Table 2.

Stages of the strategies*

Author and year	Assessing the need to update	Scope definition	Update group (number of participants)	Evidence search strategy	Evidence selection, assessment and synthesis	Update recommendations	Presentation of updates
Shekelle 2001[3]	Within specific timeframe	Identification of main recommendations	Reviewers (2) Chairs of the original CPG expert panel (15) Members related with original CPGs (2) Members of the original CPG expert panel (121) Nonpanel experts (8)	Restricted search 5 key medical journals and key specialty journals Reviews, editorials, commentaries Additional search in NGC and web sites of CPGs publishing organizations Surveyed experts by mail	Reviewed references (title, abstract and articles) Reviewed the relevance of selected references Based on new evidence and judgment guidelines were classified in to: major update, minor update or still valid	NA	NA
Bosquet 2003[9]‡	Monitoring	Discussion about priority of topics to be updated	Methodologist (NS) Original working group (NS)	Exhaustive search MEDLINE, EMBASE, SBU and APM web sites	Selection of references Evaluation the impact of reference on existing guideline: consistent with existing guidelines, inconsistent or concern new topics	NA	NA
Gartlehner 2004[7]	Within specific timeframe	Developed analytic framework, critical key questions and eligibility criteria Survey to national/ international experts	Clinicians (4) Health services researchers (2) Reviewers (4) Librarians (NS) National or international experts (13)	Modified Shekelle et al. [Shekelle2001] search AIM journals and non-AIM speciality journals Reviews, editorials, commentaries, guidelines Additional search in PreMedline, HSTAT, The Cochrane Library and selected NIH websites Surveyed to national or international experts Exhaustive search MEDLINE, The Cochrane Library Reviews, meta-analysis, RCTs Surveyed to national or international experts	Assessed the relevance of abstracts, full-text articles and original studies Used of update memos with studies that judged as eligible and addressed a critical key question	NA	NA
Nunes 2009[15]‡§**	Within specific timeframe	NS	Methodologist (3) Clinicians (3)	Restricted search Guidelines	Selection and assessment guidelines with AGREE Narrative summary of the methodological aspects and major findings of each guideline	NA	NA
Eccles 2002[10]	Within specific timeframe	NS	General practitioners (8) Consultants (2) Nurses (2) Health economists (2) Guideline methodologist (2)	Exhaustive search MEDLINE, EMBASE, The Cochrane Library	Systematic review Evidence tables or text summaries	3 situations: new recommendations; refinement recommendations; and unchanged recommendations	NS
Newton 2006[14]‡§	NS	Additional research questions	Methodologist (9) Clinicians (6)	Exhaustive search NS	Verification of results and study quality from the original review	Integrating a qualitative and quantitative data on the prior review and developing recommendations	NS
Parmelli 2010[16]	Within specific timeframe	Mail consultation to experts from development group Relevant evidence	Coordinating group (10) 3 multidisciplinary panels (NS) External methodological group (NS)	Exhaustive search MEDLINE, EMABASE, central and databases for conference (ASCO) SRs, meta-analysis, RCTs	Evidence selection Application GRADE methodology Evidence tables Informed and discussed with panellist in meetings	Classified strength of recommendation in 4 levels: strong positive, weak positive, weak negative and strong negative Voted by experts in meeting	NS
Johnston 2003[8]	Monitoring	NS	Health information specialist (3) Lead author of the original guideline (NS) DSG who developed guideline: chair, members and research assistant (NS)	Exhaustive search MEDLINE (monthly), CancerList (monthly), HealthStar (monthly), The Cochrane Library (quarterly) Guidelines, SRs, RCTs Additional search in key journals and proceedings meeting Notifications by DSG members	Identified potentially relevant new trials, meta-analyses an evidence-based guidelines or update results from trials included in original guideline Reviewed abstracts and articles Considered relevance of each reference to original guideline question Interpreted new evidence in the context of original guideline Descriptive and summaries of new evidence	DSG choose implications of new evidence on clinical recommendations: unchanged recommendation, strength recommendation, change recommendation	Notice linked to each guideline to keep practitioners aware that regular update search conduced Update bulletin with new evidence emerged Notice at the top of the guideline to alert practitioners that guideline was review Removed obsolete guidelines Integrated evidence update into original report (dynamic ‘living’ practice guidelines)

*Ordered by type of strategy and chronology; ‡Only abstract available; §Information provided by the author.

Abbreviations: AIM Abridged Index Medicus, APM Agence de Presse Médicale, ASCO American Society of Clinical Oncology, CPG Clinical practice guideline, DSG Disease site group, GRADE Grading of Recommendations Assessment, Development and Evaluation, HSTAT Health Service/Technology Assessment Text, NGC National Guideline Clearinghouse, NIH National Institutes of Health, NA Not applicable, NS Not stated, RCT. Randomized controlled trials, SBU Swedish Council on Health Technology Assessment, SR Systematic review.