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DYSCERNE: developing clinical management guidelines for selected dysmorphic syndromes

  • Pam Griffiths1Email author,
  • Kate Strong1,
  • Sara Gardner1,
  • Ruth Day1,
  • Caroline Harrison1,
  • Kerr Bronwyn1,
  • Kay Metcalfe1,
  • Han Brunner3,
  • Dian Donnai1,
  • Bruno Dallapiccola4,
  • Koenraad Devriendt2,
  • Malgorzata Krajewska-Walasek6,
  • Nicole Philip5 and
  • Jill Clayton-Smith1
Orphanet Journal of Rare Diseases20105(Suppl 1):P20

Published: 19 October 2010


Group LeaderManagement GuidelineConsensus MeetingSystematic Literature SearchInternational Dissemination

The DYSCERNE Network of Centres of Expertise for dysmorphology (, is developing clinical management guidelines for Williams (WS), Angelman (AS), Noonan (NS) and Kabuki (KS) syndromes. An initial scoping exercise identified these conditions as rare, complex, multi-system disorders, for which it was felt that affected patients, families and health/social care professionals would benefit from access to up-to-date evidence based management guidelines.

Published evidence from which to develop management recommendations for these conditions is very limited, and devising a systematic and robust methodology has been challenging. Our approach is based on the Scottish Intercollegiate Guidelines Network (SIGN) method, which we modified placing more emphasis on expert opinion and consensus, whilst maintaining systematic rigour and transparency of processes.

The development process includes:

- Identification of key management issues by guideline group leaders.

- Targeted, systematic literature searches using PubMed.

- Review, identification and grading of results by panel of invited experts.

- Consensus meetings at which experts present, discuss and agree recommendations.

- Initial drafting of guideline document which is circulated amongst experts and stakeholders for comments.

- Amendments incorporated and guidelines finalised.

- Guidelines piloted and evaluated.

- International dissemination.

The process has involved 49 experts from 8 countries reviewing between them, over 1000 papers. The WS guidelines are currently being piloted in 20 centres, by paediatricians and geneticists. The first draft of AS guidelines has been circulated for feedback. Consensus meetings for NS and KS will be held very shortly. The finished guidelines will be available from the DYSCERNE website.

Authors’ Affiliations

University of Manchester, The Nowgen Centre, University of Manchester, UK
Center for Human Genetics, Leuven, Belgium
Department of Human Genetics 417, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
Istituto C.S.S. MENDEL, Unita’ di Neurogenetica, Roma, Italy
Département de Génétique Médicale, Hôpital de la Timone Enfant, Marseille, France
Department of Medical Genetics, The Children's Memorial Health Institute, Warsaw, Poland


© Griffiths et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.