12.1 INTRODUCTION

SIGN is a collaborative network of clinicians, other health care professionals, and patient organisations, funded by the Clinical Resource and Audit Group (CRAG) of the Scottish Executive Health Department. SIGN guidelines are developed by multidisciplinary groups using a standard methodology based on a systematic review of the evidence. Further details about SIGN and the guideline development methodology are contained in SIGN 50: A guideline developer's handbook, available at http://www.sign.ac.uk.

12.2 THE GUIDELINE DEVELOPMENT GROUP

Professor Gordon Lowe (Chairman), Professor of Vascular Medicine, University of Glasgow & Chairman of SIGN
Mr Michael Aitchison, Consultant Urologist, Gartnavel General Hospital, Glasgow
Mrs Moira Balmer, Chief Officer, Borders Local Health Council
Professor Jill Belch, Professor of Vascular Medicine, Ninewells Hospital, Dundee
Mr Ivan Brenkel, Consultant Orthopaedic Surgeon, Queen Margaret Hospital, Dunfermline
Professor Ian Greer, Professor of Obstetrics & Gynaecology, University of Glasgow
Mr Robin Harbour, Quality and Information Director, SIGN
Dr John Irving Consultant Physician, St John's Hospital at Howden, Livingston
Ms Brenda Jackson, Quality Coordinator, Glasgow Royal Infirmary
Mr Nizam Mamode, Consultant Transplant Surgeon, Guy's Hospital, London
Dr Safia Qureshi, Programme Director, SIGN
Mr Lech Rymaszewski, Consultant Orthopaedic Surgeon, Glasgow Royal Infirmary
Professor Peter Sandercock, Professor of Medical Neurology, University of Edinburgh
Ms Lorna Thomson, Senior Pharmacist, Royal Infirmary of Edinburgh
Dr Isobel Walker, Consultant Haematologist, Glasgow Royal Infirmary
Professor Tony Wildsmith, Professor of Anaesthesia, Ninewells Hospital, Dundee

The membership of the guideline development group was confirmed following consultation with the member organisations of SIGN. Declarations of interests were made by all members of the guideline development group. Further details are available from the SIGN Executive. A General Practitioner and a General Surgeon were originally part of the guideline development group, but did not attend any meetings. Guideline development and literature review expertise, support, and facilitation were provided by the SIGN Executive.

12.3 Systematic literature review

The evidence base for this guideline was developed through a systematic review of the literature using an explicit search strategy devised by the SIGN Information Officer in collaboration with members of the guideline development group. Searches covered a number of key Internet sites as well as the CINAHL, Cochrane Library, Embase, Healthstar, and Medline databases. Systematic searches covered the period up until June 1998. Details of the main search strategy and supplementary searches carried out by a member of the guideline development group, are available on the website. The evidence base was updated during the development of the guideline. During this period, SIGN methodology was being reviewed and improved, resulting in the methodology now set out in SIGN 50. The timing of this review means that this guideline was not developed using current methodolgy and does not meet current standards in terms of documentation of the evidence base and considered judgement process.

12.4 Consultation and peer review

12.4.1 NATIONAL OPEN MEETING

A national open meeting is the main consultative phase of SIGN guideline development, at which the guideline development group presents their draft recommendations for the first time. The national open meeting for this guideline was held on 13th December 1999. The draft guideline was also available on the SIGN website for a limited period at this stage to allow those unable to attend the meeting to contribute to the development of the guideline.

12.4.2 SPECIALIST REVIEW

The guideline is reviewed in draft form by a panel of independent expert referees, who are asked to comment primarily on the comprehensiveness and accuracy of interpretation of the evidence base supporting the recommendations in the guideline. SIGN is very grateful to all of these experts for their contribution to this guideline. The following experts have been invited to comment on this draft:

Dr Trevor Baglin, Consultant Haematologist, Addenbrooke's Hospital, Cambridge
Dr Grant Baxter, Consultant Radiologist, Western Infirmary, Glasgow
Dr James Beattie, General Practitioner, Inverurie
Dr Chris Burton, General Practitioner, Sanquhar Health Centre
Dr Ola Dahl, Senior Researcher & Consultant, Ulleval University Hospital, Norway
Mr Stan Dobrzanski, Clinical Pharmacist, Bradford Royal Infirmary
Professor Gerald Fowkes, Professor of Epidemiology, University of Edinburgh
Professor Keith Fox, Professor of Cardiology, Royal Infirmary of Edinburgh
Miss Tracey Gillies, Surgical Registrar, Royal Infirmary of Edinburgh
Professor Michael Greaves, Professor of Haematology, University of Aberdeen
Mr Colin Howie, Consultant Orthopaedic Surgeon, Royal Infirmary of Edinburgh
Professor Christopher Ludlam, Professor of Haematology and Coagulation Medicine Royal Infirmary of Edinburgh
Dr Simon Maxwell, Clinical Pharmacologist, Western General Hospital, Edinburgh
Dr Allan Merry, General Practitioner, Ardrossan
Dr Cathy Nelson-Piercy, Consultant Obstetric Physician, Guy's and St Thomas's Hospitals, London
Professor Colin Prentice, Emeritus Professor of Medicine, University of Leeds
Dr John Reid, Consultant Radiologist, Borders General Hospital, Melrose
Professor Vaughan Ruckley, Emeritus Professor of Vascular Surgery, University of Edinburgh
Dr Richard Soutar, Consultant Haematologist, Western Infirmary, Glasgow
Professor Graham Turpie, HGH/MacMaster Hospitals, Hamilton, Ontario, Canada
Ms Anne Walker, Programme Director, Effective Professional Practice Programme, Aberdeen

12.4.3 SIGN EDITORIAL GROUP

As a final quality control check, the guideline is reviewed by an Editorial Group comprising the relevant specialty representatives on SIGN Council to ensure that the peer reviewers' comments have been addressed adequately and that any risk of bias in the guideline development process as a whole has been minimised. The Editorial Group for this guideline is as follows:

Dr Doreen Campbell, Scottish Executive Department of Health
Professor Ian Campbell, Royal College of Physicians Edinburgh
Mrs Patricia Dawson, Royal College of Nursing
Dr John Gillies, Royal College of General Practitioners
Mr Douglas Harper, Royal College of Surgeons of Edinburgh
Dr Cameron Howie, Royal College of Anaesthetists
Dr Chris Kelnar, Vice Chairman of SIGN
Ms Juliet Miller, Editor
Dr Gillian Penney, Royal College of Obstetricians & Gynaecologists

12.5 Review and updating

This guideline was issued in 2002 and will be considered for review in 2006, or sooner if new evidence becomes available. Any updates to the guideline in the interim period will be noted on the SIGN website: http://www.sign.ac.uk.