Working Groups

Working Groups

Our thirteen Working Groups have been set up through the drive and enthusiasm of members, keen to make an impact in a specific area. Some may be short term, with the objective of writing a publication; others, such as GIN Public are long established and continuously seek to make progress in their chosen area. The Working Groups have the opportunity to apply for a GIN grant to help achieve their goals.

If you are a GIN member and are interested in joining a Working Group, please email admin@g-i-n.net, noting which group/s you would like to join.

Accelerated Guideline Development

Accelerated guideline development is a way to produce clinical practice guidelines or recommendations in a short amount time, six months or less, without losing in scientific quality.

Producing clinical practice guidelines requires substantial time (usually 12 months or more), expertise (not so easy to find) and resources (in constant decrease). First, guidelines producers have struggled to develop high-quality clinical practice guidelines, from the analysis of the literature to the constitution of the working and peer-review groups. The AGREE instrument has been a true help for the guideline’s producers regarding this point – even if the tool is about evaluating; it is also a good reminder for developing best practice guidelines. The ADAPTE manual has assisted in this task. It is an interesting tool which allows the reduction in the duration of the guideline development. The pressure of the public authorities and clinicians for having guidelines developed in a short amount of time, i.e., six months or less, is so strong in a fast-paced society that the community of the guideline’s producers have to find an answer quickly in order to meet demands.

Aims & Objectives

The aim of the Accelerated Guideline Development Working Group was to provide a method for helping the GIN members to develop guidelines in an accelerated time frame, i.e., 6 months or less. This method is now available on the GIN website. The manual can be downloaded on the Resources page. GIN members can test the manual in producing an accelerated guideline and send us back information by completing the testing phase questionnaire.

Chair:
Sophie Blanchard

Adaptation

Guideline adaptation is the systematic approach to the endorsement and/or modification of a guideline(s) produced in one cultural and organisational setting for application in a different context. Where high quality guidelines are already available, adaptation may be used as an alternative to de novo guideline development to customise the existing guideline to the needs of local users.

The development and updating of high-quality clinical practice guidelines require substantial time, expertise and resources. Health organisations are increasingly confronted by the need to standardise health policies and practises to better manage finite resources and to promote optimal, evidence-based patient care. There is pressure on organisations to produce guidelines rapidly, to ensure that medical practice is consistent with current, emerging medical knowledge and this work is often done with limited resources. Guideline adaptation recognises and responds to legitimate differences in organisational, regional or local contexts that could lead to variations in recommendations supported by the same evidence. We postulate that existing high quality guidelines as a resource may be an alternative to de novo development to reduce duplication of effort, enhance efficiency, and promote local uptake of quality guideline recommendations.

Following the development and evaluation of the manual and resource toolkit, the ADAPTE Collaboration decided to make these resources available to the international community through GIN. To view the toolkits please visit the Resources section of the Adaptation Working Group pages. The establishment of the GIN Adaptation Working Group supports and facilitates the involvement of GIN members in these activities.

Aims and Objectives of the Adaptation Working Group

The Adaptation working group aims to:

  • Support methods for efficient guideline development through the adaptation of existing guidelines and other sources of evidence syntheses
  • Refine the adaptation resource toolkit and develop additional adaptation resources
  • Provide support and training to groups undertaking or planning to undertake guideline adaptation projects

Chair:
Airton Stein
Vice Chair:
Ein-Soon Shin

AID Knowledge

About the Accelerated Guideline Development Working Group

Appraising and Including Different Knowledge in Guideline Development
Evidence-based guidelines whether national, regional, or developed by specialty groups, must search for, and explicitly consider, evidence from sources other than conventional clinical trials and their quantitative data. This need for appraising and including knowledge from a wide variety of sources in guideline development is well recognised. However, how to properly appraise (judge) and include (integrate) different kinds of knowledge remains unclear.

Cited from Wieringa S, Dreesens D, Forland F on behalf of the AID Knowledge Working Group of the Guidelines International Network, et al Different knowledge, different styles of reasoning: a challenge for guideline development BMJ Evidence-Based Medicine 2018;23:87-91.

Aims & Objectives

To bring guideline developers together, to

  • Identify methods and promising initiatives for appraising and including a wider range of knowledge sources in guidelines.
  • Share experiences with such methods and their application in practice.
  • Identify areas / questions for which methods are wanting.
  • Develop methods for appraising and integrating different knowledge.

We also aim to support capacity building and to foster collaboration among guideline developers worldwide in this area of methodological uncertainty.

Chair:
Beth Shaw
Vice Chair:
Teun Zuiderent-Jerak

GINAHTA

GINAHTA’s main objective is to explore common methods and to facilitate collaboration and sharing of products between the HTA (represented by INAHTA) and guideline (represented by GIN) communities.

The worlds of guidelines and health technology assessment (HTA) may be more similar than they appear at first sight.  To explore common methods and to facilitate collaboration and sharing of products between the HTA (represented by INAHTA) and guideline community (represented by GIN) a working group was established in October 2015.

INAHTA is a network of 51 HTA agencies that support health system decision making that affects over 1 billion people in 32 countries around the globe. With more than 2,100 staff and consultants working in the INAHTA network, there are clear benefits to connecting these agencies together to cooperate and share information about producing and disseminating HTA reports for evidence-based decision making. INAHTA serves this purpose. www.inahta.org

Aims & Objectives

The working group acts as a facilitator to join efforts of the HTA and guideline community by:

  • Identifying common methods
  • Identifying complementarities between the products of both communities and promoting joint projects
  • Elaborating a platform to promote collaboration and to share products and best practices

How to Join

GIN or INAHTA members who are interested in joining should write to: admin@g-i-n.net.

Co-Chair:
Holger Schunemann
Co-Chair:
Mouna Jameleddine

GIN PUBLIC

About GIN PUBLIC

The main objective of GIN PUBLIC is to support effective patient and public involvement in the development and implementation of guidelines. GIN PUBLIC offers a forum for exchange between patient and public organisations, guideline developers, and researchers.

Who we are

GIN PUBLIC is a working group of researchers, health professionals and consumers who promote ways to inform and involve the public in guideline activity around the world.

The current Chair of the GIN PUBLIC Working Group is Jane Cowl

Aims and objectives

The main objective of the GIN PUBLIC Working Group is to promote ways to inform and involve the public in guideline activity around the world. GIN PUBLIC offers a forum of exchange between patient and public organisations, guideline developers, researchers, and others with an interest in patient and public involvement. This is mainly done through our discussion forum, working group meetings, and by holding workshops and presentations at conferences such as the GIN annual meeting.

Specific aims are to:

  • Provide a network for discussion of emerging methodology for patient and public involvement in guidelines
  • Provide a forum for the development of collaborations for guideline organisations and researchers who wish to improve patient and public involvement in guidelines
  • Develop standard methods on patient involvement in guideline development and implementation

GIN PUBLIC Toolkit: Patient and Public Involvement in Guidelines

For the full toolkit and all updates, please visit the GIN Public Toolkit section on our resources page

Chair: Jane Cowl
Vice Chair: Karen Graham

GIN Tech

GIN Tech are members that are also software developers or members that are interested in technology development. We are currently made up of member-organisations that are also software developers, (both commercial and non-profit), members of in-house digital teams from different guideline producing organisations (e.g., NICE, Duodecim, Joanna Briggs Institute) or members that are just interested in tech development. The software developers and digital teams cover all aspects of guideline development, from evidence detection to publishing guidelines and production of point of care decision support. See here for GIN Tech working group members.

Aims & Objectives

The core aim of the working group is to aid GIN members in sharing data from the various digital tools and providing a forum for members to discuss the best way to use the tools that are available. As part of this we aim to understand the needs of guideline producers, the issues you face and the opportunities for improvement that digital solutions may offer.

Chair:
Ton Kuijpers
Vice Chair:
Linn Brandt

Guidelines Collaboration

Our mission is to identify and facilitate strategies for successful collaborations among guideline developers in the development of evidence-based recommendations.

Aims & Objectives

  • Identify facilitators and barriers to collaboration between guideline development organisations
  • Facilitate a community for sharing best practices and lessons learned across guideline developing organisations
  • Create a repository of tools and resources for future guideline collaborations; and
  • Develop a core group of dedicated individuals with representation from different specialties and guideline development organisations internationally, whose work will serve the larger GIN membership in the area of guideline collaboration

GIN GCWC proposes the following activities to support their vision

  • Conduct a needs assessment of guideline development organisations to elucidate knowledge, attitudes, and practices related to collaboration
  • Identify and explore common facilitators and barriers to collaboration between guideline development organisations
  • Identify current resources and strategies for the facilitation of collaboration during the guideline-development process, and modify or standardize, if appropriate
  • Examine current practices of reducing redundancy in research, specifically guideline development, to inform strategies for collaboration
  • Disseminate findings via peer-reviewed publication(s), and webinar or conference presentations
  • An inclusive collaboration checklist (potentially building off existing guideline development checklists), which will include such documents as a template Memorandum of Understanding addressing important points that must be considered and agreed upon in advance of any collaborative effort
  • Create and maintain connections with different guideline-development organisations, especially those focused on collaboration, centralising of guidelines and evidence, and reducing research redundancy

Chair:
Rebecca Morgan
Vice Chair:
Toju Ogunremi

Implementation

The primary purpose of the Implementation Working Group (IWG) is to build capacity for guideline implementation. To do so, the IWG will progress the science of guideline implementation by generating knowledge and associated outputs/products on how to plan, undertake, enable, and evaluate guideline implementation. It will also promote the practice of guideline implementation by generating and sharing knowledge and tools and organising and offering training opportunities.

Aims & Objectives

The primary purpose of the Implementation Working Group (IWG) is to build capacity for guideline implementation.

To do so, the IWG will:

  • Progress the science of guideline implementation by generating knowledge and associated outputs/products on how to plan, undertake, enable, and evaluate guideline implementation
  • Promote the practice of guideline implementation by sharing knowledge and tools and organising and offering training opportunities.

Chair:
Anna Gagliardi
Vice Chair:
Sanne Peters

LMIC – Low and Middle Income Countries

The GIN Low and Middle Income Countries (LMIC) Working Group (WG) was created in 2015, to build a platform wherein issues related to resource-constrained health-care settings could be shared. This is an area of great need, not only in most developing countries, but also in some higher income societies wherein guideline development is at a nascent stage.

Aims & Objectives

  • To develop a network of people and institutions in developed and developing countries sharing a common goal to enhance healthcare in developing countries
  • To support activities targeted towards understanding the process of guideline development and utilisation in resource-constrained health-care settings, especially in developing countries
  • To explore methods to promote guideline development, adaptation, dissemination, implementation and research within developing countries.
  • To build capacity and capability at the institutional level in low resource settings- that can foster a culture of scientifically robust guideline development, implementation and monitoring.

Chair:
Joseph Mathew

Multimorbidity

The GIN Board of Trustees agreed to establish the Multimorbidity Working Group after considerable interest was shown in the topic at the GIN annual conference 2013, held in San Francisco. A list of useful resources on multimorbidity is now available on the website.

The newly established WP is seeking GIN members with an interest in this area to participate in and contribute to the group. The group will conduct business via teleconferences, email discussions and via the GIN website.

Aims & Objectives

  • Maintaining a section on the GIN website that will stimulate networking and contain references, materials, and tools on the management of multimorbidity
  • Providing a forum for the discussion and refinement of emerging methodology and recommendations on how multimorbidity can be addressed in guidelines
  • Arranging meetings and workshops at GIN conferences
  • Providing a forum for the development of collaborations for guideline organisations and research groups who wish to improve the care of patients with multimorbidity
  • Writing a position paper for GIN on multimorbidity

Chair:
Jako Burgers
Vice Chair:
Martin Scherer

Overdiagnosis

The GIN Board of Trustees established the Overdiagnosis Working Group in August 2014, following a successful meeting organised by Paul Glasziou ahead of the Melbourne conference.

Globally there is increasing concern about the impact of “overdiagnosis” on both the overtreatment of patients and as a major contributor to rising health care costs. Recent activities in this area include the ABIM’s Choosing Wisely campaign (www.choosingwisely.org/), JAMA Internal Medicine’s “Less is More” series, the BMJ’s Too Much Medicine series (www.bmj.com/too-much-medicine) and the controversy over the expanded definitions of psychiatric illness in the recent DSM-5 release (www.psychologytoday.com/blog/dsm5-in-distress).

Currently we have no specific rules or guidance on when and how the definitions of diseases should be modified. A recent study published in PLOS Medicine [Moynihan, 2013]] highlighted the tendency of disease definitions to widen: of 16 guidelines on 14 common conditions, 10 proposed changes widening, 1 narrowing definitions, and 5 were unclear. The widening fell into three categories: creating ‘‘pre-disease’’ (such as pre-hypertension and pre-clinical Alzheimer’s); lowering diagnostic thresholds or boundaries (such as diabetes, and depression); and proposing earlier or different diagnostic methods (such as single scan diagnosis for multiple sclerosis). None of the 16 guidelines included a rigorous assessment of potential harms of proposed definitions changes. There were also considerable conflicts of interest within the committees, including the committee chairs.

 Aims & Objectives

  • To set an internationally acceptable set of rules and guidance on the requirements for modifying the definitions of diseases.
  • Provide guidance to guideline developers who are considering a change to the definition or thresholds for specific diseases or developing new clinical categories.

Chair:
Paul Glasziou

Performance Measures

The GIN Performance Measures Working Group (PMWG) met for the first time at the 9th conference in Berlin in 2012 and consists of about 30 members from over 10 countries.

Aims & Objectives

The group set two objectives at the meeting. First, to set up a webpage for the group on the GIN site (realised in September 2012) and second to develop standards for guidelines based performance measure development.

The lead members of the GIN PMWG (Monika Nothacker – AWMF, Germany, Tim Stokes and Beth Shaw – NICE, United Kingdom) are conducting a study together with the group to develop core standards for guidelines based performance measure development. The standards will be developed based on a systematic review of the literature and a DELPHI consensus process with members of the GIN PMWG. The draft study protocol was finished in May 2013 and reviewed by international experts in the field.

The first DELPHI process with the group took place in the summer of 2013. The aim of this process was to lead to consensus on recommendations concerning core reporting standards. This work was presented at the 10th GIN conference in San Francisco and discussed at the group meeting.  The refined reporting standards were circulated in November/December for a final vote.  The group will have a teleconference in January to discuss next steps including application and validation of the standards, possible development of a performance development assessment tool and cooperation of guideline and performance measure developers.

An additional focus will be the cooperation with other GIN working groups, especially the GIRAnet section within Implementation and the newly established Multimorbidity working group.

Chair:
Monika Nothacker

Updating Guidelines

Clinical guidelines (CGs) become outdated as new evidence is published and require a periodic reassessment to remain valid. The principles of updating CGs can be a complex, potentially resource intensive, and include three main steps: 1) identifying new evidence; 2) assessing if the new evidence has a potential impact on the current guideline; and 3) reviewing and modifying the guideline.

CGs methodological handbooks include very little guidance about how to review and update guidelines. In general, guideline programmes endorse three years as a reasonable time period to review their guidelines, however, the reality is that most groups struggle to do this every five years.

Some published research has been undertaken about the identification and assessment of new evidence (encompassed sometimes as review, surveillance or monitoring process), even though there is still important areas of uncertainty. Less attention has been paid to the review, modification, and presentation of the recommendations. This is probably due, among other reasons, to the likely assumption that it is similar to the development process. Clearly, more work is required to identify a strategy or suite of strategies that find the “sweet” spot between rigour and feasibility.  Sound methodological guidance is still not available to the guideline community.

There have also been developments around a ‘living’ guideline approach and continuous updating but there is still uncertainty around how the methods for facilitating this approach. There is a lot of opportunity to promote collaboration and learning around methods for living guidelines to maximise effort.

There are several international initiatives to improve the process of developing CGs (e.g., GRADE, AGREEII, GLIA, GIN standards or IOM standards), however, these initiatives are failing to fully address the issues pertaining to updating.

We believe that there is a need to prioritise, promote and collaborate between international guideline development and research communities to improve and standardise the updating process. Working jointly with the field of systematic reviewers will also be crucial.

Aims & Objectives

  • Provide a network, for those interested in updating CGs methodology (guideline users, developers, data scientists and other stakeholders), to exchange knowledge and experiences about methodological and operational issues
  • Develop resources for the guideline community
  • Coordinate efforts with the systematic reviews community (e.g. Cochrane Collaboration) to streamline processes
  • Provide support and training to groups undertaking or planning to undertake CGs updating projects
  • Coordinate with the related GIN working groups (e.g., Accelerated Guideline development, collaboration group)
  • Organise and promote events (e.g., workshops, oral presentations) in annual GIN conferences

Chair:
Emma McFarlane
Vice Chair:
Hector Pardo-Hernandez

To collaborate on future GIN publications, toolkits and manuals, join us today!