Therefore, areas with insufficient evidence where randomized trials can be conducted to improve the evidence base should find more be identified for development. In using the AGREE II guideline assessment tool for assessing methodological rigor and transparency, we identified both global and domain-specific improvements in guideline quality from documents created from 1998 to 2012. The current AASLD guidelines appear either comparable or superior by AGREE II evaluation

with other medical specialties both nationally and globally that have undergone similar evaluation.[40-42] This assessment demonstrates the AASLD’s commitment on continued review of its recommendations along with improving the overall quality of its published guidelines for clinical use. On AGREE II evaluation, the greatest percentage of improvement in the six different domains was found in editorial independence, although its performance was the least impressive among domains assessed by this evaluation. This domain relates to the formulation of recommendations not being unduly biased with competing interests. This measure exemplifies how conflict of interest

has become a major issue in the development of practice guidelines, especially when 40% of recommendations within the current AASLD guidelines require MAPK Inhibitor Library input from expert clinicians (as shown by the number of grade III recommendations). Thus, in accordance with the findings of the IOM’s recommendations,[4] the AASLD has developed and revised a detailed policy acetylcholine for assessing conflict of interest in identifying writing group members for current guidelines being developed and revised, which has reduced the potential effects of bias in these documents. However, there will continue to be room for improvement with future guidelines. In this analysis, the greatest increases in the overall number of recommendations were from practice guidelines related to HBV, liver transplantation,

and AIH. Given that there are an estimated 350 million persons worldwide infected with HBV where the risk for cirrhosis and hepatocellular carcinoma is measurable, it is reasonable to expect that a large volume of research is performed in this area.[27] Extensive research of HBV has resulted in a wide array of tools at the clinician’s disposal: diagnostic tests for evaluation and monitoring of disease, vaccination to decrease future prevalence of disease, and multiple treatment modalities including interferon and nucleos(t)ide analogs. These observations coincide temporally with current HBV practice guidelines containing the greatest increases in grade I recommendations overall and the greatest increase in the number of treatment recommendations.