• Ibrahim K El Mikati, Joanne Khabsa, Tarek Harb, Mohamed Khamis, Arnav Agarwal, Hector Pardo-Hernandez, Sarah Farran, Assem M Khamis, Ola El Zein, Rayane El-Khoury, Holger J Schünemann, Elie A Akl, Living Guidelines Group, Pablo Alonso-Coello, Brian S Alper, Yasser Sami Amer, Thurayya Arayssi, James M Barker, Imad Bouakl, Isabelle Boutron, Romina Brignardello-Petersen, Kristine Carandang, Stephanie Chang, Yaolong Chen, Adam Cuker, Fadi El-Jardali, Ivan Florez, Nathan Ford, John Grove, Gordon H Guyatt, Glen S Hazlewood, Tamara Kredo, Francois Lamontagne, Miranda W Langendam, Simon Lewin, Helen Macdonald, Emma McFarlane, Joerg Meerpohl, Zachary Munn, M Hassan Murad, Reem A Mustafa, Ignacio Neumann, Robby Nieuwlaat, Artur Nowak, Jordi Pardo Pardo, Amir Qaseem, Gabriel Rada, Marc Righini, Bram Rochwerg, Maria X Rojas-Reyes, Deborah Siegal, Reed Siemieniuk, Jasvinder A Singh, Nicole Skoetz, Shahnaz Sultan, Anneliese Synnot, Peter Tugwell, Amy Turner, Tari Turner, Shilpa Venkatachalam, Vivian Welch, and Wojtek Wiercioch.
• Clinical Research Institute, American University of Beirut, Beirut, Lebanon (I.K.M., J.K.).
• Ann. Intern. Med. 2022 Aug 1; 175 (8): 115411601154-1160.

BackgroundLiving practice guidelines are increasingly being used to ensure that recommendations are responsive to rapidly emerging evidence.ObjectiveTo develop a framework that characterizes the processes of development of living practice guidelines in health care.DesignFirst, 3 background reviews were conducted: a scoping review of methods papers, a review of handbooks of guideline-producing organizations, and an analytic review of selected living practice guidelines. Second, the core team drafted the first version of the framework. Finally, the core team refined the framework through an online survey and online discussions with a multidisciplinary international group of stakeholders.SettingInternational.ParticipantsMultidisciplinary group of 51 persons who have experience with guidelines.MeasurementsNot applicable.ResultsA major principle of the framework is that the unit of update in a living guideline is the individual recommendation. In addition to providing definitions, the framework addresses several processes. The planning process should address the organization's adoption of the living methodology as well as each specific guideline project. The production process consists of initiation, maintenance, and retirement phases. The reporting should cover the evidence surveillance time stamp, the outcome of reassessment of the body of evidence (when applicable), and the outcome of revisiting a recommendation (when applicable). The dissemination process may necessitate the use of different venues, including one for formal publication.LimitationThis study does not provide detailed or practical guidance for how the described concepts would be best implemented.ConclusionThe framework will help guideline developers in planning, producing, reporting, and disseminating living guideline projects. It will also help research methodologists study the processes of living guidelines.Primary Funding SourceNone.

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