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Boss M, Turner J, Boss P, Hartmann P, Pritchard D, Clifford R. Integrating approaches for quality guideline development in LactaMap, an online lactation care support system. BMC Pregnancy Childbirth 2021; 21:322. [PMID: 33892640 PMCID: PMC8063164 DOI: 10.1186/s12884-021-03775-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 04/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background Health professionals caring for women and infants experiencing difficulty with breastfeeding have reported deficiencies in evidence-based lactation knowledge. LactaMap is an online lactation care support system with more than 100 clinical practice guidelines to support breastfeeding care. Clinical practice guidelines support medical decision-making by summarising scientific evidence into systematically developed statements for specific clinical circumstances. Both common-sense and theory-based approaches have been used for guideline development and debate continues regarding which is superior. LactaMap clinical practice guidelines were created over the course of 5 years using a common-sense approach that was refined inductively. The aim of this study was to incorporate a theory-based framework approach into the methodology for ongoing update and review of LactaMap clinical practice guidelines. Methods The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was chosen as the framework-based approach to appraise LactaMap guideline quality. The study was conducted in two phases. The first phase appraised all 103 original LactaMap guidelines. The second phase appraised a subset of 15 updated LactaMap guidelines using improved methodology guided by phase 1, as well as 15 corresponding original (un-updated) guidelines. Results Mean Domain scores for 103 LactaMap original guidelines were above 75% in 3 of the 6 AGREE II quality Domains and no mean Domain score rated poorly. Update of guideline methodology was guided by phase 1 appraisals. Improved documentation of methods relating to questions in the Rigour of Development Domain resulted in improvement in mean Domain score from 39 to 72%. Conclusions This study showed that a theory-based approach to guideline development methodology can be readily integrated with a common-sense approach. Factors identified by AGREE II theory-based framework provided practical guidance for changes in methodology that were integrated prior to LactaMap website publication. Demonstration of high quality in LactaMap clinical practice guideline methodology ensures clinicians and the public can have trust that the content founded on them is robust, scientific and of highest possible quality.
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Affiliation(s)
- Melinda Boss
- School of Allied Health, The University of Western Australia, Crawley, Western Australia, 6009, Australia.
| | - Jennifer Turner
- School of Allied Health, The University of Western Australia, Crawley, Western Australia, 6009, Australia
| | - Patrick Boss
- PEB Consulting Pty Ltd, 69 Federation St, Mount Hawthorn, Western Australia, 6016, Australia
| | - Peter Hartmann
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, 6009, Australia
| | - Douglas Pritchard
- School of Medicine, The University of Western Australia, Crawley, Western Australia, 6009, Australia
| | - Rhonda Clifford
- School of Allied Health, The University of Western Australia, Crawley, Western Australia, 6009, Australia
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The Critical Assessment of the Quality of Common Clinical Guidelines for Administering Chemotherapy Drugs by Using AGREE II Tool. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2019. [DOI: 10.5812/ijcm.91020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wainberg SK, Santos NCL, Gabriel FC, de Vasconcelos LP, Nascimento JS, de Godoi Rezende Costa Molino C, de Melo DO. Clinical practice guidelines for surgical antimicrobial prophylaxis: Qualitative appraisals and synthesis of recommendations. J Eval Clin Pract 2019; 25:591-602. [PMID: 30024082 DOI: 10.1111/jep.12992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 12/20/2022]
Abstract
RATIONALE, GOALS, AND OBJECTIVES Clinical practice guidelines (CPGs) for preoperative care have been developed for surgical antimicrobial prophylaxis (SAP). The objective of this study was to synthetize recommendations for SAP based on best-evaluated CPGs. METHODS A systematic literature search for documents related to SAP, published between January 2011 and December 2016, was conducted on MEDLINE (PubMed), EMBASE, and specific CPG websites. Three reviewers independently assessed the rigour of development and editorial independence of CPGs based on domains 3 and 6 of the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. CPGs with domain 3 scores of 50% and greater were selected for synthesis of recommendations. Two reviewers independently extracted CPG recommendations from among these documents. A third reviewer performed the synthesis of recommendations. RESULTS The search retrieved 363 documents, of which 29 CPGs were appraised using AGREE II. Only eight (28%) scored 50% and greater in domain 3. Most CPGs addressed topics related to preoperative care, including SAP. No conflicting recommendations were found, and most recommendations were based on clinical practice. The only recommendation for which there was a difference among CPGs was with respect to the time to initiate the administration of antibiotics (1 hour before or close to the time of the surgical incision). Four CPGs provide recommendations that demonstrate concern about inadequate SAP prolongation. CONCLUSION Several CPGs for SAP were developed without the desired methodological rigour or transparency. Synthesis of recommendations for best-evaluated CPGs provides a broad approach owing to the complementarity of the recommendations.
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Affiliation(s)
- Sheila Kalb Wainberg
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Jéssica Santos Nascimento
- Multiprofessional Residency Program in Orthopedics and Traumatology, Federal University of São Paulo, Santos, São Paulo, Brazil
| | | | - Daniela Oliveira de Melo
- Department of Pharmaceutical Sciences, Institute of Environmental Sciences, Chemical and Pharmaceutical, Federal University of São Paulo, Diadema, São Paulo, Brazil
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Nutrition guidelines vary widely in methodological quality: an overview of reviews. J Clin Epidemiol 2018; 104:62-72. [DOI: 10.1016/j.jclinepi.2018.08.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/25/2018] [Accepted: 08/22/2018] [Indexed: 12/15/2022]
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Gillespie BM, Bull C, Walker R, Lin F, Roberts S, Chaboyer W. Quality appraisal of clinical guidelines for surgical site infection prevention: A systematic review. PLoS One 2018; 13:e0203354. [PMID: 30212487 PMCID: PMC6136720 DOI: 10.1371/journal.pone.0203354] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/20/2018] [Indexed: 11/21/2022] Open
Abstract
Background Surgical site infections (SSI) occur in up to 10% of surgeries. Wound care practices to prevent infections are guided by Clinical Practice Guidelines (CPGs), yet their contribution to improving patient outcomes relies on their quality and adoption in practice. We critically evaluated the quality of CPGs for SSI prevention during pre-, intra- and post-operative phases of care. Methods We systematically reviewed the literature from 1990–2018 using the Cochrane Library, CINAHL, EMBASE, MEDLINE, ProQuest databases and five guidelines repositories. We extracted characteristics of each guideline using purposely-developed data collection tools. We assessed overall quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Results Combined searches of databases and repositories yielded 5,910 citations. Of these, we reviewed 215 full text documents. The final sample included 15 documents: 6 complete CPGs, 3 CPG updates, and 6 supplementary documents. The overall %mean scores across AGREE II domains for CPGs were: 1) scope and purpose (%mean ± SD = 86.3±23.5); 2) stakeholder involvement (%mean ± SD = 64±31.0); 3) rigour of development (%mean ± SD = 68.7±30.6); 4) clarity and presentation (%mean ± SD = 88.5±16.7); 5) applicability (%mean ± SD = 44±30.2); and, 5) editorial independence (%mean ± SD = 61±37.6). Based on individual AGREE II domains and overall scores, we appraised 4 out of 6 CPGs (inclusive of updates) as “recommended” for use in practice. Overall agreement among appraisers was excellent (ICC 0.86 [95%CI 0.73–0.94] - 0.98 [95%CI 0.96–0.99]; p <0.001). Discussion International interest in CPG development has resulted in refinements to methodologies, which has led to improvements in the overall quality of the product. Implications for translation Given the domains that received the lowest scores, it is clear that we need more consumer involvement and better consideration of the implementation challenges with CPG uptake and sustainability.
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Affiliation(s)
- Brigid M. Gillespie
- School of Nursing & Midwifery, Griffith University, Gold Coast, QLD, Australia
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
- Optimising Health Outcomes (OHO) group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- * E-mail:
| | - Claudia Bull
- Optimising Health Outcomes (OHO) group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Rachel Walker
- Division of Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Brisbane, QLD, Australia
| | - Frances Lin
- School of Nursing & Midwifery, Griffith University, Gold Coast, QLD, Australia
| | - Shelley Roberts
- Optimising Health Outcomes (OHO) group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Wendy Chaboyer
- School of Nursing & Midwifery, Griffith University, Gold Coast, QLD, Australia
- Optimising Health Outcomes (OHO) group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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Rego de Sousa MJ, Albuquerque M, Ribeiro R, Cruz G, Mateus P, de Sousa J, de Sousa G. Evaluation of Noninvasive Prenatal Testing (NIPT) guidelines using the AGREE II instrument. J Matern Fetal Neonatal Med 2018; 33:455-463. [PMID: 30205421 DOI: 10.1080/14767058.2018.1494716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: The rapid increase of cell-free fetal DNA analysis for Down syndrome screening requires evidence-based clinical practice guidelines for noninvasive prenatal testing (NIPT). Several studies show that the quality of many guidelines is low and there are still many health areas where this quality is not systematically evaluated. Given the absence of research, in the NIPT field, we used an internationally validated tool to evaluate a set of three NIPT practice guidelines and to look at dimensions that can be improved.Methods: Four appraisers, experts in prenatal screening, evaluated three main NIPT guidelines published in the last 2 years using the AGREE II (Appraisal of Guidelines for Research and Evaluation II), a tool specifically designed for guideline quality appraisal.Results: Guidelines scored higher in domains related with scope, purpose, and clarity of presentation, and lower in stakeholder involvement and rigor of development. Intradomain items evaluation showed asymmetries between guidelines. The UK-NSC was the guideline with the best scores.Discussion: Several areas of NIPT guidelines, such as stakeholders involvement, selection of supporting evidence, external reviews, updating processes, and competing interests disclosure, can be improved. Appraisers recommend modifications to all NIPT guidelines that can lead to substantial improvements in their methodological quality and subsequently make a contribution to prenatal screening improvement.
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Affiliation(s)
| | | | - Rita Ribeiro
- Centro de Medicina Laboratorial Germano de Sousa, Lisboa, Portugal
| | - Grasielle Cruz
- Centro de Medicina Laboratorial Germano de Sousa, Lisboa, Portugal
| | - Pedro Mateus
- Centro de Medicina Laboratorial Germano de Sousa, Lisboa, Portugal
| | - José de Sousa
- Centro de Medicina Laboratorial Germano de Sousa, Lisboa, Portugal
| | - Germano de Sousa
- Centro de Medicina Laboratorial Germano de Sousa, Lisboa, Portugal
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García Vera C, García Ventura M, del Castillo Aguas G, Domínguez Aurrecoechea B, Esparza Olcina MJ, Martínez Rubio A, Mengual Gil JM. Acute bacterial gastroenteritis: 729 cases recruited by a Primary Care national network. An Pediatr (Barc) 2017. [DOI: 10.1016/j.anpede.2016.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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García Vera C, García Ventura M, del Castillo Aguas G, Domínguez Aurrecoechea B, Esparza Olcina MJ, Martínez Rubio A, Mengual Gil JM. Gastroenteritis aguda bacteriana: 729 casos reclutados por una red nacional de atención primaria. An Pediatr (Barc) 2017; 87:128-134. [DOI: 10.1016/j.anpedi.2016.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/17/2016] [Accepted: 04/29/2016] [Indexed: 11/28/2022] Open
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Beglinger S. [Not Available]. PRAXIS 2017; 106:209-217. [PMID: 28211756 DOI: 10.1024/1661-8157/a002607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Zusammenfassung. Die häufigsten Gründe, weshalb ein Kind in der Praxis oder im Spital vorgestellt wird, sind Dehydratation und Trink-/Essensverweigerung aufgrund einer akuten Gastroenteritis (AGE). Die häufigste Ursache einer AGE ist das Rotavirus, gefolgt von Norovirus und seltenen bakteriellen Erkrankungen. Eine Erregerdiagnostik ist dabei nur selten nötig. Der Dehydratationsgrad wird vornehmlich klinisch anhand eines Dehydratations-Scores gestellt. Ziel der Dehydratationstherapie sind die rasche Rehydrierung und Wiederaufnahme von Flüssigkeit und Nahrung durch das Kind. Eine Rehydratationstherapie (RT) sollte wenn immer möglich per os oder per Magensonde stattfinden und nur in schweren Fällen intravenös. Bei einem prolongierten Verlauf sind weitere Abklärungen beim gastroenterologischen Spezialisten empfehlenswert.
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Affiliation(s)
- Svetlana Beglinger
- 1 Interdisziplinäre Notfallstation, Universitäts-Kinderspital beider Basel
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Radwan M, Akbari Sari A, Rashidian A, Takian A, Abou-Dagga S, Elsous A. Appraising the methodological quality of the clinical practice guideline for diabetes mellitus using the AGREE II instrument: a methodological evaluation. JRSM Open 2017; 8:2054270416682673. [PMID: 28203385 PMCID: PMC5298436 DOI: 10.1177/2054270416682673] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate the methodological quality of the Palestinian Clinical Practice Guideline for Diabetes Mellitus using the Translated Arabic Version of the AGREE II. DESIGN Methodological evaluation. A cross-cultural adaptation framework was followed to translate and develop a standardised Translated Arabic Version of the AGREE II. SETTING Palestinian Primary Healthcare Centres. PARTICIPANTS Sixteen appraisers independently evaluated the Clinical Practice Guideline for Diabetes Mellitus using the Translated Arabic Version of the AGREE II. MAIN OUTCOME MEASURES Methodological quality of diabetic guideline. RESULTS The Translated Arabic Version of the AGREE II showed an acceptable reliability and validity. Internal consistency ranged between 0.67 and 0.88 (Cronbach's α). Intra-class coefficient among appraisers ranged between 0.56 and 0.88. The quality of this guideline is low. Both domains 'Scope and Purpose' and 'Clarity of Presentation' had the highest quality scores (66.7% and 61.5%, respectively), whereas the scores for 'Applicability', 'Stakeholder Involvement', 'Rigour of Development' and 'Editorial Independence' were the lowest (27%, 35%, 36.5%, and 40%, respectively). CONCLUSIONS The findings suggest that the quality of this Clinical Practice Guideline is disappointingly low. To improve the quality of current and future guidelines, the AGREE II instrument is extremely recommended to be incorporated as a gold standard for developing, evaluating or updating the Palestinian Clinical Practice Guidelines. Future guidelines can be improved by setting specific strategies to overcome implementation barriers with respect to economic considerations, engaging of all relevant end-users and patients, ensuring a rigorous methodology for searching, selecting and synthesising the evidences and recommendations, and addressing potential conflict of interests within the development group.
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Affiliation(s)
- Mahmoud Radwan
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- School of Public Health, International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- School of Public Health, International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaa Abou-Dagga
- Department of Research Affairs and Graduates Studies, Islamic University of Gaza, Gaza Strip, Palestine
| | - Aymen Elsous
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences, Tehran, Iran
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Geurts D, de Vos-Kerkhof E, Polinder S, Steyerberg E, van der Lei J, Moll H, Oostenbrink R. Implementation of clinical decision support in young children with acute gastroenteritis: a randomized controlled trial at the emergency department. Eur J Pediatr 2017; 176:173-181. [PMID: 27933399 PMCID: PMC5243872 DOI: 10.1007/s00431-016-2819-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 11/14/2016] [Accepted: 11/21/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED Acute gastroenteritis (AGE) is one of the most frequent reasons for young children to visit emergency departments (EDs). We aimed to evaluate (1) feasibility of a nurse-guided clinical decision support system for rehydration treatment in children with AGE and (2) the impact on diagnostics, treatment, and costs compared with usual care by attending physician. A randomized controlled trial was performed in 222 children, aged 1 month to 5 years at the ED of the Erasmus MC-Sophia Children's hospital in The Netherlands ( 2010-2012). Outcome included (1) feasibility, measured by compliance of the nurses, and (2) length of stay (LOS) at the ED, the number of diagnostic tests, treatment, follow-up, and costs. Due to failure of post-ED weight measurement, we could not evaluate weight difference as measure for dehydration. Patient characteristics were comparable between the intervention (N = 113) and the usual care group (N = 109). Implementation of the clinical decision support system proved a high compliance rate. The standardized use of oral ORS (oral rehydration solution) significantly increased from 52 to 65%(RR2.2, 95%CI 1.09-4.31 p < 0.05). We observed no differences in other outcome measures. CONCLUSION Implementation of nurse-guided clinical decision support system on rehydration treatment in children with AGE showed high compliance and increase standardized use of ORS, without differences in other outcome measures. What is Known: • Acute gastroenteritis is one of the most frequently encountered problems in pediatric emergency departments. • Guidelines advocate standardized oral treatment in children with mild to moderate dehydration, but appear to be applied infrequently in clinical practice. What is New: • Implementation of a nurse-guided clinical decision support system on treatment of AGE in young children showed good feasibility, resulting in a more standardized ORS use in children with mild to moderate dehydration, compared to usual care. • Given the challenges to perform research in emergency care setting, the ED should be experienced and adequately equipped, especially during peak times.
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Affiliation(s)
- Dorien Geurts
- Department of Pediatrics, Erasmus MC - Sophia children's hospital, Wytemaweg 80, Rotterdam, CN, 3015, The Netherlands.
| | - Evelien de Vos-Kerkhof
- Department of Pediatrics, Erasmus MC - Sophia children's hospital, Wytemaweg 80, Rotterdam, CN, 3015, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Ewout Steyerberg
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - Henriëtte Moll
- Department of Pediatrics, Erasmus MC - Sophia children's hospital, Wytemaweg 80, Rotterdam, CN, 3015, The Netherlands
| | - Rianne Oostenbrink
- Department of Pediatrics, Erasmus MC - Sophia children's hospital, Wytemaweg 80, Rotterdam, CN, 3015, The Netherlands
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Vecchio AL, Dias JA, Berkley JA, Boey C, Cohen MB, Cruchet S, Liguoro I, Lindo ES, Sandhu B, Sherman P, Shimizu T, Guarino A. Comparison of Recommendations in Clinical Practice Guidelines for Acute Gastroenteritis in Children. J Pediatr Gastroenterol Nutr 2016; 63:226-35. [PMID: 26835905 PMCID: PMC6858859 DOI: 10.1097/mpg.0000000000001133] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Acute gastroenteritis (AGE) is a major cause of child mortality and morbidity. This study aimed at systematically reviewing clinical practice guidelines (CPGs) on AGE to compare recommendations and provide the basis for developing single universal guidelines. METHODS CPGs were identified by searching MEDLINE, Cochrane-Library, National Guideline Clearinghouse and Web sites of relevant societies/organizations producing and/or endorsing CPGs. RESULTS The definition of AGE varies among the 15 CPGs identified. The parameters most frequently recommended to assess dehydration are skin turgor and sunken eyes (11/15, 73.3%), general appearance (11/15, 66.6%), capillary refill time, and mucous membranes appearance (9/15, 60%). Oral rehydration solution is universally recognized as first-line treatment. The majority of CPGs recommend hypo-osmolar (Na 45-60 mmol/L, 11/15, 66.6 %) or low-osmolality (Na 75 mmol/L, 9/15, 60%) solutions. In children who fail oral rehydration, most CPGs suggest intravenous rehydration (66.6%). However, nasogastric tube insertion for fluid administration is preferred according by 5/15 CPGs (33.3%). Changes in diet and withdrawal of food are discouraged by all CPGs, and early refeeding is strongly recommended in 13 of 15 (86.7%). Zinc is recommended as an adjunct to ORS by 10 of 15 (66.6%) CPGs, most of them from low-income countries. Probiotics are considered by 9 of 15 (60%) CPGs, 5 from high-income countries. Antiemetics are not recommended in 9 of 15 (60%) CPGs. Routine use of antibiotics is discouraged. CONCLUSIONS Key recommendations for the management of AGE in children are similar in CPGs. Together with accurate review of evidence-base this may represent a starting point for developing universal recommendations for the management of children with AGE worldwide.
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Affiliation(s)
- Andrea Lo Vecchio
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Jorge Amil Dias
- Departamento de Pediatria Médica, Hospital de São João, Porto, Portugal
| | | | - Chris Boey
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mitchell B. Cohen
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | | | - Ilaria Liguoro
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | | | - Bhupinder Sandhu
- Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Philip Sherman
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Alfredo Guarino
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
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Lo Vecchio A, Vandenplas Y, Benninga M, Broekaert I, Falconer J, Gottrand F, Lifschitz C, Lionetti P, Orel R, Papadopoulou A, Ribes-Koninckx C, Salvatore S, Shamir R, Schäppi M, Staiano A, Szajewska H, Thapar N, Wilschanski M, Guarino A. An international consensus report on a new algorithm for the management of infant diarrhoea. Acta Paediatr 2016; 105:e384-9. [PMID: 27101938 DOI: 10.1111/apa.13432] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/09/2016] [Accepted: 04/12/2016] [Indexed: 12/22/2022]
Abstract
AIM Implementing international guidelines guarantees high standards of clinical care. A group of experts developed an algorithm to drive the management of common gastrointestinal symptoms in infancy by paediatricians and general practitioners. METHODS The algorithm started from the evidence-based recommendations of the European Society of Gastroenterology, Hepatology and Nutrition and the European Society of Pediatric Infectious Diseases and an updated review of the literature. We used the structured quantitative method of nominal group technique to reach a consensus. RESULTS A practical algorithm for the management of infants with acute diarrhoea was designed based on the consensus reached for each statement. The management of an infant with acute diarrhoea should include a sequence of actions: (i) a semiquantitative estimate of infant dehydration through validated clinical scores, (ii) rehydration therapy and early refeeding with breast milk or regular formula and (iii) effective agents to reduce the severity and duration of the diarrhoea. Finally, in children with prolonged diarrhoea, the search for aetiology should include persistent infections or reinfections, cows' milk protein allergy and coeliac diseases. Lactose should always be withdrawn. CONCLUSION This algorithm provides an evidence-based sequence of interventions to optimise the management of infants with acute diarrhoea.
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Affiliation(s)
- Andrea Lo Vecchio
- Department of Translational Medical Science; Section of Paediatrics; University of Naples Federico II; Naples Italy
| | - Yvan Vandenplas
- Department of Paediatrics; UZ Brussel; Vrije Universiteit Brussel; Brussels Belgium
| | - Marc Benninga
- Department of Paediatrics; Emma Children's Hospital/AMC; Amsterdam the Netherlands
| | - Ilse Broekaert
- Department of Paediatrics; University Hospital Cologne; Cologne Germany
| | - Jackie Falconer
- Nutrition and Dietetics Department; Chelsea and Westmister NHS Healthcare Foundation; London UK
| | - Frederic Gottrand
- Department of Paediatrics; Faculty of medicine; Jeanne de Flandre University Hospital; CHRU Lille; Lille France
| | - Carlos Lifschitz
- Department of Pediatrics; Section of Gastroenterology, Hepatology and Transplantation; Hospital Italiano; Buenos Aires Argentina
| | - Paolo Lionetti
- Department of Neuroscience; Pharmacology and Child Health; University of Florence-Meyer children's Hospital; Florence Italy
| | - Rok Orel
- Department of Gastroenterology, Hepatology and Nutrition; University Children's Hospital Ljubljana; Ljubljana Slovenia
| | - Alexandra Papadopoulou
- Gastroenterology Unit; First Department of Paediatrics; University of Athens; Children's Hospital “Agia Sofia”; Thivon Greece
| | - Carmen Ribes-Koninckx
- Paediatric Gastroenterology and Hepatology Unit; La Fe University Hospital; Valencia Spain
| | | | - Raanan Shamir
- Schneider Children's Medical Centre of Israel; Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Michela Schäppi
- Paediatric Center; Clinique des Grangettes and Centre Médical Universitaire; Geneva Switzerland
| | - Annamaria Staiano
- Department of Translational Medical Science; Section of Paediatrics; University of Naples Federico II; Naples Italy
| | - Hania Szajewska
- Department of Paediatrics; The Medical University of Warsaw; Warsaw Poland
| | - Nikhil Thapar
- Gastroenterology Unit; Great Ormond Street Hospital and UCL Institute of Child Health; London UK
| | - Michael Wilschanski
- Paediatric Gastroenterology; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - Alfredo Guarino
- Department of Translational Medical Science; Section of Paediatrics; University of Naples Federico II; Naples Italy
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Tian H, Ding C, Gong J, Ge X, McFarland LV, Gu L, Chen Q, Ma C, Zhu W, Li J, Li N. An appraisal of clinical practice guidelines for constipation: a right attitude towards to guidelines. BMC Gastroenterol 2016; 16:52. [PMID: 27142422 PMCID: PMC4855801 DOI: 10.1186/s12876-016-0466-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 04/25/2016] [Indexed: 12/21/2022] Open
Abstract
Background Clinical practice guidelines (CPGs) are formally developed statements that assist users to provide proper health care for a kind of disease and play a significant contribution in healthcare system. This study report the methodological quality of CPGs on constipation. Methods The “Appraisal of Guidelines and Research and Evaluation” (AGREEII) instrument was developed to determine the quality of CPGs. A comprehensive search was developed using five databases and three guideline websites until/up to December, 2015. Four independent authors evaluated the methodological issues of the CPGs by the AGREEII instrument. Results We identified 22 relevant guidelines on constipation from 1234 citations. The overall agreement among evaluators was 0.84 using the intra-class correlation coefficient. The mean AGREEII scores for the domains “scope and purpose” (51.77) and “rigor of development” (56.73) were moderate; afterward, three domains “stakeholder involvement” (32.23), “editorial independence” (29.59) and “applicability” (29.14) were low scores. The “clarity and presentation” (23.73) had the lowest scores. Conclusion Although existing constipation guidelines may accurately reflect current clinical practices, many guidelines’ methodological quality is low. Therefore, more emphasis and attentions should be taken to the development of high-quality guidelines.
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Affiliation(s)
- Hongliang Tian
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Chao Ding
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Jianfeng Gong
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China.
| | - Xiaolong Ge
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Lynne V McFarland
- Department of Medicinal Chemistry, University of Washington, Seattle, WA, USA
| | - Lili Gu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Qiyi Chen
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Chunlian Ma
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Weiming Zhu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Jieshou Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Ning Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China.
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Disidratazione acuta da gastroenterite nei lattanti. EMC - URGENZE 2016. [PMCID: PMC7158998 DOI: 10.1016/s1286-9341(16)76183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Il bambino sotto 1 anno e, soprattutto, di meno di 6 mesi è ad alto rischio di disidratazione, la cui causa principale è una gastroenterite acuta, soprattutto di origine virale. La gestione di una disidratazione da gastroenterite ha due componenti: la sua correzione e il rapido ripristino della normale perfusione tissutale e il mantenimento dei fabbisogni di acqua e di nutrienti, per limitare al massimo il deficit energetico. La valutazione della gravità della disidratazione è l’elemento chiave che guiderà la terapia. La perdita di peso, espressa in percentuale di peso corporeo prima dell’episodio di disidratazione, è il metodo di riferimento, ma è spesso difficile o impossibile da ottenere. Inoltre, i segni clinici, come l’alterazione dell’aspetto generale, l’allungamento del tempo di riempimento capillare, il riconoscimento di una plica cutanea persistente, gli occhi infossati, una secchezza delle mucose e la mancanza di lacrime, sono i principali elementi che permettono di valutare la gravità della disidratazione. Il trattamento si basa sulla rapida correzione del deficit del settore extracellulare. Un’espansione volemica di 20 ml/kg di una soluzione isotonica somministrata per via endovenosa o intraossea può essere necessaria nella fase iniziale nei casi più gravi (disidratazione > 10%). In tutti gli altri casi, la reidratazione per via orale per correggere il deficit di acqua in 4-6 ore è la tecnica di scelta, che si è dimostrata efficace, sicura e veloce. Essa utilizza delle soluzioni di reidratazione adattate che soddisfano criteri specifici. Il loro utilizzo precoce è la prevenzione più efficace delle forme gravi. L’allattamento al seno non deve essere interrotto e l’alimentazione artificiale deve essere ripresa da 4 a 6 ore dopo l’inizio della reidratazione. La vaccinazione contro i rotavirus prima dei 6 mesi è fortemente raccomandata.
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Jiang M, Liao LY, Liu XQ, He WQ, Guan WJ, Chen H, Li YM. Quality Assessment of Clinical Practice Guidelines for Respiratory Diseases in China: A Systematic Appraisal. Chest 2015; 148:759-766. [PMID: 25950752 DOI: 10.1378/chest.14-3201] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There has been a significant increase in the publication of clinical practice guidelines (CPGs) for respiratory diseases in China. However, little is known about the quality and potential impacts of these CPGs. Our objective was to critically evaluate the quality of Chinese CPGs for respiratory diseases that were published in peer-reviewed medical journals. METHODS A systematic search of scientific literature published between 1979 and 2013 was undertaken to identify and select CPGs that were related to respiratory diseases. Four Chinese databases (the Chinese Biomedical Literature database [CBM], the China National Knowledge Infrastructure [CNKI], the VIP database, and the WANFANG database) were used. The quality of eligible guidelines was assessed independently by four reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. The overall agreement among reviewers was evaluated using an intraclass correlation coefficient. RESULTS A total of 109 guidelines published in 27 medical journals from 1979 to 2013 were evaluated. The overall agreement among reviewers was considered good (intraclass correlation coefficient, 0.838; 95% CI, 0.812-0.862). The scores of the six AGREE domains were low: 57.3% for scope and purpose (range, 4.2%-80.5%), 23.8% for stakeholder involvement (range, 2.8%-54.2%), 7.7% for rigor of development (range, 0%-27.1%), 59.8% for clarity and presentation (range, 22.2%-80.6%), 10.9% for applicability (range, 0%-22.9%), and 0.6% for editorial independence (range, 0%-16.7%). Scores for all guidelines were below 60%, and only three guidelines (2.8%) were recommended for clinical practice with modifications. CONCLUSIONS The quality of the guidelines was low, and stakeholder involvement, rigor of development, applicability, and editorial independence should be considered in the future development of CPGs for respiratory diseases in China.
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Affiliation(s)
- Mei Jiang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical University, Guangzhou
| | - Li-Yue Liao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical University, Guangzhou; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical University, Guangzhou
| | - Xiao-Qing Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical University, Guangzhou
| | - Wei-Qun He
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical University, Guangzhou
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical University, Guangzhou
| | - Hao Chen
- Second Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yi-Min Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical University, Guangzhou.
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Kirby JS, Scharnitz T, Seiverling EV, Ahrns H, Ferguson S. Actinic Keratosis Clinical Practice Guidelines: An Appraisal of Quality. Dermatol Res Pract 2015; 2015:456071. [PMID: 26451140 PMCID: PMC4588356 DOI: 10.1155/2015/456071] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/20/2015] [Accepted: 08/31/2015] [Indexed: 01/11/2023] Open
Abstract
Actinic keratosis (AK) is a common precancerous skin lesion and many AK management guidelines exist, but there has been limited investigation into the quality of these documents. The objective of this study was to assess the strengths and weaknesses of guidelines that address AK management. A systematic search for guidelines with recommendations for AK was performed. The Appraisal of Guidelines for Research and Evaluation (AGREE II) was used to appraise the quality of guidelines. Multiple raters independently reviewed each of the guidelines and applied the AGREE II tool and scores were calculated. Overall, 2,307 citations were identified and 7 fulfilled the study criteria. The Cancer Council of Australia/Australian Cancer Network guideline had the highest mean scores and was the only guideline to include a systematic review, include an evidence rating for recommendations, and report conflicts of interest and funding sources. High-quality, effective guidelines are evidence-based with recommendations that are concise and organized, so practical application is facilitated. Features such as concise tables, pictorial diagrams, and explicit links to evidence are helpful. However, the rigor and validity of some guidelines were weak. So, it is important for providers to be aware of the features that contribute to a high-quality, practical document.
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Affiliation(s)
- Joslyn S. Kirby
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | | | - Elizabeth V. Seiverling
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Hadjh Ahrns
- Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Sara Ferguson
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
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Nicastro E, Lo Vecchio A, Liguoro I, Chmielewska A, De Bruyn C, Dolinsek J, Doroshina E, Fessatou S, Pop TL, Prell C, Tabbers MM, Tavares M, Urenden-Elicin P, Bruzzese D, Zakharova I, Sandhu B, Guarino A. The Impact of E-Learning on Adherence to Guidelines for Acute Gastroenteritis: A Single-Arm Intervention Study. PLoS One 2015; 10:e0132213. [PMID: 26148301 PMCID: PMC4493016 DOI: 10.1371/journal.pone.0132213] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 06/12/2015] [Indexed: 02/05/2023] Open
Abstract
Objective E-learning is a candidate tool for clinical practice guidelines (CPG) implementation due to its versatility, universal access and low costs. We aimed to assess the impact of a five-module e-learning course about CPG for acute gastroenteritis (AGE) on physicians’ knowledge and clinical practice. Study design This work was conceived as a pre/post single-arm intervention study. Physicians from 11 European countries registered for the online course. Personal data, pre- and post-course questionnaires and clinical data about 3 to 5 children with AGE managed by each physician before and after the course were collected. Primary outcome measures included the proportion of participants fully adherent to CPG and number of patients managed with full adherence. Results Among the 149 physicians who signed up for the e-learning course, 59 took the course and reported on their case management of 519 children <5 years of age who were referred to their practice because of AGE (281 and 264 children seen before and after the course, respectively). The course improved knowledge scores (pre-course 8.6 ± 2.7 versus post-course 12.8 ± 2.1, P < 0.001), average adherence (from 87.0 ± 7.7% to 90.6 ± 7.1%, P = 0.001) and the number of patients managed in full adherence with the guidelines (from 33.6 ± 31.7% to 43.9 ± 36.1%, P = 0.037). Conclusions E-learning is effective in increasing knowledge and improving clinical practice in paediatric AGE and is an effective tool for implementing clinical practice guidelines.
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Affiliation(s)
- Emanuele Nicastro
- Department of Translational Medical Science, Sector of Pediatrics. University Federico II, Naples, Italy
- Paediatric Hepatology Gastroenterology and Transplantation Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Sector of Pediatrics. University Federico II, Naples, Italy
| | - Ilaria Liguoro
- Department of Translational Medical Science, Sector of Pediatrics. University Federico II, Naples, Italy
| | - Anna Chmielewska
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Caroline De Bruyn
- Universitair Ziekenhuis Brussel Kinderen, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Elena Doroshina
- Russian Medical Postgraduate Academy, Moscow, Russian Federation
| | | | - Tudor Lucian Pop
- 2nd Pediatric Clinic, Iuliu Haţieganu, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christine Prell
- Dr. von Hauner Children’s Hospital, University of Munich Medical Center, Munich, Germany
| | | | - Marta Tavares
- Department of Pediatrics, Hospital Sao Joao, Porto, Portugal
| | | | - Dario Bruzzese
- Department of Public Health, University of Naples “Federico II,” Italy
| | - Irina Zakharova
- Russian Medical Postgraduate Academy, Moscow, Russian Federation
| | - Bhupinder Sandhu
- Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Alfredo Guarino
- Department of Translational Medical Science, Sector of Pediatrics. University Federico II, Naples, Italy
- * E-mail:
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Zhang Z, Guo J, Su G, Li J, Wu H, Xie X. Evaluation of the quality of guidelines for myasthenia gravis with the AGREE II instrument. PLoS One 2014; 9:e111796. [PMID: 25402504 PMCID: PMC4234220 DOI: 10.1371/journal.pone.0111796] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 10/07/2014] [Indexed: 12/21/2022] Open
Abstract
Background Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners in making decisions about appropriate healthcare in specific clinical circumstances. The methodological quality of CPGs for myasthenia gravis (MG) are unclear. Objective To critically evaluate the methodological quality of CPGs for MG using AGREE II instrument. Method A systematical search strategy on PubMed, EMBASE, DynaMed, the National Guideline Clearinghouse (NGC) and the Chinese Biomedical Literature database (CBM) was performed on September 20th 2013. All guidelines related to MG were evaluated with AGREE II. The software used for analysis was SPSS 17.0. Results A total of 15 CPGs for MG met the inclusion criteria (12 CPGs in English, 3 CPGs in Chinese). The overall agreement among reviews was moderate or high (ICC >0.70). The mean scores (mean ± SD) for al six domains were presented as follows: scope and purpose (60.93% ±16.62%), stakeholder involvement (40.93% ±20.04%), rigor of development (37.22% ±30.46%), clarity of presentation (64.26% ±16.36%), applicability (28.19% ±20.56%) and editorial independence (27.78% ±28.28%). Compared with non-evidence-based CPGs, evidence-based CPGs had statistically significant higher quality scores for all AGREE II domains (P<0.05). All domain scores appear slightly higher for CPGs published after AGREE II instrument development and validation (P>0.05). The quality scores of CPGs developed by NGC/AAN were higher than the quality scores of CPGs developed by other organizations for all domains. The difference was statistically significant for all domains with the exception of clarity of presentation (P = 0.07). Conclusions The qualities of CPGs on MG were generally acceptable with several flaws. The AGREE II instrument should be adopted by guideline developers, particularly in China.
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Affiliation(s)
- Zhenchang Zhang
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, P. R. China
- Department of Neurology, The Second Hospital of Lanzhou University, Lanzhou, P. R. China
| | - Jia Guo
- Department of Neurology, The Second Hospital of Lanzhou University, Lanzhou, P. R. China
| | - Gang Su
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, P. R. China
| | - Jiong Li
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, P. R. China
| | - Hua Wu
- Department of Neurology, The Second Hospital of Lanzhou University, Lanzhou, P. R. China
| | - Xiaodong Xie
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, P. R. China
- * E-mail:
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20
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Guo J, Cheng C, Yan W, Xu G, Feng J, Wang T, Chen CS, Qin X. Systematic review of clinical practice guidelines related to multiple sclerosis. PLoS One 2014; 9:e106762. [PMID: 25302678 PMCID: PMC4193735 DOI: 10.1371/journal.pone.0106762] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 08/08/2014] [Indexed: 01/01/2023] Open
Abstract
Background High quality clinical practice guidelines (CPGs) can provide clinicians with explicit recommendations on how to manage health conditions and bridge the gap between research and clinical practice. Unfortunately, the quality of CPGs for multiple sclerosis (MS) has not been evaluated. Objective To evaluate the methodological quality of CPGs on MS using the AGREE II instrument. Methods According to the inclusion and exclusion criteria, we searched four databases and two websites related to CPGs, including the Cochrane library, PubMed, EMBASE, DynaMed, the National Guideline Clearinghouse (NGC), and Chinese Biomedical Literature database (CBM). The searches were performed on September 20th 2013. All CPGs on MS were evaluated by the AGREE II instrument. The software used for analysis was SPSS 17.0. Results A total of 27 CPGs on MS met inclusion criteria. The overall agreement among reviews was good or substantial (ICC was above 0.70). The mean scores for each of all six domains were presented as follows: scope and purpose (mean ± SD: 59.05±16.13), stakeholder involvement (mean ± SD: 29.53±17.67), rigor of development (mean ± SD: 31.52±21.50), clarity of presentation (mean ± SD: 60.39±13.73), applicability (mean ± SD: 27.08±17.66), editorial independence (mean ± SD: 28.70±22.03). Conclusions The methodological quality of CPGs for MS was acceptable for scope, purpose and clarity of presentation. The developers of CPGs need to pay more attention to editorial independence, applicability, rigor of development and stakeholder involvement during the development process. The AGREE II instrument should be adopted by guideline developers.
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Affiliation(s)
- Jia Guo
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Chuang Cheng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Weiping Yan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Guanghui Xu
- Department of Neurology, The Third People's Hospital of Chengdu, Chengdu, PR China
| | - Jinzhou Feng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Tianzhu Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Cindy Si Chen
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Xinyue Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
- * E-mail:
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Jarošová D, Žitníková P. Assessing the methodological quality of clinical practice guidelines for preventing intravascular catheter-related infections. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2014. [DOI: 10.15452/cejnm.2014.05.0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Guarino A, Ashkenazi S, Gendrel D, Lo Vecchio A, Shamir R, Szajewska H. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. J Pediatr Gastroenterol Nutr 2014; 59:132-52. [PMID: 24739189 DOI: 10.1097/mpg.0000000000000375] [Citation(s) in RCA: 332] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES These guidelines update and extend evidence-based indications for the management of children with acute gastroenteritis in Europe. METHODS The guideline development group formulated questions, identified data, and formulated recommendations. The latter were graded with the Muir Gray system and, in parallel, with the Grading of Recommendations, Assessment, Development and Evaluations system. RESULTS Gastroenteritis severity is linked to etiology, and rotavirus is the most severe infectious agent and is frequently associated with dehydration. Dehydration reflects severity and should be monitored by established score systems. Investigations are generally not needed. Oral rehydration with hypoosmolar solution is the major treatment and should start as soon as possible. Breast-feeding should not be interrupted. Regular feeding should continue with no dietary changes including milk. Data suggest that in the hospital setting, in non-breast-fed infants and young children, lactose-free feeds can be considered in the management of gastroenteritis. Active therapy may reduce the duration and severity of diarrhea. Effective interventions include administration of specific probiotics such as Lactobacillus GG or Saccharomyces boulardii, diosmectite or racecadotril. Anti-infectious drugs should be given in exceptional cases. Ondansetron is effective against vomiting, but its routine use requires safety clearance given the warning about severe cardiac effects. Hospitalization should generally be reserved for children requiring enteral/parenteral rehydration; most cases may be managed in an outpatients setting. Enteral rehydration is superior to intravenous rehydration. Ultrarapid schemes of intravenous rehydration are not superior to standard schemes and may be associated with higher readmission rates. CONCLUSIONS Acute gastroenteritis is best managed using a few simple, well-defined medical interventions.
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Affiliation(s)
- Alfredo Guarino
- *Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy †Schneider Children's Medical Center, Tel-Aviv University, Tel-Aviv, Israel ‡University Paris 5 and Necker-Enfants-Malades, Paris, France §Medical University of Warsaw, Department of Pediatrics, Warsaw, Poland
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23
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Burda BU, Chambers AR, Johnson JC. Appraisal of guidelines developed by the World Health Organization. Public Health 2014; 128:444-74. [PMID: 24856197 DOI: 10.1016/j.puhe.2014.01.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 12/21/2013] [Accepted: 01/07/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To appraise the quality of guidelines developed by the World Health Organization (WHO) that were approved by its Guidelines Review Committee (GRC) and identify strengths and weaknesses in the guideline development process. STUDY DESIGN Cross-sectional. METHODS Three individuals independently assessed GRC-approved WHO guidelines using the Appraisal of Guidelines for Research and Evaluation II instrument (AGREE II). Scores were standardized across domains and overall quality was determined through consensus. RESULTS 124 guidelines met inclusion criteria and were assessed. 58 guidelines were recommended for use, 58 were recommended with modifications and eight were not recommended. The highest scoring domains across guidelines were scope and purpose, and clarity of presentation. The recommended guidelines had higher rigor of development and applicability domain scores in comparison to other guidelines. 77% of the guidelines referenced an underlying evidence review and 49% used GRADE to assess the body of evidence or the strength of the recommendation. The domains in need of improvement included stakeholder engagement, editorial independence, and applicability. Guidelines not recommended for use were generally insufficient in their rigor of development. CONCLUSIONS WHO guidelines need further improvement, most importantly in the rigor of their development (i.e., use of evidence reviews). Other areas for improvement include increased stakeholder engagement, a more explicit process for recommendation formulation and disclosure of interests, discussion of the facilitators, barriers, resource implications, and criteria for monitoring the outcomes of guideline implementation. WHO guidelines can improve through increased transparency, adherence to the WHO Handbook for Guideline Development, and better oversight by the GRC.
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Affiliation(s)
- B U Burda
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, United States.
| | - A R Chambers
- School of Professional Psychology, Pacific University, 190 SE 8th Ave., Forest Grove, OR 97123, United States
| | - J C Johnson
- Hatfield School of Government, Portland State University, 506 S.W. Mill Street, Suite 650, Portland, OR 97201, United States
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Lee GY, Yamada J, Kyololo O, Shorkey A, Stevens B. Pediatric clinical practice guidelines for acute procedural pain: a systematic review. Pediatrics 2014; 133:500-15. [PMID: 24488733 DOI: 10.1542/peds.2013-2744] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Procedural pain assessment and management have been extensively studied through multiple research studies over the past decade. Results of this research have been included in numerous pediatric pain practice guidelines. OBJECTIVE To systematically review the quality of existing practice guidelines for acute procedural pain in children and provide recommendations for their use. METHODS A systematic search was conducted on Medline, Embase, CINAHL, PsycINFO, and Scopus from 2000 to July 2013. A gray literature search was also conducted through the Translating Research Into Practice database, Guidelines International Network database, and National Guideline Clearinghouse. Four reviewers rated relevant guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument. Screening of guidelines, assessment of methodological quality, and data abstraction were conducted by 2 pairs of raters. Disagreements in overall assessments were resolved through consensus. RESULTS Eighteen guidelines from 4930 retrieved abstracts were included in this study. Based on the AGREE II domains, the guidelines generally scored high in the scope and purpose and clarity of presentation areas. Information on the rigor of guideline development, applicability, and editorial independence were specified infrequently. Four of the 18 guidelines provided tools to help clinicians apply the recommendations in practice settings; 5 were recommended for use in clinical settings, and the remaining 13 were recommended for use with modification. CONCLUSIONS Despite the increasing availability of clinical practice guidelines for procedural pain in children, the majority are of average quality. More transparency and comprehensive reporting are needed for the guideline development process.
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Affiliation(s)
- Grace Y Lee
- The Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario; and
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Zeng L, Zhang L, Hu Z, Ehle EA, Chen Y, Liu L, Chen M. Systematic review of evidence-based guidelines on medication therapy for upper respiratory tract infection in children with AGREE instrument. PLoS One 2014; 9:e87711. [PMID: 24586287 PMCID: PMC3930557 DOI: 10.1371/journal.pone.0087711] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/02/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To summarize recommendations of existing guidelines on the treatment of upper respiratory tract infections (URTIs) in children, and to assess the methodological quality of these guidelines. METHODS We searched seven databases and web sites of relevant academic agencies. Evidence-based guidelines on pediatric URTIs were included. AGREE II was used to assess the quality of these guidelines. Two researchers selected guidelines independently and extracted information on publication years, institutions, target populations, recommendations, quality of evidence, and strength of recommendations. We compared the similarities and differences of recommendations and their strength. We also analyzed the reasons for variation. RESULTS Thirteen guidelines meeting our inclusion criteria were included. Huge differences existed among these 13 guidelines concerning the categorization of evidence and recommendations. Nearly all of these guidelines lacked the sufficient involvement of stake holders. Further, the applicability of these guidelines still needs to be improved. In terms of recommendations, penicillin and amoxicillin were suggested for group A streptococcal pharyngitis. Amoxicillin and amoxicillin-clavulanate were recommended for acute bacterial rhinosinusitis (ABRS). An observation of 2-3 days prior to antibiotic therapy initiation for mild acute otitis media (AOM) was recommended with amoxicillin as the suggested first choice agent. Direct evidence to support strong recommendations on the therapy for influenza is still lacking. In addition, the antimicrobial durations for pharyngitis and ABRS were still controversial. No consensus was reached for the onset of antibiotics for ABRS in children. CONCLUSIONS Future guidelines should use a consistent grading system for the quality of evidence and strength of recommendations. More effort needs to be paid to seek the preference of stake holders and to improve the applicability of guidelines. Further, there are still areas in pediatric URTIs that need more research.
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Affiliation(s)
- Linan Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Sichuan, China
- Evidence-Based Pharmacy Centre, West China Second University Hospital, Sichuan University, Sichuan, China
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Sichuan, China
- Evidence-Based Pharmacy Centre, West China Second University Hospital, Sichuan University, Sichuan, China
| | - Zhiqiang Hu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Sichuan, China
- West China School of Pharmacy, Sichuan University, Sichuan, China
| | - Emily A. Ehle
- Department of Pharmacy, The Nebraska Medical Centre, Omaha, Nebraska, United States of America
| | - Yuan Chen
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Sichuan, China
- Evidence-Based Pharmacy Centre, West China Second University Hospital, Sichuan University, Sichuan, China
| | - Lili Liu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Sichuan, China
- West China School of Pharmacy, Sichuan University, Sichuan, China
| | - Min Chen
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Sichuan, China
- West China School of Pharmacy, Sichuan University, Sichuan, China
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Haran C, van Driel M, Mitchell BL, Brodribb WE. Clinical guidelines for postpartum women and infants in primary care-a systematic review. BMC Pregnancy Childbirth 2014; 14:51. [PMID: 24475888 PMCID: PMC3906750 DOI: 10.1186/1471-2393-14-51] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/27/2014] [Indexed: 11/24/2022] Open
Abstract
Background While many women and infants have an uneventful course during the postpartum period, others experience significant morbidity. Effective postpartum care in the community can prevent short, medium and long-term consequences of unrecognised and poorly managed problems. The use of rigorously developed, evidence-based guidelines has the potential to improve patient care, impact on policy and ensure consistency of care across health sectors. This study aims to compare the scope and content, and assess the quality of clinical guidelines about routine postpartum care in primary care. Methods PubMed, the National Guideline Clearing House, Google, Google Scholar and relevant college websites were searched for relevant guidelines. All guidelines regarding routine postpartum care published in English between 2002 and 2012 were considered and screened using explicit selection criteria. The scope and recommendations contained in the guidelines were compared and the quality of the guidelines was independently assessed by two authors using the AGREE II instrument. Results Six guidelines from Australia (2), the United Kingdom (UK) (3) and the United States of America (USA) (1), were included. The scope of the guidelines varied greatly. However, guideline recommendations were generally consistent except for the use of the Edinburgh Postnatal Depression Scale for mood disorder screening and the suggested time of routine visits. Some recommendations lacked evidence to support them, and levels or grades of evidence varied between guidelines. The quality of most guidelines was adequate. Of the six AGREE II domains, applicability and editorial independence scored the lowest, and scope, purpose and clarity of presentation scored the highest. Conclusions Only one guideline provided comprehensive recommendations for the care of postpartum women and their infants. As well as considering the need for region specific guidelines, further research is needed to strengthen the evidence supporting recommendations made within guidelines. Further improvement in the editorial independence and applicability domains of the AGREE ll criteria would strengthen the quality of the guidelines.
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Affiliation(s)
| | | | | | - Wendy E Brodribb
- Discipline of General Practice, School of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Level 8, Health Sciences Building, Herston 4029, Australia.
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Pak KJ, Hu T, Fee C, Wang R, Smith M, Bazzano LA. Acute hypertension: a systematic review and appraisal of guidelines. Ochsner J 2014; 14:655-663. [PMID: 25598731 PMCID: PMC4295743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Few clinical practice guidelines provide management recommendations for acute hypertensive episodes except in the context of specific conditions such as pregnancy and stroke. METHODS We performed a systematic search to identify guidelines addressing acute hypertension and appraised the guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) validated quality assessment tool. Two reviewers independently appraised and one extracted key recommendations. Literature on secondary hypertension, hypertension in pregnancy, preeclampsia/eclampsia, stroke, aortic dissection, and pheochromocytoma was excluded. RESULTS Three guidelines were identified, sponsored by the American College of Emergency Physicians (ACEP), the National Heart, Lung, and Blood Institute (NHLBI), and the European Society of Hypertension (ESH) in conjunction with the European Society of Cardiology (ESC). AGREE II yielded mean domain (%) and overall assessment scores (1-7) as follows: NHLBI: 73%, 5.5; ACEP: 67%, 5.5; and ESH/ESC: 56%, 4.5. In hypertensive emergencies, the NHLBI guideline recommends reducing mean arterial pressure by ≤25% for the first hour, and then to 160/100-110 mmHg by 2-6 hours with subsequent gradual normalization in 24-48 hours. The ESH/ESC has similar recommendations. The ACEP does not address guidelines for hypertensive emergency but focuses on whether screening for target organ damage or medical intervention in patients with asymptomatic elevated blood pressure in emergency departments reduces the rate of adverse outcomes, concluding that routine screening does not reduce adverse outcomes, but patients with poor follow-up may benefit from routine screening. CONCLUSION NHLBI and ESH/ESC guidelines are high quality and provide similar recommendations for management of asymptomatic acute hypertensive episodes and hypertensive emergencies. Additional research is needed to inform clinical practice guidelines for this common condition.
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Affiliation(s)
- Kirk J. Pak
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA
| | - Tian Hu
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Colin Fee
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA
| | - Richard Wang
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Morgan Smith
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Lydia A. Bazzano
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
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Affiliation(s)
- Umesh D Parashar
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Yan J, Min J, Zhou B. Diagnosis of pheochromocytoma: a clinical practice guideline appraisal using AGREE II instrument. J Eval Clin Pract 2013; 19:626-32. [PMID: 22809219 DOI: 10.1111/j.1365-2753.2012.01873.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to assess the quality of clinical practice guidelines providing diagnostic recommendations on pheochromocytoma (PHEO) using the new Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument and to promote the development of clinical guidelines. RESEARCH DESIGN AND METHODS We searched MEDLINE and electronic databases for guidelines published between 2001 and 2010 regarding the diagnosis of PHEO. The methodological quality of guidelines for three fields for the diagnosis of PHEO was evaluated using the new AGREE II instrument by two independent appraisers. We also compared two different types of guidelines to determine the superior guideline. RESULTS Four special guidelines and six general guidelines related to the diagnosis of PHEO were included in the study. According to AGREE II, two guidelines performed well in recommending biochemical evaluations. One guideline was good for radiodiagnosis, but no guideline was good for recommending genetic testing. The best-performing domain of the AGREE II instrument was domain 1 (D1) (scope and purpose), while the worst performing domain was D5 (applicability) in both types of guidelines. The special guideline was significantly better than the general guideline in D4 (P < 0.01), while the general guideline performed better in D6. There were no differences in the other four domains. CONCLUSIONS The quality and rigour of guidelines for the diagnosis of PHEO vary. It is difficult to identify one guideline that performed well in all three fields for the diagnosis of PHEO based on the AGREE II instrument. Therefore, additional studies and greater efforts should be taken to provide high-quality guidelines that serve as a useful and reliable tool for clinical decision making in diagnosing PHEO according to the AGREE II instrument.
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Affiliation(s)
- Juping Yan
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Abstract
PURPOSE OF REVIEW To review the advances in the assessment, treatment, and evaluation of care for pediatric dehydration. RECENT FINDINGS Recent studies have added new information across the spectrum of care for dehydration. Advances in the assessment of dehydration allow more accurate clinical evaluation, but do not help predict the treatment outcomes. Antiemetics as an adjunct to oral rehydration therapy have been proven well tolerated, efficacious, and cost-effective. Rapid, large-volume intravenous rehydration for outpatients with dehydration did not show any benefit over more standard regimens. Clinical guidelines incorporate all these aspects of care; however, physicians show poor adherence to the guidelines despite the evidence that guidelines improve outcomes and reduce cost. SUMMARY Dehydration burdens the healthcare system worldwide. Through advances in its assessment, treatment with antiemetics and intravenous fluids, and standardization of practice with clinical guidelines, this burden could be reduced.
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Kinlin LM, Bahm A, Guttmann A, Freedman SB. A survey of emergency department resources and strategies employed in the treatment of pediatric gastroenteritis. Acad Emerg Med 2013; 20:361-6. [PMID: 23701343 DOI: 10.1111/acem.12108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 10/28/2012] [Accepted: 11/28/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Although leading organizations have developed gastroenteritis management guidelines, little is known about emergency department (ED) use of clinical tools to improve outcomes. Our objective was to describe pediatric gastroenteritis clinical decision tools employed in EDs in the province of Ontario and to determine if a greater number of clinical decision tools are employed in academic, high-volume institutions staffed primarily by emergency medicine (EM)-trained physicians. METHODS A cross-sectional, Internet-based survey was distributed in the summer of 2010 to medical directors and managers of Ontario EDs. Domains included patient population, general resources, and gastroenteritis-specific strategies. Copies were requested of all gastroenteritis-specific strategies to enable a content review. RESULTS A total of 133 (83%) of 160 eligible participants responded. Practice guidelines, pathways, or order sets; medical directives; and printed discharge instructions were reported to be in use at 38 of the 133 (29%), 69 of 133 (52%), and 105 of 133 (79%) of the responding institutions, respectively. Oral rehydration therapy (ORT) is routinely initiated at triage in only 51 of the 133 of the EDs (38%). High-volume institutions are more likely to have clinical practice guidelines, pathways, or order sets (p = 0.001) than low- and medium-volume EDs. Physician training in EM was associated with the presence of medical directives for nursing administration of antiemetics and antipyretics (p = 0.04). Review of clinical practice guidelines, pathways, and order sets showed that only six of 27 gastroenteritis-specific strategies reviewed were correctly classified, and 20 (74%) met prespecified quality criteria. CONCLUSIONS Clinical decision tools designed to improve pediatric gastroenteritis management are not commonly implemented. Such strategies are more common in high-volume EDs and those staffed primarily by physicians with EM training.
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Affiliation(s)
- Laura M. Kinlin
- Faculty of Medicine; Dalhousie University ; Halifax; Nova Scotia
| | - Allison Bahm
- Department of Pediatrics; The Hospital for Sick Children, University of Toronto; Toronto; Ontario
| | | | - Stephen B. Freedman
- Department of Pediatrics; The Hospital for Sick Children, University of Toronto; Toronto; Ontario
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Pieścik-Lech M, Shamir R, Guarino A, Szajewska H. Review article: the management of acute gastroenteritis in children. Aliment Pharmacol Ther 2013. [PMID: 23190209 DOI: 10.1111/apt.12163] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND In 2008, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society of Paediatric Infectious Disease (ESPID) developed evidence-based guidelines for the management of acute gastroenteritis (AGE) in children in Europe. AIM To summarise data published subsequently to the ESPGHAN/ESPID guidelines. METHODS MEDLINE and The Cochrane Library were searched in August 2012 for randomised controlled trials (RCTs) or their meta-analyses published after 2008. RESULTS Efforts to improve the taste and/or efficacy of oral rehydration solution (ORS) continue, and some interventions are promising. While standard (over 24 h) nasogastric rehydration is still being used, new evidence confirms that rapid (over 4 h) rehydration is also effective. For intravenous rehydration, new evidence is available regarding rapid or ultrarapid and large-volume vs. standard-volume rehydration; as the new evidence is not consistent, until more data are available, the administration of 20 mL/kg seems appropriate. Convincing evidence has accumulated showing that ondansetron reduces the risk for vomiting; however, a clearance on safety in children is needed. New evidence has reconfirmed that in Europe, where zinc deficiency is rare, there is no benefit from the use of zinc. New data, although mainly from outside of Europe, have reconfirmed that either smectite or racecadotril is an effective adjunctive therapy to oral rehydration. There is a clear effect of using certain probiotics, such as Lactobacillus GG or S. boulardii. CONCLUSIONS The update of current ESPGHAN/ESPID recommendations is warranted.
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Affiliation(s)
- M Pieścik-Lech
- Department of Paediatrics, The Medical University of Warsaw, Dzialdowska 1, Warsaw, Poland
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Abstract
PURPOSE OF REVIEW Acute gastroenteritis (AGE) is a major cause of ED visits, hospitalizations, and prescription of investigations, drugs, and changes in diet. Several guidelines on management have been produced. RECENT FINDINGS There is new information on different rehydration protocols, use of antiemetics, and antidiarrheal drugs that could reduce the burden of AGE. The need of intravenous (i.v.) rehydration is the main cause of hospital admission yet a standardized rehydration scheme is not available. Rehydration therapy through nasogastric tube is better than i.v. rehydration, in children with moderate-severe dehydration. Ultrarapid rehydration has been proposed by enteric or i.v. route to reduce the time in hospital and costs. However, reduced rehydration times are associated with high readmission rates and side effects. Antiemetics may reduce the need of i.v. rehydration because of vomiting and the number of hospital admissions. However, the main antiemetic, ondansetron, has been loaded with a warning for potentially severe side effects. Selected antidiarrheal drugs could reduce the length of stay, but data on their use in inpatients are still not conclusive. SUMMARY Inappropriate medical interventions are still common in the hospital setting and have a high impact on costs. A validated management is still needed in inpatients.
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Greuter MJE, van Emmerik NMA, Wouters MGAJ, van Tulder MW. Quality of guidelines on the management of diabetes in pregnancy: a systematic review. BMC Pregnancy Childbirth 2012; 12:58. [PMID: 22741571 PMCID: PMC3495039 DOI: 10.1186/1471-2393-12-58] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 06/14/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Diabetes during pregnancy can lead to severe risks for both mother and fetus when it is not managed properly. The use of rigorously developed guidelines with a robust implementation process can have a positive influence on the management of diabetes during pregnancy. This study aims to compare recommendations and assess the quality of clinical guidelines on gestational diabetes mellitus (GDM) and pre-existing diabetes mellitus during pregnancy. METHODS Guidelines were selected by searching PubMed, the Guideline Clearing House and Google. All guidelines developed since 2000 on diabetes during pregnancy in English or Dutch were considered. Recommendations of the guidelines were compared. Furthermore, the quality was assessed by two authors independently, using the AGREE instrument. RESULTS Eight guidelines were included. According to the AGREE instrument, the quality of most guidelines was low. The domains editorial independence, stakeholder involvement and rigour of development had the lowest scores. Recommendations were mainly comparable on glycemic control, preconceptional counseling and prenatal care and labour. Differences between recommendations were found for screening on GDM and induction of labour. CONCLUSIONS The quality of most guidelines concerning the management of diabetes during pregnancy needs to be improved. A more systematic approach in the development of these guidelines, more attention for updating procedures and piloting of the guidelines and involvement of target users and patients is recommended.
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Affiliation(s)
- Marjolein JE Greuter
- Department of Health Sciences & EMGO + Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081, HV Amsterdam, The Netherlands
| | - Nathalie MA van Emmerik
- Department of Health Sciences & EMGO + Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081, HV Amsterdam, The Netherlands
| | - Maurice GAJ Wouters
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, the Netherlands
| | - Maurits W van Tulder
- Department of Health Sciences & EMGO + Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081, HV Amsterdam, The Netherlands
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Guarino A, Dupont C, Gorelov AV, Gottrand F, Lee JKF, Lin Z, Lo Vecchio A, Nguyen TD, Salazar-Lindo E. The management of acute diarrhea in children in developed and developing areas: from evidence base to clinical practice. Expert Opin Pharmacother 2011; 13:17-26. [PMID: 22106840 DOI: 10.1517/14656566.2011.634800] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Acute diarrhea remains a major problem in children and is associated with substantial morbidity, mortality and costs. While vaccination against rotavirus could reduce the burden of the disease, the persistent impact of intestinal infections requires effective treatment in adjunct to oral rehydration solutions, to reduce the severity and duration of diarrhea. Several therapeutic options have been proposed for acute diarrhea, but proof of efficacy is available for few of them, including zinc, diosmectite, selected probiotics and racecadotril. However, at present there is no universal drug, and therapeutic efficacy has only been shown for selected drugs in selected settings, such as: outpatients/inpatients, developed/developing countries and viral/bacterial etiology. AREAS COVERED This narrative review reports the opinions of experts from different countries of the world who have discussed strategies to improve the management of diarrhea. EXPERT OPINION More data are needed to optimize the management of diarrhea and highlight the research priorities at a global level; such priorities include improved recommendations on oral rehydration solution composition, and the reevaluation of therapeutic options in the light of new trials. Therapeutic strategies need to be assessed in different settings, and pharmacoeconomic analyses based on country-specific data are needed. Transfer to clinical practice should result from the implementation of guidelines tailored at a local level, with an eye on costs.
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Affiliation(s)
- Alfredo Guarino
- Universsity of Naples Federico II, Department of Pediatrics, Via Pansini 5, 80131 Naples, Italy.
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