Quality appraisal of clinical practice guidelines on pancreatic cancer: a PRISMA-compliant article

Involvement of methodological experts and the quality of clinical practice guidelines: a critical appraisal of clinical practice guidelines and a questionnaire survey of the development groups in Japan

OBJECTIVE

To evaluate whether the involvement of methodological experts improves the quality of clinical practice guidelines (CPGs) after adjusting for other factors.

SETTING

The quality of Japanese CPGs published in 2011-2019 was assessed using the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument. A questionnaire survey targeting CPG development groups was conducted through postal mail.

PARTICIPANTS

405 CPGs were retrieved from a Japanese CPG clearinghouse. Questionnaires were distributed to the 405 CPG development groups. Of the 178 respondents, 22 were excluded because of missing values. Finally, 156 participants representing their CPG development groups were included in the analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

CPG quality was assessed using the AGREE II tool. The characteristics of CPGs, including publication year, development organisation, versions, number of members in the development group and involvement of methodological experts, were corrected from the description in the CPGs and the questionnaire survey. We performed multiple logistic regressions using the quality of CPGs as the dependent variable and the involvement of experts as the independent variable, adjusting for other possible factors.

RESULTS

A total of 156 CPGs were included. Expert involvement was significantly associated with the AGREE II instrument scores in domains 1 (β=0.207), 2 (β=0.370), 3 (β=0.413), 4 (β=0.289), 5 (β=0.375), 6 (β=0.240) and overall (β=0.344).

CONCLUSION

This study revealed that the involvement of methodological experts in the CPG development process improves the quality of CPGs. The results suggest the importance of establishing a training and certification programme for experts and constructing expert referral systems that meet CPG developers' needs to improve the quality of CPGs.

Complementary and alternative medicine mention and recommendations in pancreatic cancer clinical practice guidelines: A systematic review and quality assessment

Background

Pancreatic cancer is the third leading cause of cancer death in the United States, which is attributed to limited treatment options. Complementary and alternative medicine (CAM) therapies have been proposed to provide benefits in treating pancreatic cancer. Despite its importance in treatment, clinicians are not generally well equipped to counsel their patients about CAM therapies. This review identified the quantity and assessed the quality of clinical practice guidelines (CPGs) providing CAM recommendations for the treatment and/or management of pancreatic cancer.

Methods

A systematic review was conducted to identify pancreatic cancer CPGs. MEDLINE, EMBASE and CINAHL were searched from 2011 to 2022. The Guidelines International Network (GIN) and the National Center for Complementary and Integrative Health (NCCIH) websites were also searched. Eligible CPGs published by non-profit agencies on treatment and/or management of pancreatic cancer for adults were assessed using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument.

Results

From 31 eligible search results, 7 CPGs mentioned CAM and 3 CPGs made CAM recommendations. The mean scaled domain percentages of the CPGs in this study (overall, CAM-specific) were as follows: scope and purpose (81.3%, 77.8%), stakeholder involvement (63.9%, 42.6%), rigor-of-development (51.0%, 40.3%), clarity-of-presentation (83.3%, 54.6%), applicability (42.3%, 30.5%), and editorial independence (58.3%, 58.3%).

Conclusions

Evaluation of the CPGs demonstrated that quality varied both within and between CPGs. CPGs that scored well could be used by patients and clinicians as the basis for discussion for the use of CAM therapies. Future research should identify other appropriate CAM therapies for further development of CPGs for pancreatic cancer.

Registration

The protocol was registered on PROSPERO (registration number: CRD42022334025).

Guidelines in Low and Middle Income Countries Paper 3: Appraisal of Philippine Clinical Practice Guidelines using Appraisal of Guidelines for Research and Evaluation II: improvement needed for rigor, applicability, and editorial independence

BACKGROUND AND OBJECTIVE

High-quality clinical practice guidelines (CPGs) are needed to guide practitioners, policy makers, and other stakeholders to provide optimal health care. This study aims to appraise the CPGs developed in the Philippines using the AGREE II instrument.

METHODS

Ninety-one CPGs were appraised independently by two health-care professionals. CPGs were considered acceptable if they garnered an overall mean score of at least 75.0% for all 6 domains and a domain score of at least 75.0% for rigor of development. A mean score of <75.0% on either of the criteria implied that the CPG needed revision.

RESULTS

Overall mean scores of the CPGs ranged from 8.4% to 79.2%, with a mean of 43.9% (standard deviation = 13.4%). In general, CPGs scored better for the domains of clarity of presentation, scope and purpose, and stakeholder involvement. Lowest scores were obtained for the domains of rigor of development, applicability, and editorial independence. Only 1 (1.1%) CPG qualified as acceptable.

CONCLUSION

AGREE II is a practical and useful guide in appraising the quality of CPGs. Strengthening technical capacity in various medical fields is essential to improve the quality of CPGs. Rigor of development, applicability issues, and editorial independence should be emphasized in CPG capacity-building activities.

Screening for osteoporosis: A systematic assessment of the quality and content of clinical practice guidelines, using the AGREE II instrument and the IOM Standards for Trustworthy Guidelines

BACKGROUND

Numerous clinical practice guidelines (CPGs) are published to guide management of osteoporosis. Little is known about their quality or how recommendations have changed over time.

OBJECTIVE

To systematically assess the quality and content of the guidelines on screening for osteoporosis, using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool, and the Institute of Medicine (IOM) standards for trustworthy guidelines.

METHODS

We conducted a systematic search for osteoporosis CPGs published between 2002-2016, using multiple databases and guideline websites. Two reviewers appraised the quality of eligible CPGs using the AGREE II. High quality CPGs were considered if they scored ≥ 60 in four or more domains including the domain for rigor of development. Non-parametric tests were used to test for the change of quality over time. One reviewer assessed the guidelines with IOM standards. We summarized the different evidence grading systems and extracted and compared the recommendations.

RESULTS

A total of 33 CPGs were identified. The mean scores for AGREE II differed by domain (range: 42% to 71%). CPGs scored higher on domains for clarity of presentation, scope and purpose, and rigor of development. CPGs scored lower on domains for stakeholder involvement, editorial independence and applicability. Assessment of CPGs by IOM standards showed that CPGs scored better on standards for systematic review, establishing evidence foundation and rating strength of recommendation, articulation of recommendation, and establishing transparency. While scored lower on standards for updating, external review, and the development group composition. There was no difference in AGREE II and IOM defined guidelines' quality before and after the introduction of the two tools (P values >0.05). The IOM identified four more guidelines as high quality compared to the AGREE II. Examining these additional guidelines indicated that the two tools may give conflicting results especially for the rigor of development domain. Recommendations in certain areas showed substantial differences between guidelines.

CONCLUSION

Osteoporosis screening CPGs are of variable quality, and their recommendations often differ. Guideline quality as measured by AGREE II and IOM standards has not improved overtime. Guideline developers should work together to improve the quality and consistency of recommendations to improve the likelihood that their guidelines will be used in practice.

Appraising the Evidence Supporting Choosing Wisely® Recommendations

Despite the growing enthusiasm surrounding the Choosing Wisely® campaign, little is known regarding the evidence underlying these recommendations. We extracted references for all 320 recommendations published through August, 2014, including the 10 adult and pediatric recommendations published by the Society for Hospital Medicine. We then categorized each item by evidence strength, and then assessed a sample of referenced clinical practice guidelines (CPGs) using the validated Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Among all recommendations, 70.3% cited CPGs, whereas 22.2% cited primary research as their highest level of evidence. Moreover, 7.8% cited case series, review articles, editorials, or lower quality data as their highest level of evidence. Hospital medicine recommendations were more likely to cite CPGs (90%) as their highest level of evidence. Among the sampled CPGs, the median overall score obtained using AGREE II was 54.2% (IQR 33.3%-70.8%), whereas among hospital medicine-referenced CPGs, the median overall score was 58.3% (IQR 50.0%-83.3%). These findings suggest that Choosing Wisely® recommendations vary in terms of evidence strength.

Lack of existing guidelines for a large group of patients in Sweden: a national survey across the acute surgical care delivery chain

RATIONALE, AIMS AND OBJECTIVES

Evidence-informed healthcare is the fundament for practice, whereby guidelines based on the best available evidence should assist health professionals in managing patients. Patients seeking care for acute abdominal pain form a common group in acute care settings worldwide, for whom decision-making and timely treatment are of paramount importance. There is ambiguity about the existence, use and content of guidelines for patients with acute abdomen. The objective was to describe and compare guidelines and management of patients with acute abdomen in different settings across the acute care delivery chain in Sweden.

METHOD

A national cross-sectional design was used. Twenty-nine ambulance stations, 17 emergency departments and 33 surgical wards covering all six Swedish health regions were included, and 23 guidelines were quality appraised using the validated Appraisal of Guidelines for Research & Evaluation II tool.

RESULTS

There is a lack of guidelines in use for the management of this large group of patients between and within different healthcare areas across the acute care delivery chain. The quality appraisal identified that several guidelines were of poor quality, especially the in-hospital ones. Further, range orders for analgesics are common in the ambulance services and the surgical wards, but are seldom present in the emergency departments. Also, education in pain management is more common in the ambulance services. These findings are noteworthy as, hypothetically, the same patient could be treated in three different ways during the same care episode.

CONCLUSIONS

There is an urgent need to develop high-quality evidence-based clinical guidelines for this patient group, with the entire care process in focus.

Regime for Bowel Preparation in Patients Scheduled to Colonoscopy: Low-Residue Diet or Clear Liquid Diet? Evidence From Systematic Review With Power Analysis

Clear liquid diet (CLD) is used to perform bowel preparation before colonoscopy traditionally, but several clinical studies indicated that low-residue diet (LRD) generates equal effects to CLD and a conclusive conclusion has not yet been yielded. The systematic review was performed to address this conflict and facilitate informed decision-making eventually. To capture randomized controlled trials (RCTs) comparing LRD with CLD in terms of bowel preparation, a search was performed in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Science Direct, recent conference abstracts, Google Scholar, and Clinicaltrials.gov through May 2015. We performed all meta-analyses based on fixed- or random-effects model, which is generated from clinical characteristics and methodology. Moreover, the G*Power software was adopted to achieve statistical power for each outcome. In total, we captured 109 potential citations at initial search stage and 2 topic-related articles were included through other sources. After critical appraisal, 7 RCTs were eligible for our inclusion criteria. Meta-analyses generated similar effects in bowel preparation quality, efficacy of colon cleansing, and compliance with recommended dietary regime when LRD versus CLD regime, but patients who were prescribed to receive LRD have slightly better tolerance (RR, 1.06; 95% CI, 1.02-1.11) and tended to repeat the same preparation regime in future (RR, 1.17; 95% CI, 1.09-1.26) relative to patients in CLD. Importantly, both regimes resulted in similar adverse events (AEs). With the best available evidence, LRD could be recommended to be as standard regime for bowel preparation prior to colonoscopy.