Methodological quality of clinical practice guidelines with physical activity recommendations for people diagnosed with cancer: A systematic critical appraisal using the 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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Assessment of the methodological quality of local clinical practice guidelines on the identification and management of gestational diabetes

BMJ Open ◽

10.1136/bmjopen-2018-027285 ◽

2019 ◽

Vol 9 (6) ◽

pp. e027285 ◽

Cited By ~ 2

Author(s):

Bridget Daley ◽

Graham Hitman ◽

Norman Fenton ◽

Scott McLachlan

Keyword(s):

Clinical Practice ◽

Gestational Diabetes ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Methodological Quality ◽

Clinical Decision Making ◽

Healthcare Delivery ◽

The Internet ◽

Agree Ii

ObjectiveGestational diabetes is the most common metabolic disorder of pregnancy, and it is important that well-written clinical practice guidelines (CPGs) are used to optimise healthcare delivery and improve patient outcomes. The aim of the study was to assess the methodological quality of hospital-based CPGs on the identification and management of gestational diabetes.DesignWe conducted an assessment of local clinical guidelines in English for gestational diabetes using the Appraisal of Guidelines for Research and Evaluation (AGREE II) to assess and validate methodological quality.Data sources and eligibility criteriaWe sought a representative selection of local CPGs accessible by the internet. Criteria for inclusion were (1) identified as a guideline, (2) written in English, (3) produced by or for the hospital in a Western country, (4) included diagnostic criteria and recommendations concerning gestational diabetes, (5) grounded on evidence-based medicine and (6) accessible over the internet. No more than two CPGs were selected from any single country.ResultsOf the 56 CPGs identified, 7 were evaluated in detail by five reviewers using the standard AGREE II instrument. Interrater variance was calculated, with strong agreement observed for those protocols considered by reviewers as the highest and lowest scoring based on the instrument. CPG results for each of the six AGREE II domains are presented categorically using a 5-point Likert scale. Only one CPG scored above average in five or more of the domains. Overall scores ranged from 91.6 (the strongest) to 50 (the weakest). Significant variation existed in the methodological quality of CPGs, even though they followed the guideline of an advising body. Specifically, appropriate identification of the evidence relied on to inform clinical decision making in CPGs was poor, as was evidence of user involvement in the development of the guideline, resource implications, documentation of competing interests of the guideline development group and evidence of external review.ConclusionsThe limitations described are important considerations for updating current and new CPGs.

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An appraisal of the Australian Resuscitation Council arrhythmia guideline

Australasian Journal of Paramedicine ◽

10.33151/ajp.11.6.127 ◽

2014 ◽

Vol 11 (6) ◽

Author(s):

Pieter F Fouche ◽

Kristina Zverinova

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Intraclass Correlation ◽

Rater Agreement ◽

Agree Ii ◽

Quality Guideline ◽

Significant Health ◽

Agree Ii Tool

IntroductionArrhythmias are a significant health burden in Australia, responsible for about 1% of deaths annually. The Australian Resuscitation Council (ARC) ‘Guideline 11.9 Managing Acute Dysrhythmias’ was designed to guide doctors, paramedics and nurses in the emergency management of arrhythmias. It is important to have high quality clinical practice guidelines to aid the treatment of these arrhythmias. The AGREE II tool utilised is widely used to asses clinical practice guidelines for quality. The objective of this study was to assess the quality of the ARC clinical practice guideline ‘Guideline 11.9 Managing Acute Dysrhythmias’.MethodsTwo raters assessed the six domains of quality of the ARC arrhythmia guideline using the AGREE II tool. The inter-rater agreement between the raters was measured with the intraclass correlation coefficient (ICC 2, 1).ResultsInter-rater agreement was good at 0.73 (95% CI 0.45 to 0.88). Both raters assigned the ARC guideline 11.9 Managing Acute Dysrhythmias a score of three, for a combined score of three out of a possible seven on the AGREE II rating scale.ConclusionsThe use of the ARC guideline 11.9 Managing Acute Dysrhythmias is not recommended based on this assessment with the AGREE II tool. Emergency departments and prehospital systems should consider not using this arrhythmia guideline to guide their practice, but to look elsewhere for a higher quality guideline.

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Methodological quality of clinical practice guidelines on probiotics in acute gastroenteritis in children using the appraisal of guidelines for research & evaluation II instrument (AGREE II)

Gastroenterology & Hepatology Open Access ◽

10.15406/ghoa.2018.09.00299 ◽

2018 ◽

Vol 9 (2) ◽

Author(s):

Aldo Maruy Saito ◽

Julio César Herrera Rodríguez ◽

Raúl Rojas Galarza

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Acute Gastroenteritis ◽

Methodological Quality ◽

Research Evaluation ◽

Agree Ii

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The Evidence Mapping and Methodological Quality of Clinical Practice Guidelines of Diagnosis and Management for Spinal Pain: A Cross-Sectional Study

10.21203/rs.3.rs-198513/v1 ◽

2021 ◽

Author(s):

Jin-Feng Huang ◽

Zongshi Qin ◽

Xuan-Qi Zheng ◽

Jia-Liang Lin ◽

Kai Zhang ◽

...

Keyword(s):

Clinical Practice ◽

Practice Guidelines ◽

Methodological Quality ◽

Spinal Pain ◽

Reporting Rate ◽

Basic Information ◽

Agree Ii ◽

Evidence Mapping ◽

The Mean

Abstract Objectives: To systematically review clinical practice guidelines (CPGs) for treating spinal pain, to assess the quality of different CPGs, and finally to provide an evidence map for the specific explication of research trends and gaps.Method: We searched CPGs in PubMed, Embase, Web of Science, Guidelines International Network (GIN), National Health and Medical Research Council (NHMRC), Scottish Intercollegiate Guidelines Network (SIGN) and the National Institute for Health and Care Excellence (NICE). We extracted basic information, recommendations, methodological quality, and reporting quality of the CPGs. Four researchers independently evaluated the quality of the CPGs according to the Appraisal of Guidelines Research and Evaluation (AGREE II) and Reporting Items for Practice Guidelines in Healthcare (RIGHT). Results: According to the AGREE II checklist, we found that the mean score was relatively high in four domains, namely, scope and purpose (78.39), stakeholder involvement (63.04), clarity of presentation (72.04), and rigor of development (61.25). However, the mean score of two domains (editorial independence and application) was relatively low. Among the seven domains of the RIGHT checklist, one field (basic information) had the highest reporting rate (86.61%), while another field (funding, declaration, and management of interest) obtained the lowest reporting rate (53.00%). Conclusion: Our study provided evidence mapping, which is a good tool to reduce research waste and facilitate the process of knowledge transfer. The results of our study can also be used to optimize the implementation of these recommendations and to improve the development of reliable CPGs for treating spinal pain.

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The Evidence Mapping and Methodological Quality of Clinical Practice Guidelines of Diagnosis and Management for Spinal Pain: A Cross-Sectional Survey

10.21203/rs.3.rs-763056/v1 ◽

2021 ◽

Author(s):

Jin-Feng Huang ◽

Zongshi Qin ◽

Xuan-Qi Zheng ◽

Jia-Liang Lin ◽

Kai Zhang ◽

...

Keyword(s):

Clinical Practice ◽

Practice Guidelines ◽

Methodological Quality ◽

Spinal Pain ◽

Reporting Rate ◽

Basic Information ◽

Agree Ii ◽

Evidence Mapping ◽

The Mean

Abstract Objectives: To systematically review clinical practice guidelines (CPGs) for treating spinal pain, to assess the quality of different CPGs, and finally to provide an evidence map for the specific explication of research trends and gaps.Method: We searched CPGs in PubMed, Embase, Web of Science, Guidelines International Network (GIN), National Health and Medical Research Council (NHMRC), Scottish Intercollegiate Guidelines Network (SIGN) and the National Institute for Health and Care Excellence (NICE). We extracted basic information, recommendations, methodological quality, and reporting quality of the CPGs. Four researchers independently evaluated the quality of the CPGs according to the Appraisal of Guidelines Research and Evaluation (AGREE II) and Reporting Items for Practice Guidelines in Healthcare (RIGHT). Results: We included 21 CPGs into our study. According to the AGREE II checklist, we found that the mean score was relatively high in four domains, namely, scope and purpose (78.39), stakeholder involvement (63.04), clarity of presentation (72.04), and rigor of development (61.25). However, the mean score of two domains (editorial independence and application) was relatively low. Among the seven domains of the RIGHT checklist, one field (basic information) had the highest reporting rate (86.61%), while another field (funding, declaration, and management of interest) obtained the lowest reporting rate (53.00%). Conclusion: Our study provided evidence mapping, which is a good tool to reduce research waste and facilitate the process of knowledge transfer. We found the mean score of the application of included CPGs was the lowest and most of CPGs didn’t consider patient preferences. Therefore, guideline makers should concentrate on patient preference and application in future guidelines. The results of our study can also be used to optimize the implementation of these recommendations and to improve the development of reliable CPGs for treating spinal pain.

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Quality of and Recommendations for Relevant Clinical Practice Guidelines for COVID-19 Management: A Systematic Review and Critical Appraisal

Frontiers in Medicine ◽

10.3389/fmed.2021.630765 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yun-Yun Wang ◽

Qiao Huang ◽

Quan Shen ◽

Hao Zi ◽

Bing-Hui Li ◽

...

Keyword(s):

Clinical Practice ◽

Health Status ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Methodological Quality ◽

Agree Ii ◽

Status Monitoring ◽

Isolation Management ◽

Diagnosis Criteria

Background: The morbidity and mortality of coronavirus disease 2019 (COVID-19) are still increasing. This study aimed to assess the quality of relevant COVID-19 clinical practice guidelines (CPGs) and to compare the similarities and differences between recommendations.Methods: A comprehensive search was conducted using electronic databases (PubMed, Embase, and Web of Science) and representative guidelines repositories from December 1, 2019, to August 11, 2020 (updated to April 5, 2021), to obtain eligible CPGs. The Appraisal of Guidelines for Research and Evaluation (AGREE II) tool was used to evaluate the quality of CPGs. Four authors extracted relevant information and completed data extraction forms. All data were analyzed using R version 3.6.0 software.Results: In total, 39 CPGs were identified and the quality was not encouragingly high. The median score (interquartile range, IQR) of every domain from AGREE II for evidence-based CPGs (EB-CPGs) versus (vs.) consensus-based CPG (CB-CPGs) was 81.94% (75.00–84.72) vs. 58.33% (52.78–68.06) in scope and purpose, 59.72% (38.89–75.00) vs. 36.11% (33.33–36.11) in stakeholder involvement, 64.58% (32.29–71.88) vs. 22.92% (16.67–26.56) in rigor of development, 75.00% (52.78–86.81) vs. 52.78% (50.00–63.89) in clarity of presentation, 40.63% (22.40–62.50) vs. 20.83% (13.54–25.00) in applicability, and 58.33% (50.00–100.00) vs. 50.00% (50.00–77.08) in editorial independence, respectively. The methodological quality of EB-CPGs were significantly superior to the CB-CPGs in the majority of domains (P < 0.05). There was no agreement on diagnosis criteria of COVID-19. But a few guidelines show Remdesivir may be beneficial for the patients, hydroxychloroquine +/– azithromycin may not, and there were more consistent suggestions regarding discharge management. For instance, after discharge, isolation management and health status monitoring may be continued.Conclusions: In general, the methodological quality of EB-CPGs is greater than CB-CPGs. However, it is still required to be further improved. Besides, the consistency of COVID-19 recommendations on topics such as diagnosis criteria is different. Of them, hydroxychloroquine +/– azithromycin may be not beneficial to treat patients with COVID-19, but remdesivir may be a favorable risk-benefit in severe COVID-19 infection; isolation management and health status monitoring after discharge may be still necessary. Chemoprophylaxis, including SARS-CoV 2 vaccines and antiviral drugs of COVID-19, still require more trials to confirm this.

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Assessing methodological quality of Russian clinical practice guidelines and introducing AGREE II instrument in Russia

PLoS ONE ◽

10.1371/journal.pone.0203328 ◽

2018 ◽

Vol 13 (9) ◽

pp. e0203328 ◽

Cited By ~ 1

Author(s):

Dina Ayratova Lienhard ◽

Lidiya Vacheslavovna Kisser ◽

Liliya Eugenevna Ziganshina

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Methodological Quality ◽

Agree Ii ◽

Agree Ii Instrument

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AGREEing on Nutritional Management of Patients with CKD—A Quality Appraisal of the Available Guidelines

Nutrients ◽

10.3390/nu13020624 ◽

2021 ◽

Vol 13 (2) ◽

pp. 624

Author(s):

Dimitra Rafailia Bakaloudi ◽

Lydia Chrysoula ◽

Kalliopi Anna Poulia ◽

Evangelia Dounousi ◽

Vassilios Liakopoulos ◽

...

Keyword(s):

Clinical Practice ◽

Kidney Disease ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Best Practice ◽

Public Health Issue ◽

Nutritional Management ◽

Agree Ii ◽

Agree Ii Tool

Chronic kidney disease (CKD) is an important public health issue with increasing prevalence worldwide. Several clinical practice guidelines have been recently published regarding the nutritional management of CKD patients. The purpose of the present study is to evaluate the quality of the published guidelines and provide recommendation for future updates. PubMed, Scopus and Google Scholar were searched for relevant guidelines and 11 clinical practice guidelines were finally included. Guidelines developed by the American Society for Parenteral and Enteral nutrition (ASPEN), the Dietitians Association of Australia (DAA), the German Society for Nutritional Medicine (DGEM), the European Best Practice Guidelines (EBPG), the European Dialysis and Transplantation Nurses Association-European Renal Care Association (EDTNA-ERCA), the European Society for Clinical Nutrition and Metabolism (ESPEN), the Andalusian Group for Nutrition Reflection and Investigation (GARIN) group, the National Kidney foundation-Kidney Disease Outcomes Quality Initiative (KDOQI), the Italian Society of Nephrology-Association of Dieticians-Italian Association of Hemodialysis, Dialysis and Transplant (SIN-ANDID-ANED), and the Renal Association were assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. Guidelines by KDOQI, ESPEN, and DAA were of moderate quality and the rest of them were low-quality guidelines. Our study demonstrates gaps related to the development of guidelines and therefore greater emphasis on methodological approaches is recommended. AGREE II tool can be useful to improve quality of guidelines.

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

10.1101/2020.06.19.20134767 ◽

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.

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