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Mancin S, Sguanci M, Andreoli D, Soekeland F, Anastasi G, Piredda M, De Marinis MG. Systematic review of clinical practice guidelines and systematic reviews: A method for conducting comprehensive analysis. MethodsX 2024; 12:102532. [PMID: 38226356 PMCID: PMC10788252 DOI: 10.1016/j.mex.2023.102532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/20/2023] [Indexed: 01/17/2024] Open
Abstract
A systematic review (SR) is a research method for synthesizing evidence on a specific topic. Among the various types of systematic reviews, there are SRs of guidelines (CPGs) and SRs of SRs. Traditionally, they are limited to just one type of secondary evidence. This paper introduces an innovative SR methodology that combines CPGs and SRs to improve evidence synthesis and overcome the limitations of isolated use. Essential steps that should always precede the actual research process include registering the research protocol, formulating research questions and setting inclusion/exclusion criteria. Using the PRISMA protocol for comprehensive database searches, it's crucial to combine keywords with boolean operators and remove duplicates. The eligibility of studies should be assessed by selecting potentially relevant articles through an initial screening of titles and abstracts, followed by a meticulous analysis of the full-texts. Rigorous evidence evaluation tools, such as AGREE II for CPGs and AMSTAR 2 for SRs, and the double reviewer approach ensure high-quality selections. Additionally, converting summarized results into percentages and applying statistical analyses facilitate interpretation and improve the reliability of rater assessments. A further characteristic of this methodology is its adaptability to the evolution of healthcare research.
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Affiliation(s)
- Stefano Mancin
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Sguanci
- Department of Medicine and Surgery, Research Unit of Nursing Science, University Campus Bio-Medico, Rome, Italy
| | - Desirèe Andreoli
- Azienda Ospedaliera Santa Maria della Misericordia, Perugia, Italy
| | - Fanny Soekeland
- University of Applied Sciences, School of Health Professions, Bern, Switzerland
| | - Giuliano Anastasi
- Department of Trauma, AOU G. Martino University Hospital, Messina, Italy
| | - Michela Piredda
- Department of Medicine and Surgery, Research Unit of Nursing Science, University Campus Bio-Medico, Rome, Italy
| | - Maria Grazia De Marinis
- Department of Medicine and Surgery, Research Unit of Nursing Science, University Campus Bio-Medico, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Al-Thuwaynee S. Assessing the efficacy and safety of Sildenafil vs. Nifedipine in improving endometrial blood flow and thickness in women with recurrent first-trimester miscarriage. J Med Life 2023; 16:890-894. [PMID: 37675159 PMCID: PMC10478652 DOI: 10.25122/jml-2023-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/10/2023] [Indexed: 09/08/2023] Open
Abstract
Endometrial thickness and uterine blood flow influence pregnancy continuation until term. Nifedipine, a type II calcium channel blocker, and Sildenafil, a type 5-specific phosphodiesterase inhibitor, have shown the potential to improve these factors. This study aims to compare the safety and efficacy of Nifedipine and Sildenafil in improving endometrial blood flow and thickness in Iraqi women with recurrent first-trimester miscarriages. Women with unexplained recurrent pregnancy loss in the first trimester (non-pregnant during the study) were randomly assigned to two groups. Transvaginal color Doppler ultrasound assessed uterine artery pulsatility, resistance indexes, and endometrial thickness during the second phase of the menstrual cycle (day 15 to day 25). The first group received oral Nifedipine (10 mg) twice daily, while the second group received oral Sildenafil citrate (20 mg) every 8 hours from day 5 to day 25. Baseline measurements showed no significant differences in pulsatility index between the groups (2.02±0.52 for Nifedipine, 2.03±0.49 for Sildenafil, p=0.927). Sildenafil treatment resulted in a more noticeable reduction in the pulsatility index. The resistive index had a significant difference in baseline readings (0.98±0.14 for Nifedipine, 1.06±0.14 for Sildenafil, p=0.033), with Sildenafil showing a more pronounced reduction. Post-treatment, Sildenafil demonstrated a greater improvement in endometrial thickness than Nifedipine (10.09±0.74 mm vs. 9.34±0.50 mm, respectively; p<0.001). Both medications were safe and effective in improving endometrial blood flow and thickness in women with recurrent pregnancy miscarriages, with Sildenafil showing greater efficacy.
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Affiliation(s)
- Saba Al-Thuwaynee
- Department of Obstetrics and Gynecology, College of Medicine, University of Al-Qadisiyah, Al Diwaniyah, Iraq
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O'Connor C, Leitao S, O'Donoghue K. A protocol for a systematic review of clinical practice guidelines for the antenatal management of dichorionic diamniotic twin pregnancy. HRB Open Res 2021; 4:115. [PMID: 38873346 PMCID: PMC11170067 DOI: 10.12688/hrbopenres.13418.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 06/15/2024] Open
Abstract
Overview: The protocol outlines the process designed to systematically review clinical practice guidelines (CPGs), addressing the antenatal management of dichorionic diamniotic (DCDA) twin pregnancies. Background: CPGs are statements that include recommendations intended to optimise patient care, that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. CPGs are typically created by scientific institutes, organisations and professional societies, and high-quality CPGs are fundamental to improve patient outcomes, standardise clinical practice and improve the quality of care. While CPGs are designed to improve the quality of care, to achieve this, the identification and appraisal of current international CPGs is required. Because twin pregnancies are identified as high-risk pregnancies, a systematic review of the CPGs in this field is a useful first step for establishing the required high level of care. Aim: The aim of the systematic review is to identify, appraise and examine published CPGs for the antenatal management of DCDA twin pregnancies, within high-income countries. Methods: We will identify published CPGs addressing any aspect of antenatal management of care in DCDA twin pregnancies, appraise the quality of the identified CPGs using the Appraisal of Guidelines for Research and Evaluation version 2 (AGREE II) the Appraisal of Guidelines Research and Evaluation - Recommendations excellence (AGREE-REX) instruments and examining the recommendations from the identified CPGs. Ultimately, this protocol aspires to clearly define the process for a reproducible systematic review of CPGs within a high-income country, addressing any aspect of antenatal management of DCDA twin pregnancies. PROSPERO registration: CRD42021248586 (24/06/2021).
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Affiliation(s)
- Caroline O'Connor
- Infant Centre, University College Cork, Cork, Ireland
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Sara Leitao
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- National Perinatal Epidemiology Centre (NPEC), University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Infant Centre, University College Cork, Cork, Ireland
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
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Pleguezuelo DE, Cabrera-Marante O, Abad M, Rodriguez-Frias EA, Naranjo L, Vazquez A, Villar O, Gil-Etayo FJ, Serrano M, Perez-Rivilla A, de la Fuente-Bitaine L, Serrano A. Anti-Phosphatidylserine/Prothrombin Antibodies in Healthy Women with Unexplained Recurrent Pregnancy Loss. J Clin Med 2021; 10:jcm10102094. [PMID: 34068095 PMCID: PMC8152729 DOI: 10.3390/jcm10102094] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/21/2021] [Accepted: 05/10/2021] [Indexed: 12/17/2022] Open
Abstract
Recurrent pregnancy loss (RPL) affects up to 6% of couples. Although chromosomal aberrations of the embryos are considered the leading cause, 50% of cases remain unexplained. Antiphospholipid Syndrome is a known cause in a few cases. Antiphospholipid antibodies (aPL) anticardiolipin, anti-Beta-2-Glycoprotein-I and Lupus Anticoagulant (criteria aPL) are recommended studies in RPL workup. We tested healthy women with unexplained RPL for criteria aPL and anti-Phosphatidylserine/Prothrombin antibodies (aPS/PT). Patients were classified into three groups according to the number and pregnancy week of RPL: Extra-Criteria (EC), with 2 miscarriages, Early Miscarriage (EM), with ≥3 before pregnancy at week 10 and Fetal Loss (FL), with ≥1 fetal death from pregnancy at week 10. Circulating criteria aPL were absent in 98.1% of EM, 90.9% of FL and 96.6% of EC groups. In contrast, aPS/PT were positive in 15.4% of EM, 15.1% of FL, 16.6% of EC patients and 2.9% in controls. aPS/PT posed a risk for RPL, with an odds ratio of 5.96 (95% confidence interval (CI): 1.85-19.13. p = 0.002) for EM, 7.28 (95% CI: 2.07-25.56. p = 0.002) for FL and 6.56. (95% CI: 1.77-24.29. p = 0.004) for EC. A successful live birth was achieved in all pregnant patients positive for aPS/PT who received treatment with heparin, aspirin and/or hydroxychloroquine.
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Affiliation(s)
- Daniel E. Pleguezuelo
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (O.C.-M.); (E.A.R.-F.); (L.N.); (F.J.G.-E.); (A.S.)
- Correspondence: ; Tel.: +34-917792756
| | - Oscar Cabrera-Marante
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (O.C.-M.); (E.A.R.-F.); (L.N.); (F.J.G.-E.); (A.S.)
| | - Magdalena Abad
- Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (M.A.); (A.V.); (O.V.); (L.d.l.F.-B.)
| | - Edgard Alfonso Rodriguez-Frias
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (O.C.-M.); (E.A.R.-F.); (L.N.); (F.J.G.-E.); (A.S.)
| | - Laura Naranjo
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (O.C.-M.); (E.A.R.-F.); (L.N.); (F.J.G.-E.); (A.S.)
| | - Alicia Vazquez
- Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (M.A.); (A.V.); (O.V.); (L.d.l.F.-B.)
| | - Olga Villar
- Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (M.A.); (A.V.); (O.V.); (L.d.l.F.-B.)
| | - Francisco Javier Gil-Etayo
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (O.C.-M.); (E.A.R.-F.); (L.N.); (F.J.G.-E.); (A.S.)
| | - Manuel Serrano
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Alfredo Perez-Rivilla
- Department of Microbiology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Laura de la Fuente-Bitaine
- Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (M.A.); (A.V.); (O.V.); (L.d.l.F.-B.)
| | - Antonio Serrano
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (O.C.-M.); (E.A.R.-F.); (L.N.); (F.J.G.-E.); (A.S.)
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Hennessy M, Dennehy R, Meaney S, Linehan L, Devane D, Rice R, O'Donoghue K. Clinical practice guidelines for recurrent miscarriage in high-income countries: a systematic review. Reprod Biomed Online 2021; 42:1146-1171. [PMID: 33895080 DOI: 10.1016/j.rbmo.2021.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
Recurrent miscarriage affects 1-2% of women of reproductive age, depending on the definition used. A systematic review was conducted to identify, appraise and describe clinical practice guidelines (CPG) published since 2000 for the investigation, management, and/or follow-up of recurrent miscarriage within high-income countries. Six major databases, eight guideline repositories and the websites of 11 professional organizations were searched to identify potentially eligible studies. The quality of eligible CPG was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Tool. A narrative synthesis was conducted to describe, compare and contrast the CPG and recommendations therein. Thirty-two CPG were included, from which 373 recommendations concerning first-trimester recurrent miscarriage were identified across four sub-categories: structure of care (42 recommendations, nine CPG), investigations (134 recommendations, 23 CPG), treatment (153 recommendations, 24 CPG), and counselling and supportive care (46 recommendations, nine CPG). Most CPG scored 'poor' on applicability (84%) and editorial independence (69%); and to a lesser extent stakeholder involvement (38%) and rigour of development (31%). Varying levels of consensus were found across CPG, with some conflicting recommendations. Greater efforts are required to improve the quality of evidence underpinning CPG, the rigour of their development and the inclusion of multi-disciplinary perspectives, including those with lived experience of recurrent miscarriage.
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Affiliation(s)
- Marita Hennessy
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland.
| | - Rebecca Dennehy
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland
| | - Sarah Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland; National Perinatal Epidemiology Centre, University College Cork, Cork University Maternity Hospital Cork T12 DC4A, Ireland
| | - Laura Linehan
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland
| | - Declan Devane
- The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; School of Nursing and Midwifery, National University of Ireland, Galway, Galway H91 E3YV, Ireland; Evidence Synthesis Ireland, National University of Ireland, Galway, Galway H91 E3YV, Ireland
| | - Rachel Rice
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; School of Applied Social Studies, University College Cork, Cork T12 D726, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland
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Hennessy M, Dennehy R, Meaney S, Devane D, O'Donoghue K. A protocol for a systematic review of clinical practice guidelines for recurrent miscarriage. HRB Open Res 2020; 3:12. [PMID: 33005862 PMCID: PMC7477641 DOI: 10.12688/hrbopenres.13024.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 12/12/2022] Open
Abstract
Recurrent miscarriage (RM) was recently re-defined by the European Society of Human Reproduction and Embryology (ESHRE) as the loss of two or more consecutive pregnancies. Before this, and indeed still in some countries, RM was defined as three or more consecutive pregnancy losses. While the incidence of RM depends on the definition employed and population studied, it is generally accepted to affect 1-6% of women of reproductive age. Clinical practice guidelines (CPGs) for RM have been published by some professional organisations. While there are CPGs on miscarriage in Ireland, there are none concerning RM specifically. The aim of this systematic review is to identify, appraise and describe published CPGs for the management, investigation and/or follow-up of RM within high-income countries. Electronic databases (MEDLINE (Ovid
®; 1946), Embase
® (Elsevier; 1980), CINAHL Complete (EBSCOhost; 1994), Web of Science™ (Thomson Reuters), Scopus (Elsevier; 2004), and Open Grey (INIST-CNRS; 2011)), selected guideline repositories, and the websites of professional societies will be searched to identify CPGs, published within the last 20 years, for potential inclusion. Two reviewers will review abstracts and full texts independently against the eligibility criteria. Characteristics and recommendations of included CPGs will be extracted by one reviewer and double-checked by another. Two reviewers will use the Appraisal of Guidelines for Research and Evaluation version 2 (AGREE II) instrument independently to assess the quality of the included CPGs. Narrative synthesis will be conducted to appraise and compare CPGs and their recommendations or guidance therein. The identification, appraisal and description of published CPGs in other high-income countries will be a valuable first step in informing efforts to promote the optimisation and standardisation of RM care.
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Affiliation(s)
- Marita Hennessy
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.,The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland.,College of Medicine and Health, University College Cork, Cork, Ireland
| | - Rebecca Dennehy
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.,The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland.,College of Medicine and Health, University College Cork, Cork, Ireland
| | - Sarah Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.,The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland.,College of Medicine and Health, University College Cork, Cork, Ireland.,National Perinatal Epidemiology Centre, University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Declan Devane
- The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland.,School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland.,Evidence Synthesis Ireland, National University of Ireland, Galway, Galway, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.,The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland.,College of Medicine and Health, University College Cork, Cork, Ireland
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