Developing Clinical Recommendations for Breast, Colorectal, and Lung Cancer Adjuvant Treatments Using the GRADE System: A Study From the Programma Ricerca e Innovazione Emilia Romagna Oncology Research Group

2008 ◽  
Vol 26 (7) ◽  
pp. 1033-1039 ◽  
Author(s):  
Rossana De Palma ◽  
Alessandro Liberati ◽  
Giovannino Ciccone ◽  
Elena Bandieri ◽  
Maurizio Belfiglio ◽  
...  
Keyword(s):  
Anticancer Drugs ◽  
Evaluation System ◽  
Risk Profile ◽  
Grade System ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
Oncology Research ◽  
Course Of Action ◽  
Effective Interventions

Purpose In the area of anticancer drugs, the legitimate search for effective interventions can be jeopardized by the strong pressure for accelerated approval, which may hinder the full assessment of their benefit-risk profile. We aimed to produce drug-specific recommendations using an explicit approach that separates the judgments on quality of evidence from the judgment about strength of recommendations. Materials and Methods We used the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system to develop recommendations for the use of specific anticancer drugs/regimens; 12 clinical questions relevant to adjuvant treatment of breast (three), colorectal (four) and lung (five) cancer have been assessed by multidisciplinary panels supported by a group of methodologists. Results For nine of 12 questions, recommendations were produced (one strong and six weak in favor and one weak and one strong against the index treatment); for the remaining three questions no specific course of action could be recommended. The perceived benefits to risk balance of the treatment was the most important and statistically significant (P < .01) predictor of panels’ recommendations and of their strength, whereas panelists’ personal (age, sex) and professional (specialty) characteristics were not statistically associated. Conclusion Because the GRADE system sets out an explicit process going from evaluation of the quality of evidence and benefit-risk profile to the judgment of the strength of recommendations, in this experience, it proved very useful to combine methodologic rigor with the interdisciplinary participation that is important in the definition of evidence based clinical policies.

scholarly journals Nursing and Midwifery Students’ Communication Skills Training: A Systematic Review

2019 ◽  
pp. 1-10
Author(s):  
Mustapha Alhassan
Keyword(s):  
Systematic Review ◽  
Communication Skills ◽  
Evaluation System ◽  
Skills Training ◽  
Communication Skills Training ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
Ovid Medline ◽  
Nurses And Midwives

Background: Communication skills are reported to be of high importance for nursing and midwifery practice. Communication skills refers to how actions are used in sending messages. The necessity for nurses and midwives to be good communicators has been demonstrated. Objective: To investigate the quality of evidence of communication skills training for nursing and midwifery students on patients’ outcome in nursing and midwifery colleges. Methods: Firstly, a search in the databases of Ovid Medline (1946 - present), Ebscohost and CINAHL (1960 - present) to find relevant studies were conducted. Secondly, there was hand searching of three journals from Africa. Thirdly, the reference lists of studies found were searched for additional studies. Fourthly, there was consultation with professionals around communication skills training and the leadership of Ghana Nurses and Midwives Association. Results: Quality assessment using the Grading of Recommendations Assessment, Development and Evaluation system found that out of the 10 studies that were included, only one was of moderate quality. The other nine studies were of low quality. Conclusions: The literature on enhancing communication skills training in nursing and midwifery students shows that the quality of evidence is generally low. This study has implications on how communication is handled in nursing schools and demonstrated which communication has high evidence. Systematic Review Registration: This systematic review was not registered in a registry.

scholarly journals Lumbar Roll Usage While Sitting Reduces the Forward Head Posture in Healthy Individuals: A Systematic Review with Meta-Analysis

2021 ◽  
Vol 18 (10) ◽  
pp. 5171
Author(s):  
Yusuke Handa ◽  
Kenya Okada ◽  
Hiroshi Takasaki
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Grade System ◽  
Cochrane Library ◽  
Forward Head Posture ◽  
Quality Of Evidence ◽  
Head Posture ◽  
Head Extension ◽  
The Cochrane Library

This systematic review and meta-analysis investigated whether the use of a lumbar roll reduced forward head posture (FHP) while sitting among individuals with or without musculoskeletal disorders. EMBASE, MEDLINE, and the Cochrane Library were systematically searched from their inception to August 2020. The quality of evidence for variables used in the meta-analysis was determined using the GRADE system. Five studies satisfied the criteria for data analysis. All studies included individuals without any spinal symptoms. Data from five studies on neck angle showed a statistically significant (p = 0.02) overall effect (standardized mean difference (SMD) = 0.77), indicating a lesser neck flexion angle while sitting with a lumbar roll than without it. Data from two studies on head angle showed a statistically significant (p = 0.04) overall effect (SMD = 0.47), indicating a lesser head extension angle while sitting with a lumbar roll than without it. In each meta-analysis, the quality of evidence was very low in the GRADE system. The use of a lumbar roll while sitting reduced FHP among individuals without spinal symptoms.

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.

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.

Effectiveness and Efficacy of Therapeutic Interventions Performed by Nurses for Anxiety Disorders: A Systematic Review

2022 ◽  
pp. 107839032110681
Author(s):  
Roslaine Ifran Amaral ◽  
Fernanda Cirne Lima Weston ◽  
Vânia Naomi Hirakata ◽  
Adriana Aparecida Paz ◽  
Ana Cristina Wesner
Keyword(s):  
Systematic Review ◽  
Anxiety Disorders ◽  
Negative Impact ◽  
Self Control ◽  
Therapeutic Interventions ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
Anxiety Levels ◽  
The Individual

BACKGROUND: Anxiety disorders are characterized by excessive anxiety, fear, and behavioral disorders that can lead the individual to have losses in daily, social, and work activities, generating a negative impact on their quality of life. AIM: To evaluate the quality of evidence of the therapeutic interventions performed by nurses for anxiety disorders. METHOD: An analysis of the quality of evidence was performed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The systematic review protocol was registered in the Prospective Register of Systematic Reviews (Prospero), CRD420202939. RESULTS: The interventions performed by nurses were effective ( d = 0.44), with significant improvement in reducing anxiety levels, reducing drug use, and improving self-control. CONCLUSIONS: The study indicates that therapeutic interventions performed by nurses are beneficial for individuals who suffer from anxiety disorders, with significant improvement in reducing anxiety levels, reducing medication use, improving self-control, and remission of anxiety symptoms.

scholarly journals Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition

Gut ◽  
2018 ◽  
Vol 67 (8) ◽  
pp. 1380-1399 ◽  
Author(s):  
Ramesh P Arasaradnam ◽  
Steven Brown ◽  
Alastair Forbes ◽  
Mark R Fox ◽  
Pali Hungin ◽  
...  
Keyword(s):  
Guideline Development ◽  
Grade System ◽  
British Society ◽  
Chronic Diarrhoea ◽  
Clinical Services ◽  
Quality Of Evidence ◽  
Guideline Development Group ◽  
Development Group

Chronic diarrhoea is a common problem, hence clear guidance on investigations is required. This is an updated guideline from 2003 for the investigations of chronic diarrhoea commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). This document has undergone significant revision in content through input by 13 members of the Guideline Development Group (GDG) representing various institutions. The GRADE system was used to appraise the quality of evidence and grading of recommendations.

scholarly journals Chronic Constipation: Current Treatment Options

2011 ◽  
Vol 25 (suppl b) ◽  
pp. 22B-28B ◽  
Author(s):  
Louis Wing Cheong Liu
Keyword(s):  
Chronic Constipation ◽  
Evaluation System ◽  
Serotonin Receptor ◽  
Treatment Options ◽  
Gastrointestinal Disorder ◽  
Treatment Modalities ◽  
Receptor Subtype ◽  
Bulking Agents ◽  
Quality Of Evidence

Chronic constipation is a common functional gastrointestinal disorder that affects patients of all ages. In 2007, a consensus group of 10 Canadian gastroenterologists developed a set of recommendations pertaining to the management of chronic constipation and constipation-dominant irritable bowel syndrome. Since then, tegaserod has been withdrawn from the Canadian market. A new, highly selective serotonin receptor subtype 4 agonist, prucalopride, has been examined in several large, randomized, placebo-controlled trials demonstrating its efficacy and safety in the management of patients with chronic constipation. Additional studies evaluating the use of stimulant laxatives, polyethylene glycol and probiotics in the management of chronic constipation have also been published. The present review summarizes the previous recommendations and new evidence supporting different treatment modalities – namely, diet and lifestyle, bulking agents, stool softeners, osmotic and stimulant laxatives, prucalopride and probiotics in the management of chronic constipation. A brief summary of lubiprostone and linaclotide is also presented. The quality of evidence is presented by adopting the Grading of Recommendations, Assessment, Development and Evaluation system. Finally, a management pyramid for patients with chronic constipation is proposed based on the quality of evidence, impact of each modality on constipation and on general health, and their availabilities in Canada.

scholarly journals Chronic Constipation: Current Treatment Options

2011 ◽  
Vol 25 (suppl b) ◽  
pp. 22B-28B ◽  
Author(s):  
Louis Wing Liu
Keyword(s):  
Chronic Constipation ◽  
Evaluation System ◽  
Serotonin Receptor ◽  
Treatment Options ◽  
Gastrointestinal Disorder ◽  
Treatment Modalities ◽  
Receptor Subtype ◽  
Bulking Agents ◽  
Quality Of Evidence

Chronic constipation is a common functional gastrointestinal disorder that affects patients of all ages. In 2007, a consensus group of 10 Canadian gastroenterologists developed a set of recommendations pertaining to the management of chronic constipation and constipationdominant irritable bowel syndrome. Since then, tegaserod has been withdrawn from the Canadian market. A new, highly selective serotonin receptor subtype 4 agonist, prucalopride, has been examined in several large, randomized, placebo-controlled trials demonstrating its efficacy and safety in the management of patients with chronic constipation. Additional studies evaluating the use of stimulant laxatives, polyethylene glycol and probiotics in the management of chronic constipation have also been published. The present review summarizes the previous recommendations and new evidence supporting different treatment modalities – namely, diet and lifestyle, bulking agents, stool softeners, osmotic and stimulant laxatives, prucalopride and probiotics in the management of chronic constipation. A brief summary of lubiprostone and linaclotide is also presented. The quality of evidence is presented by adopting the Grading of Recommendations, Assessment, Development and Evaluation system. Finally, a management pyramid for patients with chronic constipation is proposed based on the quality of evidence, impact of each modality on constipation and on general health, and their availabilities in Canada.

Systematic review of the published guidelines on Barrett’s esophagus: should we stress the consensus or the differences?

2020 ◽  
Author(s):  
Inês Marques de Sá ◽  
António Dias Pereira ◽  
Prateek Sharma ◽  
Mário Dinis-Ribeiro
Keyword(s):  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Gastrointestinal Endoscopy ◽  
Grade System ◽  
British Society ◽  
Quality Of Evidence ◽  
Ablation Therapy ◽  
Visible Lesion ◽  
Quality Evidence

Abstract Multiple guidelines on Barrett’s esophagus (BE) have being published in order to standardize and improve clinical practice. However, studies have shown poor adherence to them. Our aim was to synthetize, compare, and assess the quality of recommendations from recently published guidelines, stressing similarities and differences. We conducted a search in Pubmed and Scopus. When different guidelines from the same society were identified, the most recent one was considered. We used the GRADE system to assess the quality of evidence. We included 24 guidelines and position/consensus statements from the European Society of Gastrointestinal Endoscopy, British Society of Gastroenterology, American Society for Gastrointestinal Endoscopy, American Gastroenterological Association, American College of Gastroenterology, Australian guidelines, and Asia-Pacific consensus. All guidelines defend that BE should be diagnosed when there is an extension of columnar epithelium into the distal esophagus. However, there is still some controversy regarding length and histology criteria for BE diagnosis. All guidelines recommend expert pathologist review for dysplasia diagnosis. All guidelines recommend surveillance for non-dysplastic BE, and some recommend surveillance for indefinite dysplasia. While the majority of guidelines recommend ablation therapy for low-grade dysplasia without visible lesion, others recommend ablation therapy or endoscopic surveillance. However, controversy exists regarding surveillance intervals and biopsy protocols. All guidelines recommend endoscopic resection followed by ablation therapy for neoplastic visible lesion. Several guidelines use the GRADE system, but the majority of recommendations are based on low and moderate quality of evidence. Although there is considerable consensus among guidelines, there are some discrepancies resulting from low-quality evidence. The lack of high-quality evidence for the majority of recommendations highlights the importance of continued well-conducted research in this field.

EFFECTIVENESS OF WEARABLE DEFIBRILLATORS: SYSTEMATIC REVIEW AND QUALITY OF EVIDENCE

2014 ◽  
Vol 30 (2) ◽  
pp. 194-202 ◽  
Author(s):  
Jennifer Uyei ◽  
R. Scott Braithwaite
Keyword(s):  
Ischemic Cardiomyopathy ◽  
Absolute Risk ◽  
Artery Bypass ◽  
Absolute Risk Reduction ◽  
Coronary Intervention ◽  
Specific Patient ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
Meta Analyses

Objectives: The objectives of this systematic literature review were to identify all published literature on wearable defibrillators, assess the wearable defibrillator's efficacy and effectiveness in general and among specific patient groups, including post-myocardial infarction, post coronary artery bypass grafting or percutaneous coronary intervention, non-ischemic cardiomyopathy, and ischemic cardiomyopathy, and to evaluate the quality of evidence.Methods: The search and synthesis was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation and the Newcastle Ottawa Scale.Results: A total of thirty-six articles and conference abstracts from thirty-three studies were included in the review. It appears that wearable defibrillator use compared with no defibrillator use reduces the chance of ventricular tachycardia and ventricular fibrillation (VT/VF) associated deaths by an absolute risk reduction of approximately 1 percent, achieved by averting approximately 4/5th of all VT/VF associated deaths. The quality of evidence was low to very low quality, such that our confidence in the reported estimates is weak.Conclusions: To validate beneficial results, further investigation using robust study designs conducted by independent researchers is warranted.

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