28 WORLD GASTROENTEROLOGY NEWS JULY 2014 Editorial | Expert Point of View | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events know this needs to be based on proper study. From the beginning, Profes-sor Tytgat was well aware of the vital role evidence plays but as a world organization we needed to incorporate not just the gold standard but also we would need to take account of resources available. The idea of Cascades was born. Later, during the chairmanship of Professor Fried from Zurich, these ideas were formalized into the concept of ‘Cascades’ and it was Michael Fried’s wise tenure of the Guidelines Committee chairmanship that saw guideline production flourish. His vi-sion on Cascades guided the guideline production program for a full eight years before handing over to Professor Lindberg late 2013. In this period the guideline pro-duction flourished …perhaps even too much. As research quickens and more and more results filter down from the bench to the bedside it is vital guidelines are kept up to date. When Professor Lindberg took over he started a major update program, which will ensure all guidelines will be up-to-date and as evidence-based as possible. Through the Cascades we deliver more than the ‘gold standard’ and compensate for the limitations of strict evidence-based work. We argue that the addition of Cascades to guidelines will increase their impact in large parts of the world. By so doing, we hope to add a new dimension to the ‘knowledge into action’ debate. A Cascade is a selection of two or more hierarchical diagnostic or therapeutic options, based on proven medical procedures, methods, tools or products for the same disease, condi-tion or diagnosis, aiming to achieve the same outcome and ranked by available resources. Matching options for diagnosis and treatment to avail-able resources can save lives. While the optimal strategy, defined through an evidence-based approach, should always be the goal, one must be aware of the resource limitations that con-front our colleagues in certain parts of the world and we should endeavor to work with them in the guideline development process to develop strategies that are clinically sound yet economically feasible and acceptable to their populace. The Guideline Committee Chair and members form the basis for the guideline program. For each guideline in production, we work with Review Teams with invited experts represent-ing all the regions that make up the diversity among the membership of the society and its target readership. Team members are recruited on a voluntary basis and authorship requires active participation by each of them. For each guideline, a guideline chair heads the Review Team and together they play a crucial role in evaluating the evidence and writing the guideline. Our approach warrants a relatively short throughput time and cost-effective process. During the guide-line production there is no need to meet and everything is done to make best use of experts’ knowledge and time. We propose a balance between evidence and medical practice and, if possible and applicable, resource-based guidelines to take care of access, financial, and technical differences within the user’s communities. The guideline program results in ‘living documents’ that will impact medical practice and increase WGO’s visibil-ity and value, while offering author benefits to the Review Team members and chairs. WGO Guidelines are constantly re-viewed based on a system of monthly literature alerts for each title. The WGO Guideline library is accompanied by a set of information services to help keep users up to date with the literature and new evidence. Under the expert guidance of Pro-fessors Elewaut and Fevery, WGO’s ‘Graded Evidence’ system is built to help Member Societies of gastroenter-ology and all those interested in the practice and research of gastroenter-
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