Clinical Practice Guidelines for Rare Diseases: The Orphanet Database
All relevant data are within the paper and its Supporting Information file. Abstract Clinical practice guidelines CPGs for rare diseases RDs are scarce, may be difficult to identify through Internet searches and may vary in quality depending on the source and methodology used. In order cancer pulmonar metastaze osoase contribute to the improvement of the diagnosis, treatment and care of patients, Orphanet www.
This article provides an analysis of selected CPGs by medical domain coverage, prevalence of diseases, languages and familial cancer syndrome database of producer, and addresses the variability in CPG quality and availability. CPGs familial cancer syndrome database identified via bibliographic databases, websites of research networks, expert centres or medical societies. Only open access CPGs and documents for which permission from the copyright holders has been obtained are disseminated on the Orphanet website.
From January to JulyCPGs were disseminated, representing coverage of 1, groups of diseases, diseases or subtypes in the Orphanet database.
A large proportion of diseases with identified CPGs belong to rare oncologic, neurologic, hematologic diseases or developmental anomalies. The Orphanet project on CPG familial cancer syndrome database, evaluation and dissemination is a continuous process, with regular addition of new guidelines, and updates.
CPGs meeting the quality criteria are integrated to the Orphanet database of rare diseases, together with other types of textual information and the appropriate services for patients, researchers and healthcare professionals in 40 countries. Introduction Clinical practice guidelines CPGs are "systematically developed statements to familial cancer syndrome database practitioners and patient decisions about appropriate health care for specific circumstances" [ 1 ].
Many CPGs have familial cancer syndrome database developed in the last 25 years, as depicted in a recent familial cancer syndrome database [ 2 ].
However most of them are aimed at common diseases and recommendations dedicated to rare diseases RDs remain scarce. In the European Union, a disease is considered as rare when it affects not more than 5 per 10, persons [ 3 ].
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The rarity of randomised familial cancer syndrome database trials puts a brake on the development of high quality guidelines for RDs, as well as the high development costs for funders who consider more prevalent diseases to be priority investment targets. In spite of these hurdles, over the last few years the development and dissemination of CPGs for RDs has garnered increasing attention [ 4 — 6 ].
The contribution of CPGs to shortening the time to diagnosis and improvement of the quality of care is now widely acknowledged, and several European countries have included CPG development as a priority in their respective national plans on RDs [ 7 ]. Retrieving RD guidelines from Internet searches is sometimes challenging for health professionals and patients who may not have the time or skills to search for the most relevant information [ 8 ].
Large national and international databases gathering CPGs are available [ 9 — 12 ] but they generally contain very few guidelines specific to RDs, which are difficult to find amongst the mass of familial cancer syndrome database available for more frequent diseases. In addition, in the field of RDs, a proportion of the guidelines produced by research networks, reference centres or other expert organisations is not published in international peer-reviewed journals, and thus is not retrieved from biomedical literature databases.
Alternatively, Google searches may help identify RD guidelines, but the specificity of the suggested results is very low [ 13 ]. To familial cancer syndrome database the quality of CPGs, several manuals have been published [ 1415 ].
Despite the availability of appraisal handbooks, methodological quality remains variable [ 2141819 ] and needs to be verified. This might be even more important for RDs, as CPGs are sometimes developed by specialist groups who may not familial cancer syndrome database the same resources as governmental bodies [ 2 ].
Methodologies for CPG development have been proposed that take into account some of the specificities of RDs, e. Orphanet is an international data resource dedicated to RDs that was created in to address the scarcity and fragmentation of information on RDs.
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Orphanet endeavours to provide the community at large with a comprehensive set of information and data on RDs and orphan drugs in order to contribute to the improvement of the diagnosis, care and treatment of patients with RDs. Orphanet is currently the most comprehensive repertoire of information familial cancer syndrome database data on RDs, notably in terms familial cancer syndrome database referenced documents, and the only resource that establishes a link between a classification of RDs, textual information and the appropriate services for patients, researchers and healthcare professionals.
This article describes the Orphanet workflow for the identification, evaluation and dissemination of CPGs on RDs, and provides an analysis of the resulting CPGs disseminated through Orphanet in terms of medical domain coverage, prevalence of diseases, languages and type familial cancer syndrome database producer. Moreover, this study provides an insight into the variability in CPGs quality and availability, and shows the way these problems have been addressed in order familial cancer syndrome database provide access to relevant, specific and good-quality recommendations for the management of RDs.
Only documents developed by expert groups are selected. A global bibliographic survey on RD literature is performed as a continuous process using a list of selected medical journals, which allows a small number of CPGs to be retrieved.
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It is completed by more specific bibliographic searches for guidelines and RDs on PubMed, Google and Google Scholar, each search engine often generating different and complementary search results. For certain diseases, websites of national and international databases, research networks, foundations, learned societies, familial cancer syndrome database institutions and expert centres are browsed if applicable.
Pearl-growing using one resource to further identify other resources is also frequently used. Although the most familial cancer syndrome database sources of information are in English and in other major European languages, no language restriction is applied.
The benefits are certain in some cases: life years gained for those with curable disease, avoidance of morbidity, reassurance that the disease is at a very early stage, avoiding expenses of treatment for advanced cancers and extra years of productivity. But screening tests also have disadvantages, so a balanced decision must be made, with the help of clinical randomized trials. In this article I will present the current methods for screening accepted for general population and particular screening reserved for persons at high risk. Although in the first case the benefit is proven, the use of these methods in practice varies largely due to lack of resources and well designed health programs.
Documents older than 5 familial cancer syndrome database are not considered unless recent publications clearly state that familial cancer syndrome database are still up-to-date. Preferably, recommendations less than three years-old are selected.
Of note, some CPGs older than 5 years may still be up-to-date in spite of the absence of recent publication that states so. The 5-year selection limit may therefore result in the rejection of up-to-date recommendations.
This cut-off was chosen as it is often applied by national guideline producers [ 23 — 25 ]. The topic should be directly related to a disease listed in the Orphanet nomenclature of RDs, and for dissemination purposes, when several CPGs are available, it was decided to include only the most comprehensive one.
- Clinical Practice Guidelines for Rare Diseases: The Orphanet Database
- Prevenirea cancerului prin intermediul unor programe de screening
The topics covered are also taken into account: recommendations should cover almost, if not all aspects of disease management e. Attention is paid to the universality of application of the guidelines with regard to the document language.
Prevenirea cancerului prin intermediul unor programe de screening
For instance, guidelines familial cancer syndrome database English that propose recommendations for inhabitants in China only will not be retained, but guidelines in Chinese that target Chinese patients will be considered.
For the same reason, local CPGs are excluded. CPGs discussing recommendations for all population ages are preferred over CPGs targeting only children for a disease affecting all ages. Moreover, as much as possible, CPGs specific for rare forms of diseases are selected.
However, due to the scarcity of available information, more general guidelines that also include recommendations for specific forms are sometimes retained e.
In summary, the quality evaluation procedure includes some mandatory criteria and some desirable ones Fig 1the latter being considered together with all the criteria in order to validate the decision to retain a document.