Update, 5 July: The presentations and abstracts are now all available here.
The symposium is underway today in Melbourne at the rather lovely Malthouse Theatre, with the theme Evidence, Communication and Impact.
Below are some of the tweets from the symposium. Please note that this post does not intend to provide a full report on any of the presentations or the overall event but is simply to give you a taste of the speakers and discussions.
If you want more details, google the speakers and their publications. Speakers and participants are welcome to post additional comment/clarifications/links below in the comments section. (I will continue adding tweets as the day goes on, for those not following on Twitter).
Some immediate feedback to Paul Glasziou’s suggestion re trials providing details to enable implementation of interventions:
Adding some more tweets from the afternoon session:
Some instant feedback from a GP re the NPS comment on antibiotics:
(David Tovey is Editor in Chief of the Cochrane Library).
Update, 4 July: Some more feedback to the conference tweets
As the remote area pharmacist Robbo (aka Andrew Roberts) points out, I am behind the times. As Dr Janette Randall told us, the organisation formerly known as the National Prescribing Service is now called NPS: better choices, better health (not easily fitted into a tweet, however…)
And Dr Julie Leask from the University of Sydney gave some feedback on the suggestion that medical journals should have access to raw data, and my tweet that the writing of patient leaflets is a developing science.
Meanwhile, the Society of Hospital Pharmacists has been in touch asking for more information about the presentation on research into patient leaflets. I hope that Professor Rachelle Buchbinder and colleagues will write a follow-up post for Croakey on this.
Further to concerns raised at the conference about the quality of clinical practice guidelines, there is a relevant article in the latest Medical Journal of Australia, Clinical practice guidelines: the need for greater transparency in formulating recommendations, by Ian Scott (Princess Alexandra Hospital, Brisbane) and Gordon Guyatt (McMaster University, Canada).
The authors call for an overhaul of how clinical practice guidelines are done in order to tackle conflicts of interests, and to ensure guidelines are credible and applicable. They say:
The quality of CPG bears little relation to the level of seniority or expertise of guideline authors. Guideline panellists often harbour COI that may not be fully evident, even to the panellists themselves, but which can potentially bias their recommendations. These conflicts include not only financial ties with industry but also practice reimbursement incentives, professional affiliations and practice specialisation, intellectual attachment to their own studies, ideas and innovations, and desire for academic recognition and career advancement. The most entrenched conflict can be a disinclination to challenge or reverse strongly held beliefs. Using research evidence to make recommendations requires subjective interpretations, which will be influenced by the value structure of panel members. Vulnerability to preconceptions is greatest for recommendations based on low-quality evidence — an increasingly frequent occurrence in contemporary CPG — although recommendations based on high-quality evidence are far from invulnerable.
Their suggestions for resolving COI concerns include:
- Nominated panellists must disclose all industry-related professional activities, including research grants and speaker support, and, for the duration of guideline development, divest themselves of direct financial interests (stock ownership, board positions, consultancy agreements) in commercial companies with an interest in any guideline recommendation.
- Panellists are required to identify all sections of the draft guidelines for which they have COI. These conflicts are recorded in a COI grid maintained by the guideline chairperson.
- Methodologists free of financial or intellectual conflicts of interest share responsibility with content experts for collecting and interpreting evidence.
- Explicit processes must be used to assess evidence quality and link this directly with strength of recommendations.
- Only conflict-free panellists (both methodological and content experts) are involved in determining the direction (for or against a specific clinical action) and strength of recommendations.
- Lack of consensus around evidence quality or recommendations is resolved by explicit democratic processes (such as Delphi rounds and nominal group techniques) involving conflict-free panellists who have thoroughly reviewed the related evidence.
- Individuals should be invited to join guideline panels through an open, transparent application process centred on selection criteria that ensure an appropriate balance of content and methodological expertise. Such criteria may comprise extent of clinical experience with the topic in question, prior participation in undertaking critically appraised literature reviews, intended commitment in time and intellectual input into the guideline development process, and referee reports. For guidelines that deal with common conditions and are aimed at large, multidisciplinary audiences, panel composition should reflect the spectrum of end users and avoid being dominated by a narrow spectrum of specialists.
While their suggestions may be more expensive and time consuming, the authors say “we believe these imposts are outweighed by the minimisation of recommendations that are biased, poorly substantiated or insensitive to patient and clinician needs and which, if followed, may have far-reaching deleterious effects on clinical practice”.