scholarly journals Synopsis of the 2020 U.S. VA/DoD Clinical Practice Guideline for the Management of Adult Overweight and Obesity

2021 ◽  
Author(s):  
Stéphanie B Mayer ◽  
Sky Graybill ◽  
Susan D Raffa ◽  
Christopher Tracy ◽  
Earl Gaar ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Veterans Health Administration ◽  
Overweight And Obesity ◽  
Veterans Health ◽  
Health Administration ◽  
The U.S

ABSTRACT Introduction In May of 2020, the U.S. Veterans Health Administration (VHA) and Department of Defense (DoD) approved a new joint clinical practice guideline for assessing and managing patients who have overweight and obesity. This guideline is intended to give healthcare teams a framework by which to screen, evaluate, treat, and manage the individual needs and preferences of VA and DoD patients who may have either of these conditions. It can be accessed at https://www.healthquality.va.gov/guidelines/CD/obesity/. Materials and Methods In January of 2019, the VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included clinical stakeholders and conformed to the Institute of Medicine’s tenets for trustworthy clinical practice guidelines. Results The guideline panel developed 12 key questions, systematically searched and evaluated the literature, created a 1-page algorithm, and advanced 18 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation system. Conclusions This synopsis summarizes the key recommendations of the guideline regarding management of overweight and obesity, including referral to comprehensive lifestyle interventions that combine behavioral, dietary, and physical activity change, and additional tools of pharmacologic and procedural interventions. Additionally, recommendations based on evidence found in the literature for short-term weight loss are included. A clinical practice algorithm that is part of the guideline is also included. Additional materials, such as provider and patient summaries and a provider pocket card, are also available for public use, accessible at the U.S. Veterans Health Administration (VHA) Clinical Practice Guidelines (CPG) website listed above.

scholarly journals Evaluation of the Level of Evidence Supporting the Recommendations Constituting the American Academy of Dermatology Clinical Practice Guidelines: Cross-Sectional Analysis (Preprint)

2019 ◽  
Author(s):  
Courtney Cook ◽  
Ryan Ottwell ◽  
Taylor Rogers ◽  
Jake Checketts ◽  
Sanjeev Musuvathy ◽  
...  
Keyword(s):  
Clinical Practice ◽  
American Academy ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Practice Guideline ◽  
Strong Evidence ◽  
Practice Guideline ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Weak Evidence

BACKGROUND Clinical practice guidelines are evidence-based recommendations used by physicians to improve patient care. These guidelines provide the physician with an assessment of the benefits and harms of a treatment and its alternatives. Therefore, it is essential that the clinical practice guidelines be based on the strongest available evidence. Numerous studies in a variety of different fields of medicine have demonstrated that recommendations supported by weak evidence are a common theme in clinical practice guidelines. A clinical guideline based solely on weak evidence has the capability to reduce the quality of care provided by physicians. OBJECTIVE Our primary objective is to evaluate the levels of evidence supporting the recommendations constituting the American Academy of Dermatology clinical practice guidelines. METHODS Using a cross-sectional study design, authors SM and RO located all current clinical practice guidelines on the American Academy of Dermatology website on June 10, 2017, and December 11, 2019. Each recommendation and its corresponding evidence rating were extracted in a duplicate and blinded fashion. A consensus meeting was planned a priori to resolve disagreements in extractions or stratifications. RESULTS In total, 6 clinical guidelines and their subsections were screened and 899 recommendations were identified. Our final data set included 841 recommendations, as 58 recommendations contained no level of evidence and were excluded from calculations. Many recommendations were supported by a moderate level of evidence and therefore received a B rating (346/841, 41.1%). Roughly one-third of the recommendations were supported by a strong level of evidence and were given an A rating (n=307, 36.5%). The clinical practice guideline with the highest overall strength of evidence was regarding the treatment of acne, which had 17 of 35 (48.6%) recommendations supported by strong evidence and only 2 (5.7%) supported by weak evidence. The clinical practice guideline with the fewest recommendations supported by strong evidence was melanoma (13/63, 20.6%). CONCLUSIONS Clinical practice guidelines that lack strong supporting evidence could negatively affect patient care, and dermatologists should be mindful that not all recommendations are supported by the strongest level of evidence. An increased quantity of quality research needs to be performed in the field of dermatology to improve the evidence supporting the American Academy of Dermatology clinical practice guidelines.

scholarly journals Evaluation of the Level of Evidence Supporting the Recommendations Constituting the American Academy of Dermatology Clinical Practice Guidelines: Cross-Sectional Analysis

10.2196/17370 ◽  
2020 ◽  
Vol 3 (1) ◽  
pp. e17370
Author(s):  
Courtney Cook ◽  
Ryan Ottwell ◽  
Taylor Rogers ◽  
Jake Checketts ◽  
Sanjeev Musuvathy ◽  
...  
Keyword(s):  
Clinical Practice ◽  
American Academy ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Practice Guideline ◽  
Strong Evidence ◽  
Practice Guideline ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Weak Evidence

Background Clinical practice guidelines are evidence-based recommendations used by physicians to improve patient care. These guidelines provide the physician with an assessment of the benefits and harms of a treatment and its alternatives. Therefore, it is essential that the clinical practice guidelines be based on the strongest available evidence. Numerous studies in a variety of different fields of medicine have demonstrated that recommendations supported by weak evidence are a common theme in clinical practice guidelines. A clinical guideline based solely on weak evidence has the capability to reduce the quality of care provided by physicians. Objective Our primary objective is to evaluate the levels of evidence supporting the recommendations constituting the American Academy of Dermatology clinical practice guidelines. Methods Using a cross-sectional study design, authors SM and RO located all current clinical practice guidelines on the American Academy of Dermatology website on June 10, 2017, and December 11, 2019. Each recommendation and its corresponding evidence rating were extracted in a duplicate and blinded fashion. A consensus meeting was planned a priori to resolve disagreements in extractions or stratifications. Results In total, 6 clinical guidelines and their subsections were screened and 899 recommendations were identified. Our final data set included 841 recommendations, as 58 recommendations contained no level of evidence and were excluded from calculations. Many recommendations were supported by a moderate level of evidence and therefore received a B rating (346/841, 41.1%). Roughly one-third of the recommendations were supported by a strong level of evidence and were given an A rating (n=307, 36.5%). The clinical practice guideline with the highest overall strength of evidence was regarding the treatment of acne, which had 17 of 35 (48.6%) recommendations supported by strong evidence and only 2 (5.7%) supported by weak evidence. The clinical practice guideline with the fewest recommendations supported by strong evidence was melanoma (13/63, 20.6%). Conclusions Clinical practice guidelines that lack strong supporting evidence could negatively affect patient care, and dermatologists should be mindful that not all recommendations are supported by the strongest level of evidence. An increased quantity of quality research needs to be performed in the field of dermatology to improve the evidence supporting the American Academy of Dermatology clinical practice guidelines.

Hypertension and Epistaxis: Why Is There Limited Guidance in the Nosebleed Clinical Practice Guidelines?

2020 ◽  
Vol 162 (1) ◽  
pp. 33-34 ◽  
Author(s):  
Spencer C. Payne ◽  
David Feldstein ◽  
Samantha Anne ◽  
David E. Tunkel
Keyword(s):  
Clinical Practice ◽  
American Academy ◽  
Head And Neck ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Multivariate Analyses ◽  
Relevant Literature ◽  
Neck Surgery

Hypertension has long been thought to influence the risk and severity of epistaxis. However, evaluation of the relevant literature reveals articles with methodologic concerns or limited quality. In many instances, these studies are not adequately controlled, and lack of multivariate analyses calls into question any noted association between epistaxis and hypertension. The goal of this commentary is to explain why there is limited guidance about the management of hypertension and the possible association with nosebleed in the 2020 American Academy of Otolaryngology–Head and Neck Surgery Foundation clinical practice guideline for nosebleeds. Background on the literature that describes the association between hypertension and nosebleeds is provided.

scholarly journals Engaging target users to appraise and refine clinical practice guidelines in pediatric concussion: An integrated knowledge translation approach

2021 ◽  
Vol 5 ◽  
pp. 205970022110174
Author(s):  
Melissa Paniccia ◽  
Christine Provvidenza ◽  
Shauna Kingsnorth ◽  
Christina Ippolito ◽  
Roger Zemek ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Knowledge Translation ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Health Professionals ◽  
Agree Ii ◽  
Allied Health Professionals ◽  
Pediatric Concussion

Background Clinical practice guidelines are systematically developed statements that assist clinicians in making evidence informed decisions regarding patient care. Within pediatric concussion, the Ontario Neurotrauma Foundation released the Guidelines for Diagnosing and Managing Pediatric Concussion in 2014. The purpose of this study was to evaluate the 2014 guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation tool, in addition to a brief knowledge translation survey, and to utilize the collected feedback from end users to inform improvements to support an updated version. An integrated knowledge translation approach was employed using clinical experts as guideline appraisers. Methods A purposive sample of researchers, physicians, allied health professionals, policy makers, educators and knowledge translation experts involved in updating the guidelines (N = 31) completed the AGREE II Likert scale survey regarding the 2014 guideline, and provided written justifications for their ratings. Domain and item AGREE II scaled scores were reported stratified by demographic factors, and written justifications were synthesized using content analysis to determine areas of improvement for the 2014 guideline. Results Appraisers scored the editorial independence (88.9%) and scope and purpose (80.8%) domains the highest, indicating high quality. The guidelines scored the lowest in the applicability domain (69.3%). Participants with less than 10 years of experience in their respective disciplines, as well as physicians and allied health professionals consistently provided higher ratings across domains compared to other professions. Conclusions The process of evaluating the 2014 guideline resulted in these important outcomes: (1) identified areas of the guideline that may have affected the lack of previous clinical uptake while abiding by a clinical practice guideline development framework; (2) shared and informed decision making regarding content and format of the revised clinical practice guideline; and (3) targeted content, clinical questions and dissemination strategies, which are key to clinical uptake.

The place of non-invasive brain stimulation in the RANZCP clinical practice guidelines for mood disorders

2021 ◽  
Vol 55 (4) ◽  
pp. 349-354
Author(s):  
Paul B Fitzgerald ◽  
Shane Gill ◽  
Salam Hussain ◽  
Shanthi Sarma ◽  
Suneel Chamoli ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Transcranial Magnetic Stimulation ◽  
Mood Disorders ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Antidepressant Use

Clinical practice guidelines are important documents as they have the capacity to significantly influence and shape clinical practice in important areas of therapeutics. As such, they need to be developed informed by comprehensive and quality-based systematic reviews, involve consensus deliberations representative of the appropriate experts in the field and be subject to thorough critical review. A revised clinical practice guideline for the management of patients with mood disorders was recently published under the auspices of the Royal Australian and New Zealand College of Psychiatrists. However, this clinical practice guideline was not developed in a manner that reflects the appropriate standards that should apply to clinical practice guideline development and it has critical flaws, especially as it pertains to the use of repetitive transcranial magnetic stimulation treatment for patients with depression. The revision of the college clinical practice guideline has explicitly removed clear and unequivocal evidence-based recommendations that were found in a previous version of the clinical practice guideline and replaced these with consensus-based recommendations. However, the consensus-based recommendations were developed without consultation of the appropriate expert body within the college and contradict the scientific literature. There is substantive and unequivocal evidence supporting the antidepressant use of repetitive transcranial magnetic stimulation in the treatment of patients with depression and its use after a patient with depression has failed a limited number (typically around two) of antidepressant medication trials. Readers should refer to the college Professional Practice Guidelines for repetitive transcranial magnetic stimulation published in 2018 for thorough information about the use of this important new treatment.

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