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How Therapeutic Guidelines Are Produced - Therapeutic Guidelines
How Therapeutic Guidelines Are Produced - Therapeutic Guidelines
Log in
produced
Therapeutic Guidelines Limited (TGL) is an independent not-for-profit organisation. Its aim is to promote the quality
use of medicines, and it does this through the writing, publication and sale of Therapeutic Guidelines.
Therapeutic Guidelines are written principally for prescribers (general practitioners and trainee physicians in
particular) to provide clear, practical, succinct and up-to-date therapeutic information, for the management of
The Guidelines are based on the latest international literature, interpreted by some of Australia’s most eminent and
respected experts, with input from an extensive network of general practitioners and other users. The information is
Therapeutic Guidelines are comprehensive in that they cover all common disorders seen in clinical practice. Topics
and sections are arranged according to diagnostic entities. Each section gives sufficient surrounding information to
orient the reader, followed by succinct and explicit recommendations for therapy. The Guidelines are not primarily
meant to instruct, but rather to assist prescribers ensure their patients receive optimum treatment.
Contents
Independence
Updating topics
Expert groups
Management
Planning meeting
Referencing
Independence
Independence is a critical issue for TGL. Its reputation is staked on its publications and the independence of the
therapeutic information that has been developed by its expert groups through interpretation of the literature and
distillation of expert opinion. Its funds come solely from sales and subscriptions.
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TGL’s independence of any form of government or commercial sponsorship including the pharmaceutical
industry, and
TGL’s strict policy on conflict of interest for Directors and members of its expert groups.
Conflicts of interest are minimised by careful selection of expert group members. Any remaining conflicts are
declared and managed during the guideline development process in accord with TGL’s policy on conflict of interest
Updating topics
TGL prides itself on being one of the few guideline development organisations that commits to revising topics on a
regular basis. The decision to update current topics is determined by TGL Publishing Committee. Decisions are
based on shifts in the evidence base, feedback from clinicians, changes in practice, changing patterns of drug
usage or bacterial resistance, and other relevant issues. The current schedule permits revision of topic areas
Occasionally, new guidelines are developed; the decision to develop new guidelines is determined by TGL Board of
an expressed need by general or specialist practitioners, or other groups with interests or involvement in an
area
a perception of possible problems in an area, arising from feedback from clinicians or evidence from drug
usage data
a clear problem (eg size of health burden, cost, variations in practice, lack of evidence) that would be
Expert groups
Each group comprises approximately 14 people, including a chairman, an editor, and experts in relevant medical
specialties, a clinical pharmacology trainee, a general practitioner, a pharmacist and a nurse. Depending on the
subject matter, the group may also include a consumer or experts from other areas, such as physiotherapy and
nutrition.
Management
The chairman and editor are employees of TGL and play pivotal roles in the development of the manuscript.
The chairman ensures the project proceeds harmoniously and that true consensus is achieved for all
recommendations. The editor liaises with the chairman and expert group members to ensure that the manuscript
The editor prepares the papers for each meeting, including minutes, feedback on the previous version (when
applicable), correspondence regarding content, draft manuscripts and any other relevant background information.
The editor prepares detailed minutes (usually as a transcript) of each meeting to document the basis for all
Planning meeting
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At the initial meeting of each expert group, explanation and guidance are given to the members on:
intellectual property
conflict of interest
Within the subject area, the group decides on the specific conditions to be covered and the level of detail, taking
into account the likelihood that a condition will be encountered. Sometimes advice on uncommon but serious
diseases will be included. Decisions about which conditions should be covered may be influenced by feedback
Members agree on the allocation of tasks, with responsibility for the preparation of initial drafts being taken by
individual members.
A schedule for a series of daylong meetings at intervals of approximately 8 weeks is planned to allow successive
The starting point for content is what a clinician needs to know to manage a patient with the given condition.
Each section includes sufficient information to orient the reader, followed by succinct and explicit
After the planning meeting, authors prepare initial drafts based on their clinical expertise and the current evidence
in the relevant area. They are encouraged to also prepare a separate document summarising the rationale for their
recommendations. The editor and the medical librarian assist the authors to identify and access relevant
supporting information. This may include primary scientific papers, systematic reviews from the Cochrane
Collaboration, reviews published in reputable journals, and guidelines developed by other credible bodies.
The drafts are circulated to all members of the group before scheduled meetings to allow time for group members
Each draft is debated in a face-to-face situation with discussion becoming successively more exhaustive until
consensus is reached on the content. Areas in which there is controversy, rapid development or uncertainty are
The editor liaises with authors to document the specific studies used to support the statements and
Once the intent of the expert group is clear with respect to specific content, the editor assumes responsibility for
the text, reorganising it according to house style and format, and liaising as necessary with authors and the
chairman.
The finished manuscript is the result of detailed scrutiny, collaboration and revision, involving a wide range of
people and several editing stages. The topics are no longer attributable to any one author. All members of the
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For the preparation of each group of topics, usually a half-day planning meeting plus three full-day meetings are
held over approximately 6 to 8 months. At the final meeting all topics are scrutinised to ensure all members
approve the whole text. The time taken to produce each group of topics is usually 12 to 14 months.
The relevance and strength of the scientific evidence for the effectiveness of any given treatment are fundamental
to the development of the content in Therapeutic Guidelines. In clinical areas where there is strong evidence, there
can be a reasonably high level of certainty about which treatment(s) to recommend. However, to make sure that
the advice is clinically relevant and applicable, the information must be contextualised to reflect the reality of
everyday clinical situations—co-morbidities, risk factors, patient characteristics and affordability of treatment
options are examples of important factors that must also be taken into consideration.
‘Evidence-rich’ areas are in the minority in clinical practice, so a large proportion of the material developed for
Therapeutic Guidelines covers areas for which there is little published evidence. In these ‘evidence-poor’ areas, the
known pathophysiology of the disease, the clinical experience of expert group members, and the adverse effect
profiles, long-term safety data, and cost, of the therapeutic options become more significant in making
recommendations. When drug recommendations are made, the order of preference is indicated by numbering
them.
Rather than assigning levels of evidence to statements or grading recommendations, the Guidelines use the
surrounding text to indicate the relevant evidence. This approach gives more opportunity to communicate the
A summary of major changes is accessible from the homepage of TGL’s electronic products with each release, and
Referencing
controversial statements
numbers (eg in tables and text where the source of the information is not readily apparent)
any statement prefaced with ‘evidence shows’ (or similar) or citation of a specific trial.
Because of limited space, print versions of the Guidelines only include references for further reading or key
references that might be helpful to the reader (ie major new and pivotal studies). However, all references are
available for viewing on the TGL website via the eTG complete demonstration version.
The evaluation unit of TGL liaises with a network of approximately 200 users (including general practitioners, junior
hospital doctors, health academics, pharmacists and students) to actively solicit feedback on the Guidelines.
Participants in the network are provided with all Therapeutic Guidelines free of charge. The TGL evaluation officer
contacts these users once or twice each year to discuss and record their feedback.
Users are also encouraged to comment about the content or format of the Guidelines by emailing comments to
<feedback@tg.org.au (mailto:feedback@tg.org.au)>.
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Accrued feedback on the previous version is collated and passed on to the expert group for their consideration
Occasionally, feedback prompts changes to the content in between scheduled revisions. The decision to update a
topic in between editions is made by TGL Publishing Committee, in liaison with the previous expert writing group.
All site content © Therapeutic Guidelines Limited 2020. • Therapeutic Guidelines Limited, Ground Floor, 473 Victoria Street, West Melbourne,
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