Critical Appraisal of International Clinical Practice Guidelines in Kidney Transplantation Using the Appraisal of Guidelines for Research and Education II Tool: A Systematic Review

Systematic review of methodology and reporting quality of global guidelines on fever in children

OBJECTIVE

This study aimed to evaluate the global clinical practice guidelines on fever in children. We also aimed to select a guideline with good methodology and reporting quality to provide scientific reference for diagnosis and treatment of fever in children.

METHODS

The Chinese and English databases Embase, PubMed, Cochrane library, China National Knowledge Infrastructure, Wanfang database, clinical guides, and the website of the Department of Public Health Administration were retrieved up to January 2020. The clinical practice guidelines on fever in children were included. The AGREE II instrument and Reporting Items for Practice Guidelines in Healthcare statement were used to evaluate the methodology and reporting quality of the guidelines.

RESULTS

Eight clinical guidelines for fever in children were included. Methodological quality assessment showed that the recommendation level of ISP, South Africa, National Institute for Health and Care Excellence, China, and American College of Emergency Physicians were grade B (recommended with modification), while that of American Academy of Pediatrics, New South Wales, and South Australia was grade C recommendation (not recommended). No grade A recommendation guideline was found. The reporting quality from higher to lower was National Institute for Health and Care Excellence, the Chinese guideline, American College of Emergency Physicians, ISP, South Africa, New South Wales, South Australia, and American Academy of Pediatrics. The guideline recommendations were similar in various countries, but they were slightly different in various aspects, including body temperature measurement and the timing of drug administration.

CONCLUSION

There are limitations in the methodology and reporting quality of all eight global guidelines on fever in children. For future development of these guidelines, attention should be paid to improving applicability of the guidelines in terms of methodology. Additionally, the principles and explanations for formation of recommendations should be described, as well as the limitations of the reporting guideline in detail in terms of the reporting quality. Treatments of fever in children are similar in different countries, but there are still differences that require further research.

When evidence is lacking: a mixed-methods approach for the development of practice guidance in liver transplantation

Background

Most interventions for conditions with a small cohort size, such as transplantation, are unlikely to be part of a clinical trial. When condition-specific evidence is lacking, expert consensus can offer more precise guidance to improve care. Management of cardiovascular risk in liver-transplant recipients is one example for which clinicians have, to date, adapted evidence-based guidelines from studies in the general population. However, even when consensus is achieved, implementation of practice guidance is often inadequate and protracted. We report on a novel mixed-methods approach, the Northwestern Method©, for the development of clinical-practice guidance when condition-specific evidence is lacking. We illustrate the method through the development of practice guidance for managing cardiovascular risk in liver-transplant recipients.

Methods

The Northwestern Method© consists of (i) adaptation of relevant, existing, evidence-based clinical-practice guidelines for the target population; (ii) consensus by experts of the proposed practice guidance; (iii) identification of barriers to guidance adherence in current practice; and (iv) recommendation for implementation and dissemination of the practice guidance. The method is based on an iterative, user-centered approach in which the needs, wants, and limitations of all end users, including patients, are attended to at each stage of the design and development process.

Conclusions

The Northwestern Method© for clinical-practice-guidance development uses a mixed-methods approach to bring together broad representation from multiple disciplines and practice settings to develop consensus considering the unique needs and preferences of patients, caregivers, and practitioners who are directly impacted by clinical-practice-guidance recommendations. We hypothesize that a priori involvement of end users in the guidance-development process will lead to sustainable implementation of guidance statements into clinical practice.

Characteristics and quality of clinical practice guidelines for depression in adults: a scoping review

BACKGROUND

Clinical Practice Guidelines (CPGs) should follow an adequate methodology using an evidence-based approach in order to provide reliable recommendations. However, little is known regarding the quality of CPGs for Depression, which precludes its adequate use by stakeholders and mental health professionals. Thus, the aim of this study was to conduct a scoping review to describe the characteristics and quality of CPGs for Depression in adults.

METHODS

We searched CPGs for Depression in adults in eighteen databases. We included those that were published in English or Spanish between January 2014 and May 2018 and were based on systematic reviews of the evidence. Two independent authors extracted the characteristics, type and number of recommendations, and quality (using the Appraisal of Guidelines for Research and Evaluation-II [AGREE-II]) of each included CPG.

RESULTS

We included eleven CPGs, of which 9/11 did not include the participation of patients in the development of the CPG, 4/11 CPGs had a score ≥ 70% in the overall evaluation of AGREE-II, and 3/11 CPGs had a score ≥ 70% in its third domain (rigor of development). In addition, only 5/11 CPGs shared their search strategy, while only 4/11 listed the selected studies they used to reach recommendations, and 7/11 CPGs did not clearly state which methodology they used to translate evidence into a recommendation.

CONCLUSIONS

Most of evaluated CPGs did not take into account the patient's viewpoints, achieved a low score in the rigor of development domain, and did not clearly state the process used to reach the recommendations. Stakeholders, CPCGs developers, and CPGs users should take this into account when choosing CPGs, and interpreting and putting into practice their issued recommendations.

A critical appraisal of the quality of head and neck cancer imaging guidelines using the AGREE II tool: A EuroAIM initiative

Background

Diagnostic imaging guidelines are increasingly embraced in oncologic imaging in order to improve examinations appropriateness and technical quality. The usefulness of guidelines employment in clinical practice is dramatically related to the quality of the guidelines themselves. However, an extreme variability in guidelines’ quality may occur. Following a European Network for the Assessment of Imaging in Medicine (EuroAIM) initiative, the aim of this study was to assess the quality of the available guidelines regarding head and neck cancer (HNC) imaging.

Methods

A literature search was conducted to identify imaging guidelines focused on HNC. Selected guidelines were evaluated by four independent appraisers using the Appraisal of Guidelines for Research & Evaluation version 2.0 (AGREE II) tool, which comprises 23 key items, rated on a 7‐point scale (1—strongly disagree to 7—strongly agree) and organized within six domains. For each domain, the intraclass correlation coefficient (ICC) was used to assess the agreement among appraisers’ scores.

Results

After literature search, three guidelines were selected and evaluated. One guideline scored “average” as overall quality, while the remaining two scored a “low” overall quality. The highest result (total score = 75.0% ± 19.3%) was obtained in domain 4 (Clarity of presentation) while the lowest (total score = 27.1% ± 4.2%) in domain 6 (Editorial independence). ICC analysis showed a very good agreement (range: 0.932‐0.961) among the four appraisers.

Conclusions

Our results showed a heterogeneous quality of existing guidelines in HNC imaging. Issues raised from this appraisal should be considered when developing future guidelines on HNC imaging.