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Vilela APO, Deffert F, Lucchetta RC, da Silva Pires YM, Mainka FF, Tonin FS, Pontarolo R. Methodological Quality of Pulmonary Arterial Hypertension Treatment Evidence-Based Guidelines: A Systematic Review Using the AGREE II and AGREE REX Tools. Cardiovasc Drugs Ther 2024:10.1007/s10557-024-07605-w. [PMID: 38980530 DOI: 10.1007/s10557-024-07605-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE Pulmonary arterial hypertension (PAH) is a progressive disease with a poor prognosis, and its management should be grounded in well-developed clinical practice guidelines (CPG). Thus, we critically assess the methodological quality of the available CPG for pharmacological treatments for PAH. METHODS A systematic review (CRD42023387168) was performed in PubMed, Cochrane, Embase, and Tripdatabase (Jan-2023). Eligible records were appraised by four reviewers using the Appraisal of Guidelines, Research, and Evaluation Collaboration tool (AGREE II) and the complementary tool for assessing recommendations' quality and certainty, AGREE REX. Descriptive statistics were used to summarize the data. RESULTS Overall, 31 guidelines, mainly authored by professional societies (90%), targeting only physicians as primary users (84%), were identified. Guidelines presented a moderate overall quality (scores of 63% and 51% in AGREE II and AGREE REX, respectively), with a few domains showing slight improvements over the years. AGREE II "Scope and Purpose" (94%) and "Presentation Clarity" (99%) domains obtained the highest scores. The items related to "Stakeholder involvement," "Editorial independence," and "Clinical applicability" (AGREE REX) were fairly reported. Conversely, CPG lacks rigor in development (32% score, AGREE II), scarcely discusses the role of stakeholders, and provides deficient data on the implementation of recommendations (scores of 35% and 46% in AGREE II and AGREE REX, respectively). No differences in the quality of guidelines published by different developers or countries were observed (p > 0.05). CONCLUSION Methodological weaknesses are common among guidelines addressing PAH treatment, especially regarding scientific rigor, stakeholders' values and preferences, and facilitators and barriers to implementability. Particular attention should be given to developing future guidelines.
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Affiliation(s)
| | - Flávia Deffert
- Pharmaceutical Sciences Postgraduate Program, Universidade Federal Do Paraná, Curitiba, Brazil
| | | | | | - Felipe Fernando Mainka
- Pharmaceutical Sciences Postgraduate Program, Federal University of Paraná, Curitiba, Brazil
| | - Fernanda S Tonin
- Pharmaceutical Sciences Postgraduate Program, Federal University of Paraná, Curitiba, Brazil.
- H&TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Av. Dom João II Lote 4.69 01, 1990-096, Lisbon, Portugal.
| | - Roberto Pontarolo
- Department of Pharmacy, Federal University of Paraná, Curitiba, Brazil
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Deffert F, Vilela APO, Cobre ADF, Furlan LHP, Tonin FS, Fernandez-Lllimos F, Pontarolo R. Methodological quality and clinical recommendations of guidelines on the management of dyslipidaemias for cardiovascular disease risk reduction: a systematic review and an appraisal through AGREE II and AGREE REX tools. Fam Pract 2024:cmae029. [PMID: 38831566 DOI: 10.1093/fampra/cmae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Clinical practice guidelines (CPGs) are statements to assist practitioners and stakeholders in decisions about healthcare. Low methodological quality guidelines may prejudice decision-making and negatively affect clinical outcomes in non-communicable diseases, such as cardiovascular diseases worsted by poor lipid management. We appraised the quality of CPGs on dyslipidemia management and synthesized the most updated pharmacological recommendations. METHODS A systematic review following international recommendations was performed. Searches to retrieve CPG on pharmacological treatments in adults with dyslipidaemia were conducted in PubMed, Scopus, and Trip databases. Eligible articles were assessed using AGREE II (methodological quality) and AGREE-REX (recommendation excellence) tools. Descriptive statistics were used to summarize data. The most updated guidelines (published after 2019) had their recommendations qualitatively synthesized in an exploratory analysis. RESULTS Overall, 66 guidelines authored by professional societies (75%) and targeting clinicians as primary users were selected. The AGREE II domains Scope and Purpose (89%) and Clarity of Presentation (97%), and the AGREE-REX item Clinical Applicability (77.0%) obtained the highest values. Conversely, guidelines were methodologically poorly performed/documented (46%) and scarcely provided data on the implementability of practical recommendations (38%). Recommendations on pharmacological treatments are overall similar, with slight differences concerning the use of supplements and the availability of drugs. CONCLUSION High-quality dyslipidaemia CPG, especially outside North America and Europe, and strictly addressing evidence synthesis, appraisal, and recommendations are needed, especially to guide primary care decisions. CPG developers should consider stakeholders' values and preferences and adapt existing statements to individual populations and healthcare systems to ensure successful implementation interventions.
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Affiliation(s)
- Flávia Deffert
- Pharmaceutical Sciences Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
| | - Ana Paula Oliveira Vilela
- Pharmaceutical Assistance Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
| | - Alexandre de Fátima Cobre
- Pharmaceutical Sciences Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
| | | | - Fernanda Stumpf Tonin
- Pharmaceutical Sciences Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
- Pharmaceutical Assistance Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Avenida D. João II, Lote 4.69.01, Parque das Nações, Lisboa 1990-096, Portugal
| | - Fernando Fernandez-Lllimos
- Applied Molecular Biosciences Unit (UCIBIO), Institute for Health and Bioeconomy (i4HB), Laboratory of Pharmacology Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto 4050-313, Portugal
| | - Roberto Pontarolo
- Pharmaceutical Sciences Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
- Pharmaceutical Assistance Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
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Cortés-Jofré M, Madera M, Tirado-Amador L, Asenjo-Lobos C, Bonfill-Cosp X. Treatments for non-small cell lung cancer: a systematic quality assessment of clinical practice guidelines. Clin Transl Oncol 2023; 25:3541-3555. [PMID: 37254015 DOI: 10.1007/s12094-023-03223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/19/2023] [Indexed: 06/01/2023]
Abstract
AIM To evaluate the methodological quality of clinical practice guidelines (CPGs) on treatments for non-small cell lung cancer (NSCLC). METHODS We searched MEDLINE, CPG developer websites, lung cancer societies, and oncology organizations to identify CPGs providing recommendations on treatments for NSCLC. The methodological quality for each CPG was determined independently by three appraisers using the AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument. RESULTS Twenty-two CPGs met the eligibility criteria. The median scores per AGREE II domain were: scope and purpose 90.7% (64.8-100%), stakeholder involvement 76.9% (27.8-96.3%); rigor of development 80.9% (27.1-92.4%); clarity of presentation 89.8% (50-100%); applicability 46.5% (12.5-87.5%); and editorial independence 91.7% (27.8-100%). Most of the CPGs (54.5%) were rated as "recommended with modifications" for clinical use. CONCLUSIONS Overall, the methodological quality of CPGs proving recommendations on the management of NSCLC is moderate, but there is still room for improvement in their development and implementation.
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Affiliation(s)
- Marcela Cortés-Jofré
- Doctoral Program in Research Methodology and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain
- Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Meisser Madera
- Faculty of Dentistry, Department of Research, Universidad de Cartagena, Cartagena, Colombia.
| | - Lesbia Tirado-Amador
- Programa de Odontología, Grupo GINOUS, Universidad del Sinú, Cartagena, Colombia
| | - Claudia Asenjo-Lobos
- Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana, Universidad de Desarrollo, Santiago, Chile
| | - Xavier Bonfill-Cosp
- Iberoamerican Cochrane Center, Institute of Biomedical Research Sant Pau (IIB Sant Pau), Barcelona, Spain
- Public Health and Clinical Epidemiology Service, Hospital de la Santa Creu i Sant Pau, CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Li X, Xing X, Yao N. Critical quality appraisal and algorithm development of clinical practice guidelines for management of poststroke sensory loss: a systematic review. BMJ Open 2023; 13:e074082. [PMID: 37977862 PMCID: PMC10660658 DOI: 10.1136/bmjopen-2023-074082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES This study aimed to assess the methodological quality of clinical practice guidelines (CPGs) associated with the management of poststroke sensory loss and develop an algorithm for health professionals. METHODS We conducted a systematic review for relevant CPGs published between 2017 and 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Checklist. Appraisal of Guidelines for Research and Evaluation II instrument was used to assess methodological quality. Recommendations for managing poststroke sensory loss from high and average-quality CPGs were summarised and developed into an algorithm. RESULTS First, 1458 records were identified from the database searches and other sources. Finally, four CPGs were included: three were rated as high quality and one as average quality. Twenty-two recommendations were summarised from these CPGs and used to develop a draft algorithm. Then, we revised the draft algorithm developed by the authors based on expert feedback to form the final version. CONCLUSIONS The four CPGs included in this study had good quality. Based on these CPGs, we developed an algorithm to facilitate health professionals' adherence to CPGs and contribute to evidence-based medicine. In the future, more high-quality CPGs are required to give further scientific and convincing evidence to manage poststroke sensory loss.
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Affiliation(s)
- Xiao Li
- Intensive Care Unit, Nanjing Drum Tower Hospital, Nanjing, China
| | - Xingmin Xing
- Intensive Care Unit, Nanjing Drum Tower Hospital, Nanjing, China
| | - Nannan Yao
- Operating Theatre, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
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Sundström Rehal M, Tatucu-Babet OA, Oosterveld T. Indirect calorimetry: should it be part of routine care or only used in specific situations? Curr Opin Clin Nutr Metab Care 2023; 26:154-159. [PMID: 36729867 PMCID: PMC9894138 DOI: 10.1097/mco.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Indirect calorimetry (IC) is increasingly recommended to guide energy delivery in the ICU. This review aims to provide a critical overview of current literature in support of these recommendations. RECENT FINDINGS There is insufficient evidence to ascertain a mortality benefit from IC-guided energy delivery. However, large variations in energy expenditure during critical illness pose a risk for significant under- and overfeeding if IC is not routinely used. SUMMARY Even in the absence of demonstrable clinical benefits, there is a strong physiological rationale in favor of performing IC. Measurements can be prioritized in complex patients and should be repeated during prolonged ICU stay.
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Affiliation(s)
- Martin Sundström Rehal
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Oana A. Tatucu-Babet
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Timo Oosterveld
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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De Vito M, Alameddine S, Capannolo G, Mappa I, Gualtieri P, Di Renzo L, De Lorenzo A, D’ Antonio F, Rizzo G. Systematic Review and Critical Evaluation of Quality of Clinical Practice Guidelines on Nutrition in Pregnancy. Healthcare (Basel) 2022; 10:healthcare10122490. [PMID: 36554014 PMCID: PMC9778102 DOI: 10.3390/healthcare10122490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/20/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Objective: To report the quality and clinical heterogeneity of the published clinical practice guidelines (CPGs) on nutrition in pregnancy. Methods: MEDLINE, Embase, Scopus, and ISI Web of Science databases were searched. The following aspects related to nutrition in pregnancy were addressed: specific requirements during pregnancy, description of a balanced diet, weight gain, prevention of food-borne, nutrition in peculiar sub-groups of women, and maternal or perinatal outcomes. The assessment of the risk of bias and quality assessment of the included CPGs were performed using “The Appraisal of Guidelines for REsearch and Evaluation (AGREE II)” tool divided in six quality domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, editorial independence. Mean ± standard deviation (SD) was used to summarize the scores across all the guidelines per domain. The quality of each guideline was computed using the scoring system proposed by Amer et al. A cut-off of >60% was sued to define a CGP as recommended. Results: Eighteen CPGs were included. There was a substantial heterogeneity in the recommended dose for vitamins, folic acid, and micronutrient intake during pregnancy among the different published CPGs. 27.8% (5/18) of the CPGs recommended a daily intake of folic acid of 200 mcg, 38.8% (7/18) 400 mcg, 16.7% (3/18) 600 mcg while the remaining CPGs suggested dose between 400 and 600−800 mc per day. Adequate maternal hydration was advocated in the large majority of included CPGs, but a specific amount of water intake was not reported in 83.3% (15/18) cases. There was also significant heterogeneity in various other aspects of nutrition recommendation among the different CPGs, including gestational weight gain (55.5%), prevention of food-borne diseases in pregnancy (72.2%), nutrition in particular groups of pregnant women (83.3%), maternal and perinatal outcomes (72.2%). The AGREE II standardized domain scores for the first overall assessment (OA1) had a mean of 65% but only half scored more than 60%. Conclusion: The published CPGs on nutrition in pregnancy show an overall good methodology, but also a substantial heterogeneity as regard as different major aspects on nutrition in pregnancy.
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Affiliation(s)
- Marika De Vito
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, 00185 Roma, Italy
| | - Sara Alameddine
- Department of Obstetrics and Gynecology, Università di Chieti, 66100 Chieti, Italy
| | - Giulia Capannolo
- Department of Obstetrics and Gynecology, Università di Chieti, 66100 Chieti, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, 00185 Roma, Italy
| | - Paola Gualtieri
- Department of Biomedicine and Prevention, Università di Roma Tor Vergata Section of Clinical Nutrition and Nutrigenomic, 00185 Roma, Italy
| | - Laura Di Renzo
- Department of Biomedicine and Prevention, Università di Roma Tor Vergata Section of Clinical Nutrition and Nutrigenomic, 00185 Roma, Italy
| | - Antonino De Lorenzo
- Department of Biomedicine and Prevention, Università di Roma Tor Vergata Section of Clinical Nutrition and Nutrigenomic, 00185 Roma, Italy
| | - Francesco D’ Antonio
- Department of Obstetrics and Gynecology, Università di Chieti, 66100 Chieti, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, 00185 Roma, Italy
- Correspondence:
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