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Graham ND, Graham ID, Vanderspank-Wright B, Varin MD, Nadalin Penno L, Fergusson DA, Squires JE. A systematic review and critical appraisal of guidelines and their recommendations for sedation interruptions in adult mechanically ventilated patients. Aust Crit Care 2023; 36:889-901. [PMID: 36522246 DOI: 10.1016/j.aucc.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The objectives of the review were to (i) assess the methodological quality of all accessible and published guidelines and care bundles that offer a recommendation related to sedation interruptions, using the AGREE-II instrument, to (ii) determine what is the recommended best practice for sedation interruptions from the available guidelines, and then to have (iii) a closer inspection of the overall credibility and applicability of the recommendations using the AGREE-REX instrument. This review will benefit the outcomes of critically ill patients and the multidisciplinary team responsible for the care of mechanically ventilated adults with continuous medication infusions by providing a synthesis of the recommended action(s), actor(s), contextual information, target(s), and timing related to sedation interruptions from current best practice. REVIEW METHOD USED We conducted a systematic review. DATA SOURCES We applied a peer-reviewed search strategy to four electronic databases from 2010 to November 2021-MEDLINE, CINAHL, Embase, and The Cochrane Database of Systematic Reviews-and included grey literature. REVIEW METHOD Findings are reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses checklist. We assessed overall quality using the validated Appraisal of Guidelines for Research and Evaluation II and AGREE Recommendation Excellence tools. RESULTS We identified 11 clinical practice guidelines and care bundles comprising 15 recommendations related to sedation interruption. There are three key findings: (i) deficiencies exist with the methodological quality of included guidelines, (ii) sedation interruption is recommended practice for the care of adult mechanically ventilated patients, and (iii) the current evidence is of low quality, which impacts overall credibility and applicability of the recommendations. CONCLUSIONS Sedation interruptions are currently best practice for adult mechanically ventilated patients; however, the available guidelines and recommendations have several deficiencies. Future research is needed to further understand the role of the nurse and other actors to enact this practice.
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Affiliation(s)
- Nicole D Graham
- University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, P.O. Box 711, Ottawa ON, K1H 8L6, Canada; Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Brandi Vanderspank-Wright
- University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Melissa Demery Varin
- University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Letitia Nadalin Penno
- University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, P.O. Box 711, Ottawa ON, K1H 8L6, Canada; Department of Medicine, University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, P.O. Box 711, Ottawa ON, K1H 8L6, Canada.
| | - Janet E Squires
- University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, P.O. Box 711, Ottawa ON, K1H 8L6, Canada.
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Babiker Mohamed MA, El-Malky AM, Abdelkarim WAA, Abdulmonem Salih Aabdeen M, Hassan Elobid Ahmed T, Sarsour HHH, Mohammed Mosa M, Amer YS, Khormi AAM, Alajlan A. Evidence-based clinical practice guidelines for the management of psoriasis: systematic review, critical appraisal, and quality assessment with the AGREE II instrument. J DERMATOL TREAT 2022; 33:2771-2781. [PMID: 35737878 DOI: 10.1080/09546634.2022.2083545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/22/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Psoriasis is considered one of the stubborn lifelong dermatologic diseases, making the patients seized in their social cage. Evidence-based clinical practice guidelines (CPGs) and expert opinions ensure that patients with psoriasis render the most recent and developed care. This systematic review assessed and compared the most recently approved international CPGs with the AGREE II instrument. METHODS After we identified our research question, we searched the bibliographic international databases to identify and screen for relevant and eligible guidelines that address the topic of interest. Four independent reviewers (Senior Expert Dermatologist in Psoriasis) have critically appraised the selected guidelines via the AGREE II instrument. We conducted inter-rater analysis and percent agreement among raters and calculation of intra-class correlation coefficient (ICC) 'Kappa'. RESULTS Out of 33 articles for CPGs, only Four eligible CPGs fulfill the inclusion criteria. Selected CPGs were critically appraised; first from the American College of Rheumatology that is also National Psoriasis Foundation (ACR/NPF-2018), second from the UK's National Institute for Health and Care Excellence (NICE-2017) for Psoriasis: Assessment and Management, third from the Saudi practical guidelines on the biologic treatment for Psoriasis (Saudi CPGs, 2015), and lastly from the American Academy of Dermatology (AAD/NPF-2019) Management and Treatment of Psoriasis with Awareness and Attention to Comorbidities. The complete assessments (OA) of two CPGs (AAD/NPF and NICE) scored greater than 80%; 'six domains' of AGREE II had greater score that is congruent with results; (1) scope and motive, (2) shareholder involvement, (3) rigor of growth, (4) clarity of speech, (5) validity, and (6) journalistic independence domains. Domain (3) scored (84, 71, and 90%), domain (5) (51%, 47, and 90%), domain (6) (70, 52, and 90%) for (Saudi CPGs, AAD/NPF, and NICE), respectively. Generally, the clinical recommendations were significantly better for NICE CPGs. CONCLUSIONS Four evidence-based 'CPGs' introduced a high-quality methodological analysis. NICE indicated the greatest quality followed by Saudi CPGs and AAD/NPF and all four CPGs were suggested for practice.
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Affiliation(s)
| | - Ahmed M El-Malky
- Public Health and Community Medicine Department, Theodor Bilharz Research Institute, Academy of Scientific Research, Ministry of Higher Education, Cairo, Egypt
- Morbidity and Mortality Review Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | | | - Munirah Mohammed Mosa
- College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yasser S Amer
- Pediatric Department, King Khalid University Hospital, Riyadh, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Quality Management Department, Clinical Practice Guidelines and Quality Research Unit, King Saud University Medical City, Riyadh, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
- Adaptation Working Group, Guidelines International Network, Perth, Scotland
| | - Abdulrahman Ali M Khormi
- Internal Medicine and Rheumatology - Prince Sattam University Medical College, Al-Kharj, Saudi Arabia
| | - Abdulmajeed Alajlan
- Dermatology Department, Faculty of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Amer YS, Alenezi S, Bashiri FA, Alawami AH, Alhazmi AS, Aladamawi SA, Alnemary F, Alqahtani Y, Buraik MW, AlSuwailem SS, Akhalifah SM, Augusta de Souza Pinhel M, Penner M, Elmalky AM. AGREEing on Clinical Practice Guidelines for Autism Spectrum Disorders in Children: A Systematic Review and Quality Assessment. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1050. [PMID: 35884034 PMCID: PMC9323940 DOI: 10.3390/children9071050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a multifaceted neurodevelopmental disorder requiring multimodal intervention and an army of multidisciplinary teams for a proper rehabilitation plan. Accordingly, multiple practice guidelines have been published for different disciplines. However, systematic evidence to detect and intervene must be updated regularly. Our main objective is to compare and summarize the recommendations made in the clinical practice guidelines (CPGs) for ASD in children released from November 2015 to March 2022. METHODS CPGs were subjected to a systematic review. We developed the inclusion and exclusion criteria and health-related questions, then searched and screened for CPGs utilizing bibliographic and CPG databases. Each of the CPGs used in the study were critically evaluated using the Appraisal of Guidelines for REsearch and Evaluation II (AGREE II) instrument. In a realistic comparison table, we summarized the recommendations. RESULTS Four eligible CPGs were appraised: Australian Autism CRC (ACRC); Ministry of Health New Zealand (NZ); National Institute for Health and Care Excellence (NICE); and Scottish Intercollegiate Guidelines Network, Healthcare Improvement Scotland (SIGN-HIS). The overall assessments of all four CPGs scored greater than 80%; these findings were consistent with the high scores in the six domains of AGREE II, including: (1) scope and purpose, (2) stakeholder involvement, (3) rigor of development, (4) clarity of presentation, (5) applicability, and (6) editorial independence domains. Domain (3) scored 84%, 93%, 86%, and 85%; domain (5) 92%, 89%, 54%, and 85%; and domain (6) 92%, 96%, 88%, and 92% for ACRC, NICE, NZ, and SIGN-HIS, respectively. Overall, there were no serious conflicts between the clinical recommendations of the four CPGs, but some were more comprehensive and elaborative than others. CONCLUSIONS All four assessed evidence-based CPGs demonstrated high methodological quality and relevance for use in practice.
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Affiliation(s)
- Yasser S. Amer
- Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, Riyadh 11451, Saudi Arabia
- Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh 11451, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh 11451, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria 5424041, Egypt
- Guidelines International Network, Perth PH16 5BU, Scotland, UK
| | - Shuliweeh Alenezi
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Fahad A. Bashiri
- Pediatric Neurology Division, Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Amel Hussain Alawami
- Johns Hopkins Aramco Healthcare, Dhahran 34465, Saudi Arabia; (A.H.A.); (M.W.B.)
| | - Ayman Shawqi Alhazmi
- Developmental Pediatric Department, Children’s Hospital, King Saud Medical City, Ministry of Health, Riyadh 12746, Saudi Arabia;
| | - Somayyah A. Aladamawi
- King Abdullah bin Abdulaziz University Hospital, Riyadh 11564, Saudi Arabia;
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
| | - Faisal Alnemary
- Autism Center of Excellence, Riyadh 11564, Saudi Arabia; (F.A.); (S.S.A.); (S.M.A.)
| | | | - Maysaa W. Buraik
- Johns Hopkins Aramco Healthcare, Dhahran 34465, Saudi Arabia; (A.H.A.); (M.W.B.)
| | - Saleh S. AlSuwailem
- Autism Center of Excellence, Riyadh 11564, Saudi Arabia; (F.A.); (S.S.A.); (S.M.A.)
| | - Shahad M. Akhalifah
- Autism Center of Excellence, Riyadh 11564, Saudi Arabia; (F.A.); (S.S.A.); (S.M.A.)
| | - Marcela Augusta de Souza Pinhel
- Department of Health Science, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, Brazil;
- Department of Molecular Biology, São José do Rio Preto Medical School, São José do Rio Preto 15090-000, Brazil
| | - Melanie Penner
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada;
- Department of Pediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Ahmed M. Elmalky
- Morbidity and Mortality Unit, King Saud University Medical City, King Saud University, Riyadh 11451, Saudi Arabia;
- Public Health and Community Medicine Department, Theodor Bilharz Research Institute (TBRI), Academy of Scientific Research, Cairo 3863130, Egypt
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Hussein H, Montesinos-Guevara C, Abouelkheir M, Brown RS, Hneiny L, Amer YS. Quality appraisal of antibiotic prophylaxis guidelines to prevent infective endocarditis following dental procedures: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:562-572. [DOI: 10.1016/j.oooo.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022]
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Meoli A, Ciavola L, Rahman S, Masetti M, Toschetti T, Morini R, Dal Canto G, Auriti C, Caminiti C, Castagnola E, Conti G, Donà D, Galli L, La Grutta S, Lancella L, Lima M, Lo Vecchio A, Pelizzo G, Petrosillo N, Simonini A, Venturini E, Caramelli F, Gargiulo GD, Sesenna E, Sgarzani R, Vicini C, Zucchelli M, Mosca F, Staiano A, Principi N, Esposito S. Prevention of Surgical Site Infections in Neonates and Children: Non-Pharmacological Measures of Prevention. Antibiotics (Basel) 2022; 11:antibiotics11070863. [PMID: 35884117 PMCID: PMC9311619 DOI: 10.3390/antibiotics11070863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 12/04/2022] Open
Abstract
A surgical site infection (SSI) is an infection that occurs in the incision created by an invasive surgical procedure. Although most infections are treatable with antibiotics, SSIs remain a significant cause of morbidity and mortality after surgery and have a significant economic impact on health systems. Preventive measures are essential to decrease the incidence of SSIs and antibiotic abuse, but data in the literature regarding risk factors for SSIs in the pediatric age group are scarce, and current guidelines for the prevention of the risk of developing SSIs are mainly focused on the adult population. This document describes the current knowledge on risk factors for SSIs in neonates and children undergoing surgery and has the purpose of providing guidance to health care professionals for the prevention of SSIs in this population. Our aim is to consider the possible non-pharmacological measures that can be adopted to prevent SSIs. To our knowledge, this is the first study to provide recommendations based on a careful review of the available scientific evidence for the non-pharmacological prevention of SSIs in neonates and children. The specific scenarios developed are intended to guide the healthcare professional in practice to ensure standardized management of the neonatal and pediatric patients, decrease the incidence of SSIs and reduce antibiotic abuse.
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Affiliation(s)
- Aniello Meoli
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Lorenzo Ciavola
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Sofia Rahman
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Marco Masetti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Tommaso Toschetti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Riccardo Morini
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Giulia Dal Canto
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Cinzia Auriti
- Neonatology and Neonatal Intensive Care Unit, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy;
| | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Giannina Gaslini, 16147 Genoa, Italy;
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy;
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy;
| | - Luisa Galli
- Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
| | - Stefania La Grutta
- Institute of Translational Pharmacology IFT, National Research Council, 90146 Palermo, Italy;
| | - Laura Lancella
- Paediatric Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Mario Lima
- Pediatric Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
| | - Gloria Pelizzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy;
| | - Nicola Petrosillo
- Infection Prevention and Control—Infectious Disease Service, Foundation University Hospital Campus Bio-Medico, 00128 Rome, Italy;
| | - Alessandro Simonini
- Pediatric Anesthesia and Intensive Care Unit, Salesi Children’s Hospital, 60123 Ancona, Italy;
| | - Elisabetta Venturini
- Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
| | - Fabio Caramelli
- Pediatric Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Gaetano Domenico Gargiulo
- Department of Cardio-Thoracic and Vascular Medicine, Adult Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Enrico Sesenna
- Maxillo-Facial Surgery Unit, Head and Neck Department, University Hospital of Parma, 43126 Parma, Italy;
| | - Rossella Sgarzani
- Servizio di Chirurgia Plastica, Centro Grandi Ustionati, Ospedale M. Bufalini, AUSL Romagna, 47521 Cesena, Italy;
| | - Claudio Vicini
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Piertoni Hospital, 47121 Forli, Italy;
| | - Mino Zucchelli
- Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40138 Bologna, Italy;
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Mother, Child and Infant, 20122 Milan, Italy;
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
| | | | - Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
- Correspondence: ; Tel.: +39-0521-903524
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Babiker Mohamed MA, Abdelwahab Abdelkarim WA, Salih Aabdeen MA, Elobid Ahmed TH, Sarsour HH, El-Malky AM, Amer YS, alsaleh N, Nazer RI. Evidence-based clinical practice guidelines for the management of perioperative hypothermia: Systematic review, critical appraisal, and quality assessment with the AGREE II instrument. Ann Med Surg (Lond) 2022; 79:103887. [PMID: 35860110 PMCID: PMC9289222 DOI: 10.1016/j.amsu.2022.103887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/23/2022] [Accepted: 05/29/2022] [Indexed: 11/12/2022] Open
Abstract
Inadvertent perioperative hypothermia is considered an emergency life-threatening situation. Clinical practice guidelines (CPGs) on how to manage hypothermia, based on evidence and expert opinions, could save lives. This systematic review assessed and compared the most recently approved international CPGs with the AGREE II instrument. We searched international bibliographic databases to identify relevant guidelines for managing perioperative hypothermia. Four independent reviewers (consultant anesthesiologists) critically appraised the selected guidelines with the AGREE II instrument. We analyzed inter-rater agreement and calculated an intra-class correlation coefficient (Kappa). We identified five CPGs for perioperative hypothermia that were eligible for critical appraisal. These CPGs were issued by the National Institute for Health and Care Excellence (NICE-2016); the American Society of Peri-Anesthesia Nurses/Agency for Health Care Research and Quality (ASPAN/AHRQ-2006); the University of Southern Mississippi (USM/CPG-2017); The University Assistance Complex of Salamanca (UACS/CPG-2018); and the Justus-Liebig University of Giessen (UKGM/CPG-2015). The overall assessments of NICE-2016 and ASPAN/AHRQ-2006 scored >80%. These results were consistent with high scores achieved in the six domains of AGREE II: (1) scope and purpose, (2) stakeholder involvement, (3) rigor of development, (4) clarity of presentation, (5) applicability, and (6) editorial independence domains. The NICE-2016, ASPAN/AHRQ-2006, and USM/CPG-2017) scored, respectively, 94%, 81%, and 70% for domain 3, 91%, 87%, and 66% for domain 5, and 90%, 82%, and 77% for domain 6. Generally, the NICE CPGs received significantly better clinical recommendations. However, all five evidence-based CPGs were of high methodological quality and were recommended for use in practice. Saudi Arabia should formulate its own national CPGs for diagnosis and management of perioperative hypothermia and to be published on NICE. Guidance for adapting CPGs to a given clinical practice is a realistic, practical alternative to de novo CPG development, which is a time-consuming and resource-intensive approach. Some nations, particularly those with low- and middle-income economies, have chosen to employ CPG adaptation, rather than developing new evidence-based practice programs. Several formal adaptation approaches are currently available, and they may be tailored further to suit particular circumstances. Evaluations like the one described in the present study should provide guidance for appropriate CPG adaptation or development efforts, particularly for organizations with little expertise with the AGREE II instrument. The current critical appraisal emphasized the importance of clinicians performing quality assessments of CPGs to ensure transparency and strength in the CPG development process, in accordance with international CPG standards. Moreover, our findings will support the provision of best practices for POH. Based on our findings, we propose that anesthesiologists should include an AGREE II review of CPGs in their capacity development strategies.
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Alhasan KA, Al Khalifah R, Aloufi M, Almaiman W, Hamad M, Abdulmajeed N, Al Salloum A, Kari JA, AlJelaify M, Bassrawi RK, Al Hussain T, Alherbish A, Al Talhi A, Temsah MH, Sethi SK, Raina R, Joseph R, Amer YS. AGREEing on clinical practice guidelines for idiopathic steroid-sensitive nephrotic syndrome in children. Syst Rev 2021; 10:144. [PMID: 33971949 PMCID: PMC8112064 DOI: 10.1186/s13643-021-01666-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 04/05/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Nephrotic syndrome is the most common kidney disease in children worldwide. Our aim was to critically appraise the quality of recent Clinical Practice Guidelines (CPGs) for idiopathic steroid-sensitive nephrotic syndrome (SSNS) in children in addition to summarize and compare their recommendations. METHODS Systematic review of CPGs. We identified clinical questions and eligibility criteria and searched and screened for CPGs using bibliographic and CPG databases. Each included CPG was assessed by four independent appraisers using the Appraisal of Guidelines for REsearch & Evaluation II (AGREE-II) instrument. We summarized the recommendations in a comparison practical table. RESULTS Our search retrieved 282 citations, of which three CPGs were eligible and appraised: Kidney Disease: Improving Global Outcomes (KDIGO) 2012, Japan Society for Pediatric Nephrology (JSPN) 2014, and American Academy of Pediatrics (AAP) 2009. Among these, the overall assessment of two evidence-based CPGs scored > 70% (KDIGO and JSPN), which was consistent with their higher scores in the six domains of the AGREE II Instrument. In domain 3 (rigor of development), KDIGO, JSPN, and AAP scored 84%, 74%, and 41%, respectively. In domain 5 (applicability), they scored 22%, 16%, and 19%, respectively, and in domain 6 (editorial independence), they scored 94%, 65%, and 88%, respectively. CONCLUSIONS The methodological quality of the KDIGO CPG was superior, followed by JSPN and AAP CPGs with the relevant recommendations for use in practice. SYSTEMATIC REVIEW REGISTRATION The protocol was registered in the Center for Open Science (OSF) DOI: 10.17605/OSF.IO/6QTMD and in the International prospective register of systematic reviews PROSPERO 2020 CRD42020197511 .
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Affiliation(s)
- Khalid Abdulaziz Alhasan
- Pediatric Nephrology Unit, Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Saudi Society of Nephrology and Transplantation (SSN&T), Riyadh, Saudi Arabia
| | - Reem Al Khalifah
- Pediatric Endocrinology Unit, Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Majed Aloufi
- Department of Pediatric Nephrology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Weiam Almaiman
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Nephrology Section, Pediatrics Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Muddathir Hamad
- Pediatric Neurology Unit, Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | - Abdullah Al Salloum
- Pediatric Nephrology Unit, Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jameela A Kari
- Pediatric Nephrology Division, Department of Pediatrics, Pediatric Nephrology Center of Excellence Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muneera AlJelaify
- Pharmacy Services Department, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Rolan K Bassrawi
- General Pediatrics Unit, Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Turki Al Hussain
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Adi Alherbish
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulhadi Al Talhi
- Department of Pediatric Nephrology, Pediatrics Hospital, King Saud Medical City, Riyadh, Saudi Arabia.,Imam Mohammed Bin Saud University, Riyadh, Saudi Arabia
| | - Mohamad-Hani Temsah
- Pediatric Intensive Care Unit, Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Rupesh Raina
- Pediatric Nephrology, Akron Children's Hospital, Akron, OH, USA
| | - Reny Joseph
- Ward 11B and Day Care, Pediatrics-Nursing, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yasser Sami Amer
- Pediatrics Department, King Khalid University Hospital, Riyadh, Saudi Arabia. .,Clinical Practice Guidelines Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia. .,Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia. .,Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt.
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Amer YS, Sabr Y, ElGohary GM, Altaki AM, Khojah OT, El-Malky A, Alzahrani MF. Quality assessment of evidence-based clinical practice guidelines for the management of pregnant women with sickle cell disease using the AGREE II instrument: a systematic review. BMC Pregnancy Childbirth 2020; 20:595. [PMID: 33028233 PMCID: PMC7539517 DOI: 10.1186/s12884-020-03241-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/08/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The management of pregnant women with sickle cell disease (SCD) poses a major challenge for maternal healthcare services owing to the potential for complications associated with morbidity and mortality. Trustworthy evidence-based clinical practice guidelines (CPGs) have a major impact on the positive outcomes of appropriate healthcare. The objective of this study was to critically appraise the quality of recent CPGs for SCD in pregnant women. METHODS Clinical questions were identified and the relevant CPG and bibliographic databases were searched and screened for eligible CPGs. Each CPG was appraised by four independent appraisers using the AGREE II Instrument. Inter-rater analysis was conducted. RESULTS Four eligible CPGs were appraised: American College of Obstetricians and Gynecologists (ACOG), National Heart, Lung, and Blood Institute (NHLBI), National Institute of Health and Care Excellence (NICE), and Royal College of Obstetricians and Gynaecologists (RCOG). Among them, the overall assessments of three CPGs (NICE, RCOG, NHLBI) scored greater than 70%; these findings were consistent with the high scores in the six domains of AGREE II, including:[1] scope and purpose,[2] stakeholder involvement,[3] rigor of development,[4] clarity of presentation,[5] applicability, and [6] editorial independence domains. Domain [3] scored (90%, 73%, 71%), domain [5] (90%, 46%, 47%), and domain [6] (71%, 77%, 52%) for NICE, RCOG, and NHLBI, respectively. Overall, the clinical recommendations were not significantly different between the included CPGs. CONCLUSIONS Three evidence-based CPGs presented superior methodological quality. NICE demonstrated the highest quality followed by RCOG and NHLBI and all three CPGs were recommended for use in practice.
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Affiliation(s)
- Yasser S Amer
- Clinical Practice Guidelines Unit, Quality Management Department, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
- Department of Pediatrics, King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt.
| | - Yasser Sabr
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Prince Sattam Bin Abdul Aziz Research Chair for Epidemiology and Public Health, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ghada M ElGohary
- University Oncology Center, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Internal Medicine and Clinical Hematology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amer M Altaki
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Osamah T Khojah
- Pathology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed El-Malky
- Morbidity and Mortality Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Public Health and Community Medicine Department, Theodor Bilharz Research Institute (TBRI), Academy of Scientific Research, Cairo, Egypt
| | - Musa F Alzahrani
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Ierano C, Ayton D, Peel T, Marshall C, Thursky K. Evaluating the implementability of Antibiotic Surgical Prophylaxis guidelines. Infect Dis Health 2019; 25:11-21. [PMID: 31523036 DOI: 10.1016/j.idh.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Current Australian data highlight guideline noncompliant prescribing of antimicrobials for surgical prophylaxis. The study aim was to evaluate the implementability of the Australian national surgical prophylaxis (SAP) guidelines to identify facilitators for and barriers to compliance. METHODS Key stakeholders appraised the surgical prophylaxis guidelines using the GuideLine Implementability Appraisal (GLIA) tool. Questions with 100% agreement for the response 'Yes' were identified as facilitators and those with 100% agreement for 'No', a barrier. Questions that did not receive 100% agreement, but had a majority (40-60%) 'Yes' or 'No' consensus were considered as borderline facilitators and barriers respectively. RESULTS Ten appraisals were completed. Guideline recommendations were rated as easily identifiable and concise and were thus facilitators for implementation. The ability to measure guideline adherence and outcomes, and recommendations that were consistent with guideline user abilities and beliefs were also identified as facilitators. Borderline facilitators related to the clarity of the recommendations and whether they were explicit in what to do and in what circumstances. Evidence quality underpinning recommendations (validity), inflexibility of recommendations (flexibility) and the lack of patient data at the point of use (computability) were identified as borderline barriers to implementation. No recommendation reached agreement as being a barrier. CONCLUSION The GLIA appraisal demonstrated overall implementability of the current Australian national surgical prophylaxis guidelines. Facilitators (i.e., measurability) and borderline facilitators highlight strengths of the current guideline. Borderline barriers (i.e., validity, flexibility and computability) may negatively impact upon implementability. Guideline developers should consider these dimensions to optimise guideline uptake and consequently patient care.
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Affiliation(s)
- Courtney Ierano
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, VIC, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia.
| | - Darshini Ayton
- Monash University, Department of Epidemiology and Preventive Medicine, 553 St Kilda Road, Melbourne, VIC, Australia
| | - Trisha Peel
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, VIC, Australia; Department of Infectious Diseases, Alfred Health/Monash University, Melbourne, VIC, Australia
| | - Caroline Marshall
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, VIC, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia; Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Parkville, VIC, Australia; Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Karin Thursky
- National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, VIC, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Dobia A, Ryan K, Abutaleb M, Edwards A. Perceptions of physicians in Saudi Arabia on the use of international clinical guidelines for managing primary insomnia. PLoS One 2019; 14:e0220960. [PMID: 31398230 PMCID: PMC6688835 DOI: 10.1371/journal.pone.0220960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 07/26/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION While there are no national clinical guidelines for managing primary insomnia in Saudi Arabia, there are also no published studies of physicians' perceptions of and attitudes towards using international guidelines. The objective of this study was to explore the knowledge, perceptions, and attitudes of physicians practising in Saudi Arabia about using international guidelines for managing insomnia. METHODS A qualitative study using in-depth, face-to-face, and semi-structured interviews with 15 physicians held in July 2017 at a tertiary care hospital in Jazan, the distal south-western province in Saudi Arabia. Interviews were audio-recorded, transcribed verbatim, coded using the qualitative software NVivo11 and analysed thematically. Data saturation was assumed as no new understandings of the broad thematic issues were produced by the last three interviews. RESULTS Themes identified were: Knowledge, Resistance, Barriers and Facilitators. Participants acknowledged their lack of awareness of available guidelines and their lack of training and education about Cognitive Behavioural Therapy for Insomnia (CBT-I). They highlighted a lack of education for patients about insomnia and its treatment. Beliefs about dependence on hypnotics and the inappropriateness of international guidelines for Saudi Arabia inclined many to resist using them. Inability to document diagnosis and consultations due to limited time and lack of suitable electronic systems, lack of suitably trained practitioners for referral for CBT-I, and lack of accountability for practice were identified as key barriers to following international guidelines. Development of national guidelines was the most important facilitator suggested by participants. CONCLUSIONS The health authorities in the government of the Kingdom of Saudi Arabia (KSA) should improve general public awareness about sleep disorders and provide focused training for specialists and technologists. Above all, KSA needs its own nationwide guidelines for treating sleep-disorders based on evidence-based clinical trials, consistent with its history, culture, socioeconomic conditions and traditions.
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Affiliation(s)
- Ali Dobia
- Reading School of Pharmacy, University of Reading, Reading, United Kingdom
- General Directorate of Medical Services, Riyadh, Saudi Arabia
| | - Kath Ryan
- Reading School of Pharmacy, University of Reading, Reading, United Kingdom
| | | | - Alexander Edwards
- Reading School of Pharmacy, University of Reading, Reading, United Kingdom
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11
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Amer YS, Wahabi HA, Abou Elkheir MM, Bawazeer GA, Iqbal SM, Titi MA, Ekhzaimy A, Alswat KA, Alzeidan RA, Al-Ansary LA. Adapting evidence-based clinical practice guidelines at university teaching hospitals: A model for the Eastern Mediterranean Region. J Eval Clin Pract 2019; 25:550-560. [PMID: 29691950 DOI: 10.1111/jep.12927] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 12/15/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Clinical practice guidelines (CPGs) are significant tools for evidence-based health care quality improvement. The CPG program at King Saud University was launched as a quality improvement program to fulfil the international accreditation standards. This program was a collaboration between the Research Chair for Evidence-Based Healthcare and Knowledge Translation and the Quality Management Department. This study aims to develop a fast-track method for adaptation of evidence-based CPGs and describe results of the program. METHODS Twenty-two clinical departments participated in the program. Following a CPGs awareness week directed to all health care professionals (HCPs), 22 teams were trained to set priorities, search, screen, assess, select, and customize the best available CPGs. The teams were technically supported by the program's CPG advisors. To address the local health care context, a modified version of the ADAPTE was used where recommendations were either accepted or rejected but not changed. A strict peer-review process for clinical content and methodology was employed. RESULTS In addition to raising awareness and building capacity, 35 CPGs were approved for implementation by March 2018. These CPGs were integrated with other existing projects such as accreditation, electronic medical records, performance management, and training and education. Preliminary implementation audits suggest a positive impact on patient outcomes. Leadership commitment was a strength, but the high turnover of the team members required frequent and extensive training for HCPs. CONCLUSION This model for CPG adaptation represents a quick, practical, economical method with a sense of ownership by staff. Using this modified version can be replicated in other countries to assess its validity.
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Affiliation(s)
- Yasser S Amer
- Clinical Practice Guidelines Unit, Quality Management Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University Medical Council, Alexandria University, Alexandria, Egypt.,Guidelines International Network, Adaptation Working Group (Steering)
| | - Hayfaa A Wahabi
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Manal M Abou Elkheir
- Pharmacy Services, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Ghada A Bawazeer
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Pharmacy Services, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Shaikh M Iqbal
- Pediatrics Department, King Khalid University Hospital, King Saud University, Hospital, Riyadh, Saudi Arabia.,Department of Pediatrics and Child Health, University of Manitoba, College of Medicine, Manitoba, Canada
| | - Maher A Titi
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Patient Safety Unit, Quality Management Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Aishah Ekhzaimy
- Medicine Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Khalid A Alswat
- Medicine Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Rasmieh A Alzeidan
- Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lubna A Al-Ansary
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Guidelines International Network, Adaptation Working Group (Steering).,Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Health Metrics and Measurement, World Health Organization, Geneva, Switzerland
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12
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Chiesa-Estomba CM, Lechien JR, Fakhry N, Melkane A, Calvo-Henriquez C, de Siati D, Gonzalez-Garcia JA, Fagan JJ, Ayad T. Systematic review of international guidelines for perioperative antibiotic prophylaxis in Head & Neck Surgery. A YO-IFOS Head & Neck Study Group Position Paper. Head Neck 2019; 41:3434-3456. [PMID: 31282061 DOI: 10.1002/hed.25856] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is defined as an infection that occurs after a surgical incision or organ manipulation during surgery. The frequency reported for clean head and neck surgical procedures without antimicrobial prophylaxis is <1%. In contrast, infection rates in patients undergoing complicated cancer surgery are high, ranging from 24% to 87% of patients without antimicrobial prophylaxis. METHODS Guidelines and recommendations about the use of antibiotics in head and neck surgery from 2004 to 2019 were reviewed. RESULTS Four guidelines from Oceania, 5 from South America, 5 from North America, 2 from the United Kingdom, 11 from Europe, 1 from Africa, 1 from the Middle East, and 3 from Asia were included. A total of 118 papers were included for analysis and recommendation. CONCLUSION Antibiotic prophylaxis can decrease the incidence of SSI. However, the risks associated with antibiotic exposure and the risk of antibiotic resistance need to be taken into consideration.
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Affiliation(s)
| | - Jérome R Lechien
- Department of Human Anatomy & Experimental Oncology, University of Mons, Mons, Belgium
| | - Nicolas Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Universitary Hospital of la Conception, Marseille, France
| | - Antoine Melkane
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Christian Calvo-Henriquez
- Department of otolaryngology-Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Daniele de Siati
- Department of Otorhinolaryngology-Centre d'AudioPhonologie des Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Jose Angel Gonzalez-Garcia
- Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain
| | | | - Tareck Ayad
- Division of Otolaryngology-Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
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13
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Amer YS, Al-Joudi HF, Varnham JL, Bashiri FA, Hamad MH, Al Salehi SM, Daghash HF, Albatti TH. Appraisal of clinical practice guidelines for the management of attention deficit hyperactivity disorder (ADHD) using the AGREE II Instrument: A systematic review. PLoS One 2019; 14:e0219239. [PMID: 31276528 PMCID: PMC6611626 DOI: 10.1371/journal.pone.0219239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 06/19/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE High quality evidence-based clinical practice guidelines (CPGs) have a major impact on the appropriate diagnosis and management and positive outcomes. The evidence-based healthcare for patients with attention deficit hyperactive disorder (ADHD) is challenging. The objective of this study was to appraise the quality of published CPGs for ADHD. METHODS A systematic review was conducted for ADHD CPGs using CPG databases, DynaMed, PubMed, and Google Scholar. The quality of each included CPG was appraised by three independent appraisers using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. RESULTS Six CPGs were critically reviewed. The AGREE II standardized domain scores revealed variation between the quality of these CPGs with the National Institute of Health and Care Excellence (NICE), University of Michigan Health System, and American Academy of Pediatrics CPGs as the top three. Overall, the recommendations for management of ADHD were similar in these CPGs. CONCLUSIONS Reporting of CPG development is often poorly documented. Guideline development groups should aim to follow the AGREE II criteria to improve the standards and quality of CPGs. The NICE CPG showed the best quality. Embedding the AGREE II appraisal of CPGs in the training and education of healthcare providers is recommended. The protocol for this study was published in PROSPERO (International prospective register of systematic reviews). Link: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017078712 and is additionally available from protocols.io. Link: https://dx.doi.org/10.17504/protocols.io.q27dyhn.
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Affiliation(s)
- Yasser Sami Amer
- CPG Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
| | - Haya Faisal Al-Joudi
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Jeremy L. Varnham
- Saudi ADHD Society, Riyadh, Saudi Arabia
- School of Psychology, University of East London, London, United Kingdom
| | - Fahad A. Bashiri
- Division of Neurology, Department of Pediatrics, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Muddathir Hamad Hamad
- Division of Neurology, Department of Pediatrics, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Saleh M. Al Salehi
- Child Development Center, King Abdullah Bin Abdulaziz University Hospital, Princess Noura Bint AbdulRahman University, Riyadh, Saudi Arabia
| | - Hadeel Fakhri Daghash
- Ada’a Program, Assistant Deputyship for Hospital Services, Ministry of Health, Riyadh, Saudi Arabia
| | - Turki Homod Albatti
- Saudi ADHD Society, Riyadh, Saudi Arabia
- Department of Psychiatry, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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14
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Current Clinical Practice for the Use of Hypnotics to Manage Primary Insomnia in Adults in a Tertiary Hospital in Saudi Arabia: An Audit Study. PHARMACY 2019; 7:pharmacy7010015. [PMID: 30691097 PMCID: PMC6473234 DOI: 10.3390/pharmacy7010015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/16/2019] [Accepted: 01/22/2019] [Indexed: 01/06/2023] Open
Abstract
Despite the risks associated with hypnotics and their recent increased use in Saudi Arabia, there are no specific national guidelines for using these medicines to treat insomnia nor are there any data on how these medicines are currently prescribed. There is the potential, however, that some physicians might be adhering to the United States guidelines. The current audit study was aimed to assess the current practice in treating insomnia with hypnotics in Saudi Arabia, and to evaluate its agreement with the US guidelines. The audit was conducted using data collected between April 2012 and March 2017 at King Fahad Central Hospital (KFCH; Jazan), of patients who were either prescribed benzodiazepines (BZDs) or Z-drugs or diagnosed with insomnia. The audit criteria followed two US guidelines for the management of insomnia in adults. Data included documented diagnosis, use of CBT-I (Cognitive Behavioral Therapy for Insomnia), use of BZDs and Z-drugs including treatment regimen, and whether physicians prescribed anti-histamines for insomnia. The data were analyzed using STATA 14 after transcription to a MS XL file. Of the 504 records reviewed, 379 patients (75%) were prescribed BZDs or Z-drugs; only 182 (48%) of them had clearly documented indications for their use. Three hundred and seven patients (60%) were diagnosed with insomnia; none of them received CBT-I as initial treatment. No patients on long-term use of hypnotics were reviewed by their physicians after they began using the medication. More than 43% of patients were prescribed anti-histamines for insomnia. No records met all (or even six) of the seven criteria. KFCH physicians do not follow US guidelines. Therefore, the Ministry of Health (MOH) should improve its administrative systems including documentation, and instead of using international guidelines that are seldom followed, physicians should be trained in prescribing hypnotics and national guidelines need to be developed.
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Ribed A, Monje B, García-González X, Sanchez-Somolinos M, Sanz-Ruiz P, Rodríguez-González CG, Sanjurjo-Saez M. Improving surgical antibiotic prophylaxis adherence and reducing hospital readmissions: a bundle of interventions including health information technologies. Eur J Hosp Pharm 2018; 27:237-242. [PMID: 32587084 DOI: 10.1136/ejhpharm-2018-001666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/26/2018] [Accepted: 10/30/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Infection following orthopaedic surgery is a feared complication and an indicator of the quality of the hospital. Surgical antibiotic prophylaxis (SAP) guidelines are not always properly followed. Our aim was to describe and evaluate the impact of a multidisciplinary intervention on antibiotic prophylaxis adherence to hospital guidelines and 30-day postoperative outcomes. METHODS The study was carried out from January to May 2016 and consisted of creating a multidisciplinary team, updating institutional guidelines and embedding the recommendations in the computerised physician order entry system which is linked to dose and renal function alerts, educational activities and pharmaceutical bedside care of patients in the orthopaedic department. A prospective pre-post study was carried out in accordance with the Declaration of Helsinki. The following information was recorded: patient and surgery characteristics, adherence to SAP guidelines, surgical site infections, length of hospital stay and rate of readmission 30 days after discharge. Statistical analyses were performed using SPSS 18.0. RESULTS Eighty three orthopaedic patients of mean±SD age 68.2±17.0 years (44.6% male, 40 in the pre-intervention group and 43 in the intervention group) were included. Cefazolin was the recommended and most commonly administered antibiotic agent. In the intervention group, an improvement in global adherence to guidelines was achieved (76.7% vs 89.9%; p=0.039): antibiotic duration (75.0% vs 97.7%), correct dosage post-surgery (55.0% vs 76.7%), timing of administration (57.5% vs 72.1%), antibiotic pre-surgery prescription (92.5% vs 97.7%). Three surgical site infections were detected in the pre-intervention group and none in the intervention group (p>0.05). Length of hospital stay was reduced by 1 day and readmission decreased by 15% (p=0.038). CONCLUSIONS SAP is used in daily practice in most orthopaedic patients. The implementation of a multidisciplinary programme based on health technology improved the adherence to guidelines and appeared to reduce the readmission rate.
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Affiliation(s)
- Almudena Ribed
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Beatriz Monje
- Pharmacy Department Hospital, Universitario Del Henares, Coslada, Spain
| | - Xandra García-González
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Mar Sanchez-Somolinos
- Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Pablo Sanz-Ruiz
- Orthopaedic Surgery Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - María Sanjurjo-Saez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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