Ethnic specific recommendations in clinical practice guidelines: a first exploratory comparison between guidelines from the USA, Canada, the UK, and the Netherlands

IntroductionThe UK Department of Health have targeted a reduction in stillbirth by 50% by 2025; to achieve this, the first version of the Saving Babies’ Lives Care Bundle (SBLCB) was developed by NHS England in 2016 to improve four key areas of antenatal and intrapartum care. Clinical practice guidelines are a key means by which quality improvement initiatives are disseminated to front-line staff.MethodsSeventy-five clinical practice guidelines covering the four areas of antenatal and intrapartum care in the first version of SBLCB were obtained from 19 maternity providers. The content and quality of guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Maternity health professionals in participating organisations were invited to participate in an anonymous survey to determine perceptions toward and experiences of the use of clinical practice guidelines using a series of Likert scales.ResultsUnit guidelines showed considerable variation in quality with median scores of 50%–58%. Only 4 (5.6%) guidelines were recommended for use in clinical practice without modifications, 54 (75.0%) were recommended for use subject to modifications and 12 (16.7%) were not recommended for use. The lowest scoring domains were ‘rigour of development’, ‘stakeholder involvement’ and ‘applicability’. A significant minority of unit guidelines omitted recommendations from national guidelines. The majority of staff believed that clinical practice guidelines standardised and improved the quality of care but over 30% had insufficient time to use them and 24% stated they were unable to implement recommendations.ConclusionTo successfully implement initiatives such as the SBLCB change is needed to local clinical practice guidelines to reduce variation in quality and to ensure they are consistent with national recommendations . In addition, to improve clinical practice, adequate time and resources need to be in place to deliver and evaluate care recommended in the SBLCB.

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Clinical practice guidelines for diagnosis of autism spectrum disorder in adults and children in the UK: a narrative review

BMC Psychiatry ◽

10.1186/s12888-018-1800-1 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 18

Author(s):

Jennie Hayes ◽

Tamsin Ford ◽

Hateem Rafeeque ◽

Ginny Russell

Keyword(s):

Autism Spectrum Disorder ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Autism Spectrum ◽

Narrative Review ◽

Spectrum Disorder ◽

Adults And Children ◽

The Uk

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Validating clinical practice guidelines for the management of children with non-blanching rashes in the UK (PiC): a prospective, multicentre cohort study

The Lancet Infectious Diseases ◽

10.1016/s1473-3099(20)30474-6 ◽

2020 ◽

Author(s):

Thomas Waterfield ◽

Juli-Ann Maney ◽

Derek Fairley ◽

Mark D Lyttle ◽

James P McKenna ◽

...

Keyword(s):

Cohort Study ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Multicentre Cohort Study ◽

The Uk ◽

Multicentre Cohort

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Mind the gap: Mapping Variation between National and Local Clinical Practice Guidelines for Acute Paediatric Asthma from the United Kingdom and the Netherlands

10.1101/2021.09.20.21263735 ◽

2021 ◽

Author(s):

Charlotte Koldeweij ◽

Jonathan Clarke ◽

Carmen Rodriguez Gonzalvez ◽

Joppe Nijman ◽

Ruchi Sinha ◽

...

Keyword(s):

United Kingdom ◽

Clinical Practice ◽

The Netherlands ◽

Severe Asthma ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Clinical Care ◽

Paediatric Asthma ◽

The United Kingdom ◽

National Guidance

Background: Clinical practice guidelines (CPGs) aim to standardize clinical care. Increasingly, hospitals rely on locally produced guidelines alongside national guidance. This study examines variation between national and local CPGs, using the example of acute paediatric asthma guidance from the United Kingdom and the Netherlands. Methods: Fifteen British and Dutch local CPGs were collected with the matching national guidance for the management of acute asthma in children under 18 years old. The drug sequences, routes and methods of administration recommended for patients with severe asthma and the tone of recommendation across both types of CPGs were schematically represented. Deviations from national guidance were measured. Variation in recommended doses of intravenous salbutamol was examined. Results: British and Dutch national CPGs differed in the recommended drug choices, sequences, routes and methods of administration for severe asthma. Dutch national guidance was more rigidly defined. Local British CPGs diverged from national guidance for 23% of their recommended interventions compared to 8% for Dutch local CPGs. Five British local guidelines and two Dutch local guidelines differed from national guidance for multiple treatment steps. Variation in second-line recommendations was greater than for first-line recommendations across local CPGs from both countries. Recommended starting doses for salbutamol infusions varied by more than tenfold. Conclusions: Local CPGs for the management of severe acute paediatric asthma featured substantial variation and frequently diverged from national guidance. Although limited to one condition, this study suggests that unmeasured variation across local CPGs may contribute to variation of care more broadly, with possible effects on healthcare quality.

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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

Implementation Science ◽

10.1186/s13012-020-01036-5 ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 2

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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Professional attitudes in the UK towards neuroleptic maintenance therapy in schizophrenia

Psychiatric Bulletin ◽

10.1192/pb.21.7.394 ◽

1997 ◽

Vol 21 (7) ◽

pp. 394-397 ◽

Cited By ~ 4

Author(s):

D. A. W. Johnson ◽

J. G. C. Rasmussen

Keyword(s):

Clinical Practice ◽

Maintenance Therapy ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Relapse Prevention ◽

Community Care ◽

Controlled Trials ◽

Professional Attitudes ◽

Schizophrenic Patients ◽

The Uk

Controlled trials show that about 80% of schizophrenic patients remain relapse free when given adequate neuroleptic maintenance therapy but this level of efficacy is not achieved in clinical practice. Guidelines for proper use of neuroleptics in relapse prevention were developed by a group of experienced psychiatrists – the ‘Consensus Group’ – in 1989. In this survey, the views of UK psychiatrists, GPs, CPNs and pharmacists involved in community care of schizophrenia were compared with the Guidelines.

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Introducing the UK Ambulance Services Clinical Practice Guidelines 2016

Journal of Paramedic Practice ◽

10.12968/jpar.2016.8.2.68 ◽

2016 ◽

Vol 8 (2) ◽

pp. 68-69

Author(s):

Steve Irving ◽

Mark Millins ◽

Emma Milman

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

The Uk

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Poor overall quality of clinical practice guidelines for musculoskeletal pain: a systematic review

British Journal of Sports Medicine ◽

10.1136/bjsports-2017-098375 ◽

2017 ◽

Vol 52 (5) ◽

pp. 337-343 ◽

Cited By ~ 18

Author(s):

Ivan Lin ◽

Louise K Wiles ◽

Robert Waller ◽

Roger Goucke ◽

Yusuf Nagree ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Critical Appraisal ◽

Low Back ◽

Agree Ii ◽

The Usa

ObjectivesUndertake a systematic critical appraisal of contemporary clinical practice guidelines (CPGs) for common musculoskeletal (MSK) pain conditions: spinal (lumbar, thoracic and cervical), hip/knee (including osteoarthritis) and shoulder.DesignSystematic review of CPGs (PROSPERO number: CRD42016051653).Included CPGs were written in English, developed within the last 5 years, focused on adults and described development processes. Excluded CPGs were for: traumatic MSK pain, single modalities (eg, surgery), traditional healing/medicine, specific disease processes (eg, inflammatory arthropathies) or those that required payment.Data sources and method of appraisalFour scientific databases (MEDLINE, Embase, CINAHL and Physiotherapy Evidence Database) and four guideline repositories. The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was used for critical appraisal.Results4664 records were identified, and 34 CPGs were included. Most were for osteoarthritis (n=12) or low back pain (n=11), most commonly from the USA (n=12). The mean overall AGREE II score was 45% (SD=19.7). Lowest mean domain scores were for applicability (26%, SD=19.5) and editorial independence (33%, SD=27.5). The highest score was for scope and purpose (72%, SD=14.3). Only 8 of 34 CPGS were high quality: for osteoarthritis (n=4), low back pain (n=2), neck (n=1) and shoulder pain (n=1).

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Validating clinical practice guidelines for the management of febrile infants presenting to the emergency department in the UK and Ireland

Archives of Disease in Childhood ◽

10.1136/archdischild-2021-322586 ◽

2021 ◽

pp. archdischild-2021-322586

Author(s):

Thomas Waterfield ◽

Mark D Lyttle ◽

Charlotte Munday ◽

Steven Foster ◽

Marc McNulty ◽

...

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Bacterial Infections ◽

Clinical Decision Making ◽

Clinical Decision ◽

British Society ◽

Predictive Values ◽

The Uk ◽

Tract Infections

ObjectiveTo report the performance of clinical practice guidelines (CPG) in the diagnosis of serious/invasive bacterial infections (SBI/IBI) in infants presenting with a fever to emergency care in the UK and Ireland. Two CPGs were from the National Institutes for Health and Care Excellence (NICE guidelines NG51 and NG143) and one was from the British Society for Antimicrobial Chemotherapy (BSAC).DesignRetrospective multicentre cohort study.PatientsFebrile infants aged 90 days or less attending between the 31 August 2018 to 1 September 2019.Main outcome measuresThe sensitivity, specificity and predictive values of CPGs in identifying SBI and IBI.SettingSix paediatric Emergency Departments in the UK/Ireland.Results555 participants were included in the analysis. The median age was 53 days (IQR 32 to 70), 447 (81%) underwent blood testing and 421 (76%) received parenteral antibiotics. There were five participants with bacterial meningitis (1%), seven with bacteraemia (1%) and 66 (12%) with urinary tract infections. The NICE NG51 CPG was the most sensitive: 1.00 (95% CI 0.95 to 1.00). This was significantly more sensitive than NICE NG143: 0.91 (95% CI 0.82 to 0.96, p=0.0233) and BSAC: 0.82 (95% 0.72 to 0.90, p=0.0005). NICE NG51 was the least specific 0.0 (95% CI 0.0 to 0.01), and this was significantly lower than the NICE NG143: 0.09 (95% CI 0.07 to 0.12, p<0.0001) and BSAC: 0.14 (95% CI 0.1 to 0.17, p<0.0001).ConclusionNone of the studied CPGs demonstrated ideal performance characteristics. CPGs should be improved to guide initial clinical decision making.Trial registration numberNCT04196192.

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