scholarly journals A Clinical Practice Guideline Appraisal for Appropriate Use of Echocardiography in Adult Infective Endocarditis—When to and by Which Mode to Perform an Echo?

2020 ◽  
Author(s):  
Peihan Xie ◽  
Xiaodong Zhuang ◽  
Menghui Liu ◽  
Shaozhao Zhang ◽  
Jia Liu ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Clinical Decision Making ◽  
Imaging Modality ◽  
Mode Selection ◽  
Stakeholder Involvement ◽  
Clinical Decision ◽  
Appropriate Use ◽  
Agree Ii ◽  
Native Valve

Abstract BackgroundEchocardiography (Echo) is the primary imaging modality of infective endocarditis (IE). The recommendations on timing and mode selection of transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) are not fully in agreement among different guidelines, which can be confusing for clinical decision makers. Thus, we aimed to appraise the quality of recommendations by appraising the quality of guidelines. MethodsA search of guidelines published in English during 2007 to 2020 which contains recommendations of appropriate use of Echo in IE adult patients has been conducted. PPRAISAL OF GUIDELINES FOR RESEARCH & EVALUATION II (AGREE II) instrument was applied independently by two reviews to assess the integrated quality of identified guidelines. The recommendations of concern were extracted from related chapters.ResultsA total of 9 guidelines meet the criteria with AGREE II score ranging from 36% to 79%, the domain of “stakeholder involvement” got the lowest score. According The most debatable issue is that under what circumstances has the repeated TEE for an initial positive TTE been necessary in suspected IE, the conflicting recommendations on it were presented along with relatively lower evidence level for hardly any related evidence based on.ConclusionsIn the 9 guidelines identified, the recommendations over the appropriate use of Echo are generally satisfying. Clinicians could take into account the guideline quality score when evaluating the recommendations for clinical decision making. More researches with high-grade evidence above the most controversial issues of whether a subsequent TEE is mandatory in uncomplicated native valve IE with an initial positive TTE are needed in the future.

scholarly journals An appraisal of clinical practice guidelines for the appropriate use of echocardiography for adult infective endocarditis—the timing and mode of assessment (TTE or TEE)

2020 ◽  
Author(s):  
Peihan Xie ◽  
Xiaodong Zhuang ◽  
Menghui Liu ◽  
Shaozhao Zhang ◽  
Jia Liu ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Imaging Modality ◽  
Mode Selection ◽  
Stakeholder Involvement ◽  
Clinical Decision ◽  
Appropriate Use ◽  
Agree Ii ◽  
Native Valve ◽  
Evidence Level

Abstract BackgroundEchocardiography (echo) is the primary imaging modality for infective endocarditis (IE). However, the recommendations on timing and mode selection for transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) vary across guidelines, which can be confusing for clinical decision makers. In this case, we aim to appraise the quality of recommendations by appraising the quality of various guidelines.MethodsA search of guidelines containing recommendations for the appropriate use of echo in adult IE patients published in English between 2007 and 2019 was conducted. The APPRAISAL OF GUIDELINES FOR RESEARCH & EVALUATION II (AGREE II) instrument was applied independently by two reviewers to assess the integrated quality of the identified guidelines. The recommendations of concern are extracted from related chapters.ResultsA total of 9 guidelines met the criteria, with AGREE II scores ranging from 36% to 79%, and the domain of “stakeholder involvement” received the lowest score. The most contentious issue is whether a follow-up TEE is mandatory in uncomplicated native valve IE with an initial positive TTE. Conflicting recommendations are presented with a low evidence level based on little evidence.ConclusionsIn general, the recommendations proposed in the 9 identified guidelines on the appropriate use of echo are satisfying. The guideline quality score can be taken into account by the clinicians when evaluating the recommendations for clinical decisions. Additional studies with high evidence level should be conducted on the most controversial issues of whether a subsequent TEE is mandatory in uncomplicated native valve IE with an initial positive TTE.

scholarly journals An appraisal of clinical practice guidelines for the appropriate use of echocardiography for adult infective endocarditis—the timing and mode of assessment (TTE or TEE)

2021 ◽  
Author(s):  
Peihan Xie ◽  
Xiaodong Zhuang ◽  
Menghui Liu ◽  
Shaozhao Zhang ◽  
Jia Liu ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Imaging Modality ◽  
Mode Selection ◽  
Stakeholder Involvement ◽  
Clinical Decision ◽  
Appropriate Use ◽  
Agree Ii ◽  
Native Valve ◽  
Evidence Level

Abstract Background Echocardiography (echo) is the primary imaging modality for infective endocarditis (IE). However, the recommendations on timing and mode selection for transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) vary across guidelines, which can be confusing for clinical decision makers. In this case, we aim to appraise the quality of recommendations by appraising the quality of various guidelines.Methods A search of guidelines containing recommendations for the appropriate use of echo in adult IE patients published in English between 2007 and 2019 was conducted. The APPRAISAL OF GUIDELINES FOR RESEARCH & EVALUATION II (AGREE II) instrument was applied independently by two reviewers to assess the integrated quality of the identified guidelines. The recommendations of concern are extracted from related chapters.Results A total of 9 guidelines met the criteria, with AGREE II scores ranging from 36% to 79%, and the domain of “stakeholder involvement” received the lowest score. The most contentious issue is whether a follow-up TEE is mandatory in uncomplicated native valve IE with an initial positive TTE. Conflicting recommendations are presented with a low evidence level based on little evidence.Conclusions In general, the recommendations proposed in the 9 identified guidelines on the appropriate use of echo are satisfying. The guideline quality score can be taken into account by the clinicians when evaluating the recommendations for clinical decisions. Additional studies with high evidence level should be conducted on the most controversial issues of whether a subsequent TEE is mandatory in uncomplicated native valve IE with an initial positive TTE.

scholarly journals A clinical practice guideline appraisal for appropriate use of echocardiography in adult infective endocarditis—when and by which mode to perform an Echo?

2020 ◽  
Author(s):  
Peihan Xie ◽  
Xiaodong Zhuang ◽  
Menghui Liu ◽  
Shaozhao Zhang ◽  
Jia Liu ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Imaging Modality ◽  
Mode Selection ◽  
Stakeholder Involvement ◽  
Clinical Decision ◽  
Appropriate Use ◽  
Agree Ii ◽  
Native Valve ◽  
Evidence Level

Abstract BackgroundEchocardiography (Echo) is the primary imaging modality of infective endocarditis (IE). However, the recommendations on timing and mode selection for transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) are not fully in agreement among different guidelines, which can be confusing for clinical decision makers. In this case, we aim to appraise the quality of recommendations by appraising the quality of guidelines. MethodsA search of guidelines containing recommendations for the appropriate use of Echo in IE adult patients published in English between 2007 and 2020 has been conducted. APPRAISAL OF GUIDELINES FOR RESEARCH & EVALUATION II (AGREE II) instrument is applied independently by two reviewers to assess the integrated quality of identified guidelines. The recommendations of concern are extracted from related chapters.ResultsA total of 9 guidelines meet the criteria with AGREE II score ranging from 36% to 79%, and the domain of “stakeholder involvement” receives the lowest score. The most contentious issue is, whether a follow-up TEE is mandatory in uncomplicated native valve IE with initial positive TTE. And conflicting recommendations on it are presented with low evidence level for hardly any related evidence based on.ConclusionsIn general, the recommendations proposed in the 9 identified guidelines on the appropriate use of Echo are satisfying. And the guideline quality score could be taken into account by the clinicians when evaluating the recommendations for making clinical decision. More researches are needed in the future, which should be with high evidence level on the most controversial issues of whether a subsequent TEE is mandatory in uncomplicated native valve IE with an initial positive TTE.

scholarly journals An appraisal of clinical practice guidelines for the appropriate use of echocardiography for adult infective endocarditis—the timing and mode of assessment (TTE or TEE)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Peihan Xie ◽  
Xiaodong Zhuang ◽  
Menghui Liu ◽  
Shaozhao Zhang ◽  
Jia Liu ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Imaging Modality ◽  
Mode Selection ◽  
Stakeholder Involvement ◽  
Clinical Decision ◽  
Appropriate Use ◽  
Agree Ii ◽  
Native Valve ◽  
Evidence Level

Abstract Background Echocardiography (echo) is the primary imaging modality for infective endocarditis (IE). However, the recommendations on timing and mode selection for transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) vary across guidelines, which can be confusing for clinical decision makers. In this case, we aim to appraise the quality of recommendations by appraising the quality of various guidelines. Methods A search of guidelines containing recommendations for the appropriate use of echo in adult IE patients published in English between 2007 and 2019 was conducted. The APPRAISAL OF GUIDELINES FOR RESEARCH & EVALUATION II (AGREE II) instrument was applied independently by two reviewers to assess the integrated quality of the identified guidelines. The recommendations of concern are extracted from related chapters. Results A total of 9 guidelines met the criteria, with AGREE II scores ranging from 36 to 79%, and the domain of “stakeholder involvement” received the lowest score. The most contentious issue is whether a follow-up TEE is mandatory in uncomplicated native valve IE with an initial positive TTE. Conflicting recommendations are presented with a low evidence level based on little evidence. Conclusions In general, the recommendations proposed in the 9 identified guidelines on the appropriate use of echo are satisfying. The guideline quality score can be taken into account by the clinicians when evaluating the recommendations for clinical decisions. Additional studies with high evidence level should be conducted on the most controversial issues of whether a subsequent TEE is mandatory in uncomplicated native valve IE with an initial positive TTE.

scholarly journals Critical Appraisal of International Guidelines for the Management of Diabetic Neuropathy: Is There Global Agreement in the Internet Era?

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Mingfang Sun ◽  
Min Zhang ◽  
Jing Shen ◽  
Juping Yan ◽  
Bo Zhou
Keyword(s):  
Diabetic Neuropathy ◽  
Clinical Decision Making ◽  
Selection Process ◽  
Improve Patient Care ◽  
Clinical Decision ◽  
Care Process ◽  
Agree Ii ◽  
International Guidelines ◽  
Global Agreement

Purpose.The management of diabetic neuropathy (DN) can be challenging. There exist many guidelines for DN management, but the quality of these guidelines has not been systematically evaluated or compared. The objective of our study was to assess the quality of these guidelines as a step toward their future optimization, the development of international guidelines, and, ultimately, the improvement of the care process.Methods.Relevant data were selected to identify international guidelines. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool was used to evaluate the quality of the selected guidelines. In addition, the reviewers summarized and compared all of the recommendations from the included guidelines for DN’s management.Results.Thirteen guidelines were included after the selection process. According to AGREE II, few guidelines scored well for all three aspects of DN management. Detailed comparisons revealed that these guidelines provide inconsistent recommendations, making it difficult for diabetes clinicians to choose appropriate guideline.Conclusions.The quality of most guidelines for the management of DN should be improved. Further studies should concentrate on developing internationally accepted and evidence-based guidelines that could be used for clinical decision making to improve patient care.

scholarly journals Evaluation of clinical practice guidelines (CPG) on the management of female chronic pelvic pain (CPP) using the AGREE II instrument

2021 ◽  
Author(s):  
Vishalli Ghai ◽  
Venkatesh Subramanian ◽  
Haider Jan ◽  
Jemina Loganathan ◽  
Stergios K. Doumouchtsis ◽  
...  
Keyword(s):  
Surgical Management ◽  
Guideline Development ◽  
Stakeholder Involvement ◽  
Professional Organizations ◽  
Agree Ii ◽  
Behavioural Interventions ◽  
Recommended Treatment ◽  
Muscular Dysfunction ◽  
Health Related

Abstract Introduction and hypothesis Variations in guidelines may result in differences in treatments and potentially poorer health-related outcomes. We aimed to systematically review and evaluate the quality of national and international guidelines and create an inventory of CPG recommendations on CPP. Methods We searched EMBASE and MEDLINE databases from inception till August 2020 as well as websites of professional organizations and societies. We selected national and international CPGs reporting on the diagnosis and management of female CPP. We included six CPGs. Five researchers independently assessed the quality of included guidelines using the AGREE II tool and extracted recommendations. Results Two hundred thirty-two recommendations were recorded and grouped into six categories: diagnosis, medical treatment, surgical management, behavioural interventions, complementary/alternative therapies and education/research. Thirty-nine (17.11%) recommendations were comparable including: a comprehensive pain history, a multi-disciplinary approach, attributing muscular dysfunction as a cause of CPP and an assessment of quality of life. Two guidelines acknowledged sexual dysfunction associated with CPP and recommended treatment with pelvic floor exercises and behavioural interventions. All guidelines recommended surgical management; however, there was no consensus regarding adhesiolysis, bilateral salpingo-oophorectomy during hysterectomy, neurectomy and laparoscopic uterosacral nerve ablation. Half of recommendations (106, 46.49%) were unreferenced or made in absence of good-quality evidence or supported by expert opinion. Based on the AGREE II assessment, two guidelines were graded as high quality and recommended without modifications (EAU and RCOG). Guidelines performed poorly in the “Applicability”, “Editorial Independence” and “Stakeholder Involvement” domains. Conclusion Majority of guidelines were of moderate quality with significant variation in recommendations and quality of guideline development.

scholarly journals Warning systems in a computerized nursing process for Intensive Care Units

2014 ◽  
Vol 48 (1) ◽  
pp. 125-132 ◽  
Author(s):  
Daniela Couto Carvalho Barra ◽  
Grace Teresinha Marcon Dal Sasso ◽  
Camila Rosália Antunes Baccin
Keyword(s):  
Patient Safety ◽  
Intensive Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Healthcare Research ◽  
Pelvic Surgery ◽  
Warning Systems ◽  
Nursing Process ◽  
Promote Patient Safety

A hybrid study combining technological production and methodological research aiming to establish associations between the data and information that are part of a Computerized Nursing Process according to the ICNP® Version 1.0, indicators of patient safety and quality of care. Based on the guidelines of the Agency for Healthcare Research and Quality and the American Association of Critical Care Nurses for the expansion of warning systems, five warning systems were developed: potential for iatrogenic pneumothorax, potential for care-related infections, potential for suture dehiscence in patients after abdominal or pelvic surgery, potential for loss of vascular access, and potential for endotracheal extubation. The warning systems are a continuous computerized resource of essential situations that promote patient safety and enable the construction of a way to stimulate clinical reasoning and support clinical decision making of nurses in intensive care.

scholarly journals The quality of guidelines in non-pharmacological prevention and management of chemotherapy-induced neuropathy: A review

2018 ◽  
Author(s):  
Shahin Salarvand ◽  
Simin Hemati ◽  
Payman Adibi ◽  
Fariba Taleghani
Keyword(s):  
Methodological Quality ◽  
Stakeholder Involvement ◽  
Common Adverse Effect ◽  
Adaptation Process ◽  
Medical Sciences ◽  
High Quality ◽  
Agree Ii ◽  
Pharmacological Prevention ◽  
Agree Ii Instrument

Chemotherapy-induced peripheral neuropathy is a common adverse effect occurring in patients undergoing neurotoxic chemotherapy. However, there is no FDA-approved treatment option for it. Given the importance of clinical practice guidelines in this area, this study aimed to determine the methodological quality of extant CIPN guidelines. The study was done as part of the adaptation process of CIPN related CPGs at Isfahan University of Medical Sciences, Iran. A systematic search of published CPGs about chemotherapy-induced CIPN in which the AGREE II instrument was applied for appraising CPGs of CIPN was performed. In general, amongst all of the AGREE II Instrument’s domains in the evaluated CPGs, the clarity of presentation and stakeholder involvement domains took favorable scores; and other domains obtained unfavorable and relatively favorable scores. The quality of cancer therapy-induced neuropathy CPGs needs to be improved and designing high-quality CPGs must be considered.

scholarly journals Opioid Analgesia: Perspectives on Right Use and Utility

2007 ◽  
Vol 3;10 (5;3) ◽  
pp. 479-491 ◽  
Author(s):  
Jane C. Ballantyne
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Side Effects ◽  
Clinical Decision Making ◽  
Analgesic Efficacy ◽  
Clinical Decision ◽  
Opioid Analgesia ◽  
Opioid Treatment

The ability of opioids to effectively and safely control acute and cancer pain has been one of several arguments used to support extending opioid treatment to patients with chronic pain, against a backdrop of considerable caution that has been based upon fears of addiction. Of course, opioids may cause addiction, but the “principle of balance” may justify that “…efforts to address abuse should not interfere with legitimate medical practice and patient care.” Yet, situations are increasingly encountered in which opioid-maintained patients are refractory to analgesia during periods of pain, or even during the course of chronic treatment. The real question is whether analgesic efficacy of opioids can be maintained over time. Overall, the evidence supporting long-term analgesic efficacy is weak. The putative mechanisms for failed opioid analgesia may be related to tolerance or opioid-induced hyperalgesia. Advances in basic sciences may help in understanding these phenomena, but the question of whether long-term opioid treatment can improve patients’ function or quality of life remains a broader issue. Opioid side effects are well known, but with chronic use, most (except constipation) subside. Still, side effects can negatively affect the outcomes and continuity of therapy. This paper addresses 1) what evidence supports the long-term utility of opioids for chronic pain; 2) how side effects may alter quality of life; 3) the nature of addiction and why it is different in pain patients, and 4) on what grounds could pain medication be denied? These questions are discussed in light of patients’ rights, and warrant balancing particular responsibilities with risks. These are framed within the Hippocratic tradition of “producing good for the patient and protecting from harm,” so as to enable 1) more informed clinical decision making, and 2) progress towards right use and utility of opioid treatment for chronic pain. Key Words: Opioids, chronic pain, addiction, side effects, utility, ethics

Beyond the Development of Health-Related Quality-of-Life (HRQOL) Measures: A Checklist for Evaluating HRQOL Outcomes in Cancer Clinical Trials—Does HRQOL Evaluation in Prostate Cancer Research Inform Clinical Decision Making?

2003 ◽  
Vol 21 (18) ◽  
pp. 3502-3511 ◽  
Author(s):  
Fabio Efficace ◽  
Andrew Bottomley ◽  
David Osoba ◽  
Carolyn Gotay ◽  
Henning Flechtner ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cancer Clinical Trials ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Purpose: The aim of this study was to evaluate whether the inclusion of health-related quality of life (HRQOL), as a part of the trial design in a randomized controlled trial (RCT) setting, has supported clinical decision making for the planning of future medical treatments in prostate cancer. Materials and Methods: A minimum standard checklist for evaluating HRQOL outcomes in cancer clinical trials was devised to assess the quality of the HRQOL reporting and to classify the studies on the grounds of their robustness. It comprises 11 key HRQOL issues grouped into four broader sections: conceptual, measurement, methodology, and interpretation. Relevant studies were identified in a number of databases, including MEDLINE and the Cochrane Controlled Trials Register. Both their HRQOL and traditional clinical reported outcomes were systematically analyzed to evaluate their consistency and their relevance for supporting clinical decision making. Results: Although 54% of the identified studies did not show any differences in traditional clinical end points between treatment arms and 17% showed a difference in overall survival, 74% of the studies showed some difference in terms of HRQOL outcomes. One third of the RCTs provided a comprehensive picture of the whole treatment including HRQOL outcomes to support their conclusions. Conclusion: A minimum set of criteria for assessing the reported outcomes in cancer clinical trials is necessary to make informed decisions in clinical practice. Using a checklist developed for this study, it was found that HRQOL is a valuable source of information in RCTs of treatment in metastatic prostate cancer.

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