{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T23:41:31Z","timestamp":1777074091950,"version":"3.51.4"},"reference-count":46,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":113,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int Arch Otorhinolaryngol"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Developing region-specific clinical practice guidelines (CPGs) for ear, nose, and throat (ENT) diseases is crucial in Pakistan's primary care, given their significant contribution to clinical cases, aiming to enhance healthcare standards through evidence-based practices with local adaptations.<\/jats:p>\n                  <jats:p>To ensure the standardization of primary healthcare and reduce unnecessary specialist referrals by creating CPGs that are appropriate to our region.<\/jats:p>\n                  <jats:p>We selected eight guidelines regarding epistaxis, neck masses, hearing loss, M\u00e9ni\u00e8re's disease, dysphonia, allergic rhinitis, acute otitis externa, and rhinosinusitis from the American Academy of Otolaryngology\u2013Head and Neck Surgery Foundation as the source guidelines, and employed the Grading of Recommendations, Assessment, Development, and Evaluation\u2013Adoption, Adaptation, and De Novo Development (GRADE-ADOLOPMENT) approach to contextualize guidelines by adopting, adapting, or excluding recommendations from them. Clinical-referral algorithms were created using recommendations from the CPGs created, with additional recommendations sought through a best-evidence review process.<\/jats:p>\n                  <jats:p>We developed local CPGs for eight ENT conditions using the GRADE-ADOLOPMENT approach. While most recommendations were adopted in the local CPGs, one recommendation for acute otitis externa, hearing loss, and epistaxis and two for allergic rhinitis were adopted with minor changes. Six recommendations were excluded due to service limitations in Pakistan. Additionally, we created 8 clinical-referral algorithms, incorporating 17 additional recommendations to address gaps in practice, distributed across various conditions.<\/jats:p>\n                  <jats:p>The newly-established CPGs are instrumental in delivering standardized, high-quality care at the primary care level. Simultaneously, the development of clinical referral pathways empowers general physicians to manage patients effectively and make timely, appropriate referrals to ENT specialists.<\/jats:p>","DOI":"10.1055\/s-0046-1818583","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T23:09:08Z","timestamp":1777072148000},"page":"001-009","source":"Crossref","is-referenced-by-count":0,"title":["Development of Clinical Practice Guidelines and Primary Care Referral Pathways for the Management of Otorhinolaryngological Conditions in Pakistan"],"prefix":"10.1055","volume":"30","author":[{"given":"Alina","family":"Pervez","sequence":"additional","affiliation":[{"name":"Center for Clinical Best Practices (CCBP), Clinical and Translational Research Incubator (CITRIC), Medical College, Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Russell Seth","family":"Martins","sequence":"additional","affiliation":[{"name":"Center for Clinical Best Practices (CCBP), Clinical and Translational Research Incubator (CITRIC), Medical College, Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huzaifa","family":"Moiz","sequence":"additional","affiliation":[{"name":"Section of Otolaryngology, Head and Neck Surgery, Department of Surgery, Medical College, Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abbas Raza","family":"Syed","sequence":"additional","affiliation":[{"name":"Medical College, Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muneeb","family":"Khan","sequence":"additional","affiliation":[{"name":"Section of Otolaryngology, Head and Neck Surgery, Department of Surgery, Medical College, Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nashia Ali","family":"Rizvi","sequence":"additional","affiliation":[{"name":"Center for Clinical Best Practices (CCBP), Clinical and Translational Research Incubator (CITRIC), Medical College, Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohsin Ali","family":"Mustafa","sequence":"additional","affiliation":[{"name":"Center for Clinical Best Practices (CCBP), Clinical and Translational Research Incubator (CITRIC), Medical College, Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8499-2582","authenticated-orcid":false,"given":"Muhammad Taha","family":"Nasim","sequence":"additional","affiliation":[{"name":"Medical College, Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alina Abdul","family":"Rehman","sequence":"additional","affiliation":[{"name":"Center for Clinical Best Practices (CCBP), Clinical and Translational Research Incubator (CITRIC), Medical College, Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shayan","family":"Khalid","sequence":"additional","affiliation":[{"name":"Section of Otolaryngology, Head and Neck Surgery, Department of Surgery, Medical College, Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saif Ur","family":"Rehman","sequence":"additional","affiliation":[{"name":"Medical College, Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Nadeem","sequence":"additional","affiliation":[{"name":"Center for Clinical Best Practices (CCBP), Clinical and Translational Research Incubator (CITRIC), Medical College, Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adil H.","family":"Haider","sequence":"additional","affiliation":[{"name":"Medical College, Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shabbir","family":"Akhtar","sequence":"additional","affiliation":[{"name":"Section of Otolaryngology, Head and Neck Surgery, Department of Surgery, Medical College, Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"publisher","first-page":"411","DOI":"10.4314\/njm.v14i4.37199","article-title":"Spectrum of otorhinolaryngology emergencies in the elderly in Ibadan, Nigeria","volume":"14","author":"T S Ibekwe","year":"2005","journal-title":"Niger J 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