Method
Evidence Surveillance
Our evidence surveillance strategy is built on a comprehensive literature search developed and maintained by a medical librarian with expertise in systematic reviews. The search is updated regularly and integrates primary research with evidence from recent systematic reviews and existing guidelines. This approach ensures both efficiency and completeness in identifying the most relevant and current literature to inform recommendations.
Technology Integration
To streamline workflow, we use platforms such as Covidence for literature screening, data extraction, and risk of bias assessment. These tools enable efficient collaboration among team members and facilitate the management of large volumes of literature. Recommendation summaries and supporting evidence tables are managed digitally to allow for efficient updates and version control.
Recommendation Development
All recommendations are developed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework. This ensures that each recommendation reflects not only the quality of evidence but also the balance of benefits and harms, feasibility, and clinical relevance. Each recommendation is accompanied by a rationale and a summary of the supporting evidence, including a certainty rating based on the GRADE approach (https://www.gradeworkinggroup.org/).
A strong recommendation employs the wording “we recommend” and indicates the most appropriate action for most patients. A conditional recommendation employs the wording “we suggest” and acknowledges the most appropriate action may vary according to clinical judgement and patient preferences.
Recommendations are voted on by an expert panel (modified Delphi consensus process). A recommendation passes if it receives 70 percent agreement.
By combining real time evidence integration with rigorous methodology and practical tools, the Living HS Guidelines provide a forward thinking model for clinical guidance, offering clinicians and researchers a reliable, up to date resource to support high quality care for patients with HS.