Page 92 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 5
comparison-outcome (PICO) formats. For each Key Question at least three Guidelines Development Group members were assigned as investigators and speci c search terms were formulated.
On November 11th 2013, a meeting in Glasgow at the SIGN headquarters was held with the steering committee of the Guidelines Development Group to discuss the search strategy. A clinical librarian working for SIGN performed the primary literature research for all Key Questions. This involved a search for systematic reviews and/or meta-analyses on the Key Questions in Medline, Embase, NIHR CRD, NICE and The Cochrane library. The PRISMA ow diagram is shown in Figure1. The Guidelines Development Group members evaluated the systematic reviews for their relevance to the Key Questions and a qualitative assessment was done using the SIGN checklist No 1 for systematic reviews and meta-analyses(19). Only systematic reviews of High Quality were used as basis for the guidelines development. A second search (no lters) on the Key Questions was performed for relevant RCT’s published after the end of the search performed for the systematic reviews involved. If no High Quality systematic review was identi ed for a Key Question, the working group members performed a separate systematic review using the PRISMA statement methodology(21). To avoid lengthening of this guidelines manuscript, the results of these systematic reviews will be submitted as a separate manuscript on behalf of “The Bonham Group”, which are the members of the Guidelines Development Group. The members working together on a Key Question provided a Summary of Findings table from the results of the literature search, which were presented and discussed during the second group meeting.
The second Guidelines Development Group meeting was held in Edinburgh on April 25th 2014. For evaluation of evidence, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used(22). For each Key Question, a level of evidence was proposed using the GRADE approach and four levels of quality of the body of evidence were used: high, moderate, low, very low (Table 1). Based on the research evidence, the clinical experience and patient values the Guidelines Development Group formulated a recommendation for each Key Question. In the GRADE approach only three levels of recommendation are used: strong recommendation, weak recommendation and no recommendation.
The results of the guidelines proposed by the Guidelines Development Group were presented during the 36th Annual International Congress of the
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