Recent Development in Practice Guidelines: Interview with Dr. Jayant Talwalkar 

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By Ann Tracy

2009 has proven to be an extremely productive year for the AASLD Practice Guidelines Committee. Under the leadership of previous Committee Chair Maggie Shuhart, MD and current Committee Chair Jayant Talwalkar, MD, the Committee has made great strides in providing the hepatology community with the most up to date clinical practice guidelines in the field of liver disease. A new guideline for Primary Biliary Cirrhosis was recently published, and the guideline for Chronic Hepatitis B has been updated and posted on the AASLD website. A guideline on Primary Sclerosing Cholangitis has been approved and should be released in 2010; updated guidelines for Autoimmune Hepatitis, Hemochromatosis, TIPS in Portal Hypertension, and Hepatocellular Carcinoma are also in the works.

The process of determining which practice guidelines require annual updates is a relatively new task for the Committee. As Dr. Talwalkar explains, the authors of the most recent published guideline are contacted and asked to identify any new treatment options or diagnostic approaches that merit inclusion into existing guidelines. If important changes are identified, the Committee then asks authors to incorporate the new data or recommendations into the guideline while looking to see if any existing information has become outdated or less clinically useful. The updated guideline then undergoes a full review by the Committee, as would a brand new guideline, before being sent to the AASLD Governing Board final approval. These annual updates are then published online at www.aasld.org until the guideline reaches its five year anniversary where rewriting and print publication of a new guideline are then undertaken. Additionally, existing practice guidelines that do not require frequent annual updates are republished every five years as well.

Dr. Talwalkar stresses the importance of “providing concise, user-friendly guidelines to assist practitioners in taking care of their patients with liver disease.” This includes making sure that guidelines provide consensus recommendations on disease management areas where data from randomized controlled trials or large high-quality cohort studies will not be available. In addition, the Committee is focused on ensuring that guidelines include recommendations on how to manage unique patient populations affected by specific liver diseases. Furthermore, the Committee is finalizing details on the implementation of a new classification system for practice guideline recommendations (GRADE) which is more intuitive for readers to interpret and understand as compared to previous systems. 

The most challenging aspect of working with practice guidelines is the need to produce “concise, accurate guidelines in a timely fashion despite the rapid advances in knowledge in the field,” according to Dr. Talwalkar. In turn, the Committee is also beginning to look at ways to disseminate guideline information in various forms of electronic media to circulate new information as quickly as possible.

Dr. Talwalkar is Associate Professor of Medicine at the Mayo Clinic in Rochester, MN. He received his medical training at the University of Illinois Medical Center in Chicago, IL, and completed his residency at the Mayo Graduate School of Medicine.