Methodological Quality Assessment with the AGREE II Scale and A Comparison of European and American Guidelines for the Treatment of Lyme Borreliosis: A Systematic Review

Background: Most European and American countries recently updated their guidelines on Lyme borreliosis (LB). The aim of this study was to provide a comparative overview of existing guidelines on the treatment of LB in Europe and America and to assess the methodological quality of their elaboration. Methods: A systematic search was carried out in MEDLINE, Google Scholar, and the national databases of scientific societies from 2014 to 2020. Quality was assessed by two independent reviewers using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Results: Twelve guidelines were included. The scores for the AGREE II domains (median ± IQR) were: overall assessment 100 ± 22, scope and purpose 85 ± 46, stakeholder involvement 88 ± 48, rigour of development 67 ± 35, clarity of presentation 81 ± 36, applicability 73 ± 52 and editorial independence 79% ± 54%. Cohen’s weighted kappa showed a high agreement (K = 0.90, 95%CI 0.84–0.96). Guidelines were quite homogeneous regarding the recommended molecules (mostly doxycycline in the first intention and ceftriaxone in the second intention), their duration (10 to 28 days), and their dosage. The differences were due to the lack of well-conducted comparative trials. The International Lyme and Associated Diseases Society (ILADS) guidelines were the only ones to suggest longer antibiotics based on an expert consensus. Conclusion: European and American guidelines for the treatment of LB were quite homogeneous but based on moderate- to low-evidence studies. Well-conducted comparative trials are needed to assess the best molecules, the optimal duration and the most effective doses.

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

Oncology Reviews ◽

10.4081/oncol.2018.359 ◽

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.

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Appraisal of the current guidelines for the management of diverticular disease using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2021.0013 ◽

2021 ◽

Vol 103 (7) ◽

pp. 471-477

Author(s):

P Gavriilidis ◽

A Askari ◽

E Gavriilidis ◽

N de’Angelis ◽

S Di Saverio ◽

...

Keyword(s):

Diverticular Disease ◽

Methodological Quality ◽

Stakeholder Involvement ◽

German Society ◽

Cochrane Library ◽

Agree Ii ◽

American Society ◽

General And Visceral Surgery ◽

Agree Ii Instrument

Introduction Diverticular disease is one of the most frequent reasons for attending emergency departments and surgical causes of hospital admission. In the past decade, many surgical and gastroenterological societies have published guidelines for the management of diverticular disease. The aim of the present study was to appraise the methodological quality of these guidelines using the Appraisal of Guidelines Research and Evaluation II (AGREE II) tool. Methods PubMed, Embase, Cochrane Library and Google Scholar databases were searched systematically. The methodological quality of the guidelines was appraised independently by five appraisers using the AGREE II instrument. Findings A systematic search of the literature identified 12 guidelines. The median overall score of all guidelines was 68%. Across all guidelines, the highest score of 85% was demonstrated in the domain ‘Scope and purpose’. The domains ‘Clarity and presentation’ and ‘Editorial independence’ both scored a median of 72%. The lowest scores were demonstrated in the domains ‘Stakeholder involvement’ and ‘Applicability’ at 46% and 40%, respectively. Overall, the National Institute for Health and Care Excellence (NICE) guidelines performed consistently well, scoring 100% in five of six domains; NICE was one of the few guidelines that specifically reported stakeholder involvement, scoring 97%. Generally, the domain of ‘Stakeholder involvement’ ranked poorly with seven of twelve guidelines scoring below 50%, with the worst score in this domain demonstrated by Danish guidelines at 25%. Conclusion Six of twelve guidelines (NICE, American Society of Colon & Rectal Surgeons (ASCRS), European Society of Coloproctology (ESCP), American Gastroenterological Association, German Society of Gastroenterology/German Society for General and Visceral Surgery (German), Netherlands Society of Surgery) scored above 70%. Only three, NICE, ASCRS and ESCP, scored above 75% and were voted unanimously by the appraisers for use as they are. Therefore, use of AGREE II may help improve the methodological quality of guidelines and their future updates.

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A Critical Appraisal of Evidence- and Consensus-Based Guidelines for Actinic Keratosis

Current Oncology ◽

10.3390/curroncol28010093 ◽

2021 ◽

Vol 28 (1) ◽

pp. 950-960

Author(s):

Anja Wessely ◽

Theresa Steeb ◽

Franz Heppt ◽

Annkathrin Hornung ◽

Matthias D. Kaufmann ◽

...

Keyword(s):

Methodological Quality ◽

Treatment Options ◽

Stakeholder Involvement ◽

Agree Ii ◽

Canadian Guideline ◽

The United Kingdom ◽

Appropriate Treatment ◽

The Relationship ◽

Spearman’S Correlation

Actinic keratoses (AK) are common lesions of the skin that can be effectively treated with several lesion- and field-directed treatments. Clinical practice guidelines assist physicians in choosing the appropriate treatment options for their patients. Here, we aimed to systematically identify and evaluate the methodological quality of currently available guidelines for AK. Guidelines published within the last 5 years were identified in a systematic search of guideline databases, Medline and Embase. Then, six independent reviewers evaluated the methodological quality using the tools “Appraisal of Guidelines for Research and Evaluation” (AGREE II) and “Recommendation EXcellence” (AGREE-REX). The Kruskal–Wallis (H) test was used to explore differences among subgroups and Spearman’s correlation to examine the relationship between individual domains. Three guidelines developed by consortia from Canada, Germany and the United Kingdom were eligible for the evaluation. The German guideline achieved the highest scores, fulfilling 65 to 92% of the criteria in AGREE II and 67 to 84% in AGREE-REX, whereas the Canadian guideline scored 31 to 71% of the criteria in AGREE II and 33 to 46% in AGREE-REX. The domains “stakeholder involvement“ and “values and preferences“ were identified as methodological weaknesses requiring particular attention and improvement in future guideline efforts.

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

International Urogynecology Journal ◽

10.1007/s00192-021-04848-1 ◽

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.

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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)

10.21203/rs.3.rs-52338/v3 ◽

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.

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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)

Military Medicine ◽

10.1093/milmed/usab465 ◽

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.

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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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Quality Appraisal of Acne Clinical Practice Guidelines, 2008–2013

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2014.13190 ◽

2014 ◽

Vol 18 (6) ◽

pp. 385-391 ◽

Cited By ~ 2

Author(s):

Christopher Kawala ◽

Dilan Fernando ◽

Jerry K.L. Tan

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Methodological Quality ◽

Acne Vulgaris ◽

Stakeholder Involvement ◽

Agree Ii ◽

Common Chronic Disease ◽

Treatment Information ◽

Threshold Score

Background: Acne vulgaris is a common chronic disease, and evidence-based clinical practice guidelines (CPGs) can provide credible treatment information. Method: A literature search for acne CPGs published between January 2008 and September 2013 was conducted. Two reviewers independently applied the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Methodological quality was evaluated by ranking in AGREE II domains and the highest number of items scoring above the neutral threshold score. Results: Four CPGs fulfilled the selection criteria, and the highest ranked were the European and Malaysian. Highest scores achieved by the former were for scope/purpose, stakeholder involvement, and rigor of development and by the latter were for scope/purpose, clarity of presentation, and applicability. Applicability was the lowest scoring of all domains for all CPGs. Conclusion: European and Malaysian acne CPGs were ranked highest for methodological quality and may serve to inform clinical practice and guideline adaptation.

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

BMJ Open ◽

10.1136/bmjopen-2020-039897 ◽

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.

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