scholarly journals Integrating approaches for quality guideline development in LactaMap, an online lactation care support system

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Melinda Boss ◽  
Jennifer Turner ◽  
Patrick Boss ◽  
Peter Hartmann ◽  
Douglas Pritchard ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Support System ◽  
Practice Guidelines ◽  
Common Sense ◽  
Guideline Development ◽  
Phase 1 ◽  
Domain Score ◽  
Agree Ii ◽  
Care Support

Abstract Background Health professionals caring for women and infants experiencing difficulty with breastfeeding have reported deficiencies in evidence-based lactation knowledge. LactaMap is an online lactation care support system with more than 100 clinical practice guidelines to support breastfeeding care. Clinical practice guidelines support medical decision-making by summarising scientific evidence into systematically developed statements for specific clinical circumstances. Both common-sense and theory-based approaches have been used for guideline development and debate continues regarding which is superior. LactaMap clinical practice guidelines were created over the course of 5 years using a common-sense approach that was refined inductively. The aim of this study was to incorporate a theory-based framework approach into the methodology for ongoing update and review of LactaMap clinical practice guidelines. Methods The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was chosen as the framework-based approach to appraise LactaMap guideline quality. The study was conducted in two phases. The first phase appraised all 103 original LactaMap guidelines. The second phase appraised a subset of 15 updated LactaMap guidelines using improved methodology guided by phase 1, as well as 15 corresponding original (un-updated) guidelines. Results Mean Domain scores for 103 LactaMap original guidelines were above 75% in 3 of the 6 AGREE II quality Domains and no mean Domain score rated poorly. Update of guideline methodology was guided by phase 1 appraisals. Improved documentation of methods relating to questions in the Rigour of Development Domain resulted in improvement in mean Domain score from 39 to 72%. Conclusions This study showed that a theory-based approach to guideline development methodology can be readily integrated with a common-sense approach. Factors identified by AGREE II theory-based framework provided practical guidance for changes in methodology that were integrated prior to LactaMap website publication. Demonstration of high quality in LactaMap clinical practice guideline methodology ensures clinicians and the public can have trust that the content founded on them is robust, scientific and of highest possible quality.

scholarly journals Protocol of an interdisciplinary consensus project aiming to develop an AGREE II extension for guidelines in surgery

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e037107
Author(s):  
George A Antoniou ◽  
Dimitris Mavridis ◽  
Sofia Tsokani ◽  
Manuel López-Cano ◽  
Iván D Flórez ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Conflicts Of Interest ◽  
Guideline Development ◽  
Reporting Quality ◽  
Consensus Conference ◽  
Professional Staff ◽  
Delphi Panel ◽  
Agree Ii

IntroductionAppraisal of Guidelines for Research and Evaluation (AGREE II) is an instrument that informs development, reporting and assessment of clinical practice guidelines. Previous research has demonstrated the need for improvement in methodological and reporting quality of clinical practice guidelines specifically in surgery. We aimed to develop an AGREE II extension document for application in surgical guidelines.Methods and analysisWe have performed a structured literature review and assessment of guidelines in surgery using the AGREE II instrument. In exploratory analyses, we have identified factors associated with guideline quality. We have performed reliability and factor analyses to inform the development of an extension document. We will summarise this information and present it to a Delphi panel of stakeholders. We will perform iterative Delphi rounds and we will summarise the final results to develop the extension instrument in a dedicated consensus conference.Ethics and disseminationFunding bodies will not be involved in the development of the instrument. Research ethics committee and Health Research Authority approval was waived, since this is a professional staff study only and no duty of care lies with the National Health Service to any of the participants. Conflicts of interest, if any, will be addressed by reassigning functions or replacing participants with relevant conflicts. The results will be disseminated through publication in peer reviewed journals, the funders’ websites, social media and direct contact with guideline development organisations and peer-reviewed journals that publish guidelines.

scholarly journals Systematic review of global clinical practice guidelines for neonatal hyperbilirubinemia

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040182
Author(s):  
Meng Zhang ◽  
Jun Tang ◽  
Yang He ◽  
Wenxing Li ◽  
Zhong Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Guideline Development ◽  
Neonatal Hyperbilirubinemia ◽  
Average Score ◽  
Agree Ii ◽  
Agree Ii Instrument

ObjectiveHyperbilirubinemia is one of the most common clinical symptoms in newborns. To improve patient outcomes, evidence-based and implementable guidelines are required. However, clinical guidelines may vary in quality, criteria and recommendations among regions and countries. In this study, we aimed to systematically assess the quality of guidelines using the Appraisal of Guidelines for Research & Evaluation (AGREE)-II instrument and summarise the specific recommendations for neonatal hyperbilirubinemia in order to provide suggestions for future guideline development.DesignSystematic review.InterventionsWe searched the PubMed, Embase, Medline and guideline databases for relevant articles on 10 April 2020. The studies were screened by two independent reviewers according to our inclusion criteria. Two reviewers independently extracted the descriptive data. Four appraisers assessed the guidelines using the AGREE-II instrument.ResultsOur systematic review appraised 12 clinical practice guidelines for the diagnosis and management of neonatal hyperbilirubinemia. The 12 guidelines achieved an average score of 36%–89%. The guidelines received the highest scores for clarity of presentation and lowest scores for rigour of development. Most recommendations for diagnosis were relatively consistent, but recommendations regarding risk factors, the initiating threshold of treatment and pharmacotherapy varied.ConclusionsOur study revealed that current guidelines vary in the quality of the developing process and are inconsistent with regards to recommendations. Future guidelines should afford more attention to the quality of methodologies in guideline development, and more qualified evidence is needed to standardise the initiating threshold of treatment for neonatal hyperbilirubinemia.

scholarly journals A review of the quality of current diabetes clinical practice guidelines

2017 ◽  
Vol 41 ◽  
pp. 1 ◽  
Author(s):  
Alberto Barcelo ◽  
Muzamil Jawed ◽  
Anthony Qiang ◽  
the PAHO Diabetes Guideline Project Group
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Guideline Development ◽  
Noncommunicable Diseases ◽  
Agree Ii ◽  
Quality Guidelines ◽  
The Mean ◽  
Health Organization ◽  
Almost All

Objective To obtain an evaluation of current type 2 diabetes mellitus (T2DM) clinical practice guidelines. Methods Relevant guidelines were identified through a systematic search of MEDLINE/PubMed. Pan American Health Organization (PAHO) country offices were also contacted to obtain national diabetes guidelines in use but not published/available online. Overall, 770 records were identified on MEDLINE/PubMed for citations published from 2008 to 2013. After an initial screening of these records, 146 were found to be guidelines related to diabetes. Inclusion and exclusion criteria were used to further refine the search and obtain a feasible number of guidelines for appraisal. Guideline evaluation was conducted by health professionals using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, which was developed to address the issue of variability in guideline quality and assesses the methodological rigor and transparency in which a guideline is developed. A total of 17 guidelines were selected and evaluated. Results Ten guidelines scored ≥ 70% and seven guidelines scored ≥ 80%. The range was 21%–100%. The mean scores for Latin America and the Caribbean (LAC) country guidelines (n = 6) were compared to the mean scores for non-LAC country guidelines (n = 11). International guidelines consistently scored notably higher in all domains and overall quality than LAC guidelines. Conclusions Based on this study’s findings, it is clear that T2DM clinical practice guideline development requires further improvements, particularly with regard to the involvement of stakeholders and editorial independence. This issue is most apparent for LAC country guidelines, as their quality requires major improvement in almost all aspects of the AGREE II criteria. Continued efforts should be made to generate and update high-quality guidelines to improve the management of increasingly prevalent noncommunicable diseases, such as T2DM.

scholarly journals Clinical practice guidelines and recommendations in the context of the COVID-19 pandemic: systematic review and critical appraisal

2020 ◽  
Author(s):  
Tanja A Stamm ◽  
Margaret R Andrews ◽  
Erika Mosor ◽  
Valentin Ritschl ◽  
Linda C Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Methodological Quality ◽  
Critical Appraisal ◽  
Guideline Development ◽  
Evaluation Instrument ◽  
Agree Ii ◽  
Guidelines And Recommendations

AbstractBackgroundThe number of published clinical practice guidelines and recommendations related to SARS-CoV-2 infections causing COVID-19 has rapidly increased. However, insufficient consideration of appropriate methodologies in the guideline development could lead to misleading information, uncertainty among professionals, and potentially harmful actions for patients.PurposeRapid systematic review of clinical practice guidelines and recommendations in the context of COVID-19 to explore if basic methodological standards of guideline development have been met.Data sourcesMEDLINE [PubMed], CINAHL [Ebsco], Trip and manual search; from Feb 1st 2020 until April 27th 2020.Study selectionAll types of healthcare workers providing any kind of healthcare to any patient population in any setting.Data extractionAt least two reviewers independently extracted guideline characteristics, conducted critical appraisal according to The Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) and classified the guidelines using the Association of the Scientific Medical Societies (AWMF) Guidance Manual and Rules for Guideline Development. We plan six-month updates (living review).Data synthesisThere were 1342 titles screened and 188 guidelines included. The highest average AGREE II domain score was 89% for scope and purpose, the lowest for rigor of development (25%). Only eight guidelines (4%) were based on a systematic literature search and a structured consensus process by representative experts (classified as the highest methodological quality, S3 according to AWMF). Patients were only included in the development of one guideline. A process for regular updates was described in 27 guidelines (14%).LimitationsMethodological focus only.ConclusionsDespite clear scope, most publications fell short of basic methodological standards of guideline development. Future research should monitor the evolving methodological quality of the guidelines and their updates over time.Registration/PublicationThe protocol was published at www.researchgate.net, DOI: 10.13140/RG.2.2.21293.51689. Preliminary results are publicly available on medRxiv.

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 Clinical Practice Guidelines andHelicobacter pyloriInfection in Children

1999 ◽  
Vol 13 (7) ◽  
pp. 560-562 ◽  
Author(s):  
Colin Macarthur ◽  
Liisa Jaakkimainen
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Guideline Development ◽  
Guideline Implementation ◽  
Key Steps ◽  
Evidence Based Guidelines ◽  
Care Costs

The objective of this paper is to review the principles, methods and issues behind the development of clinical practice guidelines. Practice guidelines have been defined as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”. The ultimate goal of guidelines is to improve patient outcomes; however, they may also be used as tools to decrease health care costs, improve medical education and enhance quality assurance. Evidence-based guidelines use explicit methods to link recommendations to the quality of the underlying research. Following development of the guideline, implementation and evaluation are key steps. The ultimate aim of guideline development is to influence physician knowledge, attitudes and behaviour.

Sign in / Sign up

Export Citation Format

Share Document