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The Semmelweis Framework: structuring evidence foundations and expert opinion in clinical practice guidelines
Blin Nagavci1, Margaret Renn Andrews2,3, Jens Vikse4,5,6
1Doctoral School of Clinical Medicine, Semmelweis University, Budapest, Hungary. dr.bnagavci@gmail.com.
BMC Medical Research Methodology
|July 18, 2026
Summary
The Semmelweis Framework standardizes expert opinion in clinical guidelines by classifying recommendations based on evidence. This structured approach enhances transparency and integrity when evidence is limited.
Area of Science:
- Clinical practice guideline development
- Health research methodology
Background:
- Expert opinion is crucial in guideline development when evidence is scarce.
- Unstandardized use of expert opinion presents a methodological gap.
- The Semmelweis Framework aims to structure expert opinion in guidelines.
Purpose of the Study:
- To develop a methodological tool for structuring expert opinion in clinical practice guidelines.
- To address the gap in guideline methodology regarding the use of expert opinion.
- To provide a standardized approach for incorporating expert judgment when evidence is limited.
Main Methods:
- Developed the Semmelweis Framework through a stepwise process.
- Conducted a meta-epidemiological study of expert opinion use in 2,296 recommendations.
- Performed a methodological review of 98 guideline manuals and refined the framework through expert application and checklist development.
Main Results:
- The Semmelweis Framework classifies recommendations into four classes based on evidentiary foundation.
- Introduced a Preconditions Checklist to ensure integrity and transparency.
- Standardized communication through fixed verbs and notations, redefining the role of "expert opinion".
Conclusions:
- The Semmelweis Framework reframes and structures the use of expert opinion in clinical guidelines.
- Addresses a long-standing methodological gap by introducing safeguards and new recommendation classes.
- Enhances the integrity and transparency of guidelines relying on expert judgment.
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