scholarly journals Discordant and inappropriate discordant recommendations in consensus and evidence based guidelines: empirical analysis

BMJ ◽  
2021 ◽  
pp. e066045 ◽  
Author(s):  
Liang Yao ◽  
Muhammad Muneeb Ahmed ◽  
Gordon H Guyatt ◽  
Peijing Yan ◽  
Xu Hui ◽  
...  
Keyword(s):  
Empirical Analysis ◽  
Data Extraction ◽  
Evaluation Criteria ◽  
Heart Association ◽  
Evidence Based ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
Evidence Based Guidelines ◽  
Quality Evidence

Abstract Objective To investigate whether alignment of strength of recommendations with quality of evidence differs in consensus based versus evidence based guidelines. Design Empirical analysis. Data source Guidelines developed by the American College of Cardiology and the American Heart Association (ACC/AHA) and the American Society of Clinical Oncology (ASCO) up to 27 March 2021. Study selection Recommendations were clearly categorised as consensus or evidence based, were separated from the remainder of the text, and included both the quality of evidence and the strength of the recommendations. Data extraction Paired authors independently extracted the recommendation characteristics, including type of recommendation (consensus or evidence based), grading system used for developing recommendations, strength of the recommendation, and quality of evidence. The study team also calculated the number of discordant recommendations (strong recommendations with low quality evidence) and inappropriate discordant recommendations (those that did not meet grading of recommendations assessment, development, and evaluation criteria of appropriateness). Results The study included 12 ACC/AHA guidelines that generated 1434 recommendations and 69 ASCO guidelines that generated 1094 recommendations. Of the 504 ACC/AHA recommendations based on low quality evidence, 200 (40%) proved to be consensus based versus 304 (60%) evidence based; of the 404 ASCO recommendations based on low quality evidence, 292 (72%) were consensus based versus 112 (28%) that were evidence based. In both ACC/AHA and ASCO guidelines, the consensus approach yielded more discordant recommendations (ACC/AHA: odds ratio 2.1, 95% confidence interval 1.5 to 3.1; ASCO: 2.9, 1.1 to 7.8) and inappropriate discordant recommendations (ACC/AHA: 2.6, 1.7 to 3.7; ASCO: 5.1, 1.6 to 16.0) than the evidence based approach. Conclusion Consensus based guidelines produce more recommendations violating the evidence based medicine principles than evidence based guidelines. Ensuring appropriate alignment of quality of evidence with the strength of recommendations is key to the development of “trustworthy” guidelines.

scholarly journals The Use of Evidence-Based Acupuncture: Current Evidence

2022 ◽  
Author(s):  
Dedi Ardinata
Keyword(s):  
Clinical Evidence ◽  
Scientific Evidence ◽  
Current Evidence ◽  
Systematic Research ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
Evidence Quality

Evidence-based medicine (EBM), which emphasizes that medical decisions must be based on the most recent best evidence, is gaining popularity. Individual clinical expertise is combined with the best available external clinical evidence derived from systematic research in the practice of EBM. The key and core of EBM is the hierarchical system for categorizing evidence. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system divides evidence quality into four categories: high, moderate, low, and very low. GRADE is based on the lowest quality of evidence for any of the outcomes that are critical to making a decision, reducing the risk of mislabeling the overall evidence quality, when evidence for a critical outcome is lacking. This principle is also used in acupuncture as a complementary and integrative treatment modality, but incorporating scientific evidence is more difficult due to a number of factors. The goal of this chapter is to discuss how to establish a clinical evidence system for acupuncture, with a focus on the current quality of evidence for a variety of conditions or diseases.

Quality of evidence‐based guidelines for platelet transfusion and use: A systematic review

Transfusion ◽  
2021 ◽  
Author(s):  
Arwa Z. Al‐Riyami ◽  
Rachel Jug ◽  
Ursula La Rocca ◽  
Homa Keshavarz ◽  
Denise Landry ◽  
...  
Keyword(s):  
Systematic Review ◽  
Platelet Transfusion ◽  
Evidence Based ◽  
Quality Of Evidence ◽  
Evidence Based Guidelines

scholarly journals Expanding the Grading of Recommendations Assessment, Development, and Evaluation (Ex-GRADE) for Evidence-Based Clinical Recommendations: Validation Study

2012 ◽  
Vol 6 (1) ◽  
pp. 31-40 ◽  
Author(s):  
Linda Phi ◽  
Reem Ajaj ◽  
Manisha H Ramchandani ◽  
Xenia MC Brant ◽  
Oluwadayo Oluwadara ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Design Methodology ◽  
Qualitative Assessment ◽  
Evidence Based ◽  
Study Quality ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
New Instrument ◽  
Quality Of Research

Clinicians use general practice guidelines as a source of support for their intervention, but how much confidence should they place on these recommendations? How much confidence should patients place on these recommendations? Various instruments are available to assess the quality of evidence of research, such as the revised Wong scale (R-Wong) which examines the quality of research design, methodology and data analysis, and the revision of the assessment of multiple systematic reviews (R-AMSTAR), which examines the quality of systematic reviews.The Grading of Recommendation Assessment, Development, and Evaluation (GRADE) Working Group developed an instrument called the GRADE system in order to grade the quality of the evidence in studies and to evaluate the strength of recommendation of the intervention that is proposed in the published article. The GRADE looks at four factors to determine the quality of the evidence: study design, study quality, consistency, and directness. After combining the four components and assessing the grade of the evidence, the strength of recommendation of the intervention is established. The GRADE, however, only makes a qualitative assessment of the evidence and does not generate quantifiable data.In this study, we have quantified both the grading of the quality of evidence and also the strength of recommendation of the original GRADE, hence expanding the GRADE. This expansion of the GRADE (Ex-GRADE) permits the creation of a new instrument that can produce tangible data and possibly bridge the gap between evidence-based research and evidence-based clinical practice.

Quality of Evidence-Based Guidelines for Transfusion of Red Blood Cells and Plasma: A Systematic Review

2018 ◽  
Vol 32 (3) ◽  
pp. 135-143 ◽  
Author(s):  
Katerina Pavenski ◽  
Simon Stanworth ◽  
Mark Fung ◽  
Erica M. Wood ◽  
Joanne Pink ◽  
...  
Keyword(s):  
Systematic Review ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Evidence Based ◽  
Quality Of Evidence ◽  
Evidence Based Guidelines

scholarly journals Pompe Disease: Diagnosis and Management. Evidence-Based Guidelines from a Canadian Expert Panel

2016 ◽  
Vol 43 (4) ◽  
pp. 472-485 ◽  
Author(s):  
Mark Tarnopolsky ◽  
Hans Katzberg ◽  
Basil J. Petrof ◽  
Sandra Sirrs ◽  
Harvey B. Sarnat ◽  
...  
Keyword(s):  
Pompe Disease ◽  
Treatment Decisions ◽  
Disease Diagnosis ◽  
Evidence Based ◽  
Clinical Practices ◽  
Quality Of Evidence ◽  
Diagnosis And Management ◽  
Number Of Patients ◽  
Evidence Based Guidelines

AbstractPompe disease is a lysosomal storage disorder caused by a deficiency of the enzyme acid alpha-glucosidase. Patients have skeletal muscle and respiratory weakness with or without cardiomyopathy. The objective of our review was to systematically evaluate the quality of evidence from the literature to formulate evidence-based guidelines for the diagnosis and management of patients with Pompe disease. The literature review was conducted using published literature, clinical trials, cohort studies and systematic reviews. Cardinal treatment decisions produced seven management guidelines and were assigned a GRADE classification based on the quality of evidence in the published literature. In addition, six recommendations were made based on best clinical practices but with insufficient data to form a guideline. Studying outcomes in rare diseases is challenging due to the small number of patients, but this is in particular the reason why we believe that informed treatment decisions need to consider the quality of the evidence.

Coaching Teachers to Enhance the Implementation Quality of Evidence-Based Programs

2013 ◽  
Author(s):  
Kimberly D. Becker ◽  
Dana Darney ◽  
Celene Domitrovich ◽  
Catherine Bradshaw ◽  
Nicholas S. Ialongo
Keyword(s):  
Evidence Based ◽  
Implementation Quality ◽  
Quality Of Evidence ◽  
Evidence Based Programs

scholarly journals Acupuncture for post-stroke depression: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ran Liu ◽  
Kun Zhang ◽  
Qiu-yu Tong ◽  
Guang-wei Cui ◽  
Wen Ma ◽  
...  
Keyword(s):  
Adverse Events ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Quality Of Evidence ◽  
Post Stroke ◽  
Assessment Development ◽  
Significant Difference ◽  
Post Stroke Depression ◽  
Meta Analyses

Abstract Background Acupuncture for post-stroke depression (PSD) has been evolving, but uncertainty remains. To assess the existing evidence from randomized clinical trials (RCTs) of acupuncture for PSD, we sought to draw conclusions by synthesizing RCTs. Methods An exhaustive literature search was conducted in seven electronic databases from their inception dates to April 19, 2020, to identify systematic reviews (SRs) and meta-analyses (MAs) on this topic. The primary RCTs included in the SRs/MAs were identified. We also conducted a supplementary search for RCTs published from January 1, 2015, to May 12, 2020. Two reviewers extracted data separately and pooled data using RevMan 5.3 software. The quality of evidence was critically appraised with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system. Results A total of 17 RCTs involving 1402 patients were included. Meta-analysis showed that participants who received a combination of acupuncture and conventional treatments exhibited significantly lower scores on the HAM-D17, HAM-D24 and HAM-D (MD, − 5.08 [95% CI, − 6.48 to − 3.67], I2 = 0%), (MD, − 9.72 [95% CI, − 14.54 to − 4.91], I2 = 65%) and (MD, − 2.72 [95% CI, − 3.61 to − 1.82], respectively) than those who received conventional treatment. However, there was no significant difference in acupuncture versus antidepressants in terms of the 17-item, 24-item and HAM-D scales (MD, − 0.43 [95% CI, − 1.61 to 0.75], I2 = 51%), (MD, − 3.09 [95% CI, − 10.81 to 4.63], I2 = 90%) and (MD, − 1.55 [95% CI, − 4.36 to 1.26], I2 = 95%, respectively). For adverse events, acupuncture was associated with fewer adverse events than antidepressants (RR, 0.16 [95% CI, 0.07 to 0.39], I2 = 35%), but there was no significant difference in the occurrence of adverse events between the combination of acupuncture and conventional treatments versus conventional treatments (RR, 0.63 [95% CI, 0.21 to 1.83], I2 = 38%). The quality of evidence was low to very low due to the substantial heterogeneity among the included studies. Conclusions The current review indicates that acupuncture has greater effect on PSD and better safety profile than antidepressants, but high-quality evidence evaluating acupuncture for PSD is still needed.

Private Rooms in Low Acuity Settings: A Systematic Review of the Literature

2017 ◽  
Vol 11 (1) ◽  
pp. 57-74 ◽  
Author(s):  
Jeffrey Voigt ◽  
Michael Mosier ◽  
Rabih Darouiche
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Quality Data ◽  
Review Of The Literature ◽  
Single Patient ◽  
Patient Falls ◽  
Assessment Development ◽  
High Acuity ◽  
Data Extraction Form ◽  
Quality Evidence

Objectives: Determine if the peer-reviewed evidence supports single-patient ward bedrooms in low-acuity care settings within a hospital. Background: New evidence exists since the 2006 Facility Guideline Institute guideline recommended single-bedded rooms (SBRs) in low-acuity care settings. Additionally, prior studies evaluated high-acuity care settings (e.g., critical care) in their recommendations on SBRs. There is a need to reevaluate the evidence. Methods: A systematic review of the literature was completed including electronic and hand searches of references. A data extraction form was utilized. Two reviewers evaluated the studies independently. Studies that were included examined the effect of single-patient rooms on medical surgical ward beds only. Each study was graded using accepted clinical evidence grading instruments. Results: Over 1,400 records were identified. After excluding studies, a total of 49 records were graded. The highest quality evidence identified (Center for Evidence-Based Medicine [CEBM]: 2a, 2b, and Grading of Recommendations, Assessment, Development, and Evaluation [GRADE] C) did not support the use of single-patient rooms for reducing infections, for minimizing patient falls, for reducing medication errors, or for patient satisfaction. Operational efficiencies were improved with SBRs but only addressed the maternity ward. The lowest quality evidence (CEBM: 4/5 and GRADE D) supported the use of single-patient rooms. Conclusions: Based on CEBM and GRADE assessments, there is a lack of high-quality data supporting the use of low-acuity SBRs throughout the entire hospital. Furthermore, it is recommended that more research be conducted on the effect of SBRs, so higher quality evidence is developed.

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