Guideline Databases Research Articles

Facilitators and barriers to implement nurse-led physical activities for people with dementia in nursing homes: a protocol for a mixed-methods systematic review

IntroductionDementia is a major neurocognitive disorder and accounts for a great proportion of nursing home residents. Bodily symptoms such as gait, balance difficulties and muscle weakness are common in people...

Systematic evaluation of the guidelines for rehabilitation in multiple sclerosis patients: an overview according to ICF functioning domains.

High-quality clinical practice guidelines (CPGs) can provide evidence-based recommendations for optimizing care on managing multiple sclerosis (MS). There is currently no review that compiles recommendations of high-quality CPGs to guide decision-making for MS rehabilitation. The aim was to identify evidence-based recommendations in high-quality multidisciplinary English CPGs for rehabilitation in MS. CPGs published in the last 10 years (2009-2019) that described recommendations on rehabilitation were searched in PubMed, Turning Research into Practice database, International Guideline databases, National Guideline databases and websites of MS organizations. Quality assessment of CPGs was conducted by two evaluators using the Appraisal of Guidelines for Research and Evaluation II instrument. Recommendations were classified according to the International Classification of Functioning, Disability and Health (ICF) and the International Classification of Health Intervention (ICHI) and documented in terms of strength of recommendation and level of evidence. Five CPGs satisfied the inclusion criteria. Of 120 recommendations, 38 had a strong level with moderate to low level of evidence, 61 were of weak strength and 18 were formulated by the consensus of experts. Recommendations were categorized into 12 domains and 1 chapter on the body function level, 1 chapter on activity level and 2 domains on external factors. The existing CPGs demonstrated more than 100 evidence level recommendations to be followed at the clinical practice, most in body functions of the ICF. Developing up-to-date CPGs with more focus on activity and participation domains for countries with various healthcare backgrounds may be useful for a best clinical practice.

Do we AGREE on the targets of antihypertensive drug treatment in older adults: a systematic review of guidelines on primary prevention of cardiovascular diseases.

Backgroundtranslation of the available evidence concerning primary cardiovascular prevention into clinical guidance for the heterogeneous population of older adults is challenging. With this review, we aimed to give an overview of the thresholds and targets of antihypertensive drug therapy for older adults in currently used guidelines on primary cardiovascular prevention. Secondly, we evaluated the relationship between the advised targets and guideline characteristics, including guideline quality.Methodswe systematically searched PubMed, Embase, Emcare and five guideline databases. We selected guidelines with (i) numerical thresholds for the initiation or target values of antihypertensive drug therapy in context of primary prevention (January 2008–July 2020) and (ii) specific advice concerning antihypertensive drug therapy in older adults. We extracted the recommendations and appraised the quality of included guidelines with the AGREE II instrument.Resultsthirty-four guidelines provided recommendations concerning antihypertensive drug therapy in older adults. Twenty advised a higher target of systolic blood pressure (SBP) for octogenarians in comparison with the general population and three advised a lower target. Over half of the guidelines (n = 18) recommended to target a SBP <150 mmHg in the oldest old, while four endorsed targets of SBP lower than 130 or 120 mmHg. Although many guidelines acknowledged frailty, only three gave specific thresholds and targets. Guideline characteristics, including methodological quality, were not related with the recommended targets.Conclusionthe ongoing debate concerning targets of antihypertensive treatment in older adults, is reflected in an inconsistency of recommendations across guidelines. Recommended targets are largely set on chronological rather than biological age.

Physician-patient communication of costs and financial burden of cancer and its treatment: a systematic review of clinical guidelines

BackgroundOptimising the care of individuals with cancer without imposing significant financial burden related to their anticancer treatment is becoming increasingly difficult. The American Society of Clinical Oncology (ASCO) has recommended clinicians discuss costs of cancer care with patients to enhance shared decision-making. We sought information to guide oncologists’ discussions with patients about these costs.MethodsWe searched Medline, EMBASE and clinical practice guideline databases from January 2009 to 1 June 2019 for recommendations about discussing the costs of care and financial burden. Guideline quality was assessed with the AGREE-II instrument.ResultsTwenty-seven guidelines met our eligibility criteria, including 16 from ASCO (59%). 21 of 27 (78%) guidelines included recommendations about discussion or consideration of treatment costs when prescribing, with information about actual costs in four (15%). Recognition of the risk of financial burden or financial toxicity was described in 81% (22/27) of guidelines. However, only nine guidelines (33%) included information about managing the financial burden.ConclusionsCurrent clinical practice guidelines have little information to guide physician-patient discussions about costs of anticancer treatment and management of financial burden. This limits patients’ ability to control costs of treatment, and for the healthcare team to reduce the incidence and severity of financial burden. Current guidelines recommend clinician awareness of price variability and high costs of treatment. Clinicians are recommended to explore cost concerns and address financial worries, especially in high risk groups. Future guidelines should include advice on facilitating cost transparency discussions, with provision of cost information and resources.

Methodological and reporting quality of pediatric clinical practice guidelines: a systematic review.

BackgroundPediatric clinical practice guidelines (CPGs) can provide systematically developed clinical recommendations to guide pediatric clinicians and patients making decisions. This study aims to assess the methodological and reporting quality of pediatric CPGs.MethodsWe performed a systematic literature search of MEDLINE from 1 January 1990 to 2 April 2020 to identify pediatric CPGs published in the ten highest-impact pediatric journals and four highest-impact general medical journals. Two researchers evaluated the methodological and reporting quality of pediatric CPGs using the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument and Reporting Items for Practice Guidelines in Health care (RIGHT) checklist. We calculated the mean AGREE II scores and compliance to RIGHT overall, and for each domain of the respective tools. We compared the methodological and reporting quality by different time periods and calculated the correlation between the AGREE II score and compliance to RIGHT.ResultsA total of 159 pediatric CPGs were identified. The mean (± standard deviation) scores for the six domains of the AGREE II instrument were as follows: scope and purpose 74.5%±14.2%, stakeholder involvement 42.7%±16.2%, rigour of development 18.7%±14.2%, clarity of presentation 56.5%±17.0%, applicability 8.9%±12.7% and editorial independence 25.2%±34.6%. The overall assessment score was 37.8%±12.4%. The mean compliance to RIGHT items in the seven domains of the checklist were: basic information 73.6%±14.9%, background 67.1%±16.4%, evidence 32.7%±27.2%, recommendations 32.4%±22.5%, review and quality assurance 22.9%±40.4%, funding and declaration and management of interests 24.1%±36.3%, and other information 45.3%±30.1%. The overall reporting rate for RIGHT was 46.4%±16.6%. Both the AGREE II scores and RIGHT reporting rates increased over time. We found a high positive correlation between AGREE II scores and RIGHT reporting compliance (r=0.645, P<0.001).DiscussionThe methodological and reporting quality of pediatric CPGs have improved over time, but remain still suboptimal and needs to be further improved. An international database of pediatric guidelines is urgently needed to identify and promote high-quality guidelines and guide clinical practice in pediatrics.

Impact of the COVID-19 Pandemic on Acute Ischemic Stroke Presentation, Treatment, and Outcomes.

Introduction The World Health Organization declared COVID-19 a global pandemic last year. While a clear impact of COVID-19 on the declining stroke volume has been reported, its overall impact on stroke presentation and clinical outcomes has not been established. The purpose of this study was to assess the impact of COVID-19 on acute ischemic stroke volume, presentation, treatment, and outcomes at comprehensive stroke centers. Methods A retrospective review of patients with a discharge diagnosis of acute ischemic stroke from the Get With The Guidelines database was performed from January 1, 2019, to July 1, 2020. The following time periods were defined: Pre-COVID (January/February), Peak-COVID (March/April), and Post-COVID (May/June). Bivariate analyses were performed comparing the 2020 and 2019 time periods to determine differences in stroke volume, presentation, treatment, and outcomes. Results Stroke volumes were significantly lower during the Peak-COVID period in 2020 compared to that in 2019, with an absolute decline of 49.5% (P < 0.001). Patients were more likely to present after 24 hours from last known well during the 2020 Peak-COVID period (P = 0.03). However, there was not a significant difference in the rate of treatment with either the tissue plasminogen activator (tPA) or mechanical thrombectomy during the Peak-COVID period. Interestingly, relative treatment rates increased during the 2020 Post-COVID period to 11.4% (P = 0.01). Conclusions The overall ischemic stroke volume decreased during the pandemic, and patients had a tendency to present later, beyond eligible treatment windows. However, rates of treatment, patient demographics, and stroke outcomes did not significantly change when compared to the prior year.

Critical Review of the Scientific Evidence and Recommendations in COVID-19 Management Guidelines.

BackgroundLittle is known about the quality and potential impacts of the guidelines for coronavirus disease 2019 (COVID-19) management.MethodsWe systematically searched PubMed, Web of Science, Cochrane Library, guideline databases, and specialty society websites to evaluate the quality of the retrieved guidelines using the Appraisal of Guidelines for Research and Evaluation II.ResultsA total of 66 guidelines were identified. Only 24% were categorized as “recommended” for clinical practice. The 211 identified recommendations for COVID-19 management were classified into 4 topics: respiratory support (27), acute respiratory distress syndrome management (31), antiviral or immunomodulatory therapy (95), or other medicines (58). Only 63% and 56% of recommendations were supported by, respectively, assessment of the strength of the recommendations or level of evidence. There were notable discrepancies between the different guidelines regarding the recommendations on COVID-19 management.ConclusionsThe quality of the guidelines for COVID-19 management is heterogeneous, and the recommendations are rarely supported by evidence.

High Risk Features Contributing to 30-Day Readmission After Acute Ischemic Stroke: A Single Center Retrospective Case-Control Study.

Risk of 30-day stroke readmission has been attributed to medical comorbidities, stroke severity, and hospitalization metrics. The leading etiologies appear to vary across institutions and remain a moving target. We hypothesized that patients with increased medical complexity have higher odds of 30-day readmission and the immediate time after discharge may be most vulnerable. We aimed to characterize patients with 30-day readmission after acute ischemic stroke (IS) and identify predictors of post-IS readmission. We performed a retrospective case-control study analyzing post-IS 30-day readmission between January 2016-December 2019 using data from Mount Sinai Hospital's Get With The Guidelines database. We performed chi square analyses and multivariate adjusted logistic regression model including age, sex, coronary artery disease (CAD), renal insufficiency (RI), history of prior stroke or TIA, length of stay (LOS) > 7, and NIHSS ≥ 5. 6.7% (n = 115) of 1,706 IS encounters had 30-day readmission. The 115 cases were compared to 1,591 controls without 30-day readmission. In our adjusted model, CAD (OR = 1.7, p = 0.01), history of prior stroke or TIA (OR = 1.6, p = 0.01), LOS >7 (OR = 1.7, p = 0.02), and NIHSS ≥ 5 (OR = 4.5, p < 0.001) predicted 30-day readmission. 65% (n = 75) of readmitted patients had readmission within 14 days post-discharge. Patients with post-IS 30-day readmission were more likely to have complex medical comorbidities and history of stroke or TIA compared to controls. Patients with more severe stroke and longer LOS may benefit from individualized transition of care plans and closer follow up during the vulnerable 30-day post-stroke period.

Evaluation of the reporting quality of clinical practice guidelines on melanoma using the RIGHT checklist.

BackgroundThe International Reporting Items for Practice Guidelines in Healthcare (RIGHT) instrument was launched in 2016 to improve the reporting of clinical practice guidelines (CPGs). We aimed to systematically evaluate the reporting quality of CPGs on melanoma using RIGHT.MethodsWe systematically searched electronic databases, guideline databases and medical society websites until November 2020 to identify guidelines for melanoma published since 2018. The reporting quality of included guidelines was assessed by calculating the percentages of the 35 items of the RIGHT checklist that were appropriately reported. We stratified the results by selected characteristics to describe the correlation of these factors with reporting quality.ResultsA total of 20 guidelines were identified and analyzed. The mean reporting rate was greater than 50% in five of the seven domains of the RIGHT checklist; the remaining two domains (Other information, Review and quality assurance) both had a mean reporting rate of 35.0%. The mean overall reporting rate was 63.7%. No CPG considered equity, feasibility or acceptability of the recommendations (item 14c), and only one CPG described the role of funders (item 18b). Guidelines that reported funding or were published in higher-impact journals tended to have a higher reporting quality, whereas the reporting rate in the one included Chinese-language CPG was low.ConclusionsReporting quality of melanoma CPGs tends to be relatively good. The CPGs developed in China were however an exception. The use of the 2016 RIGHT tool in guideline development should be encouraged to support rigorous and transparent reporting.

Consideration of antimicrobial resistance and contextual factors in infectious disease guidelines: a systematic survey

ObjectivesGuidelines that include antimicrobial recommendations should explicitly consider contextual factors that influence antimicrobial resistance and their downstream effects on resistance selection. The objectives were to analyse (1) how, and to...

A Rapid Review of Burns First Aid Guidelines: Is There Consistency Across International Guidelines?

We conducted a rapid review of current international and Australian/New Zealand guidelines on first aid for burns to identify any critical variation and any recent major changes in the literature that would warrant a significant change to current recommendations. A search was conducted to identify Australian/New Zealand and international first aid guidelines for burn care using guideline databases, and we compared key recommendations from each guideline relating to burns first aid. A literature search of relevant databases (Medline, Embase, Cochrane Database of Systematic Reviews, PROSPERO international register of systematic reviews, and ClinicalTrials.gov databases) was conducted to identify existing and in-progress research published on the topic of first aid for burn injuries. Seven guidelines were identified from the Australia/New Zealand region, and 11 international guidelines were identified from the United States of America and Europe. All Australian and New Zealand guidelines recommended a cooling duration of 20 minutes and made some mention of when to refer a burn for medical evaluation, while international guidelines saw cooling duration variation, a number of guidelines failed to mention referral criteria. The review of published systematic reviews and clinical trials revealed a lack of new evidence in the last six years. Our rapid review identified key variation between first aid guidelines for burns that would benefit from the development of an international consensus on management. We identified no new significant evidence that would alter guideline recommendations and did not identify any upcoming reviews or clinical trials on this subject.

Symptomatic fever management in children: A systematic review of national and international guidelines.

Divergent attitudes towards fever have led to a high level of inconsistency in approaches to its management. In an attempt to overcome this, clinical practice guidelines (CPGs) for the symptomatic management of fever in children have been produced by several healthcare organizations. To date, a comprehensive assessment of the evidence level of the recommendations made in these CPGs has not been carried out. Searches were conducted on Pubmed, google scholar, pediatric society websites and guideline databases to locate CPGs from each country (with date coverage from January 1995 to September 2020). Rather than assessing overall guideline quality, the level of evidence for each recommendation was evaluated according to criteria of the Oxford Centre for Evidence-Based Medicine (OCEBM). A GRADE assessment was undertaken to assess the body of evidence related to a single question: the threshold for initiating antipyresis. Methods and results are reported according to the PRISMA statement. 74 guidelines were retrieved. Recommendations for antipyretic threshold, type and dose; ambient temperature; dress/covering; activity; fluids; nutrition; proctoclysis; external applications; complementary/herbal recommendations; media; and age-related treatment differences all varied widely. OCEBM evidence levels for most recommendations were low (Level 3-4) or indeterminable. The GRADE assessment revealed a very low level of evidence for a threshold for antipyresis. There is no recommendation on which all guidelines agree, and many are inconsistent with the evidence-this is true even for recent guidelines. The threshold question is of fundamental importance and has not yet been answered. Guidelines for the most frequent intervention (antipyresis) remain problematic.

Seasonal Variation in Presentation and Time to Revascularization Therapy for Acute Ischemic Stroke

<strong>Objective:</strong> Assess for seasonal variation in patient presentation and time to initiation of revascularization therapy for acute ischemic stroke (AIS). <strong>Background:</strong> Rapid revascularization results in improved outcomes, including early neurological improvement as well as functional outcomes at 90 days, for AIS patients. However, restrictive time windows for alteplase (tPA) and endovascular thrombectomy (ET) limit treatment in the majority of AIS patients. Seasonal variation in AIS etiology, severity, patient eligibility for revascularization therapy, and functional outcomes following treatment have been reported in several large cohort studies abroad. However, seasonal variation in stroke presentation and outcomes in an urban northeastern US population is not well known. Moreover, in patients eligible for treatment, it is unclear whether there are seasonal variations in time to treatment, which may impact functional outcomes. <strong>Methods:</strong> We retrospectively analyzed AIS patients presenting to the Mount Sinai Hospital (MSH) ED from 2016 to 2018 contained in the American Heart Association’s Get With The Guidelines Database. Patients were classified by season of presentation and revascularization modality and primary outcome was door-to-treatment time. Descriptive statistics were used to examine patient characteristics. Non-parametric comparative statistics using Kruskal-Wallis H tests were run between groups to compare door-to-treatment initiation times by season and type of revascularization therapy. <strong>Results: </strong>808 patients presented to the ED for AIS. 28.1% presented during spring (n = 227), 25.7% summer (n = 208), 24.1% winter (n = 195), and 22.0% (n = 178) fall. 14.7% (n = 119) were treated with revascularization therapy, including 57.1% (n = 68) tPA, 26.9% (n = 32) ET, and 16% (n = 19) tPA+ET. Median door-to-treatment time was 60 minutes for tPA, 102.5 minutes ET, and in patients treated with tPA+ET, 55 and 160 minutes for tPA and ET, respectively. Among patients treated with ET, time-to-treatment differed by season with a mean rank time score in minutes of 9.07 for winter, 13.70 spring, 22.38 summer, and 21.00 fall (χ2(3) = 10.2117, p = 0.0169). No significant differences in time-to-treatment were observed by season for patients treated with tPA with or without ET (<em><strong>Table 1</strong></em>). <strong>Conclusions:</strong> Over the two-year period of study, ET time-to-treatment was fastest during spring and winter seasons but there was no difference in time-to-treatment with tPA with or without thrombectomy. This may reflect additional experience with stroke systems of care and improved procedural skill over the course of the academic year, but further study is needed.

Evaluation of the reporting quality of clinical practice guidelines on lung cancer using the RIGHT checklist.

BackgroundIn recent years, the number of clinical practice guidelines (CPGs) for lung cancer has increased, but the quality of these guidelines has not been systematically assessed so far. Our aim was to assess the reporting quality of CPGs on lung cancer published since 2018 using the International Reporting Items for Practice Guidelines in Health Care (RIGHT) instrument.MethodsWe systematically searched the major electronic literature databases, guideline databases and medical society websites from January 2018 to November 2020 to identify all CPGs for small cell and non-small cell lung cancer (NSCLC). The search and extraction were completed using standardized forms. The quality of included guidelines was evaluated using the RIGHT statement. We present the results descriptively, including a stratification by selected determinants.ResultsA total of 49 CPGs were included. The mean proportion across the guidelines of the 22 items of the RIGHT checklist that were appropriately reported was 57.9%. The items most common to be poorly reported were quality assurance (item 17) and description of the role of funders (item 18b), both of which were reported in only one guideline. The proportions of items within each of the seven domains of the RIGHT checklist that were correctly reported were Basic information 75.9%; background 83.2%; evidence 44.5%; recommendations 55.4%; review and quality assurance 12.2%; funding and declaration and management of interests 42.9%; and other information 38.1%. The reporting quality of guidelines did not differ between publication years. CPGs published in journals with impact factor >30 tended to be best reported.ConclusionsOur results revealed that reporting in CPGs for lung cancer is suboptimal. Particularly the declaration of funding and quality assurance are poorly reported in recent CPGs on lung cancer.

Evaluation of the reporting quality of clinical practice guidelines on gliomas using the RIGHT checklist.

BackgroundThe reporting quality of clinical practice guidelines (CPGs) for gliomas has not yet been thoroughly assessed. The International Reporting Items for Practice Guidelines in Healthcare (RIGHT) statement developed in 2016 provides a reporting framework to improve the quality of CPGs. We aimed to estimate the reporting quality of glioma guidelines using the RIGHT checklist and investigate how the reporting quality differs by selected characteristics.MethodsWe systematically searched electronic databases, guideline databases, and medical society websites to retrieve CPGs on glioma published between 2018 and 2020. We calculated the compliance of the CPGs to individual items, domains and the RIGHT checklist overall. We performed stratified analyses by publication year, country of development, reporting of funding, and impact factor (IF) of the journal.ResultsOur search revealed 20 eligible guidelines. Mean overall adherence to the RIGHT statement was 54.6%. Eight CPGs reported more than 60% of the items, and five reported less than 50%. All guidelines adhered to the items 1a, 3, 7a, 13a, while no guidelines reported the items 17 or 18b (see http://www.right-statement.org/right-statement/checklist for a description of the items). Two of the seven domains, “Basic information” and “Background”, had mean reporting rates above 60%. The “Review and quality assurance” domain had the lowest mean reporting rate, 12.5%. The reporting quality of guidelines published in 2020, guidelines developed in the United States, and guidelines that reported funding tended to be above average.ConclusionsThe reporting quality of CPGs on gliomas is low and needs improvement. Particular attention should be paid on reporting the external review and quality assurance process. The use of the RIGHT criteria should be encouraged to guide the development, reporting and evaluation of CPGs.

Guidelines and Best Practice Recommendations on Obstetric Care of Pregnant Patients with COVID-19 Infection: Scoping Review

We searched guideline databases and websites of professional associations and international organizations working on sexual and reproductive health; We looked for guidelines, protocols, consensus statements and practice recommendations on management of pregnant women with COVID-19. Additionally, we searched: MEDLINE, EMBASE and Google Scholar. Data extraction was done by two independent reviewers using a customized tool that was developed to record the key information relevant to the review question. The difference between the two authors on data extraction was resolved by discussion.

Osteoporosis guidelines from a rehabilitation perspective: systematic analysis and quality appraisal using AGREE II.

People affected by osteoporosis and fragility fractures often report disability and poor health-related quality of life. Albeit rehabilitation has a crucial role in older people, post-menopausal women and other subjects with high risk of fragility fractures, the rehabilitation perspective has been poorly investigated in the available guidelines for osteoporosis. The aim of this systematic review was to systematically evaluate the quality of guidelines for osteoporosis from a rehabilitation perspective. On May 2020, we performed a systematic search on medical literature of all guidelines published in the last 10 years on PubMed, Pedro, and international guideline databases. The study selection was based on key terms "exercise," "physical activity" or "rehabilitation." All authors independently assessed the methodological quality through the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, consisting of six domains (scope, stakeholder involvement, rigor and development, clarity of presentation, applicability, editorial independence). Out of 331 documents retrieved, a total of 34 guidelines were selected after the screening phases. Twenty (58.8%) high quality guidelines were reported. According to AGREE II instrument, a mean score of 78.1±21.8% was reported for "scope and purpose" domain; for stakeholder involvement, the mean score was 58.1±22.1%; the rigor of development was good (mean score of 61.3±27.3%); for clarity of presentation the mean score was 79.4±20.3%; the applicability was poor (mean score of 30.9±25.2%); for editorial independence the mean score was 75.1±24.6%. Rehabilitation recommendations for osteoporotic patients were reported in 21 (61.8%) of the selected guidelines. This is the first systematic analysis evaluating quality of the guidelines for osteoporosis using AGREE II instrument. Starting from a state of the art of the currently available evidence, we could conclude that therapeutic exercise at moderate to high intensity is encouraged by several guidelines for the management of people with osteoporosis and fragility fractures. More than half of guidelines were of high-quality. However, most guidelines are lacking specific indications about exercise features. This study might support the implementation of a rehabilitation perspective in the guidelines for osteoporotic patients.

Abstract P837: Use of Structured Data Entry in Electronic Health Records Increases Compliance With Stroke Standards and Decreases Time of Chart Abstraction

Introduction: Comprehensive Stroke Centers (CSC) provide a high level of care and are held to rigorous standards. Meeting these standards can be challenging in a tertiary care center where multiple services admit the stroke patient population. This also hinders the compliance in meeting these standards as well as created a delay in data abstraction due to nonuniform documentation. A Cerebrovascular Navigator (CV Navigator) is a structured data entry form developed within the electronic health records (EHR) platform to document clinically relevant data in an effort to increase compliance with CSTK measures and to decrease the time for abstraction. Method: The CV Navigator was developed by a team of physicians, nurses, abstractors and informatics personnel. The team specifically focused on CSC measures as per Joint Commission. The CV Navigator captured data required for abstraction for submission into Get with the Guidelines (GWTG) database. We compared compliance for two years, before (2015-2016) and after (2017-2018) implementation of the CV Navigator at our comprehensive stroke center. Results: During the study 5869 (2842 before, 3027 after) acute stroke patients were admitted. Utilizing the CV Navigator simplified data abstraction which decreased GWTG submission from three months to two weeks post discharge. Compliance for documenting severity measurement (CSTK-3) significantly increased from 66.7% before (n=375/562) to 87.6% after implementation of CV Navigator (n=496/566), OR =3.53 (95%CI 2.60 - 4.80), p&lt; 0.001. Compliance with documentation of why procoagulant reversal agent was not given (CSTK-4) increased from 81.2% (n=39/48) to 94.1% (n=48/51), but the difference was not statistically significant OR =3.69 (95%CI 0.94 - 14.58), p=0.07. Conclusion: Use of structured data entry improves compliance with documentation of stroke standards and has immensely reduced abstraction times.

Clinical practice guidelines for the nutritional risk screening and assessment of cancer patients: a systematic quality appraisal using the AGREE II instrument.

To evaluate the quality of published clinical practice guidelines (CPGs) regarding the nutritional risk screening and assessment of cancer patients and to identify high-quality CPGs for clinical healthcare professionals. Guidelines for the nutritional risk screening and assessment of cancer patients were comprehensively searched in eight electronic databases, including The Lancet, PubMed, Cochrane Library, Excerpta Medica dataBASE (EMBASE), Web of Science, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc), and Wan Fang Data, through August 2020. Six relevant guideline databases, including the National Comprehensive Cancer Network (NCCN), the National Guideline Clearinghouse (NGC), the Guideline International Network (GIN), the New Zealand Guidelines Group (NZGG), the China Guideline Clearinghouse (CGC), and Medlive, and relevant nutrition society websites, were also searched through August 2020. The methodological quality of the included CPGs was appraised independently by three assessors using the Appraisal of Guidelines for Research and Evaluation, 2nd edition (AGREE II) tool. Seven CPGs were located, and the domain with the highest percentage was "clarity of presentation" (85.44%), while the domain with the lowest percentage was "applicability" (40.26%). From the AGREE II results, two guidelines were rated as "strongly recommended," three were assessed as "recommended with modifications," and two were deemed as "not recommended." Considering that the two "strongly recommended" guidelines were developed within the American and European contexts, translation, validation, and cultural adaptation are recommended prior to implementing these guidelines in other countries or healthcare contexts to improve their effectiveness and sensitivity for local cancer patients. PROSPERO registration of the study protocol: CRD42020177390 (July 5, 2020).

A Critical Appraisal of Evidence- and Consensus-Based Guidelines for Actinic Keratosis

Actinic keratoses (AK) are common lesions of the skin that can be effectively treated with several lesion- and field-directed treatments. Clinical practice guidelines assist physicians in choosing the appropriate treatment options for their patients. Here, we aimed to systematically identify and evaluate the methodological quality of currently available guidelines for AK. Guidelines published within the last 5 years were identified in a systematic search of guideline databases, Medline and Embase. Then, six independent reviewers evaluated the methodological quality using the tools “Appraisal of Guidelines for Research and Evaluation” (AGREE II) and “Recommendation EXcellence” (AGREE-REX). The Kruskal–Wallis (H) test was used to explore differences among subgroups and Spearman’s correlation to examine the relationship between individual domains. Three guidelines developed by consortia from Canada, Germany and the United Kingdom were eligible for the evaluation. The German guideline achieved the highest scores, fulfilling 65 to 92% of the criteria in AGREE II and 67 to 84% in AGREE-REX, whereas the Canadian guideline scored 31 to 71% of the criteria in AGREE II and 33 to 46% in AGREE-REX. The domains “stakeholder involvement“ and “values and preferences“ were identified as methodological weaknesses requiring particular attention and improvement in future guideline efforts.