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Cronin M, McLoughlin K, Foley T, McGilloway S. Supporting family carers in general practice: a scoping review of clinical guidelines and recommendations. BMC PRIMARY CARE 2023; 24:234. [PMID: 37932659 PMCID: PMC10626724 DOI: 10.1186/s12875-023-02188-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Increasing numbers of family carers are providing informal care in community settings. This creates a number of challenges because family carers are at risk of poor physical and psychological health outcomes, with consequences both for themselves and those for whom they provide care. General Practitioners (GPs), who play a central role in community-based care, are ideally positioned to identify, assess, and signpost carers to supports. However, there is a significant gap in the literature in respect of appropriate guidance and resources to support them in this role. METHODS A scoping review was undertaken to examine clinical guidelines and recommendations for GPs to support them in their role with family carers. This involved a multidisciplinary team, in line with Arksey & O'Malley's framework, and entailed searches of ten peer-reviewed databases and grey literature between September-November 2020. RESULTS The searches yielded a total of 4,651 English language papers, 35 of which met the criteria for inclusion after removing duplicates, screening titles and abstracts, and performing full-text readings. Ten papers focused on resources/guidelines for GPs, twenty were research papers, three were review papers, one was a framework of quality markers for carer support, and one was an editorial. Data synthesis indicated that nine (90%) of the guidelines included some elements relating to the identification, assessment, and/or signposting of carers. Key strategies for identifying carers suggest that a whole practice approach is optimal, incorporating a role for the GP, practice staff, and for the use of appropriate supporting documentation. Important knowledge gaps were highlighted in respect of appropriate clinical assessment and evidence-based signposting pathways. CONCLUSION Our review addresses a significant gap in the literature by providing an important synthesis of current available evidence on clinical guidelines for GPs in supporting family carers, including strategies for identification, options for assessment and potential referral/signposting routes. However, there is a need for greater transparency of the existing evidence base as well as much more research to evaluate the effectiveness and increase the routine utilisation, of clinical guidelines in primary care.
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Affiliation(s)
- Mary Cronin
- Centre for Mental Health and Community Research, Department of Psychology and Social Sciences Institute, Maynooth University, Maynooth, Ireland.
| | | | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Sinéad McGilloway
- Centre for Mental Health and Community Research, Department of Psychology and Social Sciences Institute, Maynooth University, Maynooth, Ireland
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Hou L, Ge L, Wang Q, He J, Qin T, Cao L, Cao C, Liu D, Liu X, Yang K. Nutritional Recommendations for Type 2 Diabetes: An International Review of 15 Guidelines. Can J Diabetes 2023; 47:197-206. [PMID: 36184370 DOI: 10.1016/j.jcjd.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 06/13/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Recommendations from clinical practice guidelines (CPGs) for individuals with type 2 diabetes mellitus (T2DM) may be inconsistent, and little is known about their quality. Our aim in this study was to systematically review the consistency of globally available CPGs containing nutritional recommendations for T2DM and to assess the quality of their methodology and reporting. METHODS PubMed, China Biology Medicine and 4 main guideline websites were searched. Four researchers independently assessed quality of the methodology and reporting using the Appraisal of Guidelines for Research and Evaluation, second edition (AGREE II) instrument and the Reporting Items for Practice Guidelines in HealThcare (RIGHT) checklist. RESULTS Fifteen CPGs include 65 nutritional recommendations with 6 sections: 1) body weight and energy balance; 2) dietary eating patterns; 3) macronutrients; 4) micronutrients and supplements; 5) alcohol; and 6) specific, functional foods. Current nutritional recommendations for individuals with T2DM on specific elements and amounts are not completely consistent in different CPGs and fail to assign the specific supporting evidence and strength of recommendations. To use nutritional recommendations to guide and manage individuals with T2DM, it is important to address the current challenges by establishing a solid evidence base and indicating the strength of recommendations. Overall, 8 CPGs classified as recommended for clinical practice used AGREE II. Fifteen CPGs adhere to <60% of RIGHT checklist items. CONCLUSIONS High-quality evidence is needed to potentially close knowledge gaps and strengthen the recommendation. The AGREE II instrument, along with the RIGHT checklist, should be endorsed and used by CPG developers to ensure higher quality and adequate use of their products.
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Affiliation(s)
- Liangying Hou
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Long Ge
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Qi Wang
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Juanjuan He
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Tianzhu Qin
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Liujiao Cao
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Changhao Cao
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Diru Liu
- Department of Nutrition and Healthy Food, School of Public Health, Lanzhou University, Lanzhou, China
| | - Xingrong Liu
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Kehu Yang
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
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Zhang Y, Li YX, Zhong DL, Liu XB, Zhu YY, Jin RJ, Li J. Clinical practice guidelines and expert consensus statements on rehabilitation for patients with COVID-19: protocol for a systematic review. BMJ Open 2022; 12:e060767. [PMID: 35926987 PMCID: PMC9358617 DOI: 10.1136/bmjopen-2022-060767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION COVID-19 is a highly infectious disease, characterised by respiratory, physical and psychological dysfunctions. Rehabilitation could effectively alleviate the symptoms and promote recovery of the physical and mental health of patients with COVID-19. Recently, rehabilitation medical institutions have issued clinical practice guidelines (CPGs) and expert consensus statements involving recommendations for rehabilitation assessments and rehabilitation therapies for COVID-19. This systematic review aims to assess the methodological quality and reporting quality of the guidance documents, evaluate the heterogeneity of the recommendations and summarise the recommendations with respect to rehabilitation assessments and rehabilitation therapies for COVID-19 to provide a quick reference for front-line clinicians, therapists and patients as well as reasonable suggestions for future guidelines. METHODS AND ANALYSIS The electronic databases including PubMed, Embase, Chinese Biomedical Literature Database (CBM), Chinese Science and Technology Periodical Database (VIP), Wanfang Database and China National Knowledge Infrastructure (CNKI) and websites of governments or organisations (eg, National Guideline Clearinghouse, Guidelines International Network, National Institute for Health and Clinical Excellence, Scottish Intercollegiate Guidelines Network and WHO) will be searched for eligible CPGs and expert consensus statements from inception to August 2022. CPGs and expert consensus statements published in Chinese or English and presenting recommendations for modern functional rehabilitation techniques and/or traditional Chinese medicine rehabilitation techniques for COVID-19 will be included. Reviews, interpretations, old versions of CPGs and expert consensus statements and those for the management of other diseases during the pandemic will be excluded. Two reviewers will independently review each article, extract data, appraise the methodological quality following the Appraisal of Guidelines for Research & Evaluation II tool and assess the reporting quality with the Reporting Items for Practice Guidelines in Healthcare statement. The Measurement Scale of Rate of Agreement will be used to evaluate the heterogeneity of the recommendations in different CPGs and expert consensus statements. Agreement between reviewers will be calculated using the intraclass correlation coefficient. We will also summarise the recommendations for rehabilitation in patients with COVID-19. The results will be narratively described and presented as tables or figures. ETHICS AND DISSEMINATION Ethics approval is not needed for this systematic review because information from published documents will be used. The findings will be submitted for publication in a peer-reviewed journal and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PROSPERO REGISTRATION NUMBER CRD42020190761.
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Affiliation(s)
- Yue Zhang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yu-Xi Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Dong-Ling Zhong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xiao-Bo Liu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuan-Yuan Zhu
- Department of Rehabilitation Medicine, Affiliated Hospital of Panzhihua University, Panzhihua, Sichuan, China
| | - Rong-Jiang Jin
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Department of Rehabilitation Medicine, Affiliated Hospital of Panzhihua University, Panzhihua, Sichuan, China
| | - Juan Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Ghazal S, Ridha Z, D'Aguanno K, Nassim D, Quaiattini A, Netchiporouk E, Poulin Y, Kalia S, Marcoux D, Piguet V, Jack C. Treatment Guidelines for Atopic Dermatitis Since the Approval of Dupilumab: A Systematic Review and Quality Appraisal Using AGREE-II. Front Med (Lausanne) 2022; 9:821871. [PMID: 35355606 PMCID: PMC8959491 DOI: 10.3389/fmed.2022.821871] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/21/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction Since its approval for adults with moderate-to-severe atopic dermatitis (AD) in 2017, dupilumab has been incorporated into clinical practice guidelines (CPGs). However, recommendations differ internationally, and the quality assessment of their development is unclear. Objective We aimed to systematically review and appraise the quality of CPGs for adult AD reported since 2017 and map the recommendations for dupilumab initiation relative to conventional systemic therapy (CST). Materials and Methods A literature search was conducted in June 2020 in MEDLINE, EMBASE, SCOPUS, and CINAHL. Twelve CPGs were retrieved. Methodological quality was assessed using the validated Appraisal of Guidelines for Research & Evaluation II tool (AGREE-II). Recommendations were extracted and compared. Results AGREE-II median scores per domain of the CPGs were (%, r = range): scope/purpose, 78% (50-96); stakeholder involvement, 54% (28-85); rigor of development, 39% (21-63); clarity of presentation, 85% (69-100); applicability, 27% (6-51); and editorial independence, 76% (42-100). Neither met the threshold of 70% quality criteria for rigor of development nor the applicability domains. Three CPGs met the criteria for recommendation without modification. CPGs' approach to dupilumab initiation was as follows: second line, preferred over CST and nbUVB (n = 1/12 CPG); second line, equivalent to CST or nbUVB (n = 3/12 CPGs); third line, after nbUVB or CST (n = 5/12 CPGs); and fourth line after nbUVB and CST (n = 2/12). No consensus was reached for n = 1/12 CPG. Conclusion and Relevance Dupilumab is now incorporated into CPGs for adult AD. These CPGs exhibited good quality in scope/purpose, clarity, and editorial independence domains. However, none met AGREE-II criteria for methodological rigor/applicability. Gaps were found in mechanisms for updates, facilitators/barriers, resource implications, and stakeholder involvement. Only n = 3/12 CPGs met quality criteria for recommendation without modifications. Of these, two favored a conservative sequential approach for the initiation of dupilumab relative to CST, while one did not reach consensus. Our findings highlight divergent recommendations AD treatment, underlining a need to incorporate quality criteria into future guideline development.
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Affiliation(s)
| | - Zainab Ridha
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | | | - David Nassim
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Andrea Quaiattini
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada
| | - Elena Netchiporouk
- Division of Dermatology, McGill University Health Center, Montreal, QC, Canada.,Infectious Diseases and Immunity in Global Health, The Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Yves Poulin
- Centre de Recherche Dermatologique du Québec Métropolitain, Quebec City, QC, Canada
| | - Sunil Kalia
- Department of Dermatology and Skin Science, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Danielle Marcoux
- Department of Pediatrics, Division of Dermatology, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
| | - Carolyn Jack
- Faculty of Medicine, McGill University, Montreal, QC, Canada.,Division of Dermatology, McGill University Health Center, Montreal, QC, Canada.,Infectious Diseases and Immunity in Global Health, The Research Institute of the McGill University Health Center, Montreal, QC, Canada.,Divisions of Dermatology, St. Mary's Hospital, Montreal West Island Integrated University Health and Social Services Centre, Montreal, QC, Canada.,Jewish General Hospital, Montreal West-Central Integrated University Health and Social Services Centre, Montreal, QC, Canada
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Kim JY, Kim JH, Goo BH, Park YC, Seo BK, Baek YH. Quality assessment of conventional and traditional oriental medicine clinical practice guidelines for knee osteoarthritis using AGREE II instrument. Medicine (Baltimore) 2021; 100:e28426. [PMID: 34941193 PMCID: PMC8702243 DOI: 10.1097/md.0000000000028426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/01/2021] [Accepted: 12/06/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Knee osteoarthritis is a degenerative disease and its prevalence tends to increase. Clinical practice guidelines (CPGs) are evidence-based recommendations for treatment that help policymakers, practitioners, and patients make more appropriate and efficient decisions during the course of management. This study aimed to evaluate the quality of knee osteoarthritis CPGs using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. METHOD The retrieval engines and websites were utilized from January 2010 to December 2020. The search words were "Clinical practice guideline" OR "Critical practice guideline" OR "guideline∗" AND "Osteoarthritis." The quality of the CPGs was independently examined by four appraisers using the AGREE II instrument. Consequently, the selected CPGs were graded as Classes A, B, and C according to the level of recommendation. RESULT In this study, 13 CPGs for knee osteoarthritis were selected and evaluated qualitatively using the AGREE II instrument. The overall quality percentage score was as follows: clarity of presentation, 72.6%, scope and purpose, 62.6%, rigor of development, 54.2%, stakeholder investment, 50.5%, editorial independence, 46.5%, applicability, 22.5%. CONCLUSION Auxiliary materials for the treatment process of knee OA should be supplemented in future revised versions for quality improvement of knee OA CPGs. Also, more evidence should be accumulated to support the recommendation of traditional oriental medical treatments in the clinical field. From the perspective of integrative medicine, along with conventional pharmacological treatment, exercise, weight loss, and acupuncture can be combined together in clinical situations.
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Affiliation(s)
- Jun-Yeon Kim
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
- Joint Center, Kyung Hee University Hospital at Gangdong, Guangdong-gu, Seoul, Republic of Korea
| | - Jung-Hyun Kim
- Joint Center, Kyung Hee University Hospital at Gangdong, Guangdong-gu, Seoul, Republic of Korea
| | - Bon-Hyuk Goo
- Joint Center, Kyung Hee University Hospital at Gangdong, Guangdong-gu, Seoul, Republic of Korea
| | - Yeon-Cheol Park
- Joint Center, Kyung Hee University Hospital at Gangdong, Guangdong-gu, Seoul, Republic of Korea
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
| | - Byung-Kwan Seo
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
- Spine Center, Kyung Hee University Hospital at Gangdong, Guangdong-gu, Seoul, Republic of Korea
| | - Yong-Hyeon Baek
- Joint Center, Kyung Hee University Hospital at Gangdong, Guangdong-gu, Seoul, Republic of Korea
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
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Nixon AL, Chattopadhyay K, Leonardi-Bee J. Comparison of Content and Quality of Caribbean, International, and High-Income Country-Specific Clinical Guidelines for Managing Type 2 Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12868. [PMID: 34948479 PMCID: PMC8702176 DOI: 10.3390/ijerph182412868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE Type 2 diabetes mellitus (T2DM) is poorly managed in the Caribbean region; therefore, conducting an assessment on the content and quality of clinical guidelines could assist guideline developers in detecting and addressing information gaps. Hence, this study aimed to benchmark and compare the clinical guidelines for T2DM management from the Caribbean to guidelines developed internationally and by high-income countries. METHODS Seven T2DM management clinical guidelines were a priori selected from international and high-income country-specific clinical guidelines and then compared to the country-specific T2DM management clinical guidelines of the Caribbean region. Two reviewers independently assessed content (using a previously piloted data extraction form) and quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. RESULTS The Caribbean clinical guideline was found to contain similar levels of T2DM management topics when compared to international and high-income country-specific clinical guidelines; however, one country-specific clinical guideline from New Zealand was found to have substantially lower levels of content. The clinical guideline from the Caribbean was found to be of low quality and could not be used in practice; however, only three comparator clinical guidelines were found to be of high quality and could be recommended for use in clinical practice. A further three comparator clinical guidelines could be used in practice with minor modifications. CONCLUSION Although the T2DM management clinical guidelines from the Caribbean region contained high levels of content with regards to relevant topics, it was of insufficient quality to be used in clinical practice. Therefore, an alternative high-quality clinical guideline, as identified within this study, should be adopted and used within the Caribbean region to manage T2DM until a high-quality region-specific clinical guideline can be developed.
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Affiliation(s)
- Amy Latifah Nixon
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (A.L.N.); (J.L.-B.)
- The Nottingham Centre for Evidence-Based Healthcare, A Joanna Briggs Institute Centre of Excellence, University of Nottingham, Nottingham NG7 2RD, UK
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (A.L.N.); (J.L.-B.)
- The Nottingham Centre for Evidence-Based Healthcare, A Joanna Briggs Institute Centre of Excellence, University of Nottingham, Nottingham NG7 2RD, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (A.L.N.); (J.L.-B.)
- The Nottingham Centre for Evidence-Based Healthcare, A Joanna Briggs Institute Centre of Excellence, University of Nottingham, Nottingham NG7 2RD, UK
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Wu X, Li D, Chen H, Han J, Zhou H, He Z, Ma Y, Dong B, Wu Y, Matkowskyj KA, Ejaz A, Almhanna K, Wang Q. Evaluation of the reporting quality of guidelines for gastric cancer using the RIGHT checklist. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1003. [PMID: 34277803 PMCID: PMC8267280 DOI: 10.21037/atm-21-2491] [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: 06/02/2021] [Indexed: 01/13/2023]
Abstract
Background Gastric cancer is the fifth most common type of cancer globally. We aimed to evaluate the reporting quality of clinical practice guidelines in the field of gastric cancer. Methods We searched Medline (via PubMed), China Biology Medicine, Chinese National Knowledge Infrastructure and WanFang databases and the websites of the main guideline development organizations from 2018 to 2020 for guidelines on gastric cancer. Data were extracted and the reporting quality evaluated by two researchers independently using the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist. We assessed the compliance of the guidelines to each of the 35 items of RIGHT and summarized the reporting proportions of the seven domains of RIGHT. Results Eighteen guidelines were included. The mean proportion of appropriately reported RIGHT items was 52.4%. Among the seven domains of the RIGHT checklist, Basic information had the highest reporting rate (78.7%), and Review and quality assurance domain the lowest rate (16.7%). The domains Evidence (40.0%), Funding and declaration and management of interests (43.1%), and Other information (31.5%) had also reporting rates below 50%. Two RIGHT items (17 and 19b) were not reported by any of the guidelines. Conclusions The reporting quality of gastric cancer guidelines published in the years 2018-2020 was suboptimal, especially regarding the reporting of review, quality assurance and evidence. Guideline developers should pay attention on rigorous reporting following international standard to improve the quality of guidelines.
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Affiliation(s)
- Xuan Wu
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Ding Li
- Department of Pharmacy, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Haiyang Chen
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Jing Han
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Hanqiong Zhou
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Zhen He
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Yanfang Ma
- School of Chinese Medicine of Hong Kong Baptist University, Hong Kong, China
| | - Bingqi Dong
- Department of Urology, Affiliated Cancer Hospital to Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Yingxi Wu
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Kristina A Matkowskyj
- Department of Pathology & Laboratory Medicine, University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Aslam Ejaz
- Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Khaldoun Almhanna
- Division of Hematology/Oncology, The Warren Alpert Medical School of Brown University, Lifespan Cancer Institute, Rhode Island Hospital, Providence, RI, USA
| | - Qiming Wang
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
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Wang X, Zhou Q, Chen Y, Yang N, Pottie K, Xiao Y, Tong Y, Yao L, Wang Q, Yang K, Norris SL. Using RIGHT (Reporting Items for Practice Guidelines in Healthcare) to evaluate the reporting quality of WHO guidelines. Health Res Policy Syst 2020; 18:75. [PMID: 32641144 PMCID: PMC7341641 DOI: 10.1186/s12961-020-00578-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/20/2020] [Indexed: 12/16/2022] Open
Abstract
Background Without adequate reporting of research, valuable time and resources are wasted. In the same vein, adequate reporting of practice guidelines to optimise patient care is equally important. Our study examines the quality of reporting of published WHO guidelines, over time, using the RIGHT (Reporting Items for Practice Guidelines in HealThcare) reporting checklist. Methods We examined English-language guidelines approved by the WHO Guidelines Review Committee from inception of the committee in 2007 until 31 December 2017. Pairs of independent, trained reviewers assessed the reporting quality of these guidelines. Descriptive data were summarised with frequencies and percentages. Results We included 182 eligible guidelines. Overall, 25 out of the 34 RIGHT items were reported in 75% or more of the WHO guidelines. The reporting rates improved over time. Further, 90% of the guidelines reported document type in the title. The identification of evidence, the rationale for recommendations and the review process were reported in more than 80% of guidelines. The certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was assessed in 81% of the guidelines assessed. While 82% of guidelines reported funding sources, only 25% mentioned the role of funders. Conclusions WHO guidelines provide adequate reporting of many of the RIGHT items and reporting has improved over time. WHO guidelines compare favourably to guidelines produced by other organisations. However, reporting can be further improved in a number of areas.
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Affiliation(s)
- Xiaoqin Wang
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Canada.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China.,Chinese GRADE Center, Lanzhou, China
| | - Qi Zhou
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China. .,WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China. .,Chinese GRADE Center, Lanzhou, China.
| | - Nan Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China.,Chinese GRADE Center, Lanzhou, China
| | - Kevin Pottie
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Yujie Xiao
- The Second Hospital of Lanzhou University, Lanzhou, China
| | - Yajing Tong
- School of Public Health of Lanzhou University, Lanzhou, China
| | - Liang Yao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Qi Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China. .,WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China. .,Chinese GRADE Center, Lanzhou, China.
| | - Susan L Norris
- Quality of Norms and Standards Department, Science Division, World Health Organization, Geneva, Switzerland
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Morgott M, Heinmüller S, Hueber S, Schedlbauer A, Kühlein T. Do guidelines help us to deviate from their recommendations when appropriate for the individual patient? A systematic survey of clinical practice guidelines. J Eval Clin Pract 2020; 26:709-717. [PMID: 31206241 DOI: 10.1111/jep.13187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/03/2019] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Clinical practice guidelines (CPG) were introduced to summarize the best scientific evidence available. Thereby, CPG were meant to support evidence-based medicine (EBM). However, besides evidence, EBM also asks for patients' preferences and physicians' experiences to be considered when coming to therapeutic decisions. Thus, deviations from CPG recommendations are sometimes necessary when practicing EBM. We wanted to examine whether CPG support deviations from their recommendations when appropriate. For operationalization, we asked whether absolute effect sizes (AES) for benefit and/or harm of suggested therapies were provided along with the respective CPG recommendation. METHODS This systematic survey comprised the most common CPG on chronic coronary heart disease (CCHD) and type 2 diabetes mellitus (T2DM) from English- and German-speaking countries. Only CPG recommendations on pharmacotherapy were evaluated. If AES of a recommended therapy were reported, we rated how easily findable they were within the CPG. Moreover, we assessed whether the CPG provided patient information material and whether this material supplied AES allowing patients to determine the effects to be expected. RESULTS In the 13 CPG surveyed, 144 recommendations on pharmacotherapy were identified. For 108 recommendations (75%), no AES for benefit and/or harm were reported. Thirty-one recommendations (22%) were accompanied by one or more AES for either benefit or harm. Along with five recommendations (3%), one or more AES for both benefit and harm were given. AES were considered easy to find for three of these 36 recommendations (8%). Patient information material was provided in three of the 13 CPG (23%) accounting for AES in one occasion only. CONCLUSION Current CPG on T2DM and CCHD do not sufficiently offer AES for benefits and harms of recommended therapies. Thus, they lack satisfactory information to support deviations from CPG recommendations. Consequently, CPG in their present form do not adequately facilitate EBM.
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Affiliation(s)
- Marc Morgott
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Institute of General Practice, Erlangen, Germany
| | - Stefan Heinmüller
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Institute of General Practice, Erlangen, Germany
| | - Susann Hueber
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Institute of General Practice, Erlangen, Germany
| | - Angela Schedlbauer
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Institute of General Practice, Erlangen, Germany
| | - Thomas Kühlein
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Institute of General Practice, Erlangen, Germany
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Wayant C, Cooper C, Turner D, Vassar M. Evaluation of the NCCN guidelines using the RIGHT Statement and AGREE-II instrument: a cross-sectional review. BMJ Evid Based Med 2019; 24:219-226. [PMID: 30904829 DOI: 10.1136/bmjebm-2018-111153] [Citation(s) in RCA: 16] [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] [Accepted: 03/06/2019] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Robust, clearly reported clinical practice guidelines (CPGs) are essential for evidence-based clinical practice. The Reporting Items for practice Guidelines in HealThcare (RIGHT) Statement and Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument were published to improve the methodological and reporting quality in healthcare CPGs. METHODS We applied the RIGHT Statement checklist and AGREE-II instrument to 48 National Comprehensive Cancer Network (NCCN) guidelines. Our primary objective was to assess the adherence to RIGHT and AGREE-II items. Since neither RIGHT nor AGREE-II can judge the clinical usefulness of a guideline, our study is designed to only focus on the methodological and reporting quality of each guideline. RESULTS The NCCN guidelines demonstrated notable strengths and weaknesses. For example, RIGHT Statement items 19 (conflicts of interest), 7b (description of subgroups) and 13a (clear, precise recommendations) were fully reported in all guidelines. However, the guidelines inconsistently incorporated patient values and preferences and cost. Regarding the AGREE-II instrument, the NCCN guidelines scored highly on the domains 4 (clear, precise recommendations) and 6 (handling of conflicts of interest), but lowest on domain 2 (inclusion of all relevant stakeholders). CONCLUSIONS In this investigation, we found that NCCN CPGs demonstrate key strengths and weaknesses with respect to the reporting of key items essential to CPGs. We recommend the continued use of NCCN guidelines and improvements to weaknesses in reporting and methods. Doing so serves to improve the evidence delivered to healthcare providers, thus potentially improving patient care.
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Affiliation(s)
- Cole Wayant
- Biomedical Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Craig Cooper
- Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - D'Arcy Turner
- Medical Education, Kansas City University of Medicine and Biosciences, Kansas City, Kansas, USA
| | - Matt Vassar
- Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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11
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Bahrami M, Karimi T, Yadegarfar G, Norouzi A. Assessing the Quality of Existing Clinical Practice Guidelines for Chemotherapy Drug Extravasation by Appraisal of Guidelines for Research and Evaluation II. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2019; 24:410-416. [PMID: 31772914 PMCID: PMC6875885 DOI: 10.4103/ijnmr.ijnmr_80_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/15/2019] [Accepted: 08/07/2019] [Indexed: 02/05/2023]
Abstract
Background: Extravasation is a potentially hazardous event that may occur during chemotherapy. The aim of this study is to assess the quality of existing Clinical Practice Guidelines (CPGs) for chemotherapy drug extravasation by Appraisal of Guidelines for Research and Evaluation II (AGREE II). Materials and Methods: Valid electronic databases and CPGs from 2007 to August 2018 were searched by keywords of CPGs, extravasation, chemotherapy, and cancer. CPGs were evaluated independently by five experts through AGREE II tool, and the consensus among evaluators was calculated by ICC (Intra-class Correlation Coefficient). Results: Five of the 111 CPGs matched the inclusion criteria. The methodological quality of CPGs in domains of “scope and purpose,“ “stakeholder involvement,“ “clarity of presentation,“ and “applicability“ were good, in the domain of “rigor of development,“ was acceptable, and in “editorial independence“ domain, it needed more attention of developers of CPGs. The range of assessors' consensus was within a range of moderate to very good (0.55--0.93). Conclusions: The methodological quality of existing CPGs of chemotherapy drugs extravasation assessed by AGREE II tool is appropriate. Four CPGs had high level while one had moderate level of quality. Therefore, their use is recommended in the clinic to reduce the risk of chemotherapy extravasation to the entire treatment team and the nurses working in the oncology departments.
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Affiliation(s)
- Masoud Bahrami
- Cancer Prevention Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tayebeh Karimi
- Student Research Committee, Department of Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ghasem Yadegarfar
- Heart Failure Research Centre and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Norouzi
- PhD Candidate in Medical Library and Information Sciences, Health Information Technology Research Center, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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12
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Zhang P, Lu Q, Li H, Wang W, Li G, Si L, Ding Y. The quality of guidelines for diabetic foot ulcers: A critical appraisal using the AGREE II instrument. PLoS One 2019; 14:e0217555. [PMID: 31545806 PMCID: PMC6756510 DOI: 10.1371/journal.pone.0217555] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/14/2019] [Indexed: 01/13/2023] Open
Abstract
This study aims to evaluate the quality of clinical practice guidelines(CPGs) for patients with diabetic foot worldwide. A search of guidelines websites, databases and academic institutions websites was performed from January 1st, 2010, until June 30th, 2018. Four assessors independently rated the quality of each CPG using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Twelve CPGs satisfied the inclusion criteria. The median scores for the 6 AGREE II domains (scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence) were 92.5%, 72.5%, 71.5%, 89%, 47%, and 77%, respectively. The overall quality of the CPGs was good since the majority of the CPGs reached an overall guideline quality between 5 and 7 points. Different CPGs had widely varying scores in the same area, ranging from 25 to 94 points.
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Affiliation(s)
- Peiying Zhang
- Nursing Department, Peking University First Hospital, Beijing, China
| | - Qian Lu
- School of Nursing, Peking University, Beijing, China
| | - Huijuan Li
- Department of Plastic and Burns, Peking University First Hospital, Beijing, China
| | - Wei Wang
- Schhol of Medicine, Tongji University, Shanghai, China
| | - Gaoqiang Li
- School of Nursing, Peking University, Beijing, China
| | - Longmei Si
- Nursing Department, Peking University First Hospital, Beijing, China
| | - Yanming Ding
- Nursing Department, Peking University First Hospital, Beijing, China
- * E-mail:
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Xiao Y, Jiang L, Tong Y, Luo X, He J, Liu L, Gong C, Ke L, Yang L, Zhou Q, Estill J, Shen H, Chen Y. Evaluation of the quality of guidelines for assisted reproductive technology using the RIGHT checklist: A cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2019; 241:42-48. [PMID: 31419695 DOI: 10.1016/j.ejogrb.2019.07.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION In recent years, assisted reproductive technology (ART) has developed rapidly, leading to an increasing number of clinical practice guidelines in this field. However, the reporting quality of current clinical practice guidelines in ART is still unknown. Objective To evaluate the reporting quality of clinical practice guidelines in the field of ART using the RIGHT checklist. METHOD Relevant guidelines were identified by electronic search of PubMed, Chinese Biomedical Literature Database (CBM), Wan Fang Database and Chinese National Knowledge Infrastructure (CNKI) from the beginning of the database to October, 2017. We also searched the websites of the guideline development organizations, including Guidelines International Network (GIN), National Guideline Clearinghouse (NGC) and the National Institute for Health and Care Excellence (NICE), as well as from two medical associations, including the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM). We used Google Scholar to find additional clinical practice guidelines (CPGs) as well. Two investigators searched the database, selected guidelines independently based on the inclusion criteria, and extracted the relevant information. RESULT Fifteen guidelines (i.e. six developed by individual institutions and 9 by associations) were included. On average, 12.7 out of 35 items in the RIGHT standard (36.3%) were reported in each guideline. Five items were not reported by any of these guidelines. The reporting proportion of the seven domains (i.e. Basic information; Background; Evidence; Recommendations; Review and quality assurance; Funding and declaration and management of interests; Other information) were 46.7%, 40.8%, 45.3%, 29.5%, 53.3%, 10.0%, 26.7%, respectively. CONCLUSION At present, the reporting quality of guidelines for ART is poor, especially regarding the funding. In the future guideline development, more consideration should be given to reporting, dissemination and implementation.
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Affiliation(s)
- Yujie Xiao
- The Second Medical School of Lanzhou University, Lanzhou, Gansu 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou Gansu 730000, China
| | - Li Jiang
- Reproductive Medicine Center, Peking University People's Hospital, Peking 100000, China
| | - Yajing Tong
- School of Public Health of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Xufei Luo
- School of Public Health of Lanzhou University, Lanzhou, Gansu 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou Gansu 730000, China; Chinese GRADE Center, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Jianghua He
- The Second Medical School of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Lian Liu
- The Second Medical School of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Chao Gong
- The Second Medical School of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Lixin Ke
- The first Medical School of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Liu Yang
- The Reproductive Medicine Special Hospital of the first hospital of Lanzhou University, Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu 730000, China
| | - Qi Zhou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou Gansu 730000, China; Chinese GRADE Center, Lanzhou University, Lanzhou, Gansu 730000, China; The first Medical School of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Janne Estill
- Institute of Global Health, University of Geneva, Switzerland; Institute of Mathematical Statistics and Actuarial Science, University of Bern, Switzerland
| | - Huan Shen
- Reproductive Medicine Center, Peking University People's Hospital, Peking 100000, China.
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou Gansu 730000, China; Chinese GRADE Center, Lanzhou University, Lanzhou, Gansu 730000, China.
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Song X, Wang J, Gao Y, Yu Y, Zhang J, Wang Q, Ma X, Estille J, Jin X, Chen Y, Mu Y. Critical appraisal and systematic review of guidelines for perioperative diabetes management: 2011-2017. Endocrine 2019; 63:204-212. [PMID: 30446970 DOI: 10.1007/s12020-018-1786-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/06/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE To systematically evaluate the quality, consistency and the evidence support of guidelines for perioperative diabetes management. METHODS We retrieved guidelines through systematic search, critically evaluated their quality and compared the recommendations of included guidelines. Five aspects were compared: target level, management of hyper- and hypoglycaemia, frequency of monitoring, management of insulin, and management of oral anti-diabetic drugs (OADs). RESULTS Fourteen guidelines met our criteria, and 342 recommendations were extracted, the results of Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation showed that none of the mean score in each domain was higher than 50%. On average, most guidelines had only one domain scored above 50%. Most recommendations (78.9%) did not specify their supporting evidence, 71 (20.8%) were formed using grading criteria, none cited systematic review or meta-analysis. Recommendations were inconsistent across different guidelines. CONCLUSIONS The existing guidelines about perioperative management of diabetes needs improvement in methodology, as well as the production of evidence with high quality. Evidence-based guidelines are required for the perioperative management of diabetes.
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Affiliation(s)
- Xiaoyang Song
- The First Clinical Medical College, Lanzhou University, Donggang West Road, 730000, Lanzhou, China
| | - Jinjing Wang
- Fifth Medical Center of Chinese PLA General Hospital, East Avenue, 100000, Beijing, China
- Department of Endocrinology, Chinese PLA General Hospital, Fuxing Road, 100000, Beijing, China
| | - Yuting Gao
- The First Clinical Medical College, Lanzhou University, Donggang West Road, 730000, Lanzhou, China
- Endocrinology Department, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan ErLu, Guangzhou, 510080, China
| | - Yang Yu
- The Second Clinical Medical College, Lanzhou University, Cuiyingmen, 730000, Lanzhou, China
| | - Jingyi Zhang
- School of Public Health, Lanzhou University, Donggang West Road, 730000, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Donggang West Road, 730000, Lanzhou, China
| | - Qi Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Donggang West Road, 730000, Lanzhou, China
- Health Policy PhD Program, McMaster University, 1280 Main Street West, L8S 4L8, Hamilton, ON, Canada
- McMaster Health Forum, McMaster University, 1280 Main Street West, L8S 4L8, Hamilton, ON, Canada
| | - Xiaoting Ma
- School of Public Health, Lanzhou University, Donggang West Road, 730000, Lanzhou, China
| | - Janne Estille
- Institute of Global Health, University of Geneva, Rue du Général-Dufour, 1211, Geneva, Switzerland
- Institute of Mathematical Statistics and Actuarial Science, University of Bern, Hochschulstrasse, 3012, Bern, Switzerland
| | - Xinye Jin
- Department of Endocrinology, Chinese PLA General Hospital, Fuxing Road, 100000, Beijing, China
- Department of Endocrinology, Hainan Branch of Chinese PLA General Hospital, Haitangwan, 572000, Sanya, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Donggang West Road, 730000, Lanzhou, China.
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, 730000, China.
| | - Yiming Mu
- Department of Endocrinology, Chinese PLA General Hospital, Fuxing Road, 100000, Beijing, China.
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15
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Rego de Sousa MJ, Albuquerque M, Ribeiro R, Cruz G, Mateus P, de Sousa J, de Sousa G. Evaluation of Noninvasive Prenatal Testing (NIPT) guidelines using the AGREE II instrument. J Matern Fetal Neonatal Med 2018; 33:455-463. [PMID: 30205421 DOI: 10.1080/14767058.2018.1494716] [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: 10/28/2022]
Abstract
Objective: The rapid increase of cell-free fetal DNA analysis for Down syndrome screening requires evidence-based clinical practice guidelines for noninvasive prenatal testing (NIPT). Several studies show that the quality of many guidelines is low and there are still many health areas where this quality is not systematically evaluated. Given the absence of research, in the NIPT field, we used an internationally validated tool to evaluate a set of three NIPT practice guidelines and to look at dimensions that can be improved.Methods: Four appraisers, experts in prenatal screening, evaluated three main NIPT guidelines published in the last 2 years using the AGREE II (Appraisal of Guidelines for Research and Evaluation II), a tool specifically designed for guideline quality appraisal.Results: Guidelines scored higher in domains related with scope, purpose, and clarity of presentation, and lower in stakeholder involvement and rigor of development. Intradomain items evaluation showed asymmetries between guidelines. The UK-NSC was the guideline with the best scores.Discussion: Several areas of NIPT guidelines, such as stakeholders involvement, selection of supporting evidence, external reviews, updating processes, and competing interests disclosure, can be improved. Appraisers recommend modifications to all NIPT guidelines that can lead to substantial improvements in their methodological quality and subsequently make a contribution to prenatal screening improvement.
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Affiliation(s)
| | | | - Rita Ribeiro
- Centro de Medicina Laboratorial Germano de Sousa, Lisboa, Portugal
| | - Grasielle Cruz
- Centro de Medicina Laboratorial Germano de Sousa, Lisboa, Portugal
| | - Pedro Mateus
- Centro de Medicina Laboratorial Germano de Sousa, Lisboa, Portugal
| | - José de Sousa
- Centro de Medicina Laboratorial Germano de Sousa, Lisboa, Portugal
| | - Germano de Sousa
- Centro de Medicina Laboratorial Germano de Sousa, Lisboa, Portugal
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Radwan M, Akbari Sari A, Rashidian A, Takian A, Elsous A, Abou-Dagga S. Factors hindering the adherence to clinical practice guideline for diabetes mellitus in the Palestinian primary healthcare clinics: a qualitative study. BMJ Open 2018; 8:e021195. [PMID: 30185569 PMCID: PMC6129048 DOI: 10.1136/bmjopen-2017-021195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Despite a high number of the internationally produced and implemented clinical guidelines, the adherence with them is still low in healthcare. This study aimed at exploring the perspectives and experiences of senior doctors and nurses towards the barriers of adherence to diabetes guideline. SETTING The Palestinian Primary Health Care-Ministry of Health (PHC-MoH) and Primary Health Care-United Nations Relief and Works Agency for Palestine Refugees in the Near East (PHC- UNRWA) in Gaza Strip. PARTICIPANTS Individual face-to-face in-depth interviews were conducted with 20 senior doctors and nurses who were purposefully selected. METHODS Qualitative design was employed using the theoretical framework by Cabana et al to develop an interview guide. Semi-structural and audio-recorded interviews were conducted. Data were transcribed verbatim and thematically analysed. RESULTS The key theme barriers identified by participants that emerged from the analysed data were in regard of the PHC-MoH lack reimbursement, lack of resources and lack of the guideline trustworthiness, and in regard of PHC-UNRWA the time constraints and the lack of the guideline trustworthiness. The two key subthemes elicited from the qualitative analysis were the outdated guideline and lack of auditing and feedback. CONCLUSION The analysis identified a wide range of barriers against the adherence to diabetes guideline within the PHC-MoH and PHC-UNRWA. The environmental-related and guideline-related barriers were the most prominent factors influencing the guideline adherence. Our study can inform the policy makers and senior managers to develop a tailored interventions that can target the elicited barriers through a multifaceted implementation strategy.
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Affiliation(s)
- Mahmoud Radwan
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
- International Cooperation Directorate, Palestinian Ministry of Health, Gaza Strip, Palestine
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
| | - Amirhossein Takian
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Aymen Elsous
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
| | - Sanaa Abou-Dagga
- Department of Research Affairs and Graduates Studies, Islamic University of Gaza, Gaza Strip, Palestine
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Sousa DMDN, Chagas ACMA, Vasconcelos CTM, Stein AT, Oriá MOB. Development of a clinical protocol for detection of cervical cancer precursor lesions. Rev Lat Am Enfermagem 2018; 26:e2999. [PMID: 29791673 PMCID: PMC5969826 DOI: 10.1590/1518-8345.2340.2999] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 01/12/2018] [Indexed: 01/10/2023] Open
Abstract
Objective: to develop and validate the content of a clinical protocol aimed at
prevention of cervical cancer in primary care. Method: technological research according to the steps: (1) submission of the project
to the research ethics committee; (2) bibliographic survey; (3) elaboration
of the clinical protocol; and (4) content validation. In the third step, the
information was collected through bibliographic research and gynecology
specialists were consulted. For the final step, four judges were selected to
evaluate the clinical protocol according to AGREE 2. Domains that reached
the minimum level of agreement of 75% in the scores were considered
validated. Results: the scores obtained in each domain of the instrument were as follows: domain
1 (scope and purpose) = 87.5%; domain 2 (stakeholder involvement) = 83.3%;
domain 3 (development rigor) = 79.7%; domain 4 (clarity of presentation) =
76.3%; domain 5 (applicability) = 78.1%; and domain 6 (editorial
independence) = 85.4. Conclusion: the clinical protocol proved to be a validated material with scores above the
minimum required. The protocol obtained positive recommendations with
modifications and went through adjustments in order to make it more
effective.
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18
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Ambaras Khan R, Aziz Z. The methodological quality of guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia: A systematic review. J Clin Pharm Ther 2018; 43:450-459. [PMID: 29722052 DOI: 10.1111/jcpt.12696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/27/2018] [Indexed: 12/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Clinical practice guidelines serve as a framework for physicians to make decisions and to support best practice for optimizing patient care. However, if the guidelines do not address all the important components of optimal care sufficiently, the quality and validity of the guidelines can be reduced. The objectives of this study were to systematically review current guidelines for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), evaluate their methodological quality and highlight the similarities and differences in their recommendations for empirical antibiotic and antibiotic de-escalation strategies. METHODS This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Electronic databases including MEDLINE, CINAHL, PubMed and EMBASE were searched up to September 2017 for relevant guidelines. Other databases such as NICE, Scottish Intercollegiate Guidelines Network (SIGN) and the websites of professional societies were also searched for relevant guidelines. The quality and reporting of included guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) instrument. RESULTS AND DISCUSSION Six guidelines were eligible for inclusion in our review. Among 6 domains of AGREE-II, "clarity of presentation" scored the highest (80.6%), whereas "applicability" scored the lowest (11.8%). All the guidelines supported the antibiotic de-escalation strategy, whereas the majority of the guidelines (5 of 6) recommended that empirical antibiotic therapy should be implemented in accordance with local microbiological data. All the guidelines suggested that for early-onset HAP/VAP, therapy should start with a narrow spectrum empirical antibiotic such as penicillin or cephalosporins, whereas for late-onset HAP/VAP, the guidelines recommended the use of a broader spectrum empirical antibiotic such as the penicillin extended spectrum carbapenems and glycopeptides. WHAT IS NEW AND CONCLUSIONS Expert guidelines promote the judicious use of antibiotics and prevent antibiotic overuse. The quality and validity of available HAP/VAP guidelines would be enhanced by improving their adherence to accepted best practice for the management of HAP and VAP.
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Affiliation(s)
- R Ambaras Khan
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Z Aziz
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Radwan M, Elsous A, Al-Sharif H, Abu Mustafa A. Glycemic control among primary care patients with type 2 diabetes mellitus in the Gaza Strip, Palestine. Ther Adv Endocrinol Metab 2018; 9:3-14. [PMID: 29344335 PMCID: PMC5761953 DOI: 10.1177/2042018817742070] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/19/2017] [Indexed: 11/15/2022] Open
Abstract
AIM In this study, we aimed to assess the level of good glycemic control, to determine association between adherence to antidiabetic medications and glycosylated hemoglobin (HbA1c) and to examine factors influencing good glycemic control. MATERIALS AND METHODS A cross-sectional design was employed among 369 patients with type 2 diabetes mellitus (T2DM) from four Ministry of Health health centers in 2016. A sample of 3 ml blood was taken to measure the HbA1c, and patients were asked to fill out a pretested questionnaire. Univariate and multivariate logistic regressions, to identify independent factors associated with good glycemic control, were conducted using SPSS software version 22 (IBM Corp, Armonk, NY, USA). RESULTS Mean [±standard deviation (SD)] of HbA1c was 8.97 (2.02) and one fifth of patients had good glycemic control (HbA1c ⩽ 7%). Factors associated with good glycemic control were: older age [odds ratio (OR) = 0.96, 95% confidence interval (CI): 0.933-0.988), high medication adherence (OR: 2.757, 95% CI: 1.308-4.693), and better health literacy (OR= 2.124, 95% CI: 1.917-4.921). Duration of diabetes mellitus (DM > 7 years) was inversely related to good glycemic control (OR = 2.255, 95% CI: 1.189-4.276). CONCLUSION Our study showed that glycemic control was suboptimal, and factors associated with that were: older age, high medication adherence, and better health literacy. Knowledge of these factors could be an entry toward helping patients and targeting interventions to improve glycemic control and prevent diabetes-related complications.
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Affiliation(s)
- Mahmoud Radwan
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences - International campus, Tehran, Iran Islamic Republic; and International Cooperation Department, Ministry of Health, Gaza Strip, Palestinian Territory, Occupied
| | - Aymen Elsous
- Assistant Professor, Faculty of Health Sciences, Israa University, Gaza Strip, Palestinian Territory, Occupied; and Quality Improvement and Infection Control, Shifa Medical Complex, Gaza Strip, Palestinian Territory, Occupied
| | - Hasnaa Al-Sharif
- Department of Chronic Diseases, Directorate of Primary Healthcare, Ministry of Health, Gaza Strip, Palestinian Territory, Occupied
| | - Ayman Abu Mustafa
- Palestine College of Nursing, Ministry of Health, Gaza Strip, Palestinian Territory, Occupied
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Radwan M, Akbari Sari A, Rashidian A, Takian A, Abou-Dagga S, Elsous A. Attitudes of Palestinian Health-Care Professionals in Gaza to Clinical Practice Guideline for Diagnosis and Treatment of Diabetes Mellitus. Front Endocrinol (Lausanne) 2017; 8:288. [PMID: 29163359 PMCID: PMC5671658 DOI: 10.3389/fendo.2017.00288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 10/11/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the huge numbers of the internationally produced and implemented Clinical Practice Guidelines (CPGs), the compliance with them is still low in health care. This study aimed at assessing the attitudes of Palestinian health-care professionals toward the most perceived factors influencing the adherence to the CPG for Diabetes Mellitus in the Primary Health-care centers of the Ministry of Health (PHC-MoH) and the Primary Health-care centers of the United Nations Relief and Works Agency for Palestine Refugees (PHC-UNRWA) using a validated questionnaire. METHODS A cross-sectional design was employed with a census sample of all Palestinian family doctors and nurses (n = 323). The Cabana theoretical framework was used to develop a study questionnaire. A cross cultural adaptation framework was followed to develop the Arabic version questionnaire. The psychometric properties of Arabic version were finally assessed. RESULTS The Arabic version questionnaire showed a good construct validity and internal consistency reliability. The overall adherence level to the diabetic guideline was disappointingly suboptimal 51.5% (47.3% in the PHC-MoH and 55.5% in the PHC-UNRWA) P = 0.000. The most frequently perceived barriers in the PHC-MoH were lack of incentives, lack of resources, and lack of guideline trustworthiness, whereas the lack of time and the lack of guideline trustworthiness were the most prominent barriers in the PHC-UNRWA. In spite of the lack of trustworthiness of the diabetic guideline, most respondents in both settings had a positive attitude toward guidelines in general, but this attitude was not a predictor of guideline adherence. CONCLUSION The good validity and reliability of our questionnaire can provide support for the accuracy of our findings. Multifaceted implementation strategies targeting the main barriers elicited from this study are required for addressing the lack of incentives, organizational resources, lack of confidence in the guideline, and time constraints.
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Affiliation(s)
- Mahmoud Radwan
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
- International Cooperation Directorate, Palestinian Ministry of Health, Gaza City, Palestine
- *Correspondence: Mahmoud Radwan,
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
| | - Amirhossein Takian
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sanaa Abou-Dagga
- Department of Research Affairs and Graduates Studies, Islamic University of Gaza, Gaza City, Palestine
| | - Aymen Elsous
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
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