Making Evidence Available for Hospital-Based Midwives: A Systematic Examination of the Content and Methodological Quality of Three Protocols Used in Maternity Hospitals in the Netherlands

BACKGROUND: In recent years, the Dutch have begun to question the safety and efficacy of their maternity care system. Particular concerns have been raised about the quality of care in hospital settings. One way to address concerns regarding quality and efficacy of care is by the introduction and use of evidence-based protocols for practice. The primary aims of this study are to (a) describe the availability and diffusion of protocols in Dutch maternity hospitals, (b) systematically assess the methodological quality of these protocols, and (c) consider the content of the protocols in relation to the best evidence for practice.METHODS: A mailed and Internet questionnaire to all hospitals with maternity facilities in the Netherlands inquiring about the availability, content, and methodological quality of protocols for three situations: hypertensive conditions of pregnancy, fetal surveillance, and postpartum hemorrhage. All protocols were systematically assessed twice. We first assessed the methodological quality of the protocol using the Appraisal of Guidelines Research and Evaluation (AGREE) framework, and we then evaluated protocol content using a framework we developed for this purpose. Protocols were scored using a Likert-type scale.RESULTS: There were 53% (N = 48) of all maternity hospitals in the Netherlands that responded. The methodological quality of protocols we evaluated was poor. Using the AGREE framework, 70% of fetal surveillance protocols could not be recommended. Only 1 protocol from 1 hospital scored strongly recommend. Confusion regarding the definition of a protocol and what it should contain were common problems. There was a general paucity of evidence in the protocols assessed.DISCUSSION: Protocols may not be widely available in Dutch maternity hospitals. Where they are available, the quality is poor. There is no national strategy for coordination, implementation, and dissemination of evidence-based protocols. Because centralization, uniformity, and interprofessional collaboration are known to improve adherence, it would be prudent for maternity care professions to develop and disseminate protocols based on best evidence.

Download Full-text

Do Guidelines for the Diagnosis and Monitoring of Diabetes Mellitus Fulfill the Criteria of Evidence-Based Guideline Development?

Clinical Chemistry ◽

10.1373/clinchem.2008.109082 ◽

2008 ◽

Vol 54 (11) ◽

pp. 1872-1882 ◽

Cited By ~ 17

Author(s):

Eva Nagy ◽

Joseph Watine ◽

Peter S Bunting ◽

Rita Onody ◽

Wytze P Oosterhuis ◽

...

Keyword(s):

Diabetes Mellitus ◽

Methodological Quality ◽

Guideline Development ◽

Evidence Based ◽

Test Results ◽

Time Period ◽

Therapeutic Guidelines ◽

Therapeutic Recommendations ◽

Evidence Based Guideline

Abstract Background: Although the methodological quality of therapeutic guidelines (GLs) has been criticized, little is known regarding the quality of GLs that make diagnostic recommendations. Therefore, we assessed the methodological quality of GLs providing diagnostic recommendations for managing diabetes mellitus (DM) and explored several reasons for differences in quality across these GLs. Methods: After systematic searches of published and electronic resources dated between 1999 and 2007, 26 DM GLs, published in English, were selected and scored for methodological quality using the AGREE Instrument. Subgroup analyses were performed based on the source, scope, length, origin, and date and type of publication of GLs. Using a checklist, we collected laboratory-specific items within GLs thought to be important for interpretation of test results. Results: The 26 diagnostic GLs had significant shortcomings in methodological quality according to the AGREE criteria. GLs from agencies that had clear procedures for GL development, were longer than 50 pages, or were published in electronic databases were of higher quality. Diagnostic GLs contained more preanalytical or analytical information than combined (i.e., diagnostic and therapeutic) recommendations, but the overall quality was not significantly different. The quality of GLs did not show much improvement over the time period investigated. Conclusions: The methodological shortcomings of diagnostic GLs in DM raise questions regarding the validity of recommendations in these documents that may affect their implementation in practice. Our results suggest the need for standardization of GL terminology and for higher-quality, systematically developed recommendations based on explicit guideline development and reporting standards in laboratory medicine.

Download Full-text

Incentives and Support Programs to Improve Adherence to Tuberculosis Treatment

Canadian Journal of Health Technologies ◽

10.51731/cjht.2021.35 ◽

2021 ◽

Vol 1 (2) ◽

Author(s):

Charlotte Wells ◽

Melissa Severn

Keyword(s):

High Risk ◽

Methodological Quality ◽

Clinical Effectiveness ◽

Conclusive Evidence ◽

Active Tuberculosis ◽

Tuberculosis Treatment ◽

Support Programs ◽

Evidence Based ◽

Evidence Based Guidelines

Three overviews of reviews and 11 systematic reviews were identified regarding the clinical effectiveness of adherence incentives in those who require assistance to complete their tuberculosis treatment. Four evidence-based guidelines were identified that provided recommendations regarding the use of adherence incentives in those who require assistance completing their tuberculosis treatment. The reported clinical effectiveness of adherence incentives for patients with tuberculosis was mixed. There were no detrimental effects of providing incentives, but there was also no conclusive evidence pointing to a clinical benefit. The overall quality of the included reviews was moderate to high. The included guidelines recommended that incentives and enablers be included as a part of a patient-centred strategy for treatment and for patients with active tuberculosis or patients at high risk; however, the evidence formulating these recommendations was of low certainty or quality. Two of the included guidelines were of high methodological quality, and 2 were of lower methodological quality.

Download Full-text

The Absence of Evidence-Based Practices (EBPs) in the Treatment of Sexual Abusers: Recommendations for Moving Toward the Use of a True EBP Model

Sexual Abuse ◽

10.1177/1079063219843897 ◽

2019 ◽

Vol 32 (6) ◽

pp. 679-705

Author(s):

Adam Deming ◽

Jerry L. Jennings

Keyword(s):

Mental Health ◽

Methodological Quality ◽

Treatment Effectiveness ◽

Current Status ◽

Evidence Based ◽

Evidence Based Practices ◽

Treatment Approaches ◽

Professional Discipline ◽

History Of

Despite a continued evolution of the field of sexual abuser treatment toward a distinct professional discipline with clinicians using an increasing variety of treatment approaches, there is no consensus regarding the strength of our various clinical interventions as evidence-based practices (EBPs). This article provides a brief history of the development and goals of EBPs in medicine and mental health, and a review of the earnest efforts of researchers within the field to establish treatment approaches with sexual abusers as evidence-based. An appraisal of the current status of EBP’s with sexual abusers is provided. Although there have been improvements in the methodological quality of treatment outcome research with sexual abusers, divergent opinions about treatment effectiveness remain, and the field has not yet agreed on a system or set of criteria for what constitutes “evidence.” We contend that clinical practice has been influenced as much, or more, by new paradigms that are intuitively meaningful and perceived as needed than it has by what has been determined to be scientifically efficacious. This trend and other processes in our field that seem to be slowing the development of EBPs with sexual abusers are discussed. Recommendations for conducting evidence-based reviews and moving the field of sexual abuser treatment toward the use of a true EBP model are provided.

Download Full-text

Methodological quality and synthesis of case series and case reports

BMJ evidence-based medicine ◽

10.1136/bmjebm-2017-110853 ◽

2018 ◽

Vol 23 (2) ◽

pp. 60-63 ◽

Cited By ~ 312

Author(s):

Mohammad Hassan Murad ◽

Shahnaz Sultan ◽

Samir Haffar ◽

Fateh Bazerbachi

Keyword(s):

Methodological Quality ◽

Medical Literature ◽

Case Reports ◽

Case Series ◽

Evidence Based ◽

Level Of Evidence ◽

Increased Risk ◽

Study Designs ◽

Inform Decision Making

Case reports and case series are uncontrolled study designs known for increased risk of bias but have profoundly influenced the medical literature and continue to advance our knowledge. In this guide, we present a framework for appraisal, synthesis and application of evidence derived from case reports and case series. We propose a tool to evaluate the methodological quality of case reports and case series based on the domains of selection, ascertainment, causality and reporting and provide signalling questions to aid evidence-based practitioners and systematic reviewers in their assessment. We suggest using evidence derived from case reports and case series to inform decision-making when no other higher level of evidence is available.

Download Full-text

An Assessment of the Methodological Quality of Research Published in the American Journal of Sports Medicine

The American Journal of Sports Medicine ◽

10.1177/0363546505278304 ◽

2005 ◽

Vol 33 (12) ◽

pp. 1812-1815 ◽

Cited By ~ 12

Author(s):

Robert H. Brophy ◽

Michael J. Gardner ◽

Omar Saleem ◽

Robert G. Marx

Keyword(s):

Data Collection ◽

Sports Medicine ◽

Methodological Quality ◽

Case Series ◽

Evidence Based ◽

Prospective Data ◽

Article Type ◽

Based Medicine ◽

Published Research

Background Evidence-based medicine has become a popular topic in academic medicine during the past several decades and more recently in orthopaedics and sports medicine. Hypothesis Articles published in The American Journal of Sports Medicine have shown an improvement in methodological quality in 2001-2003, compared with 1991-1993. Study Design Systematic review. Methods All articles published in The American Journal of Sports Medicine during the periods 1991-1993 and 2001-2003 were reviewed and classified by type of study. The use of pertinent methodologies such as prospective data collection, randomization, blinding, and controlled studies was noted for each article. The frequency of each article type and the use of evidence-based techniques were compared across study periods. Results Case series and descriptive studies decreased during the study period, from 27.4% to 15.3% (P=. 00003) and from 11.9% to 5.6% (P=. 001), respectively, of articles published. Prospective cohort studies increased from 4.7% to 14.1% (P=. 000005), and randomized, prospective clinical trials increased from 2.7% to 5.9% of articles (P=. 04). More studies tested an explicit hypothesis (P=. 0000002), used prospective data collection (P=. 000003), and used blinding (P=. 02), and more studies identified a funding source (P=. 004). Conclusions Overall, there was a shift toward more prospective and randomized research designs published in The American Journal of Sports Medicine during 2001-2003 compared to 1991-1993, demonstrating an improvement in the methodological quality of published research.

Download Full-text

Methodological quality of systematic reviews and clinical trials on women's health published in a Brazilian evidence-based health journal

Clinics ◽

10.6061/clinics/2013(04)20 ◽

2013 ◽

Vol 68 (4) ◽

pp. 563-567 ◽

Cited By ~ 2

Author(s):

CR Macedo ◽

R Riera ◽

MR Torloni

Keyword(s):

Clinical Trials ◽

Women’S Health ◽

Women's Health ◽

Systematic Reviews ◽

Methodological Quality ◽

Evidence Based ◽

Health Journal

Download Full-text

Analysis of the Status and Trends of Chinese Clinical Practice Guideline Development Between 2010 and 2020: A Systematic Review

Frontiers in Medicine ◽

10.3389/fmed.2021.758617 ◽

2021 ◽

Vol 8 ◽

Author(s):

Rong Zhang ◽

Si-yu Yan ◽

Yun-yun Wang ◽

Qiao Huang ◽

Xiang-ying Ren ◽

...

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Methodological Quality ◽

Evidence Based ◽

Healthcare Decision ◽

Inclusion Criteria ◽

Healthcare Decision Making ◽

Status And Trends ◽

The Status

Objective: This study aimed to systematically review the status and trends of Chinese clinical practice guidelines (CPGs) during the time period 2010–2020 and explore their methodological characteristics. Then, based on the strengths and weaknesses in development, offer several recommendations for the quality improvement which will serve as a reference for the users and developers of CPG.Introduction: With the development of evidence-based medicine (EBM), the CPGs play an increasingly important role in healthcare decision-making both in China and worldwide.Inclusion criteria: The CPGs that have been used to help the health professionals in the healthcare decision-making were included.Methodology: The China National Knowledge Infrastructure (CNKI) and WanFang databases were searched from 2010 to 2020 for the studies describing the general and methodological characteristics of Chinese CPGs. Comparisons of the methodological characteristics between the groups were conducted using the chi-square test or Fisher's exact test. The M-K test was adopted to identify the monotonically increasing or decreasing trends of methodological characteristics over the timespan.Results: A total of 2,654 CPGs fulfilled the inclusion criteria. The quantity and quality of the guidelines developed in China have improved over the time span. From 2010 to 2020,the guidelines had differing characteristics and covered a wide range of subjects. In total, 2,318(87.34%) guidelines focused on Western Medicine. Eight (0.30%) had been developed for patient versions of guidelines, 10(0.38%) were tentative guidelines, and 16(0.60%) were rapid advice guidelines. Medical specialty societies (including their branches) (71.1%) were the main guideline makers. The most addressed diseases were neoplasms (14.43%). The target population is mainly adults (84.97%). The methodological quality of consensus-based (CB)-CPGs was obviously lower than evidence-based (EB)-CPGs. Except for the item, “recommendations were based on evidence of systematic reviews,” there were statistical differences in all other methodological items between the EB-CPGS and CB-CPGS (P < 0.01). Higher methodological quality has been observed in EB-CPGs. All the data relating to the methodological characteristics indicated that higher methodological quality was present in the guidelines using GRADE (P < 0.01).Conclusion: The quantity and quality of the guidelines developed in China have improved between 2010 and 2020. CB-CPGs have also paid attention to the methodology quality, but obviously, this is lower than that in the EB-CPGs.

Download Full-text

Evaluating methodological quality of Prognostic models Including Patient-reported HeAlth outcomes iN oncologY (EPIPHANY): a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2018-025054 ◽

2018 ◽

Vol 8 (10) ◽

pp. e025054 ◽

Cited By ~ 2

Author(s):

Nina Deliu ◽

Francesco Cottone ◽

Gary S Collins ◽

Amélie Anota ◽

Fabio Efficace

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Methodological Quality ◽

Data Extraction ◽

Prognostic Models ◽

Published Data ◽

Evidence Based ◽

Patient Reported ◽

Data Extraction Form

IntroductionWhile there is mounting evidence of the independent prognostic value of patient-reported outcomes (PROs) for overall survival (OS) in patients with cancer, it is known that the conduct of these studies may hold a number of methodological challenges. The aim of this systematic review is to evaluate the quality of published studies in this research area, in order to identify methodological and statistical issues deserving special attention and to also possibly provide evidence-based recommendations.Methods and analysisAn electronic search strategy will be performed in PubMed to identify studies developing or validating a prognostic model which includes PROs as predictors. Two reviewers will independently be involved in data collection using a predefined and standardised data extraction form including information related to study characteristics, PROs measures used and multivariable prognostic models. Studies selection will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with data extraction form using fields from the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist for multivariable models. Methodological quality assessment will also be performed and will be based on prespecified domains of the CHARMS checklist. As a substantial heterogeneity of included studies is expected, a narrative evidence synthesis will also be provided.Ethics and disseminationGiven that this systematic review will use only published data, ethical permissions will not be required. Findings from this review will be published in peer-reviewed scientific journals and presented at major international conferences. We anticipate that this review will contribute to identify key areas of improvement for conducting and reporting prognostic factor analyses with PROs in oncology and will lay the groundwork for developing future evidence-based recommendations in this area of research.Prospero registration numberCRD42018099160.

Download Full-text