Iberoamerican Cochrane Centre- Biomedical Research Institute Sant Pau IIB Sant Pau, Barcelona, Spain.
Implement Sci. 2013 Aug 22;8:94. doi: 10.1186/1748-5908-8-94.
Clinical practice guidelines (CPGs) become quickly outdated and require a periodic reassessment of evidence research to maintain their validity. However, there is little research about this topic. Our project will provide evidence for some of the most pressing questions in this field: 1) what is the average time for recommendations to become out of date?; 2) what is the comparative performance of two restricted search strategies to evaluate the need to update recommendations?; and 3) what is the feasibility of a more regular monitoring and updating strategy compared to usual practice?. In this protocol we will focus on questions one and two.
The CPG Development Programme of the Spanish Ministry of Health developed 14 CPGs between 2008 and 2009. We will stratify guidelines by topic and by publication year, and include one CPG by strata.We will develop a strategy to assess the validity of CPG recommendations, which includes a baseline survey of clinical experts, an update of the original exhaustive literature searches, the identification of key references (reference that trigger a potential recommendation update), and the assessment of the potential changes in each recommendation.We will run two alternative search strategies to efficiently identify important new evidence: 1) PLUS search based in McMaster Premium LiteratUre Service (PLUS) database; and 2) a Restrictive Search (ReSe) based on the least number of MeSH terms and free text words needed to locate all the references of each original recommendation.We will perform a survival analysis of recommendations using the Kaplan-Meier method and we will use the log-rank test to analyse differences between survival curves according to the topic, the purpose, the strength of recommendations and the turnover. We will retrieve key references from the exhaustive search and evaluate their presence in the PLUS and ReSe search results.
Our project, using a highly structured and transparent methodology, will provide guidance of when recommendations are likely to be at risk of being out of date. We will also assess two novel restrictive search strategies which could reduce the workload without compromising rigour when CPGs developers check for the need of updating.
临床实践指南（CPGs）很快就会过时，需要定期重新评估证据研究，以保持其有效性。然而，关于这个主题的研究很少。我们的项目将为该领域一些最紧迫的问题提供证据：1）建议过时的平均时间是多少？；2）评估更新建议的必要性时，两种受限搜索策略的比较性能如何？；3）与常规实践相比，更定期的监测和更新策略的可行性如何？在本方案中，我们将重点关注问题 1 和问题 2。
西班牙卫生部的 CPG 开发计划在 2008 年至 2009 年期间制定了 14 项 CPG。我们将按主题和发布年份对指南进行分层，并按层纳入一项 CPG。我们将制定一项评估 CPG 建议有效性的策略，其中包括对临床专家进行基线调查、更新原始全面文献搜索、确定关键参考文献（触发潜在建议更新的参考文献）以及评估每项建议的潜在变化。我们将运行两种替代搜索策略，以有效地识别重要的新证据：1）基于 McMaster 高级文献服务（PLUS）数据库的 PLUS 搜索；2）基于找到每个原始建议的所有参考文献所需的最少数量的 MeSH 术语和自由文本词的受限搜索（ReSe）。我们将使用 Kaplan-Meier 方法对建议进行生存分析，并使用对数秩检验根据主题、目的、建议的强度和周转率分析生存曲线之间的差异。我们将从全面搜索中检索关键参考文献，并评估它们在 PLUS 和 ReSe 搜索结果中的存在。
我们的项目使用高度结构化和透明的方法，将为建议何时可能面临过时风险提供指导。我们还将评估两种新的受限搜索策略，当 CPG 开发人员检查更新需求时，这些策略可以在不影响严谨性的情况下减少工作量。
