GIN conference and Cochrane Colloquium 2018

HOW CAN WE INTEGRATE GRADE AND A FORMAL CONSENSUS
METHOD INTO AN INTERNATIONAL GUIDELINE PROJECT?
THE EXAMPLE OF AN INTERNATIONAL CONSENSUS CONFERENCE ON PATIENT BLOOD
MANAGEMENT (ICC-PBM)
HANS VAN REMOORTEL
COORDINATING RESEARCHER
CENTRE FOR EVIDENCE-BASED PRACTICE (CEBAP)
BELGIAN RED CROSS
WWW.CEBAP.ORG

Conflicts of interests
 Employee of Belgian Red Cross-Flanders, providing safe blood products
to hospitals in Flanders and Brussels which did not influence his
contribution to ICC-PBM 2018 Frankfurt
 No conflicts of interest to declare

Outline
1.Patient Blood Management: 3 topics of interest and 17
PICO questions
2. Using a formal consensus methodology: the Consensus
Development Conference
3. Using an evidence-based methodology: the GRADE approach

Patient blood management (PBM) is a patient-
focused, evidence-based and systematic
approach to optimize the management of
patient and transfusion of blood products for
quality and effective patient care.

Scientific Committee: formulating 3 topics
of interest and 17 PICO questions
Scientific Committee
Pierre Albaladejo (Grenoble University Hospital, France/ISTH)
Shubha Allard (NHS Blood & Transplant/ISBT)
Cécile Aubron (Academic Hospital of Brest, France/SFTS)
Kari Aranko (European Blood Alliance/EBA)
Dana Devine (Canadian Blood Services/CBS)
Craig French (Western Health, Melbourne Australia)
Kathrine P. Frey (Fairview Health Services and Patient Readiness
Institute, Minneapolis MN/AABB)
Christian Gabriel (Ludwig Boltzmann Institute for clinical and
experimental traumatology, Austria/DGTI)
Richard Gammon (One Blood, Orlando/AABB)
Andreas Greinacher (Institut für Immunologie und
Transfusionsmedizin Greifswald/ICTMG)
Marian van Kraaij (Sanquin, the Netherlands/EBA)
Jerrold Levy (Duke University School of Medicine, North Carolina/ISTH)
Giancarlo Liumbruno (Italian National Institute of Health/EBA)
Patrick Meybohm (University Clinics of the Johann Wolfgang Goethe University Frankfurt/Main)
Markus Müller (Institute for Transfusion Medicine and Immunohaematology Frankfurt/EBA)
Mike Murphy (NHS Blood & Transplant and AABB/EBA)
Hans Van Remoortel (Centre for Evidence-Based Practice, Belgian Red Cross)
Ben Saxon (Australian Red Cross Blood Service/ARCBS)
Erhard Seifried (German Red Cross Blood Transfusion Services/EBA) (chair)
Nadine Shehata (Mount Sinai Hospital Toronto/ICTMG)
Pierre Tiberghien (French National Blood Service/EBA)
Claudio Velati (Società Italiana di Medicina Trasfusionale e Immunoematologia)
Erica Wood (Epidemiology and Preventive Medicine at Monash University/ISBT)
Face-to-face meeting SciCom February 2017

Topic 1: Preoperative anaemia
 Definition and diagnosis (PICO 1 and PICO 2)
 Treatment (PICO 3)
Topic 2: RBC transfusion triggers
 Intensive care and acute interventions (PICO 4-9 & PICO 14)
 Haematology and oncology (PICO 10 & PICO 11)
 Neurology (PICO 12 & PICO 13)
Topic 3: PBM implementation
 Effectiveness implementation of ‘comprehensive’ PBM programs (PICO 15)
 Effectiveness behavioural interventions (PICO 16)
 Effectiveness decision support systems (PICO 17)
Face-to-face meeting SciCom February 2017
Scientific Committee: formulating 3 topics
of interest and 17 PICO questions

Outline
1. Patient Blood Management: 3 topics of interest and 17 PICO
questions
2.Using a formal consensus methodology: the Consensus
3. Using an evidence-based methodology: the GRADE approach

2-day International Consensus Conference on Patient Blood
Management
(24 & 25 April, Frankfurt, Germany)
- 200 medical experts
- From 5 continents
- Representing more than 10
disciplines (e.g. transfusion
medicine, surgery,
anesthesiology and
haematology)
- Co-sponsors: AABB, ISBT,
DGTI, SFTS, SIMTI, EBA
- Participation: ARCBS, TBS,
ICTMG, ISTH, NBA, ÖGBT,
SFAR
- Presence: WHO, EU
Commission, DGAI, National
Health Authority Australia

Decision-
making
panelists
Speakers
(Co-)chairs
Audience
Rapporteurs
Consensus Development Conference (CDC)

Consensus Development Conference (CDC)
*Nair R et al., Semin Arthritis Rheum, 2011; Sher G and Devine D, Transfusion, 2007
Major steps in the Consensus Development Conference format?
1) Evidence presented by the SCIENTIFIC COMMITTEE to the conference,
CHAIRED in a public (open) session followed by discussion (AUDIENCE)
2) Private (executive) session by DECISION-MAKING panel to further deliberate
on the evidence and discussion to reach consensus -> result: draft
consensus statement.
3) Presentation of draft consensus statement in a plenary session +
review/comment/indicative voting by conference attendees.
4) Final executive session with final consensus statement by DECISION-
MAKING PANEL.

Outline
questions
2. Using a formal consensus methodology: the Consensus
3.Using an evidence-based methodology: the GRADE
approach

GRADE approach
From evidence to recommendations – transparent and sensible
P
I
C
O
Outcome
Outcome
Outcome
Outcome
Critical
Critical
Important
Not
High
Moderate
Low
Very low
GradedownGradeup
1. Risk of bias
2. Inconsistency
3. Indirectness
4. Imprecision
5. Publication
bias
1. Large effect
2. Dose
response
3. Confounders
Summary of findings
& estimate of effect
for each outcome
Systematic review
Randomization
Experimental: High
Observational: Low

GRADE
overall quality of the evidence
across outcomes based on
lowest quality
of critical outcomes
Guideline development
GRADE recommendations
Evidence to recommendation
• For or against (direction) ↑↓
• Strong or conditional/weak
(strength)
By considering balance of consequences
(evidence to recommendation)
 Quality of evidence
 Balance benefits/harms
 Values and preferences
 Resource use (cost(-effectiveness)
 Equity – Acceptability - Feasibility
• “We recommend using…”
• “We recommend against using…”
• “We suggest using…”
• “We suggest against using…”
EtD framework
GRADEpro Guideline Formulate recommendations
Transparency, clear, actionable
Research?
Decision-making
panelists
Audience
Rapporteurs
(Co-)chairs
Panelists
GRADE approach
From evidence to recommendations – transparent and sensible

CRITERIA JUDGEMENT
RESEARCH
EVIDENCE
ADDITIONAL CONSIDERATIONS
1. DESIRABLE EFFECTS How substantial are the desirable anticipated effects?
2. UNDESIRABLE EFFECTS How substantial are the undesirable anticipated effects?
3. CERTAINTY OF EVIDENCE What is the overall quality of the evidence of effects?
4. VALUES
Is there important uncertainty about or variability in how
much people value the critical outcomes?
5. BALANCE OF EFFECTS
Does the balance between desirable and undesirable
effects favor the intervention or the comparison?
6. RESOURCES REQUIRED How large are the resource requirements (costs)?
7. COST EFFECTIVENESS
Does the cost-effectiveness of the intervention favor the
intervention or the comparison?
8. EQUITY What would be the impact on health equity?
9. ACCEPTABILITY Is the intervention acceptable to key stakeholders?
10. FEASIBILITY Is the intervention feasible to implement?
Evidence-to-Decision framework
Rapporteurs
Rapporteurs
Rapporteurs
Rapporteurs
Rapporteurs
Rapporteurs
Rapporteurs
Rapporteurs
Rapporteurs
Rapporteurs
Audience
Audience
Audience
Audience
Audience
Audience
Audience
Audience
Audience
Audience

Outline
questions
2.Using a formal consensus methodology: the Consensus
3.Using an evidence-based methodology: the GRADE
approach
+

1 year of preparation
• Feb 2017: SciCom meeting,
Frankfurt (Germany)
• June 2017: Sponsors meeting,
ISBT Copenhagen (Denmark)
• March 2017 – April 2018:
12 SciCom teleconferences
• Jan/Feb 2018: two face-to-face
meetings with SciSec and chairs,
Frankfurt (Germany)
• March 2017 – January 2018:
systematic reviews 17 PICO
questions (+/- 18.000 references
screened, 145 studies included)
• Dec 2017 – April 2018:
• 2 SciCom webinars
• 4 panellists webinars
• 3 chairs webinars
• 1 webinar rapporteurs
• 1 tutorial rapporteurs
• 2 speakers webinars

3 Parallel sessions
Session 1: Preoperative anaemia
 Definition and diagnosis
(PICO 1 and PICO 2)
 Treatment
(PICO 3)
Session 2: RBC transfusion triggers
 Intensive care and acute interventions
(PICO 4-9 & PICO 14)
 Haematology and oncology
(PICO 10 & PICO 11)
 Neurology
(PICO 12 & PICO 13)
Session 3: PBM implementation
 Effectiveness implementation of
‘comprehensive’ PBM programs
(PICO 15)
 Effectiveness behavioural interventions
(PICO 16)
 Effectiveness decision support systems
(PICO 17)
Day 1 (24 April 2018)
Part 1: Plenary
• Evidence presented by
• Based on Evidence-to-Decision (EtD) framework
• Discussion with
moderated by
• Notes recorded by
AudienceRapporteurs
(Co-)chairs Panelists
Speakers

Day 1: 3 parallel/open sessions

3 Parallel sessions
Session 1: Preoperative anaemia
 Definition and diagnosis
(PICO 1 and PICO 2)
 Treatment
(PICO 3)
Session 2: RBC transfusion triggers
 Intensive care and acute interventions
(PICO 4-9 & PICO 14)
 Haematology and oncology
(PICO 10 & PICO 11)
 Neurology
(PICO 12 & PICO 13)
Session 3: PBM implementation
 Effectiveness implementation of
‘comprehensive’ PBM programs
(PICO 15)
 Effectiveness behavioural interventions
(PICO 16)
 Effectiveness decision support systems
(PICO 17)
Day 1 (24 April 2018)
+
+
+
Part 1: Plenary
Part 2: Closed (private/executive session)
• Evidence presented by
• Based on Evidence-to-Decision (EtD) framework
• Discussion with
moderated by
• Based on EtD framework
• Draft recommendations
by
• Moderated by
AudienceRapporteurs
Speakers

Day 1: closed session with decision-making panels

Draft conclusions at the end of day 1
TYPE OF
RECOMMENDATION
Strong recommendation
against the intervention
Conditional recommendation
against the intervention
for either the intervention or
the comparison
for the intervention
Strong recommendation for
the intervention
RECOMMENDATION Option 1: Formulation of a strong or conditional recommendation
Terminology strong recommendation: “we recommend…” – “clinicians should…” – “clinicians shoud not….” – “Do….” – “Don’t…..”
Terminology weak/conditional recommendation: “we suggest…” – “clinicians might….” – “we conditionally recommend…”
Option 2: No recommendation
Option 3: Research recommendation
JUSTIFICATION
…
SUBGROUP
CONSIDERATIONS …
IMPLEMENTATION
CONSIDERATIONS …
MONITORING AND
EVALUATION …
RESEARCH PRIORITIES
…
Closed session with chairs/decision-making panels/rapporteurs

 Plenary session with the general audience (all 3 topics)
 Presentation draft recommendations/justifications by
AudienceRapporteurs
Day 2 (25 April 2018)

 Discussion with/indicative voting by , moderated by the
 Notes recorded by
AudienceRapporteurs
Day 2 (25 April 2018)

 Discussion with/indicative voting by , moderated by the
 Notes recorded by
 Closed sessions with the decision-making panelists and (co-)
chairs
 Formulation of final recommendations by , moderated by the
AudienceRapporteurs
Day 2 (25 April 2018)

Day 2: closed session with decision-making panels

Conclusions: 10 evidence-based recommendations
 Topic 1: Preoperative anaemia
 4 recommendations (1 strong, 3 conditional)
 Topic 2: RBC transfusion triggers
 4 recommendations (2 strong, 2 conditional)
 Topic 3: PBM implementation
 2 recommendations (2 conditional)
 Research recommendations for all topics

Lessons learned to improve a future
guideline project
 Preparation: time versus resources
 2 face-to-face meetings between methodologists and experts
 Beginning: PICO + selection criteria (lumping vs splitting!)
 Intermediate: to discuss results systematic review
 Improve sense of ownership and knowledge of evidence-based methodology by
different groups (panel members, chairs)
 More rigorous process to select panel members (COI!) and formal/blind voting system
on draft/final recommendations
 Organization Consensus conference immediately before/after blood transfusion
conference (e.g. ISBT) could increase participation (by general audience).

Acknowledgments
Prof. Dr. Erhard Seifried (German Red Cross Blood Transfusion
Services/EBA) (chair)
Dr. Kari Aranko (European Blood Alliance/EBA)
Willemijn Kramer (European Blood Alliance/EBA)
Dr. Markus Müller (Institute for Transfusion Medicine and
Immunohaematology Frankfurt/EBA)
Prof. Dr. Patrick Meybohm (University Clinics of the Johann
Wolfgang Goethe University Frankfurt/Main)
Chairs of the Plenary Sessions:
Prof. Dr. Reinhard Burger, Robert-Koch-Institute, Berlin, Germany
Prof. Dr. Klaus Cichutek, Paul-Ehrlich-Institute, Langen, Germany
Prof. Dr. Jimmy Volmink, Faculty of Medicine and Health Sciences at
Stellenbosch University, South Africa
Decision-making panel ‘Preoperative anaemia’
Prof. Dr. Yves Ozier, University Hospital of Brest, France (Chair)
Prof Dr. Emmy De Buck, Centre for Evidence Based Practice, Belgian Red
Cross-Flanders, Belgium (Co-Chair)
Decision-making panel ‘RBC transfusion triggers’
Prof. Dr. Reinhard Burger, Robert-Koch-Institute, Berlin, Germany (Chair)
Prof. Dr. Jimmy Volmink, Faculty of Medicine and Health Sciences at
Stellenbosch University, South Africa (Co-Chair)
Decision-making panel ‘PBM implementation’
Prof. Dr. Jonathan Waters, Magee-Womens Hospital of the University of
Pittsburgh Medical Center (Chair)
Prof. Dr. Dean Fergusson, Ottawa Hospital Research Institute, University of
Ottawa, Canada (Co-Chair)
Stefan Holtzem (Photographer)

Acknowledgments
Centre for Evidence-Based Practice (CEBaP)
Belgian Red Cross
www.cebap.org
@CEBaP_evidence

Translating evidence into practical tools
to teach first aid to children
in sub-Saharan Africa
Anne-Catherine Vanhove – Researcher Centre for Evidence-Based Practice

Conflict of interest
I have no actual or potential conflict of interest in relation to this presentation.

Why?
Only 17 and
already saved a
life thanks to
first aid course
in school

Why?
✚ First aid training:
cost-effective approach to
decrease burden of disease &
injury in sub-Saharan Africa
(World Bank)
✚ African Red Cross National
Societies expressed need for
first aid materials adapted to
African context

Why?
✚ First aid training:
cost-effective approach to
decrease burden of disease &
injury in sub-Saharan Africa
(World Bank)
✚ African Red Cross National
Societies expressed need for
first aid materials adapted to
African context
✚ 2009-2011:
• Guidelines and materials with up-to-date
first aid and prevention advice,
specifically directed at the African context
• Focus on up-to-date first aid techniques
and injury/disease prevention advice
✚ 2016:
• Guidelines updated

Methodology
First Aid Service &
International CooperationCentre for
Evidence-Based Practice
Panel of external experts

Objectives and research questions
✚ Develop an educational
pathway that indicates at
which age a child can reach
certain objectives
concerning first aid
✚ Generate a list of
recommended educational
methods and materials for
educating children in LMICs
+ = ?
First aid
+ = ?
✚ Develop first aid educational materials for African children

Educational Pathway
Experimental and observational studies
Identified through database searching
11 446
Screening based on title and abstract
9742
Full text reviews assessed for elegibility
284
Original studies included
57
Duplicates removed: 1704
First aid
+ =
P: children (5-18 years) I: first aid training
C: no first aid training
O: first aid knowledge, skills
and attitude

Educational Pathway
Africa
2%
Asia
24%
Australia/
Oceania
10%Europe
44%
North
America
16%
South
America
4%
0 5 10 15 20 25 30 35 40 45
General
Four steps in first aid
Resuscitation
Choking
Skin Wounds
Burns
Bleeding
Injuries to bones, muscles or joints
Poisoning
% of studies per continent number of studies per topic

Educational methods and materials
Identified through database searching
819
Screening based on title and abstract
697
Full text reviews assessed for elegibility
282
Systematic reviews included
2
Duplicates removed: 122
Excluded: 415
Excluded: 280
+ =
P: primary & secondary
school children in low-
and middle-income
countries
I: instructional materials
and/or alternative
pedagogical methods
C: not providing or using
these
O: knowledge, skills
and attitude
Systematic reviews:

1. Provision of instructional materials
(e.g. flipcharts, textbooks)
2. Use of alternative pedagogical methods
(e.g. problem-solving method of teaching,
cooperative teaching, constructivist teaching,
guided inquiry teaching, small-group instruction)
3. Structured pedagogy interventions
(structured lesson content +
teacher training in delivering the new content +
instructional materials for students and teachers)

Input experts: educational pathway
✚ Content
• Additional topics:
e.g. stings and bites, fever, diarrhoea, fits
• Additional interventions:
e.g. plastic bags instead of gloves
✚ Context
• Objective removed due to possible unsafety for the child
e.g. touching an unknown person
• Objective attained at later age or keep repeating until 18 years of age
e.g. seeking help from medical provider, hand washing
• Highlight specific dangers at younger age
e.g. burns are generally caused by fire or hot water and make children aware of danger
https://www.iol.co.za/dailynews/watch-national-epilepsy-week-
squashing-the-myths-on-epilepsy-13257039

Input experts: educational methods
5-8 years 9-12 years 13-18 years
Story
telling
Game
Song
Game
Case
study Role-
play
Flip
chart
Role-
play
Case
study/
video/
manikin

First aid teacher manual: first draft

Current and future steps
✚ Second expert meeting to collect feedback on the
manual and materials
✚ Piloting the materials in several countries including
Zimbabwe and Burundi
• Train the teachers and collect their feedback
• Let the teachers train the children and collect feedback
✚ January 2018: Materials will be available

Acknowledgements
www.cebap.org
info@cebap.org
@CEBaP_evidence
www.linkedin.com/company/centre-for-evidence-based-practice-cebap-
International Cooperation Belgian Red Cross
Lieve Adam – Focal point First Aid
An Vanderheyden – Delegate at Tanzania Red Cross

Evidence-based
by CEBaP
Initiatives to successfully improve the acceptance
of Evidence-Based Practice (EBP) in an aid
organization: The example of the Belgian Red Cross
Bert Avau1,2
, Vere Borra1
, Emmy De Buck1,4
, Philippe Vandekerckhove3,4
1 Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen, Belgium; 2 Cochrane Belgium, Centre for Evidence-Based Medicine (CEBAM),
Leuven, Belgium; 3 Belgian Red Cross, Mechelen, Belgium; 4 Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium;
More information? Belgian Red Cross, Centre for Evidence-Based Practice, Motstraat 42, B-2800 Mechelen, Belgium.
Contact: bert.avau@cebap.org
V.u.: Philippe Vandekerckhove, Motstraat 40, 2800 Mechelen | 2018_049
Blended learning improves EBP knowledge, but not attitude
@CEBaP_evidence
0
2
4
6
8
10
Pre Post
Medianscoreona
questionnaire(max9)
Measured knowledge regarding EBP
0
2
4
6
Pre Post
Asnwerona5-point
scale(median)
Average attitude score
0
2
4
6
Pre Post
Asnwerona6-point
scale(median)
Average self-perceived knowledge score
Activities to implement EBP have increased in the past 5 years
12 evidence-based guidelines and 18 systematic reviews
were produced in the past 5 years and are used in practice
through manuals, procedures, folders & education
Blended learning
significantly improves
self-perceived
knowledge
(Wilcoxon test,
P = 0.03, n = 8)
Blended
learning opportunities
(1.5 h e-learning + 1.5 h face-to-
face) on the use of EBP
for employees and volunteers
Monthly
journal clubs for
operational services
Foundation of a
Centre for Evidence-Based
Practice (CEBaP) within
Belgian Red Cross
EBP uptake
incorporated in the
long-term strategic vision
Uptake of Evidence-Based Practice
in all layers of the organization
Top-down
managerial focus
and screening of new
employees’ attitude
First Aid
guidelines
First aid
educational
pathway
Reviews
supporting
blood donor
management
Review on the
effectiveness
of WASH
interventions
Guideline for supporting
vulnerable children
A significant increase
in measured
knowledge could not
be demonstrated
(Wilcoxon test,
P = 0.18, n = 8)
A significant increase
in EBP attitude was not
found
(Wilcoxon test,
P = 0.94, n = 8
Strategy
Everyone Helps
0
5
10
15
20
25
2013 2014 2015 2016 2017
Amount
Year
Markers of EBP implementation within the BRC in the past 5 years
Project applications with CEBaP by
the operational services
Mutual funding proposals
between CEBaP and an
operational service
Questions for methodological
support, to be provided by CEBaP
Number of journal clubs organised
in the organization

How a systematic review and continued
stakeholder engagement can lead to a
Theory of Change relevant to the aid sector …
Anne-Catherine Vanhove1
, Emmy De Buck1,2
, Philippe Vandekerckhove2,3
1 Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen, Belgium; 2 Department of Public Health and Primary Care, Faculty of
Medicine, KU Leuven, Leuven, Belgium; 3 Belgian Red Cross, Mechelen, Belgium
Background
The Centre for Evidence-Based Practice provides evidence-based substantiation of the activities of the Belgian Red Cross. One of the activities in international
humanitarian assistance is Forecast-based Financing (FbF). Many recent natural disasters had been forecasted before they caused damage, but humanitarian aid
mostly still arrives only after the impact of the disaster becomes clear. FbF aims to bridge the gap between forecast and action by releasing funds based on forecast
information for ‘early actions’ taking place in the 3-5 days before the disaster hits, to lower the impact of the disaster.
Objectives
We aimed to establish an evidence base for the identification of early actions for an FbF project in Mozambique by conducting a review of the existing evidence and
developing a Theory of Change (ToC). A ToC is a valuable tool for the aid sector which is used to develop a shared understanding of how interventions might work
and how change will happen in a programme.
Methods
While gathering the scientific evidence by conducting a
systematic literature search in several databases (phase 1
and 2), methodologists collaborate with several experts and
practitioners. Impacts of floods and cyclones and potential
early actions during these disasters were for instance identified
through expert and stakeholder interviews in Mozambique.
Finally,anoverarchingToCisconstructedbythemethodologists
(phase 3), which is further refined through stakeholder
engagement (FbF experts, policy makers and practitioners/end
users in Mozambique from e.g. government agencies, NGOs and
the Mozambique Red Cross Society).
Research questions for literature search:
1. What is the effectiveness of different potential early actions
to reduce the impact of flooding and cyclones in LMIC?
2. What factors influence the implementation of potential
early actions to reduce the impact of flooding and cyclones
in LMIC?
Overview of research approach:
Results
Evidence for interventions in the humanitarian
sector is still limited. No evidence concerning
floods and cyclones was identified for many
interventions from the existing systematic
reviews. If we identified no relevant studies for
floods and cyclones, we expanded the setting
to systematic reviews concerning all types of
natural disasters and ultimately again to the
broad international development cooperation
setting if needed. Phase 2 is currently ongoing,
in which we aim to identify relevant individual
studies for potential early actions for which no
evidence was identified in systematic reviews.
Potential early action Effectiveness
Factors influencing
implementation
Evidence
Prevent diarrhea: chlorine
tablets
Taste and smell
Ease of use
Education
Flood setting in one SR:
Yates 2015
Prevent malaria: nets,
repellents, spray or larviciding
Nets
Personal repellent
Indoor spray
Outdoor spraying ???
Larviciding
For nets:
Education
Free distribution or pay
Incentive for use
Development cooperation
setting in Cochrane SRs:
Augustincic Polec 2015,
Gamble 2006, Lengeler
2004, Maia 2018, Plues 2010,
Tusting 2013
Evacuation: incentives,
transport, shelter
Phase 2 ongoing Phase 2 ongoing
Protect fields: early harvest,
dig drainage
Protect goods/documents/
food
Protect livestock: vaccination,
evacuation
Reinforce houses/ schools/
hospitals
Stakeholder meeting:
Stakeholders discussed the identified scientific evidence and preliminary ToCs. Their input
was used to refine the ToCs regarding issues raised such as taking action at the houses
versus in shelters, the need for education at several timepoints and barriers towards the
use of chlorine tablets and mosquito nets.
Conclusions
Conducting a review of the existing evidence provides a solid base for the construction of a
ToC,whichcanberefinedbasedonstakeholderinput.Continuousstakeholderengagement
ensures the resulting ToC is relevant for practice and creates a sense of ownership and
stakeholder buy-in.
Current humanitarian response Forecast-based Financing
References: Augustincic Polec L, Petkovic J, Welch V, Ueffing E, Tanjong Ghogomu E, Pardo Pardo J, Grabowsky M, Attaran A, Wells GA, Tugwell P. Strategies to increase the ownership and use of
insecticide-treated bednets to prevent malaria. Cochrane Database Syst Rev. 2015 (3):CD009186. Gamble CL, Ekwaru JP, ter Kuile FO. Insecticide-treated nets for preventing malaria in pregnancy.
Cochrane Database Syst Rev. 2006 (2):CD003755. Lengeler C. Insecticide-treated bed nets and curtains for preventing malaria. Cochrane Database Syst Rev. 2004 (2):CD000363. Maia MF, Kliner M,
Richardson M, Lengeler C, Moore SJ. Mosquito repellents for malaria prevention. Cochrane Database Syst Rev. 2018 (2):CD011595. Pluess B, Tanser FC, Lengeler C, Sharp BL. Indoor residual spraying
for preventing malaria. Cochrane Database Syst Rev. 2010 (4):CD006657. Tusting LS, Thwing J, Sinclair D, Fillinger U, Gimnig J, Bonner KE, Bottomley C, Lindsay SW. Mosquito larval source management
for controlling malaria. Cochrane Database Syst Rev 2013 (8):CD008923. Yates T, Allen J, Joseph ML, Lantagne, D, 2017. Short-term WASH interventions in emergency response: a systematic review. 3ie
Systematic Review 33.
Floods and
cyclones
Natural
disasters
Development
cooperation
Phase 1: Identify
evidence in existing
systematic reviews
Phase 2: Identify
individual studies
where evidence
gaps exist
Phase 3: Integration
of scientific evidence
and stakeholder
input in ToC
R.E.:PhilippeVandekerckhove,Motstraat40,2800Mechelen|2018_097
Current humanitarian response Forecast-based Financing
Evidence-based
by CEBaP
More information? Belgian Red Cross, Centre for Evidence-Based Practice, Motstraat 42, B-2800 Mechelen, Belgium.
Contact: anne-catherine.vanhove@cebap.org
V.u.: Philippe Vandekerckhove, Motstraat 40, 2800 Mechelen | 2018_097
@CEBaP_evidence

Establishment of a methodological Expert Group:
a novel approach to optimizing primary care guideline revision
and development in Belgium
Jorien Laermans1,2, Vere Borra1,2, Saphia Mokrane2,3, Jan Harm Keijzer2, Sam Cordyn2,4, Nicole Dekker2,3,
Paul Van Royen2,3
1 Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium, 2 Expert Group, Working Group Development of Primary Care Guidelines, Belgium,
3 Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium, 4 White Yellow Cross Flanders,
Brussels, Belgium
• The Working Group Development of Primary Care Guidelines is a Belgian consortium
responsible for the revision and development of evidence-based guidelines for primary care
practitioners
• Since its establishment in 2014, several Guideline Development Groups (GDGs) have
struggled with the labor-intensive rigorous methodological aspect of guideline development
Background & introduction
Objectives
To revise and redefine the roles and responsibilities of the different GDG members, allowing them to
focus on their methodological or content area of expertise
Methods
Expert Group: focus on methodology & preparation
Other GDG members: focus on content & practice
• So far, the Expert Group has supported 3 monodisciplinary guideline revisions and
3 multidisciplinary guideline development start-ups
• During monthly meetings, they follow up on revisions, optimize processes &
procedures and strenghten internal expertise
Conclusion & implications for guideline developers
• The methodological Expert Group seems to be a promising approach to sustaining high-quality primary
care guideline development in Belgium•
• Taking full advantage of the individual GDG members’ strengths, whether methodological or substantive,
may help guideline developers to optimize the quality and quantity of their guideline output
Working Group
Development of
Primary Care Guidelines
Expert
Group
(7 members)
GDG
guideline 1 • Helping define clinical questions
• Developing search strategies
• Screening & critically appraising
other guidelines
• Preparing GDG & stakeholder meetings
Results & discussion
• Providing feedback to the Expert Group
• Sharing content & practical expertise
• Writing the guideline
GDG
guideline 2
GDG
guideline 3

GIN conference and Cochrane Colloquium 2018

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