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Boaitey KP, Bakhit M, Krzyzaniak N, Hoffmann TC. Information about the natural history of acute infections commonly seen in primary care: a systematic review of clinical practice guidelines. BMC Infect Dis 2022; 22:897. [PMID: 36456959 PMCID: PMC9714117 DOI: 10.1186/s12879-022-07887-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Many of the acute infections that are seen in primary care and sometimes managed with antibiotics are self-resolving and antibiotics may be unnecessary. Information about the natural history of these infections underpins antibiotic stewardship strategies such as delayed prescribing and shared decision making, yet whether it's reported in guidelines is unknown. We examined, in clinical guidelines, the reporting of natural history information and relevant antibiotic stewardship strategies for acute infections commonly seen in primary care. METHODS A systematic review of national and international guidelines (2010 onwards), available electronically, for managing acute infections (respiratory, urinary, or skin and soft tissue). We searched MEDLINE, CINAHL, EMBASE, TRIP, and GIN databases and websites of 22 guideline-publishing organisations. RESULTS We identified 82 guidelines, covering 114 eligible infections. Natural history information was reported in 49 (59.8%) of the guidelines and 66 (57.9%) of the reported conditions, most commonly for respiratory tract infections. Quantitative information about the expected infection duration was provided for 63.5% (n = 42) of the infections. Delayed antibiotic prescribing strategy was recommended for 34.2% (n = 39) of them and shared decision making for 21% (n = 24). CONCLUSIONS Just over half of the guidelines for acute infections that are commonly managed in primary care and sometimes with antibiotics contained natural history information. As many of these infections spontaneously improve, this is a missed opportunity to disseminate this information to clinicians, promote antibiotic stewardship, and facilitate conversations with patients and informed decision making. Systematic review registration CRD42021247048.
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Affiliation(s)
- Kwame Peprah Boaitey
- grid.1033.10000 0004 0405 3820Faculty of Health Sciences and Medicine, Institute for Evidence-Based Healthcare, Bond University, 14 University Dr, Robina, QLD 4229 Australia
| | - Mina Bakhit
- grid.1033.10000 0004 0405 3820Faculty of Health Sciences and Medicine, Institute for Evidence-Based Healthcare, Bond University, 14 University Dr, Robina, QLD 4229 Australia
| | - Natalia Krzyzaniak
- grid.1033.10000 0004 0405 3820Faculty of Health Sciences and Medicine, Institute for Evidence-Based Healthcare, Bond University, 14 University Dr, Robina, QLD 4229 Australia
| | - Tammy C. Hoffmann
- grid.1033.10000 0004 0405 3820Faculty of Health Sciences and Medicine, Institute for Evidence-Based Healthcare, Bond University, 14 University Dr, Robina, QLD 4229 Australia
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2
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Seow SY, Kwok KFV, Tay KH, Chee WSA, Rawtaer I, Cheng Y, Tan QX, Tan SM. Systematic Review of Clinical Practice Guidelines for Insomnia Disorder. J Psychiatr Pract 2022; 28:465-477. [PMID: 36355585 DOI: 10.1097/pra.0000000000000670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This systematic review assessed the quality of clinical practice guidelines (CPGs) on the treatment of insomnia disorder and their reporting of recommendations, while summarizing the evidence and providing guidance on an algorithmic approach to appropriate pharmacological treatment. METHODS The PubMed and EMBASE databases, guideline repositories, and specialist association websites were searched. The quality of the CPGs was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, complemented by the AGREE-REX (Appraisal of Guidelines REsearch and Evaluation-Recommendations EXcellence). A multidisciplinary team identified the key clinical questions that a clinician would consider when taking an algorithmic approach to the use of medication for patients with insomnia disorder. By using a meta-synthesis approach, recommendations from the CPGs were characterized and summarized via a recommendation matrix. RESULTS A total of 10 records that met the inclusion criteria were included and appraised. Four CPGs were rated as high and 3 CPGs were rated as moderate in overall quality. Most of the CPGs recommended pharmacotherapy only if cognitive behavioral therapy for insomnia or other nonpharmacological interventions were unavailable, unsuccessful, or declined by patients. Recommendations on types of medicines and dose and duration of treatment varied and were nonspecific. Few of the CPGs provided recommendations on pharmacotherapy in special populations. CONCLUSIONS Indications for starting medications are the only common thread in all of the reviewed CPGs. The CPGs diverged in the choice of first-line pharmacotherapy, and most of the CPGs did not provide recommendations on all subsequent clinical considerations.
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Affiliation(s)
- Su Yin Seow
- SEOW, KWOK, TAY, CHEE, RAWTAER, CHENG, QI XUAN TAN, and SHIAN MING TAN: Sengkang General Hospital, Singapore, Singapore
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3
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Andrejko K, Whittles LK, Lewnard JA. Health-Economic Value of Vaccination Against Group A Streptococcus in the United States. Clin Infect Dis 2022; 74:983-992. [PMID: 34192307 DOI: 10.1093/cid/ciab597] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Vaccines are needed to reduce the burden of group A Streptococcus (GAS). We assessed the potential health-economic value of GAS vaccines achievable through prevention of invasive disease and acute upper respiratory infections in the United States. METHODS We estimated annual incidence of invasive GAS disease and associated costs incurred from hospitalization and management of long-term sequelae, as well as productivity losses resulting from acute illness, long-term disability, and mortality. We also estimated healthcare and productivity costs associated with GAS pharyngitis, sinusitis, and acute otitis media. We estimated costs averted by prevention of invasive disease and acute upper respiratory infections for vaccines with differing efficacy profiles; our base case considered vaccines meeting the World Health Organization Preferred Product Profile (WHO-PPP) with a 6-year average duration of protection. RESULTS Costs of invasive GAS disease and acute upper respiratory infections totaled $6.08 (95% confidence interval [CI], $5.33-$6.86) billion annually. Direct effects of vaccines meeting WHO-PPP characteristics and administered at ages 12 and 18 months would avert $609 (95% CI, $558-$663) million in costs annually, primarily by preventing noninvasive disease; with an additional dose at age 5 years, averted costs would total $869 (95% CI, $798-$945) million annually. Adult vaccination at age 65 years would avert $326 (95% CI, $271-$387) million in annual costs associated with invasive GAS disease. Indirect effects of vaccination programs reducing incidence of GAS diseases across all ages by 20% would avert roughly $1 billion in costs each year. CONCLUSIONS The economic burden of GAS is substantial. Our findings should inform prioritization of GAS vaccine development and evaluation.
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Affiliation(s)
- Kristin Andrejko
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Lilith K Whittles
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom.,Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom.,National Institute for Health Research Health Protection Research Unit in Modeling Methodology, School of Public Health, Imperial College London, London, United Kingdom
| | - Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, USA.,Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, USA.,Center for Computational Biology, College of Engineering, University of California, Berkeley, Berkeley, California, USA
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4
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Yousef B, Aldomah M, Ahmed Y, Ezaldeen A, Aldomah M, Nasir R, Abdulraheem M, Badi S. Community pharmacists' knowledge and practice toward upper respiratory tract infections in Khartoum State: A cross-sectional survey. MATRIX SCIENCE MEDICA 2022. [DOI: 10.4103/mtsm.mtsm_55_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Albayrak A, Karakaş NM, Karahalil B. Evaluation of parental knowledge, attitudes and practices regarding antibiotic use in acute upper respiratory tract infections in children under 18 years of age: a cross-sectional study in Turkey. BMC Pediatr 2021; 21:554. [PMID: 34872522 PMCID: PMC8647354 DOI: 10.1186/s12887-021-03020-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/19/2021] [Indexed: 08/30/2023] Open
Abstract
Background Upper respiratory tract infections (URTIs) are common in children. Antibiotics still continue to be prescribed although most URTIs are of viral origin. This is inappropriate use and this unnecessary administration contributes or may cause antibiotic resistance. The problem of unnecessary antibiotic use among children is a concern for antibiotic resistance in low- and middle-income developing countries. This study aims to evaluate the knowledge and attitudes of parents of children with upper respiratory tract infections regarding antibiotic use and their antibiotic administration practices in a tertiary care hospital in Turkey. Methods Our study is a cross-sectional survey study. It was carried out between 14 December 2020 and 1 April 2021 for parents over 18 years of age with a child under 18 years’ old who applied to the general pediatrics outpatient clinics of Gazi University Faculty of Medicine Hospital Department of Pediatrics. Results Five hundred fifty-four parents responded to the questionnaire (93.2% rate of response). A total of 15.7% of parents stated to use antibiotics in any child with fever. 37% of parents believed that antibiotics could cure infections caused by viruses. 6.3% of parents declared that they put pressure on pediatricians to prescribe antibiotics. While 28% of the parents who thought that the use of inappropriate antibiotics would not change the effect and resistance of the treatment, 41% thought that new antibiotics could be developed continuously. 85.6% of the parents stated that they never gave their children non-prescription antibiotics when they had a high fever. 80.9% of them declared that they never used past antibiotics in the presence of a new infection. Conclusion According to the results of our study of parents’ lack of knowledge about antibiotics in Turkey, though generally it shows proper attitude and practices. It shows that some of the restrictions imposed by the National Action Plan are partially working. However, it is still necessary to continue to inform parents, pediatricians and pharmacists about the use of antibiotics, and to be more sensitive about the prescribing of antibiotics, and if necessary, sanctions should be imposed by the state in order to prevent unnecessary antibiotic prescriptions.
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Affiliation(s)
- Aslınur Albayrak
- Faculty of Pharmacy, Department of Clinical Pharmacy, Gazi University, Ankara, Turkey.
| | - Nazmi Mutlu Karakaş
- Faculty of Medicine Department of Pediatrics, Gazi University, Ankara, Turkey
| | - Bensu Karahalil
- Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Gazi University, Ankara, Turkey
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Ślęzak K, Dembiński Ł, Konefał A, Dąbrowski M, Mazur A, Peregud-Pogorzelska M, Wawrykow P, Konefał D, Peregud-Pogorzelski J. Impact of Selected Behavioral and Environmental Factors on the Antibiotic Therapy in Polish Children With Upper Respiratory Tract Infections. Front Pediatr 2021; 9:784265. [PMID: 34926354 PMCID: PMC8678461 DOI: 10.3389/fped.2021.784265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Antibiotic therapy must be carried out consistently and according to the guidelines. Viruses are the dominant cause of upper respiratory tract infections (URTIs) in children, as has been shown in many previous studies. Unnecessary antibiotic therapy should be avoided so that it does not affect patients' health and lead to the development of resistant bacterial strains. Here we report a national survey conducted in a group of 4,389 children to assess the impact of selected behavioral and environmental factors on antibiotic therapy in patients with URTIs. We found that selected environmental factors influenced the type of treatment. The place of residence, having siblings, an absence of vaccinations, the presence of allergies, and attendance at educational institutions were conducive to antibiotic therapy. These factors also influenced the frequency of hospitalization of children and their absence from nurseries, kindergartens, and schools, as well as the absence of their guardians from work.
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Affiliation(s)
- Katarzyna Ślęzak
- Department of Pediatrics, Pediatric Oncology and Immunology, Pomeranian Medical University, Szczecin, Poland
| | - Łukasz Dembiński
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | | | - Mikołaj Dąbrowski
- Adult Spine Orthopaedics Department, Poznan University of Medical Sciences, Poznań, Poland
| | - Artur Mazur
- Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical College of Rzeszow University, Rzeszów, Poland
| | | | - Paweł Wawrykow
- Department of Pediatrics, Pediatric Oncology and Immunology, Pomeranian Medical University, Szczecin, Poland
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Suzuki HG, Dewez JE, Nijman RG, Yeung S. Clinical practice guidelines for acute otitis media in children: a systematic review and appraisal of European national guidelines. BMJ Open 2020; 10:e035343. [PMID: 32371515 PMCID: PMC7228535 DOI: 10.1136/bmjopen-2019-035343] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To appraise European guidelines for acute otitis media (AOM) in children, including methodological quality, level of evidence (LoE), astrength of recommendations (SoR), and consideration of antibiotic stewardship. DESIGN Systematic review of the literature. DATA SOURCES Three-pronged search of (1) databases: Medline, Embase, Cochrane library, Guidelines International Network and Trip Medical Database; (2) websites of European national paediatric associations and (3) contact of European experts. Data were collected between January 2017 and February 2018. ELIGIBILITY CRITERIA National guidelines of European countries for the clinical management of AOM in children aged <16 years. DATA EXTRACTION AND SYNTHESIS Data were extracted using tables constructed by the research team. Guidelines were graded using AGREE II criteria. LoE and SoR were compared. Guidelines were assessed for principles of antibiotic stewardship. RESULTS AOM guidelines were obtained from 17 or the 32 countries in the European Union or European Free Trade Area. The mean AGREE II score was ≤41% across most domains. Diagnosis of AOM was based on similar signs and symptoms. The most common indication for antibiotics was tympanic membrane perforation/otorrhoea (14/15; 93%). The majority (15/17; 88%) recommended a watchful waiting approach to antibiotics. Amoxicillin was the most common first-line antibiotic (14/17; 82%). Recommended treatment duration varied from 5 to 10 days. Seven countries advocated high-dose (75-90 mg/kg/day) and five low-dose (30-60 mg/kg/day) amoxicillin. Less than 60% of guidelines used a national or international scale system to rate level of evidence to support recommendations. Under half of the guidelines (7/17; 41%) referred to country-specific microbiological and antibiotic resistance data. CONCLUSIONS Guidelines for managing AOM were similar across European countries. Guideline quality was mostly weak, and it often did not refer to country-specific antibiotic resistance patterns. Coordinating efforts to produce a core guideline which can then be adapted by each country may help improve overall quality and contribute to tackling antibiotic resistance.
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Affiliation(s)
- Hijiri G Suzuki
- Department of Clinical Research, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Juan Emmanuel Dewez
- Department of Clinical Research, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Ruud G Nijman
- Faculty of Medicine, Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Shunmay Yeung
- Department of Clinical Research, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
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8
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Lucas S, Kumar D, Leach D, Phillips D. Complementary and alternative medicine use in Australian children with acute respiratory tract infection - A cross-sectional survey of parents. Complement Ther Clin Pract 2020; 39:101171. [DOI: 10.1016/j.ctcp.2020.101171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/02/2020] [Indexed: 12/18/2022]
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Critical appraisal of papers reporting recommendation on sarcopenia using the AGREE II tool: a EuroAIM initiative. Eur J Clin Nutr 2020; 74:1164-1172. [PMID: 32341490 DOI: 10.1038/s41430-020-0638-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/27/2020] [Accepted: 04/07/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES The growing interest of medical community about sarcopenia resulted in the production of several clinical practice guidelines (CPGs), with an unavoidable variability in terms of the overall quality of those publications. Our aim is to evaluate the quality of CPGs on sarcopenia using the AGREE II instrument. SUBJECTS/METHODS We performed an online literature search for sarcopenia CPGs using different databases. Four independent reviewers evaluated the quality of CPGs using the AGREE II instrument. To classify the quality of each guideline, we defined specific thresholds of final score: high-quality if five or more domains scored >60%; average-quality if three or four domains scored >60%; low-quality if ≤2 domains scored >60%. RESULTS Our literature search yielded 315 articles, and after applying exclusion criteria our final analysis included 19 CPGs. The overall quality of CPGs was remarkable, as 13/19 (68.4%) were considered of "high-quality" CPGs, with more than four domains reached a score higher than 60%. "Scope and Purpose" and "Clarity of Presentations" had the best domain results (78.4% and 73.8%, respectively), while the two domains with the lowest scores were "Rigor of Development" and "Applicability" (61.5% and 58.7%, respectively). Interobserver variability ranged between moderate (0.624) and fair (0.275). CONCLUSIONS Our study showed that the overall quality of CPGs about sarcopenia was noteworthy, as more than two-third of paper obtained a "high-quality" score. The domain "applicability" had the lowest score, suggesting that emphasis should be put on possible strategies for helping other doctors to implement guideline recommendations in clinical practice.
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Lucas S, Leach MJ, Kumar S, Phillips AC. Complementary And Alternative Medicine Practitioner's Management Of Acute Respiratory Tract Infections In Children - A Qualitative Descriptive Study. J Multidiscip Healthc 2019; 12:947-962. [PMID: 31819469 PMCID: PMC6875505 DOI: 10.2147/jmdh.s230845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/29/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Acute respiratory tract infection (ARTI) is one of the most prevalent types of infection among children and a common reason for hospital admission. Although parents frequently consult complementary and alternative medicine (CAM) practitioners to assist with the management of childhood ARTI, little is known about the treatments that CAM practitioners recommend and why. The aim of this research was to understand what CAM practitioners typically prescribe for the management of childhood ARTI and how practitioners formulate decisions regarding the management of this condition. METHOD The research was guided by a qualitative descriptive framework. CAM practitioners across Greater Melbourne (Victoria, Australia) who had treated children aged 0-12 years with ARTI in the past 12 months were eligible to participate. Data were captured using semi-structured interviews, which were audio-recorded and transcribed verbatim. Multiple strategies to improve trustworthiness were implemented (e.g., triangulation of data). Data were analysed using inductive content analysis. RESULTS Twenty-four CAM practitioners from ten different disciplines participated in the interviews. Most participants were female (75%), and more than half (54%) were practicing naturopaths. The treatments most commonly recommended were lifestyle modification (95%), nutrition/diet-based treatments (91%), and vitamin/mineral supplementation (87%). Practitioners' decision-making process was underpinned by four key concepts namely: the approach to management, individualisation, do no harm, and collaborative practice. Individualisation and the safety of the child are cornerstones of treatment in the practitioner's decision-making process. CONCLUSION This research sheds light on commonly used CAM interventions, many of which build on easily accessible and readily available treatments (such as soups) and are aligned with mainstream recommendations (such as rest). Practitioners' decision-making process too aligns well with mainstream health care where the focus is on safety and informed by a biopsychosocial-cultural approach.
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Affiliation(s)
- Sandra Lucas
- School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Matthew J Leach
- Department of Rural Health, University of South Australia, Adelaide, SA, Australia
| | - Saravana Kumar
- School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Anna C Phillips
- School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
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Lucas S, Kumar S, Leach MJ, Phillips A. Parent use of complementary medicine remedies and services for the management of respiratory tract infection in children: a qualitative study. J Multidiscip Healthc 2019; 12:749-766. [PMID: 31571893 PMCID: PMC6750007 DOI: 10.2147/jmdh.s216687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/15/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The use of complementary and alternative medicine (CAM) is increasing globally, in both adults and children. A common condition where CAM is used in children is acute respiratory tract infection (ARTI). However, limited information exists regarding specific CAM modalities used in children, and the factors that influence a parent's decision to use CAM for ARTI in children. This research aimed to address this knowledge gap. METHOD This research used a qualitative descriptive approach. Parents residing in Greater Melbourne, Australia, who had children aged from 0-12 years, and had used CAM for treating ARTI in their children in the last 12 months, were eligible to participate. Parents' perspectives were captured using individual semi-structured interviews, which were then transcribed verbatim. Data were analysed using content analysis. RESULTS Twenty-four families were interviewed. Several strategies to improve trustworthiness were implemented. Three themes underpinning the parents' decision to use CAM emerged from the data: safety, internal drivers and external drivers. Parents used a breadth of different treatments, predominantly food as medicine, followed by aromatherapy and other CAM remedies typically found in the kitchen, to manage ARTI in their children. Parents often used both CAM practitioners and mainstream medicine to manage ARTI in their children. While mainstream medicine was typically used to rule out any sinister pathology, CAM was often used as a frontline treatment option, with food as medicine (e.g. soups) dominating. This was due in part to concerns regarding the negative aspects of pharmaceutical use. Parents utilised a diverse range of information sources to inform their decision-making, including friends, families and the internet; traditional sources of research evidence were generally not used. CONCLUSION Child safety was a major factor influencing a primary carer's decision to utilise CAM for ARTI. The safety and effectiveness of remedies utilised by parents now warrants further investigation.
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Affiliation(s)
- S Lucas
- School of Health Sciences, Department of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - S Kumar
- School of Health Sciences, Department of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - MJ Leach
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
| | - A Phillips
- School of Health Sciences, Department of Health Sciences, University of South Australia, Adelaide, South Australia, 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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13
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Gitto S, Bisdas S, Emili I, Nicosia L, Pescatori LC, Bhatia K, Lingam RK, Sardanelli F, Sconfienza LM, Mauri G. Clinical practice guidelines on ultrasound-guided fine needle aspiration biopsy of thyroid nodules: a critical appraisal using AGREE II. Endocrine 2019; 65:371-378. [PMID: 30903569 DOI: 10.1007/s12020-019-01898-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 03/11/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE To appraise the quality of current guidelines on fine needle aspiration biopsy (FNAB) of thyroid nodules for adults using the AGREE II quality assessment tool. METHODS We conducted an online search for guidelines on FNAB of thyroid nodules published between 2013 and October 2018. They were evaluated by four independent reviewers previously trained to apply the AGREE II instrument, which is organized into items and domains. A fifth independent reviewer calculated scores for each domain and guideline as well as inter-appraiser agreement. RESULTS Six sets of guidelines were included, respectively, provided by the American Thyroid Association (ATA), the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME), the Korean Society of Thyroid Radiology (KSThR), the European Thyroid Association (ETA), the American College of Radiology (ACR) and the Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency (KSR/NECA). Five out of the six guidelines (ATA, AACE/ACE/AME, ETA, ACR and KSR/NECA) reached a high level of overall quality, having at least five domain scores >60%. An average level of overall quality was achieved in one case (KSThR recommendations). Inter-appraiser agreement ranged from moderate to excellent. CONCLUSIONS Overall, the quality of guidelines on FNAB of thyroid nodules is satisfactory when evaluated using the AGREE II instrument.
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Affiliation(s)
- Salvatore Gitto
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milano, Italy.
| | - Sotirios Bisdas
- Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
- Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, London, UK
| | - Ilaria Emili
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milano, Italy
| | - Luca Nicosia
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milano, Italy
| | | | - Kunwar Bhatia
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Ravi K Lingam
- Department of Radiology, Northwick Park & Central Middlesex Hospitals, London North West University Healthcare NHS Trust, London, UK
| | - Francesco Sardanelli
- Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Giovanni Mauri
- Divisione di Radiologia Interventistica, IRCCS Istituto Europeo di Oncologia, Milano, Italy
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O’Doherty J, Leader LFW, O’Regan A, Dunne C, Puthoopparambil SJ, O’Connor R. Over prescribing of antibiotics for acute respiratory tract infections; a qualitative study to explore Irish general practitioners' perspectives. BMC FAMILY PRACTICE 2019; 20:27. [PMID: 30764777 PMCID: PMC6374900 DOI: 10.1186/s12875-019-0917-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 02/04/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Anti-microbial resistance (AMR) is a global threat to public health and antibiotics are often unnecessarily prescribed for acute respiratory tract infections (ARTIs) in general practice. We aimed to investigate why general practitioners (GPs) continue to prescribe antibiotics for ARTIs despite increasing knowledge of their poor efficacy and worsening antimicrobial resistance. METHODS We used an explorative qualitative study design. Thirteen GPs were recruited through purposive sampling to represent urban and rural settings and years of experience. They were based in general practices within the Mid-West of Ireland. GPs took part in semi-structured interviews that were digitally audio recorded and transcribed. RESULTS Three main themes and three subthemes were identified. Themes include (1) non-comprehensive guidelines; how guideline adherence can be difficult, (2) GPs under pressure; pressures to prescribe from patients and perceived patient expectations and (3) Unnecessary prescribing; how to address it and the potential of public interventions to reduce it. CONCLUSIONS GPs acknowledge their failure to implement guidelines because they feel they are less usable in clinical situations. GPs felt pressurised to prescribe, especially for fee-paying patients and in out of hours settings (OOH), suggesting the need for interventions that target the public's perceptions of antibiotics. GPs behaviours surrounding prescribing antibiotics need to change in order to reduce AMR and change patients' expectations.
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Affiliation(s)
- Jane O’Doherty
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Leonard F. W. Leader
- Royal College of Surgeons in Ireland - Medical University of Bahrain, Busaiteen, Muharraq Governorate, Kingdom of Bahrain
| | - Andrew O’Regan
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Colum Dunne
- Centre for Infections in Infection, Inflammation & Immunity (41), Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Soorej Jose Puthoopparambil
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Raymond O’Connor
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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O'Connor R, O'Doherty J, O'Regan A, Dunne C. Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review. Ir J Med Sci 2018; 187:969-986. [PMID: 29532292 PMCID: PMC6209023 DOI: 10.1007/s11845-018-1774-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/23/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Antimicrobial resistance is an emerging global threat to health and is associated with increased consumption of antibiotics. Seventy-four per cent of antibiotic prescribing takes place in primary care. Much of this is for inappropriate treatment of acute respiratory tract infections. AIMS To review the published literature pertaining to antibiotic prescribing in order to identify and understand the factors that affect primary care providers' prescribing decisions. METHODS Six online databases were searched for relevant paper using agreed criteria. One hundred ninety-five papers were retrieved, and 139 were included in this review. RESULTS Primary care providers are highly influenced to prescribe by patient expectation for antibiotics, clinical uncertainty and workload induced time pressures. Strategies proven to reduce such inappropriate prescribing include appropriately aimed multifaceted educational interventions for primary care providers, mass media educational campaigns aimed at healthcare professionals and the public, use of good communication skills in the consultation, use of delayed prescriptions especially when accompanied by written information, point of care testing and, probably, longer less pressurised consultations. Delayed prescriptions also facilitate focused personalised patient education. CONCLUSION There is an emerging consensus in the literature regarding strategies proven to reduce antibiotic consumption for acute respiratory tract infections. The widespread adoption of these strategies in primary care is imperative.
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Affiliation(s)
- Ray O'Connor
- Graduate Entry Medical School, University of Limerick, Limerick City, Limerick, 000, Ireland.
| | - Jane O'Doherty
- Graduate Entry Medical School, University of Limerick, Limerick City, Limerick, 000, Ireland
| | - Andrew O'Regan
- Graduate Entry Medical School, University of Limerick, Limerick City, Limerick, 000, Ireland
| | - Colum Dunne
- Graduate Entry Medical School, University of Limerick, Limerick City, Limerick, 000, Ireland
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Blanco-Mavillard I, Rodríguez-Calero MA, Castro-Sánchez E, Bennasar-Veny M, De Pedro-Gómez J. Appraising the quality standard underpinning international clinical practice guidelines for the selection and care of vascular access devices: a systematic review of reviews. BMJ Open 2018; 8:e021040. [PMID: 30344166 PMCID: PMC6196863 DOI: 10.1136/bmjopen-2017-021040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Catheter-related bloodstream infections are one of the most important adverse events for patients. Evidence-based practice embraces interventions to prevent and reduce catheter-related bloodstream infections in patients. At present, a growing number of guidelines exist worldwide. The purpose of the study was to assess clinical practice guidelines for peripheral and central venous access device care and prevention of related complications. DESIGN Systematic review of clinical practice guidelines: We conducted a search of the literature published from 2005 to 2018 using Medline/PubMed, Embase, CINAHL, Ovid, ScienceDirect, Scopus and Web of Science. We also evaluated grey literature sources and websites of organisations that compiled or produced guidelines. Guideline quality was assessed with the Appraisal of Guidelines for Research and Evaluation, Second Edition tool by three independent reviewers. Cohen's kappa coefficient was used to evaluate the concordance between reviewers. RESULTS We included seven guidelines in the evaluation. The concordance between observers was substantial, K=0.6364 (95% CI 0.0247 to 1.2259). We identified seven international guidelines, which scored poorly on crucial domains such as applicability (medium 39%), stakeholder involvement (medium 65%) and methodological rigour (medium 67%). Guidelines by Spanish Health Ministry and UK National Institute for Health and Care Excellence presented the highest quality. CONCLUSIONS It is crucial to critically evaluate the validity and reliability of clinical practice guidelines so the best, most context-specific document is selected. Such choice is a necessary prior step to encourage and support health organisations to transfer research results to clinical practice. The gaps identified in our study may explain the suboptimal clinical impact of guidelines. Such low adoption may be mitigated with the use of implementation guides accompanying clinical documents.
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Affiliation(s)
| | | | - Enrique Castro-Sánchez
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
| | - Miquel Bennasar-Veny
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain
| | - Joan De Pedro-Gómez
- Evidence, Lifestyles and Health Research Group, Research Institute of Health Sciences, Universitat de les Illes Balears, Palma, Spain
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Lucas S, Leach M, Kumar S. Complementary and alternative medicine utilisation for the management of acute respiratory tract infection in children: A systematic review. Complement Ther Med 2018; 37:158-166. [PMID: 29609928 DOI: 10.1016/j.ctim.2018.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/02/2018] [Accepted: 03/02/2018] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION As many as one in two children across the globe use complementary and alternative medicine (CAM) to manage a health condition. Despite the high prevalence of use, there is still limited information on the types of CAM used in children, particularly for the management of one of the most common childhood health complaints - acute respiratory tract infection (ARTI). This systematic review was undertaken to address this knowledge gap. METHODS Eligible studies reporting the use of CAM in children with ARTI were identified using a targeted search of seven electronic databases and the grey literature. Data were extracted using a customised data extraction form and appraised using the McMaster critical review forms for quantitative and qualitative studies. Findings were synthesised in narrative form. RESULTS The search identified 2261 papers, of which 22 studies were eligible for inclusion. The 22 studies reported the use of 118 distinct CAM interventions for the management of ARTI in children. Most (53%, n = 63) of these interventions represented biologically-based therapies, followed by whole medical systems/alternative medical systems (46%, n = 55). No studies reported the use of energy therapies, or manipulative and body-based methods, or mind-body therapies. CONCLUSION A diverse range of CAM interventions are used in the management of ARTI in children. These interventions largely represent CAM use in the southern region of Asia - India, Pakistan and Bangladesh. Further research is needed to better understand the types of CAM used among children with ARTI in western countries.
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Affiliation(s)
- S Lucas
- School of Health Sciences, University of South Australia, Adelaide, South Australia, North Tce. Adelaide SA 5000, Australia.
| | - M Leach
- Department of Rural Health, University of South Australia Adelaide, South Australia, North Tce. Adelaide SA 5000, Australia.
| | - S Kumar
- School of Health Sciences, University of South Australia, Adelaide, South Australia, North Tce. Adelaide SA 5000, Australia.
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Hoffmann-Eßer W, Siering U, Neugebauer EA, Lampert U, Eikermann M. Systematic review of current guideline appraisals performed with the Appraisal of Guidelines for Research & Evaluation II instrument—a third of AGREE II users apply a cut-off for guideline quality. J Clin Epidemiol 2018; 95:120-127. [DOI: 10.1016/j.jclinepi.2017.12.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 11/29/2017] [Accepted: 12/20/2017] [Indexed: 12/20/2022]
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Messina C, Bignotti B, Tagliafico A, Orlandi D, Corazza A, Sardanelli F, Sconfienza LM. A critical appraisal of the quality of adult musculoskeletal ultrasound guidelines using the AGREE II tool: an EuroAIM initiative. Insights Imaging 2017; 8:491-497. [PMID: 28755330 PMCID: PMC5621989 DOI: 10.1007/s13244-017-0563-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 06/09/2017] [Accepted: 06/21/2017] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Our aim was to evaluate the quality of published guidelines on musculoskeletal ultrasound (MSK-US) for adults. METHODS Between June and July 2016, we conducted an online search for MSK-US guidelines, which were evaluated by four independent readers blinded to each other using the AGREE II tool. A fifth independent reviewer calculated scores per each domain and agreement between reviewers' scores using the intraclass correlation coefficient (ICC). RESULTS Five guidelines were included in this appraisal. They were published between 2001 and 2014. Our appraisal showed intermediate results, with four out of five guidelines scoring "average" as overall quality. Domain 1 (scope and purpose) achieved the highest result (total score = 71.1% ± 18.7%). Domain 6 (editorial independence) had the lowest score (total score = 26.3% ± 19.3%). Interobserver agreement was very good for all the evaluated guidelines (ICC ranged between 0.932 and 0.956). CONCLUSIONS Overall, quality of MSK-US guidelines ranges from low to average when evaluated using the AGREE II tool. The editorial independence domain was the most critical, thus deserving more attention when developing future guidelines. MAIN MESSAGES • Four of five guidelines on MSK-US had an average quality level. • Scope/purpose had the highest score (71.1% ± 18.7%). • Editorial independence had the lowest score (26.3% ± 19.3%). • Interobserver agreement was very good (ranges: 0.932-0.956).
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Affiliation(s)
- Carmelo Messina
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Bianca Bignotti
- Department of Health Sciences, University of Genova, Genoa, Italy
| | | | - Davide Orlandi
- Ospedale Evangelico Internazionale, Piazzale Gianasso 5, 16100, Genoa, Italy
| | - Angelo Corazza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Francesco Sardanelli
- Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 1, 20097, San Donato Milanese, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy.
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Messina C, Bignotti B, Bazzocchi A, Phan CM, Tagliafico A, Guglielmi G, Sardanelli F, Sconfienza LM. A critical appraisal of the quality of adult dual-energy X-ray absorptiometry guidelines in osteoporosis using the AGREE II tool: An EuroAIM initiative. Insights Imaging 2017; 8:311-317. [PMID: 28432574 PMCID: PMC5438319 DOI: 10.1007/s13244-017-0553-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/22/2017] [Accepted: 03/28/2017] [Indexed: 11/29/2022] Open
Abstract
Objectives Dual energy X-ray absorptiometry (DXA) is the most widely used technique to measure bone mineral density (BMD). Appropriate and accurate use of DXA is of great importance, and several guidelines have been developed in the last years. Our aim was to evaluate the quality of published guidelines on DXA for adults. Methods Between June and July 2016 we conducted an online search for DXA guidelines, which were evaluated by four independent readers blinded to each other using the AGREE II instrument. A fifth independent reviewer calculated scores per each domain and agreement between reviewers’ scores. Results Four out of 59 guidelines met inclusion criteria and were included. They were published between 2005 and 2014. Three out of four guidelines reached a high level of quality, having at least five domain scores higher than 60%. Domain 1 (Scope and Purpose) achieved the highest result (total score = 86.8 ± 3.7%). Domain 6 (Editorial Independence) had the lowest score (total score = 54.7 ± 12.5%). Interobserver agreement ranged from fair (0.230) to good (0.702). Conclusions Overall, the quality of DXA guidelines is satisfactory when evaluated using the AGREE II instrument. The Editorial Independence domain was the most critical, thus deserving more attention when developing future guidelines. Main messages • Three of four guidelines on DXA had a high quality level (>60%). • Scope/purpose had the highest score (86.8 ± 3.7%). • Editorial Independence had the lowest score (54.7 ± 12.5%). • Interobserver agreement ranged from fair (0.230) to good (0.702). Electronic supplementary material The online version of this article (doi:10.1007/s13244-017-0553-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carmelo Messina
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Bianca Bignotti
- Department of Health Sciences, University of Genova, Genoa, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Via G. C. Pupilli 1, 40136, Bologna, Italy
| | | | | | | | - Francesco Sardanelli
- Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 1, 20097, San Donato Milanese, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy. .,Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
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Mangione-Smith R. The Challenges of Addressing Pediatric Quality Measurement Gaps. Pediatrics 2017; 139:peds.2017-0174. [PMID: 28298483 DOI: 10.1542/peds.2017-0174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Rita Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle, Washington; and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
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Al-mahallawi AM, Khowessah OM, Shoukri RA. Enhanced non invasive trans -tympanic delivery of ciprofloxacin through encapsulation into nano-spanlastic vesicles: Fabrication, in-vitro characterization, and comparative ex-vivo permeation studies. Int J Pharm 2017; 522:157-164. [DOI: 10.1016/j.ijpharm.2017.03.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/02/2017] [Accepted: 03/05/2017] [Indexed: 01/15/2023]
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Kühnisch J, Lauenstein A, Pitchika V, McGlynn G, Staskiewicz A, Hickel R, Grupe G. Was molar incisor hypomineralisation (MIH) present in archaeological case series? Clin Oral Investig 2016; 20:2387-2393. [PMID: 26780019 DOI: 10.1007/s00784-016-1717-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 01/10/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE With respect to the unknown aetiology of molar incisor hypomineralisation (MIH), it is unclear whether this phenomenon was overlooked in the last century as a result of a high number of caries in children or if this developmental disorder was not present until then. Therefore, this study determined the presence of MIH in historical dentitions and teeth. MATERIALS AND METHODS Dental remains from late medieval (n = 191, twelfth-sixteenth century, Regensburg, Germany), post-medieval (n = 33, sixteenth-eighteenth century, Passau, Germany) and modern age archaeological skeletal series (n = 99, nineteenth-twentieth century, Altdorf, Germany) were examined for MIH. In addition, linear enamel hypoplasia (LEH), diffuse opacities, hypoplasia and Turner's teeth were documented. RESULTS MIH-related demarcated opacities or enamel breakdowns were found in only 15 (0.4 %) of the 3891 examined permanent teeth. Ten cases (3.1 %) from a total of 323 dentitions were classified as having MIH. In contrast, 98 individuals (30.3 %) showed LEH. Other enamel disorders were recorded in 64 individuals (19.8 %). CONCLUSION With respect to the low number of affected dentitions and teeth, MIH most likely did not exist or was at least rarely present in the investigated archaeological case series. CLINICAL RELEVANCE This study supports the hypothesis that MIH may be linked to contemporary living conditions or other health-related factors.
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Affiliation(s)
- Jan Kühnisch
- Department of Conservative Dentistry and Periodontology, Ludwig-Maximilians-University of Munich, Munich, Germany.
| | - Anne Lauenstein
- Department of Conservative Dentistry and Periodontology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Vinay Pitchika
- Department of Conservative Dentistry and Periodontology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - George McGlynn
- Bavarian State Collection of Anthropology and Palaeoanatomy, Munich, Germany
| | - Anja Staskiewicz
- Bavarian State Collection of Anthropology and Palaeoanatomy, Munich, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Gisela Grupe
- Biocenter, Ludwig-Maximilians-University of Munich, Munich, Germany
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Armstrong JJ, Rodrigues IB, Wasiuta T, MacDermid JC. Quality assessment of osteoporosis clinical practice guidelines for physical activity and safe movement: an AGREE II appraisal. Arch Osteoporos 2016; 11:6. [PMID: 26759266 DOI: 10.1007/s11657-016-0260-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/04/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED Many osteoporosis clinical practice guidelines are published, and the extent to which physical activity and safe movement is addressed varies. To better inform clinical decision-making, a quality assessment and structured analysis of recommendations was undertaken. Guideline quality varied substantially, and improvement is necessary in physical activity and safe movement recommendations. PURPOSE The purpose of the present study is to survey available osteoporosis clinical practice guidelines (CPGs) containing physical activity and safe movement recommendations in order to assess the methodological quality with which they were developed. An analysis of the various physical activity and safe movement recommendations was conducted to determine variability between CPGs. METHODS An online literature search revealed 19 CPGs meeting our inclusion criteria. Three independent scorers evaluated CPG quality using the Appraisal of Guidelines for Research and Evaluation version II (AGREE II) instrument. Two separate individuals used a standard table to extract relevant recommendations. RESULTS Intra-reviewer AGREE II score agreement ranged from fair to good (intra-class correlation coefficient (ICC) = 0.34 to 0.65). The quality of the 19 included CPGs was variable (AGREE sub-scores: 14 to 100%). CPGs scored higher in the "scope and purpose" and "clarity of presentation" domains. They scored the lowest in "applicability" and "editorial independence." Four CPGs were classified as high quality, ten average quality, and five low quality. Most CPGs recommended weight-bearing, muscle-strengthening, and resistance exercises. Information on exercise dosage, progression, and contraindications was often absent. Immobility and movements involving spinal flexion and/or torsion were discouraged. CONCLUSIONS There were several high-quality CPGs; however, variability in quality and lack of specific parameters for implementation necessitates caution and critical examination by readers. CPG development groups should pay special attention to the clinical applicability of their CPGs as well as fully disclosing conflicts of interest. CPGs were in general an agreement regarding safe physical activity and safe movement recommendations. However, recommendations were often vague and the more specific recommendations were inconsistent between CPGs.
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Affiliation(s)
- James Jacob Armstrong
- Schulich School of Medicine and Dentistry, 1465 Richmond St., London, ON, N6G 2M1, Canada.
| | - Isabel Braganca Rodrigues
- McMaster University School of Rehabilitation Science, 1225 Royal York Rd., Toronto, ON, M9A 4B5, Canada.
| | - Tom Wasiuta
- Schulich School of Medicine and Dentistry, 1465 Richmond St., London, ON, N6G 2M1, Canada.
| | - Joy C MacDermid
- Hand and Upper Limb Center Clinical Research Lab, 930 Richmond St., London, ON, N6A 3J4, Canada.
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Huang M, Zhou X. Appraisal of guidelines for androgenetic alopecia using the Appraisal of Guidelines for Research and Evaluation II instrument. J Eval Clin Pract 2015; 21:1089-94. [PMID: 26507460 DOI: 10.1111/jep.12474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2015] [Indexed: 11/26/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The purpose of this study is to systematically evaluate the quality of methodological guidelines for androgenetic alopecia (AGA) using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument by searching and analysing the available worldwide guidelines. This could provide a reference for selecting clinical guidelines and for developing new guidelines in the future. METHODS We searched PubMed and other electronic databases for any AGA guidelines published until 2014. The AGREE II instrument was used by two researchers to create a systematic appraisal in six domains to determine the guidelines fulfilling the inclusion and exclusion criteria. RESULTS Five guidelines associated with the therapy of AGA were identified. The mean scores for the six AGREE II domains were as follows: 89.45% for 'scope and purpose', 53.88% for 'stakeholder involvement', 53.96% for 'rigour of development', 87.22% for 'clarity of presentation', 42.92% for 'applicability' and 59.16% for 'editorial independence'. The European guideline ranked the highest, whereas the American guideline of 1996 ranked the lowest. The Asian, European and Japanese guidelines were strongly recommended, and the two from America were recommended with modifications. CONCLUSIONS Guidelines should provide accurate and evidence-based recommendations. The AGREE II instrument is a useful tool to improve the quality of guidelines, and high-quality guidelines for clinical practice can be provided by using it.
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Affiliation(s)
- Mengya Huang
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xun Zhou
- Department of Dermatology and Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
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Zyoud SH, Abu Taha A, Araj KF, Abahri IA, Sawalha AF, Sweileh WM, Awang R, Al-Jabi SW. Parental knowledge, attitudes and practices regarding antibiotic use for acute upper respiratory tract infections in children: a cross-sectional study in Palestine. BMC Pediatr 2015; 15:176. [PMID: 26561029 PMCID: PMC4642624 DOI: 10.1186/s12887-015-0494-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 10/23/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In primary health care centres, upper respiratory tract infections (URTIs) in children are commonly encountered by physicians. Viruses cause most URTIs, but parents' attitudes often represent an important reason for antibiotic abuse, which leads to the development and spread of antimicrobial resistance. The goal of this study was to examine parents' knowledge, attitudes, and practices (KAP) about antibiotic use for children with URTIs in Palestine. METHODS A cross-sectional study was performed in primary health care centres in Nablus city from 1 June to 31 October 2012. A questionnaire was developed and administered to determine parents' KAP regarding antibiotic use for their children with URTIs. RESULTS Three hundred and eighty-five parents completed the questionnaire. A total of 79.7% of the parents were attentive to the truth that antibiotic misuse is responsible for bacterial resistance. Only 18.9% of parents thought that antibiotics did not have any harmful side effects. Fifty nine per cent of parents did not agree that URTIs are mostly viral in origin and are self-limited. Almost 73% of parents choose antibiotics as a treatment for URTIs, while earache (68%) and fever (64%) were the most common reasons for which parents expected antibiotics. However, more than 38% of the parents never asked the paediatrician to prescribe antibiotics, and only 6% congratulated their paediatricians for not prescribing antibiotics. CONCLUSIONS Although there is a trusted relationship between parents and paediatricians, Palestinian parents have insufficient knowledge related to antibiotic use for URTIs in children, which results in inappropriate attitudes and practices. Educational interventions for both parents and physicians will reduce unnecessary antibiotic use and resistance.
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Affiliation(s)
- Sa'ed H Zyoud
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, 11800, Malaysia.
| | - Adham Abu Taha
- Department of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
| | - Khulood F Araj
- PharmD Program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
| | - Islam A Abahri
- PharmD Program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
| | - Ansam F Sawalha
- Department of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
| | - Waleed M Sweileh
- Department of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
| | - Rahmat Awang
- WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, 11800, Malaysia.
| | - Samah W Al-Jabi
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
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Wu AM, Wu CM, Young BK, Wu DJ, Chen A, Margo CE, Greenberg PB. Evaluation of primary open-angle glaucoma clinical practice guidelines. Can J Ophthalmol 2015; 50:192-6. [DOI: 10.1016/j.jcjo.2015.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 12/20/2014] [Accepted: 03/16/2015] [Indexed: 11/27/2022]
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Critical Appraisal of Clinical Practice Guidelines for Age-Related Macular Degeneration. J Ophthalmol 2015; 2015:710324. [PMID: 26106484 PMCID: PMC4461780 DOI: 10.1155/2015/710324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/10/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. To evaluate the methodological quality of age-related macular degeneration (AMD) clinical practice guidelines (CPGs). Methods. AMD CPGs published by the American Academy of Ophthalmology (AAO) and Royal College of Ophthalmologists (RCO) were appraised by independent reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, which comprises six domains (Scope and Purpose, Stakeholder Involvement, Rigor of Development, Clarity of Presentation, Applicability, and Editorial Independence), and an Overall Assessment score summarizing methodological quality across all domains. Results. Average domain scores ranged from 35% to 83% for the AAO CPG and from 17% to 83% for the RCO CPG. Intraclass correlation coefficients for the reliability of mean scores for the AAO and RCO CPGs were 0.74 and 0.88, respectively. The strongest domains were Scope and Purpose and Clarity of Presentation. The weakest were Stakeholder Involvement (AAO) and Editorial Independence (RCO). Conclusions. Future AMD CPGs can be improved by involving all relevant stakeholders in guideline development, ensuring transparency of guideline development and review methodology, improving guideline applicability with respect to economic considerations, and addressing potential conflict of interests within the development group.
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Gisselsson-Solen M. Acute otitis media in children-current treatment and prevention. Curr Infect Dis Rep 2015; 17:476. [PMID: 25896748 DOI: 10.1007/s11908-015-0476-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acute otitis media (AOM) is the most common bacterial infection in children and has a very varied clinical spectrum, ranging from spontaneous resolutions to serious complications. The effect of antibiotics in AOM depends on the chosen outcome, but has been shown to reduce pain somewhat, and have a greater beneficial effect in severe cases of AOM. Today, not all episodes of AOM are treated with antibiotics, but most countries have issued guidelines that include an option of watchful waiting in many cases. Prevention of AOM reaches from modification of environmental risk factors to vaccinations and surgery. Conjugate pneumococcal vaccines and influenza vaccines have been shown to somewhat reduce the number of AOM episodes in different groups of children. Grommets, with or without adenoidectomy, are effective at least during the first 6 months after surgery.
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Affiliation(s)
- Marie Gisselsson-Solen
- Department of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, 22185, Lund, Sweden,
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Al-Mahallawi AM, Khowessah OM, Shoukri RA. Nano-transfersomal ciprofloxacin loaded vesicles for non-invasive trans-tympanic ototopical delivery: in-vitro optimization, ex-vivo permeation studies, and in-vivo assessment. Int J Pharm 2014; 472:304-14. [PMID: 24971692 DOI: 10.1016/j.ijpharm.2014.06.041] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 06/19/2014] [Accepted: 06/21/2014] [Indexed: 11/15/2022]
Abstract
Ciprofloxacin is a synthetic fluoroquinolone antibiotic that has been used for systemic treatment of otitis media in adults. It was approved for topical treatment of otorrhea in children with tympanostomy tubes. The aim of this work was to enhance the local non-invasive delivery of ciprofloxacin to the middle ear across an intact tympanic membrane (TM) in an attempt to treat acute otitis media (AOM) ototopically. In order to achieve this goal, ciprofloxacin nano-transfersomal vesicles were prepared by thin film hydration (TFH) technique, using several edge activators (EAs) of varying hydrophilic-lipophilic balance (HLB) values. A full factorial design was employed for the optimization of formulation variables using Design-Expert(®) software. The optimal formulation was subjected to stability testing, ex-vivo permeation studies (through ear skin and TM of rabbits), and in-vivo evaluation. Results revealed that the optimal formulation (composed of phospholipid and sodium cholate as an EA at a molar ratio of 5:1) exhibited enhanced ex-vivo drug flux through ear skin and TM when compared with the commercial product (Ciprocin(®) drops). It demonstrated a greater extent of in-vivo drug deposition in the TM of albino rabbits relative to Ciprocin(®). Consequently, transfersomes could be promising for the non-invasive trans-tympanic delivery of ciprofloxacin.
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Affiliation(s)
- Abdulaziz Mohsen Al-Mahallawi
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El Aini Street, Cairo 11562, Egypt.
| | - Omneya Mohammed Khowessah
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El Aini Street, Cairo 11562, Egypt
| | - Raguia Ali Shoukri
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El Aini Street, Cairo 11562, Egypt
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