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

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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Appraisal of the Current Guidelines for Management of Malignant Left-Sided Colonic Obstruction Using the Appraisal of Guidelines Research and Evaluation II Instrument

Digestive Surgery ◽

10.1159/000514446 ◽

2021 ◽

pp. 1-9

Author(s):

Paschalis Gavriilidis ◽

Alan Askari ◽

Nicola de’Angelis ◽

Efstratios P. Gavriilidis ◽

James Wheeler ◽

...

Keyword(s):

Guideline Development ◽

Colonic Obstruction ◽

High Quality ◽

Agree Ii ◽

Guideline Quality ◽

Domain V ◽

Domain I ◽

Current Guidelines ◽

Agree Ii Instrument

Introduction: Colorectal cancer (CRC) is the fourth leading cause of death with 1.4 million new cases occurring annually worldwide. High-quality clinical practice guidelines are needed to tailor high-quality individualized treatment. The aim of the present study was to evaluate the methodological quality of the current guidelines for the management of acute malignant left-sided colonic bowel obstruction. Methods: A systematic search of the literature was carried out using electronic databases. The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was used to assess the quality of each guideline. Results: Search results returned a total of 14 guidelines appropriate for assessment. Both domain I (scope and purpose) and domain VI (editorial independence) were assessed with the same median score of 83%. The lowest scoring domain was domain V (applicability), scoring only 43%. The 2 guidelines that had the highest score were the National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN), each scoring 100%. However, there were significant variations in terms of quality. The NICE and New Zealand guidelines were voted unanimously for use unchanged, whilst 8 other guidelines were voted for use with modifications. Conclusion: Variation in guideline quality in CRC is a concern despite some clearly excellent published guidelines. All guidelines score poorly when it comes to describing how the guidelines could be applied. Lack of patient participation in guideline development is also a shortcoming that requires urgent redress.

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

Clinical Chemistry ◽

10.1373/clinchem.2012.185850 ◽

2012 ◽

Vol 58 (10) ◽

pp. 1426-1437 ◽

Cited By ~ 15

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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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

Pathogens ◽

10.3390/pathogens10080972 ◽

2021 ◽

Vol 10 (8) ◽

pp. 972

Author(s):

Steve Nguala ◽

Elisabeth Baux ◽

Solène Patrat-Delon ◽

Florian Saunier ◽

Julien Schemoul ◽

...

Keyword(s):

Lyme Borreliosis ◽

Methodological Quality ◽

Stakeholder Involvement ◽

Weighted Kappa ◽

Agree Ii ◽

High Agreement ◽

Effective Doses ◽

National Databases ◽

Comparative Trials

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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Critical appraisal of clinical practice guidelines for the management of COVID-19: protocol for a systematic review

Systematic Reviews ◽

10.1186/s13643-021-01871-7 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Thanansayan Dhivagaran ◽

Umaima Abbas ◽

Fahad Butt ◽

Luckshann Arunasalam ◽

Oswin Chang

Keyword(s):

Systematic Review ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Healthcare Providers ◽

World Health ◽

High Quality ◽

Agree Ii ◽

Agree Ii Instrument

Abstract Background In December 2019, a novel coronavirus, severe acute respiratory syndrome coronavirus 2 was identified as the cause of an acute respiratory disease, coronavirus disease 2019 (COVID-19). Given the lack of validated treatments, there is an urgent need for a high-quality management of COVID-19. Clinical practice guidelines (CPGs) are one tool that healthcare providers may use to enhance patient care. As such, it is necessary that they have access to high-quality evidence-based CPGs upon which they may base decisions regarding the management and use of therapeutic interventions (TI) for COVID-19. The purpose of the proposed study is to assess the quality of CPGs that make management or TI recommendations for COVID-19 using the AGREE II instrument. Methods The proposed systematic review will identify CPGs for TI use and/or the management of COVID-19. The MEDLINE, EMBASE, CINAHL, and Web of Science databases, as well as the Guidelines International Network, National Institute for Health and Clinical Excellence, Scottish Intercollegiate Guidelines Network, and the World Health Organization websites, will be searched from December 2019 onwards. The primary outcome of this study is the assessed quality of the CPGs. The quality of eligible CPGs will be assessed using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. Descriptive statistics will be used to quantify the quality of the CPGs. The secondary outcomes of this study are the types of management and/or TI recommendations made. Inconsistent and duplicate TI and/or management recommendations made between CPGs will be compared across guidelines. To summarize and explain the findings related to the included CPGs, a narrative synthesis will also be provided. Discussion The results of this study will be of utmost importance to enhancing clinical decision-making among healthcare providers caring for patients with COVID-19. Moreover, the results of this study will be relevant to guideline developers in the creation of CPGs or improvement of existing ones, researchers who want to identify gaps in knowledge, and policy-makers looking to encourage and endorse the adoption of CPGs into clinical practice. The results of this review will be published in a peer-reviewed journal and presented at conferences. Systematic review registration International Prospective Register for Systematic Reviews (PROSPERO)—CRD42020219944

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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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Assessing methodological quality of Russian clinical practice guidelines and introducing AGREE II instrument in Russia

PLoS ONE ◽

10.1371/journal.pone.0203328 ◽

2018 ◽

Vol 13 (9) ◽

pp. e0203328 ◽

Cited By ~ 1

Author(s):

Dina Ayratova Lienhard ◽

Lidiya Vacheslavovna Kisser ◽

Liliya Eugenevna Ziganshina

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Methodological Quality ◽

Agree Ii ◽

Agree Ii Instrument

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Appraising the methodological quality of the clinical practice guideline for diabetes mellitus using the AGREE II instrument: a methodological evaluation

JRSM Open ◽

10.1177/2054270416682673 ◽

2017 ◽

Vol 8 (2) ◽

pp. 205427041668267 ◽

Cited By ~ 13

Author(s):

Mahmoud Radwan ◽

Ali Akbari Sari ◽

Arash Rashidian ◽

Amirhossein Takian ◽

Sanaa Abou-Dagga ◽

...

Keyword(s):

Diabetes Mellitus ◽

Clinical Practice ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Methodological Quality ◽

Arabic Version ◽

Agree Ii ◽

Agree Ii Instrument ◽

Methodological Evaluation

Objectives To evaluate the methodological quality of the Palestinian Clinical Practice Guideline for Diabetes Mellitus using the Translated Arabic Version of the AGREE II. Design Methodological evaluation. A cross-cultural adaptation framework was followed to translate and develop a standardised Translated Arabic Version of the AGREE II. Setting Palestinian Primary Healthcare Centres. Participants Sixteen appraisers independently evaluated the Clinical Practice Guideline for Diabetes Mellitus using the Translated Arabic Version of the AGREE II. Main outcome measures Methodological quality of diabetic guideline. Results The Translated Arabic Version of the AGREE II showed an acceptable reliability and validity. Internal consistency ranged between 0.67 and 0.88 (Cronbach’s α). Intra-class coefficient among appraisers ranged between 0.56 and 0.88. The quality of this guideline is low. Both domains ‘Scope and Purpose’ and ‘Clarity of Presentation’ had the highest quality scores (66.7% and 61.5%, respectively), whereas the scores for ‘Applicability’, ‘Stakeholder Involvement’, ‘Rigour of Development’ and ‘Editorial Independence’ were the lowest (27%, 35%, 36.5%, and 40%, respectively). Conclusions The findings suggest that the quality of this Clinical Practice Guideline is disappointingly low. To improve the quality of current and future guidelines, the AGREE II instrument is extremely recommended to be incorporated as a gold standard for developing, evaluating or updating the Palestinian Clinical Practice Guidelines. Future guidelines can be improved by setting specific strategies to overcome implementation barriers with respect to economic considerations, engaging of all relevant end-users and patients, ensuring a rigorous methodology for searching, selecting and synthesising the evidences and recommendations, and addressing potential conflict of interests within the development group.

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Appraisal of national and international uterine fibroid management guidelines: a systematic review

10.22541/au.161907774.45454712/v1 ◽

2021 ◽

Author(s):

Alison Amoah ◽

Nikhitha Joseph ◽

Sophie Reap ◽

Stephen Quinn

Keyword(s):

Uterine Fibroid ◽

English Language ◽

Management Strategies ◽

Stakeholder Involvement ◽

Treatment Modalities ◽

Selection Strategy ◽

High Quality ◽

Agree Ii ◽

Power Morcellation ◽

Agree Ii Instrument

Background Guidelines standardise high-quality evidence-based management strategies for clinicians. Uterine fibroids are a highly prevalent condition and may exert significant morbidity. Objectives The purpose of this study was to appraise national and international uterine fibroid guidelines using the validated AGREE-II instrument. Selection Strategy An electronic database search of PubMed and EMBASE from inception to October 2020 for all published English-language uterine fibroid clinical practice guidelines was undertaken. Data Collection and Analysis 939 abstracts were screened for eligibility by two reviewers independently. Three reviewers used the AGREE-II instrument to assess guideline quality in six domains (scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence). Recommendations were mapped to allow a narrative synthesis regarding areas of consensus and disagreement. Main Results Eight national (AAGL, SOGC 2014, ACOG, ACR, SOGC 2019, CNGOF, ASRM, and SOGC 2015) and one international guideline (RANZOG) were appraised. The highest scoring guideline was RANZOG 2001(score 56.5%). None of the guidelines met the a priori criteria for being high-quality overall (score >= 66%). There were 166 recommendations across guidelines. There were several areas of disagreement and uncertainty. Conclusions There is a need for high-quality fibroid guidelines given heterogeneity across individuals and a large range of treatment modalities available. There are also areas of controversy in the management of fibroids (e.g. Ulipristal acetate, power morcellation) which also should be addressed in any guidelines. Future guidelines should be methodologically robust to allow high-quality decision-making regarding fibroid treatments.

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Evaluation of the current guidelines for antibacterial therapy strategies in patients with cirrhosis or liver failure

BMC Infectious Diseases ◽

10.1186/s12879-021-07018-2 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Yuzhu Dong ◽

Dan Sun ◽

Yan Wang ◽

Qian Du ◽

Ying Zhang ◽

...

Keyword(s):

Liver Failure ◽

Methodological Quality ◽

Bacterial Resistance ◽

Treatment Strategies ◽

Empirical Treatment ◽

Agree Ii ◽

First Choice ◽

Agree Ii Instrument ◽

Domain 4

Abstract Background Bacterial infections are common complications in patients with cirrhosis or liver failure and are correlated with high mortality. Clinical practice guideline (CPG) is a reference used to help clinicians make decisions. This systematic appraisal aimed to evaluate the methodological quality and summarize the recommendations of reported CPGs in these patients. Methods We systematically searched CPGs published from 2008 to 2019. The methodological quality of the included CPGs was assessed using the AGREE II instrument. We extracted and compared recommendations for prophylactic and empirical treatment strategies. Results Fourteen CPGs with a median overall score of 56.3% were included. The highest domain score was Clarity of Presentation (domain 4, 85.4%), and the lowest was for Stakeholder Involvement (domain 2, 31.3%). Three CPGs had an overall score above 80%, and 6 CPGs had a score above 90% in domain 4. Prophylaxis should be strictly limited to patients with varicose bleeding, low ascites protein levels and a history of spontaneous bacterial peritonitis. Fluoroquinolones (norfloxacin and ciprofloxacin), third-generation cephalosporins (G3) (ceftriaxone and cefotaxime) and trimethoprim–sulfamethoxazole (SXT) are recommended for preventing infections in patients with cirrhosis or liver failure. G3, β-lactam/β-lactamase inhibitor combinations (BLBLIs) and carbapenems are recommended as the first choice in empirical treatment according to local epidemiology of bacterial resistance. Conclusions The methodological quality of CPGs focused on patients with cirrhosis or liver failure evaluated by the AGREE II instrument is generally poor. Three CPGs that were considered applicable without modification and 6 CPGs that scored above 90% in domain 4 should also be paid more attention to by healthcare practitioners. Regarding recommendations, norfloxacin, ciprofloxacin, ceftriaxone, cefotaxime, and SXT are recommended for prophylactic treatment appropriately. G3, BLBLIs, and carbapenems are recommended for use in empirical treatment strategies.

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