Methodological quality of clinical practice guidelines for genetic testing in children: A systematic assessment using the appraisal of guidelines for research and evaluation II instrument

Home health care of Iranian elderly with dementia: Study protocol for guideline adaptation

BACKGROUND

Advanced stages of dementia interfere with elderly self-care. Consequently, they need caregivers who take responsibility for their care in the long-term. Restrictions to the caregiver's access to information, resources, and organizational support have created problems in their caregiver role, which is why the World Health Organization (WHO) emphasizes caring for caregivers by providing evidence-based information and training programs. As there is no clinical practice guideline for home care in the Islamic Republic of Iran, this study aims to develop a home health care guideline for the elderly with dementia.

MATERIALS AND METHODS

The ADAPTE process provided by the Guidelines International Network was considered as the basis. In order to identify the care needs of Iranian patients with dementia, semi-structured interviews were added to this guideline.

DISCUSSION

The identification and implementation of the perspectives of patients and caregivers during the process of guidelines adaptation increase the applicability of the guidelines. Improved quality of life for the patients in their place of residence is one of the expected consequences of this guideline's implementation. The developed guidelines will be used at home health care centers, and dementia and Alzheimer's associations in Iran.

Systematic review of clinical practice guidelines on the management of community acquired pneumonia in children

Childhood community acquired pneumonia (CAP) is the leading cause of mortality in children under 5 years worldwide. Clinical practice guidelines (CPGs) may be limited by method of development, scope of recommendations and the quality of supporting evidence. This study systematically identified, appraised and compared the recommendations of CPGs for the management of paediatric CAP using the AGREE II tool. The systematic review yielded 1409 non-duplicate results, of which 14 CPGs were appraised. Four of the fourteen CPGs were deemed high quality. Most CPGs were considered low-medium quality with 'rigour of development' and 'applicability' the weakest domains. These areas should be considered in deriving CPGs in the future. Recommendations were generally similar across all guidelines; however, there was notable heterogeneity in three areas. This suggests the need for further evidence to guide management decisions on oxygen saturation thresholds for admission, the utility of investigations such as acute phase reactants, and the duration of antibiotic therapy.

Guías de práctica clínica para el tratamiento de la enfermedad por Covid-19 en Brasil: revisión sistemática

Introducción: La enfermedad por coronavirus (Covid-19) es una patología infecciosa que afecta al sistema respiratorio, la cual se originó en China y se extendió rápidamente por todo el mundo. Objetivo: Evaluar la calidad metodológica y la transparencia de las guías de práctica clínica brasileñas para el tratamiento de la enfermedad por coronavirus (Covid-19). Materiales y métodos: Se realizó una revisión sistemática en 2020 en las bases de datos Medline (vía PubMed), Embase, Scopus, LILACS, National Guideline Clearinghouse y Guidelines International Network, además de consultas en los sitios web del Ministerio de Salud de Brasil, Asociación Médicas Brasileña, Consejo Federal de Medicina, Consejo Federal de Enfermería y Consejo Federal de Fisioterapia. La evaluación de la calidad metodológica y la transparencia de las guías se realizó con el instrumento Appraisal of Guidelines for Research and Evaluation (AGREE), segunda versión realizada por cuatro autores. Resultados: Se encontraron 33 guías, de las que se incluyeron 14 en el análisis. Hubo una sola guía que obtuvo una puntuación superior al 60% en todos los dominios. Entre los seis dominios, se presentaron puntuaciones más altas en los siguientes tres dominios: alcance y objetivo, participación de las partes interesadas y claridad de la presentación. Discusión: A pesar de la fragilidad metodológica, los autores se interesaron por presentar las recomendaciones de forma clara y concisa a través de información clave y opciones terapéuticas que faciliten la toma de decisiones. Conclusión: Las guías de práctica clínica brasileñas mostraron tener una baja calidad metodológica, de las que solamente una guía fue recomendada y clasificada como de alta calidad y transparencia metodológica. Como citar este artículo: Lanes, Taís Carpes; Ribeiro, Mariane Albuquerque Lima; Oliveira, Daianny Seoni de; Junior, Marcos Gabriel do Nascimento; Garcia, Filipe Reis; Melo, Jéssyca Maria França de Oliveira; Tiguman, Gustavo Magno Baldin. Diretrizes de prática clínica para o tratamento da Covid-19 no Brasil: uma revisão sistemática. Revista Cuidarte. 2021;12(2):e2025 http://dx.doi.org/10.15649/cuidarte.2025   

Genetic and metabolic investigations for individuals with neurodevelopmental disorders: A survey of Canadian geneticists' practices

Neurodevelopmental disorders (NDDs) are genetically heterogeneous. There are many possible etiological investigations for NDDs, and a lack of clear and current guidelines for such testing. Here we characterize the practices of genetic and metabolic physicians in Canada as it pertains to etiological investigation of patients with NDDs, by means of an online questionnaire. The survey response rate was 30% (n = 46). The most commonly ordered first-line tests for patients with non-syndromic NDDs are chromosomal microarray (98%) and Fragile X testing (85%). The most commonly ordered second-line test for non-syndromic NDDs is a multi-gene panel (78%) or exome sequencing (29%). Biochemical screening is ordered as a first line test by 33% of respondents, second line by 31%, and rarely or never by 36% of respondents. Those respondents with metabolics fellowship training were more likely to order biochemical screening than those without. The number of years of clinical experience generally did not affect the types of tests ordered. For patients with NDDs, test-ordering practice among Canadian clinical geneticists is highly variable, in particular with respect to biochemical screening and use of next-generation sequencing technologies. Evidence-based guidelines should be developed to facilitate best practices in Canada.

Quality assessment of clinical practice guidelines for the management of paediatric dental emergencies applicable to the COVID-19 pandemic, using the AGREE II instrument. A systematic review

OBJECTIVE

To assess the quality of Clinical Practice Guidelines (CPG) related to the management of paediatric dental emergencies applicable to the COVID-19 pandemic, through the use of the measuring instrument AGREE II (Appraisal of Guidelines for Research and Evaluation in Europe).

SOURCES AND DATA COLLECTION

A rigurous online search of CPG was accomplished among the main CPG compilers: National Institute for Health and Care Excellence (NICE), National Guideline Clearinghouse, Agency for Healthcare, Research and Quality (AHRQ), Andalusian Health Technology Assessment Department (AETSA), American Academy of Family Physicians, Tripdatabase. Furthermore, because of the need to identify CPG that meet the inclusion criteria, a manual search, among the main national and international dental organizations as well as recognized web sites, was also accomplished.

SELECTION OF RESEARCH STUDIES

All of the guides focused on paediatric dental emergencies, available in the database and "gray" literature, and published between 2000 and 2020 (applicable to COVID-19 pandemic) were included without any language restrictions. The CPG that did not contain the full paper or were addressed to adults or children with special needs, were excluded from the selection. The evaluation of the CPG, independently included, were achieved by four (04) experts by using AGREE II.

RESULTS

Five (05) out of twenty-three (23) selected CPG, were classified as "acceptable" according to AGREE II. These five guides were evaluated to determine their "Recommendation degree". Only one (01) CPG "Guía Clínica AUGE de Urgencias Odontológicas Ambulatorias-Chile, 2011" reached a score of 75%, the highest among the other guides (5 domains with a score ≥ 60%, including the domain III "Rigour of Development") to be considered as a "highly recommended" CPG.

CONCLUSIONS

According to the quality assessment and recommendation degrees criteria from AGREE II, high, middle and low quality CPG were identified. Only one CPG reached a score of 75%, to be classified as "highly recommended". Therefore, it is suggested that the existing CPG updates and future CPG use the available tools and methodologies during their elaboration, in order to guarantee their quality.

CLINICAL SIGNIFICANCE

High quality CPG for the management of dental emergencies are designed to support dental health professionals in decision-making to adopt specific dental procedures in the current COVID-19 pandemic. As a matter of fact, these CPG might contribute to reduce the risk of transmission, in case of fresh outbreak of the illness. Likewise, they might help to determine which cases warrant medical attention in centres with special facilities for COVID-19.

A systematic review of the quality of clinical practice guidelines for lymphedema, as assessed using the Appraisal of Guidelines for Research and Evaluation II instrument

OBJECTIVE

We assessed the quality of current clinical practice guidelines (CPGs) for lymphedema using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. CPGs provide recommendations for the management of medical conditions such as lymphedema. However, their evidentiary quality and methodology should determine their reliability. The AGREE II instrument was developed to externally and objectively evaluate the quality of CPGs and has been used to assess other nonvascular CPGs. A systematic review identified four CPGs for lymphedema of varying content: Lymphedema Framework's Best Practice for the Management of Lymphedema (LED F); Japanese Lymphedema Study Group-A Practice Guideline for the Management of Lymphedema (J LED); Clinical Resource Efficiency Support Team (CREST) Guidelines for the Diagnosis, Assessment and Management of Lymphedema; and Guidelines of the American Venous Forum (AVF). The quality of these CPGs appeared to vary.

METHODS

The four CPGs were analyzed using the AGREE II instrument by three independent graders, who were unaware of each other's scores. Six domains with 23 items were graded using a Likert scale (1, strongly disagree; to 7, strongly agree) regarding whether the CPG had satisfied the requirements of each item. The score for each domain was calculated by summing the scores for each item in that domain and scaling the total as a percentage of the maximum possible score for that domain (ie, obtained score - minimum score/maximum possible score - minimum possible score × 100 = percentage).

RESULTS

CREST had the highest overall score (66.8%), as an average of all domains, and J LED had the lowest (37%). CREST also had five of five domains rated >50%. In contrast, J LED had only one and AVF had only two domains that scored >50%. Although two domains, rigor of development and applicability, scored low, with only one CPG scoring >50%, the editorial independence domain scored the lowest of all six domains.

CONCLUSIONS

In addition to limitations in content and the lack of contemporary references, the four CPGs studied were judged objectively to be of low quality using the AGREE II instrument. A contemporary CPG for lymphedema, guided by the AGREE II requirements, is needed.