ISTM Publications Committee

Charter

• The Publications Committee has responsibility for coordinating and facilitating the publication of ISTM sponsored periodicals, newsletters and policy statements
• The Publications Committee is charged with reviewing and approving all ISTM publications prior to their release
• The Publications Committee is charged with the coordination of the publication of NewsShare, The Journal of Travel Medicine and other publications that the ISTM may choose from time to time to develop
• The Publications Committee is charged with managing the content of the ISTM website and the TravelMed listserv
• The Publications Committee is charged with developing and issuing consensus policy statements synthesizing the views of ISTM experts on scientific or clinical topics of importance to the ISTM

Members

• Charles Ericsson, Chair (USA)
• Hans Dieter Nothdurft, Vice Chair and Web Editor (Germany)
• Robert Steffen, Editor, Journal of Travel Medicine (Switzerland)
• Karl Neumann, Editor, NewsShare (USA)
• Jane Chiodini (UK)
• Ashley Croft (UK)
• Steven Denny (USA)
• Graham Fry (Ireland)
• Jeffery Goad (USA)
• Steve Ostroff (USA)
• Israel Potasman (Israel)
• Doug Quarry (Australia)
• Matthias Schmid (UK)
• Joseph Torresi (Australia)
• Stephen Toovey (South Africa)
• Michael Townend (UK)

Main Achievements

New Publisher

The relationship with our new publisher, Blackwell, has been collegial and productive. Submission of articles can now be done entirely online. Under the leadership of the Journal of Travel Medicine editor, Robert Steffen, the impact factor has risen nicely. JTM has clearly become the repository for cutting edge research results in travel medicine.

Karl Neumann continues to do yeoman's work as editor of NewsShare. He leads an effort to make our society's workings and deliberations transparent and useful for the membership.

If you have been online recently you should be able to easily appreciate the work of our Web Editor, Hans Dieter Nothdurft. He has revamped the look and feel of our home page. He is soliciting committee updates like this one to update the membership. As you scroll through the menu you should also appreciate a new feature like Expert Opinions, a product of the Professional Education and Training Committee, and an updated Body of Knowledge to help members prepare for the ISTM Travel Medicine Exam.

Finally, under the able leadership of Vernon Ansdell, a writing panel is being empowered to write our first Evidence Base for the Practice of Travel Medicine. The first topic will be personal protective measures against disease transmission by insects and similar vectors.

Anyone wishing more information about the Publications Committee is free to contact the Chair, Charlie Ericsson, at charles.d.ericsson@uth.tmc.edu.

Conflict of Interest Declaration (Currently required of all JTM authors)

The Journal of Travel Medicine (JTM) requires that all authors sign a declaration of conflicting interests. We will not reject papers simply because of conflicting interests, but we will declare them to the readership. A conflicting interest exists when professional judgment concerning a primary interest (such as patients' welfare or the validity or interpretation of research) may be influenced by a secondary interest (such as financial gain or personal rivalry). If conflicts of interest were revealed after an article was published, they might make a reasonable reader feel misled or deceived.

Authors should review all of the following items before concluding they have no conflicts of interest that are relevant to the manuscript being submitted for publication.

1. Acceptance in the past two years of any of the following from an organization that may in any way gain or lose financially from the results of your study or the conclusions of your paper:
   • A fee for speaking;
   • A fee for writing this article;
   • A fee for organizing or chairing education;
   • Reimbursement for attending a symposium;
   • Funds for research;
   • Funds for a member of staff;
   • Fees for consulting and/or serving on an Advisory Board;
   • Patent royalties.
2. Employment in the past five years by an organization that may in any way gain or lose financially from the results of your study or the conclusions of your paper.
3. Ownership of any stocks or shares in an organization that may, in any way, gain or lose financially from the results of your study or the conclusions of your paper?
4. Acting as an expert witness on the subject of your study or paper.
5. Any other financial, commercial, personal, political, or academic conflicts of interest.

We also require you to disclose any research sponsorship that you received to conduct the study, or prepare the manuscript or review. This information will be published together with the author affiliation information.

• Examples of acceptable statements are: "The study was carried out with support of an unrestricted educational grant from X" or "This study was funded in whole/in part a grant from Y" or "XY has accepted fees for speaking from A, B and has served on an Advisory Board for C."
• The role of the funding organization or sponsor in each of the following should be specified: design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

It is important that you return this form as early as possible in the publication process. We will not publish your article without completion and return of the form.

Please tick one of the following boxes:

	We have no interests to declare. Please print "No interest declared" with the article.
	We have sponsorship and/or interests to declare.
	•	Research sponsorship was the following: ___________________________
	•	Please print the following statement on possible authors' interest with the article: _______________________________________________________
	•	Research sponsor's contribution was the following: ___________________
	The corresponding author guarantees the integrity of the data and its analysis. Persons having a major part in manuscript preparation are acknowledged.

_______________________________________________________
Signature

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Date

Guide to Development of Evidence Bases for Clinical Practice

(Preliminary approval by Executive Board May 2005; final approval pending)

An International Society of Travel Medicine (ISTM) evidence base for clinical practice is "a systematically developed statement to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" [1]. An ISTM evidence base for clinical practice will be written with the aim of improving the quality, appropriateness or cost effectiveness of care and to serve as an educational tool [2, 3].

An ISTM Evidence Base Task Force is charged to develop topics for the development of an evidence base and will be composed of chairpersons (or designees) of the Publications, Professional Education, Practice and Nursing Issues and Exam committees and the editor (or designee) of the Journal of Travel Medicine plus one additional member of each committee and JTM editorial board. The Task Force will be chaired by the chair of PC or designee. An ISTM evidence base for clinical practice will be published in the Journal of Travel Medicine. The turnaround time from concept to final draft should be as short as possible, preferably less than 12 months.

While practitioners or organizations may choose to adopt part or all of an ISTM evidence base as a standard of care, ISTM evidence bases should not be written for such purposes. Evidence bases are never a substitute for sound clinical judgment particularly when they are applied to an individual patient.

Table 1 outlines the development procedure and timeline. The ISTM Evidence Base Task Force and writing panels should carefully consider and incorporate the following standards so that scientific validity and clarity of communication may be ensured [4]. The challenge to evidence base writers is to adhere to standards in the development process while also making the document user-friendly.

Evidence Base Development and Format

• Choosing practice topics. Evidence base topics should be chosen for the impact that they will have on the practice of medicine. Topics should typically come from an area of practice that involves a large number of travelers, high cost, issues related to risk management, or significant variation in practice. Sufficient evidence (written or expert opinion) should be available for review to justify the development of an evidence base. The scope of the topic should be narrow enough to permit thorough exploration in a relatively short, concise document. In most cases, the ISTM Evidence Base Task Force will suggest topics for approval by the ISTM Executive Board, but ISTM members can also suggest topics to the Evidence Base Task Force.
• Specifying the purpose. The purpose for which an evidence base is being written should be specified and should make clear to the audience why this is an important topic and what impact the evidence base is expected to have on the practice of medicine. Clarification of controversy, proper uses of newer technologic or diagnostic tools, and appropriate use of pharmaceuticals are examples of appropriate reasons for evidence base development. Unambiguous terminology should be used.
• Choosing the writing panel participants. Participants in the evidence base writing panel should represent a range of experts that is sufficiently broad enough to adequately explore the topic. Ideally, 6-8 members should be chosen by the evidence base writing panel chair in collaboration with The ISTM Evidence Base Task Force. When appropriate and when fiscally feasible, members of related disciplines and other relevant professional societies should be included in an effort to reach a broad consensus. Such a process will serve to enhance the validity and credibility of the evidence base.
• Specifying the target population. The targeted traveling population should be clearly specified. Consider age, sex, clinical condition, or other factors that might affect the recommendations and then define any limitations. Give consideration to the inclusion of special populations, such as pediatric, pregnant or immunocompromised travelers. If recommendations are significantly different for specific populations, it might be best to propose that a separate evidence base be developed to encompass these groups.
• Specifying the target audience. Specify clearly who the target audience is at the beginning of the evidence base. Most ISTM evidence bases will target both nurse and physician practitioners.
• Exploring the diagnostic and therapeutic options. Specify clearly the principal diagnostic or therapeutic options that are available and how they will be explored in the evidence base. Indicate why these options were chosen and, as appropriate, why other options were not considered.
• Specifying the desired outcome. Specify the desired outcome of the evidence base. If the audience adopts the evidence base, what health, economic, or other outcomes might be expected?
• Scientific review. Specify the method by which the evidence base has undergone review. The chair of the Evidence Base Task Force will invite at least three respected peers to review the evidence base for scientific validity. Reviewers may not be members of the evidence base writing panel but should be recognized experts in the same field. These outside reviewers should give their critiques anonymously to the writing panel. After the panel has successfully dealt with the criticisms and revised the evidence base as necessary and the final evidence base has been accepted for publication by the editor of JTM, then each reviewer can be personally acknowledged at the end of the evidence base document if he or she consents to be recognized. Each particular evidence base writing panel will submit its final draft to the ISTM Evidence Base Task Force, including editor of JTM, for approval of content and format. After approval is granted, the draft is forwarded to the ISTM Executive Board for final approval and then to Journal of Travel Medicine for publication.
• Posting on the ISTM web site. After evidence bases have been published in Journal of Travel Medicine they will be posted in the public section of the ISTM web site for access by the public and all practitioners.
• Updating the evidence base. Specify when and how often the evidence base will be reviewed so that it may be updated. On average, evidence bases should be reviewed for changes in the field every 2 years. The evidence base leader can determine whether the scope of change warrants simple revision that can be effected on the web site with brief notice of the change published in JTM or whether full-scale revision of the evidence base is necessary with re-publication of the evidence base in JTM.
• Suggested format. The evidence base should not be a review or meta-analysis of the topic, and it should not be excessively lengthy; a reasonable length might be 20-25 double-spaced pages, plus references. The document should begin with an executive summary that concisely states major recommendations.

Evidence Review

Specify the method by which scientific evidence was identified and collected. When scientifically rigorous material is not available, expert opinion can be used, as long as it is clearly indicated and attributed, and the basis on which expert opinion was formed is specified. Specify the time period during which evidence was reviewed and whether it has been validated in practice. Identify the evidence by use of citations and references. Specify the method used for extraction of the data for review (e.g., by means of a MEDLINE search). The writing panel should grade evidence following a standard evidence-grading system (Table 2).

Formulation of Recommendations

Recommendations should be as specific as possible, directed at the target audience and easy to use. Yet, the recommendations should also be flexible enough to deal with international differences and be adaptable to local use.

The strength of each recommendation and the quality of the evidence backing the recommendation should be indicated by the rating scale in Table 2.

If the current evidence base is making recommendations that differ significantly from those of previous evidence bases on the same subject, the differences should be reconciled (e.g., the reason for the difference is new data or differing expert opinion).

Performance and Outcomes Measures

Each evidence base should suggest at least 1 or 2 performance measures to help evidence base users measure the extent of implementation and the effect of implementation of the evidence base within their practice or organization. The measures can be process or outcome indicators, or both [6].

Areas for Future Research

Evidence bases should comment on what is lacking in the existing evidence and should also suggest areas for further study

References

1. Committee to Advise the Public Health Service on Clinical Practice Guidelines, Institute of Medicine. In: Field MJ, Lohr KN, eds. Clinical practice guidelines: directions of a new program. Washington, DC: National Academy Press, 1990.

2. Centers for Disease Control. Guidelines: improving the quality. US Department of Health and Human Services, 1996.

3. Gross PA. Practice guidelines for infectious diseases: rationale for a work in progress. Clin Infect Dis 1998; 26:1037-41.

4. Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA 1999; 281:1900-5.

5. Hadorn DC, McCormick K, Diohno A. An annotated algorithm approach to clinical guideline development. JAMA 1992; 267:3311-4.

6. Agency for Health Care Policy and Research. Using clinical practice guidelines to evaluate quality of care. Agency for Health Care Policy and Research publications 95-0045 (Vol. 1) and 95-0046 (Vol. 2).Washington, DC: US Department of Health and Human Services, 1995.

Table 1. Recommended timeline for evidence base development

Table 2. System for ranking recommendations in clinical evidence bases

Future Plans

• Continue to monitor our publications for quality. Involve committee members more in this effort.
• Work with the editor and publisher to improve the impact score of JTM.
• Constitute and convene the Evidence Base Task Force, prioritize topics for development of evidence bases, and constitute and charge the first evidence base writing panel shortly thereafter.

Please feel free to share your ideas or concerns with the Publications Committee. You may direct them to the chair, Charlie Ericsson, at Charles.D.Ericsson@uth.tmc.edu.