Category: ‘GIN’

GIN memberへ

2017年4月20日 Posted by aihara

GIN(Guideline International Network)のメンバーになりました。


2016年3月1日 Posted by aihara



しかし、そろそろ診療ガイドラインの質(特に作成手法の厳格さ)を評価する精度の高いツールを開発すべきと思います。既存のツールとしては、以下のようなものが代表的ですが、アウトカム中心のエビデンスの質評価、アウトカム全般にわたるbody of evidenceの質と推奨の強さの関連づけなど、診療ガイドラインの質を十分に評価できるかどうか疑問があります。



以下は、海外GRADE working group memberからのコメントです。

Dear Morio,
Not sure whether someone has done that yet.
Personally, I would not use AGREE as it is not specific enough and is mostly about process.
Same with IOM. It is a good starting point and broader framework, but if one would have to closely look at “guideline quality”, I think we need a new checklist. I believe there was a group that worked on this using Delphi technique, but I have not seen the final result.

There are fundamental issues at play: for example, do you rate studies or outcomes? You could have a traditional study based rating system in place and get top points with AGREE and IOM and I would argue unless you do outcomes based rating, such as GRADE, the guideline would be
worthless to me. Example in point: both IDSA and AASLD use GRADE, but they broke all their internal rules when they teamed up and created a
separate guideline for hep c that does not use GRADE. And predictably, it is very poor. They knew that if they use GRADE, there would be much less chance of injecting their opinion into the guideline.

So for any guideline rating system to be sensible, people would have to agree that you cannot give appropriate recommendations without
separating study level issues from rating our confidence in the effect of an outcome and ideally be able to trade-off outcomes against each
other (which, as you know, we did in AT9). I haven’t seen any guidelines similar in quality as AT9 but of course there’s a good chance I missed other excellent guidelines.


On 2/28/2016 10:52 PM, morio aihara wrote:
> Dear Yngve

> Is there any report that compared the quality of some CPG (with GRADE vs non-GRADE) using AGREE criteria or IOM standard?

> Best wishes,
> Morio





2015年9月24日 Posted by aihara


(1)米国IOMの「Standards for Developing Trustworthy Clinical Practice Guidelines(信頼できる診療ガイドライン(CPG)作成のための基準)

(2)診療ガイドラインの国際的ネットワークであるGIN (Guidelines International Network)の「Guidelines international network: toward international standards for clinical practice guidelines

これらの2つの基準の違いに関しては、IOM基準は非常に厳格で、GINのminimum G-I-N standardsはIOMよりは緩やかなものでより現実的で実行可能な基準と考えられていますが、米国においては、ATS (American Thoracic Society)を含むガイドラインの専門家団体は、IOM基準を順守するよう要求されているようです。

●minimum G-I-N standards:



While both the G-I-N and IOM standards will likely improve the trustworthiness of guidelines produced by professional societies, together they bring several additional challenges. First, development groups must choose between the minimum G-I-N standards and the more rigorous IOM standards, or perhaps something in between.

(A Guide to Guidelines for Pulmonary, Sleep, and Critical Care Medicine Clinicians. Proc Am Thorac Soc. 2012 Dec;9(5):211-4.

●他には、「GIN-McMasterガイドライン作成チェックリスト」という、GRADE working groupが中心となって作成したものもあります。