Creating Clinical Practice Guidelines We Can Trust, Use, and Share Per Olav Vandvik, MD, PhD, Linn Brandt, MD, Pablo Alonso-Coello, MD, PhD, Shaun Treweek, PhD, Elie A. Akl, MD, MPH, PhD, Annette Kristiansen, MD, Anja Fog-Heen, MD, Thomas Agoritsas, MD, Victor M. Montori, MD, Gordon Guyatt, MD, FCCP  CHEST  Volume 144, Issue 2, Pages 381-389 (August 2013) DOI: 10.1378/chest.13-0746 Copyright © 2013 The American College of Chest Physicians Terms and Conditions

Figure 1 Creation of the new multilayered guideline format from a traditional PDF format by adapting the American College of Chest Physicians (ACCP) Antithrombotic Therapy and the Prevention of Thrombosis, 9th Edition: American College of Chest Physicians Evidence-Based Guidelines (AT9) into a national guideline for antithrombotic therapy in Norway. CHEST 2013 144, 381-389DOI: (10.1378/chest.13-0746) Copyright © 2013 The American College of Chest Physicians Terms and Conditions

Figure 2 Conceptual framework, authoring and publication platform, and guideline outputs. App = application software; EBM = evidence-based medicine; EMR = electronic medical record; MAGIC = Making GRADE the Irresistible Choice; PICO = population, intervention, comparator, outcomes. See Figure 1 legend for expansion of other abbreviations. (Illustrated with content from an AT9 chapter. Adapted with permission from Falck-Ytter et al.18) CHEST 2013 144, 381-389DOI: (10.1378/chest.13-0746) Copyright © 2013 The American College of Chest Physicians Terms and Conditions

Figure 3 Online guideline-authoring and publication platform showing module for selecting PICO questions relevant to recommendations. HFS = hip fracture surgery; IPCD = intermittent pneumatic compression device; LDUH = low-dose unfractionated heparin; LMWH = low-molecular-weight heparin; PE = pulmonary embolism; THA = total hip arthroplasty; TKA = total knee arthroplasty; VKA = vitamin K antagonist. See Figure 1 and 2 legends for expansion of other abbreviations. (Exemplified with content from an AT9 chapter. Adapted with permission from Falck-Ytter et al.18) CHEST 2013 144, 381-389DOI: (10.1378/chest.13-0746) Copyright © 2013 The American College of Chest Physicians Terms and Conditions

Figure 4 A, Top layer of the guideline displaying recommendations. B, Key information section, one click away from the recommendation. See Figure 3 legend for expansion of abbreviations. (Both panels include content from an AT9 chapter, transformed into the new format. Adapted with permission from Falck-Ytter et al.18) CHEST 2013 144, 381-389DOI: (10.1378/chest.13-0746) Copyright © 2013 The American College of Chest Physicians Terms and Conditions

Figure 5 Summary of findings (SoF) table available in deeper layers. CHEST 2013 144, 381-389DOI: (10.1378/chest.13-0746) Copyright © 2013 The American College of Chest Physicians Terms and Conditions