, and with some initial result on reduction of variance of health utility scores. / Thesis / Master of Public Health (MPH) / OBJECTIVES: During health guideline development, panel members often have implicit, different definitions of health outcomes that can lead to variability in evidence synthesis and recommendations. McMaster GRADE Centre researchers developed a standardized description of health outcomes using the health marker state format. We aimed to determine which aspects of the development, content, and use of marker states were valuable to guideline developers. STUDY DESIGN & SETTING: We conducted a case study of marker state development with the European Commission Initiative on Breast Cancer (ECIBC) Guidelines Development Group (GDG). Eighteen GDG members provided written and interview feedback on the process. Using the health marker states, 2 health utility rating surveys were conducted near the beginning and end of development respectively. RESULTS: We developed 24 marker states for outcomes related to breast cancer screening and diagnosis. Feedback from GDG members revealed that marker states could be useful for developing recommendations and improving transparency of guideline methods. Comparison of the two health utility surveys showed a decrease in standard deviation in the second survey across 21 (88%) of the outcomes. CONCLUSIONS: Health marker states are a promising method, satisfying the pre-requisite of being feasible, acceptable, and with some initial result on reduction of variance of health utility scores.

Background: Tuberculosis (TB) is the number one infectious disease killer in the world. TB is both preventable, and curable. Since 1997, the World Health Organization’s (WHO) Global TB (GTB) Programme has released evidence-informed publications to guide member states. In their EndTB strategy, the WHO set a mandate to eradicate TB by 2035, in part by intensifying TB research and innovation. As an effort towards this goal, this project applies evidence mapping methodologies to published WHO TB recommendations, in an innovative process called “recommendation mapping” (RM). Objectives: The prime objective of RM is to allow guideline developers and key stakeholders to identify gaps and clusters of recommendations across publications, serve as an instrumental tool in the sequence of guideline development (from intelligent priority setting, to the assembly of final recommendations) and increase the accessibility of key guideline components. The secondary objective of this work is to poise guideline components for live update and refinement in a rapidly learning health system. Methods: In this mixed methods study, a methodological framework for mapping guideline components is proposed, with both a quantitative and narrative assessment of raw data and final map outputs. A qualitative analysis from the perspective of key stakeholders, policy-makers, researchers and WHO-GTB liaisons working in guideline development is also included. For the methodological piece, all publications containing WHO TB recommendations were eligible for the mapping exercise. Each recommendation was extracted according to all subdomains of their PICO backbone. Subsections of recommendations are coded using existing ontologies (SNOMED-CT, ATC, ICD-11). A centralized database containing extracted and coded recommendations was then presented in an online and interactive schematic. For the qualitative assessment of palatability of this approach within the organization, semi-structured interviews and a survey was delivered to eligible participants at two Guideline Development Group meetings for WHO tuberculosis treatment and screening guidelines. Results: The notable result of this work is the development, refinement and application of recommendation mapping methodologies. 20 WHO-GTB guidelines underwent an application of the novel recommendation methodologies proposed in this thesis to create an interactive map, and a searchable database. In-depth interviews and survey results with 21 participants (WHO GTB staff, WHO TB- guideline development group members and technical experts) pointed to concerns in the current accessibility and organization of WHO-GTB guidelines. Conclusions: Recommendation mapping may have utility in charting the terrain of recommendations, inform priority setting, and provide a scaffold for the future transition to living guidelines. / Thesis / Master of Public Health (MPH) / The World Health Organization (WHO) issues guidelines to help clinicians, policy-makers, and researchers make informed decisions in their work. Guidelines contain recommendations that can be thought of as bottom-line answers to the questions we ask the scientific literature (based on the evidence available to us today). The WHO’s Tuberculosis (TB) Department is partaking in a novel digital reorganization of their guideline recommendations using the evidence-mapping methods proposed in this thesis. This thesis uses the principles of evidence mapping to create recommendation maps that, like any map, chart the landscape in a given domain (in this case, TB recommendations). The recommendation map will help guide the WHO in setting priorities for future research and guideline development.

Evidenced based nursing seeks to integrate new knowledge from current research into practice. The use of clinical practice guidelines is one method of accomplishing this. The purpose of this study was to assess the effect of differing clinical practice guideline representation formats on the quality of nursing care plans and on the experiences of nurses. To accomplish this, an experimental study taking place in a laboratory setting was executed. BC Cancer Agency nurses volunteered as the participants. The nurses were given case scenarios and asked to generate nursing care plans with the assistance of clinical practice guidelines. The clinical practice guidelines were presented in two formats: Portable Document Format (PDF) and Web Based Interactive (WBI). The quality of the care plans was rated using a validated evaluation tool. Participants were asked to ‘think-aloud’ during the care planning process and their experiences were recorded, transcribed, and analyzed through a cognitive task analysis. This study revealed advantages and disadvantages to both formats and provided insight into nurses' experiences. This study also showed no statistically significant difference in the quality of care plan documentation, regardless of clinical practice guideline format. This study highlights the importance of evaluating health informatics projects in healthcare settings to ensure positive outcomes in measures of user experience and measures of documentation quality. / Graduate / 0569 / 0758 / 0984 / csimad@gmail.com

Background: Analytical frameworks (AF) are graphical representation of the key questions answered by a systematic review and can support the development of guideline recommendations. Our objectives are to a) conduct a systematic review to identify, describe and compare all AFs published as part of a systematic and guideline development process related to colorectal cancer (CRC); and b) to use this case study to develop guidance on how to conduct systematic reviews of AFs. Methods: We conducted a systematic review and searched Medline and Embase from 1996 until December 2020. We also manually searched guideline databases and websites. We identified all guidelines in CRC that utilized an AFs and all systematic reviews in primary prevention, screening, and diagnosis of CRC that used AFs. We assessed quality of the guidelines using the Appraisal of Guidelines for Research and Evaluation II tool. The systematic review was registered in PROSPERO, registration CRD42020172117. Results: We screened 34,505 records and identified 1166 guidelines on CRC and 3127 systematic reviews, of which 5 met our inclusion criteria identifying a total of 4 AFs in colorectal cancer. We describe our search strategy and methods for conducting systematic reviews for AFs. Conclusion: Few guidelines and systematic reviews are utilizing AFs in the development of recommendations. We developed methods for conducting a systematic review on AF / Thesis / Master of Science (MSc) / Analytical frameworks are graphical diagrams that represent key questions with flow of resining from population to outcome. We conducted a systematic review to identify all analytical frameworks in colorectal cancer and in the process we developed guidance on how to conduct a systematic review for analytical frameworks. We identified four analytical frameworks, one in primary prevention, and three in screening of colorectal cancer. We found only a few clinical practice guidelines that utilized analytical frameworks in the development of the recommendations. We developed methods for conducting a systematic review of analytical frameworks.

Systematic reviews of diagnostic test accuracy (DTA) studies are fundamental to the decision-making process in evidence-based medicine. Although such studies are regarded as high-level evidence, these reviews are not always reported completely and transparently. Sub-optimal reporting of DTA systematic reviews compromises their validity, generalizability, and value to key stakeholders. This thesis evaluates the completeness of reporting of published DTA systematic reviews based on the PRISMA-DTA checklist and provides an explanation for the new and modified items (relative to PRISMA), along with their meaning and rationale. Our results demonstrate that recently published reports of DTA systematic reviews are not fully informative, when evaluated against the PRISMA-DTA guidelines: mean reported items=18.6/26(71%, SD=1.9) for PRISMA-DTA; 5.5/11(50%, SD=1.2) for PRISMA-DTA for abstracts. The PRISMA-DTA statement, this document, and the associated website (http://www. prisma-statement.org/Extensions/DTA) are meant to be helpful resources to support the transparent reporting of DTA systematic reviews and guide knowledge translation strategies.

Faculty of Humanities School of Education 9711890e barbaramichel@absamail.co.za / The focus of this action research study was to facilitate a field generated process to develop guidelines towards standards of practice for peer education. Peer education has been widely used across the globe and often in health oriented fields. In South Africa, peer education practice is marked by the lack of agreed standards and guidelines together with a lack of empirical evidence of its impact on beneficiary groups. The researcher consulted with over 200 individuals who are, in some way, connected or involved in the management of peer education or programmes focussing on youth. The research confirmed the lack of an agreed definition of peer education, the need for guidelines and eventually standards of practice for peer education. There was consensus that peer education was considered a ‘valuable strategy’ despite a chronic lack of reporting, monitoring and clear goals for most programmes. An additional challenge was the lack of evaluation of the benefit of peer education to beneficiaries. Programmes lack underpinning theories, and often are implemented in an attempt to ‘help’ communities in any way possible. Lack of a systemic approach and lack of agreed performance standards, perpetuates peer education interventions that fail due to avoidable challenges that could have been averted with more attention to planning and systematic organisation. The research proposes that with agreed standards and support to implement and build capacity at national and provincial level, peer education could become a flagship for the prevention, care and support to many communities, particularly where there is a chronic lack of resources.