Systematic evaluation of the quality of clinical practice guidelines on the use of assisted reproductive techniques

Methodological quality of guidelines for the management of opioid use disorder: A systematic review

WHAT IS KNOWN AND OBJECTIVE

Opioid Use Disorder (OUD) has a high mortality rate and affects millions of people worldwide. Many organizations and societies develop Clinical Practice Guidelines (CPGs) to serve as a framework for healthcare providers to decide and support best practice to manage and treat OUD. However, not all CPGs sufficiently address all the important aspects of optimal care for managing OUD. This study aims to review current CPGs for management of OUD, evaluate their methodological quality and summarize their recommendations.

METHODS

We conducted this systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Various databases were searched for CPGs and Appraisal of Guidelines for Research and Evaluation (AGREE-II) instrument was used to assess the methodological quality. We also summarized the treatments plans of CPGs across continuum of care (diagnosis and assessment, treatment initiation, pharmacotherapy and psychosocial).

RESULTS

This review included 28 CPGs of varying qualities. CPGs from high-income countries and international organizations rated high for their methodological quality. Most CPGs scored high for the scope and purpose domain and scored low for applicability domain. Recommendations for the continuum of care for OUD varied across CPGs. Buprenorphine was recommended in most of the CPGs, followed by methadone. Recommendations for psychosocial interventions also varied, with cognitive behaviour therapies and counselling or education being the common recommendations in many CPGs WHAT IS NEW AND CONCLUSION: We found most CPGs have scope and purpose and clarity of presentation. However, the methodological rigour and applicability scored low. CPGs need to frame health questions in a comprehensible manner and provide an update as evidence grows. It is important for CPG developers to consider methodological quality as a factor when developing CPG recommendations.

Evaluation of the quality of guidelines for assisted reproductive technology using the RIGHT checklist: A cross-sectional study

INTRODUCTION

In recent years, assisted reproductive technology (ART) has developed rapidly, leading to an increasing number of clinical practice guidelines in this field. However, the reporting quality of current clinical practice guidelines in ART is still unknown. Objective To evaluate the reporting quality of clinical practice guidelines in the field of ART using the RIGHT checklist.

METHOD

Relevant guidelines were identified by electronic search of PubMed, Chinese Biomedical Literature Database (CBM), Wan Fang Database and Chinese National Knowledge Infrastructure (CNKI) from the beginning of the database to October, 2017. We also searched the websites of the guideline development organizations, including Guidelines International Network (GIN), National Guideline Clearinghouse (NGC) and the National Institute for Health and Care Excellence (NICE), as well as from two medical associations, including the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM). We used Google Scholar to find additional clinical practice guidelines (CPGs) as well. Two investigators searched the database, selected guidelines independently based on the inclusion criteria, and extracted the relevant information.

RESULT

Fifteen guidelines (i.e. six developed by individual institutions and 9 by associations) were included. On average, 12.7 out of 35 items in the RIGHT standard (36.3%) were reported in each guideline. Five items were not reported by any of these guidelines. The reporting proportion of the seven domains (i.e. Basic information; Background; Evidence; Recommendations; Review and quality assurance; Funding and declaration and management of interests; Other information) were 46.7%, 40.8%, 45.3%, 29.5%, 53.3%, 10.0%, 26.7%, respectively.

CONCLUSION

At present, the reporting quality of guidelines for ART is poor, especially regarding the funding. In the future guideline development, more consideration should be given to reporting, dissemination and implementation.

Guideline appraisal with AGREE II: Systematic review of the current evidence on how users handle the 2 overall assessments

INTRODUCTION

The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument is the most commonly used guideline appraisal tool. It includes 23 appraisal criteria (items) organized within 6 domains and 2 overall assessments (1. overall guideline quality; 2. recommendation for use). The aim of this systematic review was twofold. Firstly, to investigate how often AGREE II users conduct the 2 overall assessments. Secondly, to investigate the influence of the 6 domain scores on each of the 2 overall assessments.

MATERIALS AND METHODS

A systematic bibliographic search was conducted for publications reporting guideline appraisals with AGREE II. The impact of the 6 domain scores on the overall assessment of guideline quality was examined using a multiple linear regression model. Their impact on the recommendation for use (possible answers: "yes", "yes, with modifications", "no") was examined using a multinomial regression model.

RESULTS

118 relevant publications including 1453 guidelines were identified. 77.1% of the publications reported results for at least one overall assessment, but only 32.2% reported results for both overall assessments. The results of the regression analyses showed a statistically significant influence of all domains on overall guideline quality, with Domain 3 (rigour of development) having the strongest influence. For the recommendation for use, the results showed a significant influence of Domains 3 to 5 ("yes" vs. "no") and Domains 3 and 5 ("yes, with modifications" vs. "no").

CONCLUSIONS

The 2 overall assessments of AGREE II are underreported by guideline assessors. Domains 3 and 5 have the strongest influence on the results of the 2 overall assessments, while the other domains have a varying influence. Within a normative approach, our findings could be used as guidance for weighting individual domains in AGREE II to make the overall assessments more objective. Alternatively, a stronger content analysis of the individual domains could clarify their importance in terms of guideline quality. Moreover, AGREE II should require users to transparently present how they conducted the assessments.