Methodological quality of clinical practice guidelines for nutrition and weight gain during pregnancy: a systematic review

2019 ◽  
Vol 78 (7) ◽  
pp. 546-562 ◽  
Author(s):  
Maria G Grammatikopoulou ◽  
Xenophon Theodoridis ◽  
Konstantinos Gkiouras ◽  
Maria Lampropoulou ◽  
Arianna Petalidou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Weight Gain ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Methodological Quality ◽  
Maternal Nutrition ◽  
Conflicts Of Interest ◽  
Data Extraction ◽  
Institute Of Medicine

Abstract Context Ensuring a healthy pregnancy and achieving optimal gestational weight gain (GWG) are important for maternal and child health. Nevertheless, the nutritional advice provided during pregnancy is often conflicting, suggesting limited adherence to clinical practice guidelines (CPGs). Objective The aim of this review was to identify all CPGs on maternal nutrition and GWG and to critically appraise their methodological quality. Data Sources The MEDLINE/PubMed, Cochrane, Guidelines International Network, and BMJ Best Practice databases, along with gray literature, were searched from inception until February 2019 for CPGs and consensus, position, and practice papers. Study Selection Clinical practice guidelines published in English and containing advice on maternal nutrition or GWG were eligible. Data Extraction Two authors independently extracted data on items pertaining to maternal nutrition or GWG, and CPGs were appraised using the AGREE II instrument. Results Twenty-two CPGs were included. All scored adequately in the “scope” domain, but most were considered inadequate with regard to stakeholder involvement, rigor of development, applicability, and editorial independence. Many CPGs lacked patient or dietician involvement, and more than half did not disclose funding sources or conflicts of interest. Guidance on GWG was based mostly on Institute of Medicine thresholds, while nutrition recommendations appeared scattered and heterogeneous. Conclusion Despite the importance of maternal nutrition and the plethora of advising bodies publishing relevant guidance, there is room for substantial improvement in terms of development standards and content of nutritional recommendations. Systematic review registration PROSPERO registration number CRD42019120898.

scholarly journals An Update of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain. Part I: Introduction and General Considerations

2013 ◽  
Vol 2s;16 (2s;4) ◽  
pp. S1-S48
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Pain Management ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Methodological Quality ◽  
Expert Advice ◽  
Evidence Based ◽  
Consensus Statements ◽  
Interventional Pain Management

In 2011, the Institute of Medicine (IOM) re-engineered its definition of clinical guidelines as follows: “clinical practice guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefit and harms of alternative care options.” This new definition departs from a 2-decade old definition from a 1990 IOM report that defined guidelines as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.” The revised definition clearly distinguishes between the term “clinical practice guideline” and other forms of clinical guidance derived from widely disparate development processes, such as consensus statements, expert advice, and appropriate use criteria. The IOM committee acknowledged that for many clinical domains, high quality evidence was lacking or even nonexistent. Even though the guidelines are important decisionmaking tools, along with expert clinical judgment and patient preference, their value and impact remains variable due to numerous factors. Some of the many factors that impede the development of clinical practice guidelines include bias due to a variety of conflicts of interest, inappropriate and poor methodological quality, poor writing and ambiguous presentation, projecting a view that these are not applicable to individual patients or too restrictive with elimination of clinician autonomy, and overzealous and inappropriate recommendations, either positive, negative, or non-committal. Consequently, a knowledgeable, multidisciplinary panel of experts must develop guidelines based on a systematic review of the existing evidence, as recently recommended by the IOM. Chronic pain is a complex and multifactorial phenomenon associated with significant economic, social, and health outcomes. Interventional pain management is an emerging specialty facing a disproportionate number of challenges compared to established medical specialties, including the inappropriate utilization of ineffective and unsafe techniques. In 2000, the American Society of Interventional Pain Physicians (ASIPP) created treatment guidelines to help practitioners. There have been 5 subsequent updates. These guidelines address the issues of systematic evaluation and ongoing care of chronic or persistent pain, and provide information about the scientific basis of recommended procedures. These guidelines are expected to increase patient compliance; dispel misconceptions among providers and patients, manage patient expectations reasonably; and form the basis of a therapeutic partnership between the patient, the provider, and payers. Key words: Evidence-based medicine (EBM), comparative effectiveness research (CER), clinical practice guidelines, systematic reviews, meta-analysis, interventional pain management, evidence synthesis, methodological quality assessment, clinical relevance, recommendations.

Various clinical practice guidelines for sports-related concussion are of sufficient methodological quality by AGREE II: a systematic review

2020 ◽  
Vol 5 (5) ◽  
pp. 275-280
Author(s):  
Steven R Dayton ◽  
Hayden Baker ◽  
Ujash Sheth ◽  
Vehniah K Tjong ◽  
Michael Terry
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Sports Medicine ◽  
Methodological Quality ◽  
Statistical Difference ◽  
Interobserver Agreement ◽  
Healthcare Professionals ◽  
Surgical Trainees

ImportanceClinical practice guidelines (CPGs) relating to concussion management are published by various healthcare specialties, including but not limited to orthopaedic surgery, family medicine, neurology and athletic trainers. A systematic analysis can help identify high quality CPGs for clinical use by sports medicine physicians.ObjectiveThe purpose of this study is to systematically identify and appraise relevant CPGs related to sports-related concussion in adult patients.Evidence reviewPredetermined selection criteria were used by two reviewers who independently identified published CPGs before 1 November 2018. CPGs were excluded if they focused only on paediatric patients or their scope was greater than concussion in the setting of sports. The remaining guidelines were analysed by five independent reviewers with different levels of training using the Appraisal of Guidelines for Research and Evaluation II tool. Guidelines were deficient if they earned scores less than 50%. The Spearman correlation coefficient was used to assess interobserver agreement between the evaluators. Scores were compared by publishing institution and healthcare discipline using Kruskal-Wallis tests.FindingsSeven CPGs met the inclusion criteria. Guidelines came from neurologists, athletic therapists/trainers and interdisciplinary sports medicine bodies. Interobserver agreement was strong and mean scores between surgical trainees (124.5) and board-certified surgeons (125.9) were not statistically different. Guideline quality was variable but not deficient (>50%), except regarding ‘editorial independence’. No statistical difference was found between guidelines from different publishing institutions. Additionally, no statistical difference was found between guidelines published by different healthcare professionals.Conclusions and relevanceOverall, CPG quality was variable but not deficient, except for the domain of editorial independence. Bias due to poor editorial independence is a concern, particularly in CPGs published by non-physicians. Given the similarity in content and methodological quality, consideration should be given to condense evidence into a single CPG to be used by all healthcare professionals in the management of sports concussion.Level of evidence1, Systematic Review.

scholarly journals Adherence to clinical practice guidelines (CPGs) for the treatment of cancers in Australia and the factors associated with adherence: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e050912
Author(s):  
Mia Bierbaum ◽  
Frances Rapport ◽  
Gaston Arnolda ◽  
Yvonne Tran ◽  
Bróna Nic Giolla Easpaig ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Cancer Treatment ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Data Extraction ◽  
Meta Analysis ◽  
Survival Rates ◽  
Implementation Strategies ◽  
Factors Associated

IntroductionClinical practice guidelines (CPGs) synthesise the latest evidence to support clinical and patient decision-making. CPG adherent care is associated with improved patient survival outcomes; however, adherence rates are low across some cancer streams in Australia. Greater understanding of specific barriers to cancer treatment CPG adherence is warranted to inform future implementation strategies.This paper presents the protocol for a systematic review that aims to determine cancer treatment CPG adherence rates in Australia across a variety of common cancers, and to identify any factors associated with adherence to those CPGs, as well as any associations between CPG adherence and patient outcomes.Methods and analysisFive databases will be searched, Ovid Medline, PsychInfo, Embase, Scopus and Web of Science, for eligible studies evaluating adherence rates to cancer treatment CPGs in Australia. A team of reviewers will screen the abstracts in pairs according to predetermined inclusion criteria and then review the full text of eligible studies. All included studies will be assessed for quality and risk of bias. Data will be extracted using a predefined data extraction template. The frequency or rate of adherence to CPGs, factors associated with adherence to those CPGs and any reported patient outcome rates (eg, relative risk ratios or 5-year survival rates) associated with adherence to CPGs will be described. If applicable, a pooled estimate of the rate of adherence will be calculated by conducting a random-effects meta-analysis. The systematic review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Ethics and disseminationEthics approval will not be required, as this review will present anonymised data from other published studies. Results from this study will form part of a doctoral dissertation (MB), will be published in a journal, presented at conferences, and other academic presentations.PROSPERO registration numberCRD42020222962.

scholarly journals Clinical practice guidelines for hypertension in China: a systematic review of the methodological quality

BMJ Open ◽  
2015 ◽  
Vol 5 (7) ◽  
pp. e008099 ◽  
Author(s):  
Yin Chen ◽  
Shilian Hu ◽  
Lei Wu ◽  
Xiang Fang ◽  
Weiping Xu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Methodological Quality

scholarly journals Clinical practice guidelines and recommendations in the context of the COVID-19 pandemic: systematic review and critical appraisal

2020 ◽  
Author(s):  
Tanja A Stamm ◽  
Margaret R Andrews ◽  
Erika Mosor ◽  
Valentin Ritschl ◽  
Linda C Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Methodological Quality ◽  
Critical Appraisal ◽  
Guideline Development ◽  
Evaluation Instrument ◽  
Agree Ii ◽  
Guidelines And Recommendations

AbstractBackgroundThe number of published clinical practice guidelines and recommendations related to SARS-CoV-2 infections causing COVID-19 has rapidly increased. However, insufficient consideration of appropriate methodologies in the guideline development could lead to misleading information, uncertainty among professionals, and potentially harmful actions for patients.PurposeRapid systematic review of clinical practice guidelines and recommendations in the context of COVID-19 to explore if basic methodological standards of guideline development have been met.Data sourcesMEDLINE [PubMed], CINAHL [Ebsco], Trip and manual search; from Feb 1st 2020 until April 27th 2020.Study selectionAll types of healthcare workers providing any kind of healthcare to any patient population in any setting.Data extractionAt least two reviewers independently extracted guideline characteristics, conducted critical appraisal according to The Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) and classified the guidelines using the Association of the Scientific Medical Societies (AWMF) Guidance Manual and Rules for Guideline Development. We plan six-month updates (living review).Data synthesisThere were 1342 titles screened and 188 guidelines included. The highest average AGREE II domain score was 89% for scope and purpose, the lowest for rigor of development (25%). Only eight guidelines (4%) were based on a systematic literature search and a structured consensus process by representative experts (classified as the highest methodological quality, S3 according to AWMF). Patients were only included in the development of one guideline. A process for regular updates was described in 27 guidelines (14%).LimitationsMethodological focus only.ConclusionsDespite clear scope, most publications fell short of basic methodological standards of guideline development. Future research should monitor the evolving methodological quality of the guidelines and their updates over time.Registration/PublicationThe protocol was published at www.researchgate.net, DOI: 10.13140/RG.2.2.21293.51689. Preliminary results are publicly available on medRxiv.

scholarly journals Analysis of conflict of interest policies among organizations producing clinical practice guidelines

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249267
Author(s):  
J. Henry Brems ◽  
Andrea E. Davis ◽  
Ellen Wright Clayton
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Conflict Of Interest ◽  
Conflicts Of Interest ◽  
Public Trust ◽  
Institute Of Medicine ◽  
Internet Search ◽  
The Public ◽  
Document Review

Background Conflicts of interest (COI) jeopardize the validity of Clinical Practice Guidelines (CPGs). When the Institute of Medicine promulgated COI policies in 2011, few organizations met these requirements, but it is unknown if organizations have improved their policies since that time. We sought to evaluate current adherence to IOM standards of COI policies. Methods and findings We conducted a retrospective document review of COI policies and CPGs from organizations that published five or more CPGs between January 1, 2018 and December 31, 2019. Organizations were identified via CPG databases. COI policies were obtained from an internet search. We collected data on i) the number of organizations that have COI policies specific to CPG development, ii) the number of policies meeting each IOM standard and iii) the number of IOM standards met by each policy. COI disclosures from five CPGs of each organization were assessed for adherence to IOM standards. Among the 46 organizations that published 5 or more CPGs, 36 (78%) had a COI policy. Standard 2.2b (requiring divestment of financial COI) was met least frequently, by 2 of 36 (6%) organizations. Standard 2.1 (requiring disclosure of COI) was met most frequently, by 33 of 36 (92%) organizations. A total of 31 of 36 (86%) organizations met 4 or fewer of the 7 IOM standards. Among the 16 organizations limiting COI to a minority of the CPG panel (standard 2.4c) and the 15 organizations prohibiting COI among chairs or co-chairs (standard 2.4d), 12 (75%) and 10 (67%) organizations violated the respective standard in at least one CPG. The main limitations of our study are the exclusion of organizations producing fewer CPGs and ability to assess only publicly available policies. Conclusion Among organizations producing CPGs, COI policies frequently do not meet IOM standards, and organizations often violate their own policies. These shortcomings may undermine the public trust in and thus the utility of CPGs. CPG-producing organizations should improve their COI policies and their strategies to manage COI to increase the trustworthiness of CPGs.

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