Development of National Clinical Practice Guidelines for Transition in Rheumatology
Bibliographic record
Abstract
Objectives In 2017 the European League Against Rheumatism/Pediatric Rheumatology European Society published recommendations for the transition of young people with childhood-onset rheumatic diseases to adult care.[1] Building on this work, a CRA Guidelines Working Group (WG) was formed in 2020 to develop Clinical Practice Guidelines for Transition in Rheumatology in Canada. Methods Six rheumatologists (5 pediatric, 1 adult), an advanced physiotherapist practitioner, 2 young adult patients, and a methodologist formed the WG. This multi-phased project began with a scoping review of systematic reviews related to transition published between 2015-2020. From this, the WG defined key outcomes relevant to transition which informed the drafting of 20 candidate statements. Next, the “GRADE adolopment” framework was followed to adapt, adopt or develop a new recommendation, reducing the candidate statements to 15. Evidence to Decision (EtD) tables were developed for each candidate statement summarizing benefits/harms, the certainty of the evidence, values/preferences, resources, equity, acceptability, and feasibility.[2] In 2023 an updated literature review further informed the quality and strength of the evidence. In 2024, additional stakeholders (adult/pediatric rheumatology, nursing, social work, pharmacy, and parent) were invited to participate in a modified Delphi consensus process via Zoom.[3] Following an in-depth orientation session, panelists received a detailed document summarizing the candidate statements with corresponding EtD tables. Via online survey, panel members were asked to rate importance, priority, and feasibility on a Likert scale (1-9) and comment on agreement with the assigned strength of the recommendation and wording of the statement. A final consensus meeting is underway to discuss survey feedback. Any further modifications to the candidate statements will be incorporated into the final statements. Panelists will then complete an online survey asking for final endorsement of the guidelines. Results All panelists completed the survey; all statements met the pre-specified cutoff for importance and priority (median ≥7/10). This included 3 Good Practice Statements (GPS), 11 conditional recommendations, and 1 Implications for Research statement (Table 1). Two of 3 final consensus meetings are complete; it is anticipated statement 8 will become a GPS, statement 10 will be incorporated into statement 9, and statement 12 will be modified for clarity. Table 1: Fifteen candidate statements with ratings for importance, priority and feasibility from Delphi panelists (n=16) Conclusion This comprehensive clinical practice guideline will mark a significant advancement for patients, caregivers and health care providers involved in the transition of youth with rheumatic disease in Canada, offering clear, evidence-based recommendations that facilitate effective and coordinated care across various settings. [1.] Foster HE. Annals of the Rheumatic Diseases 2017;76(4):639-46. [2.] Schünemann HJ. Journal of clinical epidemiology 2017;81:101-10. [3.] Barber CEH. Arthritis Res Ther 2020;22(1):53.
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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 | 0.145 | 0.273 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.004 | 0.006 |
| Bibliometrics | 0.012 | 0.008 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.008 | 0.006 |
| Open science | 0.008 | 0.011 |
| Research integrity | 0.008 | 0.014 |
| Insufficient payload (model declined to judge) | 0.013 | 0.008 |
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".