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 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 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 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.

Critical Appraisal of Paralyzed Veterans of America Guidelines in Spinal Cord Injury: An International Collaborative Study Using the Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II)

2021 ◽  
Author(s):  
Ning Liang ◽  
Sizhan Wu ◽  
Simon Roberts ◽  
Navnit Makaram ◽  
James Reeves Mbori Ngwayi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Clinical Guidelines ◽  
Spinal Cord Injuries ◽  
Intraclass Correlation ◽  
Collaborative Study ◽  
Stakeholder Involvement ◽  
Correlation Coefficients ◽  
Agree Ii ◽  
Cord Injury

ABSTRACT Introduction Spinal cord injuries (SCI) in military personnel, veterans, and others require an evidence-based, multidisciplinary approach to their care. This appraisal used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument to evaluate the methodological quality of clinical guidelines for the management of SCI published by the Paralyzed Veterans of America (PVA) organization. Materials and Methods We searched clinical guidelines on SCI published by PVA until December 2019. Four appraisers across three international centers independently evaluated the quality of eligible clinical guidelines using AGREE II. Mean AGREE II scores for each domain were calculated. In higher quality domains, scores for individual items were analyzed. Results A total of 12 guidelines published by PVA on SCI were assessed. Mean scores for all six domains were as follows: Scope and Purpose (78.8%), Stakeholder Involvement (63.7%), Rigor of Development (68.4%), Clarity of Presentation (80.1%), Applicability (53.0%), and Editorial Independence (28.5%). The mean score for the overall quality of all PVA guidelines was 71.9% (95% CI: 69.7–74.1). No guideline was assessed as “not recommended” by any appraiser. Overall quality was significantly associated with year of publication (rs = 0.754, P = 0.0046). Overall agreement among appraisers was excellent (intraclass correlation coefficients for each guideline ranged from 0.96 to 0.99). Conclusions PVA guidelines for the management of SCI demonstrated acceptable or good quality across most domains. We recommend the use of PVA guidelines for the assessment and treatment of SCI and related disorders. The quality of PVA guidelines for the management of SCI have improved over time.

scholarly journals Management in the paediatric wards facing novel coronavirus infection: a rapid review of guidelines and consensuses

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e039897
Author(s):  
Wen-Yi Luo ◽  
Ji-Wen Sun ◽  
Wen-Lan Zhang ◽  
Qian Li ◽  
Ping Ni ◽  
...  
Keyword(s):  
Control Strategies ◽  
Stakeholder Involvement ◽  
Rapid Review ◽  
Cochrane Library ◽  
China National Knowledge Infrastructure ◽  
Agree Ii ◽  
Relevant Evidence ◽  
And Control ◽  
Agree Ii Tool

ObjectivesRelevant guidelines and consensuses for COVID-19 contain recommendations aimed at optimising the management in paediatric wards. The goal of this study was to determine the quality of those recommendations and provide suggestions to hospital managers for the adjustment of existing hospital prevention and control strategies, and also to offer recommendations for further research.DesignA rapid review of the guidelines and consensuses for the management in paediatric wards facing COVID-19.MethodsPubMed, EMBASE, the Cochrane Library, UpToDate, China National Knowledge Infrastructure, the Wanfang database and relevant websites such as medlive.cn, dxy.cn, the National Health and Health Commission and the China Center for Disease Control and Prevention were systematically searched through late May 2020. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool was then used to assess the quality of the selected articles and summarise the relevant evidence concerning management in paediatric wards.ResultsA total of 35 articles were included, composed of 3 consensus guidelines, 25 expert consensuses and 7 expert opinions. Of the 35 papers, 24 were from China, 2 from the USA, 1 from Spain, 1 from Brazil, 1 from Saudi Arabia and 6 from multinational cooperative studies. Scores for the six domains of the AGREE II tool (scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability and editorial independence) were 98.57%, 53.57%, 17.92%, 69.62%, 26.96% and 50.35%, respectively. Recommendations for nosocomial infection and control, human resource management as well as management of paediatric patients and their families were summarised.ConclusionsDue to the outbreak of COVID-19, the quality of rapid guidelines and consensuses for the management in paediatric wards affected by COVID-19 is unsatisfactory. In the future, it will be necessary to develop more high-quality guidelines or consensuses for the management in paediatric wards to deal with nosocomial outbreaks in order to fully prepare for emergency medical and health problems.

scholarly journals Appropriate Use Criteria and the Imaging Mandate

2017 ◽  
pp. 1
Author(s):  
Gregory J Dehmer ◽  
Leah White ◽  
John U Doherty ◽  
◽  
◽  
...  
Keyword(s):  
Imaging Modality ◽  
Clinical Care ◽  
Cost Savings ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Testing Procedures ◽  
Multiple Imaging ◽  
Clinical Scenarios ◽  
Unnecessary Procedures

Appropriate use criteria (AUC) have existed for over 30 years and are being deployed with increasing frequency to study the delivery of healthcare. The goal of AUC is to advise all stakeholders about the reasonable use of testing procedures or therapies to improve symptoms, quality of life, and health outcomes. Numerous studies have shown the favorable effects of AUC to limit the overuse of unnecessary procedures while also promoting high-quality clinical care and cost savings. AUC evaluating only a single imaging modality have been replaced by multimodality documents, making it easier for the clinician to evaluate the appropriateness of multiple imaging methods in various clinical scenarios. The Protecting Access to Medicare Act of 2014 contained language mandating the use of AUC when ordering certain advanced cardiac imaging tests, and this requirement is currently scheduled for implementation in January 2020. Clinicians need to be aware of the increasing use of AUC and the financial implications of the AUC mandate legislation.

scholarly journals Applicability of the AGREE II Instrument in Evaluating the Development Process and Quality of Current National Academy of Clinical Biochemistry Guidelines

2012 ◽  
Vol 58 (10) ◽  
pp. 1426-1437 ◽  
Author(s):  
Andrew C Don-Wauchope ◽  
John L Sievenpiper ◽  
Stephen A Hill ◽  
Alfonso Iorio
Keyword(s):  
Clinical Laboratory ◽  
Clinical Biochemistry ◽  
Guideline Development ◽  
Stakeholder Involvement ◽  
Laboratory Medicine ◽  
Quality Of Reporting ◽  
Agree Ii ◽  
Strongly Agree ◽  
Agree Ii Instrument

Abstract BACKGROUND Laboratory medicine practice guidelines (LMPGs) are an important part of clinical laboratory medicine. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument has been developed to evaluate the process of practice-guideline development and the quality of reporting. We assessed the applicability of AGREE II in assessing the National Academy of Clinical Biochemistry (NACB) LMPGs. METHODS The NACB website was searched for all available LMPGs up to December 2011. Two independent appraisers used the AGREE II instrument to assess each LMPG identified by the search. Quality was assessed across 6 domains (scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence), comprising a total of 23 items and 2 overall assessments, each scored on a 7-point scale (1, strongly disagree, to 7, strongly agree). All scores were expressed as AGREE II calculated percentages (100% indicates that all items scored 7 by all appraisers). RESULTS Eleven LMPGs were identified. All of the LMPGs provided some information seen as applicable to clinical practice by the appraisers. Only 5 of the LMPGs had overall scores ≥50%, with a median score of 42% (range: 8%–92%). Individual domain scores varied considerably from 0% to 100%. One guideline achieved a very high score on the instrument. CONCLUSIONS The AGREE II instrument is applicable and useful to evaluate LMPGs. All domains were evaluated as being useful to assess LMPGs, some were addressed well (e.g., clarity of presentation), whereas others could be improved (e.g., applicability).

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