10.1 Introduction

SIGN is a collaborative network of clinicians and other healthcare professionals, funded by NHS Quality Improvement Scotland. The overall direction of SIGN's development and SIGN's guideline programme is determined by members of SIGN Council. Guidelines are developed 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

10.2 The guideline development group

Dr Tricia Donald (Chair), General Practitioner, Edinburgh
Dr John Ennis (Secretary), General Practitioner, Edinburgh
Dr Lisa Mackenzie (Methodologist), SpR Rheumatology, Glasgow Royal Infirmary
Dr Colin Perry (Methodologist), Specialist Registrar (Endocrinology), Glasgow Royal Infirmary
Dr Graham Beastall, Clinical Biochemist, Glasgow Royal Infirmary
Dr Lucy Caird, Consultant Gynaecologist, Raigmore Hospital, Inverness
Dr Clare Campbell, General Practitioner, Broxburn
Dr Donald Farquhar, Consultant Geriatrician, St. John's Hospital, Livingston
Dr Ailsa Gebbie, Community Gynaecologist, Edinburgh
Mr Alberto Gregori, Consultant Orthopaedic Surgeon, Hairmyres Hospital, East Kilbride
Dr Jim Hannan, Physicist, Western General Hospital, Edinburgh
Mr Robin Harbour, Quality & Information Director, SIGN
Ms Janice Harris, Senior Pharmacist, Royal Victoria Hospital, Edinburgh
Dr Andrew Jamieson, Consultant Physician, Queen Margaret Hospital, Dunfermline
Dr Justus Krabshuis, Independent Information Consultant
Ms Ann Lees, Health Planning Manager (Health Economist), Argyll and Clyde Acute Hospitals NHS Trust
Dr Alastair McLellan, Consultant Endocrinologist, Western Infirmary, Glasgow
Ms Alice Mitchell, Health Visitor, Glasgow
Dr Sarah Mitchell, Physiotherapist, Glasgow Royal Infirmary
Dr Caroline Morrison, Public Health Consultant, Greater Glasgow Health Board
Dr Anne Payne, Lecturer in Clinical Nutrition and Dietetics, Glasgow Caledonian University
Dr Nigel Raby, Consultant Radiologist, Western Infirmary, Glasgow
Professor David Reid, Consultant Rheumatologist, Foresterhill, Aberdeen
Dr Mary Scott, General Practitioner, Dunfermline
Mrs Anne Simpson, National Osteoporosis Society Co-ordinator for Scotland

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. In addition to the work done by Dr Krabshuis, guideline development and literature review expertise, support, and facilitation were provided by the SIGN Executive.

10.3 Systematic literature review

The evidence base for this guideline was synthesised in accordance with SIGN methodology. A systematic review of the literature was carried out by Dr Justus Krabshuis using an explicit search strategy devised in collaboration with members of the guideline development group.

Searches were restricted to systematic reviews, meta-analyses, randomised controlled trials, and longitudinal studies. Internet searches were carried out on the websites of the Canadian Practice Guidelines Infobase, the UK Health Technology Assessment Programme, the US National Guidelines Clearinghouse, and the US Agency for Healthcare Research and Quality. Searches were also carried out on the search engines Google and OMNI, and all suitable links followed up. Database searches were carried out on Cochrane Library, Embase 1993-2000, and Medline 1990-2000. Searches were later updated to June 2001.

The main searches were supplemented by material identified by individual members of the development group. All selected papers were evaluated using standard methodological checklists before conclusions were considered as evidence.

10.4 Consultation and peer review

10.4.1 National open meeting

A national open meeting is the main consultative phase of SIGN guideline development, at which the guideline development group presents its draft recommendations for the first time. The national open meeting for this guideline was held in February 2002 and was attended by 328 representatives of all the key specialties relevant to the guideline. 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. The comments received from the national open meeting were considered when the guideline was redrafted for peer review.

10.4.2 Specialist review

The guideline was also reviewed in draft form by the following independent expert referees, who were 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 the guideline.

Dr Christine Bain, Consultant Gynaecologist, Aberdeen
Professor David Barlow, Nuffield Professor of Obstetrics and Gynaecology, University of Oxford
Dr Jane Bishop-Miller, Consultant Physician in Care of the Elderly, Stirling
Dr Juliet Compston, Reader in Metabolic Bone Disease, University of Cambridge Clinical School
Professor Cyrus Cooper, Consultant in Rheumatology, Southampton General Hospital
Dr Veena Dhillon, Consultant Rheumatologist, Western General Hospital, Edinburgh
Dr Roger Francis Consultant in General Medicine, Freeman Hospital, Newcastle upon Tyne
Dr Anna Glasier Director, Family Planning and Well Woman Services, Edinburgh
Professor James Hutchison, Regius Professor of Surgery, Aberdeen
Dr Elizabeth MacDonald, Consultant Physician, Royal Victoria Hospital, Edinburgh
Mr Phil Mackie, Senior Specialist in Public Health, Edinburgh
Dr Allan Merry, General Practitioner, Ardrossan
Mr Walter Newton, Consultant in Orthopaedics, Hairmyres Hospital, East Kilbride
Dr Patricia O'Connor, Consultant in Accident & Emergency, Hairmyres Hospital, East Kilbride
Dr Paul Padfield, Consultant Physician/Reader in Medicine, Western General Hospital, Edinburgh
Dr Andrew Power, Medical Prescribing Adviser, Glasgow Royal Infirmary
Professor David Purdie, Consultant in Obstetrics & Gynaecology, Hull Royal Infirmary
Dr Christine Roxburgh, General Practitioner, Perth
Professor Hamish Simpson, Professor of Orthopaedics, Edinburgh
Sister Anne Sutcliffe, Osteoporosis Sister, Freeman Hospital, Newcastle upon Tyne
Dr Peter Tothill, Honorary Fellow of the University of Edinburgh, Department of Medical Physics
Dr Sally Voice, General Practitioner, Montrose

10.4.3 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 was as follows:

Dr David Alexander, British Medical Association, Scottish General Practice Committee
Professor Gordon Lowe, Chairman of SIGN; Co-Editor
Miss Tracy Nairn, Senior Professional Adviser, Care Commission, Glasgow
Dr Sara Twaddle, Director of SIGN; Co-Editor
Dr Peter Wimpenny, School of Nursing and Midwifery, The Robert Gordon University

Each member of the guideline development group then approved the final guideline for publication.