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Mu J, Wang T, Ji M, Yin Q, Wang Z. Tracheostomy care of non-ventilated patients and COVID considerations: A scoping review of clinical practice guidelines and consensus statements. J Clin Nurs 2024; 33:3033-3055. [PMID: 38764213 DOI: 10.1111/jocn.17116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/06/2024] [Accepted: 03/05/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND The purpose of this study is to examine and evaluate the existing clinical practice guidelines and consensus statements regarding tracheostomy care for non-mechanically ventilated patients. METHODS A systematic search of databases, and professional organisations was conducted from inception to 19 March 2023. Two appraisers evaluated each guideline using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Text and Opinion Papers. RESULTS No specific clinical guidelines exist on airway management in non-mechanically ventilated patients. Of 6318 articles identified, we included 12 clinical practice guidelines, and 9 consensus statements, which were from China, the US, the UK, South Korea, Australia, France and Belgium. The AGREE II scores in six domains are (1) the scope and purpose, 70.30%; (2) stakeholder involvement, 37.61%; (3) rigor of development, 33.97%; (4) clarity of presentation, 68.16%; (5) applicability, 44.23% and (6) editorial independence, 40.06%. The overall quality of evidence was level B. The summarised recommendations for clinical practice encompass the following six areas: airway humidification, management of the trach cuff, management of inner cannula, tracheostoma care, tracheostomy suctioning and management and prevention of common post-operative complications. CONCLUSIONS The overall quality of the clinical guidelines on non-ventilated tracheostomy care was moderate, and further improvements are needed in domains of stakeholder involvement, applicability, clarity of presentation and editorial independence. Recommendations on non-ventilated tracheostomy care are often embedded in the guidelines on ventilated tracheostomy. Specific clinical guidelines are needed to provide a standardised approach to tracheostomy care for non-ventilated patients. RELEVANCE TO CLINICAL PRACTICE Patients with non-ventilated tracheostomy need specialised airway management. Improving patient outcomes requires standardised protocols, patient involvement, quality evaluation, and interdisciplinary approaches. NO PATIENT OR PUBLIC CONTRIBUTION The study reviewed clinical practice guidelines and consensus statements, therefore patient or public input was not needed.
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Affiliation(s)
- Juan Mu
- School of Nursing, Peking University, Beijing, China
| | - Tongyao Wang
- School of Nursing, LKS Faculty of Medicine, The University Hong Kong, Pokfulam, Hong Kong
| | - Mengmeng Ji
- School of Nursing, Peking University, Beijing, China
| | - Qian Yin
- Aviation General Hospital Beijing, Beijing, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, China
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Steiner L, Sackey J, Cohen D, Brody R. Evidence-based practice attitudes and nutrition support guideline knowledge between holders and nonholders of the Certified Nutrition Support Clinician credential. Nutr Clin Pract 2024; 39:934-944. [PMID: 38366972 DOI: 10.1002/ncp.11136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/26/2023] [Accepted: 01/21/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Clinical practice frequently changes, and professionals should stay abreast of evidence-based practice (EBP) guidelines. Negative attitudes towards EBP are a barrier to guideline adoption. This study explored EBP attitudes and knowledge of a complex nutrition support clinical case scenario of individuals holding or not holding the Certified Nutrition Support Clinician (CNSC) credential. METHODS This cross-sectional study used an online survey sent to American Society for Parenteral and Enteral Nutrition (ASPEN) members with and without the CNSC credential and all CNSC credential holders from the National Board of Nutrition Support Certification email list. The survey included the Evidence-Based Practice Attitude Scale Score (EBPAS-15) and eight knowledge questions using a nutrition support case scenario. An independent samples t test compared knowledge and EBPAS-15 total scores and subscores between CNSC holders and nonholders. Pearson correlation determined the correlation between knowledge and EBPAS-15 scores. RESULTS The response rate was 7.8% (N = 706). CNSC holders (n = 536) had significantly higher mean knowledge scores (4.7 ± 1.6 out of 8) than nonholders (n = 159, 4.1 ± 1.7) (P < 0.001). Total EBPAS-15 scores were not significantly different between CNSC holders (n = 542, 2.9 ± 0.4 out of 4) and nonholders (n = 164, 2.8 ± 0.7) (P = 0.434), and knowledge scores and total EBPAS-15 scores (P = 0.639) or subscores were not significantly correlated. CONCLUSIONS Regardless of holding the CNSC credential, EBPAS-15 scores indicated respondents had positive EBP attitudes. CNSC holders had significantly higher knowledge scores of recent nutrition support EBP guidelines compared with non-CNSC credential holders. Positive EBP attitudes are a precursor to clinical decision-making, but future research should determine the use of guidelines in clinical practice.
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Affiliation(s)
- Lea Steiner
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions Rutgers University, Newark, New Jersey, USA
| | - Joachim Sackey
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions Rutgers University, Newark, New Jersey, USA
| | - Deborah Cohen
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions Rutgers University, Newark, New Jersey, USA
| | - Rebecca Brody
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions Rutgers University, Newark, New Jersey, USA
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Blokzijl J, Pisters MF, Aspdahl M, de Boer W, Dybvik Matlary RE, Douma-van Riet D, de Kleijn P, Lobet S, Loughnane P, McLaughlin P, Bladen M, Roche S, Stephensen D, van Vlimmeren L, van Vulpen LFD, Timmer MA. A clinical practice guideline for primary care physiotherapy in patients with haemophilia. Haemophilia 2024. [PMID: 38987021 DOI: 10.1111/hae.15065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/30/2024] [Accepted: 05/21/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION As a result of centralisation of haemophilia care to a limited number of intramural settings, many persons with haemophilia have to travel long distances to attend their haemophilia specialised treatment centre. However, regular physiotherapy treatment can be provided by primary care physiotherapists in the person's own region. Due to the rarity of the disease most primary care physiotherapists have limited experience with this population. This study aims to provide a clinical practice guideline for primary care physiotherapists working with persons with bleeding disorders. METHOD A list of the most urgent key-questions was derived from a previous study. Literature was summarised using the grading of recommendations assessment, development, and evaluation (GRADE) evidence-to-decision framework. Recommendations were drafted based on four 90 min consensus meetings with expert physiotherapists. Recommendations were finalised after feedback and >80% consensus of all stakeholders (including PWH, physiotherapists, haematologists and the corresponding societies). RESULTS A list of 82 recommendations was formulated to support primary care physiotherapists when treating a person with a bleeding disorder. These recommendations could be divided into 13 categories: two including recommendations on organisation of care, six on therapy for adult patients with bleeding disorders and five on therapy adaptations for paediatric care. Therapy recommendations included treatment after a joint- or muscle bleed, haemophilic arthropathy, chronic synovitis, non-haemophilia related conditions and orthopaedic surgery. CONCLUSION An evidence-based practice guideline, based on current evidence from literature and clinical expertise, has been developed for primary care physiotherapists treating a person with haemophilia. To improve care, the recommendations should be implemented in daily practice.
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Affiliation(s)
- Johan Blokzijl
- Centre for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, the Netherlands
- Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Martijn F Pisters
- Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | - Magnus Aspdahl
- Women's Health and Allied Health Professionals Theme, Pediatric occupational therapy and physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Wypke de Boer
- Department of Rehabilitation, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ruth Elise Dybvik Matlary
- Department of Clinical Service, Section for physiotherapy, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Piet de Kleijn
- Centre for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Sébastien Lobet
- Hemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain (UCLouvain), Ottignies-Louvain-la-Neuve, Belgium
| | | | - Paul McLaughlin
- Research Department of Haematology, University College London, London, UK
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Melanie Bladen
- Haemophilia Center, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Great Ormond St, Institute of Child Health, University College London, London, UK
| | - Sheila Roche
- National Coagulation Centre, St. James's Hospital, Dublin, Ireland
| | - David Stephensen
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, UK
| | - Leo van Vlimmeren
- Department of Rehabilitation, Paediatric Physical Therapy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lize F D van Vulpen
- Centre for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Merel A Timmer
- Centre for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, the Netherlands
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Ugwu CV, Jergel A, Murray B, Rees CA, Jain S. Clinical Practice Guideline Development in Pediatric Emergency Medicine Departments Across the United States: A Cross-sectional Study. Pediatr Emerg Care 2024:00006565-990000000-00487. [PMID: 38950408 DOI: 10.1097/pec.0000000000003230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
OBJECTIVE This cross-sectional study aimed to assess the process of clinical practice guideline (CPG) development in pediatric emergency medicine departments (PEDs) across the United States, with a focus on identifying areas for improvement to enhance the quality of CPGs. METHODS An electronic survey was distributed to PEDs with pediatric emergency medicine fellowship programs. Respondents were asked about their CPG development processes (ie, guideline committee composition, consideration of conflicts of interest, grading recommendations, guideline training opportunities) based on the Appraisal of Guidelines, Research, and Evaluation (AGREE II) tool as well as implementation and monitoring. Univariate analysis was used to assess associations between the number of AGREE II elements adhered to and annual patient volume. RESULTS Of the 84 PEDs surveyed, 44 (52.4%) responded, representing institutions from 28 states. Most PEDs (97.7%, n = 43) reported developing their own guidelines, citing the need to improve care quality and standardize patient care as primary reasons. Although most guideline committees included multidisciplinary team members (74.4%, n = 32), routine patient involvement in committees was rare (11.6%, n = 5), and barriers such as time and resource constraints hindered their inclusion. Formal training for committee members in guideline development was uncommon (18.6%, n = 8). There was an association between higher annual patient volume and the number of AGREE II elements adhered to (P = 0.03). Few PEDs considered potential conflicts of interest among committee members (13.6%, n = 6). Over half of surveyed PEDs (54.5%, n = 24) lacked a systematic approach to grading recommendations. Educational materials and workshops were the most common guideline implementation strategies. CONCLUSIONS Our findings highlight need for improvement in the CPG development process in PEDs. Including patients in committees, providing formal training for committee members, and adopting a rigorous approach to grading recommendations are crucial steps toward enhancing guideline quality. Emphasizing these improvements has the potential to improve the quality of CPGs for pediatric emergency care.
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Affiliation(s)
| | - Andrew Jergel
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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Chen K, Lee Y, Kuriakose JP, Khan NS, Moreira A, Rajasekaran K. Appraisal of clinical practice guidelines for salivary gland cancer management utilizing AGREE II instrument. Am J Otolaryngol 2024; 45:104285. [PMID: 38657536 DOI: 10.1016/j.amjoto.2024.104285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/05/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Salivary gland cancers (SGC) are rare neoplasms which comprise 1-5 % of all head and neck cancers. SGCs can be managed by resection, radiosurgery, chemotherapy, or a combination of these. Our team appraised the quality of clinical practice guidelines (CPGs) for SGC treatment and management using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) instrument. DATA SOURCES PubMed, Scopus, & EMBASE were reviewed for CPGs regarding SGC management from database inception to January 1st, 2023. REVIEW METHODS The AGREE-II instrument was used by 4 reviewers to independently evaluate guidelines. Domain scores were generated with a satisfactory threshold being >60 % - a "high" quality CPG required >4 satisfactory domains. Intraclass correlation coefficients (ICCs) were used, via R 4.2.1., to determine inter-reviewer variability. RESULTS Literature review identified 645 articles, with six being included after applying inclusion and exclusion criteria. Of the six included articles, one CPG was "high" quality and 5 were "low" quality. The domains with the highest scores were "Editorial Independence" (72.57 ± 36.60) and "Clarity and Presentation" (63.19 ± 26.08), while the lowest were "Rigor of Development" (34.03 ± 30.63) and "Applicability" (30.21 ± 30.46). ICC scores for each domain ranged from 0.937 to 0.983, indicating a high level of inter-rater agreement. CONCLUSION This study found that most CPGs for the treatment and management of SGC were of "low" quality, with only one guideline being considered "high" quality based on the standard set by the AGREE-II instrument. These findings indicate that there is a high level of variability and little standardization when it comes to the quality of CPGs.
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Affiliation(s)
- Kaiwen Chen
- Department of Otolaryngology - Head and Neck Surgery, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, United States of America. https://twitter.com/KChenTweets
| | - Young Lee
- Central Michigan University College of Medicine, Mount Pleasant, MI, United States of America
| | - Jonathan P Kuriakose
- Department of Otolaryngology - Head and Neck Surgery, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, United States of America; Department of Otolaryngology - Head & Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America. https://twitter.com/kuriousjon96
| | - Najm S Khan
- Department of Otolaryngology - Head and Neck Surgery, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, United States of America. https://twitter.com/Najm__Khan
| | - Alvaro Moreira
- Department of Pediatrics, University of Texas Health-San Antonio, San Antonio, TX, United States of America
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America.
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Soares A, Schilling LM, Richardson J, Kommadi B, Subbian V, Dehnbostel J, Shahin K, Robinson KA, Afzal M, Lehmann HP, Kunnamo I, Alper BS. Making Science Computable Using Evidence-Based Medicine on Fast Healthcare Interoperability Resources: Standards Development Project. J Med Internet Res 2024; 26:e54265. [PMID: 38916936 PMCID: PMC11234056 DOI: 10.2196/54265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Evidence-based medicine (EBM) has the potential to improve health outcomes, but EBM has not been widely integrated into the systems used for research or clinical decision-making. There has not been a scalable and reusable computer-readable standard for distributing research results and synthesized evidence among creators, implementers, and the ultimate users of that evidence. Evidence that is more rapidly updated, synthesized, disseminated, and implemented would improve both the delivery of EBM and evidence-based health care policy. OBJECTIVE This study aimed to introduce the EBM on Fast Healthcare Interoperability Resources (FHIR) project (EBMonFHIR), which is extending the methods and infrastructure of Health Level Seven (HL7) FHIR to provide an interoperability standard for the electronic exchange of health-related scientific knowledge. METHODS As an ongoing process, the project creates and refines FHIR resources to represent evidence from clinical studies and syntheses of those studies and develops tools to assist with the creation and visualization of FHIR resources. RESULTS The EBMonFHIR project created FHIR resources (ie, ArtifactAssessment, Citation, Evidence, EvidenceReport, and EvidenceVariable) for representing evidence. The COVID-19 Knowledge Accelerator (COKA) project, now Health Evidence Knowledge Accelerator (HEvKA), took this work further and created FHIR resources that express EvidenceReport, Citation, and ArtifactAssessment concepts. The group is (1) continually refining FHIR resources to support the representation of EBM; (2) developing controlled terminology related to EBM (ie, study design, statistic type, statistical model, and risk of bias); and (3) developing tools to facilitate the visualization and data entry of EBM information into FHIR resources, including human-readable interfaces and JSON viewers. CONCLUSIONS EBMonFHIR resources in conjunction with other FHIR resources can support relaying EBM components in a manner that is interoperable and consumable by downstream tools and health information technology systems to support the users of evidence.
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Affiliation(s)
- Andrey Soares
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lisa M Schilling
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Joshua Richardson
- Center for Informatics, Research Triangle Institute International, Berkeley, CA, United States
| | - Bhagvan Kommadi
- Quantica Computacao, Hyderabad, India
- Scientific Knowledge Accelerator Foundation, Franklin, NC, United States
| | - Vignesh Subbian
- Scientific Knowledge Accelerator Foundation, Franklin, NC, United States
- College of Public Health, Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
| | - Joanne Dehnbostel
- Scientific Knowledge Accelerator Foundation, Franklin, NC, United States
- Computable Publishing LLC, Franklin, NC, United States
| | - Khalid Shahin
- Scientific Knowledge Accelerator Foundation, Franklin, NC, United States
- Computable Publishing LLC, Franklin, NC, United States
| | - Karen A Robinson
- Scientific Knowledge Accelerator Foundation, Franklin, NC, United States
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Muhammad Afzal
- Scientific Knowledge Accelerator Foundation, Franklin, NC, United States
- Department of Computing and Data Science, Birmingham City University, England, United Kingdom
| | - Harold P Lehmann
- Scientific Knowledge Accelerator Foundation, Franklin, NC, United States
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Ilkka Kunnamo
- Scientific Knowledge Accelerator Foundation, Franklin, NC, United States
- Duodecim Publishing Company Ltd, Helsinki, Finland
| | - Brian S Alper
- Scientific Knowledge Accelerator Foundation, Franklin, NC, United States
- Computable Publishing LLC, Franklin, NC, United States
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Nou-Fontanet L, Nguyen QTR, Bachoud-Levi AC, Reinhard C, Ortigoza-Escobar JD. Insights from European Reference Network for rare neurological disorders study surveys on diagnosis, treatment, and management of NKX2-1-related disorders. Eur J Paediatr Neurol 2024; 51:110-117. [PMID: 38917695 DOI: 10.1016/j.ejpn.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 04/28/2024] [Accepted: 06/18/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND NKX2-1-related disorder (NKX2-1-RD) is a rare disease characterized by a triad of primary hypothyroidism, neonatal respiratory distress, and neurological features, including chorea. OBJECTIVE This study aimed to identify discrepancies in the management of NKX2-1-RD among European Union (EU) specialists. METHODS The ERN-RND Chorea & Huntington disease group designed a survey to conduct a cross-sectional multicenter study on the management of NKX2-1-RD. Descriptive analysis was performed, and total responses are presented for each item. RESULTS The study involved 23 experts from 13 EU countries with experience in evaluating hyperkinetic patients with NKX2-1-RD: 11 were adult specialists, and 12 were pediatric specialists. NKX2-1-RD diagnosis was made at different ages, with the most common initial symptoms being hypotonia and/or motor developmental delay (reported by 11 experts) and chorea (reported by 8 experts). Chorea involved various body parts and showed improvement as reported by 9 experts, stabilization by 12 experts, and worsening by 2 experts with age. The pharmacological treatment of chorea varied widely among the experts. Misdiagnosis was reported by 14 experts. NKX2-1 pathogenic variants or deletions were confirmed in >75 % of patients (reported by 12 experts). Pulmonary and endocrinology evaluations were requested by 7 and 12 experts, respectively. The management of psychiatric comorbidities also varied among the different experts. CONCLUSIONS This study highlights the need for a clinical practice guideline for the management of NKX2-1-RD to ensure that patients across the EU receive consistent and appropriate care. Such a guideline would benefit both doctors and healthcare practitioners.
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Affiliation(s)
- Laia Nou-Fontanet
- Department of Paediatric Neurology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Quang Tuan Rémy Nguyen
- Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, National Center of Reference for Huntington's Disease, Créteil, France; Département D'Etudes Cognitives, École Normale Supérieure, PSL University, Paris, France; Univ Paris Est Creteil, INSERM, U955, Institut Mondor de Recherche Biomédicale, Laboratoire de Neuropsychologie Interventionnelle, Creteil, France
| | - Anne-Catherine Bachoud-Levi
- Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, National Center of Reference for Huntington's Disease, Créteil, France; Département D'Etudes Cognitives, École Normale Supérieure, PSL University, Paris, France; Centre for Rare Diseases and Institute of Medical Genetics and Applied Genomics, University Hospital Tübingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Carola Reinhard
- Centre for Rare Diseases and Institute of Medical Genetics and Applied Genomics, University Hospital Tübingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Juan Darío Ortigoza-Escobar
- Department of Paediatric Neurology, Hospital Sant Joan de Déu, Barcelona, Spain; Centre for Rare Diseases and Institute of Medical Genetics and Applied Genomics, University Hospital Tübingen, Calwerstr. 7, 72076, Tübingen, Germany; U-703 Centre for Biomedical Research on Rare Diseases (CIBER-ER), Instituto de Salud Carlos III, Barcelona, Spain.
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Deffert F, Vilela APO, Cobre ADF, Furlan LHP, Tonin FS, Fernandez-Lllimos F, Pontarolo R. Methodological quality and clinical recommendations of guidelines on the management of dyslipidaemias for cardiovascular disease risk reduction: a systematic review and an appraisal through AGREE II and AGREE REX tools. Fam Pract 2024:cmae029. [PMID: 38831566 DOI: 10.1093/fampra/cmae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Clinical practice guidelines (CPGs) are statements to assist practitioners and stakeholders in decisions about healthcare. Low methodological quality guidelines may prejudice decision-making and negatively affect clinical outcomes in non-communicable diseases, such as cardiovascular diseases worsted by poor lipid management. We appraised the quality of CPGs on dyslipidemia management and synthesized the most updated pharmacological recommendations. METHODS A systematic review following international recommendations was performed. Searches to retrieve CPG on pharmacological treatments in adults with dyslipidaemia were conducted in PubMed, Scopus, and Trip databases. Eligible articles were assessed using AGREE II (methodological quality) and AGREE-REX (recommendation excellence) tools. Descriptive statistics were used to summarize data. The most updated guidelines (published after 2019) had their recommendations qualitatively synthesized in an exploratory analysis. RESULTS Overall, 66 guidelines authored by professional societies (75%) and targeting clinicians as primary users were selected. The AGREE II domains Scope and Purpose (89%) and Clarity of Presentation (97%), and the AGREE-REX item Clinical Applicability (77.0%) obtained the highest values. Conversely, guidelines were methodologically poorly performed/documented (46%) and scarcely provided data on the implementability of practical recommendations (38%). Recommendations on pharmacological treatments are overall similar, with slight differences concerning the use of supplements and the availability of drugs. CONCLUSION High-quality dyslipidaemia CPG, especially outside North America and Europe, and strictly addressing evidence synthesis, appraisal, and recommendations are needed, especially to guide primary care decisions. CPG developers should consider stakeholders' values and preferences and adapt existing statements to individual populations and healthcare systems to ensure successful implementation interventions.
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Affiliation(s)
- Flávia Deffert
- Pharmaceutical Sciences Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
| | - Ana Paula Oliveira Vilela
- Pharmaceutical Assistance Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
| | - Alexandre de Fátima Cobre
- Pharmaceutical Sciences Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
| | | | - Fernanda Stumpf Tonin
- Pharmaceutical Sciences Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
- Pharmaceutical Assistance Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Avenida D. João II, Lote 4.69.01, Parque das Nações, Lisboa 1990-096, Portugal
| | - Fernando Fernandez-Lllimos
- Applied Molecular Biosciences Unit (UCIBIO), Institute for Health and Bioeconomy (i4HB), Laboratory of Pharmacology Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto 4050-313, Portugal
| | - Roberto Pontarolo
- Pharmaceutical Sciences Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
- Pharmaceutical Assistance Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
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Grimes AC, Sugalski AJ, Nuño MM, Ramakrishnan S, Beauchemin MP, Robinson PD, Santesso N, Walsh AM, Wrightson AR, Yu LC, Parsons SK, Sung L, Dupuis LL. Clinical Practice Guideline-Inconsistent Management of Fertility Preservation in Pediatric Cancer Patients in Community Settings: A Children's Oncology Group Study. J Adolesc Young Adult Oncol 2024. [PMID: 38770790 DOI: 10.1089/jayao.2024.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Background: The primary objective was to measure adherence to clinical practice guideline (CPG) recommendations for fertility preservation (FP) in pediatric cancer patients treated in National Cancer Institute Community Oncology Research Program (NCORP) sites. Secondary objectives were to describe factors such as site size associated with CPG-inconsistent care delivery and cryopreservation completion. Methods: This retrospective, multicenter study included patients 15 to 21 years old with a first cancer diagnosis from January 2014 through December 2015 who were previously enrolled to a Children's Oncology Group (COG) study and received care at a participating NCORP site. Patients were randomly selected from a list generated by the COG for chart review by participating sites. Primary outcome was care delivery that was inconsistent with a strong CPG recommendation on FP, namely discussion and offering of FP options before cancer treatment initiation, as adjudicated centrally by a panel. Results: A total of 129 patients from 25 sites were included. Among these, 48% (62/129) received CPG-inconsistent care. Most CPG-inconsistent care was due to lack of FP discussion documentation (93.5%, 58/62). Small site size, treatment at a pediatric (vs mixed adult/pediatric) site, and female sex were associated with higher odds of CPG-inconsistent care delivery. Conclusions: Newly diagnosed pediatric cancer patients often received CPG-inconsistent care for FP, with disproportionate gaps noted for females, and those treated at smaller or pediatric NCORP sites. The primary reason for CPG-inconsistent care is lack of FP discussion from clinicians. Opportunities to improve FP CPG implementation are highlighted.
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Affiliation(s)
- Allison C Grimes
- University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Aaron J Sugalski
- University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Michelle M Nuño
- Children's Oncology Group, Monrovia, California, USA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | | | | | | | - Nancy Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Alexandra M Walsh
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, University of Arizona, Phoenix, Arizona, USA
| | - Andrea R Wrightson
- Clinical Research Nurse Coordinator, Nemours Center for Cancer and Blood Disorders, Wilmington, Delaware, USA
| | - Lolie C Yu
- LSUHSC/Children's Hospital, New Orleans, Louisiana, USA
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies and Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Lillian Sung
- Research Institute, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, The Hospital for Sick Children; Faculty of Medicine, University of Toronto, Toronto, Canada
| | - L Lee Dupuis
- Research Institute, The Hospital for Sick Children, Toronto, Canada
- Department of Pharmacy, The Hospital for Sick Children; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
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10
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Andersen MZ, Zeinert P, Rosenberg J, Fonnes S. Comparative analysis of Cochrane and non-Cochrane reviews over three decades. Syst Rev 2024; 13:120. [PMID: 38698429 PMCID: PMC11064235 DOI: 10.1186/s13643-024-02531-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/13/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Systematic reviews are viewed as the best study design to guide clinical decision-making as they are the least biased publications assuming they are well-conducted and include well-designed studies. Cochrane was initiated in 1993 with an aim of conducting high-quality systematic reviews. We aimed to examine the publication rates of non-Cochrane systematic reviews (henceforth referred to simply as "systematic reviews") and Cochrane reviews produced throughout Cochrane's existence and characterize changes throughout the period. METHODS This observational study collected data on systematic reviews published between 1993 and 2022 in PubMed. Identified Cochrane reviews were linked to data from the Cochrane Database of Systematic Reviews via their Digital Object Identifier. Systematic reviews and Cochrane reviews were analyzed separately. Two authors screened a random sample of records to validate the overall sample, providing a precision of 98%. RESULTS We identified 231,602 (94%) systematic reviews and 15,038 (6%) Cochrane reviews. Publication of systematic reviews has continuously increased with a median yearly increase rate of 26%, while publication of Cochrane reviews has decreased since 2015. From 1993 to 2002, Cochrane reviews constituted 35% of all systematic reviews in PubMed compared with 3.5% in 2013-2022. Systematic reviews consistently had fewer authors than Cochrane reviews, but the number of authors increased over time for both. Chinese first authors conducted 15% and 4% of systematic reviews published from 2013-2022 and 2003-2012, respectively. Most Cochrane reviews had first authors from the UK (36%). The native English-speaking countries the USA, the UK, Canada, and Australia produced a large share of systematic reviews (42%) and Cochrane reviews (62%). The largest publishers of systematic reviews in the last 10 years were gold open access journals. CONCLUSIONS Publication of systematic reviews is increasing rapidly, while fewer Cochrane reviews have been published through the last decade. Native English-speaking countries produced a large proportion of both types of systematic reviews. Gold open access journals and Chinese first authors dominated the publication of systematic reviews for the past 10 years. More research is warranted examining why fewer Cochrane reviews are being published. Additionally, examining these systematic reviews for research waste metrics may provide a clearer picture of their utility.
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Affiliation(s)
- Mikkel Zola Andersen
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Borgmester Ib Juuls Vej 1, Herlev, 2730, Denmark.
- Cochrane Colorectal Group, Herlev and Gentofte Hospitals, University of Copenhagen, Borgmester Ib Juuls Vej 1, Herlev, 2730, Denmark.
| | - Philine Zeinert
- Copenhagen University Library, Royal Danish Library, Søren Kierkegaards Plads 1, Copenhagen K, 1221, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Borgmester Ib Juuls Vej 1, Herlev, 2730, Denmark
- Cochrane Colorectal Group, Herlev and Gentofte Hospitals, University of Copenhagen, Borgmester Ib Juuls Vej 1, Herlev, 2730, Denmark
| | - Siv Fonnes
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Borgmester Ib Juuls Vej 1, Herlev, 2730, Denmark
- Cochrane Colorectal Group, Herlev and Gentofte Hospitals, University of Copenhagen, Borgmester Ib Juuls Vej 1, Herlev, 2730, Denmark
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11
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Hu C, Zhang W, Pu H, Fei K, Li Q, Huang J. Quality evaluation of clinical practice guidelines for placenta accreta spectrum disorders. Heliyon 2024; 10:e28390. [PMID: 38571606 PMCID: PMC10988008 DOI: 10.1016/j.heliyon.2024.e28390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction We evaluated the quality of the published clinical practice guidelines on placenta accreta spectrum (PAS) disorders to provide reference for the development of high-quality PAS guidelines. Methods China National Knowledge Infrastructure (CNKI), Wan Fang, PubMed, Embase, Web of Science, and Cochrane Library were systematically searched. Quality assessments were conducted using the appraisal of guidelines for research and evaluation (AGREE) II framework and Reporting Items for practice Guidelines in Healthcare (RIGHT) checklist. Intraclass correlation coefficients (ICCs) were used to measure the agreement among reviewers. Results In total, 13 guidelines from different countries, published between 2015 and 2021 were included. There included 9 official guidelines, 3 consensuses, and 1 standard reference and covered subjects including epidemiology, diagnosis and treatment. The mean standardized scores across 6 domains (scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence) were 53.63%, 27.35%, 33.57%, 72.01%, 19.39% and 41.02%, respectively. Of the 13 guidelines, 11 were classified as grade B, whereas 2 as grade C. According to the RIGHT checklist, the overall reporting rate of the 13 guidelines ranged from 28.57% to 54.29%. Conclusion The current guidelines for PAS demonstrate commendable methodological and reporting qualities. However, the methodological and reporting quality of PAS CPGs still need to be further improved, particularly in stakeholder involvement, the rigor of development, applicability, and editorial independence domains.
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Affiliation(s)
- Caihong Hu
- Department of Obstetrics, Xiangya Hospital Central South University, Changsha, China
| | - Weishe Zhang
- Department of Obstetrics, Xiangya Hospital Central South University, Changsha, China
- Hunan Engineering Research Center of Early Life Development and Disease Prevention, Changsha, China
| | - Heyang Pu
- Department of Obstetrics, Xiangya Hospital Central South University, Changsha, China
| | - Kuilin Fei
- Department of Obstetrics, Xiangya Hospital Central South University, Changsha, China
| | - Qi Li
- Reproductive Medicine Center, Xiangya Hospital Central South University, Changsha, China
| | - Jingrui Huang
- Department of Obstetrics, Xiangya Hospital Central South University, Changsha, China
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12
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Ou J, Li J, Liu Y, Su X, Li W, Zheng X, Zhang L, Chen J, Pan H. Quality appraisal of clinical guidelines for Helicobacter pylori infection and systematic analysis of the level of evidence for recommendations. PLoS One 2024; 19:e0301006. [PMID: 38598539 PMCID: PMC11006150 DOI: 10.1371/journal.pone.0301006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 03/09/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVES To systematically assess the quality of clinical practice guidelines (CPGs) for Helicobacter pylori (HP) infection and identify gaps that limit their development. STUDY DESIGN AND SETTING CPGs for HP infection were systematically collected from PubMed, Embase, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, and six online guideline repositories. Three researchers independently used the AGREE Ⅱ tool to evaluate the methodological quality of the eligible CPGs. In addition, the reporting and recommendation qualities were appraised by using the RIGHT and AGREE-REX tools, respectively. The distribution of the level of evidence and strength of recommendation among evidence-based CPGs was determined. RESULTS A total of 7,019 records were identified, and 24 CPGs met the eligibility criteria. Of the eligible CPGs, 19 were evidence-based and 5 were consensus-based. The mean overall rating score of AGREE II was 50.7% (SD = 17.2%). Among six domains, the highest mean score was for scope and purpose (74.4%, SD = 17.7%) and the lowest mean score was for applicability (24.3%, SD = 8.9). Only three of 24 CPGs were high-quality. The mean overall score of recommendation quality was 35.5% (SD = 12.2%), and the mean scores in each domain of AGREE-REX and RIGHT were all ≤ 60%, with values and preferences scoring the lowest (16.6%, SD = 11.9%). A total of 505 recommendations were identified. Strong recommendations accounted for 64.1%, and only 34.3% of strong recommendations were based on high-quality evidence. CONCLUSION The overall quality of CPGs for HP infection is poor, and CPG developers tend to neglect some domains, resulting in a wide variability in the quality of the CPGs. Additionally, CPGs for HP infection lack sufficient high-quality evidence, and the grading of recommendation strength should be based on the quality of evidence. The CPGs for HP infection have much room for improvement and further researches are required to minimize the evidence gap.
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Affiliation(s)
- Jiayin Ou
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiayu Li
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yang Liu
- The Second Clinical Medicine College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaohong Su
- The People’s Hospital of Gaozhou, Gaozhou, China
| | - Wanchun Li
- School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaojun Zheng
- Clinical Medical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lang Zhang
- The Second Clinical Medicine College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jing Chen
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huafeng Pan
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
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Hubeishy MH, Rossen CB, Dannapfel P, Thomas K, Jensen TS, Maribo T, Rolving N. Developing a low back pain guideline implementation programme in collaboration with physiotherapists and chiropractors using the Behaviour Change Wheel: a theory-driven design study. Implement Sci Commun 2024; 5:33. [PMID: 38570830 PMCID: PMC10993475 DOI: 10.1186/s43058-024-00568-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/09/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Low back pain is still the leading cause of disability and societal burden, with 619 million prevalent cases worldwide in 2020. Most countries produce clinical guidelines to support healthcare professionals in evidence-based care regarding low back pain. However, several studies have identified relatively poor uptake of guidelines. Tailored strategies to facilitate the implementation of guidelines have been argued to increase uptake. This study aimed to develop a contextually tailored implementation programme to enhance evidence-based low back pain care among Danish physiotherapists and chiropractors in primary care. METHODS A theory-driven implementation programme development study was conducted using the Behaviour Change Wheel, with high healthcare professional involvement. Data collection included four workshops with seven physiotherapists and six chiropractors from primary care clinics. The development process consisted of [1] establishing a theoretical frame, [2] involving participants, [3] understanding the behaviour, [4] designing the implementation programme, and [5] final implementation programme. RESULTS The target behaviours selected (guideline recommendations) for the implementation programme were (i) screening of psychosocial risk factors and (ii) offering patient education. The barriers and facilitators for the selected behaviours were described and linked to intervention functions and behavioural techniques. Finally, the implementation programme comprised five strategies: webinars, e-learning videos, communication exercises, peer learning, and group dialogue meetings. In addition, the programme consisted of implementation support: champions, a physical material folder, a weekly email reminder, a specially designed website and a visit from an implementation consultant. An essential element of the overall programme was that it was designed as a step-by-step implementation process consisting of 16 h of education and training distributed over 16 weeks. CONCLUSIONS A programme for implementing low back pain guideline recommendations was developed based on behaviour change theory and four co-design workshops involving healthcare professionals to overcome the contextually identified barriers. A theory-driven approach involving healthcare professionals was useful in identifying relevant target behaviours and tailoring the programme to consider contextual barriers and facilitators for implementation. The effectiveness of the final implementation programme will be evaluated in the project's next phase. TRIAL REGISTRATION Central Denmark Region, Registered November 11, 2021, act no. 1-16-02-93-19.
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Affiliation(s)
- Maja Husted Hubeishy
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Hospital in Central Denmark Region, Falkevej 1-3, 8600, Silkeborg, Denmark.
- Department of Public Health, Aarhus University, Aarhus, Denmark.
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.
| | - Camilla Blach Rossen
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Hospital in Central Denmark Region, Falkevej 1-3, 8600, Silkeborg, Denmark
| | - Petra Dannapfel
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Kristin Thomas
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tue Secher Jensen
- Diagnostic Centre - Imaging Section, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Region Denmark, Aarhus, Denmark
| | - Nanna Rolving
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
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14
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Mostert KA, Perera J, Higano JD, Davis PT, Buus RJ, Gerberi D, Meiling J, Prideaux C. The Efficacy of Physical Therapy to Alleviate Symptomatic Thoracic Radiculopathy: A Systematic Review and Meta-Narrative Analysis. Ann Rehabil Med 2024; 48:105-114. [PMID: 38589206 PMCID: PMC11058367 DOI: 10.5535/arm.23136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 04/10/2024] Open
Abstract
To evaluate the efficacy of physical therapy (PT) to alleviate symptomatic thoracic radiculopathy (TR) without the use of invasive procedures. Database search was conducted by an experienced medical librarian from inception until January 27, 2023, in EBSCO CINAHL with Full Text, Ovid Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid MEDLINE, Scopus, and Web of Science Core Collection. Inclusion criteria included studies that involved adult patients (age≥18) who had a magnetic resonance imaging-confirmed TR and underwent a structured, supervised PT program of any length. All types of studies were included. Study quality and risk of bias were assessed using the National Heart, Lung, and Blood Institute (NHLBI) Study Quality of Assessment Tool. Certainty in evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. A meta-analysis was not performed. A total of 1,491 studies were screened and 7 studies met inclusion criteria, 5 case studies and 2 cohort studies. All studies showed improvement or resolution of the TR with PT. Quantitative improvements were not noted in most studies and PT regimens were sparsely described. Overall quality assessment demonstrated 3 studies had "good," 1 "fair," and 3 "poor" quality evidence. Certainty of evidence was "low" due to risk of bias. A dedicated PT program may help to alleviate symptomatic TR; however due to limited evidence, risk of bias, and low certainty in evidence, the data is too weak to support a definite conclusion.
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Affiliation(s)
- Karson A Mostert
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | - Jacob Perera
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | - Jennifer Dens Higano
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | - Patrick T Davis
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | - Ryan J Buus
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | - Danielle Gerberi
- Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, United States
| | - James Meiling
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Cara Prideaux
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
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15
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Lee AHH, Wright AP, Westcott MJ, Shan LL, Choong PF, Davies AH. A Systematic Review of the Quality of Clinical Practice Guidelines for Chronic Limb-Threatening Ischemia. Ann Vasc Surg 2024; 100:81-90. [PMID: 38122972 DOI: 10.1016/j.avsg.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/14/2023] [Accepted: 10/21/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND To assess the quality of clinical practice guidelines (CPGs) for chronic limb-threatening ischemia (CLTI) using the Appraisal of Guidelines for Research and Evaluation II instrument. METHODS A systematic review of Medline, Embase, and online CPG databases was carried out. Four CPGs on CLTI were identified: Global Vascular Guidelines (GVG), European Society of Cardiology (ESC), American College of Cardiology, and National Institute for Health and Care Excellence guidelines on lower limb peripheral arterial disease. Two independent appraisers analyzed the 4 CPGs using the Appraisal of Guidelines for Research and Evaluation II instrument. CPGs were ranked across 6 domains with 23 items that ranged from 1 (strongly disagree) to 7 (strongly agree). A scaled domain score was calculated as a percentage of the maximum possible score achievable. A domain score of ≥50% and an overall average domain score of ≥80% reflected a CPG of adequate quality recommended for use. RESULTS GVG had the highest overall score (82.9%), as an average of all domains, and ESC had the lowest score (50.2%). GVG and National Institute for Health and Care Excellence guidelines had all domains scoring >50%, while American College of Cardiology had 5 and ESC had 3. Two domains, rigor of development and applicability, scored the lowest among the CPGs. There was a lack of detail in describing systematic methods used in the literature review, how guidelines were formulated with minimal bias, and the planned procedure for updating the guidelines. Implications of guideline application and monitoring of outcomes after implementations were not explicitly discussed. CONCLUSIONS The GVG guideline published in 2019 discussing CLTI is assessed to be of high quality and recommended for use. This review helps to improve clinical decision-making and quality of future CPGs for CLTI.
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Affiliation(s)
| | | | - Mark J Westcott
- Department of Vascular Surgery, St Vincent's Hospital, Melbourne, Australia
| | - Leonard L Shan
- Department of Vascular Surgery, St Vincent's Hospital, Melbourne, Australia
| | - Peter F Choong
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Alun H Davies
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
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16
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Lynne-Joseph A. The reproduction of knowledge hierarchies in transgender medicine: Professional, lay, and global expertise in clinical practice guidelines. Soc Sci Med 2024:116712. [PMID: 38443306 DOI: 10.1016/j.socscimed.2024.116712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/09/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024]
Abstract
The process for developing clinical practice guidelines in medicine has changed dramatically over time. Previously, small groups of clinicians crafted clinical practice guidelines based on their professional expertise, but guideline developers must increasingly consider patients' lay expertise, global expertise, and principles of evidence-based medicine. This article analyzes how the World Professional Association for Transgender Health grappled with diverse forms of expertise and evidence-based medicine in the process of creating its "Standards of Care for the Health of Transgender and Gender Diverse People, Version 8" (hereafter, SOC-8), a prominent set of clinical practice guidelines in transgender medicine. Analysis is based on 83 interviews with clinicians, patients, and activists in the U.S. and Thailand between 2019 and 2021, as well as observation of transgender health conferences and content analysis of written materials. I find that despite the ostensible goal of incorporating more diverse expertise in this version of the guidelines, the SOC-8 ultimately reproduced traditional knowledge hierarchies in science and medicine in which the lay expertise of transgender and gender non-conforming patients and expertise from the Global South remain marginalized. I attribute this re-marginalization to the regulatory objectivity enacted in the SOC-8 revision process, which re-legitimized professional expertise, established no formal infrastructure for ensuring the equal participation of Global South stakeholders, and permitted limited inclusion of lay expertise from transgender and gender non-conforming people with relatively high levels of privilege (according to race, education, and other social statuses). These findings have implications for future research on knowledge hierarchies in science and medicine and the creation of clinical practice guidelines.
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Affiliation(s)
- Alyssa Lynne-Joseph
- Wichita State University, Department of Sociology, 1845 Fairmount Street, Wichita, KS, 67260, USA.
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Levi-Abayo S, Ben-Shabat S, Gandelman-Marton R. Guidelines and epilepsy practice: Antiseizure medication initiation following an unprovoked first seizure in adults. Epilepsy Res 2024; 200:107304. [PMID: 38237220 DOI: 10.1016/j.eplepsyres.2024.107304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES Adherence rate to evidence-based clinical practice guidelines is relatively low and the impact of guidelines on clinical practice in epilepsy is variable. The 2015 practice guideline on the management of an unprovoked first seizure in adults specifies clinical variables associated with increased risk of seizure recurrence and the impact of immediate antiseizure medication (ASM) treatment on seizure outcome. We aimed to evaluate the impact of the evidence-based guideline for the management of an unprovoked first seizure in adults on clinical practice in our adult neurology department. METHODS We retrospectively reviewed the computerized database of 169 adult patients admitted to the adult neurology department at Shamir-Assaf Harofeh Medical Center following a first unprovoked seizure between October 2011 and October 2018. RESULTS ASMs were initiated in 86% of patients with a first unprovoked seizure pre- and in all patients admitted post- guideline publication. Monotherapy and use of old generation ASMs were more common in both groups and a combination of old- and new generation ASMs - among the pre-guideline group. The pre-guideline decision to initiate ASM treatment was significantly influenced only by epileptiform discharges in the electroencephalogram (EEG). DISCUSSION This is the first study to evaluate the impact of the 2015 practice guideline on the initiation of ASM treatment after a first unprovoked seizure in adults. Further studies are needed to assess the global contribution of the guideline to clinical practice and its impact on patient outcomes.
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Affiliation(s)
- Shir Levi-Abayo
- Department of Clinical Biochemistry and Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Shimon Ben-Shabat
- Department of Clinical Biochemistry and Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Revital Gandelman-Marton
- Neurology Department, Shamir-Assaf Harofeh Medical Center, Zerifin, Israel; Faculty of Medicine, Tel Aviv University, Israel.
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18
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Block H, Paul M, Muir-Cochrane E, Bellon M, George S, Hunter SC. Clinical practice guideline recommendations for the management of challenging behaviours after traumatic brain injury in acute hospital and inpatient rehabilitation settings: a systematic review. Disabil Rehabil 2024; 46:453-463. [PMID: 36694351 DOI: 10.1080/09638288.2023.2169769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 01/13/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE Clinical practice guideline (CPG) recommendations for the management of challenging behaviours after traumatic brain injury (TBI) in hospital and inpatient rehabilitation settings are sparse. This systematic review aims to identify and appraise CPGs, and report high-quality recommendations for challenging behaviours after TBI in hospital and rehabilitation settings. MATERIALS AND METHODS A three-step search strategy was conducted to identify CPGs that met inclusion criteria. Two reviewers independently scored the AGREE II domains. Guideline quality was assessed based on CPGs adequately addressing four out of the six AGREE II domains. Data extraction was performed with a compilation of high-quality CPG recommendations. RESULTS Seven CPGs out of 408 identified records met the inclusion criteria. Two CPGs were deemed high-quality. High-quality CPG recommendations with the strongest supporting evidence include behaviour management plans; beta-blockers for the treatment of aggression; selective serotonin reuptake inhibitors for moderate agitation; adamantanes for impaired arousal/attention in agitation; specialised, multi-disciplinary TBI behaviour management services. CONCLUSIONS This systematic review identified and appraised the quality of CPGs relating to the management of challenging behaviours after TBI in acute hospital and rehabilitation settings. Further research to rigorously evaluate TBI behaviour management programs, investigation of evidence-practice gaps, and implementation strategies for adopting CPG recommendations into practice is needed.Implications for rehabilitationTwo clinical practice guidelines appraised as high-quality outline recommendations for the management of challenging behaviours after traumatic brain injury in hospital and inpatient rehabilitation settings.High-quality guideline recommendations with the strongest supporting evidence for non-pharmacological treatment include behaviour management plans considering precipitating factors, antecedents, and reinforcing events.High-quality guideline recommendations with the strongest supporting evidence for pharmacological management include beta blockers for aggression in traumatic brain injury.Few guidelines provide comprehensive detail on the implementation of recommendations into clinical care which may limit adoption.
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Affiliation(s)
- Heather Block
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, Australia
- Division of Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Maria Paul
- South Australian Brain Injury Rehabilitation Services, Adelaide, Australia
| | - Eimear Muir-Cochrane
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, Australia
| | - Michelle Bellon
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, Australia
| | - Stacey George
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, Australia
| | - Sarah C Hunter
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, Australia
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Stock L, Turcotte J, Johnson A, Holbert SE, Siska M, Pipkin K, Patton C. Evaluating the success of an inpatient PA and NP program through trends in ED consults. JAAPA 2024; 37:41-46. [PMID: 38051811 DOI: 10.1097/01.jaa.0000995648.20577.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE We investigated the effect of an inpatient physician associate/assistant (PA) and NP program on consult volume, length of stay (LOS), and ED returns. METHODS A retrospective observational study of 4,118 orthopedic ED consults was conducted from January 2017 to March 2022. Univariate statistics were used to evaluate outcomes between cohorts and multivariate regression to evaluate the odds of an LOS of less than 24 hours. RESULTS After implementation of the PA and NP program, surgeon consults steadily declined and orthopedic consults increased markedly. Statistically significant differences were found in LOS of less than 24 hours and ED arrival-to-discharge time. Adjusting for case mix, patients were 47% more likely to be discharged within 24 hours. Survey results noted that more than 80% of surgeons felt on-call workload, disruptions to clinic and surgical schedules decreased, and quality of care increased. CONCLUSIONS Implementation of an inpatient PA and NP program reduced orthopedic surgeon consults and hospital LOS while improving surgeon satisfaction with on-call workload, schedule disruptions, and quality of care.
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Affiliation(s)
- Laura Stock
- At Luminis Health Anne Arundel Medical Center in Annapolis, Md., Laura Stock is an orthopedic research fellow, Justin Turcotte is director of orthopedic and surgical research, and Andrea Johnson is an orthopedic research fellow and research analyst. Samuel E. Holbert is an orthopedic research fellow at Luminis Health Anne Arundel Medical Center and a general surgery resident at the Medical University of South Carolina in Charleston, S.C. Also at Luminis Health Anne Arundel Medical Center, Matthew Siska practices in orthopedics, Karen Pipkin is an orthopedic NP and lead advanced practice provider for Luminis Health orthopedics, and Chad Patton is an attending orthopedic surgeon and medical director for spine surgery. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Kolaski K, Logan LR, Ioannidis JPA. Guidance to best tools and practices for systematic reviews. Br J Pharmacol 2024; 181:180-210. [PMID: 37282770 DOI: 10.1111/bph.16100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 06/08/2023] Open
Abstract
Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy. A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work. Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.
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Affiliation(s)
- Kat Kolaski
- Departments of Orthopaedic Surgery, Pediatrics, and Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Lynne Romeiser Logan
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, New York, USA
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University School of Medicine, Stanford, California, USA
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21
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Couto FM, de Sousa FSDO, Vicente GC, Castro DPDF, Nadanovsky P, Dos Santos APP, Barja-Fidalgo F. Health professionals' recommendations on the use of fluoride varnish for caries prevention in preschool children. Int J Paediatr Dent 2024; 34:11-25. [PMID: 37101236 DOI: 10.1111/ipd.13074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Fluoride varnish (FV) is widely recommended for caries prevention in preschool children, despite its anticaries benefits being uncertain and modest. Dentists often report using clinical practice guidelines (CPGs) as a source of scientific information. AIM To identify and analyze recommendations for clinical practice on the use of FV for caries prevention in preschool children and to assess the methodological quality of the CPG on this topic. DESIGN Two researchers independently used 12 search strategies and searched the first five pages of Google Search™ and three guideline databases for recommendations freely available to health professionals on the use of FV for caries prevention in preschoolers. Then, they retrieved and recorded recommendations that met the eligibility criteria and extracted the data. A third researcher resolved disagreements. Each included CPG was appraised using the AGREE II instrument. RESULTS Twenty-nine documents were included. Recommendations varied according to age, patients' caries risk, and application frequency. Of the six CPGs, only one scored above 70% in the AGREE II overall assessment. CONCLUSION Recommendations on the use of FV lacked scientific evidence, and CPGs were of poor quality. Application of FV is widely recommended despite recent evidence showing an uncertain, modest, and possibly not clinically relevant anticaries benefit. Dentists should be aware that it is necessary to critically appraise CPGs since they may be of poor quality.
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Affiliation(s)
- Flávia Macedo Couto
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Gabriela Cristina Vicente
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Daniel Pereira de Faria Castro
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Paulo Nadanovsky
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ana Paula Pires Dos Santos
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Fernanda Barja-Fidalgo
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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22
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Gloviczki P, Lawrence PF, Wasan SM, Meissner MH, Almeida J, Brown KR, Bush RL, Di Iorio M, Fish J, Fukaya E, Gloviczki ML, Hingorani A, Jayaraj A, Kolluri R, Murad MH, Obi AT, Ozsvath KJ, Singh MJ, Vayuvegula S, Welch HJ. The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part II: Endorsed by the Society of Interventional Radiology and the Society for Vascular Medicine. J Vasc Surg Venous Lymphat Disord 2024; 12:101670. [PMID: 37652254 DOI: 10.1016/j.jvsv.2023.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/20/2023] [Indexed: 09/02/2023]
Abstract
The Society for Vascular Surgery, the American Venous Forum, and the American Vein and Lymphatic Society recently published Part I of the 2022 clinical practice guidelines on varicose veins. Recommendations were based on the latest scientific evidence researched following an independent systematic review and meta-analysis of five critical issues affecting the management of patients with lower extremity varicose veins, using the patients, interventions, comparators, and outcome system to answer critical questions. Part I discussed the role of duplex ultrasound scanning in the evaluation of varicose veins and treatment of superficial truncal reflux. Part II focuses on evidence supporting the prevention and management of varicose vein patients with compression, on treatment with drugs and nutritional supplements, on evaluation and treatment of varicose tributaries, on superficial venous aneurysms, and on the management of complications of varicose veins and their treatment. All guidelines were based on systematic reviews, and they were graded according to the level of evidence and the strength of recommendations, using the GRADE method. All ungraded Consensus Statements were supported by an extensive literature review and the unanimous agreement of an expert, multidisciplinary panel. Ungraded Good Practice Statements are recommendations that are supported only by indirect evidence. The topic, however, is usually noncontroversial and agreed upon by most stakeholders. The Implementation Remarks contain technical information that supports the implementation of specific recommendations. This comprehensive document includes a list of all recommendations (Parts I-II), ungraded consensus statements, implementation remarks, and best practice statements to aid practitioners with appropriate, up-to-date management of patients with lower extremity varicose veins.
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Affiliation(s)
- Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN.
| | - Peter F Lawrence
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Los Angeles, CA
| | - Suman M Wasan
- Department of Medicine, University of North Carolina, Chapel Hill, Rex Vascular Specialists, UNC Health, Raleigh, NC
| | - Mark H Meissner
- Division of Vascular Surgery, University of Washington, Seattle, WA
| | - Jose Almeida
- Division of Vascular and Endovascular Surgery, University of Miami Miller School of Medicine, Miami, FL
| | | | - Ruth L Bush
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX
| | | | - John Fish
- Department of Medicine, Jobst Vascular Institute, University of Toledo, Toledo, OH
| | - Eri Fukaya
- Division of Vascular Surgery, Stanford University, Stanford, CA
| | - Monika L Gloviczki
- Department of Internal Medicine and Gonda Vascular Center, Rochester, MN
| | | | - Arjun Jayaraj
- RANE Center for Venous and Lymphatic Diseases, Jackson, MS
| | - Raghu Kolluri
- Heart and Vascular Service, OhioHealth Riverside Methodist Hospital, Columbus, OH
| | - M Hassan Murad
- Evidence Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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23
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Bocanegra-Becerra JE, Batista S, Costa Vieitas F, Takahashi R, Oliveira LDB, Castillo-Huerta NM, Ludeña-Esquivel A, Bertani R. In reply to the Letter to the Editor regarding "Awake surgery for glioma resection during pregnancy: a systematic review". Neurosurg Rev 2023; 47:23. [PMID: 38153532 DOI: 10.1007/s10143-023-02255-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 12/29/2023]
Affiliation(s)
| | - Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rafael Takahashi
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, Brazil
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24
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Khalid M, Sutterfield B, Minley K, Ottwell R, Abercrombie M, Heath C, Torgerson T, Hartwell M, Vassar M. The Reporting and Methodological Quality of Systematic Reviews Underpinning Clinical Practice Guidelines Focused on the Management of Cutaneous Melanoma: Cross-Sectional Analysis. JMIR DERMATOLOGY 2023; 6:e43821. [PMID: 38060306 PMCID: PMC10739238 DOI: 10.2196/43821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/28/2023] [Accepted: 09/15/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Clinical practice guidelines (CPGs) inform evidence-based decision-making in the clinical setting; however, systematic reviews (SRs) that inform these CPGs may vary in terms of reporting and methodological quality, which affects confidence in summary effect estimates. OBJECTIVE Our objective was to appraise the methodological and reporting quality of the SRs used in CPGs for cutaneous melanoma and evaluate differences in these outcomes between Cochrane and non-Cochrane reviews. METHODS We conducted a cross-sectional analysis by searching PubMed for cutaneous melanoma guidelines published between January 1, 2015, and May 21, 2021. Next, we extracted SRs composing these guidelines and appraised their reporting and methodological rigor using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) checklists. Lastly, we compared these outcomes between Cochrane and non-Cochrane SRs. All screening and data extraction occurred in a masked, duplicate fashion. RESULTS Of the SRs appraised, the mean completion rate was 66.5% (SD 12.29%) for the PRISMA checklist and 44.5% (SD 21.05%) for AMSTAR. The majority of SRs (19/50, 53%) were of critically low methodological quality, with no SRs being appraised as high quality. There was a statistically significant association (P<.001) between AMSTAR and PRISMA checklists. Cochrane SRs had higher PRISMA mean completion rates and higher methodological quality than non-Cochrane SRs. CONCLUSIONS SRs supporting CPGs focused on the management of cutaneous melanoma vary in reporting and methodological quality, with the majority of SRs being of low quality. Increasing adherence to PRISMA and AMSTAR checklists will likely increase the quality of SRs, thereby increasing the level of evidence supporting cutaneous melanoma CPGs.
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Affiliation(s)
- Mahnoor Khalid
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Bethany Sutterfield
- Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States
| | - Kirstien Minley
- Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States
| | - Ryan Ottwell
- Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States
| | - McKenna Abercrombie
- Dermatology Residency, Trinity Health Ann Arbor Hospital, Ypsilanti, MI, United States
| | - Christopher Heath
- Dermatology Residency, Trinity Health Ann Arbor Hospital, Ypsilanti, MI, United States
| | - Trevor Torgerson
- Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States
| | - Micah Hartwell
- Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States
| | - Matt Vassar
- Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States
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25
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Lilova R, Dubin J, Hameed D, Pettijohn WA, Bains SS, Reich J, Moore MC, Delanois RE. Assessment of the AAOS guidelines using the AGREE II instrument: An update. J Orthop 2023; 46:83-89. [PMID: 37969226 PMCID: PMC10643090 DOI: 10.1016/j.jor.2023.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/29/2023] [Indexed: 11/17/2023] Open
Abstract
Background The American Academy of Orthopaedic Surgeons (AAOS) provides clinical guidelines and frequently updates and expands on the recommendations. High quality, up-to-date, and applicable clinical guidelines are increasingly important tools for physicians to have. Assessing these continuously updating guidelines' overall quality has most recently been done in 2013 when there were 14 guidelines. Since then, nearly all guidelines have been updated and now 28 guidelines are provided. Our goal was to evaluate the updated 2023 AAOS guidelines using the well-established Advancing Guideline Development, Reporting and Evaluation in Health Care (AGREE II) tool. Methods On April 23, 2023, all 28 guidelines set forth by AAOS were compiled. Using the AGREE II tool, a well-recognized and established tool for evaluation of guideline quality used across all disciplines, three independent reviewers appraised the current guidelines. These data were used to run descriptive statistics and assessed accordingly. Results Across the 28 guidelines, the average AGREE II domain scores were as follows: Scope and Purpose (median score, 85%), Stakeholder Involvement (median score, 87%), Rigor of Development (median score, 87%), Clarity of Presentation (median score, 87%), Applicability (median score, 48%), Editorial Independence (median score, 87%), and Overall Assessment (median score, 80s%). Conclusions Five of the six AGREE II domains, including the overall assessment, tested achieved a median score above the 50% mark. These results indicate that the AAOS guidelines met many criteria for high quality based on a critical appraisal.
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Affiliation(s)
- Radina Lilova
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Whitney A. Pettijohn
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Sandeep S. Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jeremy Reich
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Mallory C. Moore
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Ronald E. Delanois
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
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26
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Wilson TN, Roquelaure Y, Evanoff B, Aublet-Cuvelier A, Porro B. Physical activity in people diagnosed with cancer: a rapid review of recommendations and critical appraisal of international guidelines. Support Care Cancer 2023; 31:679. [PMID: 37934319 DOI: 10.1007/s00520-023-08123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE There are numerous guidelines that recommend physical activity (PA) in people diagnosed with cancer, but the quality of these guidelines is unknown. The aim of this study was to identify existing PA guidelines for cancer survivors, describe the recommendations, and assess their methodology quality. METHODS A rapid review of the literature was conducted in PubMed and EMBASE, supplemented by a search of the grey literature. The methodological quality of the guidelines was assessed using the AGREE II checklist. A descriptive synthesis of the recommendations from guidelines judged to be of good quality has been performed. RESULTS A total of nine guidelines published between 2006 and 2019 were included. Of nine guidelines, five achieved a high enough AGREE II score and were judged to be of good quality for use in clinical practice. We found that the recommendations from the five guidelines converged on the prescription of supervised PA (aerobic and resistance exercise) of at least 75 min per week of high intensity or 150 min per week of moderate intensity, spread over two to five sessions per week, equating to a PA dose between 8.70 and 17.5 MET.h/week. The recommendations were applicable to address the most common side effects of cancer and its treatment, namely fatigue, lymphedema, anxiety, depressive symptoms, health-related quality of life (QoL), survival, and physical function. However, no guideline recommends PA to improve other cancer-related outcomes, such as cognitive impairment, falls, sexual function, and peripheral neuropathy frequently experienced by cancer survivors. No guideline also referred to work outcomes (i.e., work ability, return to work, etc.). CONCLUSION Most PA guidelines for cancer survivors are of good quality. However, specific PA guidelines are needed for a given cancer site (e.g., location, stage), at a particular phase of the cancer trajectory, and for specific outcomes including return to work (RTW) in order to tailor PA to each cancer survivor.
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Affiliation(s)
- Têtê Norbert Wilson
- Univ Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, IRSET-ESTER, SFR ICAT, F-49000, Angers, France.
- Grain de Sel Togo, Inc., Athens, USA.
| | - Yves Roquelaure
- Univ Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, IRSET-ESTER, SFR ICAT, F-49000, Angers, France
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, IRSET-ESTER, SFR ICAT, F-49000, Angers, France
| | - Bradley Evanoff
- Washington University in St. Louis, School of Medicine, St. Louis, USA
| | - Agnès Aublet-Cuvelier
- INRS (Institut National de Recherche et de Sécurité), Direction des Etudes et de la Recherche, 1 rue du Morvan, CS60027, 54519, Vandœuvre-lès-Nancy, France
| | - Bertrand Porro
- Univ Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, IRSET-ESTER, SFR ICAT, F-49000, Angers, France
- Department of Human and Social Sciences, Institut de Cancérologie de l'Ouest (ICO), 49055, Angers, France
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Herasevich S, Soleimani J, Huang C, Pinevich Y, Dong Y, Pickering BW, Murad MH, Barwise AK. Diagnostic error among vulnerable populations presenting to the emergency department with cardiovascular and cerebrovascular or neurological symptoms: a systematic review. BMJ Qual Saf 2023; 32:676-688. [PMID: 36972982 DOI: 10.1136/bmjqs-2022-015038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Diagnostic error (DE) is a common problem in clinical practice, particularly in the emergency department (ED) setting. Among ED patients presenting with cardiovascular or cerebrovascular/neurological symptoms, a delay in diagnosis or failure to hospitalise may be most impactful in terms of adverse outcomes. Minorities and other vulnerable populations may be at higher risk of DE. We aimed to systematically review studies reporting the frequency and causes of DE in under-resourced patients presenting to the ED with cardiovascular or cerebrovascular/neurological symptoms. METHODS We searched EBM Reviews, Embase, Medline, Scopus and Web of Science from 2000 through 14 August 2022. Data were abstracted by two independent reviewers using a standardised form. The risk of bias (ROB) was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS Of the 7342 studies screened, we included 20 studies evaluating 7436,737 patients. Most studies were conducted in the USA, and one study was multicountry. 11 studies evaluated DE in patients with cerebrovascular/neurological symptoms, 8 studies with cardiovascular symptoms and 1 study examined both types of symptoms. 13 studies investigated missed diagnoses and 7 studies explored delayed diagnoses. There was significant clinical and methodological variability, including heterogeneity of DE definitions and predictor variable definitions as well as methods of DE assessment, study design and reporting.Among the studies evaluating cardiovascular symptoms, black race was significantly associated with higher odds of DE in 4/6 studies evaluating missed acute myocardial infarction (AMI)/acute coronary syndrome (ACS) diagnosis compared with white race (OR from 1.18 (1.12-1.24) to 4.5 (1.8-11.8)). The association between other analysed factors (ethnicity, insurance and limited English proficiency) and DE in this domain varied from study to study and was inconclusive.Among the studies evaluating DE in patients with cerebrovascular/neurological symptoms, no consistent association was found indicating higher or lower odds of DE. Although some studies showed significant differences, these were not consistently in the same direction.The overall ROB was low for most included studies; however, the certainty of evidence was very low, mostly due to serious inconsistency in definitions and measurement approaches across studies. CONCLUSIONS This systematic review demonstrated consistent increased odds of missed AMI/ACS diagnosis among black patients presenting to the ED compared with white patients in most studies. No consistent associations between demographic groups and DE related to cerebrovascular/neurological diagnoses were identified. More standardised approaches to study design, measurement of DE and outcomes assessment are needed to understand this problem among vulnerable populations. TRIAL REGISTRATION NUMBER The study protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO 2020 CRD42020178885 and is available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020178885.
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Affiliation(s)
- Svetlana Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jalal Soleimani
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Chanyan Huang
- Department of Anaesthesiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Yuliya Pinevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yue Dong
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammad H Murad
- Center for Science of Healthcare Delivery, Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Bioethics Research Program, Mayo Clinic, Rochester, MN, USA
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28
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Yan M, Chen L, Yang M, Zhang L, Niu M, Wu F, Chen Y, Song Z, Zhang Y, Li J, Tian J. Evidence mapping of clinical practice guidelines recommendations and quality for depression in children and adolescents. Eur Child Adolesc Psychiatry 2023; 32:2091-2108. [PMID: 35262810 DOI: 10.1007/s00787-022-01958-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 02/06/2022] [Indexed: 02/05/2023]
Abstract
This study systematically reviewed the clinical practice guidelines (CPGs) for depression in children and adolescents and assessed the quality and recommendation consistency of those CPGs. Evidence mapping was presented to illustrate the research trends and identify gaps to guide future research. Literature on CPGs for depression was systematically collected from PubMed, Embase, Web of Science, guideline databases, and psychiatric association/ society websites. The basic information, recommendations, methodological quality, and reporting quality of CPGs were extracted, and the supporting evidence strength for the included CPGs was analyzed in Excel. Four appraisers independently assessed the eligible CPGs using AGREE II instrument and the RIGHT checklist. All recommendations from the CPGs were summarized and analyzed, and the evidence mapping bubble charts were plotted in Excel. After excluding 15,184 records, 12 depression CPGs were eventually proved eligible, six of which were of high quality and six medium quality. A total of 39 major recommendations were summarized, 35 of which were supported by high-quality CPGs. Although direct comparisons are challenging due to differences in grading schemes and research quality, most CPGs share many pivotal recommendations that can help guide clinical practice. However, the evidence for some clinical problems is still lacking. Thus, more research is necessary on the screening and treatment of children and adolescents to put forward more evidence-based and high-quality recommendations.
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Affiliation(s)
- Meili Yan
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
| | - Lingmin Chen
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Min Yang
- Comprehensive Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Zhang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
- The Third Ward of Cardiovascular Clinical Medical Center, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Mingming Niu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
| | - Fangfang Wu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
- Shangluo Vocational and Technical College, Shangluo, Shanxi, China
| | - Yamin Chen
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
| | - Ziwei Song
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
| | - Yonggang Zhang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiang Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, China.
| | - Jinhui Tian
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China.
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China.
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, Gansu, China.
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Wang S, Zhang Y, Wen Z, Yang Y, Zhang Y, Geng Y, Liu Y, Zhang J. Development, Evaluation, and impLemenTation for guideline adaptation: a quality improvement protocol for the DELTA study in global health practice. Health Res Policy Syst 2023; 21:114. [PMID: 37915056 PMCID: PMC10619317 DOI: 10.1186/s12961-023-01060-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/07/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Guideline adaptation is an emerging field to provide more appropriate recommendations for local clinical practice quality and to promote global health equity. However, its utilization status, adaptation procedures, and related materials remain to be studied. METHODS This study developed a quality improvement protocol for a study as the Development, Evaluation, and impLemenTation for guideline Adaptation (DELTA) study. Current adapted clinical practice guidelines (CPGs) will be systematically searched. Their characteristics, utilization status, and adaptation procedures will be extracted, compared, and analyzed. Whether these adapted CPGs rigorously followed the instruments and steps of adaptation frameworks will also be appraised. In addition, the advantages and limitations of current adaptation methods and their suitable application situations will be analyzed. In addition, future perspectives as DELTA series and DELTA system, aiming for comprehensively evaluating current needs for guideline adaptation and developing a unified framework and related materials were proposed to improve the acceptability, applicability, and implementation of guideline adaptation in clinical practice. The DELTA series are divided into four phases: phase I in analyzing status, characteristics, and procedures and completeness of adapted CPGs; phase II in analyzing differences, heterogeneity, and implementation between adapted and original CPGs; and phase III in collecting, analyzing, and comparing all available adaptation materials. With these research bases, an international working group will be established in phase IV and will develop unified guideline adaptation materials after Delphi consensus, including adaptation frameworks, appraisal tools and checklists, registries, and databases. DISCUSSION Guideline adaptation has been advanced as an efficient way to guide local clinical practice. However, it still faces several major challenges. The proposed DELTA study, series, and system will further contribute to this emerging topic. TRIAL REGISTRATION This study has been registered by the PROSPERO international database. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=400170 .
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Affiliation(s)
- Shu Wang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yuan Zhang
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Zhixuan Wen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yueming Yang
- Department of Hematology, Dalian Municipal Woman and Children's Medical Center (Group), Dalian, 116000, China
| | - Yuxuan Zhang
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yixiong Geng
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yali Liu
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
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Duranteau O, Hamriti A, Ickx B, Tuna T. Influence of compliance to antithrombotic agents on perioperative morbidity and mortality. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2023; 3:38. [PMID: 37853478 PMCID: PMC10583434 DOI: 10.1186/s44158-023-00123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
For patients on antithrombotic medication, the outcome of a planned surgery depends on the adjustment of their daily treatment. This study aimed to assess the impact of non-compliance to published recommendations about antithrombotic agents, specifically those provided by the Groupement d'Intérêt pour l'hémostase Peri-opératoire (GIHP), on patient morbidity and mortality.A prospective cohort observational monocentric study was conducted over a 7-month period in 2019 in an academic hospital. The study included patients on antithrombotic agents scheduled for elective surgery, excluding cardiac surgery. The primary endpoints were morbidity and mortality at 1 month according to GIHP guidelines compliance. Blood loss during surgery and length of hospital stay were secondary endpoints.Among the 589 patients included in the study, 87 complications were recorded, resulting in a morbidity rate of 14.8%. Thirty-six patients experienced hemorrhagic events, leading to 8 deaths, while 33 patients suffered from ischemic events, resulting in 3 deaths. Additionally, 18 patients died from causes unrelated to hemorrhage or ischemia. Compliance with GIHP guidelines was observed in 62% of patients. Statistical analysis did not reveal a significant association between adherence to guidelines and morbidity (p value = 0.923), nor between adherence and 1-month survival (p value = 0.698). Similarly, no statistically significant relationships were found between compliance and intraoperative bleeding volume (p value = 0.087), postoperative bleeding (p value = 0.460), or length of hospital stay (p value = 0.339).This study did not identify any substantial associations between non-strict adherence to GIHP recommendations and patient outcomes, including morbidity, mortality, and bleeding. However, it is important to interpret these findings with caution, considering the study's limitations and the need for further research in this area.
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Affiliation(s)
- Olivier Duranteau
- Anesthesiology Service, CUB-ULB Hôpital Erasme, Brussels, Belgium.
- Intensive Care Unit, HIA Percy, Clamart, France.
| | - Ayoub Hamriti
- Anesthesiology Service, CUB-ULB Hôpital Erasme, Brussels, Belgium
| | - Brigitte Ickx
- Anesthesiology Service, CUB-ULB Hôpital Erasme, Brussels, Belgium
| | - Turgay Tuna
- Anesthesiology Service, CUB-ULB Hôpital Erasme, Brussels, Belgium
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Campione E, Wampler M, Bolch CA, Krzak JJ. Barriers and facilitators to implementation of APTA's breast cancer-related lymphedema diagnosis and intervention clinical practice guidelines. J Cancer Surviv 2023:10.1007/s11764-023-01475-1. [PMID: 37853271 DOI: 10.1007/s11764-023-01475-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE The purpose of this study was to identify barriers and facilitators influencing implementation of the diagnosis and intervention clinical practice guidelines (CPGs) related to the management of patients with breast cancer-related lymphedema (BCRL). METHODS A descriptive, cross-sectional web-based survey was conducted. Participants included physical therapists and assistants who were members of the APTA's Academy of Oncologic Physical Therapy and Lymphology Association of North America. Desriptive statisitcs were computed for all demographic and barriers and facilitators data. Individual exploratory factor analyses (EFA) were performed on survey items for both CPGs to identify themes of barriers and facilitators to implementation. RESULTS A total of 180 respondents completed the survey. 34.9% of respondents read the diagnosis CPG and 22.4% read the intervention CPG. A total of 77.8% reported that they did not have issues in changing their clinical routines and 69.5% did not have resistance working according to CPGs. The EFA resulted in 3 themes for each CPG, accounting for 46% of the variance for the diagnostic CPG and 54% of the variance for the intervention CPG. The 3 themes, clinician characteristics, patient demographics, therapist practice setting and beliefs/values, were weighted differently for each EFA. CONCLUSION Most respondents did not read either CPG, however, report a willingness to make changes to clinical practice and utilization of CPGs. For those who have attempted to implement the CPGs, this study was the first to identify the barriers and facilitators impacting the implementation of the CPGs related to the management of BCRL. IMPLICATIONS FOR CANCER SURVIVORS The results will inform the development of targeted implementation strategies to improve access to and adherence to recommendations from the CPGs ultimately improving the efficiency and efficacy of care delivery to patients.
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Affiliation(s)
- Elizabeth Campione
- Physical Therapy Program, Midwestern University, Downers Grove, IL, USA.
| | - Meredith Wampler
- Program in Physical Therapy, Oregon State University - Cascades, Bend, OR, USA
| | - Charlotte A Bolch
- Office of Research and Sponsored Programs, Midwestern University, Glendale, AZ, USA
| | - Joseph J Krzak
- Physical Therapy Program, Midwestern University, Downers Grove, IL, USA
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Firwana M, Hasan B, Saadi S, Abd-Rabu R, Alabdallah K, Al-Zu'bi H, Shalhub S, Black JH, Prokop LJ, Murad MH. A systematic review supporting the Society for Vascular Surgery guidelines on the management of heritable aortopathies. J Vasc Surg 2023; 78:1077-1082.e12. [PMID: 37327953 DOI: 10.1016/j.jvs.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/29/2023] [Accepted: 06/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND To support the development of clinical practice guidelines on the management of patients with genetic aortopathies and arteriopathies, a writing committee from the Society for Vascular Surgery has commissioned this systematic review. METHODS We conducted a systematic review and searched multiple databases for studies addressing six questions identified by the Society for Vascular Surgery guideline committee about evaluating and managing patients with genetic aortopathies and arteriopathies. Studies were selected and appraised by pairs of independent reviewers. RESULTS We included 12 studies in this systematic review. We did not identify studies about the long-term outcomes of endovascular repair for aortic aneurysm in patients with heritable aortopathy or about new aortic events in pregnant women with a history of aortic dissection (AD) or aneurysm. A small case series demonstrated a 100% survival rate and 100% aortic intervention-free survival at 15 months (range, 7-28 months) after endograft repair for type B AD. A positive genetic diagnosis was discovered in 36% of patients with aortic aneurysms and dissections who had no risk factors for hereditary aortopathies, and these patients had a mortality rate of 11% at a median follow-up duration of 5 months. Black patients had lower 30-day mortality than White patients (5.6% vs 9.0%, respectively), but they had a higher overall aortic reintervention rate at 30 days after AD repair (47% vs 27%, respectively). Aortic reinterventions owing to aneurysmal expansion and endoleak at 30 days were higher in Black patients than White patients. The certainty of evidence was judged to be very low across all the outcomes evaluated in this systematic review. CONCLUSIONS The available evidence suggests high survival after thoracic endovascular aortic repair for type B AD in young patients with heritable aortopathies, but with limited long-term follow-up. Genetic testing in patients with acute aortic aneurysms and dissections had a high yield. It was positive for most patients with risk factors for hereditary aortopathies and in more than one-third for all other patients, and was associated with new aortic events within 15 years.
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Affiliation(s)
- Mohammed Firwana
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Bashar Hasan
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Samer Saadi
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Rami Abd-Rabu
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Khaled Alabdallah
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Hossam Al-Zu'bi
- Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL
| | - Sherene Shalhub
- Division of Vascular Surgery, Oregon Health & Science University, Portland, OR
| | - James H Black
- Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
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Zhou P, Chen L, Wu Z, Wang E, Yan Y, Guan X, Zhai S, Yang K. The barriers and facilitators for the implementation of clinical practice guidelines in healthcare: an umbrella review of qualitative and quantitative literature. J Clin Epidemiol 2023; 162:169-181. [PMID: 37657616 DOI: 10.1016/j.jclinepi.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/10/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVES To identify barriers and facilitators of clinical practice guidelines (CPGs) implementation, and map those factors to the theoretical domains framework (TDF) and behavior change wheel (BCW). METHODS We conducted an umbrella review of systematic reviews. PubMed, Embase, and the Cochrane Library were searched. Two investigators independently screened the studies, extracted the data, and assessed the methodological quality. The identified barriers and facilitators of CPG implementation were categorized and mapped to the TDF domains and BCW components. RESULTS Thirty-seven studies were included, and 193 barriers and 140 facilitators were identified. Intrinsic aspects (35 barriers and 28 facilitators) mainly included the CPGs' impracticality, complexity, and inaccessibility. Extrinsic aspects (158 barriers and 113 facilitators) mainly included lack of resources, training, funding, or awareness of CPG content in barriers; audits and feedback; strong leadership and management support; and educating and training about CPGs in facilitators. Environmental context and resources (n = 97, 19.48%) were the most reported barriers in TDF domains. Physical opportunity and social opportunity were the most frequently mentioned models in BCW. CONCLUSION Multiple barriers and facilitators for healthcare CPG implementation are identified, with further links to TDF and BCW. Future knowledge translation strategies should be developed accordingly in specified health care settings.
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Affiliation(s)
- Pengxiang Zhou
- Department of Pharmacy, Peking University Third Hospital, Beijing, China; Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Lu Chen
- Department of Pharmacy, Peking University Third Hospital, Beijing, China; Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China; Department of Pharmacy, Yantai Yuhuangding Hospital, Shandong, China
| | - Ziyang Wu
- Department of Pharmacy, Peking University Third Hospital, Beijing, China; Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Ente Wang
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yingying Yan
- Department of Pharmacy, Peking University Third Hospital, Beijing, China; Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China; International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China; Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
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Kolaski K, Logan LR, Ioannidis JPA. Guidance to best tools and practices for systematic reviews. Acta Anaesthesiol Scand 2023; 67:1148-1177. [PMID: 37288997 DOI: 10.1111/aas.14295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 06/09/2023]
Abstract
Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy. A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work. Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.
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Affiliation(s)
- Kat Kolaski
- Departments of Orthopaedic Surgery, Pediatrics, and Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Lynne Romeiser Logan
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, New York, USA
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University School of Medicine, Stanford, California, USA
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Meiling JB, Schappell JB, Twohey EE, Prokop LJ, Cushman DM. Preoperative electrodiagnostic studies and postoperative outcomes for ulnar mononeuropathy at the elbow: A systematic review. PM R 2023; 15:1326-1334. [PMID: 36730149 DOI: 10.1002/pmrj.12952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/20/2022] [Accepted: 01/17/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To analyze the association between preoperative electrodiagnostic (EDX) studies and postoperative pain and functional outcomes following ulnar nerve decompression and/or transposition for ulnar neuropathy at the elbow (UNE). LITERATURE SURVEY Protocol was submitted and database search was conducted by an experienced librarian of all available studies in the English language from 1990 to June 8, 2022. Databases included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, and Scopus. METHODOLOGY Inclusion criteria consisted of randomized controlled trials, prospective and retrospective longitudinal studies, and studies involving adults ≥18 years of age who underwent ulnar nerve decompression and/or transposition for UNE. Study quality and risk of bias were assessed using the National Heart, Lung, and Blood Institute (NHLBI) Study Quality of Assessment Tool. Certainty in evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. A meta-analysis was not performed. SYNTHESIS A total of 289 studies were screened, and 8 retrospective cohort studies met inclusion criteria comprising 762 patients. A decreased or absent preoperative sensory nerve action potential amplitude (SNAP) showed significance with worse postoperative outcomes. The presence of preoperative conduction block showed significance in higher quality studies. There was limited evidence for slow preoperative motor conduction velocities or preoperative electromyography (EMG) abnormalities and postoperative outcomes. Overall quality assessment demonstrated that two studies had "good," four "fair," and two "poor" quality of evidence. Certainty in evidence was "low" due to risk of bias. CONCLUSIONS A decreased or absent preoperative ulnar SNAP may predict worse postoperative outcomes. Per higher quality studies, preoperative conduction block at the elbow may also predict worse postoperative outcomes. Careful interpretation is required with a full understanding of the limited evidence, risk of bias, and low certainty in evidence to support the use of preoperative EDX to predict postoperative outcomes in UNE.
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Affiliation(s)
- James B Meiling
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Justin B Schappell
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric E Twohey
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry J Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel M Cushman
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Parra-Calderón CL, Román-Villarán E, Alvarez-Romero C, Escobar-Rodríguez GA, Martínez-Brocca MA, Martínez-García A, García-García JA, Escalona-Cuaresma MJ. A prospective observational concordance study to evaluate computational model-driven clinical practice guidelines for Type 2 diabetes mellitus. Int J Med Inform 2023; 178:105208. [PMID: 37703798 DOI: 10.1016/j.ijmedinf.2023.105208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/18/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Clinical Practice Guidelines (CPGs) provide healthcare professionals with performance and decision-making support during the treatment of patients. Sometimes, however, they are poorly implemented. The IDE4ICDS platform was developed and validated with CPGs for type 2 diabetes mellitus (T2DM). OBJECTIVE The main objective of this paper is to present the results of the clinical validation of the IDE4ICDS platform in a real clinical environment at two health clinics in the Andalusian Public Health System (SSPA) in the southern Spanish region of Andalusia. METHODS National and international knowledge sources on T2DM were selected and reviewed and used to define a diabetes CPG model on the IDE4ICDS platform. Once the diabetes CPG was configured and deployed, it was validated. A total of 506 patients were identified as meeting the inclusion criteria, of whom 130 could be recruited and 89 attended the appointment. RESULTS A concordance analysis was performed with the kappa value. Overall agreement between the recommendations provided by the system and those recorded in each patient's EHR was good (0.61 - 0.80) with a total kappa index of 0.701, leading to the conclusion that the system provided appropriate recommendations for each patient and was therefore well-functioning. CONCLUSIONS A series of possible improvements were identified based on the limitations for the recovery of variables related to the quality of these recolected variables, the detection of duplicate recommendations based on different input variables for the same patient, and clinical usability, such as the capacity to generate reports based on the recommendations generated. Nevertheless, the project resulted in the IDE4ICDS platform: a Clinical Decision Support System (CDSS) capable of providing appropriate recommendations for improving the management and quality of patient care and optimizing health outcomes. The result of this validation is a safe and effective pathway for developing and adopting digital transformation at the regional scale of the use of biomedical knowledge in real healthcare.
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Affiliation(s)
- Carlos Luis Parra-Calderón
- Computational Health Informatics' Group. Seville Institute of Biomedicine (IbiS)/"Virgen del Rocío" University Hospital/CSIC/University of Seville, Avenida Manuel Siurot, 41013 Seville, Spain.
| | - Esther Román-Villarán
- Computational Health Informatics' Group. Seville Institute of Biomedicine (IbiS)/"Virgen del Rocío" University Hospital/CSIC/University of Seville, Avenida Manuel Siurot, 41013 Seville, Spain.
| | - Celia Alvarez-Romero
- Computational Health Informatics' Group. Seville Institute of Biomedicine (IbiS)/"Virgen del Rocío" University Hospital/CSIC/University of Seville, Avenida Manuel Siurot, 41013 Seville, Spain.
| | - Germán Antonio Escobar-Rodríguez
- Computational Health Informatics' Group. Seville Institute of Biomedicine (IbiS)/"Virgen del Rocío" University Hospital/CSIC/University of Seville, Avenida Manuel Siurot, 41013 Seville, Spain.
| | - Maria Asunción Martínez-Brocca
- Virgen Macarena" University Hospital, Seville, Spain; Comprehensive Plan for Diabetes in Andalusia, Andalusian Health Service, Calle Doctor Fedriani, 3, 41009 Seville, Spain.
| | - Alicia Martínez-García
- Computational Health Informatics' Group. Seville Institute of Biomedicine (IbiS)/"Virgen del Rocío" University Hospital/CSIC/University of Seville, Avenida Manuel Siurot, 41013 Seville, Spain.
| | - Julián Alberto García-García
- Computer Languages and Systems Department, Escuela Técnica Superior de Ingeniería Informática, Avda. Reina Mercedes s/n. 41012 Seville, Spain.
| | - María José Escalona-Cuaresma
- Computer Languages and Systems Department, Escuela Técnica Superior de Ingeniería Informática, Avda. Reina Mercedes s/n. 41012 Seville, Spain.
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Conley B, Bunzli S, Bullen J, O’Brien P, Persaud J, Gunatillake T, Nikpour M, Grainger R, Barnabe C, Lin I. What are the core recommendations for rheumatoid arthritis care? Systematic review of clinical practice guidelines. Clin Rheumatol 2023; 42:2267-2278. [PMID: 37291382 PMCID: PMC10412487 DOI: 10.1007/s10067-023-06654-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/10/2023] [Accepted: 05/28/2023] [Indexed: 06/10/2023]
Abstract
Systematic r eview to evaluate the quality of the clinical practice guidelines (CPG) for rheumatoid arthritis (RA) management and to provide a synthesis of high-quality CPG recommendations, highlighting areas of consistency, and inconsistency. Electronic searches of five databases and four online guideline repositories were performed. RA management CPGs were eligible for inclusion if they were written in English and published between January 2015 and February 2022; focused on adults ≥ 18 years of age; met the criteria of a CPG as defined by the Institute of Medicine; and were rated as high quality on the Appraisal of Guidelines for Research and Evaluation II instrument. RA CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organization of care and did not include interventional management recommendations; and/or included other arthritic conditions. Of 27 CPGs identified, 13 CPGs met eligibility criteria and were included. Non-pharmacological care should include patient education, patient-centered care, shared decision-making, exercise, orthoses, and a multi-disciplinary approach to care. Pharmacological care should include conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), with methotrexate as the first-line choice. If monotherapy conventional synthetic DMARDs fail to achieve a treatment target, this should be followed by combination therapy conventional synthetic DMARDs (leflunomide, sulfasalazine, hydroxychloroquine), biologic DMARDS and targeted synthetic DMARDS. Management should also include monitoring, pre-treatment investigations and vaccinations, and screening for tuberculosis and hepatitis. Surgical care should be recommended if non-surgical care fails. This synthesis offers clear guidance of evidence-based RA care to healthcare providers. TRIAL REGISTRATION: The protocol for this review was registered with Open Science Framework ( https://doi.org/10.17605/OSF.IO/UB3Y7 ).
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Affiliation(s)
- Brooke Conley
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC Australia
| | - Samantha Bunzli
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD Australia
- Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, QLD Australia
| | | | - Penny O’Brien
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Melbourne, VIC Australia
| | - Jennifer Persaud
- Arthritis and Osteoporosis Western Australia, Perth, WA Australia
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, WA Australia
| | - Tilini Gunatillake
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Melbourne, VIC Australia
| | - Mandana Nikpour
- Departments of Medicine and Rheumatology Melbourne, The University of Melbourne at St. Vincent’s Hospital, Melbourne, VIC Australia
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
- Te Whatu Ora Health New Zealand – Capital Coast and Hutt Valley, Wellington, New Zealand
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Ivan Lin
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA Australia
- Geraldton Regional Aboriginal Medical Service, Geraldton, WA Australia
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Conley B, Bunzli S, Bullen J, O'Brien P, Persaud J, Gunatillake T, Dowsey MM, Choong PFM, Lin I. Core Recommendations for Osteoarthritis Care: A Systematic Review of Clinical Practice Guidelines. Arthritis Care Res (Hoboken) 2023; 75:1897-1907. [PMID: 36762545 PMCID: PMC10952362 DOI: 10.1002/acr.25101] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/05/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To evaluate the quality of clinical practice guidelines (CPGs) for interventions in management of osteoarthritis (OA) and to provide a synthesis of high-quality CPG recommendations. METHODS Five databases (OvidSP Medline, Cochrane, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Embase, and the Physiotherapy Evidence Database [PEDro]) and 4 online guideline repositories were searched. CPGs for the management of OA were included if they were 1) written in English and published from January 2015 to February 2022, focused on adults age ≥18 years, and met the criteria of a CPG as defined by the Institute of Medicine; and 2) were rated as high quality on the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. CPGs for OA were excluded if they were available via institutional access only, only addressed recommendations for the system/organization of care and did not include interventional management recommendations, and/or included other arthritic conditions. RESULTS Of 20 eligible CPGs, 11 were appraised as high quality and included in the synthesis. Of interest were the hip, knee, hand, and glenohumeral joints and/or polyarticular OA. Consistent recommendations were that care should be patient centered and include exercise, education, and weight loss (where appropriate). Nonsteroidal antiinflammatory drugs and surgical interventions were recommended for disabling OA that had not improved with nonsurgical care. Hand orthoses should be recommended for patients with hand OA. CONCLUSION This synthesis of high-quality CPGs for OA management offers health care providers with clear, simple guidance of recommended OA care to improve patient outcomes.
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Affiliation(s)
- Brooke Conley
- The University of MelbourneMelbourneVictoriaAustralia
| | - Samantha Bunzli
- The University of Melbourne, Melbourne, Victoria, Australia, Griffith University, Nathan, Queensland, Australia, and Royal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | | | - Penny O'Brien
- The University of MelbourneMelbourneVictoriaAustralia
| | - Jennifer Persaud
- Arthritis and Osteoporosis Western Australia and Sir Charles Gairdner HospitalPerthWestern AustraliaAustralia
| | | | | | | | - Ivan Lin
- University of Western Australia and Geraldton Regional Aboriginal Medical ServiceGeraldtonWestern AustraliaAustralia
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Karmacharya P, Gupta S, Shahukhal R, Khanal R, Murad MH, Gensler LS. Effect of Biologics in Subgroups of Axial Spondyloarthritis Based on Magnetic Resonance Imaging and C-Reactive Protein: A Systematic Review and Meta-Analysis. ACR Open Rheumatol 2023; 5:481-489. [PMID: 37551049 PMCID: PMC10502854 DOI: 10.1002/acr2.11581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVE To determine if the efficacy of biologics differ based on magnetic resonance imaging (MRI) and C-reactive protein (CRP) findings. METHODS We compared four subgroups (MRI+/CRP+, MRI+/CRP-, MRI-/CRP+, MRI-/CRP-) from randomized controlled trials (RCTs). A comprehensive database search was performed to include axial spondylarthritis (axSpA; both radiographic axSpA [r-axSpA] and nonradiographic axSpA [nr-axSpA]) RCTs with treatment efficacy reported by different MRI and CRP subgroups. Study-specific disease activity scores (at 12-16 weeks) were pooled using a random-effects model and compared between the four subgroups. RESULTS Five trials (all nr-axSpA) were included: three with tumor necrosis factor inhibitors (TNFi, N = 729) and two with interleukin-17 inhibitors (IL-17i, N = 794). TNFi and IL-17i showed efficacy based on the Assessment of Spondyloarthritis International Society 40 (ASAS40) and Bath Ankylosing Spondylitis Disease Activity Index 50 (BASDAI50) in all MRI and CRP subgroups, except the CRP-/MRI- subgroup, which had a single study with only 39 patients. There was no statistically significant difference between the four subgroups in terms of patients achieving ASAS40 (P = 0.60, I2 = 0%) or BASDAI50 (P = 0.27, I2 = 23.9%). The number needed to treat was three for the CRP+/MRI+ and CRP+/MRI- subgroups and six for the CRP-/MRI+ and CRP-/MRI- subgroups. All trials had a low risk of bias. Between-study heterogeneity was low to moderate. Sensitivity analyses comparing TNFi or IL-17i versus placebo similarly showed no difference between subgroups in terms of ASAS40 (TNFi, P = 0.57; IL-17i, P = 0.28) and BASDAI50 (TNFi, P = 0.37; IL-17i, P = 0.18). CONCLUSION In this systematic review, there was no statistically significant difference between the four subgroups in terms of efficacy based on ASAS40 or BASDAI50.
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Affiliation(s)
- Paras Karmacharya
- Vanderbilt University Medical Center, Nashville, Tennessee, and Mayo ClinicRochesterMinnesota
| | | | | | - Raju Khanal
- Valley Health–Winchester Medical CenterWinchesterVirginia
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Abstract
Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy. A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work. Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.
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Affiliation(s)
- Kat Kolaski
- Departments of Orthopaedic Surgery, Pediatrics, and Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lynne Romeiser Logan
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, USA
| | - John P.A. Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University School of Medicine, Stanford, CA, USA
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Kolnik SE, Upadhyay K, Wood TR, Juul SE, Valentine GC. Reducing Severe Intraventricular Hemorrhage in Preterm Infants With Improved Care Bundle Adherence. Pediatrics 2023; 152:e2021056104. [PMID: 37609772 DOI: 10.1542/peds.2021-056104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Intraventricular hemorrhage prevention bundles (IVHPBs) can decrease the incidence of intraventricular hemorrhage (IVH) in premature infants. Our center had a high rate of severe (grade III/IV) IVH (9.8%), and poor adherence (24%) to an IVHPB in neonates born ≤1250 g or ≤30 gestational weeks. Improvement initiatives were planned to decrease the incidence of severe IVH by 30% over 2 years. METHODS A multidisciplinary team undertook interventions including in-service training, prompt initiation of IVHPB, revision of guidelines, and process standardization. Baseline data were collected from May 2016 to June 2018, with interventions occurring from July 2018 to May 2020. Adherence to the IVHPB was the primary process measure, and incidence of severe IVH the primary outcome measure. Control charts were used to analyze the effect of interventions on outcome. Balancing measures included use of breast milk at discharge, use of mechanical ventilation after initial resuscitation, and bronchopulmonary dysplasia. RESULTS A total of 240 infants were assessed preintervention, and 185 during interventions. Adherence to the IVHPB improved from 24% to 88%. During this period, the incidence of severe IVH decreased from 9.8% to 2.4%, a 76% reduction from baseline. A higher adherence score was associated with reduced odds of IVH (odds ratio 0.30; 95% confidence interval 0.10-0.90, P = .03). CONCLUSIONS Interventions focused on enhancing adherence to an IVHPB were associated with a reduced rate of severe IVH in high-risk neonates, highlighting the importance of assessing adherence to clinical guidelines.
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Affiliation(s)
- Sarah E Kolnik
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, Washington
| | - Kirtikumar Upadhyay
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, Washington
| | - Thomas R Wood
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, Washington
- Center on Human Development and Disability, University of Washington, Seattle, Washington
| | - Sandra E Juul
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, Washington
- Center on Human Development and Disability, University of Washington, Seattle, Washington
| | - Gregory C Valentine
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, Washington
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas
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Quiñoz Gallardo MD, Barrientos-Trigo S, Porcel-Gálvez AM. Effectiveness of the best practice spotlight organizations program to reduce the prevalence of pressure injuries in acute care settings for hospitalized patients in Spain: A quasi-experimental study. Worldviews Evid Based Nurs 2023; 20:306-314. [PMID: 36894521 DOI: 10.1111/wvn.12631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/29/2022] [Accepted: 01/21/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Pressure injuries are a major public health problem because of their impact on morbidity and mortality, quality of life, and increased healthcare costs. The Centros Comprometidos con la Excelencia en Cuidados/Best Practice Spotlight Organization (CCEC/BPSO®) program provides guidelines that can improve these outcomes. AIMS This study aimed to assess the effectiveness of the CCEC/BPSO® program in improving the care of patients at risk of pressure injury (PI) at an acute care hospital in Spain. METHODS A quasi-experimental regression discontinuity design in three periods was used: (1) baseline (2014), (2) implementation (2015-2017), and (3) sustainability (2018-2019). The study population was comprised of 6377 patients discharged from 22 units of an acute care hospital. The performance of the PI risk assessment and reassessment, the application of special pressure management surfaces, and the presence of PIs were all monitored. RESULTS Forty-four percent of patients (n = 2086) met the inclusion criteria. After implementing the program, the number of patients assessed (53.9%-79.5%), reassessed (4.9%-37.5%), the application of preventive measures (19.6%-79.7%), and the number of people identified with a PI in implementation (1.47%-8.44%) and sustainability (1.47%-8.8%) all increased. LINKING EVIDENCE TO ACTION The implementation of the CCEC/BPSO® program achieved improved patient safety. Risk assessment monitoring, risk reassessment, and special pressure management surfaces were practices that increased during the study period and were incorporated by professionals to prevent PIs. The training of professionals was instrumental to this process. Incorporating these programs is a strategic line to improve clinical safety and the quality of care. The implementation of the program has been effective in terms of improving the identification of patients at risk and the application of surfaces.
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Affiliation(s)
- María Dolores Quiñoz Gallardo
- Virgen de las Nieves Hospital, Granada, Spain
- Research Group Ee-12 Hygia linked to Health Research Institute (ibs.Granada), Granada, Spain
- Research Chair in Health Care and Results (INVESCARE) Virgen de las Nieves Hospital and Department of Nursing Universidad de Sevilla (Code 4477/1155), Seville, Spain
| | - Sergio Barrientos-Trigo
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Universidad de Sevilla, Seville, Spain
- Research Group under the Andalusian Research CTS 1050 Complex Care, Chronicity, and Health Outcomes, University of Seville, Seville, Spain
| | - Ana María Porcel-Gálvez
- Research Chair in Health Care and Results (INVESCARE) Virgen de las Nieves Hospital and Department of Nursing Universidad de Sevilla (Code 4477/1155), Seville, Spain
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Universidad de Sevilla, Seville, Spain
- Research Group under the Andalusian Research CTS 1050 Complex Care, Chronicity, and Health Outcomes, University of Seville, Seville, Spain
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Quintana Montejo N, Vega Peña NV, Domínguez Torres LC. Knowledge-building in surgery: An evolving craft. Cir Esp 2023; 101:565-569. [PMID: 37532221 DOI: 10.1016/j.cireng.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/26/2023] [Indexed: 08/04/2023]
Abstract
In surgery, the construction of knowledge is shaped in two scenarios: evidence-based medicine, and experiential learning. The former has become an essential pillar in this process. Based on this fact, clinical practice guidelines have been developed. However, their transient nature, constant renewal, and lack of individualization distance them from daily clinical activity. On the other hand, there is the construction of knowledge through vicarious and experiential learning. Its existence is linked to the beginning of medicine, and its importance is irrefutable. However, it is laden with the "truth effect", surgical dogma and singularism. When integrating the construction of knowledge in these scenarios, critical thinking skills are paramount and necessary to guide the surgeon in the decision-making process within the context of surgical dynamism. This article explores this situation and its impact.
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Sloboda Z, Johnson KA, Fishbein DH, Brown CH, Coatsworth JD, Fixsen DL, Kandel D, Paschall MJ, Silva FS, Sumnall H, Vanyukov M. Normalization of Prevention Principles and Practices to Reduce Substance Use Disorders Through an Integrated Dissemination and Implementation Framework. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1078-1090. [PMID: 37052866 PMCID: PMC10476513 DOI: 10.1007/s11121-023-01532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/14/2023]
Abstract
Major research breakthroughs over the past 30 years in the field of substance use prevention have served to: (1) enhance understanding of pharmacological effects on the central and peripheral nervous systems and the health and social consequences of use of psychoactive substances, particularly for children and adolescents; (2) delineate the processes that increase vulnerability to or protect from initiation of substance use and progression to substance use disorders (SUDs) and, based on this understanding, (3) develop effective strategies and practices to prevent the initiation and escalation of substance use. The challenge we now face as a field is to "normalize" what we have learned from this research so that it is incorporated into the work of those involved in supporting, planning, and delivering prevention programming to populations around the world, is integrated into health and social service systems, and helps to shape public policies. But we wish to go further, to incorporate these effective prevention practices into everyday life and the mind-sets of the public, particularly parents and educators. This paper reviews the advances that have been made in the field of prevention and presents a framework and recommendations to achieve these objectives generated during several meetings of prevention and implementation science researchers sponsored by the International Consortium of Universities for Drug Demand Reduction (ICUDDR) that guides a roadmap to achieve "normalization."
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Affiliation(s)
- Zili Sloboda
- Applied Prevention Science International, Ontario, OH, USA.
| | - Kimberly A Johnson
- Department of Mental Health Law and Policy, College of Community and Behavioral Sciences, University of South Florida, Tampa, FL, USA
- International Consortium of Universities of Drug Demand Reduction, Tampa, FL, USA
| | - Diana H Fishbein
- Frank Porter Graham Child Development Institute, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- National Prevention Science, The Pennsylvania State University, State College, Harrisburg, PA, USA
| | | | | | - Dean L Fixsen
- Active Implementation Research Network, Inc, Chapel Hill, NC, USA
| | - Denise Kandel
- Department of Psychiatry and School of Public Health, Columbia University, New York, NY, USA
| | - Mallie J Paschall
- Prevention Research Center (PRC), Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | | | - Harry Sumnall
- Faculty of Health, Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Michael Vanyukov
- Departments of Pharmaceutical Sciences, Psychiatry, and Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA
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Shellenberger RA, Gowda S, Kurn H, Albright J, Mayo MH. Vitamin D insufficiency and serum levels related to the incidence and stage of cutaneous melanoma: a systematic review and meta-analysis. Melanoma Res 2023; 33:265-274. [PMID: 37199748 DOI: 10.1097/cmr.0000000000000897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Cutaneous melanoma (CM) is the deadliest skin cancer, and vitamin D insufficiency has been suggested as a risk factor. We evaluated the relationship between both vitamin D insufficiency and 25-hydroxy vitamin D levels with the incidence and stage of CM. Five databases were searched from inception until 11 July 2022. Inclusion criteria were cohort and case-control studies that reported mean 25-hydroxy vitamin D levels or the presence of vitamin D insufficiency in CM patients and compared with healthy controls; or those that reported vitamin D insufficiency and Breslow tumor depth or the development of metastasis in CM. Fourteen studies were included in the analysis. Statistically significant relationships were found between vitamin D level <20 ng/dl and incidence of CM [pooled RR 1.45, 95% confidence interval (CI) 1.04-2.02]; lower mean vitamin D level and Breslow depth >1 mm (SMD 0.19, 95% CI 0.11-0.28); and vitamin D level >20 ng/dl and Breslow depth <1 mm (pooled RR 0.69, 95% CI 0.58-0.82). Statistical significance was not found in the relationships between vitamin D levels and the presence of metastasis (pooled SMD -0.13, 95% CI, -0.38 to 0.12); or mean vitamin D level and the incidence of CM (pooled SMD -0.39, 95% CI, -0.80 to 0.01). We identified an association of increased incidence of CM and vitamin D insufficiency, as well as less favorable Breslow tumor depth with lower levels of vitamin D and the presence of vitamin D insufficiency.
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Affiliation(s)
| | - Sunaina Gowda
- Department of Internal Medicine, Trinity Health Ann Arbor Hospital, Ann Arbor, Michigan
| | - Heidi Kurn
- Department of Internal Medicine, Trinity Health Ann Arbor Hospital, Ann Arbor, Michigan
| | | | - MacKenzie H Mayo
- Department of Internal Medicine, Trinity Health Ann Arbor Hospital, Ann Arbor, Michigan
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Conley B, Bunzli S, Bullen J, O’Brien P, Persaud J, Gunatillake T, Dowsey MM, Choong PF, Nikpour M, Grainger R, Lin I. What are the core recommendations for gout management in first line and specialist care? Systematic review of clinical practice guidelines. BMC Rheumatol 2023; 7:15. [PMID: 37316871 PMCID: PMC10268528 DOI: 10.1186/s41927-023-00335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/03/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Gout is the most common inflammatory arthritis, increasing in prevalence and burden. Of the rheumatic diseases, gout is the best-understood and potentially most manageable condition. However, it frequently remains untreated or poorly managed. The purpose of this systematic review is to identify Clinical Practice Guidelines (CPG) regarding gout management, evaluate their quality, and to provide a synthesis of consistent recommendations in the high-quality CPGs. METHODS Gout management CPGs were eligible for inclusion if they were (1) written in English and published between January 2015-February 2022; focused on adults aged ≥ 18 years of age; and met the criteria of a CPG as defined by the Institute of Medicine; and (2) were rated as high quality on the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Gout CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organisation of care and did not include interventional management recommendations; and/or included other arthritic conditions. OvidSP MEDLINE, Cochrane, CINAHL, Embase and Physiotherapy Evidence Database (PEDro) and four online guideline repositories were searched. RESULTS Six CPGs were appraised as high quality and included in the synthesis. Clinical practice guidelines consistently recommended education, commencement of non-steroidal anti-inflammatories, colchicine or corticosteroids (unless contraindicated), and assessment of cardiovascular risk factors, renal function, and co-morbid conditions for acute gout management. Consistent recommendations for chronic gout management were urate lowering therapy (ULT) and continued prophylaxis recommended based on individual patient characteristics. Clinical practice guideline recommendations were inconsistent on when to initiate ULT and length of ULT, vitamin C intake, and use of pegloticase, fenofibrate and losartan. CONCLUSION Management of acute gout was consistent across CPGs. Management of chronic gout was mostly consistent although there were inconsistent recommendations regarding ULT and other pharmacological therapies. This synthesis provides clear guidance that can assist health professionals to provide standardised, evidence-based gout care. TRIAL REGISTRATION The protocol for this review was registered with Open Science Framework (DOI https://doi.org/10.17605/OSF.IO/UB3Y7 ).
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Affiliation(s)
- Brooke Conley
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC 3065 Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC Australia
| | - Samantha Bunzli
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD Australia
- Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, QLD Australia
| | | | - Penny O’Brien
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC 3065 Australia
| | - Jennifer Persaud
- Arthritis and Osteoporosis Western Australia, Perth, WA Australia
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, WA Australia
| | - Tilini Gunatillake
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC 3065 Australia
| | - Michelle M Dowsey
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC 3065 Australia
| | - Peter F Choong
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC 3065 Australia
| | - Mandana Nikpour
- Departments of Medicine and Rheumatology, The University of Melbourne at St. Vincent’s Hospital, Melbourne, VIC Australia
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
- Te Whatu Ora Health New Zealand – Capital Coast and Hutt Valley, Wellington, New Zealand
| | - Ivan Lin
- The University of Western Australia, Western Australian Centre for Rural Health, Geraldton, WA Australia
- Geraldton Regional Aboriginal Medical Service, Geraldton, WA Australia
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Kolaski K, Logan LR, Ioannidis JPA. Guidance to best tools and practices for systematic reviews. BMC Infect Dis 2023; 23:383. [PMID: 37286949 DOI: 10.1186/s12879-023-08304-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/03/2023] [Indexed: 06/09/2023] Open
Abstract
Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy.A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work.Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.
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Affiliation(s)
- Kat Kolaski
- Departments of Orthopaedic Surgery, Pediatrics, and Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Lynne Romeiser Logan
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, USA
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University School of Medicine, Stanford, CA, USA
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Kolaski K, Logan LR, Ioannidis JPA. Guidance to best tools and practices for systematic reviews. Syst Rev 2023; 12:96. [PMID: 37291658 DOI: 10.1186/s13643-023-02255-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/19/2023] [Indexed: 06/10/2023] Open
Abstract
Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy.A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work.Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.
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Affiliation(s)
- Kat Kolaski
- Departments of Orthopaedic Surgery, Pediatrics, and Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Lynne Romeiser Logan
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, USA
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University School of Medicine, Stanford, CA, USA
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Kolaski K, Logan LR, Ioannidis JPA. Guidance to Best Tools and Practices for Systematic Reviews. JBJS Rev 2023; 11:01874474-202306000-00009. [PMID: 37285444 DOI: 10.2106/jbjs.rvw.23.00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
» Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy.» A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work.» Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.
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Affiliation(s)
- Kat Kolaski
- Departments of Orthopaedic Surgery, Pediatrics, and Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lynne Romeiser Logan
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, New York
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University School of Medicine, Stanford, California
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Jiang P, Ali S, Peta A, Arada RB, Brevik A, Xie L, Okhunov Z, Clayman R, Landman J. A Review of the Recommendations and Strength of Evidence for Clinical Practice Guidelines on the Management of Small Renal Masses. J Endourol 2023. [PMID: 37254526 DOI: 10.1089/end.2022.0840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Introduction With the rise in the detection of incidental small renal masses (SRM), the management paradigm for these patients has become an issue of increasing concern. We aim to identify areas of consensus, controversy, and opportunities for improvement among recently published guidelines and assess the strength of evidence for the management of SRMs. Methods We reviewed practice guidelines for SRMs promulgated by the American Urological Association, European Association of Urology, National Comprehensive Cancer Network, American Society of Clinical Oncology, European Society for Medical Oncology, and the Chinese Society of Clinical Oncology. Levels of evidence and strength of recommendations for evaluation, management and follow-up were analyzed with regard to consensus, conflict, and neglect. Results There is consensus among guidelines for the initial evaluation and treatment of SRMs, however, discrepancies exist with regard to indications for active surveillance, thermal ablation and timing/method of follow-up after treatment. Routine renal mass biopsy is not recommended by any guideline. Overwhelmingly, guideline statements are based on low to moderate levels of evidence; only 23% of the reviewed guidelines were based on high-level evidence; 38% based on moderate and 39% on low-level evidence or expert opinion. Conclusions Despite all six guidelines sharing a consensus on most management topics regarding SRMs, the ongoing lack of high-level evidence precludes gold standard recommendations in the areas of diagnosis, treatment, and follow-up. More high-quality studies are needed in order to develop stronger, data-supported universal guideline for the management of SRMs.
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Affiliation(s)
- Pengbo Jiang
- University of California Irvine, 8788, Urology, Irvine, California, United States;
| | - Sohrab Ali
- University of California Irvine, 8788, Urology, 3800 W Chapman Ave, Suite 7200, Irvine, California, United States, 92697;
| | - Akhil Peta
- University of California Irvine, 8788, Urology, 333 City Blvd. West, Suite 2100, Irvine, California, United States, 92868;
| | - Raphael B Arada
- University of California Irvine Department of Urology, 481083, 101 The City Dr S, Orange, California, United States, 92868-2987;
| | - Andrew Brevik
- Kansas City University of Medicine and Biosciences College of Osteopathic Medicine, 472547, Urology, 1850 Whittier Ave, Apt G105, Costa Mesa, California, United States, 92627;
| | - Lillian Xie
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Zhamshid Okhunov
- Northwell Health, 5799, 304 Community Drive, Apt 3R, Manhasset, New York, United States, 11030;
| | - Ralph Clayman
- University of California Irvine, 8788, Urology, 3800 Chapman Avenue, Suite 7200, Orange, California, United States, 92868;
| | - Jaime Landman
- University of California Irvine, 8788, Urology, Orange, California, United States;
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