Eating, sleeping and moving recommendations in clinical practice guidelines for paediatric depression: umbrella review

Background Current first-line treatments for paediatric depression demonstrate mild-to-moderate effectiveness. This has spurred a growing body of literature on lifestyle recommendations pertaining to nutrition, sleep and exercise for treating paediatric depression. Aims Paediatric depression clinical practice guidelines (CPGs) were reviewed for quality and to catalogue recommendations on nutrition, sleep and exercise made by higher-quality CPGs. Method Searches were conducted in Medline, EMBASE, PsycINFO, Web of Science and CINAHL, and grey literature CPGs databases for relevant CPGs. Eligible CPGs with a minimum or high-quality level, as determined by the Appraisal of Guidelines for Research and Evaluation, Second Edition instrument, were included if they were (a) paediatric; (b) CPGs, practice parameter or consensus or expert committee recommendations; (c) for depression; (d) the latest version and (e) lifestyle recommendations for nutrition, sleep or exercise. Key information extracted included author(s), language, year of publication, country, the institutional body issuing the CPG, target disorder, age group, lifestyle recommendation and the methods used to determine CPG lifestyle recommendations. Results Ten paediatric CPGs for depression with a minimum or high-quality level contained recommendations on nutrition, sleep or exercise. Lifestyle recommendations were predominately qualitative, with quantitative details only outlined in two CPGs for exercise. Most recommendations were brief general statements, with 50% lacking supporting evidence from the literature. Conclusions Interest in lifestyle interventions for treatment in child and youth depression is growing. However, current CPG lifestyle recommendations for nutrition, sleep or exercise are based on expert opinion rather than clinical trials.

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

BMJ Open ◽

10.1136/bmjopen-2017-021040 ◽

2018 ◽

Vol 8 (10) ◽

pp. e021040 ◽

Cited By ~ 4

Author(s):

Ian Blanco-Mavillard ◽

Miguel Angel Rodríguez-Calero ◽

Enrique Castro-Sánchez ◽

Miquel Bennasar-Veny ◽

Joan De Pedro-Gómez

Keyword(s):

Systematic Review ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Central Venous Access ◽

Grey Literature ◽

Bloodstream Infections ◽

Quality Standard ◽

Validity And Reliability ◽

Vascular Access Devices

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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Antenatal magnesium sulfate for fetal neuroprotection: a critical appraisal and systematic review of clinical practice guidelines

Journal of Perinatal Medicine ◽

10.1515/jpm-2018-0174 ◽

2019 ◽

Vol 47 (3) ◽

pp. 262-269 ◽

Cited By ~ 6

Author(s):

Pradeep M. Jayaram ◽

Manoj K. Mohan ◽

Ibrahim Farid ◽

Stephen Lindow

Keyword(s):

Systematic Review ◽

Clinical Practice ◽

Magnesium Sulfate ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Supporting Evidence ◽

Agree Ii ◽

Fetal Neuroprotection ◽

Agree Ii Tool

Abstract Background Magnesium sulfate is an accepted intervention for fetal neuroprotection. There are some perceived differences in the international recommendations on the use magnesium sulfate for fetal neuroprotection in preterm labor. Content This systematic review analyses the available clinical guidelines for the use of magnesium sulfate for fetal neuroprotection and compares the recommendations, and assesses the quality of guidelines. This provides the consensus, differences and explores the areas for future collaborative research. We searched databases of PUBMED, EMBASE, COCHRANE, Web of Science, LILACS; and included the national and the international clinical practice guidelines. We included seven guidelines out of 227 search results. We evaluated the methodological quality of guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE II) tool and systematically extracted guideline characters, recommendation and supporting evidence base. Summary Five guidelines were of high quality and two were of moderate quality. One guideline achieved more than an 80% score in all the domains of AGREE II tool. All guidelines recommend use of magnesium sulfate for fetal neuroprotection. However, there are differences in other recommendations such as upper gestational age, dose, duration, repeating treatment and use of additional tocolytics. Outlook Future guidelines should include recommendations on all aspects of magnesium sulfate therapy for fetal neuroprotection. Future research and international collaboration should focus on areas where there are no international consensual recommendations.

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The Italian Society of Rheumatology clinical practice guidelines for the diagnosis and management of gout

Reumatismo ◽

10.4081/reumatismo.2019.1176 ◽

2019 ◽

Vol 71 (S1) ◽

pp. 50-79

Author(s):

N. Ughi ◽

I. Prevete ◽

R. Ramonda ◽

L. Cavagna ◽

G. Filippou ◽

...

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Task Force ◽

Grey Literature ◽

Italian Society ◽

Clinical Expertise ◽

Level Of Evidence ◽

Diagnosis And Management ◽

Increased Risk

Gout is a chronic disease with an increased risk of premature death related to comorbidities. Treatment of gout has proved suboptimal and clinical practice guidelines (CPGs) are expected to have a key role in achieving improvement. Since new evidence has become available, the Italian Society for Rheumatology (SIR) has been prompted to update the 2013 recommendations on the diagnosis and management of gout. The framework of the Guidelines International Network Adaptation Working Group was adopted to identify, appraise (AGREE II), synthesize, and customize the existing gout CPGs to the needs of the Italian healthcare context. The task force consisting of rheumatologists from the SIR Epidemiology Unit and a committee with experience on gout identified key health questions to guide a systematic literature review. The target audience includes physicians and health professionals who manage gout in practice, and the target population includes adult patients suspected or diagnosed as having gout. These recommendations were finally rated by an external multi-disciplinary commission. From a systematic search in databases (Medline, Embase) and grey literature, 8 CPGs were selected and appraised by two independent raters. Combining evidence and statements from these CPGs and clinical expertise, 14 recommendations were developed and graded according to the level of evidence. The statements and potential impact on clinical practice were discussed and assessed. These revised recommendations are intended to provide guidance for the diagnosis and the treatment of gout and to disseminate the best evidence-based healthcare for this disease.

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Critical appraisal and comparison of recommendations of clinical practice guidelines for treatment of schizophrenia in children and adolescents: a methodological survey protocol

BMJ Open ◽

10.1136/bmjopen-2020-038646 ◽

2020 ◽

Vol 10 (9) ◽

pp. e038646

Author(s):

Maíra Ramos Alves ◽

Cristiane de Cássia Bergamaschi ◽

Flávia Blaseck Sorrilha ◽

Izabela Fulone ◽

Silvio Barberato-Filho ◽

...

Keyword(s):

Clinical Practice ◽

Children And Adolescents ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Future Research ◽

High Quality ◽

Agree Ii ◽

Ethical Approval ◽

Over Time

IntroductionThe number of clinical practice guidelines (CPGs) have increased substantially mainly in the paediatric area of mental health. However, little is known about the quality or how recommendations for the treatment of disorders such as schizophrenia in children and adolescents have changed over time. The aim of this study will be to assess the quality of the development of CPGs for the treatment and management of schizophrenia in children and adolescents over time using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and to compare the recommendations and interventions described in these documents.Methods and analysisCPGs will be identified using a prospective protocol through a systematic search of multiple databases (Medline, Embase, Health Systems Evidence, Epistemonikos, Lilacs, etc) and guideline websites from 2004 to December 2020. The quality of the guidelines will be assessed by three reviewers, independently using the AGREE II. CPGs will be considered of high-quality if they scored ≥60% in four or more domains of the AGREE II instrument. Non-parametric tests will be used to test for the change of quality over time. We will summarise the different evidence grading systems and compare the recommendations.Ethics and disseminationEthical approval is not required since it is a literature-based study. Future results of the research can be submitted for publication in scientific journals of high impact, peer reviewed and also published in national and international conferences. The results derived from this study will contribute to the improvement of health institutions and policies, informing about existing recommendation guidelines and about deficiencies and qualities found in those. This study may also identify key areas for future research. This study may guide the search and choice for high quality CPGs by health policy makers and health professionals and subsidise future adaptations.Protocol registration numberCRD42020164899.

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The Italian Society for Rheumatology clinical practice guidelines for rheumatoid arthritis

Reumatismo ◽

10.4081/reumatismo.2019.1202 ◽

2019 ◽

Vol 71 (S1) ◽

pp. 22-49 ◽

Cited By ~ 2

Author(s):

S. Parisi ◽

A. Bortoluzzi ◽

G.D. Sebastiani ◽

F. Conti ◽

R. Caporali ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Functional Disability ◽

Task Force ◽

Grey Literature ◽

Italian Society ◽

Clinical Practices ◽

Increased Risk

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder characterised by chronic joint inflammation, leading to functional disability and increased risk of premature death. Clinical practice guidelines (CPGs) are expected to play a key role in improving management of RA, across the different phases of the disease course. Since new evidence has become available, the Italian Society for Rheumatology (SIR) has been prompted to update the 2011 recommendations on management of RA. The framework of the Guidelines International Network Adaptation Working Group was adopted to identify, appraise (AGREE II), synthesize, and customize the existing RA CPGs to the Italian healthcare context. The task force consisting of rheumatologists from the SIR Epidemiology Research Unit and a committee with experience in RA identified key health questions to guide a systematic literature review. The target audience includes physicians and health professionals who manage RA in practice, and the target population includes adult patients diagnosed as having RA. An external multi-disciplinary committee rated the final version of the CPGs. From the systematic search in databases (Medline, Embase) and grey literature, 6 CPGs were selected and appraised by two independent raters. Combining evidence and statements from these CPGs and clinical expertise, 8 (Management) +6 (Safety) recommendations were developed and graded according to the level of evidence. The statements and potential impact on clinical practice were discussed and assessed. These revised recommendations are intended to provide guidance for the management of RA and to disseminate the best evidence-based clinical practices for this disease.

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On the Need for (Only) High-Quality Clinical Practice Guidelines

JAMA Internal Medicine ◽

10.1001/jamainternmed.2018.7471 ◽

2019 ◽

Vol 179 (4) ◽

pp. 561 ◽

Cited By ~ 3

Author(s):

Michael Incze ◽

Joseph S. Ross

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

High Quality

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What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review

British Journal of Sports Medicine ◽

10.1136/bjsports-2018-099878 ◽

2019 ◽

Vol 54 (2) ◽

pp. 79-86 ◽

Cited By ~ 66

Author(s):

Ivan Lin ◽

Louise Wiles ◽

Rob Waller ◽

Roger Goucke ◽

Yusuf Nagree ◽

...

Keyword(s):

Systematic Review ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Best Practice ◽

Quality Care ◽

Surgical Care ◽

High Quality ◽

Eligibility Criteria ◽

Evidence Database

ObjectivesTo identify common recommendations for high-quality care for the most common musculoskeletal (MSK) pain sites encountered by clinicians in emergency and primary care (spinal (lumbar, thoracic and cervical), hip/knee (including osteoarthritis [OA] and shoulder) from contemporary, high-quality clinical practice guidelines (CPGs).DesignSystematic review, critical appraisal and narrative synthesis of MSK pain CPG recommendations.Eligibility criteriaIncluded MSK pain CPGs were written in English, rated as high quality, published from 2011, 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 sourcesFour scientific databases (MEDLINE, Embase, CINAHL and Physiotherapy Evidence Database) and four guideline repositories.Results6232 records were identified, 44 CPGs were appraised and 11 were rated as high quality (low back pain: 4, OA: 4, neck: 2 and shoulder: 1). We identified 11 recommendations for MSK pain care: ensure care is patient centred, screen for red flag conditions, assess psychosocial factors, use imaging selectively, undertake a physical examination, monitor patient progress, provide education/information, address physical activity/exercise, use manual therapy only as an adjunct to other treatments, offer high-quality non-surgical care prior to surgery and try to keep patients at work.ConclusionThese 11 recommendations guide healthcare consumers, clinicians, researchers and policy makers to manage MSK pain. This should improve the quality of care of MSK pain.

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A Critical Approach to Clinical Practice Guidelines

Canadian Journal of Gastroenterology ◽

10.1155/2000/302785 ◽

2000 ◽

Vol 14 (6) ◽

pp. 505-509 ◽

Cited By ~ 6

Author(s):

John K Marshall

Keyword(s):

Health Care ◽

Clinical Practice ◽

Patient Outcomes ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Care Delivery ◽

Critical Approach ◽

High Quality ◽

Number Of Publications ◽

Improve Patient

The rate of publication of clinical practice guidelines for the management of common medical illnesses continues to accelerate. The appropriate dissemination and uptake of high quality practice guidelines can synthesize evidence, improve patient outcomes and enhance the efficiency of health care delivery. However, the methodological rigour and relevance of the growing number of publications labelled ’clinical practice guidelines’ vary widely. Health care payers, providers and advocates must learn to appraise and interpret guideline recommendations critically. A simple and practical nine-question approach to evaluating the quality, relevance and effectiveness of clinical practice guidelines is presented.

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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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