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Doniselli FM, Zanardo M, Mazon M, Cuccarini V, Rovira A, Costa A, Sconfienza LM, Arana E. A Critical Appraisal of the Quality of Vertigo Practice Guidelines Using the AGREE II Tool: A EuroAIM Initiative. Otol Neurotol 2022; 43:1108-1115. [PMID: 36214510 DOI: 10.1097/mao.0000000000003724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this review is to assess the methodological quality of guidelines for the management of vertigo and dizziness and to compare their recommendations, with specific focus on neuroimaging. DATABASES REVIEWED MEDLINE, EMBASE, National Guideline Clearinghouse, and National Institute for Health and Clinical Excellence database. METHODS In March 2022, a systematic search was performed to find practice guidelines of management of vertigo and dizziness. The evaluation of guidelines quality was performed independently by four authors using the AGREE II tool. We excluded from the results those guidelines that were not primarily focused on vertigo and dizziness, such as national/international guidelines in which vertigo and dizziness were only briefly mentioned. RESULTS Our strategy of literature search identified 161 studies, and 18 guidelines were selected for the appraisal. Only five guidelines reached the acceptance level in the overall result (at least 60%), with three of them reaching the highest scores (at least 80%). The highest scores were found in Domain 6 "Editorial Independence," Domain 1 "Scope and purpose," and Domain 4 "Clarity of presentation" (median value = 66%, 62%, and 61%, respectively). The remaining domains showed a low level of quality: Domain 2 "Stakeholder Involvement," Domain 3 "Rigor of development," and Domain 5 "Applicability" had median values of 27%, 27%, and 22%, respectively. The quality of these guidelines was very low, because of low involvement of multidisciplinary teams in writing guidelines recommendations. CONCLUSION Considering all guidelines, only three had a "high" overall score, whereas 13 of 18 (72%) of them were rated as of "low" quality. Future guidelines might take this into account to improve clinical applicability.
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Affiliation(s)
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano
| | - Miguel Mazon
- Radiology and Biomedical Imaging Research Group (GIBI230), La Fe University and Polytechnic Hospital and La Fe Health Research Institute, Valencia
| | - Valeria Cuccarini
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico "C. Besta", Milan, Italy
| | - Alex Rovira
- Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology (IDI), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonella Costa
- Department of Neuroradiology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico
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Boussageon R, Blanchard C, Charuel E, Menini T, Pereira B, Naudet F, Kassai B, Gueyffier F, Cucherat M, Vaillant-Roussel H. Project rebuild the evidence base (REB): A method to interpret randomised clinical trials and their meta-analysis to present solid benefit-risk assessments to patients. Therapie 2022:S0040-5957(22)00177-9. [PMID: 36371260 DOI: 10.1016/j.therap.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 09/16/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022]
Abstract
Evidence-based medicine is the cornerstone of shared-decision making in healthcare today. The public deserves clear, transparent and trust-worthy information on drug efficacy. Yet today, many drugs are prescribed and used without solid evidence of efficacy. Clinical trials and randomised clinical trials (RCTs) are the best method to evaluate drug efficacy and side effects. In a shared medical decision-making approach, general practitioners need drug assessment based on patient-important outcomes. The aim of project rebuild the evidence base (REB) is to bridge the gap between the data needed in clinical practice and the data available from clinical research. The drugs will be assessed on clinical patient important outcomes and for a population. Using the Cochrane tools, we propose to analyse for each population and outcome: 1) a meta-analysis based on RCTs with a low risk of bias overall; 2) an evaluation of results of confirmatory RCTs; 3) a statistical analysis of heterrogeneity between RCTs and 4) an analysis of publication bias. Depending on the results of these analyses, the evidence will be categorized in 4 different levels: firm evidence, evidence (to be confirmed), signal or absence of evidence. Project REB proposes a method for reading and interpreting RCTs and their meta-analysis to produce quality data for general practitioners to focus on risk-benefit assessment in the interest of patients. If this data does not exist, it could enable clinical research to better its aim.
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Magnani FG, Barbadoro F, Cacciatore M, Leonardi M. The importance of instrumental assessment in disorders of consciousness: a comparison between American, European, and UK International recommendations. Crit Care 2022; 26:245. [PMID: 35948933 PMCID: PMC9367125 DOI: 10.1186/s13054-022-04119-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
The use of instrumental tools for improving both the diagnostic accuracy and the prognostic soundness in patients with disorders of consciousness (DOC) plays an important role. However, the most recent international guidelines on DOC published by the American and the European Academies of Neurology and by the UK Royal College of Physicians contain heterogeneous recommendations on the implementation of these techniques in the clinical routine for both diagnosis and prognosis. With the present work, starting from the comparison of the DOC guidelines’ recommendations, we look for possible explanations behind such discrepancies considering the adopted methodologies and the reference health systems that could have affected the guidelines’ perspectives. We made a provocative argument about the need to find the most appropriate common methodology to retrieve and grade the evidence, increase the meta-analytic studies, and reduce the health policies that influence on the guidelines development that, in turn, should inform the health policies with the strongest scientific evidence.
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Ludwin A, Tudorache S, Martins WP. ASRM Müllerian Anomalies Classification 2021: a critical review. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:7-21. [PMID: 35678250 DOI: 10.1002/uog.24905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/21/2022] [Accepted: 02/14/2022] [Indexed: 06/15/2023]
Affiliation(s)
- A Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
- Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland
| | - S Tudorache
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - W P Martins
- SEMEAR Fertilidade, Reproductive Medicine, Ribeirão Preto, Brazil
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Roe J, Cresswell A, Mittal S, Al-Uzri M, Tanner J, Moore M, Simpson S, Guo B, Morriss R. Service user experiences of care recommendations from the 2014 NICE guideline for bipolar disorder: a survey. J Ment Health 2022; 31:724-731. [DOI: 10.1080/09638237.2021.2022614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- James Roe
- National Institute for Health Research: Applied Research Collaboration (ARC) East Midlands, University of Nottingham, Nottingham, UK
| | - Adele Cresswell
- National Institute for Health Research: Applied Research Collaboration (ARC) East Midlands, University of Nottingham, Nottingham, UK
| | - Shweta Mittal
- Nottinghamshire HealthCare NHS Foundation Trust, Nottingham, UK
| | | | - James Tanner
- Northamptonshire Healthcare NHS Foundation Trust, Kettering, UK
| | - Matthew Moore
- National Institute for Health Research: Applied Research Collaboration (ARC) East Midlands, University of Nottingham, Nottingham, UK
| | - Sandra Simpson
- Nottinghamshire HealthCare NHS Foundation Trust, Nottingham, UK
| | - Boliang Guo
- National Institute for Health Research: Applied Research Collaboration (ARC) East Midlands, University of Nottingham, Nottingham, UK
| | - Richard Morriss
- National Institute for Health Research: Applied Research Collaboration (ARC) East Midlands, University of Nottingham, Nottingham, UK
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Pereira VC, Silva SN, Carvalho VKS, Zanghelini F, Barreto JOM. Strategies for the implementation of clinical practice guidelines in public health: an overview of systematic reviews. Health Res Policy Syst 2022; 20:13. [PMID: 35073897 PMCID: PMC8785489 DOI: 10.1186/s12961-022-00815-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/10/2022] [Indexed: 01/08/2023] Open
Abstract
Abstract
Background
As a source of readily available evidence, rigorously synthesized and interpreted by expert clinicians and methodologists, clinical guidelines are part of an evidence-based practice toolkit, which, transformed into practice recommendations, have the potential to improve both the process of care and patient outcomes. In Brazil, the process of development and updating of the clinical guidelines for the Brazilian Unified Health System (Sistema Único de Saúde, SUS) is already well systematized by the Ministry of Health. However, the implementation process of those guidelines has not yet been discussed and well structured. Therefore, the first step of this project and the primary objective of this study was to summarize the evidence on the effectiveness of strategies used to promote clinical practice guideline implementation and dissemination.
Methods
This overview used systematic review methodology to locate and evaluate published systematic reviews regarding strategies for clinical practice guideline implementation and adhered to the PRISMA guidelines for systematic review (PRISMA).
Results
This overview identified 36 systematic reviews regarding 30 strategies targeting healthcare organizations, healthcare providers and patients to promote guideline implementation. The most reported interventions were educational materials, educational meetings, reminders, academic detailing and audit and feedback. Care pathways—single intervention, educational meeting—single intervention, organizational culture, and audit and feedback—both strategies implemented in combination with others—were strategies categorized as generally effective from the systematic reviews. In the meta-analyses, when used alone, organizational culture, educational intervention and reminders proved to be effective in promoting physicians' adherence to the guidelines. When used in conjunction with other strategies, organizational culture also proved to be effective. For patient-related outcomes, education intervention showed effective results for disease target results at a short and long term.
Conclusion
This overview provides a broad summary of the best evidence on guideline implementation. Even if the included literature highlights the various limitations related to the lack of standardization, the methodological quality of the studies, and especially the lack of conclusion about the superiority of one strategy over another, the summary of the results provided by this study provides information on strategies that have been most widely studied in the last few years and their effectiveness in the context in which they were applied. Therefore, this panorama can support strategy decision-making adequate for SUS and other health systems, seeking to positively impact on the appropriate use of guidelines, healthcare outcomes and the sustainability of the SUS.
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8
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COVID-19 vaccine guidelines was numerous in quantity but many lack transparent reporting of methodological practices. J Clin Epidemiol 2021; 144:163-172. [PMID: 34920115 PMCID: PMC8669940 DOI: 10.1016/j.jclinepi.2021.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 12/12/2022]
Abstract
AIM To describe the current status of COVID-19 vaccine guidelines. STUDY DESIGN AND SETTING We searched databases, Google and guideline platforms to retrieve COVID-19 vaccine guidelines published between January 1, 2020 and July 8, 2021. We worked in pairs to identify the eligible guidelines and extract data of whether the methodology, funding, and conflict of interests were assessed/reported, and so on. Results were presented descriptively. RESULTS A total of 106 COVID-19 vaccine guidelines were included. In the first half of 2021, on average 15 guidelines were published every month. Fifty (47.2%) guidelines addressed the vaccination of people with specific medical conditions, and 18 (17.0%) guidelines focused on adverse effects after vaccination. Only 28 (26.4%) guidelines reported the methodology they used. Four (3.8%) of guidelines assessed both the quality of evidence and strength of recommendations; 42 (39.6%) and 65 (61.3%) guidelines reported their funding sources and conflict of interest, respectively. Most guidelines were published in English (n=92, 86.8%). CONCLUSION A high number of guidelines on COVID-19 vaccines have been published in the recent months, but most of them lack clear and transparent reporting of methodology, funding, and conflicts of interest. Rigorous methodological and reporting quality evaluation of these guidelines is needed.
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Pack R. The slow medicine approach to chronic pain. Physiother Theory Pract 2021; 38:2307-2315. [PMID: 34429023 DOI: 10.1080/09593985.2021.1970295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Pain is an aversive motivational state that drives an organism to escape, terminate, and avoid whatever is potentially threatening tissue health or survival, while teaching it to avoid situations associated with harm. The pain experience is distributed across a wide neural network that involves activation of the stress, autonomic, immune and opioid systems. Sustained or intense stimulation of the dynamic pain connectome results in nociplastic changes contribute to the development of persistent pain. A bidirectional relationship exists between these changes and psychosocial factors, further complicating the clinical picture. Objective: The comprehensive, wholistic approach to managing chronic pain is needed. The principles of slow medicine represent a potential theoretic framework capable of changing how the healthcare system views, manages and reimburses the management of chronic pain. Methods: The paper discusses these principles an their applicattion in the management of chronic pain. In slow medicine, the clinician is a master gardener who nurtures the patient back to optimal health rather than a mechanic who repairs damage. It seeks to replace haste, and its unintended consequences, with a calm, slow, deliberate approach to pain that benefits everyone involved in the care process. Conclusion: The slow medicine approach is capable of improving the management of chronic pain.
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Affiliation(s)
- Roger Pack
- Intermountain Healthcare, Utah Valley Pain Management, Orem, Utah
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Chen H, Tao M, Li D, Han J, Cheng C, Ma Y, Wu Y, Shelat VG, Tustumi F, Satapathy SK, Kang KJ, Wang Q. An evaluation of the reporting quality in clinical practice guidelines for hepatocellular carcinoma using the RIGHT checklist. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1004. [PMID: 34277804 PMCID: PMC8267298 DOI: 10.21037/atm-21-2611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/11/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. Clinical practice guidelines (CPGs) on the prevention, surveillance, diagnosis and management of HCC are essential to guide clinical practice. The objective of this study was to evaluate the reporting quality of the most recent CPGs for HCC published worldwide. METHODS We systematically searched literature databases and websites of guideline development organizations and medical associations to extract CPGs on HCC published between January 2018 and December 2020. We evaluated the reporting quality using the Reporting Items for practice Guidelines in Healthcare (RIGHT) statement. We assessed for each of the 35 RIGHT checklist items whether the guidelines reported the corresponding information. We calculated the mean (± standard error of the mean, SEM) percentages of the guidelines' compliance with the items (reporting rate), both overall and for each of the seven domains of the RIGHT checklist. RESULTS We identified 22 guidelines, of which three (14%) were written in Chinese and 19 (86%) in English. The mean ±SEM overall reporting rate in the twenty-two guidelines was 56%±4%. The reporting rates of the seven domains were the following: basic information 81%±3%, background 58%±6%, evidence 58%±6%, recommendations 59%±5%, review and quality assurance 34%±10%, funding and declaration and management of interests 39%±4%, and other information 23%±6%. CONCLUSIONS The reporting quality of the recently published guidelines for HCC was suboptimal. While there is no doubt about the great value of the CPGs' recommendations in clinical practice, the reporting in CPGs for HCC still needs improvement.
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Affiliation(s)
- Haiyang Chen
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Meng Tao
- Department of General Surgery, Huaihe Hospital of Henan University, Kaifeng, China
| | - Ding Li
- Department of Pharmacy, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Jing Han
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Cheng Cheng
- Department of Hematology, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Yanfang Ma
- School of Chinese Medicine of Hong Kong Baptist University, Kowloon Tong, Hong Kong, China
| | - Yingxi Wu
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Francisco Tustumi
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Sanjaya K. Satapathy
- Division of Hepatology and Sandra Atlas Bass Center for Liver Diseases, Northwell Health, Manhasset, NY, USA
| | - Koo Jeong Kang
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, Keimyung University, Dongsan Medical Center, Daegu, Republic of Korea
| | - Qiming Wang
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
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Chen Y, Guyatt GH, Munn Z, Florez ID, Marušić A, Norris SL, Kredo T, Qaseem A. Clinical Practice Guidelines Registry: Toward Reducing Duplication, Improving Collaboration, and Increasing Transparency. Ann Intern Med 2021; 174:705-707. [PMID: 33721516 DOI: 10.7326/m20-7884] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, and WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China (Y.C.)
| | | | - Zachary Munn
- Guidelines International Network, Pitlochry, Scotland, and Joanna Briggs Institute, University of Adelaide, Adelaide, Australia (Z.M.)
| | - Ivan D Florez
- McMaster University, Hamilton, Ontario, Canada, and University of Antioquia, Medellin, Colombia (I.D.F.)
| | - Ana Marušić
- University of Split School of Medicine, Split, Croatia (A.M.)
| | - Susan L Norris
- Oregon Health & Science University, Portland, Oregon (S.L.N.)
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa (T.K.)
| | - Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
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12
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Bulmer T, Volders D, Kamal N. Analysis of Thrombolysis Process for Acute Ischemic Stroke in Urban and Rural Hospitals in Nova Scotia Canada. Front Neurol 2021; 12:645228. [PMID: 33790851 PMCID: PMC8005571 DOI: 10.3389/fneur.2021.645228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/12/2021] [Indexed: 11/27/2022] Open
Abstract
Background: Stroke is a devastating disease, but it is treatable with alteplase or tissue plasminogen activator (tPA). The effectiveness of tPA is highly time-dependent, meaning rapid treatment is critical. Fast treatment with tPA has been reported in many urban hospitals, but hospitals in rural locations struggle to reduce treatment times. This qualitative study examines current thrombolysis processes in one urban and two rural hospitals in Nova Scotia, Canada, by mapping and comparing the treatment process in these settings for acute ischemic stroke (AIS) patients, and by analyzing the healthcare professionals views on various treatment topics. Methods: Structured interviews were conducted with healthcare professionals involved in stroke treatment across the three sites. The interviews focused on the various activities in the thrombolysis treatment at each site. Additionally, participants were asked about the following 10 topics: comfort treating acute ischemic stroke patients; perceptions about tPA; appropriate tPA treatment window; stroke patient priority; tPA availability; patient consent; urban-rural treatment differences; efficiency of their treatment process; treatment delays; and suggested process improvements. Results were analyzed using the Framework Method, as well as through the development of process maps. Results: Twenty three healthcare professionals were interviewed at 2 rural hospitals and 1 urban hospital. Acute ischemic stroke patients are triaged as the highest or urgent priority at each included site. Physicians are more hesitant to treat with tPA in rural settings. A total of 11 urban-rural treatment differences were noted by the rural sites. Additionally, 11 patient-related and 29 system treatment delays were described. A process map was developed for each site, representing the arrival by ambulance and by private vehicle pathways. Conclusions: Guidelines and clear protocols are critical in reducing treatment times and ensuring consistent access to treatment. The majority of treatment delays encountered are system delays, which can be appropriately planned for to reduce delays within the care pathway. There is a general consensus that there is an urban-rural treatment gap for acute ischemic stroke patients in Nova Scotia, and that continuing education is key in rural hospitals to improve Emergency Department (ED) physician comfort with treating patients with tPA.
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Affiliation(s)
- Tessa Bulmer
- Department of Industrial Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS, Canada
| | - David Volders
- Interventional & Diagnostic Neuroradiology, QEII Health Sciences Centre, Nova Scotia Health, Halifax, NS, Canada.,Department of Radiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Noreen Kamal
- Department of Industrial Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS, Canada
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Hoffmann TC, Bakhit M, Durand MA, Perestelo-Pérez L, Saunders C, Brito JP. Basing Information on Comprehensive, Critically Appraised, and Up-to-Date Syntheses of the Scientific Evidence: An Update from the International Patient Decision Aid Standards. Med Decis Making 2021; 41:755-767. [PMID: 33660539 DOI: 10.1177/0272989x21996622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients and clinicians expect the information in patient decision aids to be based on the best available research evidence. The objectives of this International Patient Decision Aid Standards (IPDAS) review were to 1) check the currency of, and where needed, update evidence for the domain of "basing the information in decision aids on comprehensive, critically appraised, and up-to-date syntheses of the evidence"; 2) analyze the evidence characteristics of decision aids; and 3) propose updates to relevant IPDAS criteria. METHODS We searched MEDLINE and PubMed to inform updates of this domain's definitions, justifications, and components. We also searched 5 sources to identify all publicly available decision aids (N = 471). Two assessors independently extracted each aid's evidence characteristics. RESULTS Minor updates to the definitions and theoretical justifications of this IPDAS domain are provided and changes to relevant IPDAS criteria proposed. Nearly all aids (97%) provided a year of creation/update, but most (81%) did not report an explicit update or expiration policy. No scientific references were cited in 33% of aids. Of the 314 that cited at least 1 reference, 39% cited at least 1 guideline, 44% cited at least 1 systematic review, and 23% cited at least 1 randomized trial. In 35%, it was unclear what statement in the aid the citations referred to. Only 14% reported any of the processes used to find and decide on evidence inclusion. Only 14% reported the evidence quality. Many emerging issues and future research areas were identified. CONCLUSIONS Although many emerging issues need to be addressed, this IPDAS domain is validated and criteria refined. High-quality patient decision aids should be based on comprehensive and up-to-date syntheses of critically appraised evidence.
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Affiliation(s)
- Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Mina Bakhit
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Marie-Anne Durand
- Universite Toulouse III Paul Sabatier, Toulouse, France.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | | | - Catherine Saunders
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.,Department of Psychiatry, Dartmouth-Hitchcock Medical Centre, Lebanon NH, USA
| | - Juan P Brito
- Knowledge Evaluation and Research Unit, Mayo Clinic, Minnesota, Rochester, MN, USA
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Halms T, Strasser M, Kunz M, Hasan A. How to Reduce Mental Health Burden in Health Care Workers During COVID-19?-A Scoping Review of Guideline Recommendations. Front Psychiatry 2021; 12:770193. [PMID: 35126194 PMCID: PMC8811254 DOI: 10.3389/fpsyt.2021.770193] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/15/2021] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic has posed an unprecedented demand and a huge burden for healthcare workers (HCWs) worldwide, with alarming reports of heightened mental health problems. To counteract these mental health challenges, guidelines and recommendations for the support of HCWs during the COVID-19 pandemic have been published. With this scoping review and guideline evaluation, we aim to provide a critical overview of these guidelines and recommendations and to guide policy makers in establishing respective surveillance and care programs. In summary, 41 articles were included in this review which were published between April 2020 and May 2021. Across all articles, the guidelines and recommendations could be clustered into four main categories: "Social/structural support," "Work environment," "Communication/Information," "Mental health support." Although there was substantial agreement across articles about the recommendations given, empirical evidence on the effectiveness of these recommendations is still lacking. Moreover, most recommendations were developed without involving different members of the target group (HCWs) or other involved stakeholders. Strategies to detect potential barriers and to implement these guidelines in clinical practice are lacking.
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Affiliation(s)
- Theresa Halms
- Medical Faculty, Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany.,Medical Faculty, Department of Medical Psychology and Sociology, University of Augsburg, Augsburg, Germany
| | - Martina Strasser
- Medical Faculty, Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Miriam Kunz
- Medical Faculty, Department of Medical Psychology and Sociology, University of Augsburg, Augsburg, Germany
| | - Alkomiet Hasan
- Medical Faculty, Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
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15
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Trawick E, Pecoriello J, Quinn G, Goldman KN. Guidelines informing counseling on female age-related fertility decline: a systematic review. J Assist Reprod Genet 2021; 38:41-53. [PMID: 33188440 PMCID: PMC7822973 DOI: 10.1007/s10815-020-01967-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/04/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To identify, appraise, and assess clinical practice guidelines informing patient counseling on female age-related fertility decline. METHODS Searched electronic database records from January 1, 2006, to September 10, 2018, and professional society websites. The search terms included iterations of "guideline," "counseling," "preconception," "age-related fertility decline," and "reproductive life planning." English-language professional organization guidelines addressing patient counseling on age-specific reproductive health topics were included. Assessed the methodological quality of included guidelines using the AGREE II instrument. Guidelines were categorized as high quality or low quality based on AGREE II scores. Extracted age-specific reproductive health recommendations of high-quality guidelines. RESULTS The search identified 2918 records. Nineteen records addressed counseling on age-related fertility decline; only 6 focused only on reproductive aging, with the remaining 13 covering related topics. Eleven met criteria for high quality. All high-quality guidelines had high "rigor of development" scores on AGREE II. Ten high-quality guidelines stated an age at which female fertility declines, ranging from 30 to "late 30s." One recommended a specific age at which patients should be counseled. Five of eleven high-quality guidelines did not discuss the obstetric and perinatal risks of advanced maternal age. CONCLUSIONS Few high-quality guidelines address counseling on female age-related fertility decline, and existing guidance on reproductive aging counseling is inconsistent and incomplete. Greater rigor of development and incorporation of age-specific counseling recommendations into clinical practice guidelines could lead to improved patient anticipatory guidance and more informed reproductive choices.
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Affiliation(s)
- Emma Trawick
- Department of Obstetrics and Gynecology, NYU School of Medicine, 462 First Avenue, NBV 9N1-C, New York, NY, 10016, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair Street, Suite 2300, Chicago, IL, 60611, USA
| | - Jillian Pecoriello
- Department of Obstetrics and Gynecology, NYU School of Medicine, 462 First Avenue, NBV 9N1-C, New York, NY, 10016, USA
| | - Gwendolyn Quinn
- Department of Obstetrics and Gynecology, NYU School of Medicine, 462 First Avenue, NBV 9N1-C, New York, NY, 10016, USA
| | - Kara N Goldman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair Street, Suite 2300, Chicago, IL, 60611, USA.
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Britton RA, Hoffmann DE, Khoruts A. Probiotics and the Microbiome-How Can We Help Patients Make Sense of Probiotics? Gastroenterology 2021; 160:614-623. [PMID: 33307023 DOI: 10.1053/j.gastro.2020.11.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/01/2020] [Accepted: 11/03/2020] [Indexed: 12/19/2022]
Abstract
The notion of probiotics as microbes that confer health benefits has its origins in the speculative ideas that are more than a century old, yet remain largely unsubstantiated by scientific evidence. The recent advances in microbiome science have highlighted the importance of intestinal microbes in human physiology and disease pathogenesis. These developments have provided a boost to the probiotics industry, which continues to experience exponential growth driven mainly by creative marketing. Consumers, patients, and most health care providers are not able to discern the underlying science or differentiate the permitted claims that promise vague health benefits from disease-specific claims reserved for drugs. No probiotic product has been able to satisfy the regulatory requirements to be categorized as a drug, a substance intended to cure, mitigate, or prevent disease. However, patients take probiotic products in the belief that they will help to treat their intestinal or systemic diseases. Thus far, the regulators have failed to create policies that would assist to inform the public in this area. In fact, the existing regulatory regime actually creates formidable barriers to research that could provide evidence for clinical efficacy of probiotic products. We propose a potential solution to this vexing problem, where a committee created through a partnership of academia, professional organizations, and industry, but free of potential conflicts of interest, would be charged with rigorous evaluation of specific probiotic products and the evidence in support of their different claims. Companies that would submit to this process would earn the trust of consumers and healthcare providers, as well as a distinction in the marketplace.
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Affiliation(s)
- Robert A Britton
- Department of Molecular Virology and Microbiology, Alkek Center for Metagenomics and Microbiome Research, Dan Duncan Cancer Center Member, Baylor College of Medicine, Houston, Texas
| | - Diane E Hoffmann
- University of Maryland Francis King Carey School of Law, Baltimore, Maryland
| | - Alexander Khoruts
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Center for Immunology, BioTechnology Institute, University of Minnesota, Minneapolis, Minnesota.
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Tudrej BV, Favard D, Vaillant-Roussel H, Pouchain D, Jaafari N, Boussageon R. Validity of the Good Practice Guidelines: The example of type 2 diabetes. Diabetes Res Clin Pract 2020; 169:108459. [PMID: 32956744 DOI: 10.1016/j.diabres.2020.108459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 01/09/2023]
Abstract
AIMS To assess the methodological quality of the systematic reviews of the literature for Good Practice Guidelines (GPGs) for treatment of type 2 diabetes (T2D). METHODS The GPGs on treatment of T2D from May 2012 onwards were searched on PubMed, the Guidelines International Network, the National Guidelines Clearing House and the Infobanque des guides de pratique clinique. Quality of the GPGs was assessed by means of grading of levels of evidence, strength of recommendations, statements pertaining to systematic reviews, description of their methods, search for Randomized Controlled Trials meta-analyses, and citations from three meta-analyses which contested the strategy of intensive glycemic control and metformin as first-line treatment. RESULTS Fiflty-two GPGs were included; half of them had and applied a system of grading and strength of recommendation and 58% stated they had carried out a systematic review. Only one GPG cited the three meta-analyses. Three quarters of the GPGs failed to detail their bibliographic research methods. CONCLUSION The GPGs for treatment of T2D were of poor quality and their methodological rigor was insufficient. Even though the meta-analyses had a higher level of evidence, they were seldom cited.
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Affiliation(s)
- Benoit V Tudrej
- Universite de Poitiers UFR Medecine et Pharmacie, General Practice Department, 6 rue de la miletrie, Poitiers, Nouvelle Aquitaine FR 86073, France; Société Française et Francophone d'Ethique Médicale, SFFEM, 45 Rue des Saints-Pères, Paris FR 75006, France; Universite Claude Bernard Lyon 1, University College of General Medicine, 8 Avenue Rockefeller, 69008 Lyon, France.
| | - Delphine Favard
- Universite de Poitiers UFR Medecine et Pharmacie, General Practice Department, 6 rue de la miletrie, Poitiers, Nouvelle Aquitaine FR 86073, France
| | - Hélène Vaillant-Roussel
- Department of General Practice, Faculty of Medicine, Clermont Auvergne University, 28 place Henri Dunant, 63001 Clermont-Ferrand, France; UPU, ACCePPT, Clermont Auvergne University, 28 place Henri Dunant, 63001 Clermont-Ferrand, France
| | - Denis Pouchain
- Département universitaire de médecine générale - Faculté de médecine de Tours, 10 Boulevard Tonnellé - BP 3223, 37032 Tours, France
| | - Nemat Jaafari
- Centre Hospitalier Henri Laborit, Unité de recherché clinique Pierre Deniker, INSERM CIC-P 1402, France
| | - Rémy Boussageon
- Universite Claude Bernard Lyon 1, University College of General Medicine, 8 Avenue Rockefeller, 69008 Lyon, France; Universite Claude Bernard Lyon 1, UMR 5558, LBBE CNRS, 8 Avenue Rockefeller, 69008 Lyon, France
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18
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Löhrs L, Handrack M, Kopp I, Jessen F, Wagner E, Falkai P, Röh A, Strube W, Hasan A. Evaluation of evidence grades in psychiatry and psychotherapy guidelines. BMC Psychiatry 2020; 20:503. [PMID: 33046040 PMCID: PMC7552557 DOI: 10.1186/s12888-020-02897-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Information regarding the distribution of evidence grades in psychiatry and psychotherapy guidelines is lacking. Based on the German evidence- and consensus- based (S3) psychiatry and psychotherapy and the Scottish Intercollegiate Guidelines Network (SIGN) treatment guidelines, we aimed to specify how guideline recommendations are composed and to what extent recommendations are evidence-based. METHODS Data was collected from all published evidence- and consensus-based S3-classified psychiatry and psychotherapy guidelines. As control conditions, data from German neurology S3-classified guidelines as well as data from recent SIGN guidelines of mental health were extracted. Two investigators reviewed the selected guidelines independently, extracted and analysed the numbers and levels of recommendations. RESULTS On average, 45.1% of all recommendations are not based on strong scientific evidence in German guidelines of psychiatry and psychotherapy. A related pattern can be confirmed for SIGN guidelines, where the mean average of recommendations with lacking evidence is 33.9%. By contrast, in the German guidelines of neurology the average of such recommendations is 16.5%. A total of 24.5% of all recommendations in the guidelines of psychiatry and psychotherapy are classified as level A recommendations, compared to 31.6% in the field of neurology and 31.1% in the SIGN guidelines. Related patterns were observed for B and 0 level recommendations. CONCLUSION Guidelines should be practical tools to simplify the decision-making process based on scientific evidence. Up to 45% of all recommendations in the investigated guidelines of psychiatry and psychotherapy are not based on strong scientific evidence. The reasons for this high number remain unclear. Possibly, only a limited number of studies answer clinically relevant questions. Our findings thereby question whether guidelines should include non-evidence-based recommendations to be methodologically stringent and whether specific processes to develop expert-opinion statements must be implemented.
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Affiliation(s)
- Lisa Löhrs
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336, München, Germany.
| | - Mirjam Handrack
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336 München, Germany
| | - Ina Kopp
- grid.10253.350000 0004 1936 9756Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, Institut für Medizinisches Wissensmanagement, c/o Philipps-Universität Marburg, Marburg, Germany
| | - Frank Jessen
- grid.6190.e0000 0000 8580 3777Department of Psychiatry, University of Cologne, Medical Faculty, Cologne, Germany
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336 München, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336 München, Germany
| | - Astrid Röh
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336 München, Germany
| | - Wolfgang Strube
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336 München, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336 München, Germany ,grid.7307.30000 0001 2108 9006Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, University of Augsburg, Dr.-Mack-Straße 1, 86156 Augsburg, Germany
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Hicks D, Melkers J, Isett KR. A characterization of professional media and its links to research. Scientometrics 2020; 119:827-843. [PMID: 32284667 DOI: 10.1007/s11192-019-03072-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The publishing industry is a vast system whose elements form a metaphorical ecosystem with knowledge flowing through connections between heterogeneous elements. In this paper we seek a more robust understanding of different types of literature, and whether and how they support one another in the diffusion of knowledge. We analyze a corpus comprising professional electronic media in US dentistry and its relation to the peer reviewed journal literature. Our corpus includes full text from magazines, news sites and blogs that provide information to clinicians. We find links to research are made through several mechanisms: articles describing new clinical guidelines, referencing, summaries of recently published journal articles and crossover authoring. There is little to no apparent time lag in the diffusion of information from research literature to professional media.
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Affiliation(s)
- Diana Hicks
- Georgia Institute of Technology School of Public Policy
| | - Julia Melkers
- Georgia Institute of Technology School of Public Policy
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20
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Varndell W, Fry M, Lutze M, Elliott D. Use of the Delphi method to generate guidance in emergency nursing practice: A systematic review. Int Emerg Nurs 2020; 56:100867. [PMID: 32238322 DOI: 10.1016/j.ienj.2020.100867] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
AIM To examine the application and methodological quality of the Delphi method used in developing guidance for emergency nursing practice. BACKGROUND Emergency nursing scope of practice has rapidly expanded in response to increasing patient acuity, complexity and technological innovation. Determining best practice is crucial for delivering high quality, safe and effective emergency nursing care. The Delphi method has been used to identify, prioritise complex issues and develop evidence-driven guidance in emergency nursing practice. The use and quality of the Delphi method in emergency nursing practice has not been examined. DESIGN Systematic literature review. DATABASES AND DATA TREATMENT A systematic literature search was conducted using the following databases: SCOPUS, EMBASE, Medline and ProQuest from date of inception to August 2019. The database search was limited to scholarly articles or peer-reviewed journals. No language restrictions were applied. The Cochrane Collaboration method and PRISMA checks were utilized to conduct the review. RESULTS Of 246 records identified 22 (8.9%) studies met the inclusion criteria. A modified Delphi method was commonly used (n = 15; 68.2%) and often conducted online (n = 11; 50.0%). Eight practice guidance themes were identified. Overall study quality was high (score 12/14; range 4-13), transparency of reporting varied. CONCLUSION Based on this review, the Delphi method is an appropriate method for exploring emergency nursing practice. The studies reviewed demonstrated that knowledge, skills and clinical expertise has progressively expanded in the specialty of emergency nursing. Variation in the application, conduct and transparency of reporting in Delphi studies developing guidance for emergency nursing practice is discussed.
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Affiliation(s)
- Wayne Varndell
- Prince of Wales Hospital Emergency Department, Randwick 2031, NSW, Australia; Faculty of Health, University of Technology Sydney, Ultimo 2007, NSW, Australia.
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, Ultimo 2007, NSW, Australia; Director Research and Practice Development Nursing and Midwifery Directorate NSLHD, Level 7 Kolling Building, Royal North Shore Hospital, St Leonards 2065, NSW, Australia.
| | - Matthew Lutze
- Faculty of Health, University of Technology Sydney, Ultimo 2007, NSW, Australia; Nursing Practice and Informatics, NSW Ministry of Health, St Leonards 2065, NSW, Australia; School of Nursing, University of Sydney, Camperdown 2050, NSW, Australia.
| | - Doug Elliott
- Faculty of Health, University of Technology Sydney, Ultimo 2007, NSW, Australia.
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Olweny CN, Arnold P. Clinical practice guidelines in pediatric anesthesia: What constitutes high-quality guidance? Paediatr Anaesth 2020; 30:89-95. [PMID: 31883354 DOI: 10.1111/pan.13805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 11/27/2022]
Abstract
The explosion of scientific evidence has outstripped the ability of individual clinicians to acquire, process, and apply it within a clinical context. Clinical practice guidelines bridge the gap between this large body of evidence and clinical practice by translating evidence into recommendations. As such, they are an important extension of the evidence-based medicine paradigm. Guidelines promise to translate evidence into actionable clinical recommendations. However, this promise can only be realized if they are both useful and trustworthy. As the number of guidelines increases users' question their role, the quality of the scientific evidence behind them and the strength of the recommendations made. In this article, we provide definitions and outline the features of the common forms of clinical guidance. We then describe the essential characteristics of good quality clinical guidance and outline initiatives aimed at improving quality. Specific issues and limitations related to guideline development in perioperative care of children are discussed. Finally, two clinical guidance documents, published recently in Pediatric Anesthesia, are discussed based upon these criteria.
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Affiliation(s)
- Catherine N Olweny
- Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Parkville, Vic, Australia
| | - Philip Arnold
- Department of Paediatric Anaesthesia, Alder Hey Children's Hospital, Liverpool, UK
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Medicolegal Sidebar: Clinical Practice Guidelines-Do They Reduce Professional Liability Risk? Clin Orthop Relat Res 2020; 478:23-25. [PMID: 31794486 PMCID: PMC7000047 DOI: 10.1097/corr.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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23
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de Melo-Martín I. The commercialization of the biomedical sciences: (mis)understanding bias. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2019; 41:34. [PMID: 31485872 DOI: 10.1007/s40656-019-0274-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/21/2019] [Indexed: 06/10/2023]
Abstract
The growing commercialization of scientific research has raised important concerns about industry bias. According to some evidence, so-called industry bias can affect the integrity of the science as well as the direction of the research agenda. I argue that conceptualizing industry's influence in scientific research in terms of bias is unhelpful. Insofar as industry sponsorship negatively affects the integrity of the research, it does so through biasing mechanisms that can affect any research independently of the source of funding. Talk about industry bias thus offers no insight into the particular epistemic shortcomings at stake. If the concern is with the negative effects that industry funding can have on the research agenda, conceptualizing this influence as bias obscures the ways in which such impact is problematic and limits our ability to offer solutions that can successfully address the concerns raised by the growing role of private funding in science.
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Qaseem A, Wilt TJ, Forciea MA, Kansagara D, Crandall CJ, Fitterman N, Hicks LA, Horwitch CA, Lin JS, Maroto M, McLean RM, Mustafa RA, Roa J, Tufte J, Vijan S. Disclosure of Interests and Management of Conflicts of Interest in Clinical Guidelines and Guidance Statements: Methods From the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med 2019; 171:354-361. [PMID: 31426089 DOI: 10.7326/m18-3279] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
One of the hallmarks of a trustworthy clinical guideline or guidance statement is a comprehensive process for disclosure of interests (DOI) and management of conflicts of interest (COIs). The American College of Physicians (ACP) Clinical Guidelines Committee (CGC) aims to disclose all health care-related interests and manage conflicts in a manner that is transparent, proportional, and consistent. Any person involved in the development of an ACP clinical guideline or guidance statement must disclose all financial and intellectual interests related to health care from the previous 3 years. Persons complete disclosures at the start of their participation and are required to update them over the course of their involvement with the CGC, including before each CGC meeting. A DOI-COI Review and Management Panel reviews the disclosures; flags potential conflicts; grades the COI as low-, moderate-, or high-level; and manages the person's participation accordingly. A high-level COI results in recusal from authorship, voting, and all committee discussions. Participants with a moderate-level COI are recused from authorship and voting for clinically relevant topics but may participate in all discussions. A low-level COI results in no role restrictions. All disclosures and COI management decisions are publicly reported.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
| | - Timothy J Wilt
- Minneapolis VA Medical Center, Minneapolis, Minnesota (T.J.W.)
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25
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Conte D, Triantafyllou K. Small bowel capsule endoscopy: It's time for quality assurance. Dig Liver Dis 2019; 51:824-825. [PMID: 31014941 DOI: 10.1016/j.dld.2019.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Dario Conte
- University of Milan, Medical School, Milan, Italy.
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic Research Institute and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Attikon University General Hospital, Athens, Greece
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26
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Afshari A, De Hert S. Pitfalls of clinical practice guidelines in the era of broken science: Let's raise the standards. Eur J Anaesthesiol 2019; 35:903-906. [PMID: 30376487 DOI: 10.1097/eja.0000000000000892] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Arash Afshari
- From the Department of Paediatric and Obstetric Anaesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (AA) and Department of Anaesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium (SDH)
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Lafuente-Lafuente C, Leitao C, Kilani I, Kacher Z, Engels C, Canouï-Poitrine F, Belmin J. Knowledge and use of evidence-based medicine in daily practice by health professionals: a cross-sectional survey. BMJ Open 2019; 9:e025224. [PMID: 30928940 PMCID: PMC6475442 DOI: 10.1136/bmjopen-2018-025224] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Healthcare professionals are expected to firmly ground their practice in sound evidence. That implies that they know and use evidence-based medicine (EBM). In this study, our aim was to know how often health professionals actually made use of EBM in their daily practice. DESIGN A questionnaire survey of healthcare professionals. PARTICIPANTS Healthcare professionals who attended six university postgraduate courses. 226 answered the questionnaire (144 physicians, 64 nurses and 24 pharmacists; response rate 63.3%). SETTING 56.5% of respondents worked in hospitals (mostly non-teaching), 25.0% in nursing homes and 10.2% in primary care. All participants were French-speaking and lived in France or Switzerland. MEASURES Declared degree of knowledge and use of EBM, use of EBM-related information sources. RESULTS Overall, 14.2% of respondents declared to use EBM regularly in their daily practice and 15.6% declared to use EBM only occasionally. The remaining respondents declared they: knew about EBM but did not use it (33.1%), had just heard about EBM (31.9%) or did not know what EBM is (4.0%). Concerning the use of EBM-related information sources, 83.4% declared to use at least monthly (or more often) clinical guidelines, 47.1% PubMed, 21.3% the Cochrane Library and 6.4% other medical databases.Fewer pharmacists (12%) declared to use EBM in their practice than nurses (22%) or doctors (36%). No difference appeared when analysed by gender, work setting or years after graduation. The most frequent obstacles perceived for the practice of EBM were: lack of general knowledge about EBM, lack of skills for critical appraisal and lack of time. CONCLUSIONS Only a minority of health professionals-with differences between physicians, nurses and pharmacists-declare to regularly use EBM in their professional practice. A larger proportion appears to be interested in EBM but seems to be deterred by their lack of knowledge, skills and personal time.
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Affiliation(s)
- Carmelo Lafuente-Lafuente
- Gériatrie à orientation Cardiologique et Neurologique, APHP, Hôpitaux univesitaires Pitié-Salpêtrière-Charles Foix, Ivry-sur-Seine, France
- Geriatrics Deparment, Sorbonne Université, Paris, France
| | - Catia Leitao
- Plateforme de recherche clinique, APHP, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix, Ivry-sur-Seine, France
| | - Insaf Kilani
- Plateforme de recherche clinique, APHP, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix, Ivry-sur-Seine, France
| | - Zineb Kacher
- Plateforme de recherche clinique, APHP, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix, Ivry-sur-Seine, France
| | - Cynthia Engels
- IMRB, A-TVB DHU, CEpiA EA 4393 (Clinical Epidemiology and Ageing Unit), Institut d’Ergothérapie, Université Paris Est Créteil (UPEC), Créteil, France
| | - Florence Canouï-Poitrine
- IMRB, A-TVB DHU, CEpiA EA 4393 (Clinical Epidemiology and Ageing Unit), Institut d’Ergothérapie, Université Paris Est Créteil (UPEC), Créteil, France
- Public Health Department, Henri Mondor Hospital, Assistance Publique - Hopitaux de Paris, Paris, France
- IMRB, A-TVB DHU, CEpiA EA 4393 (Clinical Epidemiology and Ageing Unit), Université Paris Est Créteil (UPEC), Créteil, France
| | - Joël Belmin
- Gériatrie à orientation Cardiologique et Neurologique, APHP, Hôpitaux univesitaires Pitié-Salpêtrière-Charles Foix, Ivry-sur-Seine, France
- Geriatrics Deparment, Sorbonne Université, Paris, France
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Wyssa D, Tramèr MR, Elia N. Reporting of conflicts of interest and of sponsorship of guidelines in anaesthesiology. A cross-sectional study. PLoS One 2019; 14:e0212327. [PMID: 30811517 PMCID: PMC6392260 DOI: 10.1371/journal.pone.0212327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/31/2019] [Indexed: 11/29/2022] Open
Abstract
Guideline recommendations may be biased due to conflicts of interest (COI) of panel members and sponsorship of the guideline. Potential impact of COI, and their management, should be transparently reported. We analysed 110 guidelines published in ten anaesthesia journals from 2007 to June 2018. We report on the number (%) that 1) published COI disclosures; 2) in a distinct paragraph; 3) described and explained the COI of panel members, and 4) of the Chairperson; 5) reported and described the presence or absence and potential impact of a sponsor of the guideline on the recommendations; and 6) reported how COI were managed. COI were published in 70/110 (64%) guidelines; in a distinct paragraph in 25/70 (36%). Panel members reported having no COI in 27/70 (39%) guidelines, disclosed COI without describing their potential impact in 41/70 (59%), and described their potential impact in 2/70 (3%). Chairpersons were identified in 50 guidelines, 32 of which published COI disclosures; 16/32 (50%) reported having no COI, 14/32 (44%) disclosed COI without describing their potential impact, 1/32 (3%) described their impact and 1/32 (3%) made no statement regarding COI. Presence or absence of a sponsor of the guideline was reported in 40 guidelines; 12/40 (30%) declared none, 24/40 (60%) reported sponsoring without explanation of the potential impact, and 4/40 (10%) described the potential influence of the sponsor on the guideline recommendations. Seventy-five guidelines reported COI of panel members and/or sponsorship of the guideline but only seven described how the COI had been managed. Disclosures of COI of panel members and of sponsors of guidelines have increased over the 12 year period, but remain insufficiently described and their potential influence on the guidelines' recommendations is poorly documented.
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Affiliation(s)
- Damien Wyssa
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Martin R. Tramèr
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nadia Elia
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Zupon A, Rothenberg C, Couturier K, Tan TX, Siddiqui G, James M, Savage D, Melnick ER, Venkatesh AK. An appraisal of emergency medicine clinical practice guidelines: Do we agree? Int J Clin Pract 2019; 73:e13289. [PMID: 30372798 PMCID: PMC6351191 DOI: 10.1111/ijcp.13289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/08/2018] [Accepted: 10/24/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Clinical practice guidelines (CPGs) have been published by the American College of Emergency Physicians (ACEP) since 1990 to advance evidence-based emergency care. ACEP clinical policies have drawn anecdotal criticism for bias, yet the overall quality of these guidelines has not previously been quantified. We sought to examine ACEP clinical policies using a recognised, validated appraisal instrument: Appraisal of Guidelines for Research & Evaluation (AGREE II). METHODS Systematic assessment of current ACEP clinical policies was conducted using the AGREE II instrument, which contains 23 appraisal items (scored on a 1-7 scale) in six domains and two overall assessments. Each policy was independently appraised by five trained appraisers. Primary outcomes were AGREE II ratings for each item, domain and "Overall Assessment," and scores were reported as standardised percentages from all five appraisers. Secondary analyses examined associations between AGREE II ratings and policy publication date, strength of underlying evidence and strength of recommendations. Additional analysis examined relationships between domain and "Overall Assessment" ratings. RESULTS Twenty guidelines published from April 2007 to November 2017 were included. Of the six domains, "Scope and Purpose" scored highest (mean 90%) and "Applicability" scored lowest (mean 35%). The four remaining domains ("Stakeholder Involvement," "Rigor of Development," "Clarity of Presentation" and "Editorial Independence") had mean scores of 53%-78%. The mean "Overall Assessment" rating was 69% and was not associated with policy publication date, strength of underlying evidence or strength of recommendations. We found positive associations between "Overall Assessment" ratings and two domains: "Rigor of Development" (r = 0.70) and "Clarity of Presentation" (r = 0.70). CONCLUSIONS Based on validated AGREE II criteria, ACEP clinical policies can be most improved by addressing their application in practice. ACEP clinical policies' overall quality did not improve over the assessed time period and is not explained by the quality of underlying evidence.
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Affiliation(s)
- Alyssa Zupon
- Yale University School of Medicine, New Haven, Connecticut
| | - Craig Rothenberg
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Katherine Couturier
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Ting-Xu Tan
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Gina Siddiqui
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Matthew James
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Dan Savage
- Department of Emergency Medicine, University of California, San Francisco (UCSF) Fresno Medical Education Program, San Francisco, California
| | - Edward R Melnick
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
- Yale New Haven Hospital, Center for Outcomes Research and Evaluation, New Haven, Connecticut
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Marongiu F, Barcellona D. Direct oral anticoagulants: what can we learn? Intern Emerg Med 2018; 13:989-992. [PMID: 29500618 DOI: 10.1007/s11739-018-1811-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/25/2018] [Indexed: 11/25/2022]
Abstract
Direct oral anticoagulants (DOACs) represent an innovation because they avoid periodic laboratory monitoring, and also reduce cerebral bleeding. An examination of the performance of DOACs versus warfarin in randomized clinical trials dedicated to atrial fibrillation would reveal the poor performance of warfarin because the percentage of major bleeding is always above 3%; however, the percentage of major bleeding is less than half of that when the management is done in anticoagulation clinics (ACs). Several years ago, a common opinion was that ACs would disappear as soon as DOACs enter the market. We proposed then that ACs could be transformed into thrombosis centres (TCs) because we envisaged many new activities in terms of diagnostic tools and therapeutic choices. After the introduction of DOACs, the role of the ACs has been re-evaluated because their role may be crucial in selecting both the most appropriate diagnostic approach and the best therapeutic option (including anti-vitamin K drugs) for the single patient. TCs can organize a regular follow-up to improve patient adherence to DOACs. Marketing might have a role in the decision making of the single doctor. Efforts should be made for limiting the relationships between doctors and pharmaceutical companies. It seems reasonable to better prepare doctors, during their university courses, for them to develop a greater scientific culture that would enable them to critically read clinical studies and acquire an independent opinion. Ideally, an expert in haemostasis and thrombosis should handle new and old anticoagulants.
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Affiliation(s)
- Francesco Marongiu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Doris Barcellona
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
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Affiliation(s)
- Robert DuBroff
- University of New Mexico School of Medicine, Department of Medicine, Division of Cardiology, Albuquerque.
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Byrne RA. The use and impact of clinical practice guidelines in interventional cardiology. EUROINTERVENTION 2018; 14:607-608. [PMID: 30122657 DOI: 10.4244/eijv14i6a106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Diagnostic test guidelines based on high-quality evidence had greater rates of adherence: a meta-epidemiological study. J Clin Epidemiol 2018; 103:40-50. [PMID: 29981871 DOI: 10.1016/j.jclinepi.2018.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/14/2018] [Accepted: 06/28/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To determine the association between the quality of guidelines for diagnostic tests (both the quality and reporting and the quality of the evidence underpinning recommendations) and nonadherence. STUDY DESIGN AND SETTING We conducted a meta-epidemiological study. We previously published a systematic review that quantified the percentage of test use that was nonadherent with guidelines. For the present study, we assessed these guidelines using the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool. We then assessed the quality of evidence underpinning recommendations within these guidelines using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Linear models were then constructed to determine the association between guideline nonadherence and (1) AGREE II score and (2) GRADE score. RESULTS There was no significant association between AGREE II score and nonadherent testing (P = 0.09). There was a significant association between GRADE score and nonadherence: recommendations based on low-quality and very low-quality evidence had 38% (P < 0.01) and 24% (P = 0.02) more nonadherent testing, compared with recommendations based on high-quality evidence. CONCLUSION Diagnostic test guideline recommendations based on high-quality evidence are adhered to more frequently.
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Napierala H, Schäfer L, Schott G, Schurig N, Lempert T. Management of financial conflicts of interests in clinical practice guidelines in Germany: results from the public database GuidelineWatch. BMC Med Ethics 2018; 19:65. [PMID: 29954379 PMCID: PMC6022410 DOI: 10.1186/s12910-018-0309-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 06/05/2018] [Indexed: 11/15/2022] Open
Abstract
Background The reliability of clinical practice guidelines has been disputed because guideline panel members are often burdened with financial conflicts of interest (COI). Current recommendations for COI regulation advise not only detailed declaration but also active management of conflicts. To continuously assess COI declaration and management in German guidelines we established the public database LeitlinienWatch (GuidelineWatch). Methods We analyzed all German guidelines at the highest methodological level (S3) that included recommendations for pharmacological therapy (n = 67) according to five criteria: declaration and assessment of COI, composition of the guideline development group, independence of the coordinators and lead authors, imposed abstentions because of COI and public external review. Each criterion was assessed using predefined outcome categories. Results Most guidelines (76%) contained a detailed declaration of COI. However, none of the guidelines provided full transparency of COI assessment results. The guideline group was composed of a majority of participants with COI in 55% of the guidelines, no guideline was free of participants with COI. Only 9% of guidelines had coordinators and lead authors without any financial COI. Most guidelines (70%) did not provide a rule for abstentions for participants with COI. In 21% of guidelines there was a rule, but abstentions were either not practiced or not documented, whereas in 7% partial abstentions and in 2% complete abstentions were documented. Two thirds of the guideline drafts (67%) were not externally reviewed via a public website. Conclusions COI are usually documented in detail in German guidelines of the highest methodological level. However, considerable improvement is needed regarding active management of COI, including recruitment of independent experts for guideline projects, abstention from voting for participants with COI and external review of the guideline draft. We assume that the publicly available ratings on GuidelineWatch will improve the handling of conflicts of interest in guideline development. Electronic supplementary material The online version of this article (10.1186/s12910-018-0309-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Gisela Schott
- Drug Commission of the German Medical Association, Berlin, Germany
| | | | - Thomas Lempert
- Department of Neurology, Schlosspark-Klinik, Berlin, Germany.
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Pound P, Nicol CJ. Retrospective harm benefit analysis of pre-clinical animal research for six treatment interventions. PLoS One 2018; 13:e0193758. [PMID: 29590200 PMCID: PMC5874012 DOI: 10.1371/journal.pone.0193758] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 02/16/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The harm benefit analysis (HBA) is the cornerstone of animal research regulation and is considered to be a key ethical safeguard for animals. The HBA involves weighing the anticipated benefits of animal research against its predicted harms to animals but there are doubts about how objective and accountable this process is. OBJECTIVES i. To explore the harms to animals involved in pre-clinical animal studies and to assess these against the benefits for humans accruing from these studies; ii. To test the feasibility of conducting this type of retrospective HBA. METHODS Data on harms were systematically extracted from a sample of pre-clinical animal studies whose clinical relevance had already been investigated by comparing systematic reviews of the animal studies with systematic reviews of human studies for the same interventions (antifibrinolytics for haemorrhage, bisphosphonates for osteoporosis, corticosteroids for brain injury, Tirilazad for stroke, antenatal corticosteroids for neonatal respiratory distress and thrombolytics for stroke). Clinical relevance was also explored in terms of current clinical practice. Harms were categorised for severity using an expert panel. The quality of the research and its impact were considered. Bateson's Cube was used to conduct the HBA. RESULTS The most common assessment of animal harms by the expert panel was 'severe'. Reported use of analgesia was rare and some animals (including most neonates) endured significant procedures with no, or only light, anaesthesia reported. Some animals suffered iatrogenic harms. Many were kept alive for long periods post-experimentally but only 1% of studies reported post-operative care. A third of studies reported that some animals died prior to endpoints. All the studies were of poor quality. Having weighed the actual harms to animals against the actual clinical benefits accruing from these studies, and taking into account the quality of the research and its impact, less than 7% of the studies were permissible according to Bateson's Cube: only the moderate bisphosphonate studies appeared to minimise harms to animals whilst being associated with benefit for humans. CONCLUSIONS This is the first time the accountability of the HBA has been systematically explored across a range of pre-clinical animal studies. The regulatory systems in place when these studies were conducted failed to safeguard animals from severe suffering or to ensure that only beneficial, scientifically rigorous research was conducted. Our findings indicate a pressing need to: i. review regulations, particularly those that permit animals to suffer severe harms; ii. reform the processes of prospectively assessing pre-clinical animal studies to make them fit for purpose; and iii. systematically evaluate the benefits of pre-clinical animal research to permit a more realistic assessment of its likely future benefits.
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Affiliation(s)
- Pandora Pound
- Population Health Sciences, University of Bristol, Canynge Hall, Bristol, United Kingdom
| | - Christine J. Nicol
- School of Veterinary Science, University of Bristol, Langford House, Langford, United Kingdom
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Graham RK, Tavella G, Parker GB. Is there consensus across international evidence-based guidelines for the psychotropic drug management of bipolar disorder during the perinatal period? J Affect Disord 2018; 228:216-221. [PMID: 29274567 DOI: 10.1016/j.jad.2017.12.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/04/2017] [Accepted: 12/11/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Clinicians treating a patient with bipolar disorder who is pregnant or breastfeeding may seek advice from bipolar management guidelines that provide recommendations for perinatal treatment. We examine the consistency of such recommendations across several evidence-based guidelines. METHODS A literature search in the National Guideline Clearinghouse, the Cochrane Database of Systematic Reviews, PsycInfo and PubMed was undertaken using the search terms "bipolar disorder" and "guidelines," which generated 11 sets of evidence-based guidelines published by professional organizations during the 2005-2015 period. Information relevant to management during the perinatal period was reviewed by two independent reviewers, with key themes qualitatively analysed. RESULTS There was a moderate level of agreement across guidelines regarding the potential teratogenic effects of lithium, sodium valproate and carbamazepine, with most highlighting caution in using these medications during the perinatal period. There was less agreement regarding the safety risks associated with lamotrigine, antipsychotics, and antidepressants, and little agreement regarding the risks and recommendations of medications during breastfeeding. LIMITATIONS Some differences in recommendations are likely due to varying publication dates, with recent guidelines having more up-to-date evidence available to use when formulating recommendations. Further, due to ethical issues surrounding pregnancy and infant research, the evidence used to formulate perinatal recommendations is largely based on retrospective reports and/or case studies. It is therefore unrealistic to expect such recommendations to be entirely consistent and based on rigorous evidence. CONCLUSIONS While there was some consistency across guidelines on key recommendations, there were also substantial inconsistencies, with the latter risking compromising clinical management.
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Affiliation(s)
- Rebecca K Graham
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia
| | - Gabriela Tavella
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia
| | - Gordon B Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia.
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O'Sullivan JW, Albasri A, Nicholson BD, Perera R, Aronson JK, Roberts N, Heneghan C. Overtesting and undertesting in primary care: a systematic review and meta-analysis. BMJ Open 2018; 8:e018557. [PMID: 29440142 PMCID: PMC5829845 DOI: 10.1136/bmjopen-2017-018557] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Health systems are currently subject to unprecedented financial strains. Inappropriate test use wastes finite health resources (overuse) and delays diagnoses and treatment (underuse). As most patient care is provided in primary care, it represents an ideal setting to mitigate waste. OBJECTIVE To identify overuse and underuse of diagnostic tests in primary care. DESIGN Systematic review and meta-analysis. DATA SOURCES AND ELIGIBILITY CRITERIA We searched MEDLINE and Embase from January 1999 to October 2017 for studies that measured the inappropriateness of any diagnostic test (measured against a national or international guideline) ordered for adult patients in primary care. RESULTS We included 357 171 patients from 63 studies in 15 countries. We extracted 103 measures of inappropriateness (41 underuse and 62 overuse) from included studies for 47 different diagnostic tests.The overall rate of inappropriate diagnostic test ordering varied substantially (0.2%-100%)%).17 tests were underused >50% of the time. Of these, echocardiography (n=4 measures) was consistently underused (between 54% and 89%, n=4). There was large variation in the rate of inappropriate underuse of pulmonary function tests (38%-78%, n=8).Eleven tests were inappropriately overused >50% of the time. Echocardiography was consistently overused (77%-92%), whereas inappropriate overuse of urinary cultures, upper endoscopy and colonoscopy varied widely, from 36% to 77% (n=3), 10%-54% (n=10) and 8%-52% (n=2), respectively. CONCLUSIONS There is marked variation in the appropriate use of diagnostic tests in primary care. Specifically, the use of echocardiography (both underuse and overuse) is consistently poor. There is substantial variation in the rate of inappropriate underuse of pulmonary function tests and the overuse of upper endoscopy, urinary cultures and colonoscopy. PROSPERO REGISTRATION NUMBER CRD42016048832.
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Affiliation(s)
- Jack W O'Sullivan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| | - Ali Albasri
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| | - Brian D Nicholson
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| | - Rafael Perera
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| | - Jeffrey K Aronson
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
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Cosgrove L, Shaughnessy AF, Shaneyfelt T. When is a guideline not a guideline? The devil is in the details. BMJ Evid Based Med 2018; 23:33-36. [PMID: 29367325 DOI: 10.1136/ebmed-2017-110845] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Lisa Cosgrove
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Allen F Shaughnessy
- Department of Family Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Terrence Shaneyfelt
- Division of General Internal Medicine, University of Alabama, Birmingham, Alabama, USA
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Leach MJ, Canaway R, Hunter J. Evidence based practice in traditional & complementary medicine: An agenda for policy, practice, education and research. Complement Ther Clin Pract 2018; 31:38-46. [PMID: 29705478 DOI: 10.1016/j.ctcp.2018.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/29/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To develop a policy, practice, education and research agenda for evidence-based practice (EBP) in traditional and complementary medicine (T&CM). METHODS The study was a secondary analysis of qualitative data, using the method of roundtable discussion. The sample comprised seventeen experts in EBP and T&CM. The discussion was audio-recorded, and the transcript analysed using thematic analysis. RESULTS Four central themes emerged from the data; understanding evidence and EBP, drivers of change, interpersonal interaction, and moving forward. Captured within these themes were fifteen sub-themes. These themes/sub-themes translated into three broad calls to action: (1) defining terminology, (2) defining the EBP approach, and (3) fostering social movement. These calls to action formed the framework of the agenda. CONCLUSIONS This analysis presents a potential framework for an agenda to improve EBP implementation in T&CM. The fundamental elements of this action plan seek clarification, leadership and unification on the issue of EBP in T&CM.
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Affiliation(s)
- Matthew J Leach
- Department of Rural Health, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia.
| | - Rachel Canaway
- Department of General Practice, The University of Melbourne, 200 Berkeley St, Victoria, 3010, Australia.
| | - Jennifer Hunter
- NICM, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith NSW, 2751, Australia.
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Keijzers G, Cullen L, Egerton-Warburton D, Fatovich DM. Don't just do something, stand there! The value and art of deliberate clinical inertia. Emerg Med Australas 2018; 30:273-278. [DOI: 10.1111/1742-6723.12922] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/04/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Gerben Keijzers
- Department of Emergency Medicine; Gold Coast University Hospital; Gold Coast Queensland Australia
- School of Medicine; Bond University; Gold Coast Queensland Australia
- School of Medicine; Griffith University; Gold Coast Queensland Australia
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women’s Hospital, Queensland University of Technology; The University of Queensland; Brisbane Queensland Australia
| | - Diana Egerton-Warburton
- School of Clinical Science at Monash Health; Monash University Faculty of Medicine, Nursing and Health Sciences; Melbourne Victoria Australia
| | - Daniel M Fatovich
- Emergency Medicine, Royal Perth Hospital; The University of Western Australia; Perth Western Australia Australia
- Centre for Clinical Research in Emergency Medicine; Harry Perkins Institute of Medical Research; Perth Western Australia Australia
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Newton EH. Addressing overuse in emergency medicine: evidence of a role for greater patient engagement. Clin Exp Emerg Med 2017; 4:189-200. [PMID: 29306268 PMCID: PMC5758625 DOI: 10.15441/ceem.17.233] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/05/2017] [Accepted: 06/30/2017] [Indexed: 01/01/2023] Open
Abstract
Overuse of health care refers to tests, treatments, and even health care settings when used in circumstances where they are unlikely to help. Overuse is not only wasteful, it threatens patient safety by exposing patients to a greater chance of harm than benefit. It is a widespread problem and has proved resistant to change. Overuse of diagnostic testing is a particular problem in emergency medicine. Emergency physicians cite fear of missing a diagnosis, fear of law suits, and perceived patient expectations as key contributors. However, physicians' assumptions about what patients expect are often wrong, and overlook two of patients' most consistently voiced priorities: communication and empathy. Evidence indicates that patients who are more fully informed and engaged in their care often opt for less aggressive approaches. Shared decision making refers to (1) providing balanced information so that patients understand their options and the trade-offs involved, (2) encouraging them to voice their preferences and values, and (3) engaging them-to the extent appropriate or desired-in decision making. By adopting this approach to discretionary decision making, physicians are better positioned to address patients' concerns without the use of tests and treatments patients neither need nor value.
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Affiliation(s)
- Erika H. Newton
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY, USA
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Geiderman JM, Iserson KV, Marco CA, Jesus J, Venkat A. Conflicts of Interest in Emergency Medicine. Acad Emerg Med 2017; 24:1517-1526. [PMID: 28688200 DOI: 10.1111/acem.13253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 06/22/2017] [Accepted: 06/27/2017] [Indexed: 01/08/2023]
Abstract
Conflicts of interest (COIs) are common in the practice of emergency medicine and may be present in the areas of clinical practice, relations with industry, expert witness testimony, medical education, research, and organizations. A COI occurs when there is dissonance between a primary interest and another interest. The concept of professionalism in medicine places the patient as the primary interest in any interaction with a physician. We contend that patient welfare is the ultimate interest in the entire enterprise of medicine. Recognition and management of potential, real, and perceived COIs is essential to the ethical practice of emergency medicine. This paper discusses how to recognize, address, and manage them.
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Affiliation(s)
- Joel Martin Geiderman
- Department of Emergency Medicine; Ruth and Harry Roman Emergency Department; Cedars-Sinai Medical Center; Los Angeles CA
| | | | - Catherine A. Marco
- Department of Emergency Medicine; Wright State University Boonshoft School of Medicine; Dayton OH
| | | | - Arvind Venkat
- Department of Emergency Medicine; Allegheny Health Network; Pittsburgh PA
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Charlesworth M, Ashworth AD, Barker JM. Decision-making in response to respiratory veno-venous extracorporeal membrane oxygenation referrals: is current practice precise enough? Anaesthesia 2017; 73:154-159. [DOI: 10.1111/anae.14155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- M. Charlesworth
- Department of Cardiothoracic Anaesthesia; University Hospital South Manchester; Manchester UK
| | - A. D. Ashworth
- Department of Cardiothoracic Anaesthesia; University Hospital South Manchester; Manchester UK
| | - J. M. Barker
- Department of Cardiothoracic Anaesthesia; University Hospital South Manchester; Manchester UK
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Fatovich DM. The ACEM trainee research requirement is no longer relevant. No. Emerg Med Australas 2017; 29:726-727. [PMID: 29080271 DOI: 10.1111/1742-6723.12893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel M Fatovich
- Department of Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.,Division of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia.,Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
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Mechanick JI, Pessah-Pollack R, Camacho P, Correa R, Figaro MK, Garber JR, Jasim S, Pantalone KM, Trence D, Upala S. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY PROTOCOL FOR STANDARDIZED PRODUCTION OF CLINICAL PRACTICE GUIDELINES, ALGORITHMS, AND CHECKLISTS - 2017 UPDATE. Endocr Pract 2017; 23:1006-1021. [PMID: 28786720 DOI: 10.4158/ep171866.gl] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Clinical practice guideline (CPG), clinical practice algorithm (CPA), and clinical checklist (CC, collectively CPGAC) development is a high priority of the American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE). This 2017 update in CPG development consists of (1) a paradigm change wherein first, environmental scans identify important clinical issues and needs, second, CPA construction focuses on these clinical issues and needs, and third, CPG provide CPA node/edge-specific scientific substantiation and appended CC; (2) inclusion of new technical semantic and numerical descriptors for evidence types, subjective factors, and qualifiers; and (3) incorporation of patient-centered care components such as economics and transcultural adaptations, as well as implementation, validation, and evaluation strategies. This third point highlights the dominating factors of personal finances, governmental influences, and third-party payer dictates on CPGAC implementation, which ultimately impact CPGAC development. The AACE/ACE guidelines for the CPGAC program is a successful and ongoing iterative exercise to optimize endocrine care in a changing and challenging healthcare environment. ABBREVIATIONS AACE = American Association of Clinical Endocrinologists ACC = American College of Cardiology ACE = American College of Endocrinology ASeRT = ACE Scientific Referencing Team BEL = best evidence level CC = clinical checklist CPA = clinical practice algorithm CPG = clinical practice guideline CPGAC = clinical practice guideline, algorithm, and checklist EBM = evidence-based medicine EHR = electronic health record EL = evidence level G4GAC = Guidelines for Guidelines, Algorithms, and Checklists GAC = guidelines, algorithms, and checklists HCP = healthcare professional(s) POEMS = patient-oriented evidence that matters PRCT = prospective randomized controlled trial.
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Heneghan C, Mahtani KR, Goldacre B, Godlee F, Macdonald H, Jarvies D. Evidence based medicine manifesto for better healthcare. ACTA ACUST UNITED AC 2017; 22:120-122. [DOI: 10.1136/ebmed-2017-j2973rep] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rahman H. Influence of Research on Health Policy and Clinical Practice. J Obstet Gynaecol India 2017; 67:319-323. [PMID: 28867881 DOI: 10.1007/s13224-017-1013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022] Open
Abstract
Clinical research is a type of biomedical research conducted to aid and support the development of knowledge wherein there is involvement of patient. One of the key duties of healthcare professionals is to involve in research and change existing practice, when there is robust evidence in favour of new strategies that can have better patient care. Knowledge derived from research and experience may be of little value unless it is put into practice. Evidence-based medicine (EBM) is the diligent, clear, and wise use of current best research evidence in making decisions about clinical care of patients. The practice of EBM is incorporating clinician's expertise with the best available clinical evidence from research. It leads to improved patient outcomes and promote critical thinking and reflective practice. Effective research utilization can enhance policy decisions, resource allocation for programmes, and decisions about how to deliver those services.
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Affiliation(s)
- Hafizur Rahman
- Sikkim Manipal Institute of Medical Sciences, 5th Mile, Tadong, Gangtok, Sikkim India
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Scott IA, Chew DP, Branagan M. Raising the bar on guideline utility and trustworthiness. Intern Med J 2017; 47:613-616. [DOI: 10.1111/imj.13444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/24/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Ian A. Scott
- Department of Internal Medicine and Clinical Epidemiology; Princess Alexandra Hospital; Brisbane Queensland Australia
- School of Clinical Medicine; University of Queensland; Brisbane Queensland Australia
| | - Derek P. Chew
- Department of Cardiology; Flinders University; Adelaide South Australia Australia
- Department of Cardiovascular Medicine; Southern Adelaide Local Health Network; Adelaide South Australia Australia
| | - Maree Branagan
- National Heart Foundation of Australia; Canberra Australian Capital Territory Australia
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Bush SH, Marchington KL, Agar M, Davis DHJ, Sikora L, Tsang TWY. Quality of clinical practice guidelines in delirium: a systematic appraisal. BMJ Open 2017; 7:e013809. [PMID: 28283488 PMCID: PMC5353343 DOI: 10.1136/bmjopen-2016-013809] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 01/13/2017] [Accepted: 02/20/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine the accessibility and currency of delirium guidelines, guideline summary papers and evaluation studies, and critically appraise guideline quality. DESIGN Systematic literature search for formal guidelines (in English or French) with focus on delirium assessment and/or management in adults (≥18 years), guideline summary papers and evaluation studies.Full appraisal of delirium guidelines published between 2008 and 2013 and obtaining a 'Rigour of Development' domain screening score cut-off of >40% using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. DATA SOURCES Multiple bibliographic databases, guideline organisation databases, complemented by a grey literature search. RESULTS 3327 database citations and 83 grey literature links were identified. A total of 118 retrieved delirium guidelines and related documents underwent full-text screening. A final 21 delirium guidelines (with 10 being >5 years old), 12 guideline summary papers and 3 evaluation studies were included. For 11 delirium guidelines published between 2008 and 2013, the screening AGREE II 'Rigour' scores ranged from 3% to 91%, with seven meeting the cut-off score of >40%. Overall, the highest rating AGREE II domains were 'Scope and Purpose' (mean 80.1%, range 64-100%) and 'Clarity and Presentation' (mean 76.7%, range 38-97%). The lowest rating domains were 'Applicability' (mean 48.7%, range 8-81%) and 'Editorial Independence' (mean 53%, range 2-90%). The three highest rating guidelines in the 'Applicability' domain incorporated monitoring criteria or audit and costing templates, and/or implementation strategies. CONCLUSIONS Delirium guidelines are best sourced by a systematic grey literature search. Delirium guideline quality varied across all six AGREE II domains, demonstrating the importance of using a formal appraisal tool prior to guideline adaptation and implementation into clinical settings. Adding more knowledge translation resources to guidelines may improve their practical application and effective monitoring. More delirium guideline evaluation studies are needed to determine their effect on clinical practice.
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Affiliation(s)
- Shirley H Bush
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Katie L Marchington
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Meera Agar
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Daniel H J Davis
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
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