scholarly journals Over half of clinical practice guidelines use non-systematic methods to inform recommendations: A methods study

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250356
Author(s):  
Carole Lunny ◽  
Cynthia Ramasubbu ◽  
Lorri Puil ◽  
Tracy Liu ◽  
Savannah Gerrish ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Assessment Tool ◽  
Evidence Synthesis ◽  
Validity And Reliability ◽  
Eligibility Criteria ◽  
Comprehensive Search

Introduction Assessing the process used to synthesize the evidence in clinical practice guidelines enables users to determine the trustworthiness of the recommendations. Clinicians are increasingly dependent on guidelines to keep up with vast quantities of medical literature, and guidelines are followed to avoid malpractice suits. We aimed to assess whether systematic methods were used when synthesizing the evidence for guidelines; and to determine the type of review cited in support of recommendations. Methods Guidelines published in 2017 and 2018 were retrieved from the TRIP and Epistemonikos databases. We randomly sorted and sequentially screened clinical guidelines on all topics to select the first 50 that met our inclusion criteria. Our primary outcomes were the number of guidelines using either a systematic or non-systematic process to gather, assess, and synthesise evidence; and the numbers of recommendations within guidelines based on different types of evidence synthesis (systematic or non-systematic reviews). If a review was cited, we looked for evidence that it was critically appraised, and recorded which quality assessment tool was used. Finally, we examined the relation between the use of the GRADE approach, systematic review process, and type of funder. Results Of the 50 guidelines, 17 (34%) systematically synthesised the evidence to inform recommendations. These 17 guidelines clearly reported their objectives and eligibility criteria, conducted comprehensive search strategies, and assessed the quality of the studies. Of the 29/50 guidelines that included reviews, 6 (21%) assessed the risk of bias of the review. The quality of primary studies was reported in 30/50 (60%) guidelines. Conclusions High quality, systematic review products provide the best available evidence to inform guideline recommendations. Using non-systematic methods compromises the validity and reliability of the evidence used to inform guideline recommendations, leading to potentially misleading and untrustworthy results.

scholarly journals Over half of clinical practice guidelines use non-systematic methods to inform recommendations: A methods study

2021 ◽  
Author(s):  
Carole Lunny ◽  
Cynthia Ramasubbu ◽  
Lorri Puil ◽  
Savannah Gerrish ◽  
Tracy Liu ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Evidence Synthesis ◽  
Eligibility Criteria ◽  
Chi Square ◽  
Systematic Process ◽  
Chi Square Test ◽  
Comprehensive Search

Abstract Introduction Assessing the process used to synthesise the evidence in clinical practice guidelines (CPGs) enables users to determine the trustworthiness of the recommendations. We aimed to assess whether systematic methods were used when synthesizing the evidence for CPGs; and whether reviews or ‘overviews of reviews’ were cited in support of recommendations.Methods and analysis We followed a study protocol. CPGs published in 2017 and 2018 were retrieved from TRIP and Epistemonikos. We randomly sorted and sequentially screened the CPGs to select the first 50 that met our inclusion criteria. Our primary outcomes were the numbers and proportions of recommendations that were based on reviews and ‘overviews‘, and CPGs using either a systematic or non-systematic process to gather, assess, and synthesise evidence. We also looked for evidence that critical appraisal was conducted. We also performed a chi-square test of independence to examine the relationship between variables. Results Of the 50 guidelines, 34% did an exceptional job in systematically synthesising the evidence to inform recommendations. These guidelines clearly reported their objectives and eligibility criteria, conducted comprehensive search strategies, and assessed the quality of the studies. 66% of CPGs reported non-systematic methods to develop their recommendations. This percentage is likely an underestimation because we excluded some CPGs when selecting studies. Overall, 90% of CPGs cited reviews to inform recommendations, and one fifth cited a Cochrane systematic review. Of the 29 CPGs that included reviews, 21% critically appraised the review. 60% of CPGs assessed the quality of primary studies. Conclusions We used novel methodology to evaluate recommendations in a random sample of CPGs, and found that 62% did not use a systematic process to gather, appraise, and synthesise the evidence. Significant improvement is needed in the conduct and reporting of CPG methods. Guideline developers should use systematic methods endorsed by reputable evidence synthesis organisations.

scholarly journals Methodology for Evidence Synthesis and Development of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain

2021 ◽  
Vol S1;24 (1;S1) ◽  
pp. S1-S26
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Systematic Reviews ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Observational Studies ◽  
Evidence Synthesis ◽  
Evidence Based ◽  
Interventional Techniques

BACKGROUND: The re-engineered definition of clinical guidelines in 2011 from the IOM (Institute of Medicine) states, “clinical practice guidelines are statements that include recommendations intended to optimize patient care that is informed by a systematic review of evidence and an assessment of the benefit and harms of alternative care options.” The revised definition distinguishes between the term “clinical practice guideline” and other forms of clinical guidance derived from widely disparate development processes, such as consensus statements, expert advice, and appropriate use criteria. OBJECTIVE: To assess the literature and develop methodology for evidence synthesis and development of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. METHODS: A systematic review of the literature including methodology of guideline development encompassing GRADE approach for guidance on evidence synthesis with recommendations. RESULTS: Some of the many factors described in 2011 continue as of 2020 and impede the development of clinical practice guidelines. These impediments include biases due to a variety of conflicts and confluence of interest, inappropriate and poor methodological quality, poor writing and ambiguous presentation, projecting a view that these are not applicable to individual patients or too restrictive with the elimination of clinician autonomy, and overzealous and inappropriate recommendations, either positive, negative, or non-committal. Thus, ideally, a knowledgeable, multidisciplinary panel of experts with true lack of bias and confluence of interest must develop guidelines based on a systematic review of the existing evidence. This manuscript describes evidence synthesis from observational studies, various types of randomized controlled trials (RCTs), and, finally, methodological and reporting quality of systematic reviews. The manuscript also describes various methods utilized in the assessment of the quality of observational studies, diagnostic accuracy studies, RCTs, and systematic reviews. LIMITATIONS: Paucity of publications with appropriate evidence synthesis methodology in reference to interventional techniques. CONCLUSION: This review described comprehensive evidence synthesis derived from systematic reviews, including methodologic quality and bias measurement. The manuscript described various methods utilized in the assessment of the quality of the systematic reviews, RCTs, diagnostic accuracy studies, and observational studies. KEY WORDS: Evidence-based medicine (EBM), interventional pain management, evidence synthesis, methodological quality assessment, conflict of interest, confluence of interest, comparative effectiveness research (CER), clinical practice guidelines, systematic reviews, meta-analysis

scholarly journals Systematic review of clinical practice guidelines for adults with fractures: identification of best evidence for rehabilitation to develop the WHO’s Package of Interventions for Rehabilitation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Francesca Gimigliano ◽  
◽  
Sara Liguori ◽  
Antimo Moretti ◽  
Giuseppe Toro ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Hip Fracture ◽  
Distal Radius ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Adult Population ◽  
World Health ◽  
The World

Abstract Background The identification of existing rehabilitation interventions and related evidence represents a crucial step along the development of the World Health Organization’s (WHO) Package of Interventions for Rehabilitation (PIR). The methods for such identification have been developed by the WHO Rehabilitation Programme and Cochrane Rehabilitation under the guidance of the WHO’s Guideline Review Committee secretariat. The aim of this paper is to report on the results of the systematic search for clinical practice guidelines (CPGs) relevant to the rehabilitation of adults with fractures and to present the current state of evidence available from the identified CPGs. Methods This paper is part of the Best Evidence for Rehabilitation (be4rehab) series, developed according to the methodology presented in the World Health Organization’s (WHO) Package of Interventions for Rehabilitation (PIR) introductory paper. It is a systematic review of existing CPGs on fractures in adult population published from 2009 to 2019. Results We identified 23 relevant CPGs after title and abstract screening. According to inclusion/exclusion criteria, we selected 13 CPGs. After checking for quality, publication time, multiprofessionality, and comprehensiveness, we finally included five CPGs dealing with rehabilitative management of fractures in adult population, two CPGs addressing treatment of distal radius fracture and three the treatment of femoral/hip fracture. Conclusion The selected CPGs on management of distal radius and femoral/hip fracture include few recommendations regarding rehabilitation, with overall low to very low quality of evidence and weak/conditional strength of recommendation. Moreover, several gaps in specific rehabilitative topics occur. Further high-quality trials are required to upgrade the quality of the available evidence. Level of evidence Level 1.

scholarly journals 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 ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e021040 ◽  
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.

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

2019 ◽  
Vol 47 (3) ◽  
pp. 262-269 ◽  
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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