Authorship in reports of clinical practice guidelines: A systematic cross-sectional analysis

2018 ◽  
Vol 72 (7) ◽  
pp. e13083 ◽  
Author(s):  
Mohamed Nomier ◽  
Assem M. Khamis ◽  
Ahmed Ali ◽  
Karim N. Daou ◽  
Aline T. Semaan ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Sectional Analysis

Reliability and Concurrent Validity of Shoulder Tissue Irritability Classification

2021 ◽  
Author(s):  
Stephen M Kareha ◽  
Philip W McClure ◽  
Alicia Fernandez-Fernandez
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Repeated Measures ◽  
Concurrent Validity ◽  
Reliability And Validity ◽  
Strong Relationship ◽  
Rating System ◽  
Roc Curve Analysis ◽  
Cross Sectional

Abstract Objective Rating tissue irritability has been recommended to aid decision making in several recent clinical practice guidelines. An explicit method for rating tissue irritability was proposed as part of the Staged Algorithm for Rehabilitation Classification: Shoulder Disorders (STAR-Shoulder), but the reliability and validity of this classification are unknown. The purpose of this study was to examine the reliability and concurrent validity of shoulder tissue irritability ratings as part of a system designed to guide appropriate treatment strategy and intensity. Methods A clinical measurement, prospective repeated-measures cross-sectional design was used. The 101 consecutive participants with primary complaints of shoulder pain were assessed by pairs of blinded raters (24 raters in total) and rated for tissue irritability. Patients completed 3 patient-rated outcome (PRO) measures reflecting both pain and disability, and these scores were compared with ratings of tissue irritability. Paired ratings of irritability were analyzed for reliability with prevalence-adjusted, bias-adjusted Kappa for ordinal scales (PABAK-OS). Analysis of variance (ANOVA) was used to compare PRO measures across different levels of irritability. Receiver operating characteristic (ROC) curve analysis was utilized to derive cut-off scores for 3 PRO instruments. Results Interrater reliability was 0.69 (95% CI = 0.59–0.78), with 67% agreement. All PRO measures were significantly different among 3 levels of tissue irritability. Conclusion There appear to be acceptable reliability and a strong relationship between PRO measures and therapist-rated tissue irritability, supporting the use of the STAR-Shoulder irritability rating system. Impact Several clinical practice guidelines have recommended that clinicians rate tissue irritability as part of their examination. This study provides important new information supporting the reliability and validity of the STAR-Shoulder tissue irritability rating system.

Antimicrobial Use Control Measures to Prevent and Control Antimicrobial Resistance in US Hospitals

2006 ◽  
Vol 27 (10) ◽  
pp. 1088-1095 ◽  
Author(s):  
Alan J. Zillich ◽  
Jason M. Sutherland ◽  
Stephen J. Wilson ◽  
Daniel J. Diekema ◽  
Erika J. Ernst ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Antimicrobial Resistance ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Veterans Affairs ◽  
Control Measures ◽  
Antimicrobial Use ◽  
Cross Sectional ◽  
Term Care ◽  
Recommended Practices

Objective.Clinical practice guidelines and recommended practices to control use of antibiotics have been published, but the effect of these practices on antimicrobial resistance (AMR) rates in hospitals is unknown. The objective of this study was to examine relationships between antimicrobial use control strategies and AMR rates in a national sample of US hospitals.Design.Cross-sectional, stratified study of a nationally representative sample of US hospitals.Methods.A survey instrument was sent to the person responsible for infection control at a sample of 670 US hospitals. The outcome was current prevalences of 4 epidemiologically important, drug-resistant pathogens, considered concurrently: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, ceftazidime-resistant Klebsiella species, and quinolone (ciprofloxacin)-resistant Escherichia coli Five independent variables regarding hospital practices were selected from the survey: the extent to which hospitals (1) implement practices recommended in clinical practice guidelines and ensure best practices for antimicrobial use, (2) disseminate information on clinical practice guidelines for antimicrobial use, (3) use antimicrobial-related information technology, (4) use decision support tools, and (5) communicate to prescribers about antimicrobial use. Control variables included the hospitals' number of beds, teaching status, Veterans Affairs status, geographic region, and number of long-term care beds; and the presence of an intensive care unit, a burn unit, or transplant services. A generalized estimating equation modeled all resistance rates simultaneously to identify overall predictors of AMR levels at the facility.Results.Completed survey instruments were returned by 448 hospitals (67%). Four antimicrobial control measures were associated with higher prevalence of AMR. Implementation of recommended practices for antimicrobial use (P< .01) and optimization of the duration of empirical antibiotic prophylaxis (P<.01) were associated with a lower prevalence of AMR. Use of restrictive formularies (P = .05) and dissemination of clinical practice guideline information (P<.01) were associated with higher prevalence of AMR. Number of beds and Veterans Affairs status were also associated with higher AMR rates overall.Conclusions.Implementation of guideline-recommended practices to control antimicrobial use and optimize the duration of empirical therapy appears to help control AMR rates in US hospitals. A longitudinal study would confirm the results of this cross-sectional study. These results highlight the need for systems interventions and reengineering to ensure more-consistent application of guideline-recommended measures for antimicrobial use.

scholarly journals Early Mobilization After Stroke: Do Clinical Practice Guidelines Support Clinicians' Decision-Making?

2021 ◽  
Vol 12 ◽  
Author(s):  
Venesha Rethnam ◽  
Kathryn S. Hayward ◽  
Julie Bernhardt ◽  
Leonid Churilov
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Early Mobilization ◽  
Cross Sectional Study ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Delivery Of Care ◽  
Individual Patient Level

Importance: Early mobilization, out-of-bed activity, is a component of acute stroke unit care; however, stroke patient heterogeneity requires complex decision-making. Clinically credible and applicable CPGs are needed to support and optimize the delivery of care. In this study, we are specifically exploring the role of clinical practice guidelines to support individual patient-level decision-making by stroke clinicians about early mobilization post-stroke.Methods: Our study uses a novel, two-pronged approach. (1) A review of CPGs containing recommendations for early mobilization practices published after 2015 was appraised using purposely selected items from the Appraisal of Guidelines Research and Evaluation–Recommendations Excellence (AGREE-REX) tool relevant to decision-making for clinicians. (2) A cross-sectional study involving semi-structured interviews with Australian expert stroke clinicians representing content experts and CPG target users. Every CPG was independently assessed against the AGREE-REX standard by two reviewers. Expert stroke clinicians, invited via email, were recruited between June 2019 to March 2020.The main outcomes from the review was the proportion of criteria addressed for each AGREE-REX item by individual and all CPG(s). The main cross-sectional outcomes were the distributions of stroke clinicians' responses about the utility of CPGs, specific areas of uncertainty in early mobilization decision-making, and suggested parameters for inclusion in future early mobilization CPGs.Results: In 18 identified CPGs, many did not adequately address the “Evidence” and “Applicability to Patients” AGREE-REX items. Out of 30 expert stroke clinicians (11 physicians [37%], 11 physiotherapists [37%], 8 nurses [26%]; median [IQR] years of experience, 14 [10–25]), 47% found current CPGs “too broad or vague,” while 40% rely on individual clinical judgement and interpretation of the evidence to select an evidence-based choice of action. The areas of uncertainty in decision-making revealed four key suggestions: (1) more granular descriptions of patient and stroke characteristics for appropriate tailoring of decisions, (2) clear statements about when clinical flexibility is appropriate, (3) detailed description of the intervention dose, and (4) physical assessment criteria including safety parameters.Conclusions: The lack of specificity, clinical applicability, and adaptability of current CPGs to effectively respond to the heterogeneous clinical stroke context has provided a clear direction for improvement.

scholarly journals Assessment of the Quality of Recommendations from 161 Clinical Practice Guidelines Using the Appraisal of Guidelines for Research and Evaluation – Recommendations Excellence (AGREE-REX) Instrument Shows There Is Room for Improvement

2020 ◽  
Author(s):  
Ivan D Florez ◽  
Melissa C Brouwers ◽  
Kate Kerkvliet ◽  
Karen Spithoff ◽  
Pablo Alonso-Coello ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Relevance ◽  
Cross Sectional Study ◽  
Average Score ◽  
Response Scale ◽  
Agree Ii ◽  
Cross Sectional

Abstract Background: A new tool, the AGREE-REX, was recently developed to support the development, reporting, and assessment of clinical practice guidelines’ (CPGs) recommendations, and to complement the AGREE II tool. We assessed the credibility and implementability of 161 CPGs recommendations using the AGREE-REX draft tool. Methods: Cross sectional study. CPGs were assessed by two independent appraisers using the AGREE-REX draft tool. The CPGs were rated with the tool’s 7-point response scale for each item. Differences between CPGs according to country, year and type of organization (government-supported/professional society) were evaluated. One-way ANOVA tests were used to examine differences in the score. Results: Recommendations from 161 CPGs from 70 organizations were appraised by 322 participants from 51 countries, using the AGREE-REX draft tool. The total overall average score of the recommendations was 4.23 (standard deviation(SD)=1.14). AGREE-REX items that scored the highest were (mean; SD): Evidence (5.51; SD=1.14), Clinical relevance (5.95; SD=0.8), and Patients/population relevance (4.87; SD=1.33), while the lowest scores were observed for the Policy values (3.44; SD=1.53), Local applicability (3,56; SD=1.47) and Resources, tools and capacity (3.49; SD=1.44) items. CPGs developed by government-supported organizations and developed in the UK and Canada had significantly higher recommendation quality scores with the AGREE-REX tool (p=0.01) than their comparators.Conclusions: We found that there is significant room for improvement of some CPGs such as the considerations of patient/population values, policy values, local applicability and resources, tools and capacity. These findings may be considered a baseline upon which to measure future improvements in the quality of CPGs.Contribution to the literature· We applied the AGREE II and the recently developed tool (AGREE-REX draft version), to assess quality, credibility and implementability of 161 international clinical practice guidelines (CPGs). The AGREE REX draft tool was applied by 322 guidelines’ developers, users and researchers from 51 countries.· The scores of the AGREE REX draft tool items were higher in those items related to the quality of the evidence and the clinical relevance. The items related to patients and population relevance and implementation relevance scored in the mid-range, while the items related to patients/population or policy values, the alignment of values, the local applicability, and the resouces, tools and capacity items scored low.· CPGs produced by government-supported organizations scored higher on all the items of the AGREE-REX draft tool than those produced by professional societies or other types of groups, and CPGs produced in United Kingdom and Canada scored higher in selected items in comparison to United States and international CPGs· The correlations between the overall AGREE-REX draft tool and AGREE II domains were low, except for the Applicability domain where the correlation was modest.

scholarly journals Assessment of the quality of recommendations from 161 clinical practice guidelines using the Appraisal of Guidelines for Research and Evaluation–Recommendations Excellence (AGREE-REX) instrument shows there is room for improvement

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Ivan D. Florez ◽  
Melissa C. Brouwers ◽  
Kate Kerkvliet ◽  
Karen Spithoff ◽  
Pablo Alonso-Coello ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Cross Sectional Study ◽  
Average Score ◽  
Sectional Study ◽  
Point Scale ◽  
Cross Sectional ◽  
The Uk

Abstract Objective To assess the quality of recommendations from 161 clinical practice guidelines (CPGs) using AGREE-REX-D (Appraisal of Guidelines REsearch and Evaluation-Recommendations Excellence Draft). Design Cross-sectional study Setting International CPG community. Participants Three hundred twenty-two international CPG developers, users, and researchers. Intervention Participants were assigned to appraise one of 161 CPGs selected for the study using the AGREE-REX-D tool Main outcome measures AGREE-REX-D scores of 161 CPGs (7-point scale, maximum 7). Results Recommendations from 161 CPGs were appraised by 322 participants using the AGREE-REX-D. CPGs were developed by 67 different organizations. The total overall average score of the CPG recommendations was 4.23 (standard deviation (SD) = 1.14). AGREE-REX-D items that scored the highest were (mean; SD): evidence (5.51; 1.14), clinical relevance (5.95; SD 0.8), and patients/population relevance (4.87; SD 1.33), while the lowest scores were observed for the policy values (3.44; SD 1.53), local applicability (3,56; SD 1.47), and resources, tools, and capacity (3.49; SD 1.44) items. CPGs developed by government-supported organizations and developed in the UK and Canada had significantly higher recommendation quality scores with the AGREE-REX-D tool (p < 0.05) than their comparators. Conclusions We found that there is significant room for improvement of some CPGs such as the considerations of patient/population values, policy values, local applicability and resources, tools, and capacity. These findings may be considered a baseline upon which to measure future improvements in the quality of CPGs.

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