Aim

To develop a series of clear recommendations relevant to the clinical care of Aboriginal and Torres Strait Islander Australians that are:
i) based on the best available evidence
ii) acceptable to a multi-disciplinary expert panel experienced in this area
iii) presented in plain English and incorporated into algorithms.

Identification of Important Clinical Care Questions

The information contained within the ‘Recommendations for Clinical Care Guidelines on the Management of Otitis Media in Aboriginal and Torres Strait Islander Populations - March 2001’ was reviewed and compared to the available new high quality evidence-based guidelines and systematic reviews. Additional draft recommendations were suggested by the Darwin Otitis Guidelines Group and the Technical Advisory Group. These statements were then converted into evidence-based clinical questions. These questions were answered using the best available evidence identified by the search strategy used in the Recommendations of March 2001 and updated by the Guidelines Group in April 2010. The final recommendation had to be consistent with this evidence.

Search Strategy

We used a hierarchical approach to identify the best available evidence relevant to the recommendations. The search strategy described in Phase 1 was used to find all the relevant evidence-based guidelines, evidence summaries and systematic reviews. The search strategy described in Phase 2 was used to find well-designed original studies relevant to the management of OM published since 2001. These searches were modified versions of the filters available through Clinical Queries in PubMed (US National Library of Medicine). For clinical questions that were not addressed in the original Guidelines, the search strategy was extended to cover studies published prior to 2001 (in the Cochrane Library and MEDLINE database).

Phase 1

1. otitis OR hearing loss

in the National Guideline Clearinghouse, Agency for Healthcare Research and Quality, Canadian Medical Association Clinical Practice Guidelines, the Guide to Clinical Preventive Services, (2nd edition), Centres for Disease Control and Prevention, Scottish Intercollegiate Guidelines Network, the UK Health Technology Assessment, and the World Health Organization (accessed via the NIHR HTA programme http://www.hta.ac.uk/, the National Guideline Clearinghouse http://www.guidelines.gov/, and the WHO http://www.who.int/ on 1st April 2010).

2. (otitis [MeSH Terms] OR otitis [Text Word] OR hearing loss, partial [MeSH Terms] OR deafness [Text Word] OR hearing loss [Text Word]) AND practice guideline [PTYP]
in MEDLINE (accessed via PubMed on 1st April 2010).

3. Handsearch of “Evidence-Based Otitis Media”8 and “Clinical Evidence, April 2010.”6;27,28

4. (otitis [MeSH Terms] OR otitis [Text Word] OR hearing loss, partial [MeSH Terms] OR deafness [Text Word] OR hearing loss [Text Word])
in the Cochrane Library, Issue 2, 2010 and limited to reviews (accessed on 1st April 2010).

5. (otitis [MeSH Terms] OR otitis [Text Word] OR hearing loss, partial [MeSH Terms] OR deafness [Text Word] OR hearing loss [Text Word]) AND (meta-analysis [PTYP] OR meta-analysis [Text Word] OR meta analysis [Text Word] OR (review [PTYP] AND medline [Text Word]) OR (review [PTYP] AND systematic* [Text Word]) OR overview [Text Word])
in MEDLINE (accessed via PubMed on 1st April 2010).

Phase 2

6. (otitis [MeSH Terms] OR otitis [Text Word] OR hearing loss, partial [MeSH Terms] OR deafness [Text Word] OR hearing loss [Text Word])
in the Cochrane Library, 2010 and limited to studies listed in the Controlled Clinical Trials Register and published since 2001 (accessed on 1st April 2010).

7. (otitis [MeSH Terms] OR otitis [Text Word] OR hearing loss, partial [MeSH Terms] OR deafness [Text Word] OR hearing loss [Text Word]) AND (clinical trial [PTYP] OR random* [Text Word])

8. (otitis [MeSH Terms] OR otitis [Text Word]) AND (sensitivity and specificity [MeSH Terms] OR sensitivity [Text Word] OR specificity [Text Word] OR (predictive [Text Word] AND value* [Text Word]))

9. (otitis [MeSH Terms] OR otitis [Text Word]) AND (cohort studies [MeSH Terms] OR prognos* [Text Word] OR risk [Text Word] OR case control* [Text Word])
in MEDLINE and limited to publications since 1997 (accessed via PubMed on 1st April 2010).

10. otitis OR hearing loss

in the Aboriginal and Torres Strait Islander Health Information database and limited to publications since 1997 (accessed via http://www.healthinfonet.ecu.edu.au/ on 1st April 2010).

Result of Search

A thorough literature search identified more than 300 articles. Additional references were identified by group members and peer reviewers. All material was assessed and evidence synthesised in accordance with NHMRC methodology. Material not deemed to be of sufficient quality was discarded. Overall, we identified 51 evidence-based guidelines, reviews, and summaries: 12 evidence-based guidelines,13-24 10 clinical evidence reports,5-7;25-31 1 evidence-based text-book,8 21 Cochrane Systematic Reviews,32-52 and 7 other systematic reviews.2;53-58 Nearly all of these were new publications. When necessary, we extended our search prior to 2001 to address new clinical questions. On the basis of this explicit search, we prepared 116 recommendations. Out these, we have 23 recommendations which are based on Cochrane Systematic Reviews. Those recommendations which are not evidence-based, but considered to be good practice by the expert panel, have been labelled as Good Practice Points (GPP).

Links to Best Available Evidence

Each recommendation has been explicitly linked to the level of evidence on which it is based. All relevant Level I Evidence Studies and Guidelines have been referenced. Selections of the best Level II, Level III and Level IV Evidence Studies have also been referenced. The source of expert opinion for Good Practice Points has not been referenced.
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