Adapting National and International Leg Ulcer Practice Guidelines for Local Use
Bibliographic record
Abstract
In Brief BACKGROUND: Because of growing resources devoted to individuals requiring community care for leg ulcers, the authority responsible for home care in Ottawa, Ontario, Canada, established and evaluated a demonstration leg ulcer service. In an effort to provide current and evidence-based care, existing leg ulcer clinical practice guidelines were identified and appraised for quality and suitability to the new service. PROCESS: The Practice Guideline Evaluation and Adaptation Cycle guided development of a local protocol for leg ulcer care, which included: (1) systematically searching for practice guidelines, (2) appraising the quality of identified guidelines using a validated guideline appraisal instrument, (3) conducting a content analysis of guideline recommendations, (4) selecting recommendations to include in the local protocol, and (5) obtaining practitioner and external expert feedback on the proposed protocol. Updating the protocol followed a similar process. RESULTS: Of 19 identified leg ulcer practice guidelines, 14 were not evaluated because they did not meet the criteria (ie, treatment-focused guidelines, written in English and developed after 1998). Of the 5 remaining guidelines, 3 were fairly well developed and made similar recommendations. The level of evidence supporting specific recommendations ranged from randomized clinical trial evidence to expert opinion. By comparing the methodologic quality and content of the guidelines, the Task Force reached consensus regarding recommendations appropriate for local application. Two additional guidelines were subsequently identified and incorporated into the local protocol during a scheduled update. CONCLUSIONS: Local adaptation of international and national guidelines is feasible following facilitation of the Practice Guidelines Evaluation and Adaptation Cycle. To address the need for resources devoted to individuals requiring community care for leg ulcers, the authority responsible for home care in Ottawa, Ontario, Canada, established and evaluated a demonstration leg ulcer service. The authors discuss how existing leg ulcer clinical practice guidelines were identified and appraised for quality and suitability to the new service.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.162 | 0.357 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.005 | 0.004 |
| Open science | 0.005 | 0.005 |
| Research integrity | 0.004 | 0.006 |
| Insufficient payload (model declined to judge) | 0.006 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".