scholarly journals From SARS and MERS to COVID-19: a review of the quality and responsiveness of clinical management guidelines in outbreak settings

2021 ◽  
Author(s):  
Samuel Lipworth ◽  
Ishmeala Rigby ◽  
Vincent Cheng ◽  
Peter Bannister ◽  
Eli Harriss ◽  
...  
Keyword(s):  
Supportive Care ◽  
Clinical Management ◽  
Guideline Development ◽  
Specific Treatment ◽  
Health Agency ◽  
Agree Ii ◽  
Eligibility Criteria ◽  
Management Guidelines ◽  
Over Time

AbstractObjectiveTo assess the responsiveness and quality of clinical management guidelines (CMGs) in SARS, MERS and COVID-19 and determine whether this has improved over time.DesignRapid literature review, quality assessment and focus group consultation.Data Sources– Google and Google Scholar were systematically searched from inception to 6th June 2020.This was supplemented with hand searches of national and international public health agency and infectious disease society websites as well as directly approaching clinical networks in regions where few CMGs had been identified via the primary search.Eligibility CriteriaCMGs for the treatment of COVID-19/SARS/MERS providing recommendations on supportive care and/or specific treatment.MethodsData extraction was performed using a standardised form. The Appraisal of Guidelines for Research and Evaluation (AGREE-II) tool was used to evaluate the quality of the CMGs. Six COVID-19 treatments were selected to assess the responsiveness of a subset of guidelines and their updates to 20th November 2020. We ran two sessions of focus groups with patient advocates to elicit their views on guideline development.ResultsWe included 37 COVID-19, six SARS, and four MERS CMGs. Evidence appraisals in CMGs generally focused on novel drugs rather than basic supportive care; where evidence for the latter was provided it was generally of a low quality. Most CMGs had major methodological flaws (only two MERS-CoV and four COVID-19 CMGs were recommended for use by both reviewers without modification) and there was no evidence of improvement in quality over time. CMGs scored lowest in the following AGREE-II domains: scope and purpose, editorial independence, stakeholder engagement, and rigour of development. Of the COVID-19 CMGs, only eight included specific guidance for the management of elderly patients and only ten for high-risk groups; a further eight did not specify the target patient group at all. Early in the pandemic, multiple guidelines recommended unproven treatments and whilst in general findings of major clinical trials were eventually adopted, this was not universally the case. Eight guidelines recommended that use of unproven agents should be considered on a case-by-case basis. Patient representatives expressed concern about the lack of engagement with them in CMG development and that these documents are not accessible to non-experts.ConclusionThe quality of most CMGs produced in coronaviridae outbreaks is poor and we have found no evidence of improvement over time, highlighting that current development frameworks must be improved. There is an need to strengthen the evidence base surrounding basic supportive care and develop methods to engage patients in CMG development from the beginning in outbreak settings.Systematic review registrationPROSPERO CRD42020167361

scholarly journals Nonconformity in the clinical practice guidelines for subclinical Cushing's syndrome: which guidelines are trustworthy?

2014 ◽  
Vol 171 (4) ◽  
pp. 421-431 ◽  
Author(s):  
Jing Shen ◽  
Mingfang Sun ◽  
Bo Zhou ◽  
Juping Yan
Keyword(s):  
Clinical Practice ◽  
Cushing’S Syndrome ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Guideline Development ◽  
Cushing's Syndrome ◽  
Subclinical Cushing’S Syndrome ◽  
Agree Ii ◽  
Management Guidelines

ObjectiveThis study aimed to systematically evaluate the quality of clinical practice guidelines (CPGs) and to compare their recommendations for managing subclinical Cushing's syndrome (SCS) to assist practitioners in making rapid clinical decisions.Design and methodsSCS management guidelines were retrieved from electronic databases. The Appraisal of Guidelines Research and Evaluation II (AGREE-II) tool and the Institute of Medicine (IOM) criteria were used to evaluate the quality of the selected guidelines. In addition, we further compared recommendations, cited references and levels of evidence between the SCS management guidelines.ResultsWe included five guidelines that were obtained through the literature selection process. On the basis of the AGREE-II and IOM criteria, none of the selected guidelines were satisfactory in all aspects. However, the Italian Association of Clinical Endocrinologists (IACE) guidelines demonstrated slightly higher scores than did the other guidelines, so this guideline was recommended (with certain modifications for several domains). Regarding the content of the CPGs, we found considerable differences in the recommendations for managing SCS. These differences were derived from citation selection bias, evidence interpretation bias, differences in the composition of the guidelines' workgroups and the omission of guidelines for updating and externally reviewing the recommendations.ConclusionsThere is generally poor guideline quality among different organisations, and remarkable differences exist in the recommendations for the same clinical subject. Therefore, future guideline development should be performed in strict accordance with the AGREE-II and IOM criteria.

scholarly journals Evaluation of clinical practice guidelines (CPG) on the management of female chronic pelvic pain (CPP) using the AGREE II instrument

2021 ◽  
Author(s):  
Vishalli Ghai ◽  
Venkatesh Subramanian ◽  
Haider Jan ◽  
Jemina Loganathan ◽  
Stergios K. Doumouchtsis ◽  
...  
Keyword(s):  
Surgical Management ◽  
Guideline Development ◽  
Stakeholder Involvement ◽  
Professional Organizations ◽  
Agree Ii ◽  
Behavioural Interventions ◽  
Recommended Treatment ◽  
Muscular Dysfunction ◽  
Health Related

Abstract Introduction and hypothesis Variations in guidelines may result in differences in treatments and potentially poorer health-related outcomes. We aimed to systematically review and evaluate the quality of national and international guidelines and create an inventory of CPG recommendations on CPP. Methods We searched EMBASE and MEDLINE databases from inception till August 2020 as well as websites of professional organizations and societies. We selected national and international CPGs reporting on the diagnosis and management of female CPP. We included six CPGs. Five researchers independently assessed the quality of included guidelines using the AGREE II tool and extracted recommendations. Results Two hundred thirty-two recommendations were recorded and grouped into six categories: diagnosis, medical treatment, surgical management, behavioural interventions, complementary/alternative therapies and education/research. Thirty-nine (17.11%) recommendations were comparable including: a comprehensive pain history, a multi-disciplinary approach, attributing muscular dysfunction as a cause of CPP and an assessment of quality of life. Two guidelines acknowledged sexual dysfunction associated with CPP and recommended treatment with pelvic floor exercises and behavioural interventions. All guidelines recommended surgical management; however, there was no consensus regarding adhesiolysis, bilateral salpingo-oophorectomy during hysterectomy, neurectomy and laparoscopic uterosacral nerve ablation. Half of recommendations (106, 46.49%) were unreferenced or made in absence of good-quality evidence or supported by expert opinion. Based on the AGREE II assessment, two guidelines were graded as high quality and recommended without modifications (EAU and RCOG). Guidelines performed poorly in the “Applicability”, “Editorial Independence” and “Stakeholder Involvement” domains. Conclusion Majority of guidelines were of moderate quality with significant variation in recommendations and quality of guideline development.

scholarly journals Critical appraisal and comparison of recommendations of clinical practice guidelines for treatment of schizophrenia in children and adolescents: a methodological survey protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038646
Author(s):  
Maíra Ramos Alves ◽  
Cristiane de Cássia Bergamaschi ◽  
Flávia Blaseck Sorrilha ◽  
Izabela Fulone ◽  
Silvio Barberato-Filho ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Children And Adolescents ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Future Research ◽  
High Quality ◽  
Agree Ii ◽  
Ethical Approval ◽  
Over Time

IntroductionThe number of clinical practice guidelines (CPGs) have increased substantially mainly in the paediatric area of mental health. However, little is known about the quality or how recommendations for the treatment of disorders such as schizophrenia in children and adolescents have changed over time. The aim of this study will be to assess the quality of the development of CPGs for the treatment and management of schizophrenia in children and adolescents over time using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and to compare the recommendations and interventions described in these documents.Methods and analysisCPGs will be identified using a prospective protocol through a systematic search of multiple databases (Medline, Embase, Health Systems Evidence, Epistemonikos, Lilacs, etc) and guideline websites from 2004 to December 2020. The quality of the guidelines will be assessed by three reviewers, independently using the AGREE II. CPGs will be considered of high-quality if they scored ≥60% in four or more domains of the AGREE II instrument. Non-parametric tests will be used to test for the change of quality over time. We will summarise the different evidence grading systems and compare the recommendations.Ethics and disseminationEthical approval is not required since it is a literature-based study. Future results of the research can be submitted for publication in scientific journals of high impact, peer reviewed and also published in national and international conferences. The results derived from this study will contribute to the improvement of health institutions and policies, informing about existing recommendation guidelines and about deficiencies and qualities found in those. This study may also identify key areas for future research. This study may guide the search and choice for high quality CPGs by health policy makers and health professionals and subsidise future adaptations.Protocol registration numberCRD42020164899.

Alzheimer’s Disease Dementia Guidelines for Diagnostic Testing

2013 ◽  
Vol 28 (2) ◽  
pp. 111-119 ◽  
Author(s):  
Ingrid Arevalo-Rodriguez ◽  
Olga L. Pedraza ◽  
Andrea Rodríguez ◽  
Erick Sánchez ◽  
Ignasi Gich ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Guideline Development ◽  
Diagnostic Testing ◽  
Agree Ii ◽  
Adequate Treatment ◽  
Wide Variability ◽  
Alzheimer’S Disease Dementia ◽  
Clinical Practice Guideline Development

Alzheimer’s disease dementia (AD dementia) is one of the most common neurodegenerative diseases worldwide, with a growing incidence during the last decades. Clinical diagnosis of cognitive impairment and presence of AD biomarkers have become important issues for early and adequate treatment. We performed a systematic literature search and quality appraisal of AD dementia guidelines, published between 2005 and 2011, which contained diagnostic recommendations on AD dementia. We also analyzed diagnostic recommendations related to the use of brief cognitive tests, neuropsychological evaluation, and AD biomarkers. Of the 537 retrieved references, 15 met the selection criteria. We found that Appraisal of Guidelines Research and Evaluation (AGREE)-II domains such as applicability and editorial independence had the lowest scores. The wide variability on assessment of quality of evidence and strength of recommendations were the main concerns identified regarding diagnostic testing. Although the appropriate methodology for clinical practice guideline development is well known, the quality of diagnostic AD dementia guidelines can be significantly improved.

scholarly journals Concurrent Disorder Management Guidelines. Systematic Review

2020 ◽  
Vol 9 (8) ◽  
pp. 2406
Author(s):  
Syune Hakobyan ◽  
Sara Vazirian ◽  
Stephen Lee-Cheong ◽  
Michael Krausz ◽  
William G. Honer ◽  
...  
Keyword(s):  
English Language ◽  
Assessment Tool ◽  
Evidence Base ◽  
Agree Ii ◽  
Concurrent Disorders ◽  
Management Guidelines ◽  
Nice Guidelines ◽  
Literature Searches ◽  
Clinical Recommendation

Concurrent disorder refers to a diverse set of combinations of substance use disorders and mental disorders simultaneously in need of treatment. Concurrent disorders are underdiagnosed, undertreated, and more complex to manage, practicing the best recommendations can support better outcomes. The purpose of this work is to systematically assess the quality of the current concurrent disorders’ clinical recommendation management guidelines. Literature searches were performed by two independent authors in electronic databases, web, and gray literature. The inclusion criteria were English language clinical management guidelines for adult concurrent disorders between 2000 and 2020. The initial search resulted in 8841 hits. A total of 24 guidelines were identified and assessed with the standardized guidelines assessment tool: AGREE II (Appraisal of Guidelines for Research and Evaluation). Most guidelines had acceptable standards, however, only the NICE guidelines had all detailed information on all AGREE II Domains. Guidelines generally supported combinations of treatments for individual disorders with a very small evidence base for concurrent disorders, and they provided little recommendation for further structuring of the field, such as level of complexity or staging, or evaluating different models of treatment integration.

scholarly journals Appraisal of the Current Guidelines for Management of Malignant Left-Sided Colonic Obstruction Using the Appraisal of Guidelines Research and Evaluation II Instrument

2021 ◽  
pp. 1-9
Author(s):  
Paschalis Gavriilidis ◽  
Alan Askari ◽  
Nicola de’Angelis ◽  
Efstratios P. Gavriilidis ◽  
James Wheeler ◽  
...  
Keyword(s):  
Guideline Development ◽  
Colonic Obstruction ◽  
High Quality ◽  
Agree Ii ◽  
Guideline Quality ◽  
Domain V ◽  
Domain I ◽  
Current Guidelines ◽  
Agree Ii Instrument

Introduction: Colorectal cancer (CRC) is the fourth leading cause of death with 1.4 million new cases occurring annually worldwide. High-quality clinical practice guidelines are needed to tailor high-quality individualized treatment. The aim of the present study was to evaluate the methodological quality of the current guidelines for the management of acute malignant left-sided colonic bowel obstruction. Methods: A systematic search of the literature was carried out using electronic databases. The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was used to assess the quality of each guideline. Results: Search results returned a total of 14 guidelines appropriate for assessment. Both domain I (scope and purpose) and domain VI (editorial independence) were assessed with the same median score of 83%. The lowest scoring domain was domain V (applicability), scoring only 43%. The 2 guidelines that had the highest score were the National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN), each scoring 100%. However, there were significant variations in terms of quality. The NICE and New Zealand guidelines were voted unanimously for use unchanged, whilst 8 other guidelines were voted for use with modifications. Conclusion: Variation in guideline quality in CRC is a concern despite some clearly excellent published guidelines. All guidelines score poorly when it comes to describing how the guidelines could be applied. Lack of patient participation in guideline development is also a shortcoming that requires urgent redress.

scholarly journals Quality and Specific Concerns of Clinical Guidelines for Integrated Chinese and Western Medicine: A Critical Appraisal

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Xu Zhou ◽  
Sheng Xu ◽  
Qing Ren ◽  
Jianrong Chen
Keyword(s):  
Chinese Medicine ◽  
Clinical Guidelines ◽  
Western Medicine ◽  
Methodological Quality ◽  
Guideline Development ◽  
Intraclass Correlation ◽  
Biomedical Literature ◽  
China National Knowledge Infrastructure ◽  
Agree Ii

Objective. This study aimed to investigate the methodological quality of clinical guidelines (CGs) for integrated Chinese and Western medicine (ICWM) to inform clinical practice and guideline development. Methods. We searched PubMed, EMBASE, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Data, VIP, five guideline databases, and four online book malls to identify ICWM CGs published up to January 11, 2019. Four independent appraisers assessed the quality of CGs using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument and evaluated six specific concerns for ICWM. The standardized scores were calculated for the individual AGREE II domains. Results. Sixty-two ICWM CGs were included. The median standardized scores in the six domains of AGREE II were 65% in scope and purpose, 46% in clarity of presentation, 26% in applicability, 24% in stakeholder involvement, 15% in rigor of development, and 0% in editorial independence. The quality of ICWM CGs was significantly associated with the publication year (higher quality for CGs published after 2014) and the development method (higher quality for evidence-based CGs). Only one ICWM CG obtained a direct recommendation for use, and 14 could be recommended for use after modifications. The intra-appraiser consistency of the AGREE II appraisal was good (mean intraclass correlation coefficient range, 0.813–0.998). ICWM CGs also lacked a systematic search of ancient traditional Chinese medicine (TCM) classics (40.3%), conversion of TCM recommendations from ancient Chinese to the vernacular (14.5%), a discussion of interactions between TCM and Western medicine (27.4%), and rankings of different ICWM choices (0%). Conclusions. Although an improvement after 2014 occurred, the current 64 ICWM CGs are generally of poor methodological quality. Only 15 ICWM CGs can be recommended for use directly or with modifications. As the key distinctions from Western/Chinese medicine CGs, the ICWM-specific recommendations are also insufficient for the ICWM CGs, especially for interactions between TCM and Western medicine and rankings of different ICWM choices. Study Registration. This study has been registered at PROSPERO (no. CRD42018095767).

scholarly journals Applicability of the AGREE II Instrument in Evaluating the Development Process and Quality of Current National Academy of Clinical Biochemistry Guidelines

2012 ◽  
Vol 58 (10) ◽  
pp. 1426-1437 ◽  
Author(s):  
Andrew C Don-Wauchope ◽  
John L Sievenpiper ◽  
Stephen A Hill ◽  
Alfonso Iorio
Keyword(s):  
Clinical Laboratory ◽  
Clinical Biochemistry ◽  
Guideline Development ◽  
Stakeholder Involvement ◽  
Laboratory Medicine ◽  
Quality Of Reporting ◽  
Agree Ii ◽  
Strongly Agree ◽  
Agree Ii Instrument

Abstract BACKGROUND Laboratory medicine practice guidelines (LMPGs) are an important part of clinical laboratory medicine. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument has been developed to evaluate the process of practice-guideline development and the quality of reporting. We assessed the applicability of AGREE II in assessing the National Academy of Clinical Biochemistry (NACB) LMPGs. METHODS The NACB website was searched for all available LMPGs up to December 2011. Two independent appraisers used the AGREE II instrument to assess each LMPG identified by the search. Quality was assessed across 6 domains (scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence), comprising a total of 23 items and 2 overall assessments, each scored on a 7-point scale (1, strongly disagree, to 7, strongly agree). All scores were expressed as AGREE II calculated percentages (100% indicates that all items scored 7 by all appraisers). RESULTS Eleven LMPGs were identified. All of the LMPGs provided some information seen as applicable to clinical practice by the appraisers. Only 5 of the LMPGs had overall scores ≥50%, with a median score of 42% (range: 8%–92%). Individual domain scores varied considerably from 0% to 100%. One guideline achieved a very high score on the instrument. CONCLUSIONS The AGREE II instrument is applicable and useful to evaluate LMPGs. All domains were evaluated as being useful to assess LMPGs, some were addressed well (e.g., clarity of presentation), whereas others could be improved (e.g., applicability).

scholarly journals Korean Clinical Practice Guideline for the Diagnosis and Treatment of Insomnia in Adults

2020 ◽  
Vol 17 (11) ◽  
pp. 1048-1059
Author(s):  
Hayun Choi ◽  
Soyoung Youn ◽  
Yoo Hyun Um ◽  
Tae Won Kim ◽  
Gawon Ju ◽  
...  
Keyword(s):  
Clinical Guidelines ◽  
Guideline Development ◽  
Diagnosis And Treatment ◽  
Evidence Based ◽  
Agree Ii ◽  
Medical Guideline ◽  
Sentence Form ◽  
Evidence Based Treatments ◽  
Made In

Objective We aim to present a clinical guideline for the diagnosis and treatment of insomnia in adults by reviewing and integrating existing clinical guidelines. The purpose of this guideline is to assist clinicians who perform evidence-based insomnia treatment.Methods We selected literature that may be appropriate for use in guideline development from evidence-based practice guidelines that have been issued by an academic or governmental institution within the last five years. The core question of this guideline was made in sentence form including Patient/Problem, Intervention, Comparison, Outcome (PICO) elements. After searching PubMed, EMBASE, and medical guideline issuing agencies, three guidelines were judged to be the most appropriately reviewed, up-to-date, and from trusted sources.Results The Appraisal of Guidelines for Research and Evaluation (AGREE) II tool was used to evaluate the quality of the three clinical guidelines. The final outcome of the guideline development process is a total of 15 recommendations that report the strength of the recommendation, the quality of evidence, a summary of content, and considerations in applying the recommendation.Conclusion It is vital for clinical guidelines for insomnia to be developed and continually updated in order to provide more accurate evidence-based treatments to patients.

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