\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[english]{babel}



\usepackage{float}








\begin{document}

\title{How to create local national clinical guidelines in Libya?}



\author[1]{Anis Abobaker}%
\author[2]{Aboubaker Alzwi}%
\author[3]{Hamdi Hussien}%
\affil[1]{Spire Fylde Coast Hospital}%
\affil[2]{7th of October Hospital}%
\affil[3]{Benghazi Medical Center}%


\vspace{-1em}



  
  \date{May 21, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
In this letter we will discuss the reasons why there is no national
medical guidelines in Libya, and we will provide suggestions on how to
create local national clinical guidelines to improve the quality of
healthcare in Libya.%
\end{abstract}%



\sloppy


\textbf{}Dear Editor

The clinical guidelines provide guidance and recommendations for
healthcare professionals based on the best available evidences {[}1{]}.
They optimise the quality of the clinical care by reducing the
variations in practice across different clinical settings {[}2-3{]}.
They also improve the diagnostic accuracy and the effectiveness of the
medical treatment by guiding the medical management based on evidences
obtained from high quality resources {[}2{]}. Therefore, it is of
paramount importance to have national clinical guidelines to improve and
maintain a high quality of care delivered by the healthcare system. In
Libya for instance, despite having local hospital protocols, still there
are no formulated clinical guidelines at a national level. In this
correspondence, we will discuss the possible reasons for this, and we
will provide suggestions to create local clinical guidelines in Libya.

There are few possible reasons which could explain why there are no
local clinical guidelines in Libya. First of all, most of specialists
and consultants have different training backgrounds. In addition to
their local training in Libya, they trained in other countries, such as
the United Kingdom, France, Germany, Canada, Australia, Egypt and the
united states. Each consultant uses different management protocols based
on their previous training backgrounds, which could explain the
variation in practice between different departments and hospitals across
the country. Secondly, there are no well-established medical
associations and societies in many medical specialities. This leads to
lack of collaborative work, national meetings and arrangements between
specialists working in different healthcare settings. The last possible
reason is that the underdeveloped scientific infrastructure and lack of
resources and sufficient fund available for conducting clinical research
limit the ability to retrieve scientific evidences to develop national
guidance and recommendations.

We would like to provide few suggestions which might help to create
local clinical guidelines in Libya. The first suggested approach is by
arrangement of regular meetings between the experts in a particular
field at a national level. During these meetings, a topic of interest
will be picked up and discussed so that the important questions related
to the topic will be addressed and answered. After this step, a group of
volunteers from different medical backgrounds and expertise analyse the
available evidences in the published literature by conducting a
systematic review to retrieve the best available evidences. Once the
evidences are available, the national guidelines and recommendations can
be written. Although that this approach is comprehensive, the process is
long and takes several months to be finalised {[}4{]}. Due to lack of
local available resources to conduct research and systematic review, an
alternative approach can be used. We can rely on the existing
international guidelines which can be adapted and modified to be used
locally. This approach has been successfully implemented in Saudi Arabia
{[}3{]}

In conclusion, the creation of local national guidelines in Libya
require efforts exerted at both individual and national levels. Special
emphasis is needed to improve the scientific research infrastructure by
providing sufficient fund and resources.

\textbf{Reference}

1- Clinical Practice Guideline Manual {[}Internet{]}. Aafp.org. 2020
{[}cited 12 May 2020{]}. Available from:
https://www.aafp.org/patient-care/clinical-recommendations/cpg-manual.html

2- Rosenfeld R, Shiffman R. Clinical Practice Guideline Development
Manual: A Quality-Driven Approach for Translating Evidence into Action.
Otolaryngology--Head and Neck Surgery. 2009;140(6\_suppl):S1-S43.

3- Saudi Arabian Handbook for Healthcare Guideline Development
{[}Internet{]}. The Saudi Center for Evidence Based Health Care. 2014
{[}cited 12 May 2020{]}. Available from:
http://106.14.139.22/uploadfile/2016/0914/20160914051852300.pdf

4- What is a medical guideline, and how is it created? {[}Internet{]}.
www.heart.org. 2020 {[}cited 12 May 2020{]}. Available from:
https://www.heart.org/en/news/2018/11/10/what-is-a-medical-guideline-and-how-is-it-created?fbclid=IwAR1OkpjEL-eVP896BbHAn0wuwnniyTGCVVaixkIYSkslK6yo5kY2CXs2zmU

\selectlanguage{english}
\FloatBarrier
\end{document}

