references, enhances screening, assigns reviews and tracks progress.
Importantly, it also creates evidence profiles or summary of
findings tables, which display the overall quality of evidence rating
for each outcome as well as across outcomes. These tables are
critical for proof of transparency in the process and are required
for posting on the AHRQ repository for CPGs, the National
Guideline Clearinghouse. Recommendations are then formulated
as strong or weak/conditional for, or against, a management
strategy. There are specific considerations for the quality of
evidence and also the balance of benefit/harm, patients’ values
and preferences, as well as resource utilization.
7. Vote on recommendations: The writing group convenes in
person at the annual meeting to vote on the recommendations.
Each evidentiary table is reviewed and determination of
recommendations is made according to the GRADE process.
8. Draft the manuscript: After recommendations are determined,
the writing group prepares a manuscript for publication. A
medical writer is then contracted to assist in the final composition
and editing of the manuscript.
9. Perform review/seek endorsements: Once the manuscript of the
CPG is complete, NCS calls upon the membership to review
the document. Members have one to two weeks to perform
an exhaustive review. The results are collated and summarized
by the GC co-chairs elect, who present the comprehensive
assessment to the GC for discussion. The feedback is then
provided to the writing committee for incorporation into the
final draft. Once the final draft is complete, it is sent to external
societies for endorsement. Endorsement or affirmation may be
subject to methodology employed, and may include addition
revisions if warranted.
10. Publish and publicize the guideline: Once the review and
endorsement process is complete, the CPG is presented at the
annual meeting with concomitant publication in Neurocritical
Care, with all relevant endorsements. The CPG is also posted on
the NCS website to facilitate access. Once posted on the NCS
website, the CPG is also submitted for posting on the National
Guideline Clearinghouse website. Required for posting on that
website is a comprehensive review of the methodology, a timeline
of the process, the evidentiary tables and completion of a formal
checklist. The GC updates the advocacy and publicity committees
to promote visibility of the CPG.
How can you get involved?
If you are interested in participating in the guidelines process,
there are many opportunities for involvement. Society members
are encouraged to submit topic ideas via our annual survey to
the membership, which is a critical component in identifying
potential topics. Alternatively, members can volunteer to review
drafts of internal guidelines, or to review CPGs from other
societies to determine level of NCS endorsement. Members
interested in joining the GC should respond to the member and
leadership surveys conducted every spring, as these are the most
direct routes to committee membership.
Members involved in CPG development with other societies,
including (but not limited to) the American Academy of
Neurology, the American Stroke Association and the Society for
Critical Care Medicine are encouraged to inform the GC co-chairs
of current projects. Knowledge of NCS member participation
on external guidelines and projects facilitates coordination and
collaboration with partnering societies, and can streamline review
and endorsement processes.
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Health Service on Clinical Practice Guidelines. Clinical Practice
Guidelines: Directions for a New Program. Washington DC:
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2. United States Congress. Medicare Improvements for Patients and
Providers Act of 2008, Public Law 110-275. Retrieved February
3. Institute of Medicine. Clinical Practice Guidelines We Can Trust.
Washington DC: National Academies Press, 2011.
4. American Academy of Family Physicians. AAFP Definitions for
Policy Statement, Position Paper, and Discussion Paper. Retrieved
February, 2018: https://www.aafp.org/about/policies/all/policydefinitions.
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clinical practice recommendations, position papers, and
consensus statements: Definition, preparation, role, and
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6. Guyatt GH, Oxman AD, Schunemann HJ, Tugwell P,
Knottnerus A. GRADE guidelines: A new series of articles in
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7. Schünemann H, Brożek J, Guyatt G, Oxman A, editors.
GRADE handbook for grading quality of evidence and strength of
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Group, 2013. Retrieved February 2018: guidelinedevelopment.
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