Guía de Práctica Clínica Tumores Primarios del Sistema Nervioso Central en personas de 15 años o más - 2017

Objectives

The guidance aims to provide evidence-based recommendations for the management of people aged 15 years and over with primary central nervous system tumours, including people who have previously received treatment. It applies to care in secondary and tertiary services in both public and private sectors.[1]Its clinical scope includes follow-up imaging, neurorehabilitation, radiotherapy techniques and swallowing rehabilitation.[2][1]

• Support decisions on selected treatments and follow-up practices, including use of second-generation somatostatin analogues for selected people with refractory acromegaly, magnetic resonance imaging after surgery for non-functioning adenomas, neurorehabilitation for people requiring radiotherapy, radiosurgery for selected operated pituitary tumours requiring radiotherapy, and swallowing rehabilitation for dysphagia.[2][1]
• Update recommendations by identifying and prioritising clinical questions and considering evidence, patient values and preferences, feasibility, resource use, costs and cost-effectiveness.[3][4]
• Express recommendations as either strong or conditional recommendations for or against an intervention, while identifying minimum necessary standards through good clinical practice recommendations.[4][5]
• Report the certainty of supporting evidence using the Grading of Recommendations Assessment, Development and Evaluation system, with certainty ranging from high to very low and several cited clinical recommendations being conditional with moderate to very low certainty.[2][1][5]

No broader programme mission, population-level outcome targets, explicit strategic pillars, or quantified service objectives are specified in the supplied material.[3][4]

Implementation

The guidance uses a multidisciplinary, evidence-to-recommendation model for specialist clinical care. It is intended for general, emergency, neurological, neurosurgical, oncology, radiotherapy and other professionals involved in the care of people with primary central nervous system tumours, or people previously treated for them.[1]Development and updating are led by an Expert Panel and methodological team, with recommendations formulated through the Grading of Recommendations Assessment, Development and Evaluation approach.[1][3][4]

• Deliver guidance through secondary and tertiary health services across public and private sectors.[1]
• Engage a development group comprising a thematic coordinator, methodological advisers, evidence-search and synthesis leads, and an expert panel that includes clinicians, representatives of the Ministry of Health and National Health Fund, and, where possible, patients.[1]
• Review the currency of recommendations from the preceding guideline before producing updated recommendations.[1][2]
• Identify and prioritise clinical questions through a survey of Expert Panel members, led by the thematic coordinator and methodological advisers.[3]
• Assess desirable and undesirable effects, patient values and preferences, implementation feasibility, resource use, costs and cost-effectiveness when making recommendations.[3][4]
• Evaluate evidence certainty according to study design, study limitations, inconsistency, indirectness, imprecision and publication bias, with potential upgrading considerations for observational evidence including strong associations and dose-response gradients.[5]
• Maintain a notification platform to periodically identify relevant systematic reviews and primary studies, incorporate pertinent new evidence into evidence syntheses, and modify recommendations where warranted.[4]

The supplied material does not specify a detailed implementation plan, service-delivery timetable, training model, referral pathway, procurement arrangements, quantitative indicators, audit process, reporting schedule, or named body accountable for operational implementation.[1][4]Cost and cost-effectiveness are considered during recommendation development, but no budgets, monetary estimates, funding sources, financing mechanisms, resource-mobilisation plans or funding gaps are specified.[3][4]

Monitoring & Evaluation

Evaluation is centred on systematic evidence assessment and periodic updating of clinical recommendations for people aged 15 years or over with primary central nervous system tumours. Recommendations are developed through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, which makes the certainty of evidence and the strength of each recommendation explicit.[1][2][3][4]The available material does not specify service-performance indicators, outcome targets, routine audit procedures, reporting schedules, surveillance arrangements, or formal accountability mechanisms for implementation.[1][4]

• Assess evidence through searches and synthesis led by the guideline development team, supported by methodological advisers, evidence-search and synthesis leads, and an Expert Panel.[1][2]
• Classify evidence certainty as high, moderate, low, or very low under GRADE.[5]
• Consider study design, methodological limitations, inconsistency, indirectness, imprecision, and publication bias when judging evidence certainty; consider factors including strong associations and dose-response gradients for observational evidence.[5]
• Distinguish strong and conditional recommendations, either for or against an intervention, and identify minimum necessary standards as good clinical practice recommendations.[4][5]
• Monitor emerging research through a notification platform that periodically identifies relevant systematic reviews and primary studies.[4]
• Incorporate pertinent new evidence into evidence syntheses and modify recommendations where warranted.[4]
• Review the currency of recommendations from the previous guideline before producing updated guidance.[1][2]
• Address decisions for which evidence certainty ranges from moderate to very low, including selected uses of second-generation analogues for refractory acromegaly, postoperative magnetic resonance follow-up for non-functioning adenomas, neurorehabilitation for patients requiring radiotherapy, radiosurgery for selected operated pituitary tumours requiring radiotherapy, and swallowing rehabilitation for dysphagia.[2][1]

Costing & Financing

Economic considerations are incorporated into the recommendation-development process rather than presented as a funded implementation plan. Resource use, costs, and cost-effectiveness are considered alongside desirable and undesirable effects, patient values and preferences, and implementation feasibility when formulating recommendations.[3][4]No monetary costs, budgets, allocations, financing sources, resource-mobilisation mechanisms, funding gaps, or economic assumptions are specified in the available material.[2][1][3][4]

• Consider resource use and costs when assessing interventions and developing recommendations.[3][4]
• Consider cost-effectiveness evidence together with clinical effects, feasibility, and patient values and preferences.[3][4]
• Apply this assessment within a GRADE-based process that supports strong or conditional recommendations for or against interventions.[4][5]
• Do not infer implementation budgets or service funding requirements from the conditional recommendations, because the supplied material provides no monetary values or financing arrangements.[2][1][3][4]