Assessment Of Clinical Practice Guidelines Research Articles

GRADE pearls and pitfalls-Part 2: Clinical practice guidelines.

The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is the de facto standard framework for summarising evidence in systematic reviews and developing recommendations in clinical practice guidelines. We describe how the GRADE approach is used in clinical practice guidelines, including key points and examples. The intended audience of this overview of GRADE is clinicians and researchers who are, or plan to be, involved in the development or assessment of clinical practice guidelines. We cover guideline endorsement and adaptation; guideline panels and sponsors; conflicts of interest; guideline questions and outcome prioritisation; systematic review creation, updating and re-use; rating the overall certainty of evidence; development of recommendations and implications; and peer review, publication, implementation and updating of guidelines. This overview aims to help developers, assessors and users of clinical practice guidelines understand how trustworthy, high-quality guidelines are developed using the GRADE approach.

Ocena Jakości Wytycznych Praktyki Klinicznej Dotyczących Postępowania w Astmie za Pomocą Narzędzia AGREE II

Przedmiot badań Wytyczne praktyki klinicznej stanowią wsparcie w optymalizacji opieki zdrowotnej poprzez promowanie zaleceń opartych na dowodach naukowych. Odpowiednia metodyka i rygorystyczna strategia podczas formułowania zaleceń zawartych w wytycznych klinicznych ma istotny wpływ na ich jakość, wiarygodność i możliwość skutecznego wdrożenia zaleceń w praktyce. Cel badań Celem przeprowadzonego badania była ocena jakości wytycznych praktyki klinicznej dotyczących postępowania w astmie przy użyciu narzędzia AGREE II. W ramach analizy porównano jakość polskich wytycznych klinicznych z wytycznymi opracowanymi w innych krajach oraz przez organizacje międzynarodowe. Ocenie poddano 9 dokumentów wytycznych: Postępowanie w zaostrzeniach astmy u dorosłych – wytyczne dla lekarzy rodzinnych (twórca: Naczelna Izba Lekarska, Polska), Global Strategy for Asthma Management and Prevention (twórca: The Global Initiative for Asthma (GINA)), Asthma and Respiratory Foundation NZ Adolescent and Adult Asthma Guidelines 2020: a quick reference guide (twórca: Asthma and Respiratory Foundation Nowa Zelandia), Australian Asthma Handbook V2.0 (twórca: National Asthma Council Australia), National Clinical Guideline: The Diagnosis and Management of Asthma in Adults V2.1 (twórca: Ministry of Public Health Katar), SIGN 158 British guideline on the management of asthma (twórca: Scottish Intercollegiate Guidelines Network (SIGN) British Thoracic Society), , Management of Asthma in Adults (twórca: Malaysian Health Technology Assessment Section (MaHTAS)), Asthma: diagnosis, monitoring and chronic asthma management (twórca: National Institute for Health and Care Excellence (NICE)) oraz The Spanish Guideline on the Management of Asthma (twórca: Guía Española para el Manejo del Asma (GEMA)). Wyniki Najwyżej punktowanymi obszarami były: przejrzystość i sposób prezentacji zaleceń (wszystkie wytyczne oceniono na 100% lub blisko 100%), zakres wytycznych i cel oraz niezależność redakcyjna. Domeny, które zostały najniżej ocenione dotyczyły obszarów związanych z zaangażowaniem zainteresowanych podmiotów oraz stosowalnością (odpowiednio 79,3% oraz 69.2%). Największe różnice zaobserwowano w obszarze niezależności redakcyjnej - od 100% (maksymalna możliwa do uzyskania liczba punktów) do 16,7%. Najwyższą ocenę ogólną uzyskały wytyczne opracowane przez National Institute for Health and Care Excellence oraz Scottish Intercollegiate Guidelines Network. Wytyczne polskie otrzymały maksymalną liczbę punktów w obszarach związanych z zakresem i celem, przejrzystością i sposobem prezentacji oraz niezależnością redakcyjną. Wnioski Odpowiednio przeprowadzony proces opracowania wytycznych, w tym zaangażowanie ekspertów oraz przestrzeganie standardów metodycznych pozwala na uzyskanie wytycznych praktyki klinicznej charakteryzujących się wysoką jakością. Wysokiej jakości wytyczne praktyki klinicznej, mogą być z powodzeniem wykorzystywane jako narzędzia wspomagające podejmowanie decyzji klinicznych w danym obszarze, przy czym twórcy wytycznych powinni zwrócić szczególną uwagę na możliwości zastosowania wytycznych w praktyce oraz zaangażowanie wszystkich interesariuszy. W celu usprawnienia procesu tworzenia wytycznych oraz dostępu pacjentów do najnowszych terapii istotne jest również uwzględnienie synergii pomiędzy rekomendacjami zawartymi w wytycznych klinicznych oraz raportach oceny technologii medycznych.

A Qualitative Assessment of Clinical Practice Guidelines and Patterns for Congenital Cytomegalovirus in the United States.

Cytomegalovirus (CMV) infection during pregnancy may result in long-term health problems for children with congenital CMV (cCMV). Currently, no prevention or treatment interventions are approved by the Food and Drug Administration for a cCMV indication. Healthcare provider and public awareness is low, and formal clinical practice guidelines and local practice patterns vary. A pilot study of eight cCMV experts was performed using qualitative semi-structured interviews to better understand clinical practice guidelines and patterns in the United States. Results from participant interviews highlighted the need for better prenatal diagnostic techniques, broader neonatal screening opportunities, and more robust evidence supporting intervention strategies. Healthcare provider and public partnerships are essential for advancing cCMV guidelines and improving care delivery. Our results provide a preliminary knowledge base and framework for developing a consensus cCMV research agenda to address evidence gaps that limit the revision of clinical practice guidelines. The changes in clinical practice patterns that may arise as a result of further research have the potential to reduce risk during pregnancy and improve care for children with cCMV infection.

Treatments for non-small cell lung cancer: a systematic quality assessment of clinical practice guidelines.

To evaluate the methodological quality of clinical practice guidelines (CPGs) on treatments for non-small cell lung cancer (NSCLC). We searched MEDLINE, CPG developer websites, lung cancer societies, and oncology organizations to identify CPGs providing recommendations on treatments for NSCLC. The methodological quality for each CPG was determined independently by three appraisers using the AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument. Twenty-two CPGs met the eligibility criteria. The median scores per AGREE II domain were: scope and purpose 90.7% (64.8-100%), stakeholder involvement 76.9% (27.8-96.3%); rigor of development 80.9% (27.1-92.4%); clarity of presentation 89.8% (50-100%); applicability 46.5% (12.5-87.5%); and editorial independence 91.7% (27.8-100%). Most of the CPGs (54.5%) were rated as "recommended with modifications" for clinical use. Overall, the methodological quality of CPGs proving recommendations on the management of NSCLC is moderate, but there is still room for improvement in their development and implementation.

Abstract 5768: Genetic screening in a tertiary medical center identifies carriers of cancer predisposition diseases that would be missed by clinical guidelines

Abstract Two inherited autosomal dominant cancer predisposition conditions - BRCA related hereditary breast and ovarian cancer (HBOC) and Lynch syndrome (LS) - are termed Centers for Disease Control and Prevention Tier 1 (CDCT1) genetic conditions, for which early identification and intervention have a positive impact on public health. Selection of individuals for genetic testing for these conditions is based on personal and family history. The goal of this study was to evaluate whether screening in a tertiary medical center using exome sequencing could efficiently identify carriers of HBOC and LS and to determine the frequency of incremental carriers identified outside of traditional clinical practice guidelines. Participants from three geographically diverse Mayo Clinic practices in the USA (Rochester MN, Phoenix AZ, Jacksonville FL) consented to clinical “Exome+” sequencing (Helix, San Mateo, CA; Mayo GeneGuide, Rochester, MN) in the TAPESTRY study (NCT05212428), which links sequencing data with electronic health records and the return of CDCT1 genetic findings. For this study we focused on two inherited cancer predisposition conditions: BRCA-related HBOC (BRCA1 and BRCA2) and LS (MLH1, MSH2, MSH6, PMS2 and EPCAM). Detailed chart review to collect demographic information, personal and family history, and assessment of clinical practice guidelines for genetic evaluation (National Cancer Control Network 2021). To date, 44,306 patients have enrolled and sequenced in TAPESTRY. Annotation and interpretation of all variants in 7 genes for HBOC and LS resulted in identification of 550 carriers (prevalence 1.24%) which included 387 with HBOC (27.2% BRCA1, 42.8% BRCA2) and 163 with LS (12.3% MSH6, 8.8% PMS2, 4.5% MLH1, 3.8% MSH2 and 0.2% EPCAM). Demographics of the cohort included: 62.7% female, mean age 55.2 years, non-white race 9.6% and 3.8% Hispanic/Latino ethnicity. A personal history of cancer was present in 46.4% of test positive patients, including 22.5% of HBOC patients with breast or ovarian cancer and 20.9% of LS patients with colorectal or uterine cancer. More than half of the patients (52.1%) were newly diagnosed with HBOC and LS based on the results of this study. Overall, 39.2% of HBOC/LS carriers identified through Exome+ sequencing did not satisfy NCCN criteria for genetic evaluation, this was higher for LS (56.2%) compared to HBOC (32%). Amongst those newly diagnosed with HBOC/LS (n=286), NCCN criteria were not satisfied in 60% of cases (78% for LS and 51% for HBOC). Of the pathogenic germline variant carriers who met NCCN guidelines for testing, 34.2% were not aware of their diagnosis prior to participation in this study. Our results emphasize the need for wide genomic screening for CDCT1 cancer predisposition syndromes. Such screening could identify at-risk carriers of HBOC and LS, who would not otherwise be identified through clinical practice guidelines. Citation Format: Emily Gay, Niloy Jewel Samadder, Michelle L. Bublitz, Melanie M. Peterson, Tammy A. Wilson, Lorelei A. Bandel, Sebastian M. Armasu, Robert A. Vierkant, Matthew J. Ferber, Eric W. Klee, Nicholas B. Larson, Teresa M. Kruisselbrink, Timothy B. Curry, Jan B. Egan, Jennifer L. Kemppainen, Jessa S. Bidwell, Jennifer L. Anderson, Tammy M. McAllister, T'Nita S. Walker, Katie L. Kunze, Vanda Lindpere, Michael A. Golafshar, Margaret Klint, Richard J. Presutti, William V. Bobo, Aleksander Sekulic, Jolene M. Summer Bolster, Cheryl L. Willman, Konstantinos N. Lazaridis. Genetic screening in a tertiary medical center identifies carriers of cancer predisposition diseases that would be missed by clinical guidelines [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5768.

AGREE II for TCM: Tailored to evaluate methodological quality of TCM clinical practice guidelines.

Background: The Appraisal of Guidelines Research and Evaluation (AGREE) II instrument has been widely used in the methodological quality assessment of clinical practice guidelines (CPG). Chinese medicine CPGs have unique characteristics which distinguish them from those of Western medicine, e.g. syndrome differentiation, on which treatments are based. As such, certain domains and items in AGREE II are unsuitable for assessing TCM CPGs. Therefore, it is necessary to adjust and supplement the description and rating section of some items of the AGREE Ⅱinstrument. Purpose: To adjust and expand AGREE II according to characteristics of TCM clinical practice guidelines. Methods: A research working group was established, consisting of a core working group and an expert consensus group, before a systematic literature search performed to screen for TCM guidelines. Two researchers evaluated the quality of the included guidelines using AGREE Ⅱ and later proposed adjustments to some items of AGREE Ⅱ and supplementary comments, which were applicable to TCM CPGs, and drafted an initial version of AGREE Ⅱ for TCM. Suggestions from literature on development and evaluation of TCM CPGs were solicited and integrated into the revised version, which 16 experts were then invited to advise on. When the experts reached a consensus, their comments to the draft were adopted by the core group into the final version. Results: After evaluating the included TCM guidelines, the two researchers offered adjustments and supplementary comments for AGREE Ⅱ Items 1, 7, 10, 11, 12, 15, and 18, and drafted an initial version of AGREE Ⅱ for TCM. Combining suggestions from the literature on development and quality evaluation of TCM clinical guidelines, the core working group modified AGREE Ⅱ items 2, 4, 5, 8, 9, 13, 20, and 21, then proposed the revised version of AGREE Ⅱ for TCM, on which was advised by a group of experts, before consensus on improvements was reached. The results of the first round of expert surveys showed strong agreement, and experts' opinions were adopted into the final version of AGREE Ⅱ for TCM. Conclusion: Based on the characteristics of the TCM CPGs, we adjustment and expansion were made to create AGREE II for TCM. This version is suitable for the assessment of methodological quality of TCM CPGs, capable of providing content support for the standardization of procedures and methods of formulating TCM CPGs.

A quality assessment of clinical practice guidelines with recommendations for family involvement in the care of individuals diagnosed with schizophrenia, bipolar mood disorder, and major depressive disorder: Critical appraisal utilizing AGREE II.

Evidence suggests that family-center collaborative care is useful for individuals identified with chronic mental illness. Clinical practice guidelines offer specific recommendations primarily based on to be had studies and are beneficial in informing evidence-based practice and guiding destiny studies. Identify current scientific practice guidelines including family-center collaborative care suggestions for individuals with Bipolar Mood Disorder, Schizophrenia, and Major Depressive Disorder and analyze the selection of guidelines for their methodological quality. A systematic search was conducted on seven electronic databases (G-I-N), (NICE), (MOH), (SIGN), (WHO), (NIH) and (APA) and additional sources. Three referees independently reviewed articles and selected guidelines for inclusion criteria. Subsequently, 18 trained appraisers independently assessed all 15 guidelines using AGREE II. The mean scores for domains and overall quality were computed. For the overall assessment of the guidelines, 60% reached the quality threshold with domain scores of 60%. The overall average quality rating for these guidelines was 58/29%. The applicability of the guidelines needs to be improved in order to improve their relevance and clinical utilization. As individuals with chronic mental illnesses progress through their disease course, families and health care providers play a crucial role in helping them. The analysis of research knowledge on effective rehabilitation techniques, including the involvement of families in treatment, can be enhanced by using well-developed and appropriate methods.

Quality assessment of clinical practice guidelines for the management of wheezing disorders in children.

BACKGROUND: The quality of available clinical practice guidelines (CPGs) for childhood wheezing disorders have not been systematically evaluated.METHODS: CPGs were systematically evaluated by four independent reviewers using Appraisal of Guidelines Research and Evaluation (AGREE) II instrument and the Reporting Items for Practice Guidelines in HealTHcare (RIGHT) checklist. We calculated the overall agreement among reviewers with the intraclass correlation coefficient (ICC).RESULTS: A total of 35 CPGs published between January 2000 and December 2020 were evaluated. The overall agreement among reviewers was good (ICC 0.85, 95% CI 0.83-0.87). The average CPGs score was 42% (range: 25-79). The mean scores of four domains were low: 37% for Stakeholder Involvement (range: 10-85), 28% for Rigour of Development (range: 42-81), 35% for Applicability (range: 11-73) and 24% for Editorial Independence (range: 0-83). The mean reporting rate of the RIGHT checklist was 31%. The Basic Information domain had the highest reporting rate (65%); the Review and Quality Assurance domain had the lowest rate (3%).CONCLUSIONS: The quality of the CPGs was poor. Greater efforts are needed to improve quality in domains to provide high-quality guidelines that can be used as reliable tools for clinical decision-making.

Quality Assessment of Clinical Practice Guidelines for Ankle Sprains Using the Appraisal of Guidelines for Research and Evaluation II Assessment Tool

This study aimed to evaluate clinical practice guidelines (CPGs) for ankle sprains using the Appraisal of Guidelines for Research and Evaluation II tool, using electronic databases (GIN, PubMed, EMBASE, NCKM, CNKI, CiNii, WanFang database, RISS, and SCOPUS), to suggest strategies for improvement in the future. The search was performed on April 23, 2021 and 10 CPGs were selected for evaluation. Three CPGs were recommended without modification (Class A scores), five were recommended with modification (Class B), and two were not recommended (Class C scores). The CPG domain that received the lowest score was “applicability.” The traditional medicine CPGs scored higher [Class A (<i>n</i> = 1) and Class B (<i>n</i> = 1)] than the conventional Western medicine CPGs [Class A (<i>n</i> = 2), Class B (<i>n</i> = 4), and Class C (<i>n</i> = 2)] and were considered to be more methodical. In the future, more research into traditional medicine is required.

Quality assessment of Clinical Practice Guidelines (CPG) for the diagnosis and treatment of inflammatory bowel disease using the AGREE II instrument: a systematic review

BackgroundThe incidence and diagnosis of inflammatory bowel disease (IBD) has increased considerably in recent years. Many clinical practice guidelines (CPG) have been developed for the management of this disease across different clinical contexts, however, little evidence exists on their methodological quality. Therefore, we aimed to systematically evaluate the quality of CPGs for the diagnosis and treatment of IBD using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.MethodsWe identified CPGs by searching databases (MEDLINE - PubMed, EMBASE, CINAHL, LILACS) and other sources of gray literature on January 2022. We included guidelines with specific recommendations for the diagnosis and treatment of IBD and evaluated them with the AGREE II instrument to assess their methodological quality. Six independent reviewers assessed the quality of the guidelines and resolved conflicts by consensus. We assessed the degree of agreement using the intraclass correlation coefficient (ICC) and change in quality over time was appraised in two periods: from 2012 to 2017 and from 2018 to 2022.ResultsWe analyzed and evaluated 26 CPGs that met the inclusion criteria. The overall agreement among reviewers was moderate (ICC: 0.74; 95% CI 0.36 - 0.89). The mean scores of the AGREE II domains were: “Scope and purpose” 84.51%, “Stakeholder involvement” 60.90%, “Rigor of development” 69.95%, “Clarity of presentation” 85.58%, “Applicability” 26.60%, and “Editorial independence” 62.02%. No changes in quality were found over time.ConclusionsThe quality of the CPGs evaluated was generally good, with a large majority of the assessed guidelines being “recommended” and “recommended with modifications”; despite this, there is still room for improvement, especially in terms of stakeholder involvement and applicability. Efforts to develop high quality CPGs for IBD need to be further optimized.

What should nurses do on post-stroke depression? A global systematic assessment of clinical practice guidelines

ObjectivesPost-stroke depression (PSD) is the most common mental disorder in post-stroke patients. Yet, the recommendations related to nursing in clinical practice guidelines (CPGs) have not been systematically sorted out. This...

Management of Ventilator-Associated Pneumonia: Quality Assessment of Clinical Practice Guidelines and Variations in Recommendations on Drug Therapy for Prevention and Treatment.

Purpose: To assess the quality of clinical practice guidelines (CPGs) related to drug therapy for prevention and control of ventilator-associated pneumonia (VAP) and compare the differences and similarities between recommendations. Methods: Electronic databases (including PubMed, Cochrane library, Embase, Web of Science), guideline development organizations, and professional societies were searched to identify CPGs for VAP from 20 January 2012 to 20 January 2022. The Appraisal of Guidelines Research & Evaluation (AGREE) II instrument was used to evaluate the quality of the guidelines. The recommendations on drug therapy for prevention and treatment for each guideline were extracted, and then a descriptive synthesis was performed to analyze the scope/topic, and consistency of the recommendations. Results: Thirteen CPGs were included. The median score and interquartile range (IQR) in each domain are shown below: scope and purpose 72.22% (63.89%,83.33%); stakeholder involvement 44.44% (38.89%,52.78%); rigor of development 43.75% (31.25%,57.29%); clarity and presentation 94.44% (77.78%,94.44%); applicability 20.83 (8.34%,33.34%) and editorial independence 50% (33.33%,66.67%). We extracted 21 recommendations on drug therapy for prevention of VAP and 51 recommendations on drugs used for treatment. Some controversies remained among the included guidelines. Conclusion: There is considerable variability in the development processes and reporting of VAP guidelines. Despite many similarities, the recommendations still had some inconsistencies in the details. For the prevention and treatment of VAP, local microbial epidemiology and antibiotic sensitivity must be considered, and recommendations should be regularly revised as new evidence emerges.

Translated article] Quality Assessment of Clinical Practice Guidelines on the Treatment of Psoriasis Using the AGREE II Tool

BackgroundClinical practice guidelines (CPGs) are designed to help health professionals provide patients with excellent medical care. The last critical appraisal of CPGs on the treatment of psoriasis evaluated publications up to 2009, but several new guidelines have been published since and their methodological quality remains unclear. ObjectiveThe aim of this study was to systematically evaluate the quality of CPGs on the treatment of psoriasis published between 2010 and 2020 using the Appraisal Guidelines Research and Evaluation II (AGREE II) tool. Material and methodsWe searched for relevant CPGs in MEDLINE, Embase, and LILACS (Latin American and Caribean Health Sciences Literature) as well as in the gray literature. Two reviewers working independently selected the guidelines for analysis and extracted the relevant data. Each guideline was then assessed using the AGREE II instrument by 5 reviewers, also working independently. ResultsNineteen CPGs met the inclusion criteria and most of them had been produced in high-income countries. The mean (SD) domain scores were 84.9% (14.7%) for scope and purpose, 65.5% (19.3%) for stakeholder involvement, 66.7% (15.6%) for rigor of development, 72.8% (16.8%) for clarity of presentation, 46.6% (21.7%) for applicability, and 57.0% (30.4%) for editorial independence. ConclusionsAlthough about three-quarters of the CPGs assessed were judged to be of high quality and over half were recommended for use in clinical practice, standards of guideline development need to be raised to improve CPG quality, particularly in terms of applicability and editorial independence, which had the lowest scores in our evaluation.

Sperm DNA Fragmentation: A Critical Assessment of Clinical Practice Guidelines.

Sperm DNA fragmentation (SDF) is implicated in male infertility and adverse reproductive outcomes. With the publication of many studies regarding the etiologies and contributors to SDF, as well as the effects of SDF, guidelines are necessary to aid clinicians in the application of SDF for male fertility evaluation. Two recent clinical practice guidelines were published by Agarwal et al and Esteves et al. In this article, we have evaluated and compared both guidelines. We have found fairly similar recommendations between the two guidelines and have also highlighted the differences between them. Finally, we have summarized and combined the best practice recommendations from both guidelines.

Complementary and alternative medicine recommendations for depression: a systematic review and assessment of clinical practice guidelines

BackgroundUp to 50% of individuals diagnosed with depression are known to use complementary and alternative medicine (CAM). The aim of this study was to identify the quantity and assess the quality of CAM recommendations in clinical practice guidelines for the treatment and/or management of depression in adults using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument.MethodsA systematic review was conducted to identify depression guidelines. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018. The Guidelines International Network and the National Center for Complementary and Integrative Health websites were also searched. Eligible guidelines published by non-profit agencies on treatment of depression for adults were assessed with the AGREE II instrument twice, once for the overall guideline and once for the CAM sections.ResultsFrom 931 unique search results, 19 guidelines mentioned CAM, of which 16 made CAM recommendations. Scaled domain percentages from highest to lowest were as follows (overall, CAM section): clarity of presentation (87.0, 66.1%), scope and purpose (80.9, 77.6%), stakeholder involvement (62.0, 44.3%), editorial independence (61.6, 61.6%), rigour of development (58.0, 52.0%), and applicability (42.2, 25.4%). Quality varied within and across guidelines. Only 1 of 16 guidelines was recommended without modifications for both its overall and CAM sections by both appraisers.ConclusionsThere are multiple depression guidelines containing CAM recommendations available and there are a comprehensive set of CAM therapy options for depression. The quality of guidelines varied within and across guidelines and the quality of CAM recommendations was generally lower than the overall recommendations in the guidelines for all domains except editorial independence. Generally, characteristics of guidelines, including the year of publication and region of development varied across the guidelines irrespective of quality. Guidelines with higher AGREE II scores can serve as a guide to facilitate communication between patients and medical professionals regarding CAM use for depression, while guidelines with lower scores could be improved in future updates using the AGREE II instrument as a guide.

Protocol of an interdisciplinary consensus project aiming to develop an AGREE II extension for guidelines in surgery

IntroductionAppraisal of Guidelines for Research and Evaluation (AGREE II) is an instrument that informs development, reporting and assessment of clinical practice guidelines. Previous research has demonstrated the need for improvement...

Medicina Basada en la Evidencia. Lectura Crítica de “Guías de Práctica Clínica”

Las guías de práctica clínica (GPC) son documentos que incluyen recomendaciones basadas en la evidencia científica para la toma de decisiones clínicas; al mismo tiempo, pueden desempeñar un papel importante en la elaboración de políticas de salud. Por lo tanto, es crucial que se evalúe críticamente su calidad y aplicabilidad en diversos contextos, para lo cual se ha desarrollado la herramienta AGREE II. Este artículo tiene como objetivo dar a conocer el desarrollo, la aplicación y la evaluación de la calidad de las guías de práctica clínica, de manera que se pueda realizar una lectura crítica de las mismas.

Plasmodium vivax malaria across South America: management guidelines and their quality assessment.

INTRODUCTION: Plasmodium vivax malaria represents a major public health problem. This study presents the quality assessment of clinical practice guidelines for the management of P. vivax malaria.METHODS: A systematic review was conducted in PubMed, SciELO, and Google Scholar. Additionally, five guidelines were assessed with the AGREE (Appraisal of Guidelines Research and Evaluation) II protocol.RESULTS The general performance on the domains of stakeholder involvement, development rigor, and editorial independence was low. CONCLUSIONS: Most guidelines lack a solid research methodology, which implies ambiguous accuracy. Much needs to be done in the area of therapeutics and quality of policies.

Quality assessment of clinical practice guidelines of Chinese and western medicine for acute bronchitis

IntroductionSeveral studies have reported that clinical practice guidelines (CPGs) in a variety of clinical areas are of modest or variable quality. The objective of this study was to systematically review the quality, methodology, and consistency of recently developed CPGs for Chinese and western medicine on the management of acute bronchitis, and provide specific recommendations for patients with acute bronchitis. MethodsA systematic search was conducted for acute bronchitis CPGs in adults and children from 2000–2019. The quality of CPGs was independently assessed by four assessors using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument, the CPGS were rated as recommended, recommended with modifications, or not recommended and the specific pharmacological, non-pharmacological and prevention recommendations in the CPGs were summarized and evaluated. ResultsThere was considerable variation in the quality of the CPGs across the AGREE II domains in 13 CPGs. The overall quality ranged from 3.5–6.5 out of 7. The domains that scored the highest were ‘clarity of presentation’, with a mean value of 71.1 % (range 45.8–86.1 %), scored the lowest were ‘editorial independence’ 40.6 % (range 0–81.3 %). The CPGs recommendations of pharmacological, non-pharmacological and prevention management were fairly consistent. ConclusionOur results could help improve reporting of future guidelines, and affect the selection and usage of guidelines in clinical practice. Further research is needed on interventions for acute bronchitis, and higher quality CPGs to facilitate implementation of the best evidence-based recommendations in clinical practice.

The structure of the quality of clinical practice guidelines with the items and overall assessment in AGREE II: a regression analysis

BackgroundThe Appraisal of Guidelines for Research & Evaluation (AGREE) II has been widely used to evaluate the quality of clinical practice guidelines (CPGs). While the relationship between the overall assessment of CPGs and scores of six domains were reported in previous studies, the relationship between items constituting these domains and the overall assessment has not been analyzed. This study aims to investigate the relationship between the score of each item and the overall assessment and identify items that could influence the overall assessment.MethodsAll Japanese CPGs developed using the evidence-based medicine method and published from 2011 to 2015 were used. They were independently evaluated by three appraisers using AGREE II. The evaluation results were analyzed using regression analysis to evaluate the influence of 6 domains and 23 items on the overall assessment.ResultsA total of 206 CPGs were obtained. All domains and all items except one were significantly correlated to the overall assessment. Regression analysis revealed that Domain 3 (Rigour of Development), Domain 4 (Clarity of Presentation), Domain 5 (Applicability), and Domain 6 (Editorial Independence) had influence on the overall assessment. Additionally, four items of AGREE II, clear selection of evidence (Item 8), specific/unambiguous recommendations (Item 15), advice/tools for implementing recommendations (Item 19), and conflicts of interest (Item 22), significantly influenced the overall assessment and explained 72.1% of the variance.ConclusionsThese four items may highlight the areas for improvement in developing CPGs.