Improving the use of research evidence in guideline development: 13. Applicability, transferability and adaptation

Schünemann, Holger J; Fretheim, Atle; Oxman, Andrew D

Threats of new emerging diseases (e.g. severe acute respiratory syndrome (SARS) and avian influenza A (H5N1) infection) as well as pandemics of chronic diseases such as obesity and heart disease have prompted international action and are clear examples of the existence of international health problems and the need for international recommendations. Given the international orientation of WHO and the advantages of large international organizations (e.g. accessing and pooling of resources, reducing unnecessary duplication, and involving international scientists), there is an important role for international recommendations [32] . International recommendations may be most helpful when variation in settings and local circumstances is less important. Therefore, consideration of need (prevalence, baseline risk or health status), setting (e.g. availability of resources) and modifying factors (factors that modify translation of recommendation into practice such as microbiological resistance patterns) can be key components that influence the strength of a recommendation and should be specified in recommendations formulated by the WHO [33] .