Appraising the quality standard underpinning international clinical practice guidelines for the selection and care of vascular access devices: a systematic review of reviews

ObjectiveCatheter-related bloodstream infections are one of the most important adverse events for patients. Evidence-based practice embraces interventions to prevent and reduce catheter-related bloodstream infections in patients. At present, a growing number of guidelines exist worldwide. The purpose of the study was to assess clinical practice guidelines for peripheral and central venous access device care and prevention of related complications.DesignSystematic review of clinical practice guidelines: We conducted a search of the literature published from 2005 to 2018 using Medline/PubMed, Embase, CINAHL, Ovid, ScienceDirect, Scopus and Web of Science. We also evaluated grey literature sources and websites of organisations that compiled or produced guidelines. Guideline quality was assessed with the Appraisal of Guidelines for Research and Evaluation, Second Edition tool by three independent reviewers. Cohen’s kappa coefficient was used to evaluate the concordance between reviewers.ResultsWe included seven guidelines in the evaluation. The concordance between observers was substantial, K=0.6364 (95% CI 0.0247 to 1.2259). We identified seven international guidelines, which scored poorly on crucial domains such as applicability (medium 39%), stakeholder involvement (medium 65%) and methodological rigour (medium 67%). Guidelines by Spanish Health Ministry and UK National Institute for Health and Care Excellence presented the highest quality.ConclusionsIt is crucial to critically evaluate the validity and reliability of clinical practice guidelines so the best, most context-specific document is selected. Such choice is a necessary prior step to encourage and support health organisations to transfer research results to clinical practice. The gaps identified in our study may explain the suboptimal clinical impact of guidelines. Such low adoption may be mitigated with the use of implementation guides accompanying clinical documents.

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Are Clinical Practice Guidelines for Low Back Pain interventions of high quality and updated? A systematic review using the AGREE II instrument

10.21203/rs.3.rs-42082/v2 ◽

2020 ◽

Author(s):

Greta Castellini ◽

Valerio Iannicelli ◽

Matteo Briguglio ◽

Davide Corbetta ◽

Luca Maria Sconfienza ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Grey Literature ◽

Pharmacological Intervention ◽

Low Back ◽

Agree Ii

Abstract BACKGROUND: Clinical practice guidelines (CPGs) provide recommendations for practice, but the proliferation of CPGs issued by multiple organisations in recent years has raised concern about their quality. The aim of this study was to systematically appraise CPGs quality for low back pain (LBP) interventions and to explore inter-rater reliability (IRR) between quality appraisers. The time between systematic review search and publication of CPGs was recorded.METHODS: Electronic databases (PubMed, Embase, PEDro, TRIP), guideline organisation databases, websites, and grey literature were searched from January 2016 to January 2020 to identify GPCs on rehabilitative, pharmacological or surgical intervention for LBP management. Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to evaluate CPGs quality and record the year the CPGs were published and the year the search strategies were conducted. RESULTS: A total of 21 CPGs met the inclusion criteria and were appraised. Seven (33%) were broad in scope and involved surgery, rehabilitation or pharmacological intervention. The score for each AGREE II item was: Editorial Independence (median 67%, interquartile range [IQR] 31 – 84%), Scope and Purpose (median 64%, IQR 22 – 83%), Rigour of Development (median 50%, IQR 21 – 72%), Clarity and Presentation (median 50%, IQR 28 – 79%), Stakeholder Involvement (median 36%, IQR 10 – 74%), and Applicability (median 11%, IQR 0 – 46%). The IRR between the assessors was nearly perfect (interclass correlation 0.90; 95% confidence interval 0.88 – 0.91). The median time span was 2 years (range, 1-4), however, 38% of the CPGs did not report the coverage dates for systematic searches.CONCLUSIONS: We found methodological limitations that affect CPGs quality. A universal database is needed in which guidelines can be registered and recommendations dynamically developed through a living systematic reviews approach to ensure that guidelines are based on updated evidence. LEVEL OF EVIDENCE: 1REGISTRATION PROSPERO DETAILS: CRD42019127619.

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Ethical challenges in palliative sedation of adults: protocol for a systematic review of current clinical practice guidelines

10.21203/rs.3.rs-1170023/v1 ◽

2021 ◽

Author(s):

Martyna TOMCZYK ◽

Cécile JAQUES ◽

Ralf J. JOX

Keyword(s):

Systematic Review ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Positive Impact ◽

Grey Literature ◽

Palliative Sedation ◽

Current Clinical Practice ◽

Ethical Challenges

Abstract Introduction: This study aims to identify the full spectrum of ethical challenges of all forms of palliative sedation for adults as presented in current clinical practice guidelines (CPGs), and to determine whether CPGs specify ethical challenges of this therapy for cancer and non-cancer patients and, if so, how exactly they do this. To the best of our knowledge, no studies have yet investigated this topic. The purpose is purely descriptive; our aim is not to make any kind of normative judgements on these challenges. Nor is our aim to assess the quality of the CPGs. Methods and analysis : We will perform a systematic review of CPGs on palliative sedation for adults via five electronic databases, grey literature search tools, citation tracking, and contact with palliative care experts. Current CPGs validated by an international, national, or regional authority, published in English, German, French, Italian, or Polish, from 2000 to the date of the search, will be subjected to content analysis at the textual, linguistic, and thematic levels. This study protocol is reported in accordance with the PRISMA-P criteria and registered on PROSPERO. Discussion The results of our systematic review can help raise awareness and understanding of the complexity of ethical problems, rigorously guide reflection in this field, and be useful in elaborating ethical guidelines in an interdisciplinary approach, in order to have a positive impact on the quality of patient care, education and training, and research in respect of this complex and challenging practice.

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Over half of clinical practice guidelines use non-systematic methods to inform recommendations: A methods study

PLoS ONE ◽

10.1371/journal.pone.0250356 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0250356

Author(s):

Carole Lunny ◽

Cynthia Ramasubbu ◽

Lorri Puil ◽

Tracy Liu ◽

Savannah Gerrish ◽

...

Keyword(s):

Systematic Review ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Assessment Tool ◽

Evidence Synthesis ◽

Validity And Reliability ◽

Eligibility Criteria ◽

Comprehensive Search

Introduction Assessing the process used to synthesize the evidence in clinical practice guidelines enables users to determine the trustworthiness of the recommendations. Clinicians are increasingly dependent on guidelines to keep up with vast quantities of medical literature, and guidelines are followed to avoid malpractice suits. We aimed to assess whether systematic methods were used when synthesizing the evidence for guidelines; and to determine the type of review cited in support of recommendations. Methods Guidelines published in 2017 and 2018 were retrieved from the TRIP and Epistemonikos databases. We randomly sorted and sequentially screened clinical guidelines on all topics to select the first 50 that met our inclusion criteria. Our primary outcomes were the number of guidelines using either a systematic or non-systematic process to gather, assess, and synthesise evidence; and the numbers of recommendations within guidelines based on different types of evidence synthesis (systematic or non-systematic reviews). If a review was cited, we looked for evidence that it was critically appraised, and recorded which quality assessment tool was used. Finally, we examined the relation between the use of the GRADE approach, systematic review process, and type of funder. Results Of the 50 guidelines, 17 (34%) systematically synthesised the evidence to inform recommendations. These 17 guidelines clearly reported their objectives and eligibility criteria, conducted comprehensive search strategies, and assessed the quality of the studies. Of the 29/50 guidelines that included reviews, 6 (21%) assessed the risk of bias of the review. The quality of primary studies was reported in 30/50 (60%) guidelines. Conclusions High quality, systematic review products provide the best available evidence to inform guideline recommendations. Using non-systematic methods compromises the validity and reliability of the evidence used to inform guideline recommendations, leading to potentially misleading and untrustworthy results.

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Are Clinical Practice Guidelines of Low Back Pain interventions of high quality and updated? A systematic review using the AGREE II instrument

10.21203/rs.3.rs-42082/v3 ◽

2020 ◽

Author(s):

Greta Castellini ◽

Valerio Iannicelli ◽

Matteo Briguglio ◽

Davide Corbetta ◽

Luca Maria Sconfienza ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Grey Literature ◽

Pharmacological Intervention ◽

Low Back ◽

Agree Ii

Abstract BACKGROUND: Clinical practice guidelines (CPGs) provide recommendations for practice, but the proliferation of CPGs issued by multiple organisations in recent years has raised concern about their quality. The aim of this study was to systematically appraise CPGs quality for low back pain (LBP) interventions and to explore inter-rater reliability (IRR) between quality appraisers. The time between systematic review search and publication of CPGs was recorded. METHODS: Electronic databases (PubMed, Embase, PEDro, TRIP), guideline organisation databases, websites, and grey literature were searched from January 2016 to January 2020 to identify GPCs on rehabilitative, pharmacological or surgical intervention for LBP management. Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to evaluate CPGs quality and record the year the CPGs were published and the year the search strategies were conducted. RESULTS: A total of 21 CPGs met the inclusion criteria and were appraised. Seven (33%) were broad in scope and involved surgery, rehabilitation or pharmacological intervention. The score for each AGREE II item was: Editorial Independence (median 67%, interquartile range [IQR] 31 – 84%), Scope and Purpose (median 64%, IQR 22 – 83%), Rigour of Development (median 50%, IQR 21 – 72%), Clarity and Presentation (median 50%, IQR 28 – 79%), Stakeholder Involvement (median 36%, IQR 10 – 74%), and Applicability (median 11%, IQR 0 – 46%). The IRR between the assessors was nearly perfect (interclass correlation 0.90; 95% confidence interval 0.88 – 0.91). The median time span was 2 years (range, 1-4), however, 38% of the CPGs did not report the coverage dates for systematic searches. CONCLUSIONS: We found methodological limitations that affect CPGs quality. In our opinion, a universal database is needed in which guidelines can be registered and recommendations dynamically developed through a living systematic reviews approach to ensure that guidelines are based on updated evidence. LEVEL OF EVIDENCE: 1 REGISTRATION PROSPERO DETAILS: CRD42019127619.

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Are clinical practice guidelines for low back pain interventions of high quality and updated? A systematic review using the AGREE II instrument

BMC Health Services Research ◽

10.1186/s12913-020-05827-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

G. Castellini ◽

V. Iannicelli ◽

M. Briguglio ◽

D. Corbetta ◽

L. M. Sconfienza ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Grey Literature ◽

Pharmacological Intervention ◽

Low Back ◽

Agree Ii

Abstract Background Clinical practice guidelines (CPGs) provide recommendations for practice, but the proliferation of CPGs issued by multiple organisations in recent years has raised concern about their quality. The aim of this study was to systematically appraise CPGs quality for low back pain (LBP) interventions and to explore inter-rater reliability (IRR) between quality appraisers. The time between systematic review search and publication of CPGs was recorded. Methods Electronic databases (PubMed, Embase, PEDro, TRIP), guideline organisation databases, websites, and grey literature were searched from January 2016 to January 2020 to identify GPCs on rehabilitative, pharmacological or surgical intervention for LBP management. Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to evaluate CPGs quality and record the year the CPGs were published and the year the search strategies were conducted. Results A total of 21 CPGs met the inclusion criteria and were appraised. Seven (33%) were broad in scope and involved surgery, rehabilitation or pharmacological intervention. The score for each AGREE II item was: Editorial Independence (median 67%, interquartile range [IQR] 31–84%), Scope and Purpose (median 64%, IQR 22–83%), Rigour of Development (median 50%, IQR 21–72%), Clarity and Presentation (median 50%, IQR 28–79%), Stakeholder Involvement (median 36%, IQR 10–74%), and Applicability (median 11%, IQR 0–46%). The IRR between the assessors was nearly perfect (interclass correlation 0.90; 95% confidence interval 0.88–0.91). The median time span was 2 years (range, 1–4), however, 38% of the CPGs did not report the coverage dates for systematic searches. Conclusions We found methodological limitations that affect CPGs quality. In our opinion, a universal database is needed in which guidelines can be registered and recommendations dynamically developed through a living systematic reviews approach to ensure that guidelines are based on updated evidence. Level of evidence 1 Trial registration REGISTRATION PROSPERO DETAILS: CRD42019127619.

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