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The aim of an EFNS neurological management guideline is to provide guidance for clinical neurologists, other health care professionals and health care providers about important aspects of management of neurological disease. It represents the view of an expert task force appointed by the chairperson of the scientific committee with the agreement of the chairperson of a Scientist Panel. It will be a peer-reviewed statement of minimum desirable standards for the guidance of practice based on the best available evidence. It is not intended to have legally binding implications in individual cases.
1 Neurological Management Guidelines will be produced by Task Forces appointed by the chairperson of the Scientific Committee.
2 Proposals for Task Forces concerning neurological management should be submitted to the chairperson of the Scientific Committee by the chairperson of a Scientist Panel1. The proposal should include the title, objectives, proposed membership, short (100–300 words) explanation of why the guideline is needed, and search strategy. Task Forces will usually be appointed following a proposal from the chairperson of a Scientist Panel to the chairperson of the Scientific Committee and approved by the Scientific Committee and President.
3 The Task Force will consist of a chairperson and at least six but not usually more than 12 members. No more than two members should usually come from any one country. The Task Force should include a patient advocate (normally an officer from a European patient organization if the Task Force deals with a clinically relevant topic) and other relevant specialists and health professionals. If Task Forces have a budget, they must nominate a secretary and treasurer and submit an annual account to the Management Committee.
4 The Task Force will review the available evidence and include within its report the search strategy employed. Where appropriate, the evidence concerning health care interventions must be based on a thorough systematic literature search and review. The task force should publish a systematic review in the Cochrane Library if one does not exist.
5 Existing guidelines prepared by other organizations (including European national neurological societies, non-European neurological societies, and other organizations) will be sought and where appropriate adopted in part or whole with appropriate acknowledgement and respect for copyright rules.
6 Classification of evidence levels for health care interventions
Ia: Evidence obtained from meta-analysis of randomized controlled trials
Ib: Evidence obtained from at least one randomized controlled trial
IIa: Evidence obtained from at least one well-designed, controlled, but not randomized study
IIb: Evidence obtained from at least one other type of well-designed quasi-experimental study (in which implementation of an intervention is outside the control of the investigators, but an opportunity exists to evaluate its effect)
III: Evidence obtained from well-designed, non- experimental descriptive studies, such as comparative studies, correlation studies and case studies
IV: Evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities
7 Classification of evidence levels for diagnostic tests
Class I: Evidence provided by a prospective study in a broad spectrum of persons with the suspected condition, using a ‘gold standard’ for case definition, where the test was applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy.
Class II: Evidence provided by a prospective study of a narrow spectrum of persons with the suspected condition, or a well-designed retrospective study of a broad spectrum of persons with the condition established by a ‘gold standard’ and compared with a broad spectrum of controls. The test should have been applied in a blinded evaluation, enabling the assessment of appropriate tests of diagnostic accuracy.
Class III: Evidence provided by a retrospective study where either persons with the established condition or controls are of a narrow spectrum, and where the test was applied in a blinded evaluation.
Class IV: Any design where the test was not applied in blinded evaluation OR evidence provided by expert opinion alone or in descriptive case series (without controls).
8 Classification of grades of recommendation
A: Requires at least one randomized controlled trial as part of a body of literature of overall good quality and consistency addressing the specific recommendation (Evidence levels Ia, Ib)
B: Requires the availability of well conducted studies but not randomized evidence on the topic of the recommendation (Evidence levels II, IIa, IIb, III)
C: Requires evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities. Indicates an absence of directly applicable clinical studies of good quality (Evidence level IV)
9 The format of the guidelines will use the style of the European Journal of Neurology and follow a template with these sections:
1. Title. This should read: EFNS Guideline on …… Report of an EFNS Task Force on……. (title of Task Force, if different form the topic of the guideline)
2. Membership of task force
8. Statement about the likely time when the guidelines will need to be updated
10 The length of the guideline report should not be more than eight printed pages including references (4000 words). Supplementary material may be published on the EFNS website. Guidelines will be called European Guidelines for the management/diagnosis/other of condition. The authors will be the EFNS Task Force on management/diagnosis/other of condition. The authors will be listed as Members of the Task Force with the chairman first and the other authors in alphabetical order thus Schröder G Germany (Chair), Blair M UK, Jospin L France, Putin W Russia.
11 When the task force has completed preparation of the guidelines it should submit guidelines for approval to the chairperson of the Scientific Committee
12 The chairperson of the Scientific Committee will have the proposed management guideline reviewed by the other members of the Scientific Committee, the President, and the chairpersons of any Scientist Panels, which might be affected by the guidelines but were not involved in the preparation of them. Within 8 weeks of submission, the chairman of the Scientific Committee will advise the chairperson of the Task Force whether the guidelines have been accepted as the official guidelines of the EFNS or not. If revision is needed, the chairperson of the Task Force will prepare a revised version and submit this to the review process again, highlighting the revisions and documenting the responses to each of the referees’ comments.
13 Following approval, the management guidelines will be submitted by the chairperson of the Task Force to the editor/s of the European Journal of Neurology with a view to publication. The editor will have the power to accept or reject the guidelines for publication and may make minor editorial changes.
14 The validity of published guidelines will be reviewed by the chairperson of the Task Force or the relevant Scientist Panel at least every other year.
15 Guidelines will be published on the EFNS web, in the European Journal of Neurology and by sending offprints to European national neurological societies and other relevant bodies.
16 National societies will be encouraged to translate guidelines for dissemination in their own countries.
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- Further reading
American Academy of Neurology, Quality Standards Subcommittee (1999). Process for developing Practice Parameters.
Grilli R, Magrini N, Penna A, Mura G, Liberati A (2000). Practice guidelines developed by specialty societies: the need for a critical appraisal. The Lancet355:103–106.
Grimshaw J, Eccles M, Russell I (1995). Developing clinically valid practice guidelines. Journal of Evaluation in Clinical Practice1:37–48.
Miller J, Petrie J (2000). Development of practice guidelines (2000). The Lancet355:82–83.
Shekelle PG, Woolf SH, Eccles M, Grimshaw J (1999). Developing Guidelines. BMJ318:593–596.