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Original Research: Education, Research, And Quality Improvement |

Applying New Strategies for the National Adaptation, Updating, and Dissemination of Trustworthy GuidelinesNorwegian Adaptation of Clinical Guidelines: Results From the Norwegian Adaptation of the Antithrombotic Therapy and the Prevention of Thrombosis, 9th Ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

Annette Kristiansen, MD; Linn Brandt, MD; Thomas Agoritsas, MD; Elie A. Akl, MD, PhD, MPH; Eivind Berge, MD, PhD; Anne Flem Jacobsen, MD, PhD; Lars-Petter Granan, MD, PhD; Sigrun Halvorsen, MD, PhD; Gordon Guyatt, MD, FCCP; Per Olav Vandvik, MD, PhD
Author and Funding Information

From the Department of Internal Medicine (Drs Kristiansen, Brandt, and Vandvik), Innlandet Hospital Trust, Gjøvik, Norway; Institute for Health and Society (Drs Kristiansen, Brandt, and Vandvik), Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Internal Medicine (Drs Kristiansen and Brandt), Deaconess Hospital, Oslo, Norway; Department of Clinical Epidemiology and Biostatistics (Drs Agoritsas, Akl, and Guyatt), McMaster University, Hamilton, ON, Canada; Department of Internal Medicine (Dr Akl), American University of Beirut, Beirut, Lebanon; Department of Internal Medicine (Dr Berge), Oslo University Hospital, Ullevål, Oslo, Norway; Department of Obstetrics and Gynaecology (Dr Flem Jacobsen), Department of Physical Medicine and Rehabilitation (Dr Granan), Department of Pain Management and Research (Dr Granan), Division of Emergencies and Critical Care, and Department of Cardiology B (Dr Halvorsen), Oslo University Hospital, Oslo, Norway; Oslo Sports Trauma Research Center (Dr Granan), Norwegian School of Sport Sciences, Oslo, Norway; and Norwegian Knowledge Centre for the Health Services (Dr Vandvik), Oslo, Norway.

CORRESPONDENCE TO: Annette Kristiansen, MD, Department of Internal Medicine, Sykehuset Innlandet HF, Gjøvik, Norway; e-mail: annettekrist@gmail.com


Part of this article has been presented in poster form at the 2012 G-I-N Conference, August 22-25, 2012, Berlin, Germany.

FUNDING/SUPPORT: Innlandet Hospital Trust, the Southern and Eastern Norway Regional Health Authority, and the Norwegian Research Council have provided research grants. The Norwegian Medical Association has provided grants to support completion of the adaptation process.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(3):735-761. doi:10.1378/chest.13-2993
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BACKGROUND:  The Antithrombotic Therapy and the Prevention of Thrombosis, 9th Edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) represent trustworthy international guidelines for antithrombotic treatment and thromboprophylaxis. We describe major changes to the format and content resulting from applying new strategies for guideline adaptation and dissemination.

METHODS:  A Norwegian guideline panel of 46 experts completed a structured and systematic adaptation process, updated the recommendations based on new evidence, and rewrote the recommendations in an electronic multilayered presentation format. We published the adapted guideline using the web-based Making GRADE the Irresistible Choice Guideline Authoring and Publication Platform.

RESULTS:  We applied a novel presentation format to 333 recommendations from 11 of the 15 management chapters in AT9 and condensed and restructured them into 249 recommendations in a multilayered format. We added additional relevant information, such as 29 best-practice statements about new oral anticoagulants and practical information sections for 121 recommendations. Common reasons for modifications included feasibility of the recommendations in a national context, disagreement with applied baseline risk estimates, and reevaluation of the balance between the benefits and harms of interventions in relation to assumed typical patient preferences and values. The adapted guideline was published and disseminated online in November 2013.

CONCLUSIONS:  New strategies for adapting, updating, and disseminating trustworthy guidelines proved feasible and will provide Norwegian health-care professionals and patients with up-to-date guidance tailored to national circumstances.

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