REPORT ANALYTICAL REVIEW OF THE CURRENT SITUATION RELATED TO THE DEVELOPMENT OF EVIDENCE BASED CLINICAL GUIDELINES IN RUSSIA 1 TABLE OF CONTENTS PREFACE ......................................................................................................................................................................2 ABBREVIATIONS........................................................................................................................................................3 ABBREVIATIONS........................................................................................................................................................3 INTRODUCTION..........................................................................................................................................................4 DETAILED ASSESSMENT..........................................................................................................................................9 SUMMARY OF RESULTS .........................................................................................................................................12 INTERPRETATION ....................................................................................................................................................23 DISCUSSION ..............................................................................................................................................................32 CONCLUSION ............................................................................................................................................................34 APPENDIX 1. ..............................................................................................................................................................38 APPEDNIX 2 ...............................................................................................................................................................94 1 PREFACE One of the major challenges currently facing the Russian Federation is health care quality improvement. In order to assure the quality of health care, providers, consumers, policy makers, and others need to have an accessible, reliable indicators that they can use to flag the potential problems or successes. Clinical guidelines are viewed as useful tools for making care more consistent and efficient, way to close the gap between clinical practice and scientific evidence. Clinical guidelines have their origin in issues faced by most healthcare systems : rising health care costs, variation in services delivery, the intrinsic desire of healthcare practitioners to offer and patients to receive the best possible care. Clinical guidelines help the clinicians, patients and decision makers to make appropriate use of the best information available. Given that, clinical guidelines become well measurable indicators moving the health system from solely intuitive to that taking explicit account of relevant evidence. Within Russia, there is a growing interest to the development of guidelines but the areas covered and methods used do not always meet international requirements. The report highlights a number of issues such as state of art with regard to clinical guidelines, quality of clinical guidelines developed in Russia, areas of healthcare covered. The report is based on interviews with key donors throughout the Russian Federation together with discussions with experts in the field of evidence based medicine, literature review and internet search. It includes three-steps research study. Two appendixes give an overview of current situation with clinical guidelines in Russia and demonstrates the results of the assessment with the Cluzeau Instrument. ABBREVIATIONS DFID - Department for International Development in Great Britain EBM – Evidence Based Medicine ERB – European Regional Bureau HCA – Health Care Authorities ISEBMS - Interregional Society of EBM Specialists. NWHRP – North West Health Reforms Project OSI – Open Society Institute RF – Russian Federation STD – Sexually Transmitted Diseases USAID – United State Agency for International Development WHO – World Health Organization 3 INTRODUCTION Concept of Evidence Based Medicine Evidence Based Medicine, a term that didn’t exist a decade ago, has captured the imagination of clinicians and health policy makers. We now have journals exclusively devoted to EBM, databases on systematic reviews (like the Cochrane Collaboration), workshops, courses and books on EBM. In 1980th –90th clinicians who introduced the concept of EBM (primarily representatives of McMaster University) argued for health care and clinical decisions to be made on the basis of strong evidence generated by well done controlled trials and research studies. They felt that this approach was better than traditional decision-making approaches which they saw as being far more open to bias and error. EBM arose out of the need to make well-informed decisions in a setting of limited resources. How can one get the best deal for given limited resources? It became obvious that those who need to make decisions should evaluate the benefits and risks of competing options on the basis of the best available evidence (which can be reproduced and described) rather than on an unsystematic or haphazard evaluation. An extended definition of EBM is: “Evidence-based medicine is the conscientious, explicit and rational use of the best available evidence in making decisions about any individual clinical case” [David L. Sackett, William MC Rosenberg, JA Muir Gray, R. Brian Haynes, W. Scott Richardson [BMJ 1996; 312: 71-2]. The practice of Evidence Based Medicine means integrating individual clinical expertise with the best available external evidence from systematic research” [Sackett DL, Straus S, Richardson S, Rosenberg W, Haynes RB. Evidence-based Medicine: how to practice and teach EBM, ed 2. London: Churchill Livingston, 2000]. All expert recommendations should be based on a systematic appraisal of the best evidence available. Good evidence is usually derived from strong epidemiological study designs (like a randomized controlled clinical trial). Evidence derived from poorly done observational study designs is weak and therefore not very useful in decision making. Clinical guidelines, defined as “systematically developed statements to assist both practitioner and patient decision in specific circumstances”, have become an increasingly familiar part of clinical care [M.Eccles, J.Mason. How to develop cost-conscious guidelines. Health Technology Assessment 2001, 5[16]]. 5 Background Why EBM is needed in Russia One of the major challenges facing the Russian Federation is improvement of medical care quality, which was rather low until recent days. The term “Evidence-Based Medicine” became known among professionals only few years ago and generally there seems to be poor understanding of what its real meaning. There is a rise of interest to the development of guidelines but methods used to develop guidelines do not always meet international requirements and irrational medical practice still remains very common in Russia. There are some reasons for that: • Historical factors related to the isolation of the Russian health system and pharmacy from the international practices. • Factors of the transition economical period related to the necessity of adaptation to the free market model. One of the problem here might be a distortion of the centralized drug supply system. • Factors related to the pharmaceutical policy, that lie to inability of drug reimbursement system (from economical point of view). In some of the regions physicians have limited access to the up-to-date medical literature. In part as a result of that, health institutions largely depend on the often outdated protocols provided by the Ministry of Health. Medical associations don’t enforce ethical standards and medical school lecturers routinely take cash in exchange of promoting specific drug sand the term is used more frequently by advertisers than physicians [V.Vlasov]. Most of the physicians find it difficult to read international publications because of the language barriers. They draw information from the Russian journals that very often do not comply with International standards. • Principles of EBM, epidemiology and biostatistics are often neglected areas of undergraduate and postgraduate medical education. Very few centers in Russia offer training in these disciplines. The EBM approach to health care practice is one in which the clinician is aware of the evidence that bears on their clinical practice, and the strength of that evidence. The EBM movement is aimed at helping health care practitioners, patients and policy makers to make decisions based on the best evidence available. The number of new scientific insights that emerge every year is overwhelming. But at the same time it is important to keep in mind that “health interventions are not free, people are not infinitely rich and the budgets of health care are limited. For every dollar’s worth of health care that is consumed, a dollar will be paid. While these payments can be laundered, disguised or hidden, they will not go away” [Eddy DM. A manual for assessing health practices and designing practice policies: the explicit approach. Philadelphia: American College of physicians, 1992]. Given that, the Evidence Based approach is very important, especially for the Russian health system struggling to survive with very limited resources. The implementation of evidence based principles will also support the planned restructuring of the health care system by showing what can be done in ambulatory care and what can be shifted from tertiary to secondary and from secondary to primary care level. Policy of health care quality improvement in the Russian Federation Over the last 7 years the Ministry of Health of the Russian Federation has undertaken a number of steps to design a system of standardization in healthcare with the emphasis on the development of evidence-based clinical protocols. In this framework a National laboratory for standardization was set up. The National Healthcare Program “Quality Management in Healthcare for 2004-2007” was approved by the Collegiums of the Ministry of Health of the Russian Federation in March 2003. One of the major goals of the Russian national healthcare policy is to improve quality and efficiency of health care. The priorities of this policy are: development and implementation of a unified strategy to improve quality of services in health care according to the internationally accepted standards, development of strategies and tools for quality management in health care, development of standards, licensing, accreditation, certification and attestation in healthcare, insurance of effective cooperation between regulatory bodies at all levels, funds of compulsory medical insurance, medical insurance companies, health care facilities and other institutions and organizations in order to secure continuous quality improvement of health products and services, 7 transition to efficient and safe technologies in healthcare with due regard to their cost-effectiveness, increasing motivation of health workers for the continuous quality improvement (this includes both improvement of education in the field of quality management in healthcare and introduction of the dependence of payment for the services provided on their quality ). Development of clinical protocols based on selected clinical technologies with the proved effectiveness and efficiency will be one of the major achievements of the program. Effectiveness of this strategy is proven by the experience accumulated in Great Britain, the United States, the Netherlands, Sweden, Norway, Australia, Canada, Germany and other countries. This seems to be providing a good framework for improvement of quality of health care in Russia. 8 DETAILED ASSESSMENT The aim of this project is to conduct a situation analysis of existing clinical guidelines in Russia, supplemented by a quality analysis so as to be able to recommend an effective strategy of improving quality of health care by evidence based clinical practice. Methodology The study was conducted in three steps: key informants were interviewed, existing guidelines were collected and analyzed with the consecutive quality assessment. STEP 1. Obtain information on activities of various organizations aimed at developing clinical guidelines The research team identified primary key informants followed by snowball sampling of secondary interviewees, carried out until saturation. The sample was not intended to be representative to any population; rather, individuals were selected on the basis of their involvement in the developing of clinical guidelines in Russia. Three broad audiences were interviewed: donor agencies, non-governmental organizations involved in developing evidence based practices, professional associations and scientific societies. Key informant interviews were questioned in an in-depth format by phone or face-to-face. All the interviews were carried out in January 2003 – April 2003. The information was collected through the interviews concerning activities of various organizations aimed at developing clinical guidelines, guidelines themselves, information about partners and other organizations involved in Evidence based medicine promotion in Russia. STEP 2. Search the literature and web-sites Structured review of the literature was performed in order to identify clinical guidelines available in Russia. Fifty names of the Russian journals [see Appendix 3] for the period from 1996 until present time have been reviewed [see Appendix 1]. The information from the articles was abstracted in two stages. At the first stage, each of the identified articles was evaluated for the presence of complete description of clinical guideline, clinical rational, and strengths and weaknesses. At the second stage each clinical guideline was analyzed according to the framework developed. The framework was developed to classify the guidelines into three groups: original guidelines, translated international guidelines and developed in Russia, but in the frames of international projects [see Appendix1]. Descriptive information was collected about every guideline. This included type of the guidelines (standard, recommendation, protocol, etc), level of evidence the guideline was based on, type of organization developing it, source of funding, means of dissemination, etc. The guidelines were also sorted according to clinical subject or issue, or disease. In cases of duplication the guidelines were compared. List of the guidelines collected see in the Appendix 1. Guidelines developed by Russian research institutes based on studies of weak design or having no evidence in international literature were mainly excluded as opinion based. The same scheme of review was applied for the Internet search. Federal clinical standards, created by different leading central clinical institutes and leading scientists under umbrella of Semashko Public Health Research Institute were not included in the analysis as they are almost not used. STEP 3. Quality assessment The standardized instrument used to assess the guidelines was the Cluzeau instrument. This instrument was selected after systematic search of the literature, which revealed that it was the best guideline appraisal instrument available. Although limited, there are data showing that the Instrument has acceptable reliability and there is preliminary evidence of criterion validity. [Cluzeau FA, Littlejohns P, Grimshaw JM, Feder G, Moran SE. Development and application of a generic methodology to assess the quality of clinical guidelines. Int J Qual Health Care 1999;11:21-8.] The purpose of this instrument is to encourage the systematic development of clinical guidelines and to provide a structured and transparent approach to their appraisal. It can be used by independent appraisers to assess existing guidelines or by guideline developers as an aide memoir. The instrument contains 37 questions addressing different aspects of guideline development. It is divided into three dimensions. Dimension one: rigour of development (questions 1-20) assesses the process of development including responsibility for the guidelines, composition of development group, identification and interpretation of evidence, formulation of recommendations, link between evidence and main recommendations, peer review and updating. 10 Dimension two: Context and content (questions 21-32) assesses the aims and objectives of the guidelines, the target group, circumstances for applying the recommendations, presentation and the format of the guideline and the estimated outcomes benefits, harms and costs. Dimension three: application (questions 33 to 37) addresses the implementation and dissemination strategies and monitoring. Ten clinical guidelines from each of the group of the guidelines collected (original guidelines, translated international guidelines and developed in Russia in the frames of international projects) [see Appendix1] were selected randomly to be assessed by the Cluzeau Instrument [see Appendix 2]. Although not formally part of the appraisal instrument, we also included a global assessment of guidelines that Cluzeau and associates have used previously (Cluzeau FA, Littlejohns P, Grimshaw JM, Feder G, Moran SE. Development and application of a generic methodology to assess the quality of clinical guidelines. Int J Qual Health Care 1999;11:21-8.) The three summary scores of guidelines quality: rigour of development [dimension 1], context and content [dimension 2] and application [dimension 3] were calculated by summing the values for each item constituting each dimension. A “Yes” response was assigned a value of 1, and all other responses were given a value of 0. A dimension quality score was then expressed as a percentage of the maximum possible score out of 100% for each dimension in order to compare scores across three dimensions, as done by Cluzeau and associates. All the materials, the report and samples of clinical practice guidelines will be made available on the World Bank Internet site specifically tailored for this purpose [www.cgr.mednet.ru]. Additionally there are links between files with clinical practice guidelines and URL, where these documents were originally located in Internet. 11 SUMMARY OF RESULTS Results of the quality assessment We identified 147 clinical practical guidelines that met our inclusion criteria. 22% of included guidelines were developed by national institutions and organizations, 14% were developed in collaboration with international partners and 64% were translated international guidelines . In all, 39 of guidelines were published and 22.% reported receiving sponsorship. The most common health conditions addressed by the guidelines were CVD 14 %, Lung diseases 11.%, maternal and child health 11.%. Thirty clinical guidelines from three groups (original guidelines, translated international guidelines and developed in Russia but in the frames of international projects) [see Appendix1] were assessed with the use of Cluzeau Instrument [see Appendix 2]. The quality of the guidelines varied significantly by developer, degree of international partners participation and sponsorship. Tables 1-3 present the proportion of the guidelines that met each of the 37 quality criteria in the appraisal instrument. Table 1. Proportion of clinical guidelines developed under international support that met quality criteria. Criterion Score Criterion Score Dimention 1: Rigour of guideline development Dimention 2: Contex and content Is the agency responsible for the development of the guidelines clearly Are the reasons for the developing the guidelines identified? 90 clearly stated? 60 Was external funding or other support Are the objectives of the guidelines clearly received for developing the guidelines? 90 defined? 90 If external funding or support was received, is there evidence that the potential biases of the funding body Is there a satisfactory description of the patients (ies) were taken into account? 0 to which the guidelines are meant to apply? 90 Is there a description of the individuals (e.g. professionals, interest groups- Is there a description of the circumstances including patients) who were involved (clinical or non clinical) in which exceptions in the guidelines development group? 90 might be made in using the guidelines? 80 Is there an explicit statement of how the patient's If so, did the group contain preferences should be taken into account in representatives of all key disciplines? 70 applying the guidelines? 30 Is there a description of the sources of information used to select the evidence Do the guidelines describe the condition to be on which the recommendations are detected, treated, or prevented in unambiguous based? 40 terms? 100 Are the different possible options for If so, are the sources of information management of the condition clearly stated in the adequate? 40 guidelines? 70 Is there a description of the method(s) used to interpret and assess the strength of the evidence? 2 Are the recommendations clearly presented? 100 Is there an adequate description of the health If so, is(are) the method(s) for rating the benefits that are likely to be gained from the evidence satisfactory? 0 recommended management? 50 Is there a description of the methods Is there an adequate description of the potential used to formulate the harms or risks that may occur as a result of the recommendations? 50 recommended management? 0 Is there an estimate of the costs or expenditures likely to incur from the recommended If so, are the methods satisfactory? 0 management? 10 Is there an indication of how the views Are the recommendations supported by the of interested parties not on the panel estimated benefits, harms and costs of the were taken into account? 0 intervention? 10 Is there an explicit link between the major recommendations and level of supporting evidence? 0 Dimension 3: Application Were the guideline independently reviewed prior to their Does the guideline document suggest possible publication/release? 0 methods for dissemination and implementation? 70 If so, is explicit information given about methods and how comments were Does the guideline document specify criteria for addressed? 0 monitoring compliance? 100 Does the guideline document identify clear Were the guideline piloted? 0 standards or targets? 100 If the guidelines were piloted, is explicit information given about the Does the guideline document define measurable methods used and the results adopted? 0 outcomes that can be monitored? 0 Does the guideline document identify key Is there a mention of a date for elements which need to be considered by reviewing the guidelines? 0 guideline groups? 80 Is the body responsible for the reviewing and updating clearly identified? 0 Overall, have the potential biases of guideline development been adequately dealt with? 0 14 Table 2. Proportion of Russian clinical guidelines that met quality criteria. Criterion Score Criterion Score Dimention 1: Rigour of guideline development Dimention 2: Contex and content Is the agency responsible for the development of the Are the reasons for the developing the guidelines clearly identified? 80 guidelines clearly stated? 90 Was external funding or other support received for Are the objectives of the guidelines developing the guidelines? 0 clearly defined? 70 If external funding or support was received, is there Is there a satisfactory description of the evidence that the potential biases of the funding body patients to which the guidelines are (ies) were taken into account? 0 meant to apply? 100 Is there a description of the Is there a description of the individuals (e.g. circumstances (clinical or non clinical) professionals, interest groups-including patients) who in which exceptions might be made in were involved in the guidelines development group? 70 using the guidelines? 90 Is there an explicit statement of how the patient's preferences should be If so, did the group contain representatives of all key taken into account in applying the disciplines? 60 guidelines? 20 Is there a description of the sources of information Do the guidelines describe the used to select the evidence on which the condition to be detected, treated, or recommendations are based? 80 prevented in unambiguous terms? 100 Are the different possible options for management of the condition clearly If so, are the sources of information adequate? 60 stated in the guidelines? 100 Is there a description of the method(s) used to interpret Are the recommendations clearly and assess the strength of the evidence? 0 presented? 80 Is there an adequate description of the health benefits that are likely to be If so, is(are) the method(s) for rating the evidence gained from the recommended satisfactory? 0 management? 30 Is there an adequate description of the potential harms or risks that may occur Is there a description of the methods used to formulate as a result of the recommended the recommendations? 10 management? 0 Is there an estimate of the costs or expenditures likely to incur from the If so, are the methods satisfactory? 10 recommended management? 10 Are the recommendations supported by Is there an indication of how the views of interested the estimated benefits, harms and costs parties not on the panel were taken into account? 0 of the intervention? 10 Is there an explicit link between the major recommendations and level of supporting evidence? 0 Dimension 3: Application Does the guideline document suggest Were the guideline independently reviewed prior to possible methods for dissemination and their publication/release? 0 implementation? 0 If so, is explicit information given about methods and Does the guideline document specify how comments were addressed? 0 criteria for monitoring compliance? 60 Does the guideline document identify Were the guideline piloted? 0 clear standards or targets? 60 Does the guideline document define If the guidelines were piloted, is explicit information measurable outcomes that can be given about the methods used and the results adopted? 0 monitored? 0 Does the guideline document identify Is there a mention of a date for reviewing the key elements which need to be guidelines? 0 considered by guideline groups? 80 Is the body responsible for the reviewing and updating clearly identified? 0 Overall, have the potential biases of guideline development been adequately dealt with? 0 16 Table 3. Proportion of translated clinical guidelines that met quality criteria. Criterion Score Criterion Score Dimention 1: Rigour of guideline development Dimention 2: Contex and content Is the agency responsible for the development of the Are the reasons for the developing the guidelines clearly identified? 90 guidelines clearly stated? 70 Was external funding or other support received for Are the objectives of the guidelines developing the guidelines? 0 clearly defined? 60 If external funding or support was received, is there Is there a satisfactory description of the evidence that the potential biases of the funding body patients to which the guidelines are meant (ies) were taken into account? 0 to apply? 80 Is there a description of the circumstances Is there a description of the individuals (e.g. (clinical or non clinical) in which professionals, interest groups-including patients) who exceptions might be made in using the were involved in the guidelines development group? 30 guidelines? 80 Is there an explicit statement of how the If so, did the group contain representatives of all key patient's preferences should be taken into disciplines? 10 account in applying the guidelines? 0 Is there a description of the sources of information Do the guidelines describe the condition used to select the evidence on which the to be detected, treated, or prevented in recommendations are based? 70 unambiguous terms? 100 Are the different possible options for management of the condition clearly If so, are the sources of information adequate? 50 stated in the guidelines? 100 Is there a description of the method(s) used to interpret Are the recommendations clearly and assess the strength of the evidence? 30 presented? 100 Is there an adequate description of the If so, is(are) the method(s) for rating the evidence health benefits that are likely to be gained satisfactory? 20 from the recommended management? 30 Is there an adequate description of the potential harms or risks that may occur as Is there a description of the methods used to formulate a result of the recommended the recommendations? 50 management? 10 Is there an estimate of the costs or expenditures likely to incur from the If so, are the methods satisfactory? 40 recommended management? 20 Are the recommendations supported by Is there an indication of how the views of interested the estimated benefits, harms and costs of parties not on the panel were taken into account? 0 the intervention? 20 Is there an explicit link between the major recommendations and level of supporting evidence? 10 Dimension 3: Application Does the guideline document suggest Were the guideline independently reviewed prior to possible methods for dissemination and their publication/release? 80 implementation? 0 If so, is explicit information given about methods and Does the guideline document specify how comments were addressed? 0 criteria for monitoring compliance? 70 Does the guideline document identify Were the guideline piloted? 0 clear standards or targets? 90 Does the guideline document define If the guidelines were piloted, is explicit information measurable outcomes that can be given about the methods used and the results adopted? 0 monitored? 0 Does the guideline document identify key Is there a mention of a date for reviewing the elements which need to be considered by guidelines? 0 guideline groups? 0 Is the body responsible for the reviewing and updating clearly identified? 0 Overall, have the potential biases of guideline development been adequately dealt with? 0 18 Figures 1-3 show the distribution of the guidelines developed under international collaboration by dimension quality score. Dimension 1. Rigour of development Dimension 3. Application 10 9 8 7 6 5 No. of CPGs 4 3 2 1 0 <10 20_29 40_49 60_69 80_89 10 9 8 7 6 5 4 No. of CPGs 3 2 1 0 <10 20_29 40_49 60_69 80_89 Dimension 2. Context and content 10 9 8 7 6 5 No. of CPGs 4 3 2 1 0 <10 20_29 40_49 60_69 80_89 Figure 1. Frequency distribution of guidelines developed under international support by dimension quality score (% of criteria met in each dimension), determined using the Appraisal Instrument for Clinical Guidelines. Dimension 1. Rigour of development Dimension 3. Application 10 9 8 7 6 5 No. of CPGs 4 3 2 1 0 <10 20_29 40_49 60_69 80_89 10 9 8 7 6 5 4 No. of CPGs 3 2 1 0 <10 20_29 40_49 60_69 80_89 Dimension 2. Content and context. 10 9 8 7 6 5 No. of CPGs 4 3 2 1 0 <10 20_29 40_49 60_69 80_89 Figure 2. Frequency distribution of Russian guidelines by dimension quality score (% of criteria met in each dimension), determined using the Appraisal Instrument for Clinical Guidelines. Dimension 1. Rigour of development Dimension 3. Application 10 9 8 7 6 5 No. of CPGs 4 3 2 1 0 <10 20_29 40_49 60_69 80_89 10 9 8 7 6 5 4 No. of CPGs 3 2 1 0 <10 20_29 40_49 60_69 80_89 Dimension 2. Content and context 10 9 8 7 6 5 No. of CPGs 4 3 2 1 0 <10 20_29 40_49 60_69 80_89 Figure 3. Frequency distribution of translated guidelines by dimension quality score (% of criteria met in each dimension), determined using the Appraisal Instrument for Clinical Guidelines. Out of all clinical guidelines developed with international support (see Figure1), 80% of the guidelines met 20 - 40% of the rigour of guideline development criteria; for the rest the results were lower. In the section devoted to the assessment of guideline context and content 30% of the guidelines met 50-60% criteria. The results of guideline application assessment were higher, 60% of studied guidelines met 80 % of criteria. Out of all clinical guidelines developed in Russian Institutions [see Figure 2], 50% of the guidelines met 20 - 30% of the rigour of guideline development criteria. In the section devoted to the assessment of guideline context and content, 40% met 50 - 60% of criteria . The results of guideline application assessment showed that about 60% of studied guidelines met 50 - 60% of criteria. Out of all translated clinical guidelines (see Figure 3), 50% of the studied guidelines met 10 - 20 % of criteria of the rigour of clinical guidelines development; 60 % met 50 - 60% of criteria assessing context and content of clinical guidelines and about 70% met 50 - 60% of guideline application criteria. 22 INTERPRETATION Rigour of guideline development varied significantly among the three groups of guidelines with highest score 30 - 40% for 30% of the guidelines developed with international support. The quality of the guidelines in terms of their context and content was considerably high for all groups of guidelines: 80% of translated clinical guidelines and developed with international support have met half or more of the criteria in this dimension and 70% of Russian clinical guidelines have reached the same result. The score for application of the guidelines was high for all groups :100% of guidelines developed under international support, 70% of Russian guidelines and 70% of translated guidelines have met half or more of the criteria in this dimension. The findings suggest that the quality of the guidelines varied by group of the guidelines. The overall quality (for all three dimensions) was higher for the guidelines developed with international support. The important caveat about the results is that the guideline appraisal instrument actually assesses the quality of the reporting of the guideline development process rather than actual quality of the process. Despite that we assessed the quality of clinical guidelines on the basis of only the written and published materials. It is based on the assumption that practitioners and policy makers wishing to make a decision about the particular guideline would probably not have any additional information besides published. Another limitation is the sample size. We have assessed the quality of only 30 guidelines out of collected, they were selected randomly . Role of organizations acting in the field of EBM in Russia The analysis has identified organizations acting in the filed of Quality and Effectiveness Improvement on the bases of EBM and EEA in Russia: • The Department for Standardization in HealthCare under the Moscow Medical Academy is authorized by the MoH to develop the framework for standards and guidelines development and review of existing and newly developed guidelines [http://zdrav.net/lab_about.html]. Department of Standardization in Health maintains a close cooperation with the Ministry of Health and participates in developing departmental and extra departmental normative, legal and backbone documents. This Department supervised development of sectoral documents related to the Law of the Russian Federation on Product and Service Certification. Federal level of the work of the Department and its methodological activity have affected development of the system of quality management in the Russian healthcare andestablishment of the institution of officers responsible for quality in the subjects of the Russian Federation. Near 90 clinical protocols are being developed under supervision and methodological assurance of Department of Standardization in Health • Interregional Public Organization “Pharmaco-Economic Research Society” – Russian Branch of ISPOR, established in 1999 [http://www.rspor.ru]. The Interregional Public Organization “Pharmaco-Economic Research Society” is currently engaged in the following activities: pharmaco-economic research; organization ofdomestic conferences and congresses; lectures and master classes in pharmaco-economics, standardization, formulary, evidence-based medicine. • Federal Methodological Center for Quality Assurance under the Central Public Health Research Institute, MoH [www.healthquality.ru;] works with regions to develop EB clinical- organizational guidelines on the bases of Quality Improvement Methodology. • Under intergovernmental cooperation between Russia and the US, Great Britain and the European Union the EBM Center was organized in the Sechenov Moscow Medical Academy. • In April, 2003 MoH established Federal Center for Licensing, Accreditation and Standardization. • Professional Societies have developed clinical recommendations in relevant clinical fields. • Russian office of European Regional Bureau, World Health Organization. Upon establishment of the Russian Branch in 1999 WHO accelerated its efforts to promote evidence-based guidelines in Russia, including cooperation with sponsors. The following programs are under a large-scale implementation: Breast feeding, Early putting to breast, Rooming-in, Neonatal resuscitation, Reproductive health. These programs result in comprehensive changes in the system of health care delivery in maternity hospitals and antenatal care and are called “Child friendly hospital”. It was those programs that became the basis for USAID WIN project and WHO Health Reform project; WIN project, in particular, elevated the set of the documents of the programs to the format of a clinical practice guideline. • Many scientists, medical professionals, institutes are involved in the development of clinical guidelines on the federal level and in regions. • International agencies, donors and institutes support in some way the development of EBM and guidelines based on scientific evidence in Russia: USAID, DFID, TACIS (Europe Union Program), OSI, Council of the Baltic Sea States and others. • Russian cities set up resource centers to provide methodological support and free-of-charge access to evidence-based data. The Open Society Institute [www.osi.ru] has also contributed to the development of this area, i.e. series of projects and grants to provide free access to Internet resources primarily to the institutes of higher education and to develop clinical practice protocols [www.osi.ru/web/homepage.nsf]. USAID 1) ZdravReform Project USAID large comprehensive ZdravReform Project implemented in 6 subjects of the Russian Federation over the period from 1992 to 1996 was the first to make most valuable contribution to the EBM dissemination in Russia. The Project covered a wide range of areas: 25 1. Economic and Demographic data analysis 2. Payment Systems 3. Financial Management 4. Organization and Management 5. Primary Care 6. Public Health 7.Policy & Legislation 8. Quality Assurance 9. Information Systems 10. Pharmacy Sector 11. Training and Development Upon Project 7 clinical protocols and 22 clinical and practice guidelines have been developed. Project experts promoted the ideas of EBM throughout the period of the Project implementation and wrote a book about EBM clinical guidelines implementation in Russia and other problems titled “Manual for Clinical Quality Improvement for the Transformation of the Russian Health Care System”. The developed clinical protocols remained unknown and non-disseminated in Russia. Their electronic format may partially account for remaining unclaimed. 2) American International Health Alliance AIHA partnerships made a great contribution to the development of Evidence-based medicine in Russia. The Russian partners are provided with the required literature, access to WEB-resources; they are trained to work with original sources both written and electronic ones. To master the acquired skills the Russian partners prepare analytical reviews of standard practices to answer crucial clinical questions and upload them on the AIHA WEB-site [www.aiha.com ]. As a result, the Russian participants of the partnerships started to create gradually an environment favoring evidence-based clinical decisions and development of culture and skills of Internet search for the best available information. Understanding of the principles of the clinical etiology makes the users “choosy” with respect to the information available on the Internet. Results of the partnerships work executed as clinical practice guidelines are uploaded on the AIHA WEB-portal Infonet “Eurasian Health” in a multilingual library. [http://www.eurasiahealth.org/russian/library/results.cfm]. Follow up activities of the AIHA partnerships include development of the local communities in line with the democratic principles of public health promotion and human well-being. The communities should be built around the Russian partners participated in adapting clinical practice guidelines to the Russian health care system and acquired knowledge and skills to improve health care system according to EBM data. Expansion beyond the health care system will help to 26 develop a cross-sectoral and public cooperative coalition consisting of different national and public institutions with an aim to improve public health. 3) Healthy Russia 2020 USAID is soliciting applications from non-commercial, non-governmental organizations to implement Healthy Russia 2020, a new $25 million, five-year health communication activity, that will promote healthy behavior, encourage adoption of practices proven effective under USAID health program, and advocate for broad participation to reverse declining health indicators. Activity outputs will include forming an alliance of health services providers into a sustainable health advocacy NGO, creating a Healthy Russia 2020 web portal, conducting mass media and communication campaigns, and creating a health communication and delivery infrastructure through technical assistance and capacity building. The Healthy Russia 2020 activity forms a cornerstone of USAID’s health strategy 2001-2005. Healthy Russia 2020 will contribute to these specific health outcomes: 1) a healthier lifestyle for young Russians, 2) reduced HIV/AIDS/STI infections, 3) improved control of TB, including Multi-Drug-Resistant infections, and 4) improved women and infants health. This activity will draw upon USAID and other projects as sources for proven health interventions and technologies and work closely with them in developing advocacy and dissemination strategies. Healthy Russia 2020’s primary contribution will be health communication expertise and activities. 4) Quality Assurance Project - Russia Within the project framework the 4 clinical-organizational guidelines were developed. The guidelines are available on www.healthquality.ru both in Russian and English. The development methods are based on the methodology for Improving systems of health care delivery, adapted within the project framework to Russian health system. The American counterparts shared their know-how of quality management technology with their Russian counterparts The guidelines are evidence-based, while in respect to the guideline for Pregnancy induced hypertension cost effectiveness has been proven. The Project has initiated its second phase. 32 regions of the Russian Federation expressed their willingness to participate. Program to coordinate participation of EBM specialists and experts in teams to develop clinical guidelines both in the center and regions is shaped based on the survey analysis of participants. It is planned to conduct a number of trainings in EBM and knowledge 27 management for the project participants. In framework of this Project CPHRI developed WEB- communicator for exchange of information with territories. Department For International Development www.dfid.gov.uk; www.britemb.msk.ru DFID became an active player in the Russian Healthcare in early 90s. It actively operates at the federal level and in a number of territories, i.e. Samara, Kemerovo and Sverdlov Oblasts; besides those activities it has developed a mechanism of small project implementation Russia-wide. With regard to that area DFID maintains a close cooperation with the basic multilateral organizations including WHO, United Nations Educational, Scientific and Cultural Organization and World Bank. The main avenues of work to support the healthcare include systemic changes, population coverage with medical care, diseases control primarily socially sound diseases, i.e. TB, STDs and AIDS, and reproductive health improvement. In many cases the approach used by DFID consisted of the following components: first comes implementation of pilot projects then goes large-scale dissemination of success stories. Good example of deliverables: Prevention of infectious diseases among injection drug users. Ekaterinburg, 2002, Methodological recommendations In the TB control area DFID actively coordinates its activities with anti-TB activities developed under the World Bank with the aim to ensure their complementarities. DFID also collaborates with WHO to find economic ways to curb the TB spread. Follow up activities - DFID In close cooperation with the World Bank DFID takes part in the disbursement of the projected loan for TB and HIV/AIDS control in Russia. DFID assistance includes support of health education, diagnostic, preventive and treatment activities as well as work on TB and HIV/AIDS spread modeling. Current bilateral projects in Russia include: ♦ Development of TB prevention and treatment system [in addition to the activities projected by the World Bank] primarily in Kemerovo and Samara; ♦ Children mental institutions reforms in Sverdlovsk; 28 TACIS 1) North West Health Replication Project TACIS NWHR Project is aimed at assessing the value of different international projects implemented in Russia [primarily, TACIS itself] related to health reforms, and introducing their positive results into the subjects of the Russian Federation in the Northwest. The project has conducted a considerable research, and donors and Russian partners were surveyed. A great library with materials in hard and electronic copies has been created. Only 16 out of 600 basic documents collected can be referred to as guidelines. The project was not aimed at assessing the guidelines collected; therefore, there is no indication of the level of their evidence. The project is about to finalize the Web-portal [www.zdravinform.ru] with the library of the documents collected. As decided by the Ministry of Health, this Internet resource is to be transferred to the Central Public Health Research Institute with the Ministry of Health for further administration and replenishment. Besides, the project is developing methods for assessing completed and on-going international projects and also transfers them to the Institute. As decided by the Ministry of Health, in future Central Public Healthcare Research Institute will evaluate international projects in terms of their know-how and results applicability to the Russian healthcare at the request from the Ministry of Health and other parties concerned. This generates hopes that clinical guidelines as the project deliverables will be also evaluated in terms of their evidence and effectiveness. One of the important deliverable is Evaluation of Interventions in the Health Care Sector - A Toolkit for Researchers. The major aim of this toolkit is to provide researchers with the necessary concepts, approaches, methods and issues related to evaluation of health reform interventions of any kind. The toolkit can also be used as a teaching aid to strengthen capacities for evaluation. Besides, this manual will enable decision makers in the sphere of health policy formulation, including heads of health care authorities [HCA] and health care facilities at the federal and regional levels, to better understand evaluation and how to interpret the findings. 2) Primary Health Care Development 29 The aim of the Project – strengthening Primary Care, redesigning Scope of Authority for GP/ Family doctor, including development of 10 CGs for GP/ Family doctor. Task Force for Communicable Disease Control in the Baltic Sea Region http://www.baltichealth.org/balticproject/projects.php There are a lot of grants in the framework of Task Force for Communicable Disease Control in the Baltic Sea Region. They deal with STD, HIV/AIDS, TB and Primary Care for these diseases. Among deliverables of some grants mentioned should be CGs. Interregional Society of EBM Specialists EBM knowledge has been diffused into the Russian regions where independent groups were developed under medical schools that provide education, training and EBM promotion. In December 2002 those groups consolidated into Interregional Society of EBM Specialists. Situation with EBM dissemination in Russia can be visualized through answers to the first questionnaire given by representatives of the Regional branches of Interregional Society of EBM Specialists [ISEBMS]. ISEBMS overall activities include: ♦ Participate in development of Clinical Guidelines, which develop under umbrella of Professional Associations. ♦ Development of Internet forum [ http://www.osdm.org], the web-site was launched in April. ♦ Preparation of quarterly bulletin, the first copy will be issued in early April. ♦ The first ISEBMS conference “EBM Development in Russia: rules of regions” was held on April 11, 2003 in the framework of the regular congress “Man and Drugs” with more than 800 attendees. ♦ Development of an EBM training course subject to the Health Ministry approval. ♦ Information about regional branches is outlined in the Attachment. ♦ ISEBMS are the member of “AGREE” - an international collaboration of researchers and policy makers who seek to improve the quality and effectiveness of clinical practice guidelines by establishing a shared framework for their development, reporting and assessment. [http://www.agreecollaboration.org]. 30 ISEBMS officially translated AGREE Appraisal Instruments into Russian and it possible to download this document [http://www.agreecollaboration.org/pdf/Russia.pdf] Department of Standardization Federal Standards for Rational Drug Use Third edition of the Federal Guidelines for Rational Drug Use is available on the web-site of the All-Russia Public Fund “Human Health”. Its structure allows for “falling down” into relevant subsections and open them http://www.medlife.ru/formular/index.htm . Federal standard is one of the standards developed at the federal level used as a tool for calculating the costs of basic health care package . Web-site www.antibiotic.ru [www.iacmac.ru] is designed to cover the problems of drug resistance in Russia, clinical and molecular microbiology, treatment and prevention of infectious diseases. This job was supported by USAID and US Pharmacopoeia. The mentioned above Federal Center for Quality Assurance in Healthcare under the Central Public Health Research Institute aims to support methodologically development of clinical and organizational guidelines at the regional level, prepare materials for relevant trainings, organize and conduct scientific conferences, workshops and symposiums on quality improvement of health care delivery systems. 31 DISCUSSION The current study was designed to conduct a situation analysis of existing clinical guidelines in Russia, supplemented by a quality analysis of the guidelines collected. The results of our study show that within Russia, there is a growing interest to the development of guidelines. Over the last decade Russia has experienced several waves of introduction of clinical standards to healthcare: Federal clinical standards [ca. 800], created by different leading central clinical institutes and leading scientists under umbrella of Semashko Public Health Research Institute. At the current moment they are not used by health care practitioners. Clinical protocols are currently being developed under supervision and with the methodological support of the Department of Standardization in Health. Clinical guidelines, developed by professional Associations/Research Institutes Clinical guidelines developed in the frames of international projects conducted in Russia Clinical guidelines translated from English language. As a result of that, clinical guidelines became available via internet and Russian health care journals. But after collecting data, it has become clear to us that understanding of what clinical guideline is and what is the “evidence” differs. For instance, some of the interviewed informants developed recommendations on the basis of “experience” of heads of institutions or facilities. Out of 56 applications submitted to Open Society Institute in 2002 for a grant competition on developing clinical recommendations only 5 had a description of using international studies as a basis. The rest were based either on one center research or on opinions of some distinguished physicians. The results of the guidelines assessment performed with the use of Cluzeau Instrument demonstrate that quality of the guidelines vary significantly by developer, degree of international partnerships and sponsorship. Methods of clinical guidelines development in Russia still remain basically opinion based. Methods that take explicit account of relevant evidence are used very rarely. Translated clinical guidelines and developed in the framework of international projects did appear to have higher quality in terms of content and context of clinical guidelines. However, there seems to be consensus that a simple translation of evidence is not sufficient and most recommendations translated can not be used straight away and need to be adapted to the local realities, including health system and legal framework. There is no big variety in guideline application by developer. Despite guideline application appeared to be medium (more than half of the guidelines have met 50-60% of criteria assessing guideline application) interviews with key informants revealed some problems related to guidelines implementation. Guidelines developed by professional associations are often not disseminated outside the organization, which developed them. For instance, translation of international standards on pregnancy and childbirth – ECPC, funded by donors was kept in the international department of a research institute and not disseminated. Even standards developed by the Ministry of Health are not often accessible to the target audiences or only few copies are available. Another part of problem related to the clinical guidelines implementation is the resistance of physicians. This point of view is shared by a number of key informants and was related to a gap between what physicians need and what is really available to them. So, in some case it’s a problem of adaptation. In many cases, however, there seems to be an issue of resistance related to the strict hierarchy within health facilities and the view of senior doctors as the ones possessing experience and hence the knowledge about best ways to treat. Another issue relates to the lack of good methods to control sources of funding. It is generally accepted that many of the small trials in Russia are funded by pharmaceutical companies. Given the low level of state funding and low salaries of researchers it is plausible to preclude that there is a real danger of some of the studies being biased. Most of guidelines in Russia have tended to focus on issues of clinical effectiveness and have not explicitly considered broader issues, particularly cost. There has been no widely accepted successful way of incorporating economic considerations into guidelines. There is little practical and theoretical experience to incorporate the cost issues into clinical guideline. In the US it has been recommended that every set of clinical guidelines should include information on the cost implications of the alternative preventive, diagnostic and management strategies for each clinical situation. The stated rational was that this information would help potential users to evaluate better the potential consequences of different practices. 33 CONCLUSION 1) There is no unified understanding of terms, i.e. what is standard, protocol and what are clinical guidelines. 2) There are many types of documents falling into the broad category of recommendations for clinical procedures developed by various research institutes in Russia but most of them not based on robust evidence 3) The word “guideline” is used in many publications and/or practice advice but that many of the publications or guidelines are not based on robust and state of the art obtained evidence from research done in accordance with internationally accepted standards for EBM; the double blind cross over clinical trial with statistically sufficient numbers of patients being the gold standard. 4) There is no comprehensive strategy/plan for clinical guidelines development with clear priorities and definition/designation of clear organizational and institutional roles and responsibilities at the national, regional, and local levels. 5) Another part of the problem is related to the clinical guidelines implementation. Most of recommendations developed by different institutions are not disseminated wider then the group included in pilot. Another part of problem related to the clinical guidelines implementation is the resistance of physicians. This point of view is shared by a number of key informants and was related to a gap between what physicians need and what is really available to them. So, in some case it’s a problem of adaptation. In many cases, however, there seems to be an issue of resistance related to the strict hierarchy within health facilities and the view of senior doctors as the ones possessing experience and hence the knowledge about best ways to treat. RECOMMENDATIONS Suggestions that emerged as a result of analysis for important next steps included (but are not limited to) 1) It would be good to strive for a common understanding and acceptance of terms, i.e. what is a standard and what are clinical guidelines and what are the requirements for guidelines to be internationally acceptable in the (scientific) medical community. It seems to be crucial for physicians to understand why they need clinical guidelines, how to use them in an appropriate way 2) It would be good need for medical students and clinicians in Russia to get trained in EBM and the underlying methods like clinical epidemiology and statistics. 3) Russia could greatly contribute in the international effort to the further develop EBM and CPG’s and therefore cooperation with and integration in the international networks of EBM and CG developers would be very useful for all parties. In order to achive this it may be useful to review the accessibility of international studies and CPG’s to the Russian health professionals at different levels, including practicing/ teaching and researching, physicians 4) Develop and articulate a comprehensive strategy/plan for clinical guidelines development with clear priorities and definition/designation of clear organizational and institutional roles and responsibilities at the national, regional, and local levels. Such a strategy and implementation plan should also include the resources needed (and if they are not there how to obtain them) 5) It is important to continue the development of the National CPGs for leading health diseases and syndromes that primary care physicians routinely face in their clinical practice and that could have a big impact on health outcomes and efficiency in health care delivery are mitigating the heavy disease burden for society. 6) Pursue the enabling environment by providing equipment, training and auxiliary staff, necessary for the implementation of the CPG’s, as well as the right (financial and other) incentives for professionals to apply CPG’s in a sensible way and use actors that generally are known to influence doctor behavior (like peers and well respected clinicians/scientists/teachers) . Contracts between the medical institutions and the doctors could include references to the use of CPG’s, to the need for adequate documenting of diagnosis/treatment in patients records, as well as to the possibility of external review. Professional associations could act as peer groups and promote the adoption of CPG’s, A system of (re-) licensing of professionals in combination with mandatory continuous medical education could enhance the uptake of new CPG’s. Accreditation systems could play a role in changing practices and the organization of care in a more systematic way. A more competitive environment for health care facilities (i.e. competing for market share and money in relation to the appropriate application of CPG’s) in Russia could also help in improving quality of services and the uptake of CPG’s. 7) Consider the review of the current process of dissemination of CPG’s and uptake of CPG’s 8) To collaborate in a systematic way with the regional opinion leaders and decision makers in the field of EBM/CPG’s as they are responsible for implementation within the entire territory of the subjects of the Russian Federation 9) Medical schools should incorporate EBM/CPG’s into all clinical curricula and issues related to resource utilization should be included in retraining courses for practicing physicians 10) Since the question of resources is of particular relevance to the health sector today, it is important to develop a strategy of clinical guidelines development which focuses not only on clinical effectiveness, but also on economical aspects and the use of resources in general. Medico- economic standards were developed about ten years ago. The started process of re-working these medico-economic standards on the basis of EBM seems to be the right approach. 36 REFERENCES 1. David L. Sackett, William MC Rosenberg, JA Muir Gray, R. Brian Haynes, W. Scott Richardson. What it is and what it is not. BMJ 1996; 312: 71-2. 2. Sackett DL, Straus S, Richardson S, Rosenberg W, Haynes RB. Evidence-based Medicine: how to practice and teach EBM, ed 2. London: Churchill Livingston; 2000 3. M.Eccles, J.Mason. How to develop cost-conscious guidelines. Journal of Health Technology Assessment 2001, 5(16) 4. Eddy DM. A manual for assessing health practices and designing practice policies: the explicit approach. Philadelphia. American College of physicians, 1992 5. Cluzeau A, Littlejohns P, Grimshaw JM, Feder G, Moran SE. Development and application of a generic methodology to assess the quality of clinical guidelines. Int J Qual Health Care 1999,11:21-8 6. .www.cgr.mednet.ru 7. http://zdrav.net/lab_about.html 8. .http://www.rspor.ru 9. .www.healthquality.ru 10. .www.osi.ru 11. www.osi.ru/web/homepage.nsf 12. www.aiha.com 13. http://www.eurasiahealth.org/russian/library/results.cfm 14. www.healthquality.ru 15. . www.dfid.gov.uk 16. . www.britemb.msk.ru 17. . www.zdravinform.ru 18. . http://www.baltichealth.org/balticproject/projects.php 19. . http://www.osdm.org 20. . http://www.agreecollaboration.org 21. http://www.agreecollaboration.org/pdf/Russia.pdf 22. . http://www.medlife.ru/formular/index.htm 23. . www.iacmac.ru APPENDIX 1. Table 1. Russian Clinical Guidelines developed under collaboration with international partners. For Analytical Review on Current Situation Related to Evidence-Based Clinical Practice Guidelines Development in Russia N Guideline Guideline Field: Bases of evidence or Description of Methods of Monitoring/evalu Description of the Source Comments u type as full title clinical – title of original methods of used to dissemination and ation of use of individuals3 involved in of (Language, m defined by treatment recommendation, interpret and assess implementation2 guideline and its the guidelines funding Level, b authors 1 prevention source, and degree of the strengths of the effectiveness development group Other e diagnostic adaptation evidence /or comm.) r organizational adaptation for guidelines “Prikaz” On Clinical – treatment, Consensus of The High No information is Hard copies of the Pilot studies in No information is Governm Russian improveme prevention, Level Working Group available. document have been Orel, Ivanovo, available ent of the 1 nt of diagnostic, sent to each Novosibirsk RF and antitubercul and organizational administrative internatio ar service territory and nal in the published in MoH partners Russian periodicals (WHO, Federation USAID, DFID) Guideline Practical Clinical – treatment, Consensus of working No information is Though partners in No information is Editors – L.Stracthunsky, USAID, Russian guideline prevention group. available. other USAID available Y.Belousov, S. Kozlov. US 2 on anti projects, full text is Pharmac infectious available at the opoeia chemothera Internet py 1 Recommendations, standards, protocols, algorithms 2 Publications in journals or on websites – with URL 3 For example, professionals, interest groups including patients or organizations 38 N Guideline Guideline Field: Bases of evidence or Description of Methods of Monitoring/evalu Description of the Source Comments u type as full title clinical – title of original methods of used to dissemination and ation of use of individuals3 involved in of (Language, m defined by treatment recommendation, interpret and assess implementation2 guideline and its the guidelines funding Level, b authors 1 prevention source, and degree of the strengths of the effectiveness development group Other e diagnostic adaptation evidence /or comm.) r organizational adaptation for guidelines Guideline A guide to Clinical – Translation from No information is Though partners in Pilot studies in M. Enkin et al., Mac Swedish English effective prevention, English language - available USAID WIN- regions. Master University. East- care in diagnostic, project European Russian pregnancy treatment (Perm, Murmansk, Editor of translation – Committ and Petrozavodsk A.V. Mikhailov ee on childbirth Archangelsk, SPb) Health care Clinical Guideline Clinical – Based on Reports about No information is Through different Pilot studies O.Kuznetsova and SPb city recommend on diabetes prevention, CRTs available international colleagues, SPb Medical program ation mellitus diagnostic, projects, Academy of Post- “Family managemen treatment conferences Diploma Education medicine t by GP ” Practical Sexually Clinical – Recommendation of Translation and Through different Pilot projects in the O. Kuznetsova et al., SPb Baltic guideline transmitted prevention, CDC, WHO, adopted adaptation international regions Medical Academy of Sea diseases in diagnostic, projects, Post-Graduate Education Council general treatment conferences Project practice. Clinical and Guideline Clinical – treatment, Description in Quality Improvement Published and Quarterly MoH, Center of USAID Russian Organizatio on post- prevention, “Methods” (QI) methodology4 monitoring of obstetrics, gynecology nal abortive diagnostic, disseminated at indicators, Cost- and perinatology, RAMS, Guideline care and organizational WIN final effectiveness WIN project conference analysis (Moscow, May 2003) 4 Quality Improvement methodology was developed in Quality Assurance Project – USAID. One of the basic principle of this methodology – use evidence base materials for chosen of clinical technology. 39 N Guideline Guideline Field: Bases of evidence or Description of Methods of Monitoring/evalu Description of the Source Comments u type as full title clinical – title of original methods of used to dissemination and ation of use of individuals3 involved in of (Language, m defined by treatment recommendation, interpret and assess implementation2 guideline and its the guidelines funding Level, b authors 1 prevention source, and degree of the strengths of the effectiveness development group Other e diagnostic adaptation evidence /or comm.) r organizational adaptation for guidelines Clinical and Guideline Clinical and Description in QI-methodology Published and Quarterly MoH, WIN project USAID Russian Organizatio on Breast Organizational “Methods disseminated at monitoring of nal Feeding WIN final indicators Guideline conference (May 19-20, 2003, Moscow) Clinical and Improving Clinical – treatment, Description in QI-methodology Published on paper Monthly Health Care Department of USAID Russian, Organizatio the system prevention, “Methods” and available at monitoring of Tula Oblast Administration English nal of care for diagnostic, indicators, Cost- Central Public Health Guideline patients and Organizational http://www.healthqu effectiveness Research Institute, MoH, RF suffering ality.ru/english/flow analysis from charts/index.html Quality Assurance Project, University Research Co., arterial LLC/Center For Human hypertensio Services, Bethesda, USA n http://www.healthqu ality.ru/flowcharts/i ndex.html Clinical and Improving Clinical – treatment, Description in QI-methodology Published on paper Monthly Tver Oblast Health Care USAID Russian, organization the system diagnostic, “Methods” and available at monitoring of Department English al Guideline of health and Organizational indicators, Cost- Central Public Health care for http://www.healthqu effectiveness Research Institute, Ministry women ality.ru/english/flow analysis of Health of the Russian suffering charts/index.html Federation from Quality Assurance Project - Pregnancy- University Research Co., Induced http://www.healthqu LLC/ Hypertensi ality.ru/flowcharts/i on ndex.html Center for Human Services, Bethesda, USA 40 N Guideline Guideline Field: Bases of evidence or Description of Methods of Monitoring/evalu Description of the Source Comments u type as full title clinical – title of original methods of used to dissemination and ation of use of individuals3 involved in of (Language, m defined by treatment recommendation, interpret and assess implementation2 guideline and its the guidelines funding Level, b authors 1 prevention source, and degree of the strengths of the effectiveness development group Other e diagnostic adaptation evidence /or comm.) r organizational adaptation for guidelines Clinical and (Re) Clinical – treatment, Description in QI-methodology Published and Monthly Tver Oblast Health Care USAID Russian, organization designing diagnostic, “Methods” available at monitoring of Department English al Guideline the system and organizational indicators Central Public Health of care for http://www.healthqu Research Institute of neonates ality.ru/english/flow suffering charts/index.html The MoH, RF from Quality Assurance Project - respiratory University Research Co., distress http://www.healthqu LLC/ syndrome ality.ru/flowcharts/i Center for Human Services, ndex.html Bethesda, MD, USA Guideline “Medical Clinical – treatment, Description in QI-methodology Published, to be Pilot study Health Care Department of USAID Russian, care diagnostic, “Methods” disseminated yet Tula Oblast Administration English provided by and Organizational Public Health Research primary Institute, MoH care physicians Quality Assurance Project - University Research Co., for patients LLC/Center For Human with Services, Bethesda, USA depression (mild and American Psychiatric moderate Institute for Research and Education, American depressive Psychiatric Association, episodes)” Washington, DC, USA guideline National Institute of Mental Health, Bethesda, USA US Agency for Health Care Policy And Research 41 N Guideline Guideline Field: Bases of evidence or Description of Methods of Monitoring/evalu Description of the Source Comments u type as full title clinical – title of original methods of used to dissemination and ation of use of individuals3 involved in of (Language, m defined by treatment recommendation, interpret and assess implementation2 guideline and its the guidelines funding Level, b authors 1 prevention source, and degree of the strengths of the effectiveness development group Other e diagnostic adaptation evidence /or comm.) r organizational adaptation for guidelines Clinical and Guideline Clinical – treatment, Description in QI-methodology To be published Annual monitoring Health Care Department Of USAID Russian organization on diagnostic, “Methods” provided by pilot Samara Oblast al Guideline prevention prevention studies in Samara, Administration and early and organizational Cost-effectiveness Samara Medical University Guideline is DRAFT detection of analysis developed as breast Public Health Research Institute, MoH, RF a result of cancer at several primary Quality Assurance Project - projects care University Research Co., activities. LLC/Center For Human Services, Bethesda, USA American International Medical Alliance Clinical and Guideline Clinical – treatment, Description in QI- methodology To be published. Annual monitoring Health Care Department USAID Russian organization on diagnostic, “Methods”, provided by pilot of Samara Oblast al guideline bronchial prevention studies in Samara, Administration, Guideline is asthma and organizational Cost-effectiveness developed as DRAFT managemen analysis Samara Medical a result of t at primary University several health care projects Public Health Research activities Institute, MoH, RF Quality Assurance Project - University Research Co., LLC/Center For Human Services, Bethesda, MD, USA American International Medical Alliance 42 N Guideline Guideline Field: Bases of evidence or Description of Methods of Monitoring/evalu Description of the Source Comments u type as full title clinical – title of original methods of used to dissemination and ation of use of individuals3 involved in of (Language, m defined by treatment recommendation, interpret and assess implementation2 guideline and its the guidelines funding Level, b authors 1 prevention source, and degree of the strengths of the effectiveness development group Other e diagnostic adaptation evidence /or comm.) r organizational adaptation for guidelines Clinical and Clinical Clinical – treatment, Description in QI-methodology To be published. Annual monitoring Health Care Department USAID Russian organization guideline diagnostic, “Methods”. provided by pilot Of Samara Oblast al Guideline on prevention studies in Samara, Administration Guideline is prevention and Organizational Cost-effectiveness developed as DRAFT of coronary analysis Samara Medical a result of heart University several disease projects Public Health Research activities complicatio Institute, MoH, RF ns in general Quality Assurance practice Project - University Research Co., LLC/Center For Human Services, Bethesda, MD, USA American International Medical Alliance Clinical and Clinical Clinical – treatment, Description in QI-methodology To be published. Annually Health Care Department Of USAID Russian organization guideline diagnostic, “Methods”. monitoring Samara Oblast al Guideline on prevention provided by pilot Administration Guideline is prevention and organizational studies in Samara, developed as Samara Medical University DRAFT of diabetes Cost-effectiveness a result of complicatio analysis Public Health Research several Institute, MoH, RF projects ns in general Quality Assurance Project - activities practice University Research Co., LLC/Center For Human Services, Bethesda, MD, USA American International Medical Alliance 43 N Guideline Guideline Field: Bases of evidence or Description of Methods of Monitoring/evalu Description of the Source Comments u type as full title clinical – title of original methods of used to dissemination and ation of use of individuals3 involved in of (Language, m defined by treatment recommendation, interpret and assess implementation2 guideline and its the guidelines funding Level, b authors 1 prevention source, and degree of the strengths of the effectiveness development group Other e diagnostic adaptation evidence /or comm.) r organizational adaptation for guidelines Clinical Abortion No information OSI protocol protocol available Clinical Protocol for No information OSI protocol follow-up available on patients with irritable bowel syndrome Clinical Clinical No information OSI recommend recommend available ation ation for GP on arterial hypertensio n Clinical Clinical No information OSI recommend recommend available ation ation for GP on clamidiosis Clinical Clinical No information OSI recommend recommend available ation ation for GP for urinary tract infection 44 N Guideline Guideline Field: Bases of evidence or Description of Methods of Monitoring/evalu Description of the Source Comments u type as full title clinical – title of original methods of used to dissemination and ation of use of individuals3 involved in of (Language, m defined by treatment recommendation, interpret and assess implementation2 guideline and its the guidelines funding Level, b authors 1 prevention source, and degree of the strengths of the effectiveness development group Other e diagnostic adaptation evidence /or comm.) r organizational adaptation for guidelines Clinical Clinical Clinical – treatment, Adaptation “UCLA Adaptation in the Published and No information Russana Uzbashan et al. AIHA English, guideline guideline prevention, Chest Pain and Unstable framework of US- disseminate at the available Russian “Chest diagnostic Angina” Patient Armenia partnership conference “10 Pain” for Management Guideline Years of Health primary and others System Transition in care Central and Eastern physicians Europe Eurasia”, June, 2003 Clinical Protocol Clinical – Adaptation “Peptic Adaptation in the Published and No information Marta Lebedeva, MD, AIHA English, protocol for treatment, ulcer Diseases” framework of US- disseminate at the available Department of Internal Russian Diagnostic diagnostic University of Ukraine partnership conference “10 Medicine, Donetsk s and Michigan health Years of Health City, Ukraine Treatment system, Ontario System Transition of Peptic guideline for peptic in Central and Ulcer in ulcer diseases, and Eastern Europe Adults others Eurasia”, June, 2003 45 Table 2. Clinical guidelines published in the Russian Journals (review of 50 names of the Russian Journals from 1996 until now) Guideline Guideline Field (clinical – Bases of evidence Source of Comments on Methods of Monitoring/evalu Authors and Comme type as full title treatment, or title of original funding methods of dissemination and ation of use of organizations nts defined by prevention, recommendation, development /or implementation guideline and its involved in (Langua authors diagnostic, source, and degree adaptation for effectiveness developing ge, organizational) of adaptation guidelines guideline Level, Other comm.) Recomme Pregnancy, Clinical – Guidelines of No data is Randomized control Published in journals: No data is Guidelines of Russian ndation diagnosis treatment, WHO/Internationa available trial available WHO/Internationa Clinical and prevention, l Hypertension l Hypertension pharmacology and treatment of diagnostic, Society, 1999 Society, 1999 therapeutics, 2000 (3) hypertension and organizational Experts of Experts of in the RF International Russian Medical International Hypertension Journal, 2000 (8) Hypertension Society. Society, Russian Cardiology, 2000 Society of (11) cardiologists and Interregional Council of coronary heart diseases Guideline Guideline Field (clinical – Bases of evidence Source of Comments on Methods of Monitoring/evalu Authors and Comme type as full title treatment, or title of original funding methods of dissemination and ation of use of organizations nts defined by prevention, recommendation, development /or implementation guideline and its involved in (Langua authors diagnostic, source, and degree adaptation for effectiveness developing ge, organizational) of adaptation guidelines guideline Level, Other comm.) Standard Standards of Clinical – Guidelines for No data is No data is available. Published in journal: No data is No data is Russian, heart attach treatment, Cardiopulmonary available available available English Russian Family management prevention, Resuscitation and Doctor, 1997 (1) diagnostic, Emergency and organizational Cardiac Care: Recommendations of the 1992 National Conference// J. of A. Med. Assoc. – 1992. - Vol. 16. – P. 2135-2302 Guidelines Guidelines Clinical – No data is No data is No data is available Published in journal:Clinical Miasnikov State Russian, of heart treatment, available available effectiveness Scientific Institute English Consilium medicum failure diagnostic, analysis, Cost- of Cardiology, 1999, (3) treatment and organizational effectiveness National Congress analysis “Person and Drugs” Standards Standards of Clinical and No data is No data is No data is available Published in journal: No data is А. Sdvizkov Head Russian out-patient treatment available. available available oncologist of Moscow medical medical care Moscow; M. Authors opinion. journal, 1998 (5) for Lichinicer, oncological professor, RAMS patients V. Borisov, Deputy Head doctor, Moscow Oncological dispancer M.Biahov Deputy Head doctor 47 Guideline Guideline Field (clinical – Bases of evidence Source of Comments on Methods of Monitoring/evalu Authors and Comme type as full title treatment, or title of original funding methods of dissemination and ation of use of organizations nts defined by prevention, recommendation, development /or implementation guideline and its involved in (Langua authors diagnostic, source, and degree adaptation for effectiveness developing ge, organizational) of adaptation guidelines guideline Level, Other comm.) Guidelines Recommend Clinical – primary K. Pokhis, V. No data is No data is available Published in journal: No data is K. Pokhis, V. Russian ations of prevention, Medvedev available available Medvedev. Russian Family association secondary Recommendations Putersburg Doctor 1999 (3) of several prevention. of association of Medical European several European Academy, of medical medical societies postgraduate societies on on coronary aducation. coronary disease disease prevention. prevention. Guidelines Recommend Clinical – No data is No data is No data is available Published in journal: No data is P. Grigorev , Russian ations on treatment, available available available Chief Moscow Medical treatment diagnostic. astroenterologyst, Journal, 2001 (2) patients with MoH obesity . A. Yakovenko Russian State Medical University . Guidelines Dispanseriza Clinical – No data is No data is No data is available Published in journal: No data is P. Grigorev, Chief Russian tion of treatment, available available available astroenterologyst, Moscow Medical patients with diagnostic. MoH Journal, 2001 (5-6) digestive Russian State tract disease Medical University A. Yakovenko 48 Guideline Guideline Field (clinical – Bases of evidence Source of Comments on Methods of Monitoring/evalu Authors and Comme type as full title treatment, or title of original funding methods of dissemination and ation of use of organizations nts defined by prevention, recommendation, development /or implementation guideline and its involved in (Langua authors diagnostic, source, and degree adaptation for effectiveness developing ge, organizational) of adaptation guidelines guideline Level, Other comm.) Guidelines Using of Clinical – Original No data is Randomized control Published in journal Effectiveness of K. Gurevich, I. Russian antibiotics to treatment, available trials. Meta-analysis. treatment. Maev, Department Quality of Medical treat diagnostic. Effectiveness of of physiology , Care 2001 (2) helicobacter drugs. Moscow State pillory Medical Institute infectious Guidelines Advantages Clinical – Original No data is Randomized control Published in journal Effectiveness of N. Feldsherova, Russian of using long treatment, available trials, double treatment. Saint-Petersburg Quality of Medical acting prevention. blinded. Placebo State medical Care 2001 (2) inhaled β2- controlled clinical Academy agonist to trials. manage night attack of bronchial asthma Algorithm Algorithms Clinical – Original No data is No data is available Published in journal No data is G. Melnichenko, Russian s of diagnosis treatment, available available Sechenov Russian Medical and prevention. Moscow Medical Journal, 2002 (17) treatment of Academy thyroid diseases 49 Guideline Guideline Field (clinical – Bases of evidence Source of Comments on Methods of Monitoring/evalu Authors and Comme type as full title treatment, or title of original funding methods of dissemination and ation of use of organizations nts defined by prevention, recommendation, development /or implementation guideline and its involved in (Langua authors diagnostic, source, and degree adaptation for effectiveness developing ge, organizational) of adaptation guidelines guideline Level, Other comm.) Guidelines Treatment of Clinical – Original No data is No data is available Published in journal No data is N. Mihaylova, Russian sleep treatment. available available RAMS , scientific Russian Medical disorders Center of Mental Journal, 2003 (2) Health . Guidelines Clinical Clinical – Original No data is No data is available Published in journal No data is S. Yakovlev, I. Russian recommenda treatment. available available Derevyanko, Russian Medical tions of Sechenov Journal, 2003 (2) antibiotics Moscow Medical therapy to Academy treat urinary tract infectious Algorithm Algorithms Clinical – Original No data is No data is available Published in journal No data is L. Dvoretskiy, Russian s of anemia treatment, available available Sechenov Russian Medical treatment diagnostic. Moscow Medical Journal, 2003 (2) Academy 50 Guideline Guideline Field (clinical – Bases of evidence Source of Comments on Methods of Monitoring/evalu Authors and Comme type as full title treatment, or title of original funding methods of dissemination and ation of use of organizations nts defined by prevention, recommendation, development /or implementation guideline and its involved in (Langua authors diagnostic, source, and degree adaptation for effectiveness developing ge, organizational) of adaptation guidelines guideline Level, Other comm.) Algorithm Algorithm of Clinical – Original No data is No data is available Published in journal: No data is Donetckij State Russian s multiple diagnostic. available available Medical International medical sclerosis University. journal 1998 (4) diagnosis. Algorithm Algorithm of Clinical – Original No data is No data is available Published in journal: No data is E. Dyaktereva, Russian s bioactive treatment. available available Russian Medical International medical nutriceutics Academy of journal 1998 (6) and postgreduated parapharmac education, eutics in the Moscow practice of family doctor. Recomme National Clinical – Based on No data is No data is available http://www.cardiosite No data is Experts of the Russian ndations recommenda treatment, International available .ru/medical/recom- available Russian Scientific tions on prevention, standards and artgip.asp Society of prevention, diagnostic Report of WHO- Cardiologists - diagnostics experts on Arterial Almazov et al. and Hypertension treatment of arterial hypertension 51 Guideline Guideline Field (clinical – Bases of evidence Source of Comments on Methods of Monitoring/evalu Authors and Comme type as full title treatment, or title of original funding methods of dissemination and ation of use of organizations nts defined by prevention, recommendation, development /or implementation guideline and its involved in (Langua authors diagnostic, source, and degree adaptation for effectiveness developing ge, organizational) of adaptation guidelines guideline Level, Other comm.) Guidelines Guidelines Organizational European Society Uploaded No data is available http://nld.unibel.by/g No data is Members of the Russian on Contrast and Diagnostic of Urogenital by uidelines available Contrast Media Media Radiology. authority of Safety Committee ESUR of the European Society of Urogenital Radiology (ESUR). Standards/ Diagnostics Treatment, Developed by No data is No data is available Medical Library No data is Science Editor - Russian protocol and Organizational Russian Academy available http://www.medlinks. available A. Chuchalin, . treatment of and Diagnostic of Sciences on the ru/sections/sec3.htm RAMS nonspecific bases of lung international diseases in programs and adults guidelines Clinical Clinical Treatment, Report of the Uploaded No data is available http://www.medlinks. No data is Report of the recommen recommenda Organizational American by ru/article.php?sid=29 available American Translat dations/sta tions and and Diagnostic Association of authority of 0 Association of ion from ndards standards to DM Committee Russian DM Committee English treat patients on diagnostics and Medical on diagnostics and languag with treatments of DM. Journal treatments of DM e diabetes Original Language mellitus - English 52 Guideline Guideline Field (clinical – Bases of evidence Source of Comments on Methods of Monitoring/evalu Authors and Comme type as full title treatment, or title of original funding methods of dissemination and ation of use of organizations nts defined by prevention, recommendation, development /or implementation guideline and its involved in (Langua authors diagnostic, source, and degree adaptation for effectiveness developing ge, organizational) of adaptation guidelines guideline Level, Other comm.) Clinical Clinical Diagnostic and Consensus of No data is No data is available http://thyronet.rusme No data is E, Kasatkina et al. Russian recommen Recommend Treatment experts. available dserv.com/th_spec/re available Russian dations ations of the comend.htm Association of Russian Endocrinologists Association of Endocrinolo gists to Treat Autoimmune Thyroiditis in Children Methodol Clamidiosis: Diagnostic and Consensus of No data is No data is available News of Infectology No data is Prof Serov et al Russian ogical clinical Treatment experts. available and Parasitology available Center for recommen presentations http://www.infectolog obstetrics, dations , diagnostics y.spb.ru/RUK/Clamy gynecology and and dia/CONTENTS.asp perinatology, treatment RAMS Clinical Clinical Diagnostic and Consensus of No data is No data is available Russian Medical No data is Sechenov MMA, Russian recommen recommenda Treatment experts without available Journal available scientific dations tions on EB-references http://www.rmj.ru/rm Research Institute antibacterial j/t11/n2/94.htm of Urology, MOH, treatment of RF urinary tract S. Yakovlev, infections I.Derevianko, Sechenov MMA 53 Guideline Guideline Field (clinical – Bases of evidence Source of Comments on Methods of Monitoring/evalu Authors and Comme type as full title treatment, or title of original funding methods of dissemination and ation of use of organizations nts defined by prevention, recommendation, development /or implementation guideline and its involved in (Langua authors diagnostic, source, and degree adaptation for effectiveness developing ge, organizational) of adaptation guidelines guideline Level, Other comm.) Clinical Clinical Diagnostic and Consensus of No data is No data is available http://www.rhinology No data is A.Lopatin, et al. Russian recommen Recommend Treatment experts. available .ru/crar.htm available Members of the dations ations on Expert Panel diagnostics and treatment of allergic rhinitis Clinical Recommend Diagnostic and Consensus of No data is No data is available http://cito.medcity.ru/ No data is Department of Russian recommen ations on Treatment specialists from available Recommend/Koma/ available clinical dations comas Moscow State pharmacology and treatment. Medical internal diseases, University, Moscow State Scientific Society Medical of Acute Medical University, Care Scientific Society of Acute Medical Care Algorithm Algorithms Prevention, Developed by No data is No data is available http://www.osp.ru/do No data is Developed by Russian s to diagnose, Diagnostic and Federal Center of available ctore/1998/02/07.htm available Federal Center of treat and Treatment diabetes, MoH, diabetes, MoH, prevent RF RF diabetic foot Published at A.Ohklobystin, “Attending V.Ivashkin, physician”, 1998(2) Sechenov MMA 54 Guideline Guideline Field (clinical – Bases of evidence Source of Comments on Methods of Monitoring/evalu Authors and Comme type as full title treatment, or title of original funding methods of dissemination and ation of use of organizations nts defined by prevention, recommendation, development /or implementation guideline and its involved in (Langua authors diagnostic, source, and degree adaptation for effectiveness developing ge, organizational) of adaptation guidelines guideline Level, Other comm.) Algorithm Algorithm Diagnostic and Consensus of No data is No data is available http://www.nedug.ru/ No data is A.Ohklobystin, Russian s for Treatment experts without available lib/lit/therap/01oct/th available V.Ivashkin, managing EB-references erap15/therap.htm Sechenov MMA patients with acute and chronic pancreatitis Recomme Recommend Diagnostic and Consensus of No data is No data is available http://www.cardiosite No data is Russian Society of Russian ndations ations to Treatment experts. available .ru/medical/recom- available cardiologists treat acute ostcorsin-contents.asp coronary syndrome without steadily high ST segment on ECG Clinical Clinical Prevention, Consensus of No data is No data is available http://www.medlife.r No data is A. Chuchalin Russian recommenda Diagnostic and experts. available u/pulmo/copd.HTM available Academician recommen tions on Treatment RAMS. Head, dations chronic Research institute obstructive of pulmonology. lung disease N. Hmelkova Pulmonology Research Institute, MoH 55 Guideline Guideline Field (clinical – Bases of evidence Source of Comments on Methods of Monitoring/evalu Authors and Comme type as full title treatment, or title of original funding methods of dissemination and ation of use of organizations nts defined by prevention, recommendation, development /or implementation guideline and its involved in (Langua authors diagnostic, source, and degree adaptation for effectiveness developing ge, organizational) of adaptation guidelines guideline Level, Other comm.) Physicians Stroke Prevention Resuscitation and No data is No data is available On Web-site of No data is U. Varakin, Head, Russian concept - prevention Intensive care available Institute of available Laboratory of article Institute, MoH Neurology, RAMS epidemiology and Center for stroke prevention of http://www.neurology brain circulation .ru/ldvarak.htm diseases of the Institute of Neurology, RAMS. Research center of stroke research, MoH RF Physicians Intensive Prevention, Resuscitation and No data is No data is available http://www.neurology No data is N.Vereshchagin Russian conspect - therapy of Diagnostic and Intensive care available .ru/ldpirad.htm available Head, Institute of article acute Treatment Institute, MOH Neurology disorders of Center for stroke RAMS, Head, brain Research center of circulation stroke research, MoH, RF M.Piradov. Deputy director on science, Institute of Neurology, RAMS. Head of the dept. of resuscitation and intensive therapy. 56 Guideline Guideline Field (clinical – Bases of evidence Source of Comments on Methods of Monitoring/evalu Authors and Comme type as full title treatment, or title of original funding methods of dissemination and ation of use of organizations nts defined by prevention, recommendation, development /or implementation guideline and its involved in (Langua authors diagnostic, source, and degree adaptation for effectiveness developing ge, organizational) of adaptation guidelines guideline Level, Other comm.) Methodol Diagnostic Diagnostic and Neurology No data is No data is available http://www.neurology No data is Institute of Russian ogical principles Treatment Institute, MoH available .ru/metodich.htm available Neurology, Approv recommen and RAMS. ed by dations treatment of MOH patients with acute disorders of brain circulation Physicians Stroke Rehabilitation No data is No data is No data is available http://www.neurology No data is A. Kadykov, N. Russian conspect - rehabilitatio available available .ru/ldkad.htm available Shahparonova article n Neurology Institute, MoH Physicians Guillain- Rehabilitation No data is No data is No data is available http://www.neurology No data is M. Piradov Russian conspect - Barre available available .ru/ldpir_i.htm available Deputy director article syndrome on science Institute of Neurology, RAMS. Head of the dept. of resuscitation and intensive therapy. Neurology Institute, MOH 57 Guideline Guideline Field (clinical – Bases of evidence Source of Comments on Methods of Monitoring/evalu Authors and Comme type as full title treatment, or title of original funding methods of dissemination and ation of use of organizations nts defined by prevention, recommendation, development /or implementation guideline and its involved in (Langua authors diagnostic, source, and degree adaptation for effectiveness developing ge, organizational) of adaptation guidelines guideline Level, Other comm.) Clinical Clinical Treatment No data is No data is Results of abroad http://www.rosoncow No data is I. Dedov et al. Russian recommen Recommend available available trails eb.ru/treatment/04.ht available Russian dations ations of the m Association of Russian endocrinology Association of Endocrinolo gists to Treat Autoimmune Thyroiditis in Adults Clinical Disbacteriosi Diagnostic and No data is Governmen Consensus of the No data is Russian protocol s treatment available t of the RF Working group available headed by P.Vorobiev Clinical Heart Prevention, No data is Governmen Consensus of the No data is Russian Protocol Failure diagnoses and available t of the RF Working group available treatment headed by P.Vorobiev 58 Guideline Guideline Field (clinical – Bases of evidence Source of Comments on Methods of Monitoring/evalu Authors and Comme type as full title treatment, or title of original funding methods of dissemination and ation of use of organizations nts defined by prevention, recommendation, development /or implementation guideline and its involved in (Langua authors diagnostic, source, and degree adaptation for effectiveness developing ge, organizational) of adaptation guidelines guideline Level, Other comm.) Clinical Bedsore’s Prevention No data is Governmen Consensus of the No data is Russian protocol prevention available t of the RF Working group available headed by P.Vorobiev Clinical Honoree Diagnosis and No data is Governmen Consensus of the No data is Russian protocol treatment available t of the RF Working group available headed by P.Vorobiev 59 Table 3. Clinical guidelines translated from English language (published in the Russian Journals, web-sites) Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Official Recommendati Treatment GoldHirsch A., Glick Results of http://thyronet.rusme No data is S. Tulandin Chief No data is recommen ons of the G.H., Gelber R.D., abroad trails dserv.com/th_spec/re available of Blohin’s available dations seventh Coates A.S., Senn H.J. comend1.htm Russian Conference on Oncological Adjuvant Scientific Center, therapy of RAMS. Meeting breast cancer Highlights: (St.Hallen, International Switzerland, Consensus Panel February 2001 on the Treatment year of Primary Breast Cancer. J Clin Oncol 19: 3817- 3827, 2001. Guidelines Global strategy Clinical – Global Initiative for Randomized http://www.nedug.ru/ No data is 12 pharmaceutical No data is for asthma treatment, Asthma - translation control trials lib/lit/therap/01nov/th available companies available management prevention, erap507/therap.htm Russian society and prevention diagnostic, Pulmonologists. and GINA National Heart, Organizationa Lung, and Blood l Institute, WHO Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guideline Guidelines for Clinical – Ann Intern Med 1996; Randomized Published in journal: Cost-effectiveness A. Garber, W. No data is using serum screening 124:515-517 control trials, analysis Browner, S. available International Journal cholesterol, tests meta-analysis Hulley of Medical Practice, high-density 1997 (1) lipoprotein cholesterol, and triglyceride levels as screening tests for preventing coronary hearth disease in adults Standard Standard of Clinical- No data is available No data is Published in journal: Weekly Soll A. ,JAMA, No data is diagnosis and diagnosis, available monitoring of 1996 (275), p.622- available Quality of Medical treatment of treatment. treatment 629 Care, 1998 (4) gastrointestinal Organizationa tract diseases l Practical Practical Clinical - Developed by clinic of No data is Published in journal: No data is Clinic of No data is guidelines guidelines for treatment California university, available available California available Quality of Medical treatment and San Francisco. university, San Care, 1997(3) prevention of Francisco. peptic ulcer. 61 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Recomme Recommendati Clinical – Developed by the No data is Published in journal No data is Standards No data is ndation on of treatment, Standard committee of available available Committee of available Quality of Medical diagnostic and diagnostic. American thyreologysts American Care1996 (2) treatment of association thyreologysts hyper- and association hypothyroidis E.Indeykin, PhD, m Moscow 1Guideline Clinical Clinical – 1.Clinical practice No data is Published in journal: No data is E.V.Frolova St. No data is recommendati treatment, guidelines for the available available Petersburg available Russian Family on of medical diagnostic, management of diabetes Medical Academy Doctor, 2001 (1) care for and in Canada 1998 of Postgraduate patients with Organizationa Education 2.A desktop Guide to diabetes, type l type 2 diabetes mellitus. II European Diabetes Policy Group 1998-1999 3.Clinical guidelines for the management of diabetes in East London. 62 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) 2Guideline Modern Clinical- 1993 Guidelines for the No data is Published in journal: No data is V.Gorin, No data is treatment of treatment. management of mild available available G.Arabidze available International medical hypertension: Organizationa hypertension: journal 1998 (2) expectations l memorandum from and reality. World Health Organization/Internation al Society of Hypertension meeting. Guidelines Sub- Committee. //J.Hypertens. -1993.Vol. 11. -P.905-918 3Guideline Guideline of Clinical – The British Guidelines No data is Published in journal: No data is B.Higins MD, No data is Translatio bronchial treatment, on Asthma Managment. available available Newcustle-on- available n from Physician, 1999(8) asthma Organizationa 1995 Review and Tine English treatment l Position Statement// language Thorax 1997; 52 (suppl 1): 1-20. North of England Asthma Guideline Development Project. Summary version of evidence based guideline for the primary care management of asthma in adults// B.M.J. 1996; 312:762-766 63 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) 4Guideline Guideline of Clinical, No data is available No data is Published in journal: No data is V.Cannedy, BM No data is Translatio Chronic treatment available available R. Yanks, MD available n from The Practitioner, sinusitis Hospital of West English 1999 (2-3) treatment Suffolk language 5Clinical Screening for Clinical – 1.D. Eddy How to think Prospective Published in journal: No data is M.Gelfand No data is Russian guideline thyroid treatment, about screening. In: clinical and available available International Journal Translatio diseases. diagnostic, Eddy D., ed. Common epidemiologica of Medical Practice, n from prevention Screening Tests. l studies. 1999 (11) English and Philadelphia: American Randomized language organizational Coll Physicians; 1991:1- control trials 21 2.American College of Physicians. Guideline: screening for thyroid disease. In: Eddy D., ed. Common Screening Tests. Philadelphia: American Coll Physicians; 1991:179- 201 3.Helfand M., Crapo L.M. Screening for thyroid disease. Ann Intern Med 1990; 112:840-9 64 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) 6Guidelines Hepatitis C Clinical – No data is available No data is Published in journal: No data is National Health No data is Translatio treatment treatment, available Clinical available Institute, USA available n from prevention, pharmacology and English diagnostic therapeutics, 2003 (1) language 7Guidelines Global Prevention No data is available No data is Published in journal: No data is National Institute No data is Translatio initiative on Diagnostic available available of Heart, Lungs available n from Clinical chronic and and Blood, WHO English pharmacology and obstructive Treatment language therapeutics, 2001 (5) lung disease. 8Guidelines Guidelines of Organizationa Warren J., Abrutyn E., Randomized Published in journal: Clinical American society No data is Translatio antimicrobial l and Heble J. et al. Guidelines control trials, effectiveness of infection available n from Clinical therapy of Diagnostic for antimicrobial double diseases English pharmacology and bacterial treatment of blinded, meta- language therapeutic, 2000 (2) cystitis and uncomplicated acute analysis pyelonephritis bacterial cystitis and among women acute pyelonephritis in women. Clin. Inf. Dis., 1999,29,745-758 65 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) 9Guidelines Guidelines for Clinical – Feinberg W.M., Albers Randomized Published in journal: Clinical Stroke Council of No data is Translatio the treatment, G.W., Barnett H.J.M., control trials, effectiveness of the American available n from International Journal management prevention, Biller J., Caplan L.R., prospective surgery methods. Heart Association. English of Medical Practice of transient diagnostic Carter L.P., et al. and case- language 2000 (8) Clinical ischemic Guidelines for the control studies effectiveness of attacks management of transient treatment. ischemic attacks: from the Ad Hoc Committee on Guidelines for the Management of Transient Ischemic Attacks of the Stroke Council of the American Heart Association. AHA medical/ scientific statement: special report. Circulation 1994; 89: 2950-65 1Guidelines WHO- Organizationa 1999 WHO-ISH Randomized Published in journal: No data is 1999 WHO-ISH No data is Russian International l, treatment, guidelines for the control trials available guidelines for the available and Consilium medicum Society of prevention management of management of translation 2000 vol.2 (3) Hypertension hypertension hypertension from guidelines for English B.Sidorenko et al. management language President of Administration hypertension, Medical Center, 1999 RF . 66 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) 1Guidelines Diagnostic, Clinical – Rimola A. et al. Randomized Published in journal: Clinical Rimola A., No data is Translatio treatment and treatment, International Ascites control trials, effectiveness of Guadalupe G., available n from Clinical prevention of prevention, Club. Diagnostic, prospective antibacterial Navasa M., English pharmacology and spontaneous diagnostic treatment and prevention cohort studies, treatment Piddock L., Planas language therapeutics, 2000 (2) bacterial of spontaneous bacterial meta-analysis R., Bernard B., peritonitis. peritonitis: a consensus Inadomi J. and the document. J. International Hepatology, 2000 (32) Ascites Club. 142-153 1Guidelines Guidelines of Clinical – No data is available No data is Published in journal: Clinical Department of No data is Translatio HIV treatment treatment, available effectiveness Health USA, available n from Clinical for adults and diagnostic Genry Kaiser English pharmacology and youths. Foundation language therapeutics, 1999 (5) 1Guidelines Guidelines for Clinical – Am. J. Cardiol, 1999,83 Randomized Published in journal: No data is Advisory Council No data is Translati treatment of treatment, (2A), 1-38 control trials available To Improve available on from Clinical heart failure prevention, Outcomes English pharmacology and diagnostic Nationwide in language therapeutics, 1999 (4) Heart Failure 67 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) 1Guidelines Guidelines for Treatment No data is available No data is Published in journal: No data is VI Report of Joint No data is Translati diagnosis and available available Committee on available on from Clinical treatment of Prevention, English pharmacology and arterial Diagnosis and language therapeutics, 1999 (3) hypertension Treatment of arterial hypertension National Healthy Institute USA 1Guidelines World Health Treatment Guidelines Randomized Published in journal: No data is World Health No data is Translatio Organization Subcommittee. 1999 control trials available Organization – available n from Clinical and – World Health International English pharmacology and International Organization – Society of language therapeutics, 1999 (3) Society of International Society of Hypertension Hypertension Hypertension guidelines Guidelines for for the management of management hypertension. J. of Hypertension, 1999, hypertension. 17(2), 151-183 1Guidelines Guidelines for Diagnostic Original publication – Meta-analysis Published in journal: Clinical American College No data is Translati management and JACC, 1999, 33(7), randomized effectiveness of of cardiologists/ available on from Clinical of patients Treatment 2092-2197 control trials, treatment American English pharmacology and with stable prospective association of language therapeutics, 1999 (6) stenocardia studies. heart. (1999). 68 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) 1Guidelines Diagnosis and Diagnostic Diagnosis and Treatment Randomized Published in journal: Effectiveness of American Society No data is Translati Treatment of and of Idiopathic and non- treatment and of Hematology. available on from International Journal Idiopathic Treatment Thrombocytopenic randomized diagnostic based English of Medical Practice Thrombocytop Purpura: trials. on outcomes language 1997 (6) enic Purpura: Recommendations of the Recommendati American Society of ons of the Hematology. Ann Intern American Med 1997; 126: 319-326 Society of Hematology. 1Clinical Early Clinical- C.M. Coley et al. Prospective Published in journal: Effectiveness of C.M. Coley, M.J. No data is Translati guidelines Detection of diagnostic Clinical guidelines: Part and diagnosis Barry, C. Fleming, available on from International Journal Prostate II. Early Detection of retrospective M.C. Fahs, A.G. English of Medical Practice Cost-effectiveness Cancer. Part II: Prostate Cancer. Part II: studies, meta- Mulley. language 1998 (2) analysis Estimating the Estimating the Risks, analysis, Risks, Benefits, and Costs. Ann randomized Benefits, and Intern Med 1997; control trial. Costs. 126:468-479 Cost- effectiveness analysis 1Clinical Clinical Diagnostic Helfand M., Redfern C., Prospective Published in journal: Cost-effectiveness Helfand M., No data is Translatio guidelines guideline, part Sox H.C. Clinical clinical and analysis Redfern C.C., Sox available n from International Journal 1. Screening guideline, part 1. epidemiologica H.C. Department English of Medical Practice Quality of life for thyroid Screening for thyroid l studies of Medicine (111- language 1999 (11) assessment, disease. disease. . Ann Intern Randomized P), Portland effectiveness of Med 1998; 129: 141-3 trials. http://www.acponlin Veterans Affairs treatment e.org Medical Center, USA. 69 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) 2Guidelines Modern Clinical – Based on the joined 2001 Randomized Published in journal: Effectiveness of American College No data is Translatio approaches of treatment, consensus guidelines of control trials treatment based of Cardiology, available n from Russian Journal of auricular prevention, the American College of on outcomes American Heart English Cardiology, 2003 (3) fibrillation diagnostic Cardiology, American Association, language treatment. Heart Association and European Society and the European Society of of cardiology. Russian. cardiology. Preobrazhensky D. et al. President Administration Medical Center. 2Algorithm Algorithms for Clinical – Ballock R. et al.: No data is Published in journal: No data is Ballock R. No data is Translatio s treatment of treatment, Guidelines for the available available Chesnut R., available n from Consilium medicum severe head diagnostic. management of severe Clitton G. et al. English 1999 (2) trauma, active head injury. Brain language period. Trauma foundation. New York, 1996 Ballock R. Chesnut R., Clitton G. et al. The integration of brein- specific treatment into initial resuscitation of the severe head injury patient: guidelines for the management of severe head injury. J. Neurotrauma 1996; 13:653-9 70 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) 2Guidelines Expert panel Clinical – Executive summary of Epidemiologic Published in journal: Effectiveness of National No data is Translatio on detection, treatment, the third Report of the al studies, treatment. Cost- Cholesterol available n from Clinical evaluation, and primary National Cholesterol case-control effectiveness education English pharmacology and treatment of prevention, education program studies. analysis. program. National language therapeutics, 2002 (3) high blood diagnostic (NCEP). Expert panel on Health Institute, cholesterol in detection, evaluation, International medical USA adults. and treatment of high journal 2003 (1) blood cholesterol in adults. JAMA, 2001; 285: 2486-2497 2Guidelines Guidelines for Clinical – 1998 Guidelines for No data is Published in journal: Effectiveness of Centers for No data is Translatio Treatment of treatment. Treatment of Sexually available treatment. Disease Control available n from Clinical Sexually Transmitted diseases. and Prevention, English pharmacology and Transmitted MM WR, 1998 (47), 1- USA language therapeutics, 1999 (2) diseases 118 2Guidelines Guidelines for Clinical – Expert Panel Report 2. No data is Published in journal: No data is National Institute No data is Translatio the diagnosis treatment, Guidelines for the available available of Heart, Lungs available n from Clinical and prevention. diagnosis and and Blood, USA English pharmacology and management management of asthma. language therapeutics, 1998 (4) of bronchial NIH Publication, July asthma. 1997: 97-4051 71 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) 2Guidelines Contemporary Clinical – Contemporary Retrospective Published in journal: Effectiveness of American College No data is Translatio Approaches to treatment, Approaches to Diagnosis Analyses of drugs of available n from Cardiology 2002 (6) Diagnosis and prevention. and Management of randomized Cardiology/Ameri English Management Chronic Heart Failure control trials. can Heart language of Chronic (Summary of the Randomized Association. Heart Failure. American College of control trials. B. Sidorenko, D. Cardiology/American Placebo Preobrazhenskij, Heart Association controlised Presidential Guidelines). clinical trials. Medical Center of Russia Central Clinical Hospital, Moscow, Russia 2Recomme Corona virus Clinical – Information News No data is Published in paper No data is Russian Academy No data is ndations SARS – agent treatment, Release. Corona virus available available of Medical available causes atypical prevention, SARS – agent causes Sciences. pneumonia diagnostic, Atypical Pneumonia. Northern-Western and Recommendations of Division. Institute Organizationa WHO and CDC of Influenza l RAMN. Institute of Epidemiology. Ministry of Public Health. WHO, CDC 72 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) 2Recomme Effects of Clinical – No data is available Randomized Published in journal No data is No data is No data is Translatio ndations. medications treatment. control trials, available available available n from Quality of Medical from different double English Care 2002 (1) pharmacologic blinded. language al groups to Placebo the heart controlled rhythm. clinical trials. 2Guideline Practical Clinical – Based on different EBM- No Selling of book No data is Editor – acad. No Translatio guideline for prevention, sources and international information available RAMS I.N. informatio n and PG diagnostic, recommendation available Denisov n available adaptation treatment 2Practical Clinical – Based on No information available Selling of book No data is available Editor – acad. Translation and No Translatio guideline prevention, different RAMC I.N. adaptation informatio n from for PG diagnostic, EBM-sources Denisov n available English treatment and language international recommendati on 73 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) 3Guidelines Making the Organizationa The Royal College of No data is http://nld.unibel.by/g No data is The Royal No data is Russian for Best Use of a l and Radiologists, London. available uidelines available College of available English Doctors, Department of Diagnostic Radiologists, http://euro 4th edition Clinical London pa.eu.int Radiology 3Guidelines Contrast- Organizationa European Society of No data is http://nld.unibel.by/g No data is S.K. Morcos et al. Uploaded Translatio media-induced l and Urogenital Radiology. available uidelines available Contrast Media by n from nephrotoxicity: Diagnostic Translation from English Safety Committee authority English a consensus language of the European of ESUR language report. Society of Urogenital Radiology (ESUR). 3Clinical Clinical Treatment, Report of the American No data is http://www.medlinks. No data is Report of the Uploaded Translatio recommen recommendati Organizationa Association of available ru/article.php?sid=29 available American by n from dations/sta ons and l and Committee on 0 Association of authority English ndards standards to Diagnostic diagnostics and DM Committee of Russian language treat patients treatments of DM. on diagnostics and Medical with diabetes Original Language - treatments of DM Journal mellitus English 74 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guidelines Global strategy Clinical – Global Initiative for Results of http://www.nedug.ru/ No data is Society of No data is Translatio of asthma treatment, Asthma - translation abroad trails lib/lit/therap/01nov/th available Russian- available n from management prevention, erap507/therap.htm Pulmonologists. English and prevention diagnostic, National Heart, language and Lung, and Blood Organizationa Institute: Claude l Lenfant. WHO: Nikolai Khaltaev Guidelines 1998 Treatment No data is available No data is http://www.eurasiahe No data is No data is AIHA Russian Guidelines for available alth.org/index.jsp?sid available available treatment of =1&id=3542&lid=0& sexually pid=3540 transmitted diseases Guidelines Acute Diagnosis and No data is available No data is http://www.eurasiahe No data is No data is AIHA Russian Pneumonia. treatment in available alth.org/index.jsp?sid available available Clinical primary care =1&id=3542&lid=0& Protocols for and in pid=3540 Primary and hospital Hospital Care 75 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guidelines Basic Infection Clinical – No data is available No data is http://www.eurasiahe No data is Ackerman P., AIHA English, Control prevention, available alth.org/index.jsp?sid available Brachman M., et Russian Manual (2nd diagnostic. =1&id=3542&lid=0& al. edition) pid=3540 Детский госпиталь и клиника, г Миннеаполис, штат Миннесота Brachman and Associates Госуд. Медиц.академия имю Мечникова снкт-Пет Guidelines Bronchial Clinical – No data is available No data is http://www.eurasiahe No data is Hajiyev K., AIHA English, Asthma: treatment, available alth.org/index.jsp?sid available Eyubova A., et al. Russian Clinical prevention, =1&id=3542&lid=0& Practice diagnostic. pid=3540 Guideline for General Practitioners 76 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guidelines Cervical Clinical – No data is available No data is http://www.eurasiahe No data is Shikhashvili M., AIHA English, Screening: prevention, available alth.org/index.jsp?sid available Gemazashvili E., Russian Clinical diagnostic =1&id=3542&lid=0& et al. Practice pid=3540 members of the Guidelines for Georgian Primary Family Care Team Physicians Guidelines Chest Pain: Clinical – No data is available No data is http://www.eurasiahe No data is Yuzbashyan R., AIHA English, Clinical treatment, available alth.org/index.jsp?sid available Grigoryan L.A., et Russian Practice diagnostic. =1&id=3542&lid=0& al. Guideline for pid=3540 members of the Primary Health Armenia Clinical Care Practice Guideline Physicians expert group. Guidelines Clinical Organizationa No data is available No data is http://www.eurasiahe No data is No data is AIHA Russian Criteria for l available alth.org/index.jsp?sid available available Nursing Care: =1&id=3542&lid=0& Thoracotomy pid=3540 with Chest Tubes 77 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guidelines Clinical Organizationa No data is available No data is http://www.eurasiahe No data is Balchevsky V., AIHA English, Practice l available alth.org/index.jsp?sid available Kairys S., et al. Russian Guidelines =1&id=3542&lid=0& (CPG) Process pid=3540 Manual Guidelines Epidural Organizationa No data is available No data is http://www.eurasiahe No data is No data is AIHA Russian Analgesia: l available alth.org/index.jsp?sid available available How to Make =1&id=3542&lid=0& it Safe and pid=3540 Effective Guidelines Guidelines for Organizationa No data is available No data is http://www.eurasiahe No data is No data is AIHA Russian Hand washing l available alth.org/index.jsp?sid available available and Hospital =1&id=3542&lid=0& Environmental pid=3540 Control 78 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guidelines Guidelines for Prevention MMWR 1999; 48 (No. Randomized http://www.eurasiahe No data is US Public Health AIHA Russian Prevention of RR-10) Medical Journal control trials, alth.org/index.jsp?sid available Service (USPHS) Surgical of Australian, 1997 Series studies =1&id=3542&lid=0& and Infectious Wound AIDS 2000 Jul pid=3540 Disease Society of Infections 28;14(11):1563-1569 America (IDSA) Ann Trop Paediatr 1997 [MMWR Jun; 17(2):121-6 Pediatr 1999;48(No. RR- Infect Dis J 1999 10)] Feb;18(2):147-52 Guidelines Guidelines for Clinical – No data is available No data is http://www.eurasiahe No data is Julia Garner, AIHA English, the Use of treatment. available alth.org/index.jsp?sid available Centers for Russian Antiretroviral =1&id=3542&lid=0& Disease Control Agents in pid=3540 (Atlanta, GA), HIV-Infected 1985 Adults and Adolescents. Regulations for the Use of Antiretroviral Therapy in HIV Pregnant Women. Guidelines Guidelines for Clinical – No data is available No data is http://www.eurasiahe therapy risk for No data is AIHA Russian the Use of treatment. available alth.org/index.jsp?sid fetus and available Antiretroviral =1&id=3542&lid=0& newborn. Agents in pid=3540 Pediatric HIV Infection 79 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guidelines Guidelines for Clinical – Working Group on Meta-analysis, http://www.eurasiahe No data is The Working National English, the Use of treatment, Antiretroviral Therapy: Cohort studies alth.org/index.jsp?sid available Group on Institutes Russian Antiretroviral diagnostic. National Pediatric HIV =1&id=3542&lid=0& Antiretroviral of Health Drugs in Resource Center. pid=3540 Therapy and Pregnant Antiretroviral therapy Medical Women and medical management Management of Infected with of the human HIV-Infected HIV-1 for immunodeficiency virus- Children Maternal infected child. Pediatr convened by the Health and for Infect Dis, 1993. Jun; National Pediatric Reducing 12(6):513-22. and Family HIV Perinatal Resource Center Transmission (NPHRC),The Health Resources and Services Administration (HRSA), and The National Institutes of Health (NIH). Guidelines Guidelines on Organizationa No data is available No data is http://www.eurasiahe No data is No data is AIHA English, infection l available alth.org/index.jsp?sid available available Russian control =1&id=3542&lid=0& organization pid=3540 and practices 80 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guidelines Hypertensive Clinical – No data is available No data is http://www.eurasiahe No data is US Department of AIHA Russian Disorders of treatment, available alth.org/index.jsp?sid available Healthcare and Pregnancy diagnostic. =1&id=3542&lid=0& Social Services pid=3540 and CDC Guidelines Instructions Clinical – No data is available No data is http://www.eurasiahe No data is No data is AIHA English, and Manuals treatment, available alth.org/index.jsp?sid available available Russian for Nurses on prevention, =1&id=3542&lid=0& Preparation of diagnostic. pid=3540 Milk and Milk Formulas Guidelines Instructions on Clinical – No data is available No data is http://www.eurasiahe No data is No data is AIHA Russian Infection prevention. available alth.org/index.jsp?sid available available Prevention in =1&id=3542&lid=0& Case of pid=3540 Ophthalmologi cal Operations 81 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guidelines Neonatal Clinical – No data is available No data is http://www.eurasiahe No data is No data is Children's Russian Hydronephrosi prevention. available alth.org/index.jsp?sid available available Hospital s =1&id=3542&lid=0& No. 4 pid=3540 Guidelines New Data on Clinical – No data is available No data is http://www.eurasiahe No data is Richard Bellah AIHA Russian the Prevention diagnostic. available alth.org/index.jsp?sid available of Mother-to- =1&id=3542&lid=0& Child pid=3540 Transmission of HIV and their Policy Implications. Conclusions and recommendati ons Guidelines Performance Clinical – WHO Technical No data is http://www.eurasiahe No data is WHO No data is Russian Standards for prevention. Consultation available alth.org/index.jsp?sid available available Antimicrobial =1&id=3542&lid=0& Disk pid=3540 Susceptibility Tests; Approved Standard — Seventh Edition 82 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guidelines Practical Clinical – National Commmittee No data is http://www.eurasiahe Treatment No data is AIHA Russian Guide for treatment. for Clinical Laboratory available alth.org/index.jsp?sid affectivity available Feeding Standards (NCCLS). =1&id=3542&lid=0& Infants Born to ISBN 1-56238-393-0. pid=3540 HIV-Positive www.nccls.org. Women Guidelines Practical Clinical – No data is available No data is http://www.eurasiahe No data is N.L. Aryaev, MD, AIHA English, Guide on prevention, available alth.org/index.jsp?sid available PhD; N.V. Russian Counseling for diagnostic. =1&id=3542&lid=0& Kotova, MD; E.A. Prevention of pid=3540 Starets, MD; ed. Mother-To- V. Zaporozhan, Child HIV MD, PhD. Transmission Guidelines Practical Clinical – No data is available No data is http://www.eurasiahe No data is N.N. Nizova, MD, AIHA English, Guide on prevention. available alth.org/index.jsp?sid available PhD; S.P. Russian Sexually =1&id=3542&lid=0& Posokhova, MD; Transmitted pid=3540 ed. V. Infections and Zaporozhan, MD, HIV PhD. Prevention 83 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guidelines Practical Clinical – No data is available No data is http://www.eurasiahe No data is N.N. Nizova, MD, AIHA English, Guide on prevention. available alth.org/index.jsp?sid available PhD; S.P. Russian Treatment of =1&id=3542&lid=0& Posokhova, MD; Sexually pid=3540 ed. V. Transmitted Zaporozhan, MD, Infections in PhD. HIV-Positive Pregnant Women Guidelines Practice Clinical – WHO, UNAIDS No data is http://www.eurasiahe No data is N.N. Nizova, MD, AIHA English, Guidelines: treatment. available alth.org/index.jsp?sid available PhD; S.P. Russian US Centers for Disease Introduction to =1&id=3542&lid=0& Posokhova, MD; Control and Prevention Acute pid=3540 ed. V. (CDC), Gastroenteritis Zaporozhan, MD, among young “1998 Guidelines for PhD. children Treatment of Sexually Transmitted Diseases,”Morbidity and Mortality Weekly Report, 47, 1-118 (1998). 84 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guidelines Prenatal Care Clinical – No data is available No data is http://www.eurasiahe No data is From Dushanbe- AIHA Russian for Normal treatment, available alth.org/index.jsp?sid available Boulder Pregnancy prevention, =1&id=3542&lid=0& partnership diagnostic. pid=3540 Guidelines Protocol for Clinical – No data is available No data is http://www.eurasiahe No data is No data is AIHA Russian Diagnosis and treatment, available alth.org/index.jsp?sid available available Treatment of prevention, =1&id=3542&lid=0& Chronic diagnostic. pid=3540 Bronchitis Guidelines Safety and Clinical – No data is available No data is http://www.eurasiahe No data is No data is AIHA Russian Toxicity of treatment, available alth.org/index.jsp?sid available available Individual diagnostic. =1&id=3542&lid=0& Antiretroviral pid=3540 Agents in Pregnancy 85 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guidelines Standards for Clinical – Wade N, Unadkat J, No data is http://www.eurasiahe No data is No data is No data is English, Operating prevention, Huang S, et al. available alth.org/index.jsp?sid available available available Russian Room Nurses diagnostic. Pharmacokinetics and =1&id=3542&lid=0& safety of d4T and 3TC in pid=3540 HIV-infected pregnant women and their infants (PACTG 332). 10th Conference on Retroviruses and Opportunistic Infections. Boston, MA. February 10-14, 2003. (Abstract 886). Guidelines Standards for Organizationa No data is available No data is http://www.eurasiahe No data is No data is AIHA Russian Pediatric l available alth.org/index.jsp?sid available available Nurses =1&id=3542&lid=0& pid=3540 86 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guidelines Subarachnoid Clinical – No data is available No data is http://www.eurasiahe No data is No data is AIHA Russian Analgesia for prevention. available alth.org/index.jsp?sid available available Cesarean =1&id=3542&lid=0& Section pid=3540 (general principles) Guidelines Temporary Clinical – No data is available No data is http://www.eurasiahe No data is Gutche B. AIHA Russian Standards for treatment and available alth.org/index.jsp?sid available Diagnosis and organizational =1&id=3542&lid=0& Treatment in pid=3540 Emergency Medical Services of the Republic of Uzbekistan Guidelines USPHS/IDSA Clinical – No data is available No data is http://www.eurasiahe No data is National National Russian Guidelines for treatment, available alth.org/index.jsp?sid available Republican Center Republica the Prevention diagnostic. =1&id=3542&lid=0& for Emergency n Center of pid=3540 Medical Care for Opportunistic Emergenc Infections in y Medical Persons Care Infected with Human Immunodeficie ncy Virus (HIV) 87 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guidelines USPHS/IDSA Clinical – U.S. Public Health No data is http://www.eurasiahe No data is No data is AIHA Russian Recommendati prevention. Service (USPHS) and available alth.org/index.jsp?sid available available ons on Infectious Diseases =1&id=3542&lid=0& Opportunistic Society of America pid=3540 Infections (IDSA). MMWR 1999; Prevention 48 (№ RR-10); 89 pages. among HIV Infected Persons Infected with Human Immunodeficie ncy Virus (HIV) Guidelines WHO Global Clinical – USPHS/IDSA [MMWR No data is http://www.eurasiahe No data is No data is No data is Russian Strategy on treatment, 1999; 48 (No.RR-10) 71 available alth.org/index.jsp?sid available available available Antimicrobial prevention, p. =1&id=3542&lid=0& Служба Resistance diagnostic. pid=3540 здравоохранения США и Американское общество инфекционистов 88 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guidelines Acute Clinical – No data is available No data is http://www.eurasiahe No data is World Health AIHA Russian Pneumonia. treatment. available alth.org/index.jsp?sid available Organization Guidelines for =1&id=3542&lid=0& (WHO) Diagnosis and pid=3540 Treatment in Children's Hospitals Guidelines Clinical Clinical – No data is available No data is http://www.eurasiahe No data is Ryzhikova G. AIHA Russian Guidelines for treatment, available alth.org/index.jsp?sid available Management prevention, =1&id=3542&lid=0& of Acute diagnostic. pid=3540 Bronchitis in Children in Primary Care Setting Guidelines Practice Clinical – No data is available No data is http://www.eurasiahe No data is Ryzhikova G., AIHA Russian Guidelines for treatment, available alth.org/index.jsp?sid available Svatkovskaya O. Primary and prevention, =1&id=3542&lid=0& Hospital Care diagnostic. pid=3540 of Asthma Diagnosis and Treatment in Adults 89 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guidelines Practice Clinical – No data is available No data is http://www.eurasiahe No data is Burdasov A., Korsakov Russian Guidelines for treatment, available alth.org/index.jsp?sid available Fomitskaya V., Central Primary and diagnostic. =1&id=3542&lid=0& Artemenko L., et District Hospital Care pid=3540 al. Hospital on protocols from Hypertension Dubna and Diagnosis and Samara Treatment in Adults Guidelines Protocol for Clinical – No data is available No data is http://www.eurasiahe No data is Burdasov A., AIHA Russian Diagnosis and treatment, available alth.org/index.jsp?sid available Fomitskaya V., Treatment of diagnostic. =1&id=3542&lid=0& Artemenko L., et Bronchial pid=3540 al. Asthma in Dubna and Tula Adults Guidelines Protocol for Clinical – No data is available No data is http://www.eurasiahe No data is Donetsk City AIHA Russian Diagnosis and treatment, available alth.org/index.jsp?sid available Hospital #25 Treatment of diagnostic. =1&id=3542&lid=0& Chronic pid=3540 Cholecystitis 90 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guidelines Protocol for Diagnosis and No data is available No data is http://www.eurasiahe No data is Donetsk City AIHA Russian Diagnosis and Treatment available alth.org/index.jsp?sid available Hospital #25 Treatment of =1&id=3542&lid=0& Chronic pid=3540 Hepatitis Guidelines Protocol for Clinical – No data is available No data is http://www.eurasiahe No data is Donetsk City AIHA Russian Diagnosis and treatment, available alth.org/index.jsp?sid available Hospital #25 Treatment of diagnostic. =1&id=3542&lid=0& Chronic pid=3540 Pancreatitis Guidelines Protocol for Clinical – No data is available No data is http://www.eurasiahe No data is Donetsk City AIHA Russian Diagnosis and treatment, available alth.org/index.jsp?sid available Hospital #25 Treatment of diagnostic. =1&id=3542&lid=0& Peptic and pid=3540 Duodenum Ulcer in Adults 91 Guideline Guideline full Field (clinical Bases of evidence or title Comments on Methods of Monitoring/evalua Authors and Source of Comments type as title – treatment, of original methods of dissemination and tion of use of organizations funding (Language defined by prevention, recommendation, source, development implementation guideline and its involved in , Level, authors diagnostic, and degree of adaptation /or adaptation effectiveness developing Other organizational for guidelines guideline comm.) ) Guidelines Protocol for Clinical – No data is available No data is http://www.eurasiahe No data is Donetsk City AIHA Russian Diagnosis and treatment, available alth.org/index.jsp?sid available Hospital #25 Treatment of diagnostic. =1&id=3542&lid=0& Pneumonia pid=3540 Guidelines Standards for Clinical – No data is available No data is http://www.eurasiahe No data is Donetsk City AIHA Russian Mammology treatment, available alth.org/index.jsp?sid available Hospital #25 Screening in diagnostic. =1&id=3542&lid=0& Primary Care pid=3540 Guidelines WHO Global Clinical – No data is available No data is http://www.eurasiahe No data is Samara outpatient AIHA Russian Strategy on prevention, available alth.org/index.jsp?sid available clinic #15. Antimicrobial diagnostic. =1&id=3542&lid=0& Resistance pid=3540 92 93 APPEDNIX 2 TABLE 1 Clinical Protocol “Medical (Re)desig Improving Global Guidelines Clinical Imp Guideli Total and for care ning the system of strategy for the guidelin rovi ne on Organizati Diagnosti provided system of care for for treatment e on ng Breast onal cs and by primary care for women asthma of preventi the Feeding Guideline Treatment care neonates suffering manage infectious on of syst on post- of Peptic physicians suffering from ment and disease. diabetes em abortive Ulcer in for patients from Pregnancy preventio complica of care Adults with respirator -Induced n tions in care depression” y distress Hypertens general for guideline syndrome ion practice pati ents suff erin g fro m arte rial hyp erte nsio n 1. Is the agency Yes * * * * * * * * * 9 responsible for the No development of the guidelines Not * 1 clearly identified? sure Responsibility for guideline imension 1: Rigour of N/A 2.Was external Yes * * * * * * * * * 9 funding or other No evelopment support received development for developing the Not * 1 guidelines? sure N/A 3. If external Yes 94 funding or support No * * * * * * * * * 9 was received, is there evidence Not that the potential sure biases of the funding body (ies) N/A * 1 were taken into account? 4. Is there a Yes * * * * * * * * * 9 description of the individuals (e.g. No * 1 professionals, Not interest groups- sure including patients) who N/A were involved in Guideline development group the guidelines development group? 5. If so, did the Yes * * * * * * * 7 group contain representatives of No * 1 all key Not * * 2 disciplines? sure N/A and 6. Is there a Yes * * * * 3 description of the No * * * * 4 interpretation of evidence sources of information used Not * * 2 to select the sure evidence on which the N/A Identification recommendations are based? 7. If so, are the Yes * * * * 4 sources of No 95 information Not adequate? sure N/A * * * * * * 6 8. Is there a Yes * * 2 description of the method(s) used to No * * * * * 5 interpret and Not * * * 3 assess the strength sure of the evidence? N/A 9. If so, is(are) the Yes method(s) for No rating the evidence Not * * 2 satisfactory? sure N/A * * * * * * * * 8 10. Is there a Yes * * * * * 5 description of the No * * 2 methods used to formulate the Not * * * 3 recommendations sure ? N/A 11. If so, are the Yes methods No satisfactory? Not * * * * 4 sure N/A * * * * * * 6 12. Is there an Yes indication of how No * * * * * * * * * * 10 the views of interested parties Not not on the panel sure 96 were taken into N/A account? 13. Is there an Yes explicit link between the major No * 1 recommendations Not * * * * * * * * * 9 and level of sure supporting evidence? N/A 14. Were the Yes guideline No * * * * * * * * 8 independently reviewed prior to Not * * 2 their sure publication/releas e? N/A 15. If so, is Yes explicit information given No about methods Not and how sure comments were addressed? N/A * * * * * * * * * * 10 16. Were the Yes guideline piloted? No * * * * * * * * * * 10 Peer review Not sure N/A 17. If the Yes 97 guidelines were No piloted, is explicit information given Not about the methods sure used and the results adopted? N/A * * * * * * * * * * 10 18. Is there a Yes mention of a date for reviewing the No * * * * * * * * * * 10 guidelines? Not sure N/A 19. Is the body Yes responsible for the reviewing and No * * * * * * * * * * 10 Updating updating clearly Not identified? sure N/A of 20. Overall, have Yes the potential No * * * * * * * * * * 10 biases of assessment guideline Not development been development process sure adequately dealt with? N/A Overall 21. Are the Yes * * * * * * 6 Dimensio Objectives reasons for the developing the No * 1 n 2: guidelines clearly Not * * * 3 stated? sure 98 N/A 22. Are the Yes * * * * * * * * * 9 objectives of the No guidelines clearly defined? Not * 1 sure N/A 23. Is there a Yes * * * * * * * * * 9 satisfactory description of the No patients to which Not * 1 the guidelines are sure meant to apply? N/A 24. Is there a Yes * * * * * * * * 8 description of the No circumstances (clinical or non Not * * 2 clinical) in which sure exceptions might be made in using N/A the guidelines? 25. Is there an Yes * * * 3 explicit statement No of how the patient's Not * * * * * * * 7 preferences sure should be taken into account in N/A Context applying the guidelines? 99 26. Do the Yes * * * * * * * * * * 10 guidelines describe the No condition to be Not detected, treated, sure or prevented in unambiguous N/A terms? 27. Are the Yes * * * * * * * 7 different possible No options for management of Not * * * 3 the condition sure clearly stated in the guidelines? N/A 28. Are the Yes * * * * * * * * * * 10 recommendations No clearly presented? Not Clarity sure N/A 29. Is there an Yes * * * * * 5 adequate No * 1 description of the health benefits Not * * * * 4 Likely costs and benefits that are likely to sure be gained from the recommended N/A management? 30. Is there an Yes adequate description of the No * * * * * * * 7 potential harms or Not * * * 3 risks that may sure 100 occur as a result N/A of the recommended management? 31. Is there an Yes * 1 estimate of the costs or No * * * * * * * * 8 expenditures Not * 1 likely to incur sure from the recommended N/A management? 32. Are the Yes * 1 recommendations No * * * * * * * * 8 supported by the estimated Not * 1 benefits, harms sure and costs of the intervention? N/A and 33. Does the Yes * * * * * * * 7 guideline No * * 2 document suggest Dimension 3: Application dissemination possible methods Not * 1 for dissemination sure Guideline and implementation? N/A 34. Does the Yes * * * * * * * * * * 10 Monitoring guideline No document specify criteria for Not of monitoring sure 101 compliance? N/A 35. Does the Yes * * * * * * * * * * 10 guideline document identify No clear standards or Not targets? sure N/A 36. Does the Yes guideline No document define measurable Not * * * * * * * * * * 10 outcomes that can sure be monitored? N/A National Guidelines Only 37. Does the Yes * * * * * * * * 8 guideline No * * 2 document identify key elements Not which need to be sure considered by guideline groups? N/A 102 TABLE 2 Russian guidelines Pregnan Standards Algorith Diagnosti Diagno Clamidi Clinical Algorith Standar Nation Tot cy, of out- m of c stics osis: Recomm m for ds of al al diagnosi patient multiple principles and clinical endations managing medica recom s and medical sclerosis and treatme presenta on patients l care menda treatme care for diagnosis. treatment nt of tions, diagnosti with in the tions nt of people of nonspec diagnost cs and acute and cases on hyperte with patients ific ics and treatment chronic of preven nsion in oncology with lung treatme of pancreatit heart tion, the acute diseases nt allergic is attack diagno Russian disorders in rhinitis stics Federati of brain adults and on circulatio treatm n ent of arterial hypert ension of 1. Is the agency Yes * * * * * * * * 8 Responsibility for guideline development responsible for No * * 2 the Rigour development of Not the guidelines sure clearly identified? N/A 1: 2. Was external Yes funding or other evelopment No * * * * * * * * * * 10 support imension received for Not developing the sure guidelines? N/A 103 3.If external Yes funding or No support was received, is Not there evidence sure that the potential biases N/A * * * * * * * * * * 10 of the funding body (ies) were taken into account? 4.Is there a Yes * * * * * * * 7 description of No * * * 3 the individuals (e.g. Not professionals, sure interest groups- including N/A patients) who were involved Guideline development group in the guidelines development group? 5. If so, did the Yes * * * * * * 6 group contain No representatives of all key Not * 1 disciplines? sure N/A * * * 3 and interpretatio 6.Is there a Yes * * * * * * * * 8 Identificatio description of the sources of No * 1 information Not * 1 n used to select sure 104 the evidence on N/A which the recommendatio ns are based? 7.If so, are the Yes * * * * * * 6 sources of No * 1 information adequate? Not * 1 sure N/A * * 2 8. Is there a Yes description of No * * * * * * * * * * 10 the method(s) used to interpret Not and assess the sure strength of the evidence? N/A 9. If so, is(are) Yes the method(s) No for rating the evidence Not satisfactory? sure N/A * * * * * * * * * * 10 10. Is there a Yes * 1 description of No * * * * * * * * * 9 the methods used to Not formulate the sure recommendatio ns? N/A 11. If so, are the Yes * 1 methods satisfactory? No Not sure 105 N/A * * * * * * * * * 9 12. Is there an Yes indication of No * * * * * * * * * * 10 how the views of interested Not parties not on sure the panel were taken into N/A account? 13. Is there an Yes explicit link No * * * * * * * * * 9 between the major Not * 1 recommendatio sure ns and level of supporting N/A evidence? 14. Were the Yes guideline No * * * * * * * * * * 10 independently reviewed prior Not to their sure publication/rele ase? N/A 15. If so, is Yes explicit No information given about Not methods and sure how comments N/A * * * * * * * * * * 10 Peer review were addressed? 16. Were the Yes guideline No * * * * * * * * * * 10 106 piloted? Not sure N/A 17. If the Yes guidelines were piloted, is No explicit Not information sure given about the methods used N/A * * * * * * * * * * 10 and the results adopted? 18. Is there a Yes mention of a No * * * * * * * * * * 10 date for reviewing the Not guidelines? sure N/A 19. Is the body Yes responsible for No * * * * * * * * * * 10 the reviewing and updating Not Updating clearly sure identified? N/A assessment of 20. Overall, Yes have the development No * * * * * * * * * * 10 potential biases of guideline Not Overall development sure been adequately dealt with? N/A 21. Are the Yes * * * * * * * * * 9 Obje ctive me Di reasons for the s No 107 developing the Not * 1 guidelines sure clearly stated? N/A 22. Are the Yes * * * * * * * 7 objectives of the guidelines No clearly defined? Not * * * 3 sure N/A 23. Is there a Yes * * * * * * * * * * 10 satisfactory description of No the patients to Not which the sure guidelines are meant to apply? N/A 24. Is there a Yes * * * * * * * * * 9 description of the No circumstances Not * 1 (clinical or non sure clinical) in which N/A exceptions might be made in using the guidelines? 25. Is there an Yes * * 2 explicit statement of No * * * * * * * 7 how the Not * 1 patient's sure preferences should be taken N/A Context into account in applying the guidelines? 108 26. Do the Yes * * * * * * * * * * 10 guidelines No describe the Not condition to sure be detected, treated, or N/A prevented in unambiguous terms? 27. Are the Yes * * * * * * * * * * 10 different No possible options for management Not of the condition sure clearly stated in the guidelines? N/A 28.Are the Yes * * * * * * * * 8 recommendatio ns clearly No presented? Not * * 2 Clarity sure N/A 29. Is there an Yes * * * 3 adequate description of No * * * 3 the health Not * * * * 4 benefits that are sure Likely costs and benefits likely to be gained from the N/A recommended management? 30. Is there an Yes adequate No * * * * * * * * * * 10 description of the potential Not harms or risks sure 109 that may occur N/A as a result of the recommended management? 31. Is there an Yes * 1 estimate of the No * * * * * * * * * 9 costs or expenditures Not likely to incur sure from the recommended N/A management? 32. Are the Yes * 1 recommendati No * * * * * * * * * 9 ons supported by the Not estimated sure benefits, N/A harms and costs of the intervention? and Dimension 3: Application 33. Does the Yes guideline document No * * * * * * * * * * 10 implementation suggest possible dissemination Not methods for sure Guideline dissemination and N/A implementation ? g of Moni 34. Does the Yes * * * * * * 6 torin guideline No * * 2 110 document Not * * 2 specify criteria sure for monitoring compliance? N/A 35. Does the Yes * * * * * * 6 guideline No * 1 document identify clear Not * * * 3 standards or sure targets? N/A 36. Does the Yes guideline No * 1 document define Not * * * * * * * * * 9 measurable sure outcomes that N/A can be monitored? 37. Does the Yes * * * * * * * * 8 guideline No * * 2 National Guidelines Only document identify key Not elements which sure need to be considered by N/A guideline groups? 111 TABLE 3.Clinical guidelines translated from English language Screenin Guideli Early Hepatit Guideli Guideli Global Modern Guide Clinica To g for nes for Detection is C nes for nes of initiative treatme lines l tal thyroid the of Prostate treatm treatme HIV on nt of for guideli diseases. manage Cancer. ent nt of treatme chronic hyperte diagn ne, ment of Part II: heart nt for obstructi nsion: osis part 1. transien Estimatin failure adults ve lung expectat and Screen t g the disease ions and treat ing for ischemi Risks, reality ment thyroid c Benefits, of disease attacks and Costs. arteri . al hyper tensio n 1. Is the agency Yes * * * * * * * * * 9 responsible for the development of the No guidelines clearly Not * 1 Dimension 1: Rigour of Development identified? sure Responsibility for guideline development N/A 2. Was external funding Yes or other support received for developing No * * * * * * * * * * 10 the guidelines? Not sure N/A 3. If external funding or Yes support was received, is No 112 there evidence that the Not potential biases of the sure funding body (ies) were taken into account? N/A * * * * * * * * * * 10 4. Is there a description Yes * * * 3 of the individuals (e.g. professionals, interest No * * * * * * * 7 groups-including patients) who were Not Guideline development group involved in the sure guidelines development N/A group? 5. If so, did the group Yes * 1 contain representatives of all key disciplines? No Not * * 2 sure N/A * * * * * * * 7 6. Is there a description Yes * * * * * * * 7 Identification and interpretation of evidence of the sources of information used to No * * * 3 select the evidence on which the Not recommendations are sure based? N/A 7. If so, are the sources Yes * * * * * 5 of information adequate? No Not * * 2 sure N/A * * * 3 8. Is there a description Yes * * * 3 113 of the method(s) used No * * * * 4 to interpret and assess the strength of the Not * * * 3 evidence? sure N/A 9. If so, is(are) the Yes * * 2 method(s) for rating the evidence satisfactory? No Not * 1 sure N/A * * * * * * * 7 10. Is there a Yes * * * * * 5 description of the methods used to No * * * * 4 formulate the recommendations? Not * 1 sure N/A 11. If so, are the Yes * * * * 4 methods satisfactory? No Not * 1 sure N/A * * * * * 5 12. Is there an Yes indication of how the views of interested No * * * * * * * * * * 10 parties not on the panel were taken into Not account? sure N/A 114 13. Is there an explicit Yes * 1 link between the major recommendations and No * * * * * * * 7 level of supporting evidence? Not * * 2 sure N/A 14. Were the guideline Yes * * * * * * * * 8 independently reviewed prior to their No * 1 publication/release? Not * 1 sure N/A 15. If so, is explicit Yes information given about methods and how No * * * * * * * 7 comments were addressed? Not * * 2 sure N/A * 1 16. Were the guideline Yes piloted? No * * * * * * * * * * 10 Not sure N/A 17. If the guidelines Yes Peer review were piloted, is explicit information given about No the methods used and the results adopted? Not sure 115 N/A * * * * * * * * * * 10 18. Is there a mention Yes of a date for reviewing the guidelines? No * * * * * * * * * * 10 Not sure N/A 19. Is the body Yes responsible for the reviewing and updating No * * * * * * * * * * 10 clearly identified? Updating Not sure N/A of 20. Overall, have the Yes potential biases of Overall assessment guideline development No * * * * * * * * * * 10 development process been adequately dealt with? Not sure N/A and 2: 21. Are the reasons for Yes * * * * * * * 7 the developing the guidelines clearly No * 1 Dimension stated? Not * * 3 Content Context Objectives sure N/A 22. Are the objectives Yes * * * * * * 6 116 of the guidelines clearly No * 1 defined? Not * * * 3 sure N/A 23. Is there a Yes * * * * * * * * 8 satisfactory description of the patients to which No the guidelines are meant to apply? Not * * 2 sure N/A 24. Is there a Yes * * * * * * * * 8 description of the circumstances (clinical No or non clinical) in which exceptions might Not * * 2 be made in using the sure guidelines? N/A 25. Is there an explicit Yes statement of how the patient's preferences No * * * 3 should be taken into Not * * * * * * * 7 Context account in applying the guidelines? sure N/A 26. Do the guidelines Yes * * * * * * * * * * 10 describe the condition to be detected, treated, No or prevented in unambiguous terms? Not sure Clarity N/A 27. Are the different Yes * * * * * * * * * * 10 117 possible options for No management of the condition clearly stated Not in the guidelines? sure N/A 28. Are the Yes * * * * * * * * * * 10 recommendations clearly presented? No Not sure N/A 29. Is there an adequate Yes * * * 3 description of the health benefits that are likely No * 1 to be gained from the recommended Not * * * * * * 6 management? sure N/A 30. Is there an adequate Yes * 1 description of the potential harms or risks No * * * * * 5 that may occur as a result of the Not * * * * 4 recommended sure management? N/A Likely costs and benefits 31. Is there an estimate Yes * * 2 of the costs or expenditures likely to No * * * * * * * 7 incur from the recommended Not * 1 management? sure N/A 32. Are the Yes * * 2 118 recommendations No * * * * * * * * 8 supported by the estimated benefits, Not harms and costs of the sure intervention? N/A and 33. Does the guideline Yes document suggest possible methods for No * * * * * * * * * * 10 dissemination and dissemination implementation? Not sure Guideline N/A 34. Does the guideline Yes * * * * * * * 7 document specify criteria for monitoring No * 1 compliance? Not * * 2 sure N/A Monitoring of guidelines/ clinical audit Dimension 3: Application 35. Does the guideline Yes * * * * * * * * * 9 document identify clear standards or targets? No Not * 1 sure N/A 36. Does the Yes guideline document No * 1 define measurable outcomes that can be Not * * * * * * * * * 9 monitored? sure 119 N/A National Guidelines 37. Does the guideline Yes document identify key elements which need to No * * * * * * * * * * 10 be considered by guideline groups? Not Only sure N/A 120 Table 4. Dimension, quality score of Clinical Guidelines developed under collaboration with international partners.* Rigour of Context and CG title developmet,% content,% Application,% Clinical and Organizational Guideline on post-abortive care 35 42 80 Protocol for Diagnostics and Treatment of Peptic Ulcer in Adults 25 58 60 Medical care provided by primary care physicians for patients with depression” guideline 25 33 80 (Re)designing the system of care for neonates suffering from respiratory distress syndrome 25 50 40 Improving system of care for women suffering from Pregnancy-Induced Hypertension 35 50 60 Global strategy for asthma management and prevention 15 75 80 Guidelines for the treatment of uninfection disease 25 42 80 Clinical guideline on prevention of diabetes complications in general practice 10 92 80 Improving the system of care for patients suffering from arterial hypertension 20 67 60 Guideline on Breast Feeding 30 75 80 * Maximum score is 100. 121 Table 5. Dimension, quality score of Russian Guidelines.* Rigour of Context and CG title development,% content,% Application,% Pregnancy, diagnosis and treatment of hypertension in the Russian Federation 35 58 60 Standards of out-patient medical care for people with oncology 20 75 20 Algorithm of multiple sclerosis diagnosis. 5 25 0 Diagnostic principles and treatment of patients with acute disorders of brain circulation 5 33 0 Diagnostics and treatment of nonspecific lung diseases in adults 15 58 40 Clamidiosis: clinical presentations, diagnostics and treatment 25 67 40 Clinical Recommendations on diagnostics and treatment of allergic rhinitis 20 67 40 Algorithm for managing patients with acute and chronic pancreatitis 25 58 60 Standards of medical care in the cases of heart attack 10 58 40 National recommendations on prevention, diagnostics and treatment of arterial hypertension 25 67 40 * Maximum score is 100. 122 Table 6. Dimension, quality score of translated clinical guidelines. Rigour of Context and CG title development, % content,% Application,% Screening for thyroid diseases 35 50 40 Guidelines for the management of transient ischemic attacks 35 67 40 Early Detection of Prostate Cancer. Part II: Estimating the Risks, Benefits, and Costs. 35 92 40 Hepatitis C treatment 15 58 40 Guidelines for treatment of heart failure 20 50 40 Guidelines of HIV treatment for adults 10 58 40 Global initiative on chronic obstructive lung disease 10 58 40 Modern treatment of hypertension: expectations and reality 10 33 20 Guidelines for diagnosis and treatment of arterial hypertension 15 33 0 Clinical guideline, part 1. Screening for thyroid disease 40 58 20 * Maximum score is 100. 123 Donor / Projects Done Plans USAID – AIHA 42 adapted, translated clinical guidelines Adaptation of clinical practice guidelines USAID – WIN 3 clinical and organization guidelines [COGs] Finished USAID –QAP 4 COGs 15 COGs – under development [6 – for Primary Care, 9 – for Mother and Child] WEB-communicator Healthy Russia 2020 New Dissemination. Priority areas – Mother and Child, HIV/AIDS, TB, STD . Health Portal in Internet WHO, AIHA, QAP “Prikaz 372” on resuscitation of newborns Finished WHO, USAID – TB, “PRIKAZ” TB Continue to improve “PRIKAZ” TB Red Cross WHO, USAID, SU Practical guidelines on anti infectious chemotherapy Finished Pharmacopoeia OSI 5 EB CGs 10 CGs for Primary Care TACIS - PHCD GP/Family doctors – scope of authority 10 CGs for GP/Family doctors TACIS - NWHRP Collected CGs, developed by others. Database in Finished Internet www.zdravinform.ru with documents and results of others achievements DFID HIV/AIDS organization protocol HIV/AIDS strategy Task Force for Number of projects are currently under way, including development of CGs on HIV/AIDS, TB, STD, Communicable Primary Care Disease Control in the Baltic Sea Region CIDA The project is currently under way, deals with HIV/AIDS, TB, STD 124