Evidence-based nutritional guidelines: What is meant by trustworthy recommendations

The article aims to describe the characteristics of trustworthy recommendations as well as standards for trustworthy guidelines published by the Institute of Medicine and tools that can be used for quality assessment. The next section summarizes published assessments of guidelines quality using AGREE (Appraisal of Guidelines, Research and Evaluation Collaboration) Instrument and the problems raised by the National Academy of Sciences regarding nutritional guidelines development process. In this ones, similar problems are also reflected in the assessment of quality of nutritional guidelines, also using AGREE Instrument, since less than 50?% of the documents rated as high quality. The article is concluded with the description of NutriRECS protocol, as an example of strict, transparent and comprehensive approach to develop nutritional guidelines.

Evaluation of guidelines regarding surgical treatment of breast cancer using the AGREE Instrument: a systematic review

ObjectivesMany clinical practice guidelines and consensus statements (CPGs/consensus statements) have been developed for the surgical treatments for breast cancer. This study aims to evaluate the quality of these CPGs/consensus statements.MethodsWe systematically searched the PubMed and EMBASE databases, as well as four guideline repositories, to identify CPGs and consensus statements regarding surgical treatments for breast cancer between January 2009 and December 2016. We used the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument to assess the quality of the CPGs and consensus statements included. The overall assessment scores from the AGREE instrument and radar maps were used to evaluate the overall quality. We also evaluated some factors that may affect the quality of CPGs and consensus statements using the Mann-Whitney U test or Kruskal-Wallis H test. All analyses were performed using SPSS V.19.0. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsA total of 19 CPGs and four consensus statements were included. In general, the included CPGs/consensus statements (n=23) performed well in the ‘Scope and Purpose’ and ‘Clarity and Presentation’ domains, but performed poorly in the ‘Applicability’ domain. The American Society of Clinical Oncology (ASCO), National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), New Zealand Guidelines Group (NZGG) and Belgium Health Care Knowledge Centre (KCE) guidelines had the highest overall quality, whereas the Saskatchewan Cancer Agency, Spanish Society of Medical Oncology (SEOM), Japanese Breast Cancer Society (JBCS) guidelines and the D.A.C.H and European School of Oncology (ESO) consensus statements had the lowest overall quality. The updating frequency of CPGs/consensus statements varied, with the quality of consensus statements generally lower than that of CPGs. A total of six, eight and five CPGs were developed in the North American, European and Asian/Pacific regions, respectively. However, geographic region was not associated with overall quality.ConclusionsThe ASCO, NICE, SIGN, NZGG and KCE guidelines had the best overall quality, and the quality of consensus statements was generally lower than that of CPGs. More efforts are needed to identify barriers and facilitators for CPGs/consensus statement implementation and to improve their applicability.

A Critical Review of Low Back Pain Guidelines

Low back pain (LBP) remains one of the most common and challenging musculoskeletal conditions encountered by health care professionals and is a leading cause of absenteeism. Clinical guidelines are often considered best evidence in health care. The aim of this critical review was to assess the quality and recommendations of LBP guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. Electronic databases were used to identify LBP guidelines published between 2000 and 2015. Nine guidelines were selected for review from a total of 17. Only five guidelines effectively addressed the AGREE scoring. On the basis of the appraisal and domain scores, only four guidelines were strongly recommended. Improved translation of research evidence from guidelines to clinical practice is needed.