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Abstract Clinical practice guidelines CPGs for rare diseases RDs are scarce, may be difficult to identify through Internet searches and may vary in quality depending on the source and methodology used. In order to contribute to the improvement of the diagnosis, treatment and care of patients, Orphanet www.
This article provides an analysis of selected CPGs by medical domain coverage, prevalence of diseases, languages and type of producer, and addresses the variability in CPG quality and availability. CPGs are identified via bibliographic databases, websites of research networks, expert centres or medical societies.
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Only open access CPGs and documents for which permission from the copyright holders has been obtained are disseminated on the Orphanet website. From January to JulyCPGs were disseminated, representing coverage of 1, groups of diseases, diseases or subtypes in the Orphanet database.
A large proportion of diseases with identified CPGs belong to rare oncologic, neurologic, hematologic diseases or developmental anomalies. The Orphanet project on CPG collection, evaluation and dissemination is a continuous process, with regular addition of new guidelines, and updates. CPGs meeting the quality criteria are integrated to the Orphanet database of rare diseases, together with other types of textual information and the appropriate services for patients, researchers and healthcare professionals in 40 countries.
Introduction Clinical practice guidelines CPGs are "systematically developed statements to assist practitioners and patient decisions about appropriate health care for cancer of genetic disorders circumstances" [ 1 ]. Many CPGs have been developed in the last 25 years, cancer of genetic disorders depicted in a recent review [ 2 ]. However most of them are aimed at common diseases and recommendations dedicated to rare diseases RDs remain scarce.
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In the European Union, a disease is considered as rare when it affects not more than 5 per 10, persons [ 3 ]. The rarity of randomised controlled trials puts a brake on the development of high quality guidelines for RDs, as well as the high development costs for funders who consider more prevalent diseases to be priority investment targets.
In spite of these hurdles, over the last few years the development and dissemination of CPGs for RDs has garnered increasing attention [ 4 — 6 ].
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The contribution of CPGs to shortening the time to diagnosis and improvement of the quality of care is now widely acknowledged, and several European countries have included CPG development as a priority in their respective national plans on RDs [ 7 ].
Retrieving RD guidelines from Internet searches is sometimes challenging for health professionals and patients who may not have the time or skills to search for the most relevant information [ 8 ].
Large national and international databases gathering CPGs are available [ 9 — 12 ] but they generally contain very few guidelines specific to RDs, which are difficult to find amongst the mass of recommendations available for more frequent diseases. In addition, in the field of RDs, a proportion of the guidelines produced by research networks, reference centres or other expert organisations is not published in international peer-reviewed journals, and thus is not retrieved from biomedical literature cancer of genetic disorders.
Alternatively, Google searches may help identify RD guidelines, but the specificity of the suggested results is very low [ 13 ].
To assess the quality of CPGs, several manuals have been published [ 1415 ]. Despite cancer of genetic disorders availability of appraisal handbooks, methodological quality remains variable [ 2 cancer of genetic disorders, 141819 ] and needs to be verified.
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This might be even more important for RDs, as CPGs are sometimes developed by specialist groups who may not have the same resources as governmental bodies [ 2 ]. Methodologies for CPG development have been proposed that take into account some of the specificities of RDs, e. Orphanet is an international data resource dedicated to RDs that was created in to address the scarcity and fragmentation of information on RDs.
Clinical Practice Guidelines for Rare Diseases: The Orphanet Database
Orphanet endeavours to provide the community at large with a comprehensive set of information and data on RDs and orphan drugs in order to contribute to the improvement of the diagnosis, care and treatment of patients with RDs. Orphanet is currently the most comprehensive repertoire of information and data on RDs, notably in terms of referenced documents, and the only resource that establishes a link between a classification of RDs, textual information and the appropriate services for patients, researchers and healthcare professionals.
This article describes the Orphanet workflow for the identification, evaluation and dissemination of CPGs on RDs, and provides an analysis of the resulting CPGs disseminated through Orphanet in terms of medical domain coverage, prevalence of diseases, languages and type of producer.
Moreover, this study provides an insight into the variability in CPGs quality and availability, and shows the way these problems have been addressed in order cancer of genetic disorders provide access to relevant, specific and good-quality recommendations for the management of RDs.
Only documents developed by expert cancer of genetic disorders are selected. A global bibliographic survey on RD literature is performed as a continuous process using a list of selected medical journals, which allows a small cancer of genetic disorders of CPGs to be retrieved.
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It is completed by more specific bibliographic searches for guidelines and RDs on PubMed, Google and Google Scholar, each search engine often generating different and complementary search results.
For certain diseases, websites of national and international databases, research networks, foundations, learned societies, governmental institutions and expert centres are cancer of genetic disorders if applicable. Pearl-growing using one resource to further identify other resources is also frequently used. Although the most frequent sources of information are in English and in other major European languages, no language restriction is applied. Documents older than 5 years are not considered unless recent publications clearly state that they are still up-to-date.
Preferably, recommendations less than three years-old are selected.
Clinical Practice Guidelines for Rare Diseases: The Orphanet Database
Of note, some CPGs older than 5 years may still be up-to-date in spite of the absence of recent publication that states so. The 5-year selection limit may therefore result in the rejection of up-to-date recommendations.
This cut-off was chosen as it is often applied by national guideline producers [ 23 — 25 ].
The topic should be directly related to a disease listed in the Orphanet nomenclature of RDs, and for dissemination purposes, when several CPGs are available, it was decided to include only the most comprehensive one.
The topics covered are also taken into account: recommendations should cover almost, if not all aspects of disease management e. Attention is paid to the universality of application of the guidelines with regard to the document language. For instance, guidelines in English that propose recommendations for inhabitants in China only will not be retained, but guidelines in Chinese that target Chinese patients will be considered.
For the same reason, local CPGs are excluded. CPGs discussing recommendations for all population ages are preferred over CPGs targeting only children for a disease affecting all ages. Moreover, as cancer of genetic disorders as possible, CPGs cancer of genetic disorders for rare forms of diseases are selected. However, due to the scarcity of available information, more general guidelines that also include recommendations for specific forms are sometimes retained e.
In summary, the quality evaluation procedure includes some mandatory criteria and some desirable ones Fig 1the latter being considered together with all the criteria in order to validate the decision to retain a document.