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Mokhtar G, Abdelbaky A, Adly A, Ezzat D, Abdel Hakeem G, Hassab H, Youssry I, Ragab I, Sherief LM, Zakaria M, Hesham M, Salama N, Salah N, Afifi RAA, El-Ashry R, Makkeyah S, Adolf S, Amer YS, Omar TEI, Bussel J, Abd El Raouf E, Atfy M, Ellaboudy M, Florez I. Egyptian Pediatric Guidelines for the Management of Children with Isolated Thrombocytopenia Using the Adapted ADAPTE Methodology-A Limited-Resource Country Perspective. Children (Basel) 2024; 11:452. [PMID: 38671669 PMCID: PMC11048986 DOI: 10.3390/children11040452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Thrombocytopenia is a prevalent presentation in childhood with a broad spectrum of etiologies, associated findings, and clinical outcomes. Establishing the cause of thrombocytopenia and its proper management have obvious clinical repercussions but may be challenging. This article provides an adaptation of the high-quality Clinical Practice Guidelines (CPGs) of pediatric thrombocytopenia management to suit Egypt's health care context. METHODS The Adapted ADAPTE methodology was used to identify the high-quality CPGs published between 2010 and 2020. An expert panel screened, assessed and reviewed the CPGs and formulated the adapted consensus recommendations based on the best available evidence. DISCUSSION The final CPG document provides consensus recommendations and implementation tools on the management of isolated thrombocytopenia in children and adolescents in Egypt. There is a scarcity of evidence to support recommendations for various management protocols. In general, complete clinical assessment, full blood count, and expert analysis of the peripheral blood smear are indicated at initial diagnosis to confirm a bleeding disorder, exclude secondary causes of thrombocytopenia and choose the type of work up required. The International Society of Hemostasis and thrombosis-Bleeding assessment tool (ISTH-SCC BAT) could be used for initial screening of bleeding manifestations. The diagnosis of immune thrombocytopenic purpura (ITP) is based principally on the exclusion of other causes of isolated thrombocytopenia. Future research should report the outcome of this adapted guideline and include cost-analysis evaluations.
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Affiliation(s)
- Galila Mokhtar
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Ashraf Abdelbaky
- Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt;
| | - Amira Adly
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Dina Ezzat
- Pediatric Hematology Unit, Pediatric Department, Beni-Suef University, Beni-Suef 62521, Egypt;
- Pediatric Department, October 6 University, Giza 12585, Egypt
| | - Gehan Abdel Hakeem
- Pediatric Hematology and Oncology Unit, Pediatric Department, Minia University, Minia 61519, Egypt;
| | - Hoda Hassab
- Pediatric Hematology and Oncology Unit, Pediatric Department, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt;
| | - Ilham Youssry
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt; (I.Y.); (N.S.); (R.A.A.A.); (E.A.E.R.)
| | - Iman Ragab
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Laila M. Sherief
- Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt; (L.M.S.); (M.Z.); (M.H.); (M.A.)
| | - Marwa Zakaria
- Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt; (L.M.S.); (M.Z.); (M.H.); (M.A.)
| | - Mervat Hesham
- Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt; (L.M.S.); (M.Z.); (M.H.); (M.A.)
| | - Niveen Salama
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt; (I.Y.); (N.S.); (R.A.A.A.); (E.A.E.R.)
| | - Nouran Salah
- Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt;
| | - Rasha A. A. Afifi
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt; (I.Y.); (N.S.); (R.A.A.A.); (E.A.E.R.)
| | - Rasha El-Ashry
- Pediatric Hematology and Oncology Unit, Pediatric Department, Mansoura University, Mansoura 35516, Egypt;
| | - Sara Makkeyah
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Sonia Adolf
- Pediatric, Hematology Department, Institute of Medical Research and Clinical Studies, National Research Center, Giza 1770, Egypt;
| | - Yasser S. Amer
- Pediatrics Department, Quality Management Department, King Saud University Medical City, Riyadh 11451, Saudi Arabia;
- Research Chair for Evidence Based Health Care and Knowledge Translation, King Saud University, Riyadh 11451, Saudi Arabia
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (FMRP-USP), Ribeirao Preto 14040-900, SP, Brazil
| | - Tarek E. I. Omar
- Pediatrics Department, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt;
| | - James Bussel
- Pediatrics Department, Well Cornell Medical College, New York, NY 10065, USA;
| | - Eman Abd El Raouf
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt; (I.Y.); (N.S.); (R.A.A.A.); (E.A.E.R.)
| | - Mervat Atfy
- Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt; (L.M.S.); (M.Z.); (M.H.); (M.A.)
| | - Mohamed Ellaboudy
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Ivan Florez
- Department of Pediatrics, University of Antioquia, Medellin 050010, Colombia;
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Anwar SAM, Elsakka EE, Khalil M, Ibrahim AAG, ElBeheiry A, Mohammed SF, Omar TEI, Amer YS. Corrigendum to "Adapted Evidence-Based Clinical Practice Guidelines for Diagnosis and Treatment of Epilepsies in Children: A Tertiary Children's Hospital Update" Pediatric Neurology 141C (2023) (87-92). Pediatr Neurol 2024:S0887-8994(24)00041-9. [PMID: 38388333 DOI: 10.1016/j.pediatrneurol.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
- Shimaa A M Anwar
- Paediatric Neurology Unit, Faculty of Medicine, Paediatrics Department, Alexandria University, Alexandria, Egypt
| | - Elham E Elsakka
- Paediatric Neurology Unit, Faculty of Medicine, Paediatrics Department, Alexandria University, Alexandria, Egypt
| | - Mona Khalil
- Paediatric Neurology Unit, Faculty of Medicine, Paediatrics Department, Alexandria University, Alexandria, Egypt
| | - Afaf A G Ibrahim
- Faculty of Medicine, Community Medicine Department, Alexandria University, Alexandria, Egypt
| | - Ahmed ElBeheiry
- Faculty of Medicine, Diagnostic Radiology and Medical Imaging Department, Alexandria University, Alexandria, Egypt
| | | | - Tarek E I Omar
- Paediatric Neurology Unit, Faculty of Medicine, Paediatrics Department, Alexandria University, Alexandria, Egypt.
| | - Yasser S Amer
- Paediatrics Department, Quality Management, King Saud University Medical City, Riyadh, Saudi Arabia; Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt; Adaptation Working Group, Guidelines International Network, Perth, Scotland, UK.
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Wahabi H, Elmorshedy H, Amer YS, Saeed E, Razak A, Hamama IA, Hadid A, Ahmed S, Aleban SA, Aldawish RA, Alyahiwi LS, Alnafisah HA, AlSubki RE, Albahli NK, Almutairi AA, Alsanad LF, Fayed A. Neonatal Birthweight Spectrum: Maternal Risk Factors and Pregnancy Outcomes in Saudi Arabia. Medicina (Kaunas) 2024; 60:193. [PMID: 38399481 PMCID: PMC10890056 DOI: 10.3390/medicina60020193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/29/2023] [Accepted: 01/15/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Low-birth-weight (LBW) neonates are at increased risk of morbidity and mortality which are inversely proportional to birth weight, while macrosomic babies are at risk of birth injuries and other related complications. Many maternal risk factors were associated with the extremes of birthweight. The objectives of this study are to investigate maternal risk factors for low and high birthweight and to report on the neonatal complications associated with abnormal birth weights. Materials and Methods: We conducted a retrospective analysis of medical records of deliveries ≥ 23 weeks. We classified the included participants according to birth weight into normal birth weight (NBW), LBW, very LBW (VLBW), and macrosomia. The following maternal risk factors were included, mother's age, parity, maternal body mass index (BMI), maternal diabetes, and hypertension. The neonatal outcomes were APGAR scores < 7, admission to neonatal intensive care unit (NICU), respiratory distress (RD), and hyperbilirubinemia. Data were analyzed using SAS Studio, multivariable logistic regression analyses were used to investigate the independent effect of maternal risk factors on birthweight categories and results were reported as an adjusted odds ratio (aOR) and 95% Confidence Interval (CI). Results: A total of 1855 were included in the study. There were 1638 neonates (88.3%) with NBW, 153 (8.2%) with LBW, 27 (1.5%) with VLBW, and 37 (2.0%) with macrosomia. LBW was associated with maternal hypertension (aOR = 3.5, 95% CI = 1.62-7.63), while increasing gestational age was less likely associated with LBW (aOR = 0.51, 95% CI = 0.46-0.57). Macrosomia was associated with maternal diabetes (aOR = 3.75, 95% CI = 1.67-8.41), in addition to maternal obesity (aOR = 3.18, 95% CI = 1.24-8.14). The odds of VLBW were reduced significantly with increasing gestational age (aOR = 0.41, 95% CI = 0.32-0.53). In total, 81.5% of VLBW neonates were admitted to the NICU, compared to 47.7% of LBW and 21.6% of those with macrosomia. RD was diagnosed in 59.3% of VLBW neonates, in 23% of LBW, in 2.7% of macrosomic and in 3% of normal-weight neonates. Hyperbilirubinemia was reported in 37.04%, 34.21%, 22.26%, and 18.92% of VLBW, LBW, NBW, and macrosomic newborns, respectively. Conclusions: Most neonates in this study had normal birthweights. Maternal hypertension and lower gestational age were associated with increased risk of LBW. Additionally, maternal obesity and diabetes increased the risk of macrosomia. Neonatal complications were predominantly concentrated in the LBW and VLBW, with a rising gradient as birthweight decreased. The main complications included respiratory distress and NICU admissions.
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Affiliation(s)
- Hayfaa Wahabi
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh 11451, Saudi Arabia; (H.W.); (Y.S.A.); (S.A.)
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Hala Elmorshedy
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria 5424041, Egypt;
| | - Yasser S. Amer
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh 11451, Saudi Arabia; (H.W.); (Y.S.A.); (S.A.)
- Clinical Practice Guidelines and Quality Research Unit, Corporate Quality Management Department, King Saud University Medical City, Riyadh 11451, Saudi Arabia
| | - Elshazaly Saeed
- Prince Abdulla Bin Khaled Coeliac Disease Research Chair, Department of Pediatrics, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Abdul Razak
- Neonatal Intensive Care Unit, Department of Pediatrics, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (A.R.); (I.A.H.)
| | - Ibrahim Abdelaziz Hamama
- Neonatal Intensive Care Unit, Department of Pediatrics, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (A.R.); (I.A.H.)
| | - Adnan Hadid
- Neonatal Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, Riyadh 11451, Saudi Arabia;
| | - Samia Ahmed
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh 11451, Saudi Arabia; (H.W.); (Y.S.A.); (S.A.)
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Sarah A. Aleban
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (S.A.A.); (R.A.A.); (L.S.A.); (H.A.A.); (R.E.A.); (N.K.A.); (A.A.A.)
| | - Reema Abdullah Aldawish
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (S.A.A.); (R.A.A.); (L.S.A.); (H.A.A.); (R.E.A.); (N.K.A.); (A.A.A.)
| | - Lara Sabri Alyahiwi
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (S.A.A.); (R.A.A.); (L.S.A.); (H.A.A.); (R.E.A.); (N.K.A.); (A.A.A.)
| | - Haya Abdullah Alnafisah
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (S.A.A.); (R.A.A.); (L.S.A.); (H.A.A.); (R.E.A.); (N.K.A.); (A.A.A.)
| | - Raghad E. AlSubki
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (S.A.A.); (R.A.A.); (L.S.A.); (H.A.A.); (R.E.A.); (N.K.A.); (A.A.A.)
| | - Norah Khalid Albahli
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (S.A.A.); (R.A.A.); (L.S.A.); (H.A.A.); (R.E.A.); (N.K.A.); (A.A.A.)
| | - Aljohara Ayed Almutairi
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (S.A.A.); (R.A.A.); (L.S.A.); (H.A.A.); (R.E.A.); (N.K.A.); (A.A.A.)
| | | | - Amel Fayed
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; (S.A.A.); (R.A.A.); (L.S.A.); (H.A.A.); (R.E.A.); (N.K.A.); (A.A.A.)
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Ibrahim Arif S, Amer YS, Adnan Alkamal T, Abdulrahman Binsaeed M, Ibrahim Arif B, Dhaifallah Albaqami M, Bakri Alfahed O. Patient response to the management during the acute presentation of cough variant Asthma: Retrospective cohort study. Saudi J Biol Sci 2023; 30:103875. [PMID: 38058763 PMCID: PMC10696240 DOI: 10.1016/j.sjbs.2023.103875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/26/2023] [Accepted: 11/10/2023] [Indexed: 12/08/2023] Open
Abstract
The clinical improvement after assessing patients with cough variant asthma in outpatient clinics, and therapy success varied depending on the subjective improvement. Cough could be controlled within appropriate time and subsequent management can consist of inhaled corticosteroids. In this study we used the cough improvement, the only available clinical response, as a predictable factor to determine the effect of different modalities of treatment among patients with cough variant asthma. Retrospective observational analysis was performed in Saudi Arabia's King Saud University Medical City, on the presentation, diagnosis, course of therapy, and responsiveness to oral and inhaled steroids in patients with cough variant asthma. All patients who visited the clinic on multiple occasions with persistent, acute coughing without being pre-screened between September 2021 and September 2022 included based on medical records. Cough resembles cough variant asthma is the term used to describe a cough without a diagnosed etiology. To identify patients eligible for CVA treatment, iindividuals having GERD-associated cough, allergic rhinitis, bronchial asthma, smokers and atopic cough was excluded. For the examination of these findings, IBM SPSS version 28 (Armonk, NY, USA) was employed. As a result of using budesonide-formoterol inhaler, most patients (86.3 %) showed improvement in their cough symptoms (with 95 %CI: 78.3 to 94.9). There was a significant yet weak positive correlation between the frequency of cough symptoms before and after using budesonide-formoterol (r = 0.318, P value < 0.001). The understanding of treatment response and patient selection for budesonide-formoterol inhaler therapy, providing clinicians with valuable information to optimize patient care.
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Affiliation(s)
- Samir Ibrahim Arif
- Family Medicine Center, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yasser S. Amer
- CPG and Quality Research Unit, Quality Management Department, Pediatrics Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | | | - Bandar Ibrahim Arif
- Intern, Clinical Pharmacy, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Meshari Dhaifallah Albaqami
- Nursing Services Department, Occupational Health and Safety Clinic King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ousama Bakri Alfahed
- Family Medicine Center, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
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Meneses-Echavez JF, Bidonde J, Montesinos-Guevara C, Amer YS, Loaiza-Betancur AF, Tellez Tinjaca LA, Fraile Navarro D, Poklepović Peričić T, Tokalić R, Bala MM, Storman D, Swierz M, Zając J, Flórez ID, Schünemann H, Flottorp S, Alonso-Coello P. Using evidence to decision frameworks led to guidelines of better quality and more credible and transparent recommendations. J Clin Epidemiol 2023; 162:38-46. [PMID: 37517506 DOI: 10.1016/j.jclinepi.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/30/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND AND OBJECTIVES To determine whether the use of Evidence to Decision (EtD) frameworks is associated to higher quality of both guidelines and individual recommendations. METHODS We identified guidelines recently published by international organizations that have methodological guidance documents for their development. Pairs of researchers independently extracted information on the use of these frameworks, appraised the quality of the guidelines using the Appraisal of Guidelines, Research and Evaluation II Instrument (AGREE-II), and assessed the clinical credibility and implementability of the recommendations with the Appraisal of Guidelines for REsearch & Evaluation Recommendations Excellence (AGREE-REX) tool. We conducted both descriptive and inferential analyses. RESULTS We included 66 guidelines from 17 different countries, published in the last 5 years. Thirty guidelines (45%) used an EtD framework to formulate their recommendations. Compared to those that did not use a framework, those using an EtD framework scored higher in all domains of both AGREE-II and AGREE-REX (P < 0.05). Quality scores did not differ between the use of the The Grading of Recommendations Assessment, Development and Evaluation-EtD framework (17 guidelines) or another EtD framework (13 guidelines) (P > 0.05). CONCLUSION The use of EtD frameworks is associated with guidelines of better quality, and more credible and transparent recommendations. Endorsement of EtD frameworks by guideline developing organizations will likely increase the quality of their guidelines.
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Affiliation(s)
- Jose F Meneses-Echavez
- Norwegian Institute of Public Health, Oslo, Norway; Facultad de Cultura Física, Deporte y Recreación, Universidad Santo Tomás, Bogotá, Colombia.
| | - Julia Bidonde
- Norwegian Institute of Public Health, Oslo, Norway; School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Camila Montesinos-Guevara
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Yasser S Amer
- Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, Pediatrics Department, King Saud University Medical City, Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
| | - Andres Felipe Loaiza-Betancur
- Instituto Universitario de Educación Física, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Entrenamiento Deportivo y Actividad Física para la Salud (GIEDAF), Universidad Santo Tomás, Tunja, Colombia
| | - Luis Andres Tellez Tinjaca
- Grupo de Investigación en Entrenamiento Deportivo y Actividad Física para la Salud (GIEDAF), Universidad Santo Tomás, Tunja, Colombia
| | - David Fraile Navarro
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tina Poklepović Peričić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Ružica Tokalić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Systematic Reviews Unit, Department of Adult Psychiatry, University Hospital Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Zając
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Ivan D Flórez
- Department of Pediatrics, University of Antioquia, Calle 67 No. 53-108, Medellin, Colombia; School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Pediatric Intensive Care Unit, Clínica Las Américas-AUNA, Medellín, Colombia
| | - Holger Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Signe Flottorp
- Norwegian Institute of Public Health, Oslo, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway
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Wahabi H, Fayed A, Elmorshedy H, Esmaeil SA, Amer YS, Saeed E, Jamal A, Aleban SA, Aldawish RA, Alyahiwi LS, Abdullah Alnafisah H, AlSubki RE, Albahli NK, Almutairi AA. Prediction of Emergency Cesarean Section Using Detectable Maternal and Fetal Characteristics Among Saudi Women. Int J Womens Health 2023; 15:1283-1293. [PMID: 37576185 PMCID: PMC10422959 DOI: 10.2147/ijwh.s414380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Background The worldwide rate of cesarean section (CS) is increasing. Development of prediction models for a specific population may improve the unmet need for CS as well as reduce the overuse of CS. Objective To explore risk factors associated with emergency CS, and to determine the accuracy of predicting it. Methods A retrospective analysis of the medical records of women who delivered between January 1, 2021-December 2022 was conducted, relevant maternal and neonatal data were retrieved. Results Out of 1793 deliveries, 447 (25.0%) had emergency CS. Compared to control, the risk of emergency CS was higher in primiparous women (OR 2.13, 95% CI 1.48 to 3.06), in women with higher Body mass index (BMI) (OR 1.77, 95% CI 1.27 to 2.47), in association with history of previous CS (OR 4.81, 95% CI 3.24 to 7.15) and in women with abnormal amniotic fluid (OR 2.30, 95% CI 1.55 to 3.41). Additionally, women with hypertensive disorders had a 176% increased risk of emergency CS (OR 2.76, 95% CI 1.35-5.63). Of note, the risk of emergency CS was more than three times higher in women who delivered a small for gestational age infant (OR 3.29, 95% CI 1.93-5.59). Based on the number of risk factors, a prediction model was developed, about 80% of pregnant women in the emergency CS group scored higher grades compared to control group. The area under the curve was 0.72, indicating a good discriminant ability of the model. Conclusion This study identified several risk factors associated with emergency CS in pregnant Saudi women. A prediction model showed 72% accuracy in predicting the likelihood of emergency CS. This information can be useful to individualize the risk of emergency CS, and to implement appropriate measures to prevent unnecessary CS.
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Affiliation(s)
- Hayfaa Wahabi
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University Medical City and College of Medicine, Riyadh, Saudi Arabia
| | - Amel Fayed
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hala Elmorshedy
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Samia Ahmad Esmaeil
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University Medical City and College of Medicine, Riyadh, Saudi Arabia
| | - Yasser S Amer
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Clinical Practice Guidelines Unit, Quality Management Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Elshazaly Saeed
- Prince Abdulla bin Khaled Coeliac Disease Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Amr Jamal
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University Medical City and College of Medicine, Riyadh, Saudi Arabia
| | - Sarah A Aleban
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Reema Abdullah Aldawish
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Lara Sabri Alyahiwi
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Haya Abdullah Alnafisah
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Raghad E AlSubki
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Norah khalid Albahli
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Aljohara Ayed Almutairi
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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Christensen RE, Yi MD, Kang BY, Ibrahim SA, Anvery N, Dirr M, Adams S, Amer YS, Bisdorff A, Bradfield L, Brown S, Earley A, Fatheree LA, Fayoux P, Getchius T, Ginex P, Graham A, Green CR, Gresele P, Hanson H, Haynes N, Hegedüs L, Hussein H, Jakhmola P, Kantorova L, Krishnasamy R, Krist A, Landry G, Lease ED, Ley L, Marsden G, Meek T, Meremikwu M, Moga C, Mokrane S, Mujoomdar A, Newton S, O'Flynn N, Perkins GD, Smith EJ, Prematunge C, Rychert J, Saraco M, Schünemann HJ, Senerth E, Sinclair A, Shwayder J, Stec C, Tanni S, Taske N, Temple-Smolkin RL, Thomas L, Thomas S, Tonnessen B, Turner AS, Van Dam A, van Doormaal M, Wan YL, Ventura CB, McFarlane E, Morgan RL, Ogunremi T, Alam M. Development of an international glossary for clinical guidelines collaboration. J Clin Epidemiol 2023; 158:84-91. [PMID: 37019344 DOI: 10.1016/j.jclinepi.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES Clinical practice guidelines (CPGs) are often created through collaboration among organizations. The use of inconsistent terminology may cause poor communication and delays. This study aimed to develop a glossary of terms related to collaboration in guideline development. STUDY DESIGN AND SETTING A literature review of collaborative guidelines was performed to develop an initial list of terms related to guideline collaboration. The list of terms was presented to the members of the Guideline International Network Guidelines Collaboration Working Group, who provided presumptive definitions for each term and proposed additional terms to be included. The revised list was subsequently reviewed by an international, multidisciplinary panel of expert stakeholders. Recommendations received during this pre-Delphi review were implemented to augment an initial draft glossary. The glossary was then critically evaluated and refined through two rounds of Delphi surveys and a virtual consensus meeting with all panel members as Delphi participants. RESULTS Forty-nine experts participated in the pre-Delphi survey, and 44 participated in the two-round Delphi process. Consensus was reached for 37 terms and definitions. CONCLUSION Uptake and utilization of this guideline collaboration glossary by key organizations and stakeholder groups may facilitate collaboration among guideline-producing organizations by improving communication, minimizing conflicts, and increasing guideline development efficiency.
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Affiliation(s)
- Rachel E Christensen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland
| | - Michael D Yi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland
| | - Bianca Y Kang
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah A Ibrahim
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Noor Anvery
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - McKenzie Dirr
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephanie Adams
- Clinical Practice Guidelines, American Association of Clinical Endocrinology, Jacksonville, FL, USA
| | - Yasser S Amer
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Pediatrics Department and Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia; Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | - Amy Earley
- Kidney Disease Improving Global Outcomes (KDIGO), Brussels, Belgium
| | - Lisa A Fatheree
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; American College of Rheumatology, OH, USA
| | - Pierre Fayoux
- Department of Pediatric Otolaryngology-Head Neck Surgery, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Thomas Getchius
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; American Heart Association/American College of Cardiology, Dallas, Texas, USA
| | - Pamela Ginex
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Stony Brook University School of Nursing, Stony Brook, NY, USA
| | - Amanda Graham
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Courtney R Green
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, Canada
| | - Paolo Gresele
- Department of Medicine and Surgery - Head section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Helen Hanson
- St. George's University Hospitals National Health Service Foundation Trust, London, UK
| | | | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Heba Hussein
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Oral Medicine, Oral Diagnosis, and Periodontology Department, Cairo University, Cairo, Egypt
| | - Priya Jakhmola
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lucia Kantorova
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, Masaryk University, Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Rathika Krishnasamy
- Department of Nephrology, Sunshine Coast University Hospital, Australia; The University of Queensland, Australia
| | - Alex Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, VA, USA
| | - Gregory Landry
- Division of Vascular Surgery, Kootenai Clinic, Coeur d'Alene, ID, USA
| | | | - Luis Ley
- Department of Neurosurgery, Hospital Ramón y Cajal, Madrid, Spain
| | - Gemma Marsden
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Healthcare Infection Society, London UK
| | - Tim Meek
- Association of Anaesthetists, London, UK
| | - Martin Meremikwu
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Department of Pediatrics, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Carmen Moga
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Saphia Mokrane
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; WOREL (Werkgroep Ontwikkeling Richtlijnen Eerste Lijn) - Working Group Development of Primary Care Guidelines, Belgium; Department of Primary Care, Université Libre de Bruxelles, Brussels, Belgium; Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Amol Mujoomdar
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, Western University, London, ON, Canada
| | - Skye Newton
- Adelaide Health Technology Assessment, University of Adelaide, Australia
| | | | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Emma-Jane Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Chatura Prematunge
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jenna Rychert
- Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT
| | | | - Holger J Schünemann
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Emily Senerth
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Cardiovascular Angiography & Interventions, Washington, DC, USA
| | | | - James Shwayder
- Department of Pulmonology, Botucatu Medical School-UNESP, São Paulo, Brazil
| | - Carla Stec
- Clinical Practice Guidelines, American Association of Clinical Endocrinology, Jacksonville, FL, USA
| | | | - Nichole Taske
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Association for Molecular Pathology, MD, USA
| | - Robyn L Temple-Smolkin
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Association for Molecular Pathology, MD, USA
| | - Louise Thomas
- Head of Quality Improvement, Royal College of Obstetricians and Gynaecologists, London, UK
| | | | - Britt Tonnessen
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Amy S Turner
- American College of Rheumatology, OH, USA; American College of Rheumatology, Atlanta, GA, USA
| | - Anne Van Dam
- Canadian Thoracic Society, Ottawa, Ontario, Canada
| | | | - Yung Liang Wan
- Dept. of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Christina B Ventura
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; College of American Pathologists, Northfield, IL, USA
| | - Emma McFarlane
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; National Institute for Health and Care Excellence, Manchester, UK
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Toju Ogunremi
- Healthcare Associated Infections and Infection Prevention and Control Section, National Advisory Committee on Infection Prevention and Control, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Murad Alam
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Dabbagh R, Jamal A, Bhuiyan Masud JH, Titi MA, Amer YS, Khayat A, Alhazmi TS, Hneiny L, Baothman FA, Alkubeyyer M, Khan SA, Temsah MH. Harnessing Machine Learning in Early COVID-19 Detection and Prognosis: A Comprehensive Systematic Review. Cureus 2023; 15:e38373. [PMID: 37265897 PMCID: PMC10230599 DOI: 10.7759/cureus.38373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/03/2023] Open
Abstract
During the early phase of the COVID-19 pandemic, reverse transcriptase-polymerase chain reaction (RT-PCR) testing faced limitations, prompting the exploration of machine learning (ML) alternatives for diagnosis and prognosis. Providing a comprehensive appraisal of such decision support systems and their use in COVID-19 management can aid the medical community in making informed decisions during the risk assessment of their patients, especially in low-resource settings. Therefore, the objective of this study was to systematically review the studies that predicted the diagnosis of COVID-19 or the severity of the disease using ML. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), we conducted a literature search of MEDLINE (OVID), Scopus, EMBASE, and IEEE Xplore from January 1 to June 31, 2020. The outcomes were COVID-19 diagnosis or prognostic measures such as death, need for mechanical ventilation, admission, and acute respiratory distress syndrome. We included peer-reviewed observational studies, clinical trials, research letters, case series, and reports. We extracted data about the study's country, setting, sample size, data source, dataset, diagnostic or prognostic outcomes, prediction measures, type of ML model, and measures of diagnostic accuracy. Bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO), with the number CRD42020197109. The final records included for data extraction were 66. Forty-three (64%) studies used secondary data. The majority of studies were from Chinese authors (30%). Most of the literature (79%) relied on chest imaging for prediction, while the remainder used various laboratory indicators, including hematological, biochemical, and immunological markers. Thirteen studies explored predicting COVID-19 severity, while the rest predicted diagnosis. Seventy percent of the articles used deep learning models, while 30% used traditional ML algorithms. Most studies reported high sensitivity, specificity, and accuracy for the ML models (exceeding 90%). The overall concern about the risk of bias was "unclear" in 56% of the studies. This was mainly due to concerns about selection bias. ML may help identify COVID-19 patients in the early phase of the pandemic, particularly in the context of chest imaging. Although these studies reflect that these ML models exhibit high accuracy, the novelty of these models and the biases in dataset selection make using them as a replacement for the clinicians' cognitive decision-making questionable. Continued research is needed to enhance the robustness and reliability of ML systems in COVID-19 diagnosis and prognosis.
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Affiliation(s)
- Rufaidah Dabbagh
- Family & Community Medicine Department, College of Medicine, King Saud University, Riyadh, SAU
| | - Amr Jamal
- Family & Community Medicine Department, College of Medicine, King Saud University, Riyadh, SAU
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, SAU
| | | | - Maher A Titi
- Quality Management Department, King Saud University Medical City, Riyadh, SAU
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, SAU
| | - Yasser S Amer
- Pediatrics, Quality Management Department, King Saud University Medical City, Riyadh, SAU
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, SAU
| | - Afnan Khayat
- Health Information Management Department, Prince Sultan Military College of Health Sciences, Al Dhahran, SAU
| | - Taha S Alhazmi
- Family & Community Medicine Department, College of Medicine, King Saud University, Riyadh, SAU
| | - Layal Hneiny
- Medicine, Wegner Health Sciences Library, University of South Dakota, Vermillion, USA
| | - Fatmah A Baothman
- Department of Information Systems, King Abdulaziz University, Jeddah, SAU
| | | | - Samina A Khan
- School of Computer Sciences, Universiti Sains Malaysia, Penang, MYS
| | - Mohamad-Hani Temsah
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University, Riyadh, SAU
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Anwar SAM, Elsakka EE, Khalil M, Ibrahim AAG, ElBeheiry A, Mohammed SF, Omar TEI, Amer YS. Adapted Evidence-Based Clinical Practice Guidelines for Diagnosis and Treatment of Epilepsies in Children: A Tertiary Children's Hospital Update. Pediatr Neurol 2023; 141:87-92. [PMID: 36774685 DOI: 10.1016/j.pediatrneurol.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 12/08/2022] [Accepted: 12/17/2022] [Indexed: 01/09/2023]
Abstract
HYPOTHESIS AND/OR BACKGROUND We recently updated and merged the adapted clinical practice guidelines (CPGs) for the diagnosis and treatment of children with epilepsy of a tertiary-level hospital. Medical knowledge is always evolving. As a result, it is critical to revisit the clinical standards on a frequent basis to ensure that the best services are offered to the target receivers. The purpose of this article was to update and merge the CPGs at Alexandria University Children Hospital (AUCH) for the diagnosis (2014) and treatment (2016) of children with epilepsy to unify and standardize the practice for better care and outcome. METHODS This review and update CPG project was initiated by assembling a Guideline Review Group (GRG). The GRG conducted focus group discussions and decided to search any published updates of the recommendations of the previously identified high-quality and evidence-based CPG developed by the SIGN (Scottish Intercollegiate Guidelines Network) and to merge the two previous local CPGs under one comprehensive CPG for full management of epilepsy in children. The high quality of the selected source CPG from SIGN was based on quality assessment of CPGs undertaken previously using the Appraisal of Guidelines for Research and Evaluation II Instrument. The GRG followed the Checklist for the Reporting of Updated Guidelines (CheckUp), which is the CPG tool recommended by the Enhancing the Quality and Transparency of health Research Network for reporting of updated CPGs in addition to the RIGHT-Ad@pt Checklist for Adapted CPGs. The finalized updated CPG draft was sent to the external reviewer group topic experts. RESULTS The group updated 10 main categories of recommendations from one source CPG (SIGN). The recommendations included (1) epilepsy diagnosis; (2) recognition, identification, and referral; (3) pharmacological treatment of epilepsy and epilepsy syndromes; (4) nonpharmacological treatment of epilepsy and epilepsy syndromes; (5) managing pharmacoresistant epilepsy; (6) management of epilepsy in special groups; (7) medications; (8) children and caregiver education and support; (9) comorbidities and mortality; and (10) transitional care from pediatric to adult care services. CONCLUSIONS The finalized CPG provides evidence-based guidance to health care providers in AUCH for the diagnosis and management of epilepsy in children. The study also established the significance of a collaborative clinical and methodological expert group for the update of CPGs, as well as the usability of the "CheckUp" and "RIGHT-Ad@pt" CPG Tools.
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Affiliation(s)
- Shimaa A M Anwar
- Paediatric Neurology Unit, Faculty of Medicine, Paediatrics Department, Alexandria University, Alexandria, Egypt
| | - Elham E Elsakka
- Paediatric Neurology Unit, Faculty of Medicine, Paediatrics Department, Alexandria University, Alexandria, Egypt
| | - Mona Khalil
- Paediatric Neurology Unit, Faculty of Medicine, Paediatrics Department, Alexandria University, Alexandria, Egypt
| | - Afaf A G Ibrahim
- Faculty of Medicine, Community Medicine Department, Alexandria University, Alexandria, Egypt
| | - Ahmed ElBeheiry
- Faculty of Medicine, Diagnostic Radiology and Medical Imaging Department, Alexandria University, Alexandria, Egypt
| | | | - Tarek E I Omar
- Paediatric Neurology Unit, Faculty of Medicine, Paediatrics Department, Alexandria University, Alexandria, Egypt
| | - Yasser S Amer
- Paediatrics Department, Quality Management, King Saud University Medical City, Riyadh, Saudi Arabia; Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt; Adaptation Working Group, Guidelines International Network, Perth, Scotland, UK.
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10
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Moustafa B, Moselhy S, Rabie M, Hammad A, Youssef D, Shouman M, Makar S, Badr A, Mansour S, Ebrahim D, Nabhan M, Ateia F, Abdel-Nabi H, Hussein A, Salman M, Korkor MS, Elbahkiry EA, Dagher M, Selim A, Amer YS, Omar T, Baky AA, Badr A, Attia F, Bahkiry IE, Youssef D, Shouman M, Amer YS, Sarhan A, Soliman NA, Hakim IE, Zotta F. Egyptian pediatric clinical practice adapted guidelines: evidence-based [2] steroid-resistant nephrotic syndrome (SRNS) 2022. Egypt Pediatric Association Gaz 2023. [DOI: 10.1186/s43054-022-00118-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Abstract
Background
Nephrotic syndrome is one of the most common chronic kidney diseases in children. Steroid sensitive type (SSNS) constitutes about 85–90%, whereas steroid-resistant type (SRNS) only 15–20% (Mickinney et al. Pediatr Nephrol 16:1040-1044, 2001). While MCD is the most common histopathology in SS type, children with SRNS have MCD, mesangial proliferative glomerulonephritis, or focal and segmental glomerulosclerosis (FSGS) (International Study Kidney Disease in children, Kidney Int 20;765-771, 1981). SRNS is defined as those who do not show remission after 6 weeks and standard dose of oral steroids ± 3 IV MPD doses (Trautmann et al. Pediatr Nephrol 35:1529-1561, 2020).
Objectives
These national adapted guidelines aim to frame evidence-based recommendations adopted or adapted from the IPNA 2020, KDIGO 2021, and Japanese 2014 de novo guidelines for diagnosis and management of nephrotic children to be presented in two manuscripts: (1) steroid sensitive (SSNS) and (2) steroid-resistant nephrotic syndrome (SRNS).
Methodology
Formulation of key questions was followed with a review of literature guided by our appraised guidelines using AGREE plus appraisal tool. Virtual monthly meetings all through the year 2021 were activated for reviewing and validation of final adaptation evidence-based draft, considering all comments of external reviewers including KDIGO assigned reviewer.
Discussion
Rationale behind the selection of adopted statements and tailoring of others to suit our local facilities, expertise, and our local disease profile was discussed in the text with reasons.
Conclusion
The provided guidelines aim to optimize patient care and outcome and suggest research areas lacking validated research recommendations.
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Moustafa B, El-Kersh MM, Shalaby S, Salam NA, Moselhy S, Soliman GT, Selim A, Amer YS, Baky AA. Egyptian evidence -based pediatric clinical practice adapted guidelines for management of [1] steroid sensitive nephrotic syndrome (EPG/SSNS 2022). Egypt Pediatric Association Gaz 2023. [PMCID: PMC9968631 DOI: 10.1186/s43054-022-00119-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Background Nephrotic syndrome is one of the most common chronic kidney diseases in children. Steroid sensitive type constitutes about 90% and steroid resistant 10% of total cases. Objectives These national adapted guidelines aim to frame evidence-based recommendations adopted or adapted from IPNA 2020, KDIGO 2021, and Japanese 2014 for diagnosis, evaluation, management and follow-up of nephrotic children for Steroid sensitive nephrotic syndrome (SSNS) as paper one to be followed with SRNS as paper two. Methodology Formulation of key questions was followed with review of literature, guided by our retrieved and appraised guidelines using Agree plus appraisal tool. After virtual monthly meetings through the year 2021, the final draft was validated considering the comments of external local reviewers and KDIGO-assigned reviewers. Discussion Rationale behind the selection of adopted statements and tailoring of others to suit our local facilities’ expertise and disease profile was discussed in the text with reasons. Conclusion The provided guidelines aim to optimize patient care and outcome and suggest research areas lacking validated research recommendations. Supplementary Information The online version contains supplementary material available at 10.1186/s43054-022-00119-w.
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Affiliation(s)
- Bahia Moustafa
- grid.7776.10000 0004 0639 9286Department of Pediatrics, Pediatric Nephrology Division, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud M. El-Kersh
- grid.7155.60000 0001 2260 6941Department of Pediatrics, Pediatric Nephrology Division, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sherin Shalaby
- grid.33003.330000 0000 9889 5690Department of Pediatrics, Pediatric Nephrology Division, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Nancy Abdel Salam
- grid.7155.60000 0001 2260 6941Department of Pediatrics, Pediatric Nephrology Division, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sawsan Moselhy
- grid.7269.a0000 0004 0621 1570Department of Pediatrics, Pediatric Nephrology Division, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Gamal Taha Soliman
- Department of Pediatrics, Faculty of Medicine, Port Saeed University, Port Fuad, Egypt
| | - Abeer Selim
- grid.419725.c0000 0001 2151 8157Department of Pediatrics, Medical Research and Clinical Studies Institute, National Research Centre, Cairo, Egypt
| | - Yasser S Amer
- grid.7155.60000 0001 2260 6941Alexandria Center for Evidence-Based Clinical Practice Guidelines, Faculty of Medicine, Alexandria University, Alexandria, Egypt ,grid.56302.320000 0004 1773 5396Department of Pediatrics, CPGs & Quality Research Unit, Quality Management Department, and Research Chair for Evidence-Based Health Care and Knowledge Translation, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ashraf Abdel Baky
- grid.7269.a0000 0004 0621 1570Department of Pediatrics, Pediatric Allergy, Immunology and Rheumatology Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt ,Chairman, Egyptian Pediatric National Clinical Practice Guidelines, Committee, Cairo, Egypt
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Amer YS, Anabrees J, Abdelmawla M, Abdalgader A, Almazroei A, Alhifzi I, AlOnazi AH, Sabr Y, Hneiny L, El-Malky A, Alshalawi A, Alayoubi A, Chaudhry IA, Elkhateeb O. Clinical practice guidelines for neonatal hypoxic-ischemic encephalopathy: A systematic review using the appraisal of guidelines for research and evaluation (AGREE) II instrument. Front Pediatr 2023; 11:1092578. [PMID: 37033166 PMCID: PMC10073446 DOI: 10.3389/fped.2023.1092578] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Background and Objective To systematically review, critically appraise the quality of recent clinical practice guidelines (CPGs) for neonatal hypoxic ischemic encephalopathy (HIE), and map their recommendations. Data Sources CPG databases (GIN, ECRI, NICE, SIGN, DynaMed), Bibliographic databases (PubMed, Embase, CINAHL), and related specialized professional societies (e.g., AAP, CPS, BAPM, RCPCH, and SNS). Study Selection Original de-novo developed evidence-based CPGs for HIE, group authorship, Arabic or English languages, and international or national scope. The systematic review was drafted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and Johnston et al methodological guide. Data Extraction Quality assessment of the included HIE CPGs by the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) Instrument and report their characteristics, AGREE II ratings, and recommendations. Data Synthesis Our search retrieved 2,489 citations, of which two recent HIE CPGs were eligible and appraised: Canadian Paediatric Society (CPS) and Queensland Maternity and Neonatal Services (QMN). The overall assessment of the QMN CPG was superior (83%). Domain 1 (Scope & Purpose) scored (47%, 63%), Domain 2 (Stakeholder Involvement) (72%, 39%), Domain 3 (Rigour of Development) (48%, 43%), Domain 4 (Clarity & Presentation) (100%, 96%), Domain 5 (Applicability) (59%, 9%), and Domain 6 (Editorial Independence) (67%, 17%) for the QMN and CPS CPGs respectively. All appraisers recommended the QMN CPG for use in practice. Conclusion The methodological quality of the QMN CPG was superior with the relevant recommendations for its use in neonatal practice. Limitations limited to Arabic and English languages. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258291, identifier: CRD42021258291.
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Affiliation(s)
- Yasser S. Amer
- Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
- Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
- Adaptation Working Group, Guidelines International Network, Perth, Scotland
- Correspondence: Yasser S. Amer Jasim Anabrees
| | - Jasim Anabrees
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Saudi Neonatology Society (SNS), Riyadh, Saudi Arabia
- Correspondence: Yasser S. Amer Jasim Anabrees
| | - Mohamed Abdelmawla
- Pediatrics Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Ayman Abdalgader
- Neonatology Department, Pediatric Hospital, King Saud Medical City, Riyadh, Saudi Arabia
| | - Asmaa Almazroei
- Pediatrics Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | | | - Abdullah Hawash AlOnazi
- Neonatal Intensive Care Unit, Critical Care Services, King Fahad Medical City, MOH, Riyadh, Saudi Arabia
| | - Yasser Sabr
- Obstetrics and Gynecology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Layal Hneiny
- Wegner Health Sciences Library, University of South Dakota, Sioux Falls, SD, United States
| | - Ahmed El-Malky
- Morbidity and Mortality Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Public Health and Community Medicine Department, Theodor Bilharz Research Institute (TBRI), Academy of Scientific Research, Cairo, Egypt
| | - Ayesha Alshalawi
- Nursing Department, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Ahmed Alayoubi
- Pediatric Department, Umm Al Qura University, Makkah, Saudi Arabia
| | - Iftikhar A. Chaudhry
- Obstetrics and Gynecology Department, Al-Yamamah Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Omar Elkhateeb
- Neonatal Intensive Care Unit, Critical Care Services, King Fahad Medical City, MOH, Riyadh, Saudi Arabia
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Babiker Mohamed MA, El-Malky AM, Abdelkarim WAA, Abdulmonem Salih Aabdeen M, Hassan Elobid Ahmed T, Sarsour HHH, Mohammed Mosa M, Amer YS, Khormi AAM, Alajlan A. Evidence-based clinical practice guidelines for the management of psoriasis: systematic review, critical appraisal, and quality assessment with the AGREE II instrument. J DERMATOL TREAT 2022; 33:2771-2781. [PMID: 35737878 DOI: 10.1080/09546634.2022.2083545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/22/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Psoriasis is considered one of the stubborn lifelong dermatologic diseases, making the patients seized in their social cage. Evidence-based clinical practice guidelines (CPGs) and expert opinions ensure that patients with psoriasis render the most recent and developed care. This systematic review assessed and compared the most recently approved international CPGs with the AGREE II instrument. METHODS After we identified our research question, we searched the bibliographic international databases to identify and screen for relevant and eligible guidelines that address the topic of interest. Four independent reviewers (Senior Expert Dermatologist in Psoriasis) have critically appraised the selected guidelines via the AGREE II instrument. We conducted inter-rater analysis and percent agreement among raters and calculation of intra-class correlation coefficient (ICC) 'Kappa'. RESULTS Out of 33 articles for CPGs, only Four eligible CPGs fulfill the inclusion criteria. Selected CPGs were critically appraised; first from the American College of Rheumatology that is also National Psoriasis Foundation (ACR/NPF-2018), second from the UK's National Institute for Health and Care Excellence (NICE-2017) for Psoriasis: Assessment and Management, third from the Saudi practical guidelines on the biologic treatment for Psoriasis (Saudi CPGs, 2015), and lastly from the American Academy of Dermatology (AAD/NPF-2019) Management and Treatment of Psoriasis with Awareness and Attention to Comorbidities. The complete assessments (OA) of two CPGs (AAD/NPF and NICE) scored greater than 80%; 'six domains' of AGREE II had greater score that is congruent with results; (1) scope and motive, (2) shareholder involvement, (3) rigor of growth, (4) clarity of speech, (5) validity, and (6) journalistic independence domains. Domain (3) scored (84, 71, and 90%), domain (5) (51%, 47, and 90%), domain (6) (70, 52, and 90%) for (Saudi CPGs, AAD/NPF, and NICE), respectively. Generally, the clinical recommendations were significantly better for NICE CPGs. CONCLUSIONS Four evidence-based 'CPGs' introduced a high-quality methodological analysis. NICE indicated the greatest quality followed by Saudi CPGs and AAD/NPF and all four CPGs were suggested for practice.
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Affiliation(s)
| | - Ahmed M El-Malky
- Public Health and Community Medicine Department, Theodor Bilharz Research Institute, Academy of Scientific Research, Ministry of Higher Education, Cairo, Egypt
- Morbidity and Mortality Review Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | | | - Munirah Mohammed Mosa
- College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yasser S Amer
- Pediatric Department, King Khalid University Hospital, Riyadh, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Quality Management Department, Clinical Practice Guidelines and Quality Research Unit, King Saud University Medical City, Riyadh, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
- Adaptation Working Group, Guidelines International Network, Perth, Scotland
| | - Abdulrahman Ali M Khormi
- Internal Medicine and Rheumatology - Prince Sattam University Medical College, Al-Kharj, Saudi Arabia
| | - Abdulmajeed Alajlan
- Dermatology Department, Faculty of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Alenezi S, Alyahya AS, AlKhalifah SM, Bakhsh HR, Alismail EH, Aldhalaan H, Alwazna T, Alzrayer N, AlSuwailem SS, Alnemary F, AlAnsari AMS, Alqulaq EI, Alyamani A, Amer YS, Albawardi IM, Albalawi WM, Alhassan MA, Algazlan MS, Alramady M, Ad-Dab’bagh Y. Saudi Expert Consensus-Based Autism Spectrum Disorder Statement: From Screening to Management. Children 2022; 9:children9091269. [PMID: 36138578 PMCID: PMC9496905 DOI: 10.3390/children9091269] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/04/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Abstract
Background: There is a large gap between the needs of individuals diagnosed with autism spectrum disorder (ASD) and the currently available services in Saudi Arabia. Services are often difficult to access, inconsistent in quality, incomplete, unsatisfactory, and costly. As such, there is a national need for expert consensus on the appropriate standards for the assessment and management of children on the autism spectrum. Methodology: A guideline development group (GDC) was formed by professionals representing all related specialties and institutions involved in the management of individuals on the autism spectrum in Saudi Arabia. They met on a regular basis over 21 months. The guideline development process consisted of five steps starting from reviewing existing guidelines and ending with discussing and writing this manuscript. A formal voting process was utilized and recommendations were discussed until a consensus was reached. Results: There was consensus on the following: A specialized diagnostic assessment needs to be carried out by an experienced multidisciplinary team for children referred to assess for ASD. They should be assessed for medical etiology, their behavioral history carefully reviewed, and symptoms directly observed. Longitudinal assessments are encouraged to reflect the effects of symptoms on the individual’s ability to function while with their family, among peers, and in school settings. An additional formal assessment of language, cognitive, and adaptive abilities as well as sensory status is essential to complete the diagnostic process. Interventions should be individualized, developmentally appropriate, and intensive, with performance data relevant to intervention goals to evaluate and adjust interventions. Target symptoms must be identified to address and develop monitoring systems to track change. Conclusion: ASD is a complex condition with widely varying clinical manifestations, thus requiring evaluation and intervention by a range of professionals working in coordination. Behavioral and environmental interventions are the key to optimal outcomes, in conjunction with medications when indicated for specific symptoms. Parental involvement in interventions is vital to sustaining therapeutic gains.
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Affiliation(s)
- Shuliweeh Alenezi
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ahmad S. Alyahya
- Department of Psychiatry, Eradah Complex for Mental Health, Riyadh 12571, Saudi Arabia
- Correspondence:
| | - Shahad M. AlKhalifah
- Center for Autism Research, King Faisal Specialist Hospital & Research Center, Riyadh 11564, Saudi Arabia
| | - Hadeel R. Bakhsh
- Department of Rehabilitation, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
| | - Eiman H. Alismail
- Center for Autism Research, King Faisal Specialist Hospital & Research Center, Riyadh 11564, Saudi Arabia
| | - Hesham Aldhalaan
- Department of Neuroscience, King Faisal Specialist Hospital & Research Center, Riyadh 11564, Saudi Arabia
| | - Talat Alwazna
- Department of Neurology, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Nouf Alzrayer
- Department of Special Education, College of Education, King Saud University, Riyadh 11451, Saudi Arabia
| | | | | | - Ahmed M. S. AlAnsari
- Department of Psychiatry, College of Medecine and Medical Sciences, Arabian Gulf University, Manama 293, Bahrain
| | - Enas I. Alqulaq
- Prince Mohammed Bin Salman Center for Autism and Neurodevelopment, Riyadh 12426, Saudi Arabia
- Health Services of Ministry of Defense, Riyadh 12426, Saudi Arabia
| | - Amal Alyamani
- Prince Mohammed Bin Salman Center for Autism and Neurodevelopment, Riyadh 12426, Saudi Arabia
- Department of Psychiatry, King Fahad Armed Forces Hospital, Jeddah 23311, Saudi Arabia
| | - Yasser S. Amer
- Pediatrics Department, King Khalid University Hospital, Riyadh 12372, Saudi Arabia
- Quality Management Department, King Saud University Medical City, Riyadh 12746, Saudi Arabia
- Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh 11451, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria 5424041, Egypt
- Adaptation Working Group, Guidelines International Network (GIN), Perth PH16 5BU, UK
| | - Ibrahim M. Albawardi
- Department of Psychiatry, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam 34212, Saudi Arabia
| | | | - Mohammed A. Alhassan
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Maha S. Algazlan
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | | | - Yasser Ad-Dab’bagh
- Mental Health Department, Neuroscience Center, King Fahad Specialist Hospital-Dammam (KFSH-D), Dammam 32253, Saudi Arabia
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Titi MA, Wahabi HA, Elmorshedy H, Shata ZN, Amer YS, Elamir H, Esmaeil S, Jamal AA, Fayed A, Group C. Mental health impact of the first wave of the COVID-19 pandemic on healthcare workers in 12 Arab countries. East Mediterr Health J 2022; 28:707-718. [DOI: 10.26719/emhj.22.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/29/2022] [Indexed: 11/09/2022]
Abstract
Background: The COVID-19 pandemic has had a significant impact on public health and healthcare systems worldwide, including the psychological impact on healthcare workers (HCWs). Aims: To investigate the COVID-19-related psychological impact on HCWs in 12 Arab countries. Methods: This was a cross-sectional, hospital-based online survey conducted between May 4 and June 8, 2020. We evaluated stress, depression, anxiety and insomnia using the Depression Anxiety Stress Scale and Insomnia Severity Index. Results: A total of 2879 respondents from 12 Arab countries completed the survey. Anxiety, depression, stress and insomnia were identified in 48.9%, 50.6%, 41.4% and 72.1% of respondents, respectively. Lower-middle- and low-income countries had a significantly higher prevalence of all the psychological outcomes compared with high-income countries. The prevalence of mental health symptoms was higher in HCWs aged 30–39 years, those who worked > 44 hours/week, and those in contact with COVID-19 cases, as well as HCWs who were not satisfied with the preventive measures. The prevalence of mental health symptoms was lower among male HCWs. Conclusion: COVID-19 had a considerable impact on the mental and psychological health of HCWs in Arab countries. This was aggravated by the particular geopolitical positions of some Arab countries and social norms during the month of Ramadan. Physicians, young HCWs, and long working hours were all risk factors for greater psychological impact of the outbreak.
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Sultan S, Siedler MR, Morgan RL, Ogunremi T, Dahm P, Fatheree LA, Getchius TSD, Ginex PK, Jakhmola P, McFarlane E, Murad MH, Temple Smolkin RL, Amer YS, Alam M, Kang BY, Falck-Ytter Y, Mustafa RA. An International Needs Assessment Survey of Guideline Developers Demonstrates Variability in Resources and Challenges to Collaboration between Organizations. J Gen Intern Med 2022; 37:2669-2677. [PMID: 34545466 PMCID: PMC9411275 DOI: 10.1007/s11606-021-07112-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/20/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The development of rigorous, high-quality clinical guidelines increases the need for resources and skilled personnel within guideline-producing organizations. While collaboration between organizations provides a unique opportunity to pool resources and save time and effort, the collaboration presents its own unique challenges. OBJECTIVE To assess the perceived needs and current challenges of guideline producers worldwide related to guideline development and collaboration efforts. DESIGN Survey questions were developed by the Guidelines International Network and the US GRADE Network, pilot-tested among attendees of a guideline development workshop, and disseminated electronically using convenience and snowball sampling methods. PARTICIPANTS A total of 171 respondents representing 30 countries and more than 112 unique organizations were included in this analysis. MAIN MEASURES The survey included free-response, multiple-choice, and seven-point Likert-scale questions. Questions assessed respondents' perceived value of guidelines, resource availability and needs, guideline development processes, and collaboration efforts of their organization. KEY RESULTS Time required to develop high-quality systematic reviews and guidelines was the most relevant need (median=7; IQR=5.5-7). In-house resources to conduct literature searches (median=4; IQR=3-6) and the resources to develop rigorous guidelines rapidly (median=4; IQR=2-5) were perceived as the least available resources. Difficulties reconciling differences in guideline methodology (median=6; IQR=4-7) and the time required to establish collaborative agreements (median=6; IQR=5-6) were the most relevant barriers to collaboration between organizations. Results also indicated a general need for improvement in conflict of interest (COI) disclosure policies. CONCLUSION The survey identified organizational challenges in supporting rigorous guideline development, including the time, resources, and personnel required. Connecting guideline developers to existing databases of high-quality systematic reviews and the use of freely available online platforms may facilitate guideline development. Guideline-producing organizations may also consider allocating resources to hiring or training personnel with expertise in systematic review methodologies or utilizing resources more effectively by establishing collaborations with other organizations.
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Affiliation(s)
- Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Health Care System, Minneapolis, MN, USA.
| | - Madelin R Siedler
- Kinesiology & Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Rebecca L Morgan
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Toju Ogunremi
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Philipp Dahm
- Department of Urology, Minneapolis VA Health Care System, University of Minnesota, Minneapolis, MN, USA
| | | | - Thomas S D Getchius
- Guideline Strategy and Operations, American Heart Association and American College of Cardiology, Dallas, TX, USA
| | - Pamela K Ginex
- Evidence-Based Practice, Oncology Nursing Society, Pittsburgh, PA, USA
| | - Priya Jakhmola
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emma McFarlane
- National Institute for Health and Care Excellence, Manchester, UK
| | - M Hassan Murad
- Evidence-based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | - Yasser S Amer
- Pediatrics, Quality Management, King Saud University Medical City, Riyadh, Saudi Arabia.,Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia.,Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yngve Falck-Ytter
- Gastroenterology Seection, VA Northeast Ohio Healthcare System, Case Western Reserve University, Cleveland, OH, USA
| | - Reem A Mustafa
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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17
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Amer YS, Alenezi S, Bashiri FA, Alawami AH, Alhazmi AS, Aladamawi SA, Alnemary F, Alqahtani Y, Buraik MW, AlSuwailem SS, Akhalifah SM, Augusta de Souza Pinhel M, Penner M, Elmalky AM. AGREEing on Clinical Practice Guidelines for Autism Spectrum Disorders in Children: A Systematic Review and Quality Assessment. Children 2022; 9:children9071050. [PMID: 35884034 PMCID: PMC9323940 DOI: 10.3390/children9071050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 11/17/2022]
Abstract
Background: Autism spectrum disorder (ASD) is a multifaceted neurodevelopmental disorder requiring multimodal intervention and an army of multidisciplinary teams for a proper rehabilitation plan. Accordingly, multiple practice guidelines have been published for different disciplines. However, systematic evidence to detect and intervene must be updated regularly. Our main objective is to compare and summarize the recommendations made in the clinical practice guidelines (CPGs) for ASD in children released from November 2015 to March 2022. Methods: CPGs were subjected to a systematic review. We developed the inclusion and exclusion criteria and health-related questions, then searched and screened for CPGs utilizing bibliographic and CPG databases. Each of the CPGs used in the study were critically evaluated using the Appraisal of Guidelines for REsearch and Evaluation II (AGREE II) instrument. In a realistic comparison table, we summarized the recommendations. Results: Four eligible CPGs were appraised: Australian Autism CRC (ACRC); Ministry of Health New Zealand (NZ); National Institute for Health and Care Excellence (NICE); and Scottish Intercollegiate Guidelines Network, Healthcare Improvement Scotland (SIGN-HIS). The overall assessments of all four CPGs scored greater than 80%; these findings were consistent with the high scores in the six domains of AGREE II, including: (1) scope and purpose, (2) stakeholder involvement, (3) rigor of development, (4) clarity of presentation, (5) applicability, and (6) editorial independence domains. Domain (3) scored 84%, 93%, 86%, and 85%; domain (5) 92%, 89%, 54%, and 85%; and domain (6) 92%, 96%, 88%, and 92% for ACRC, NICE, NZ, and SIGN-HIS, respectively. Overall, there were no serious conflicts between the clinical recommendations of the four CPGs, but some were more comprehensive and elaborative than others. Conclusions: All four assessed evidence-based CPGs demonstrated high methodological quality and relevance for use in practice.
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Affiliation(s)
- Yasser S. Amer
- Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, Riyadh 11451, Saudi Arabia
- Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh 11451, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh 11451, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria 5424041, Egypt
- Guidelines International Network, Perth PH16 5BU, Scotland, UK
- Correspondence: (Y.S.A.); (S.A.); Tel.: +966-508577246 (Y.S.A.); +966-504848864 (S.A.)
| | - Shuliweeh Alenezi
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
- Correspondence: (Y.S.A.); (S.A.); Tel.: +966-508577246 (Y.S.A.); +966-504848864 (S.A.)
| | - Fahad A. Bashiri
- Pediatric Neurology Division, Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Amel Hussain Alawami
- Johns Hopkins Aramco Healthcare, Dhahran 34465, Saudi Arabia; (A.H.A.); (M.W.B.)
| | - Ayman Shawqi Alhazmi
- Developmental Pediatric Department, Children’s Hospital, King Saud Medical City, Ministry of Health, Riyadh 12746, Saudi Arabia;
| | - Somayyah A. Aladamawi
- King Abdullah bin Abdulaziz University Hospital, Riyadh 11564, Saudi Arabia;
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
| | - Faisal Alnemary
- Autism Center of Excellence, Riyadh 11564, Saudi Arabia; (F.A.); (S.S.A.); (S.M.A.)
| | | | - Maysaa W. Buraik
- Johns Hopkins Aramco Healthcare, Dhahran 34465, Saudi Arabia; (A.H.A.); (M.W.B.)
| | - Saleh S. AlSuwailem
- Autism Center of Excellence, Riyadh 11564, Saudi Arabia; (F.A.); (S.S.A.); (S.M.A.)
| | - Shahad M. Akhalifah
- Autism Center of Excellence, Riyadh 11564, Saudi Arabia; (F.A.); (S.S.A.); (S.M.A.)
| | - Marcela Augusta de Souza Pinhel
- Department of Health Science, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, Brazil;
- Department of Molecular Biology, São José do Rio Preto Medical School, São José do Rio Preto 15090-000, Brazil
| | - Melanie Penner
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada;
- Department of Pediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Ahmed M. Elmalky
- Morbidity and Mortality Unit, King Saud University Medical City, King Saud University, Riyadh 11451, Saudi Arabia;
- Public Health and Community Medicine Department, Theodor Bilharz Research Institute (TBRI), Academy of Scientific Research, Cairo 3863130, Egypt
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Hussein H, Montesinos-Guevara C, Abouelkheir M, Brown RS, Hneiny L, Amer YS. Quality appraisal of antibiotic prophylaxis guidelines to prevent infective endocarditis following dental procedures: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:562-572. [DOI: 10.1016/j.oooo.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022]
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Babiker Mohamed MA, Abdelwahab Abdelkarim WA, Salih Aabdeen MA, Elobid Ahmed TH, Sarsour HH, El-Malky AM, Amer YS, alsaleh N, Nazer RI. Evidence-based clinical practice guidelines for the management of perioperative hypothermia: Systematic review, critical appraisal, and quality assessment with the AGREE II instrument. Ann Med Surg (Lond) 2022; 79:103887. [PMID: 35860110 PMCID: PMC9289222 DOI: 10.1016/j.amsu.2022.103887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/23/2022] [Accepted: 05/29/2022] [Indexed: 11/12/2022] Open
Abstract
Inadvertent perioperative hypothermia is considered an emergency life-threatening situation. Clinical practice guidelines (CPGs) on how to manage hypothermia, based on evidence and expert opinions, could save lives. This systematic review assessed and compared the most recently approved international CPGs with the AGREE II instrument. We searched international bibliographic databases to identify relevant guidelines for managing perioperative hypothermia. Four independent reviewers (consultant anesthesiologists) critically appraised the selected guidelines with the AGREE II instrument. We analyzed inter-rater agreement and calculated an intra-class correlation coefficient (Kappa). We identified five CPGs for perioperative hypothermia that were eligible for critical appraisal. These CPGs were issued by the National Institute for Health and Care Excellence (NICE-2016); the American Society of Peri-Anesthesia Nurses/Agency for Health Care Research and Quality (ASPAN/AHRQ-2006); the University of Southern Mississippi (USM/CPG-2017); The University Assistance Complex of Salamanca (UACS/CPG-2018); and the Justus-Liebig University of Giessen (UKGM/CPG-2015). The overall assessments of NICE-2016 and ASPAN/AHRQ-2006 scored >80%. These results were consistent with high scores achieved in the six domains of AGREE II: (1) scope and purpose, (2) stakeholder involvement, (3) rigor of development, (4) clarity of presentation, (5) applicability, and (6) editorial independence domains. The NICE-2016, ASPAN/AHRQ-2006, and USM/CPG-2017) scored, respectively, 94%, 81%, and 70% for domain 3, 91%, 87%, and 66% for domain 5, and 90%, 82%, and 77% for domain 6. Generally, the NICE CPGs received significantly better clinical recommendations. However, all five evidence-based CPGs were of high methodological quality and were recommended for use in practice. Saudi Arabia should formulate its own national CPGs for diagnosis and management of perioperative hypothermia and to be published on NICE. Guidance for adapting CPGs to a given clinical practice is a realistic, practical alternative to de novo CPG development, which is a time-consuming and resource-intensive approach. Some nations, particularly those with low- and middle-income economies, have chosen to employ CPG adaptation, rather than developing new evidence-based practice programs. Several formal adaptation approaches are currently available, and they may be tailored further to suit particular circumstances. Evaluations like the one described in the present study should provide guidance for appropriate CPG adaptation or development efforts, particularly for organizations with little expertise with the AGREE II instrument. The current critical appraisal emphasized the importance of clinicians performing quality assessments of CPGs to ensure transparency and strength in the CPG development process, in accordance with international CPG standards. Moreover, our findings will support the provision of best practices for POH. Based on our findings, we propose that anesthesiologists should include an AGREE II review of CPGs in their capacity development strategies.
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Luo X, Akl EA, Zhu Y, Lv M, Liu X, Song Y, Wang P, Wang J, Song X, Amer YS, Litvin A, Chen Y. Developing the RIGHT extension statement for practice guideline protocols: the RIGHT-P statement protocol. F1000Res 2022. [DOI: 10.12688/f1000research.109547.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Abstract
Background: A protocol for a practice guideline can facilitate the guideline development process, ensure its transparency, and improve the quality of the guidelines. However, there are currently no reporting guideline for guideline protocols. Methods: We intend to develop an extension of the Reporting Items for Practice Guidelines in HealThcare (RIGHT) statement for guideline protocols (RIGHT-P). We will follow the toolkit for developing a reporting guideline developed by the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network. We will form a multidisciplinary international team of experts. The development of RIGHT-P will be conducted in 12 steps grouped in three stages over a two-year period. Results: The results of RIGHT-P statement will be presented in an article to be published later. Conclusion: This report describes the process of RIGHT-P statement development. We believe RIGHT-P will help guideline developers improve the reporting of guideline protocols and indirectly improve their quality and the quality of guidelines. Registration: We registered the protocol on the EQUATOR network.
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Amer YS, Titi MA, Godah MW, Wahabi HA, Hneiny L, Abouelkheir MM, Hamad MH, ElGohary GM, Hamouda MB, Ouertatani H, Velasquez-Salazar P, Acosta-Reyes J, Alhabib SM, Esmaeil SA, Fedorowicz Z, Zhang A, Chen Z, Liptrott SJ, Frungillo N, Jamal AA, Almustanyir SA, Dieyi NU, Powell J, Hon KJ, Alzeidan R, Azzo M, Zambrano-Rico S, Ramirez-Jaramillo P, Florez ID. International alliance and AGREE-ment of 71 clinical practice guidelines on the management of critical care patients with COVID-19: a living systematic review. J Clin Epidemiol 2022; 142:333-370. [PMID: 34785346 PMCID: PMC8590623 DOI: 10.1016/j.jclinepi.2021.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/10/2021] [Accepted: 11/06/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We aimed to systematically identify and critically assess the clinical practice guidelines (CPGs) for the management of critically ill patients with COVID-19 with the AGREE II instrument. STUDY DESIGN AND SETTING We searched Medline, CINAHL, EMBASE, CNKI, CBM, WanFang, and grey literature from November 2019 - November 2020. We did not apply language restrictions. One reviewer independently screened the retrieved titles and abstracts, and a second reviewer confirmed the decisions. Full texts were assessed independently and in duplicate. Disagreements were resolved by consensus. We included any guideline that provided recommendations on the management of critically ill patients with COVID-19. Data extraction was performed independently and in duplicate by two reviewers. We descriptively summarized CPGs characteristics. We assessed the quality with the AGREE II instrument and we summarized relevant therapeutic interventions. RESULTS We retrieved 3,907 records and 71 CPGs were included. Means (Standard Deviations) of the scores for the 6 domains of the AGREE II instrument were 65%(SD19.56%), 39%(SD19.64%), 27%(SD19.48%), 70%(SD15.74%), 26%(SD18.49%), 42%(SD34.91) for the scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, editorial independence domains, respectively. Most of the CPGs showed a low overall quality (less than 40%). CONCLUSION Future CPGs for COVID-19 need to rely, for their development, on standard evidence-based methods and tools.
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Affiliation(s)
- Yasser S. Amer
- Pediatrics Department and Clinical Practice Guidelines Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia,Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia,Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University Medical Council, Alexandria University, Alexandria, Egypt
| | - Maher A. Titi
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia,Patient Safety Unit, Quality Management Department King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mohammad W. Godah
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hayfaa A. Wahabi
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia,Family & Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Layal Hneiny
- Saab Medical Library, University Libraries, American University of Beirut, Beirut, Lebanon
| | | | - Muddathir H. Hamad
- Division of Neurology, Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ghada Metwally ElGohary
- Internal Medicine and Clinical Hematology, Faculty of Medicine, Ain Shams University, Cairo, Egypt,University Oncology Center, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Ben Hamouda
- Clinical Practice Guidelines Unit, INEAS l instance Nationale de l'évaluation et de l'accréditation en santé 7 Rue Ahmed Rami le belvedere 1001 Tunis-TUNISIA
| | - Hella Ouertatani
- Clinical Pathways Unit, National Authority for Assessment and Accreditation in Healthcare (INEAS), Tunis, Tunisia
| | - Pamela Velasquez-Salazar
- Unidad de Evidencia y Deliberación para la toma de Decisiones (UNED), Faculty of Medicine, University of Antioquia, Medellín, Colombia
| | - Jorge Acosta-Reyes
- Department of Public Health, Universidad del Norte, Barranquilla, Colombia
| | - Samia M. Alhabib
- National Center for Evidence-Based Health Practice, Saudi Health Council, Riyadh, Saudi Arabia,King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Samia Ahmed Esmaeil
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia
| | - Zbys Fedorowicz
- Veritas Health Sciences Consultancy Ltd., Huntingdon, United Kingdom
| | - Ailing Zhang
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhe Chen
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Niccolò Frungillo
- Oncology Unit, ASST Fatebenefratelli-Sacco, PO Fateberefratelli, Piazza Principessa Clotilde 3, 20121, Milan, Italy
| | - Amr A. Jamal
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia,Family & Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Newman Ugochukwu Dieyi
- Division of Community Health and Humanities, Memorial University, St. John's Newfoundland and Labrador, Canada
| | - John Powell
- National Institute for Health and Care Excellence, London, UK,Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Katrina J. Hon
- Division of Community Health and Humanities, Memorial University, St. John's Newfoundland and Labrador, Canada,Neuroscience, Mind, Brain, and Behavior, Harvard University, MA, USA
| | - Rasmieh Alzeidan
- Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Majduldeen Azzo
- Pediatrics Emergency Department, The International Medical Center, Hail Street, 21451, Jeddah, Saudi Arabia
| | | | | | - Ivan D. Florez
- Department of Pediatrics, University of Antioquia, Medellin, Colombia,School of Rehabilitation Science, McMaster University, Hamilton, Canada,Corresponding author: Tel.: +57 4 219 2480
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Amer YS, Shaiba LA, Hadid A, Anabrees J, Almehery A, AAssiri M, Alnemri A, Darwish ARA, Baqawi B, Aboshaiqah A, Hneiny L, Almaghrabi RH, El-Malky AM, Al-Dajani NM. Quality assessment of clinical practice guidelines for neonatal sepsis using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument: A systematic review of neonatal guidelines. Front Pediatr 2022; 10:891572. [PMID: 36052365 PMCID: PMC9424847 DOI: 10.3389/fped.2022.891572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Neonatal sepsis (NS) continues to be a critical healthcare priority for the coming decades worldwide. The aim of this study was to critically appraise the quality of recent clinical practice guidelines (CPGs) for neonatal sepsis and to summarize and compare their recommendations. METHODS This study involves a systematic review of CPGs. We identified clinical questions and eligibility criteria and searched and screened for CPGs using bibliographic and CPG databases and professional societies. Each included CPG was assessed by four independent appraisers using the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument. We summarized the recommendations in a comparison practical table. The systematic review was drafted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Its protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42021258732). RESULTS Our search retrieved 4,432 citations; of which five CPGs were eligible and appraised: American Academy of Pediatrics (AAP 2018) (35 and 34 weeks); Canadian Pediatric Society (CPS 2017); National Institute for Health and Care Excellence (NICE 2021); and Queensland Maternity and Neonatal Services (QH 2020). Among these, the overall assessment of two evidence-based CPGs scored > 70% (NICE and QH), which was consistent with their higher scores in the six domains of the AGREE II instrument. In domain 3 (rigor of development), NICE and QH scored 99 and 60%, respectively. In domain 5 (applicability), they scored 96 and 74%, respectively, and in domain 6 (editorial independence), they scored 90 and 71%, respectively. CONCLUSION The methodological quality of the NICE CPG was superior followed by the QH CPG with relevant recommendations for use in practice. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021258732, PROSPERO (CRD42021258732).
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Affiliation(s)
- Yasser S Amer
- Pediatrics Department, King Khalid University Hospital, Riyadh, Saudi Arabia.,Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia.,Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia.,Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt.,Adaptation Working Group, Guidelines International Network, Perth, Scotland
| | - Lana A Shaiba
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Neonatal Intensive Care Unit, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Adnan Hadid
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Neonatal Intensive Care Unit, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Jasim Anabrees
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Neonatal Intensive Care Unit, King Saud University Medical City, Riyadh, Saudi Arabia.,Saudi Neonatology Society (SNS), Riyadh, Saudi Arabia
| | | | - Manal AAssiri
- Neonatology Department, King Abdulaziz Hospital, Ministry of Health, Jeddah, Saudi Arabia
| | - Abdulrahman Alnemri
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Neonatal Intensive Care Unit, King Saud University Medical City, Riyadh, Saudi Arabia.,Saudi Neonatology Society (SNS), Riyadh, Saudi Arabia
| | - Amira R Al Darwish
- Clinical Pharmacy Department, Pharmacy Services, Second Health Cluster in Central Region, Riyadh, Saudi Arabia.,Pharmacy Department, King Fahad Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Badi Baqawi
- Obstetrics and Gynecology Department, King Fahad Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Layal Hneiny
- Saab Medical Library, University Libraries, American University of Beirut, Beirut, Lebanon.,Wegner Health Sciences Library, University of South Dakota, Sioux Falls, SD, United States
| | - Rana H Almaghrabi
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ahmed M El-Malky
- Morbidity and Mortality Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.,Public Health and Community Medicine Department, Theodor Bilharz Research Institute (TBRI), Academy of Scientific Research, Cairo, Egypt
| | - Nawaf M Al-Dajani
- Neonatal Intensive Care Unit, Infectious Diseases Unit, Pediatrics Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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23
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Titi MA, Alotair HA, Fayed A, Baksh M, Alsaif FAA, Almomani Z, Atallah M, Alsharif AF, Jamal AA, Amer YS. Effects of Computerised Clinical Decision Support on Adherence to VTE Prophylaxis Clinical Practice Guidelines among Hospitalised Patients. Int J Qual Health Care 2021; 33:6153904. [PMID: 33647102 DOI: 10.1093/intqhc/mzab034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/27/2021] [Accepted: 02/26/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Venous thromboembolism (VTE) is an important patient safety concern. VTE leads to significant mortality and morbidity and a burden on healthcare resources. Despite the widespread availability of evidence-based clinical practice guidelines on VTE prophylaxis, we found that only 50.9% of our patients were receiving appropriate prophylaxis. The purpose of this study was to evaluate the impact of automation of an adapted VTE prophylaxis CPG using a clinical decision support system (the VTE-CDSS) on VTE prevention among hospitalised adult patients. DESIGN AND SETTING A quasi-experimental study (pre- and post-implementation) was conducted at a large 900-bed tertiary teaching multi-specialty hospital in Riyadh, Saudi Arabia. PARTICIPANTS The 1809 adult patients in the study included 871 enrolled during the pre-implementation stage and 938 enrolled during the post-implementation stage. INTERVENTION Multi-faceted implementation interventions were utilised, including leadership engagement and support, quality and clinical champions, staff training and education and regular audit and feedback. MAIN OUTCOME MEASURE Two rate-based process measures were calculated for each admission cohort (i.e. pre- and post-implementation): the percentage of inpatients who were assessed for VTE risk on admission and the percentage of inpatients who received appropriate VTE prophylaxis. Two outcome measures were calculated: the prevalence of hospital-acquired VTE (HA-VTE) events and the in-hospital all-cause mortality. RESULTS The percentage of inpatients risk assessed for VTE on admission increased from 77.4% to 93.3% (P < 0.01). The percentage of patients who received appropriate VTE prophylaxis increased from 50.9% to 81.4% (P < 0.01). The HA-VTE events decreased by 50% from 0.33% to 0.15% (P < 0.01).All-cause in-hospital mortality did not significantly change after implementation of the VTE-CDSS compared with pre-implementation mortality (P > 0.05). CONCLUSION The VTE-CDSS improved patient safety by enhancing adherence to the VTE prophylaxis best practice and adapted CPG. The multi-faceted implementation strategies approach improved the compliance rate of risk assessment and the adherence to prophylaxis recommendations and substantially reduced the HA-VTE prevalence. A successful CDSS requires a set of critical components to ensure better user compliance and positive patient outcomes.
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Affiliation(s)
- Maher A Titi
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Scientific Research, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia.,Quality Management Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Hadil A Alotair
- Division of Pulmonary and Critical Care, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Amel Fayed
- College of Medicine, Clinical Department, Princess Nora Bint Abdulrahman University, Riyadh 11671, Saudi Arabia.,High Institute of Public Health, Alexandria University, 165 El-Horeya Road, El-Ibrahimia Qebli wa El-Hadarah Bahari, Qism Bab Sharqi, Alexandria Governorate, Alexandria 165, Egypt
| | - Maram Baksh
- Quality Management Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Faisal Abdullah Abdulaziz Alsaif
- Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Ziad Almomani
- Quality Management Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Mohammad Atallah
- Nursing Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Asrar F Alsharif
- Information Technology Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Amr A Jamal
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Scientific Research, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia.,Department of Family and Community Medicine, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Yasser S Amer
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Scientific Research, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia.,Quality Management Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia.,Alexandria Center for Evidence-Based Clinical Practice Guidelines, New University Hospital, Alexandria University, Alexandria 21131, Egypt
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24
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Titi MA, Baksh MM, Zubairi B, Abdalla RAM, Alsaif FA, Amer YS, Jamal D, El-Jardali F. Staying ahead of the curve: avigating changes and maintaining gains in patient safety culture - a mixed-methods study. BMJ Open 2021; 11:e044116. [PMID: 33664079 PMCID: PMC7934776 DOI: 10.1136/bmjopen-2020-044116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/05/2021] [Accepted: 02/18/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study examines how the results of the Hospital Survey on Patient Safety Culture changed between 2012 and 2019 and identifies organisational factors affecting these changes. DESIGN The study combined the use of quantitative surveys of staff and qualitative interviews with hospital leadership. Secondary data analysis was performed for previous surveys. SETTING This study was conducted in a tertiary care teaching multisite hospital in Riyadh, Saudi Arabia. PARTICIPANTS One thousand hospital staff participated in the survey. Thirty-one executive board members and directors and four focus groups of frontliners were qualitatively interviewed. PRIMARY AND SECONDARY OUTCOME MEASURES Twelve safety culture dimensions were assessed to study the patient safety culture as perceived by the healthcare professionals. An additional semi-structured interview was conducted to identify organisational factors, changes, and barriers affecting the patient safety culture. Furthermore, suggestions to improve patient safety were proposed. RESULTS Comparing the results revealed a general positive trend in scores from 2012 to 2019. The areas of strength included teamwork within and across units, organisational learning, managerial support, overall perception of safety and feedback and communication about error. Non-punitive response to error, staffing and communication and openness consistently remain the lowest-scoring composites. Interview results revealed that organisational changes may have influenced the answers of the participants on some survey composites. CONCLUSIONS Patient safety is a moving target with areas for improvement that are continuously identified. Effective quality improvement initiatives can lead to visible changes in the patient safety culture in a hospital, and consistent leadership commitment and support can maintain these improvements.
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Affiliation(s)
- Maher Abdelraheim Titi
- Quality Management, King Saud University Medical City, Riyadh, Riyadh Province, Saudi Arabia
- Research Chair for Evidence Based Health Care and Knowledge Translation, King Saud University Medical City, Riyadh, Riyadh Province, Saudi Arabia
| | - Maram Mohammed Baksh
- Quality Management, King Saud University Medical City, Riyadh, Riyadh Province, Saudi Arabia
| | - Beena Zubairi
- Quality Management, King Saud University Medical City, Riyadh, Riyadh Province, Saudi Arabia
| | | | - Faisal Abdullah Alsaif
- Surgery, King Saud University College of Medicine, Riyadh, Riyadh Province, Saudi Arabia
| | - Yasser S Amer
- Quality Management, King Saud University Medical City, Riyadh, Riyadh Province, Saudi Arabia
- Research Chair for Evidence Based Health Care and Knowledge Translation, King Saud University Medical City, Riyadh, Riyadh Province, Saudi Arabia
- Pediatrics, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Diana Jamal
- Health Management and Policy, American University of Beirut Faculty of Health Sciences, Beirut, Lebanon
| | - Fadi El-Jardali
- Health Management and Policy, American University of Beirut Faculty of Health Sciences, Beirut, Lebanon
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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25
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Bashiri FA, Albatti TH, Hamad MH, Al-Joudi HF, Daghash HF, Al-Salehi SM, Varnham JL, Alhaidar F, Almodayfer O, Alhossein A, Aldhalaan H, Ad-Dab’bagh YA, Al Backer N, Altwaijri W, Alburikan K, Buraik MW, Ghaziuddin M, Nester MJ, Wahabi HA, Alhabib S, Jamal AA, Amer YS. Adapting evidence-based clinical practice guidelines for people with attention deficit hyperactivity disorder in Saudi Arabia: process and outputs of a national initiative. Child Adolesc Psychiatry Ment Health 2021; 15:6. [PMID: 33557914 PMCID: PMC7871371 DOI: 10.1186/s13034-020-00351-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/17/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND We recently adapted the published National Institute for Health and Care Excellence (NICE) Attention deficit hyperactivity disorder (ADHD) diagnosis and management guideline to the Saudi Arabian context. It has been postulated that adaptation of evidence-based clinical practice guidelines to the local healthcare context rather than de-novo development will improve their adoption and implementation without imposing a significant burden on resources. The objective of this paper is to describe the adaptation process methodology utilized for the generation of the first national guideline for management of people with ADHD in Saudi Arabia. METHODS We used the KSU-Modified-ADAPTE methodology for the guideline adaptation process. We describe the full process in detail including the three phases of set-up, adaptation, and finalization. The process was conducted by a multidisciplinary guideline adaptation group in addition to an external review for the clinical content and methodology. RESULTS The group adapted ten main categories of recommendations from one source CPG (NICE). The recommendations include: (i) service organisation and training, (ii) recognition, identification and referral, (iii) diagnosis, (iv) support, (v) managing ADHD, (vi) dietary advice, (vii) medication, (viii) maintenance and monitoring, (ix) adherence to treatment, and (x) review of medication and discontinuation. Several implementation tools were compiled and developed to enhance implementability including a clinical algorithm, quality measures, coding system, medication tables, translations, patient information, and online resources. CONCLUSIONS The finalized clinical practice guideline provides healthcare providers with applicable evidence-based guidance for the management of people with ADHD in Saudi Arabia. The project also demonstrated the effectiveness of KSU-Modified-ADAPTE, and emphasized the value of a collaborative clinical and methodological expert group for adaptation of national guidelines.
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Affiliation(s)
- Fahad A. Bashiri
- grid.56302.320000 0004 1773 5396Pediatrics Department, Pediatric Neurology Division, College of Medicine and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia ,Saudi Pediatric Neurology Society, Riyadh, Saudi Arabia
| | - Turki H. Albatti
- grid.56302.320000 0004 1773 5396Psychiatry Department, Child Psychiatry Unit and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia ,Saudi ADHD Society, Riyadh, Saudi Arabia ,grid.454833.d0000 0004 0402 3592Ministry of Education, Abdullatif Alfozan Autism Center, Al Khobar, Saudi Arabia
| | - Muddathir H. Hamad
- grid.56302.320000 0004 1773 5396Pediatrics Department, Pediatric Neurology Division, College of Medicine and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Haya F. Al-Joudi
- grid.415310.20000 0001 2191 4301Department of Neurosciences, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Hadeel F. Daghash
- grid.415696.9Ada’a Program, Assistant Deputyship for Hospital Services, Ministry of Health, Riyadh, Saudi Arabia
| | - Saleh M. Al-Salehi
- grid.449346.80000 0004 0501 7602King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | - Fatimah Alhaidar
- grid.56302.320000 0004 1773 5396Psychiatry Department, Child Psychiatry Unit and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Omar Almodayfer
- grid.415254.30000 0004 1790 7311King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulkarim Alhossein
- grid.56302.320000 0004 1773 5396Department of Special Education, King Saud University, Riyadh, Saudi Arabia
| | - Hesham Aldhalaan
- grid.415310.20000 0001 2191 4301Department of Neurosciences, Center for Autism Research, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Yasser A. Ad-Dab’bagh
- Department of Mental Health, Neuroscience Center, King Faisal Specialist Hospital-Dammam (KFSH-D), Dammam, Saudi Arabia ,Research Center, King Khalid Medical City (RC-KKMC), Dammam, Saudi Arabia
| | - Nouf Al Backer
- grid.56302.320000 0004 1773 5396Department of Pediatrics, Developmental-Behavioral Pediatrics Division, College of Medicine and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Waleed Altwaijri
- grid.415254.30000 0004 1790 7311King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | | | - Maysaa W. Buraik
- grid.415305.60000 0000 9702 165XNeuroscience Institute, Psychiatry Division, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Mohammad Ghaziuddin
- grid.214458.e0000000086837370Department of Psychiatry, University of Michigan, Ann Arbor, USA
| | | | - Hayfaa A. Wahabi
- grid.56302.320000 0004 1773 5396Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
| | - Samia Alhabib
- National Centre for Evidence-Based Health Practice, Saudi Health Council, Riyadh, Saudi Arabia
| | - Amr A. Jamal
- grid.56302.320000 0004 1773 5396Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia ,National Centre for Evidence-Based Health Practice, Saudi Health Council, Riyadh, Saudi Arabia ,grid.56302.320000 0004 1773 5396Family and Community Medicine Department, College of Medicine and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia ,National Centre for Health Information, Saudi Health Council, Riyadh, Saudi Arabia
| | - Yasser S. Amer
- grid.56302.320000 0004 1773 5396Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia ,grid.56302.320000 0004 1773 5396CPG Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia ,grid.56302.320000 0004 1773 5396Pediatrics Department, King Saud University Medical City, Riyadh, Saudi Arabia ,grid.7155.60000 0001 2260 6941Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
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Amer YS, Sabr Y, ElGohary GM, Altaki AM, Khojah OT, El-Malky A, Alzahrani MF. Quality assessment of evidence-based clinical practice guidelines for the management of pregnant women with sickle cell disease using the AGREE II instrument: a systematic review. BMC Pregnancy Childbirth 2020; 20:595. [PMID: 33028233 PMCID: PMC7539517 DOI: 10.1186/s12884-020-03241-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/08/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The management of pregnant women with sickle cell disease (SCD) poses a major challenge for maternal healthcare services owing to the potential for complications associated with morbidity and mortality. Trustworthy evidence-based clinical practice guidelines (CPGs) have a major impact on the positive outcomes of appropriate healthcare. The objective of this study was to critically appraise the quality of recent CPGs for SCD in pregnant women. METHODS Clinical questions were identified and the relevant CPG and bibliographic databases were searched and screened for eligible CPGs. Each CPG was appraised by four independent appraisers using the AGREE II Instrument. Inter-rater analysis was conducted. RESULTS Four eligible CPGs were appraised: American College of Obstetricians and Gynecologists (ACOG), National Heart, Lung, and Blood Institute (NHLBI), National Institute of Health and Care Excellence (NICE), and Royal College of Obstetricians and Gynaecologists (RCOG). Among them, the overall assessments of three CPGs (NICE, RCOG, NHLBI) scored greater than 70%; these findings were consistent with the high scores in the six domains of AGREE II, including:[1] scope and purpose,[2] stakeholder involvement,[3] rigor of development,[4] clarity of presentation,[5] applicability, and [6] editorial independence domains. Domain [3] scored (90%, 73%, 71%), domain [5] (90%, 46%, 47%), and domain [6] (71%, 77%, 52%) for NICE, RCOG, and NHLBI, respectively. Overall, the clinical recommendations were not significantly different between the included CPGs. CONCLUSIONS Three evidence-based CPGs presented superior methodological quality. NICE demonstrated the highest quality followed by RCOG and NHLBI and all three CPGs were recommended for use in practice.
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Affiliation(s)
- Yasser S Amer
- Clinical Practice Guidelines Unit, Quality Management Department, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
- Department of Pediatrics, King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt.
| | - Yasser Sabr
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Prince Sattam Bin Abdul Aziz Research Chair for Epidemiology and Public Health, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ghada M ElGohary
- University Oncology Center, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Internal Medicine and Clinical Hematology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amer M Altaki
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Osamah T Khojah
- Pathology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed El-Malky
- Morbidity and Mortality Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Public Health and Community Medicine Department, Theodor Bilharz Research Institute (TBRI), Academy of Scientific Research, Cairo, Egypt
| | - Musa F Alzahrani
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Wahabi HA, Fayed A, Esmaeil S, Elmorshedy H, Titi MA, Amer YS, Alzeidan RA, Alodhayani AA, Saeed E, Bahkali KH, Kahili-Heede MK, Jamal A, Sabr Y. Systematic review and meta-analysis of the effectiveness of pre-pregnancy care for women with diabetes for improving maternal and perinatal outcomes. PLoS One 2020; 15:e0237571. [PMID: 32810195 PMCID: PMC7433888 DOI: 10.1371/journal.pone.0237571] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 07/30/2020] [Indexed: 12/17/2022] Open
Abstract
Background Pre-gestational diabetes mellitus is associated with increased risk of maternal and perinatal adverse outcomes. This systematic review was conducted to evaluate the effectiveness and safety of pre-conception care (PCC) in improving maternal and perinatal outcomes. Methods Databases from MEDLINE, EMBASE, WEB OF SCIENCE, and Cochrane Library were searched, including the CENTRAL register of controlled trials, and CINHAL up until March 2019, without any language restrictions, for any pre-pregnancy care aiming at health promotion, glycemic control, and screening and treatment of diabetes complications in women with type I or type II pre-gestational diabetes. Trials and observational studies were included in the review. Newcastle-Ottawa scale and the Cochrane collaboration methodology for data synthesis and analysis were used, along with the GRADE tool to evaluate the body of evidence. Results The search identified 8500 potentially relevant citations of which 40 reports of 36 studies were included. The meta-analysis results show that PCC reduced congenital malformations risk by 71%, (Risk ratio (RR) 0.29; 95% CI: 0.21–0.40, 25 studies; 5903 women; high-certainty evidence). The results also show that PCC may lower HbA1c in the first trimester of pregnancy by an average of 1.27% (Mean difference (MD) 1.27; 95% CI: 1.33–1.22; 4927 women; 24 studies, moderate-certainty evidence). Furthermore, the results suggest that PCC may lead to a slight reduction in the risk of preterm delivery of 15%, (RR 0.85; 95% CI: 0.73–0.99; nine studies, 2414 women; moderate-certainty evidence). Moreover, PCC may result in risk reduction of perinatal mortality by 54%, (RR 0.46; 95% CI: 0.30–0.73; ten studies; 3071 women; moderate-certainty evidence). There is uncertainty about the effects of PCC on the early booking for antenatal care (MD 1.31; 95% CI: 1.40–1.23; five studies, 1081 women; very low-certainty evidence) and maternal hypoglycemia in the first trimester, (RR 1.38; 95% CI: 1.07–1.79; three studies; 686 women; very low- certainty evidence). In addition, results of the meta-analysis indicate that PCC may lead to 48% reduction in the risk of small for gestational age (SGA) (RR 0.52; 95% CI: 0.37–0.75; six studies, 2261 women; moderate-certainty evidence). PCC may reduce the risk of neonatal admission to intensive care unit (NICU) by 25% (RR 0.75; 95% CI: 0.67–0.84; four studies; 1322 women; moderate-certainty evidence). However, PCC may have little or no effect in reducing the cesarean section rate (RR 1.02; 95% CI: 0.96–1.07; 14 studies; 3641 women; low-certainty evidence); miscarriage rate (RR 0.86; 95% CI: 0.70–1.06; 11 studies; 2698 women; low-certainty evidence); macrosomia rate (RR 1.06; 95% CI: 0.97–1.15; nine studies; 2787 women, low-certainty evidence); neonatal hypoglycemia (RR 0.93; 95% CI: 0.74–1.18; five studies; 880 women; low-certainty evidence); respiratory distress syndrome (RR 0.78; 95% CI: 0.47–1.29; four studies; 466 women; very low-certainty evidence); or shoulder dystocia (RR 0.28; 95% CI: 0.07–1.12; 2 studies; 530 women; very low-certainty evidence). Conclusion PCC for women with pre-gestational type 1 or type 2 diabetes mellitus is effective in improving rates of congenital malformations. In addition, it may improve the risk of preterm delivery and admission to NICU. PCC probably reduces maternal HbA1C in the first trimester of pregnancy, perinatal mortality and SGA. There is uncertainty regarding the effects of PCC on early booking for antenatal care or maternal hypoglycemia during the first trimester of pregnancy. PCC has little or no effect on other maternal and perinatal outcomes.
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Affiliation(s)
- Hayfaa A. Wahabi
- Research Chair for Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University Medical City and College of Medicine, Riyadh, Saudi Arabia
| | - Amel Fayed
- College of Medicine, Clinical Department, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- High Institute of Public Health, Alexandria University, Alexandria, Egypt
- * E-mail:
| | - Samia Esmaeil
- Research Chair for Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
| | - Hala Elmorshedy
- College of Medicine, Clinical Department, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Maher A. Titi
- Research Chair for Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Patient Safety Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yasser S. Amer
- Research Chair for Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Clinical Practice Guidelines Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Rasmieh A. Alzeidan
- Cardiac Science Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz A. Alodhayani
- Department of Family and Community Medicine, King Saud University Medical City and College of Medicine, Riyadh, Saudi Arabia
| | - Elshazaly Saeed
- Prince Abdulla bin Khaled Coeliac Disease Research Chair, King Saud University, Riyadh, Saudi Arabia
| | | | - Melissa K. Kahili-Heede
- John A. Burns School of Medicine, Health Sciences Library, University of Hawaii at Manoa, Honolulu, HI, United States of America
| | - Amr Jamal
- Research Chair for Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University Medical City and College of Medicine, Riyadh, Saudi Arabia
| | - Yasser Sabr
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Amer YS, Wahabi HA, Abou Elkheir MM, Bawazeer GA, Iqbal SM, Titi MA, Ekhzaimy A, Alswat KA, Alzeidan RA, Al-Ansary LA. Adapting evidence-based clinical practice guidelines at university teaching hospitals: A model for the Eastern Mediterranean Region. J Eval Clin Pract 2019; 25:550-560. [PMID: 29691950 DOI: 10.1111/jep.12927] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 12/15/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Clinical practice guidelines (CPGs) are significant tools for evidence-based health care quality improvement. The CPG program at King Saud University was launched as a quality improvement program to fulfil the international accreditation standards. This program was a collaboration between the Research Chair for Evidence-Based Healthcare and Knowledge Translation and the Quality Management Department. This study aims to develop a fast-track method for adaptation of evidence-based CPGs and describe results of the program. METHODS Twenty-two clinical departments participated in the program. Following a CPGs awareness week directed to all health care professionals (HCPs), 22 teams were trained to set priorities, search, screen, assess, select, and customize the best available CPGs. The teams were technically supported by the program's CPG advisors. To address the local health care context, a modified version of the ADAPTE was used where recommendations were either accepted or rejected but not changed. A strict peer-review process for clinical content and methodology was employed. RESULTS In addition to raising awareness and building capacity, 35 CPGs were approved for implementation by March 2018. These CPGs were integrated with other existing projects such as accreditation, electronic medical records, performance management, and training and education. Preliminary implementation audits suggest a positive impact on patient outcomes. Leadership commitment was a strength, but the high turnover of the team members required frequent and extensive training for HCPs. CONCLUSION This model for CPG adaptation represents a quick, practical, economical method with a sense of ownership by staff. Using this modified version can be replicated in other countries to assess its validity.
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Affiliation(s)
- Yasser S Amer
- Clinical Practice Guidelines Unit, Quality Management Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University Medical Council, Alexandria University, Alexandria, Egypt.,Guidelines International Network, Adaptation Working Group (Steering)
| | - Hayfaa A Wahabi
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Manal M Abou Elkheir
- Pharmacy Services, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Ghada A Bawazeer
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Pharmacy Services, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Shaikh M Iqbal
- Pediatrics Department, King Khalid University Hospital, King Saud University, Hospital, Riyadh, Saudi Arabia.,Department of Pediatrics and Child Health, University of Manitoba, College of Medicine, Manitoba, Canada
| | - Maher A Titi
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Patient Safety Unit, Quality Management Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Aishah Ekhzaimy
- Medicine Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Khalid A Alswat
- Medicine Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Rasmieh A Alzeidan
- Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lubna A Al-Ansary
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Guidelines International Network, Adaptation Working Group (Steering).,Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Health Metrics and Measurement, World Health Organization, Geneva, Switzerland
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Bashiri FA, Hamad MH, Amer YS, Abouelkheir MM, Mohamed S, Kentab AY, Salih MA, Al Nasser MN, Al-Eyadhy AA, Al Othman MA, Al-Ahmadi T, Iqbal SM, Somily AM, Wahabi HA, Hundallah KJ, Alwadei AH, Albaradie RS, Al-Twaijri WA, Jan MM, Al-Otaibi F, Alnemri AM, Al-Ansary LA. Management of convulsive status epilepticus in children: an adapted clinical practice guideline for pediatricians in Saudi Arabia. ACTA ACUST UNITED AC 2019; 22:146-155. [PMID: 28416791 PMCID: PMC5726823 DOI: 10.17712/nsj.2017.2.20170093] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective: To increase the use of evidence-based approaches in the diagnosis, investigations and treatment of Convulsive Status Epilepticus (CSE) in children in relevant care settings. Method: A Clinical Practice Guideline (CPG) adaptation group was formulated at a university hospital in Riyadh. The group utilized 2 CPG validated tools including the ADAPTE method and the AGREE II instrument. Results: The group adapted 3 main categories of recommendations from one Source CPG. The recommendations cover; (i)first-line treatment of CSE in the community; (ii)treatment of CSE in the hospital; and (iii)refractory CSE. Implementation tools were built to enhance knowledge translation of these recommendations including a clinical algorithm, audit criteria, and a computerized provider order entry. Conclusion: A clinical practice guideline for the Saudi healthcare context was formulated using a guideline adaptation process to support relevant clinicians managing CSE in children.
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Affiliation(s)
- Fahad A Bashiri
- Department of Pediatrics, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail:
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Alsohime F, Temsah MH, Al-Eyadhy A, Bashiri FA, Househ M, Jamal A, Hasan G, Alhaboob AA, Alabdulhafid M, Amer YS. Satisfaction and perceived usefulness with newly-implemented Electronic Health Records System among pediatricians at a university hospital. Comput Methods Programs Biomed 2019; 169:51-57. [PMID: 30638591 DOI: 10.1016/j.cmpb.2018.12.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/19/2018] [Accepted: 12/24/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Apposite implementation of Electronic Health Records (EHR) is anchoring standards of care in healthcare settings by reducing long-run operational costs, improving healthcare quality, and enhancing patient safety. OBJECTIVE This study aims to explore factors that might influence Pediatricians' satisfaction with an implemented EHR system and its perceived usefulness at a tertiary-care teaching hospital, Riyadh, Saudi Arabia. METHODS A cross-sectional survey distributed to all physicians working in the pediatric department of King Saud University Medical City (KSUMC) in the period from June to November 2015, two months after the launch of the EHR system, internally branded as electronic system for integrated health information (eSiHi). Bivariate and multivariate regression were analyzed to examine factors associated with physicians' satisfaction. RESULTS Of the 112 physicians who completed the survey, 97 (86.6%) attended training courses before the implementation of new EHR. On average, the participants rated the perceived usefulness of the new system at 6.4/10 for patient care and physicians' satisfaction levels were 5.2/10. The top indicator of EHR usefulness was the system's ability to reduce errors and improve the quality of care [mean 3.31, SD 0.9, RII 82.8%]; the lowest-ranking indicator was the physicians' perceived familiarity with functions and benefits [mean 2.68, SD 0.7, RII 67%]. The top indicator of satisfaction with the EHR system was enhanced "individual performance" [mean 3.04, SD 1, RII 60.9%]; the lowest-ranking perceived indicator was the limited availability of workplace computers [mean 1.91, SD 1.2, RII 38.2%]. CONCLUSIONS Limited data regarding EHR implementation and end-users satisfaction in the Middle East region necessitates further work on factors affecting levels of satisfaction with the EHR system among different health institutes. Lack of information technology (IT) support, hardware, and time-consuming data entry process are challenging barriers for proper utilization of EHR for pediatric health care services.
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Affiliation(s)
- Fahad Alsohime
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Intensive Care Unit, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mohamad-Hani Temsah
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Intensive Care Unit, King Saud University Medical City, Riyadh, Saudi Arabia; Prince Abdullah Ben Khaled Celiac Disease Research Chair, King Saud University, Riyadh, Saudi Arabia.
| | - Ayman Al-Eyadhy
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Intensive Care Unit, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Fahad A Bashiri
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Division of Neurology, Department of Pediatrics, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mowafa Househ
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Amr Jamal
- Family and Community Medicine Department, King Saud University, Riyadh, Saudi Arabia
| | - Gamal Hasan
- Pediatric Intensive Care Unit, King Saud University Medical City, Riyadh, Saudi Arabia; Pediatric Department, Assiut Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ali A Alhaboob
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Intensive Care Unit, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Majed Alabdulhafid
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Intensive Care Unit, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yasser S Amer
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Clinical Practice Guidelines Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia; Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
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Babiker A, Amer YS, Osman ME, Al-Eyadhy A, Fatani S, Mohamed S, Alnemri A, Titi MA, Shaikh F, Alswat KA, Wahabi HA, Al-Ansary LA. Failure Mode and Effect Analysis (FMEA) may enhance implementation of clinical practice guidelines: An experience from the Middle East. J Eval Clin Pract 2018; 24:206-211. [PMID: 29285849 DOI: 10.1111/jep.12873] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 01/12/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Implementation of clinical practice guidelines (CPGs) has been shown to reduce variation in practice and improve health care quality and patients' safety. There is a limited experience of CPG implementation (CPGI) in the Middle East. The CPG program in our institution was launched in 2009. The Quality Management department conducted a Failure Mode and Effect Analysis (FMEA) for further improvement of CPGI. METHODS This is a prospective study of a qualitative/quantitative design. Our FMEA included (1) process review and recording of the steps and activities of CPGI; (2) hazard analysis by recording activity-related failure modes and their effects, identification of actions required, assigned severity, occurrence, and detection scores for each failure mode and calculated the risk priority number (RPN) by using an online interactive FMEA tool; (3) planning: RPNs were prioritized, recommendations, and further planning for new interventions were identified; and (4) monitoring: after reduction or elimination of the failure mode. The calculated RPN will be compared with subsequent analysis in post-implementation phase. RESULTS The data were scrutinized from a feedback of quality team members using a FMEA framework to enhance the implementation of 29 adapted CPGs. The identified potential common failure modes with the highest RPN (≥ 80) included awareness/training activities, accessibility of CPGs, fewer advocates from clinical champions, and CPGs auditing. Actions included (1) organizing regular awareness activities, (2) making CPGs printed and electronic copies accessible, (3) encouraging senior practitioners to get involved in CPGI, and (4) enhancing CPGs auditing as part of the quality sustainability plan. CONCLUSION In our experience, FMEA could be a useful tool to enhance CPGI. It helped us to identify potential barriers and prepare relevant solutions.
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Affiliation(s)
- Amir Babiker
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Abdullah Specialized Children's Hospital, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Yasser S Amer
- Quality Management Department, Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia.,Alexandria Center for Evidence-based Clinical Practice Guidelines, Healthcare Quality Directorate, Alexandria University, Alexandria, Egypt
| | - Mohamed E Osman
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ayman Al-Eyadhy
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Solafa Fatani
- Pharmacy Services Department, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Sarar Mohamed
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Prince Sultan Military Medical City, Pediatrics Department Riyadh, Saudi Arabia
| | - Abdulrahman Alnemri
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Maher A Titi
- Quality Management Department, Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
| | - Farheen Shaikh
- Quality Management Department, King Saud University, Riyadh, Saudi Arabia.,Administration of Clinical Projects, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Khalid A Alswat
- Quality Management Department, King Saud University, Riyadh, Saudi Arabia.,Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hayfaa A Wahabi
- Family and Community Medicine Department, Research Chair for Evidence-Based Health Care and Knowledge Translation, College of Medicine, King Saud University, Saudi Arabia
| | - Lubna A Al-Ansary
- Family and Community Medicine Department, Research Chair for Evidence-Based Health Care and Knowledge Translation, College of Medicine, King Saud University, Saudi Arabia
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Anwer MA, Al-Fahed OB, Arif SI, Amer YS, Titi MA, Al-Rukban MO. Quality assessment of recent evidence-based clinical practice guidelines for management of type 2 diabetes mellitus in adults using the AGREE II instrument. J Eval Clin Pract 2018; 24:166-172. [PMID: 28948654 DOI: 10.1111/jep.12785] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/25/2017] [Accepted: 05/25/2017] [Indexed: 12/20/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Type 2 diabetes mellitus (T2DM) is a worldwide and national public health problem that has a great impact on the population in Saudi Arabia. High-quality clinical practice guidelines (CPGs) are cornerstones in improving the health care provided for patients with diabetes. This study evaluated the methodological rigour, transparency, and applicability of recently published CPGs. METHODS Our group conducted a systematic search for recently published CPGs for T2DM. The searching and screening for Source CPGs were guided by tools from the ADAPTE methods with specific inclusion/exclusion criteria. Five reviewers using the second version of the Appraisal of Guidelines for Research and Evaluation (AGREE II) Instrument independently assessed the quality of the retrieved Source CPGs. RESULTS Domains of Scope and purpose and Clarity of presentation received the highest scores in all CPGs. Most of the assessed CPGs (86%) were considered with high overall quality and were recommended for use. Rigour of development and applicability domains were together highest in 3 CPGs (43%). The overall high quality of DM CPGs published in the last 3 years demonstrated the continuous development and improvement in CPG methodologies and standards. CONCLUSIONS Health care professionals should consider the quality of any CPG for T2DM before deciding to use it in their daily clinical practice. Three CPGs have been identified, using the AGREE criteria, as high-quality and trustworthy. Ideally, the resources provided by the AGREE trust including the AGREE II Instrument should be used by a clinician to scan through the large number of published T2DM CPGs to identify the CPGs with high methodological quality and applicability.
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Affiliation(s)
- Muhammad A Anwer
- Family and Community Medicine Department, FCM CPG Departmental Committee, King Saud University, Riyadh, Saudi Arabia
| | - Ousama B Al-Fahed
- Family and Community Medicine Department, FCM CPG Departmental Committee, King Saud University, Riyadh, Saudi Arabia
| | - Samir I Arif
- Family and Community Medicine Department, FCM CPG Departmental Committee, King Saud University, Riyadh, Saudi Arabia
| | - Yasser S Amer
- Quality Management Department, CPG Steering Committee, Research Chair for Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia.,Alexandria Center for Evidence-based Clinical Practice Guidelines, Healthcare Quality Directorate, Alexandria University, Alexandria, Egypt
| | - Maher A Titi
- Quality Management Department, CPG Steering Committee, Research Chair for Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed O Al-Rukban
- Family and Community Medicine Department, FCM CPG Departmental Committee, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Altokhais TI, Al-Obaid OA, Kattan AE, Amer YS. Assessment of implementability of an adapted clinical practice guideline for surgical antimicrobial prophylaxis at a tertiary care university hospital. J Eval Clin Pract 2017; 23:156-164. [PMID: 27807920 DOI: 10.1111/jep.12658] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 08/28/2016] [Accepted: 08/29/2016] [Indexed: 12/24/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Surgical site infections are the most common healthcare-associated infections. Appropriate surgical antimicrobial prophylaxis (SAP), which is an integral part of surgical site infection SSI prevention, is one of the major preventable risks to surgical patient safety. Several clinical practice guidelines (CPGs) for SAP have been published. The aim of this study was to adapt a CPG for SAP and to assess its implementability. METHODS The methodology was based on two validated tools for CPGs, namely, the ADAPTE and the Guideline Implementability Appraisal (GLIA). RESULTS The ADAPTE CPG adaptation process methodology was utilized to produce an adapted CPG for SAP based on the American Society of Health System Pharmacists 2013 CPG. The finalized CPG was then assessed to identify any possible intrinsic barriers for implementation. CONCLUSIONS In conclusion, the ADAPTE tool is a practical and successful tool for production of CPGs. The GLIA tool is useful for assessing and preparing the finalized adapted CPG for the transition from the production stage to the implementation stage. GLIA could be added to the ADAPTE process either as a final step or to check the draft of the CPG before finalization.
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Affiliation(s)
- Tariq I Altokhais
- Division of Pediatric Surgery, Department of Surgery, Surgery Departmental CPG Committee, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Omar A Al-Obaid
- Division of Colorectal Surgery, Department of Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah E Kattan
- Division of Plastic Surgery, Department of Surgery, Surgery Departmental Quality Team, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Yasser S Amer
- Quality Management Department, CPG Steering Committee, Research Chair for Evidence-based Health Care and Knowledge Translation, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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- King Saud University Medical City, Riyadh, Saudi Arabia
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Abstract
Abstract
Background: Our aim was to adapt recommendations from high-quality, evidence-based clinical practice guidelines (CPGs) for central vascular access device (CVAD) insertion, management, and removal in King Saud University Medical City. Currently, the hospital has a policy and procedure for CVAD insertion; however, the methodology of creating the policy document was not evidence-based, and the clinical content was not up to date. A new CPG will guide the revision of CVAD policies and procedures and eliminate variation in clinician practices.
Methods: The King Saud University Medical City CPG Committee introduced the modified ADAPTE process methodology for adaptation and implementation of CPGs originally developed by the ADAPTE Collaboration.
Results: The final decision of the panel after full assessment of 2 selected source CPGs was to adopt all Centers for Disease Control and Prevention CPG recommendations and some essential sections from the Infusion Nurses Society CPG recommendations. In addition, the team developed new implementation tools.
Conclusions: The ADAPTE process is an excellent scientific and rigorous process for CPG adaptation and clinical performance improvement. It can be further adapted according to the local context and resources to promote a sense of ownership of the adapted CPG. Furthermore, new CPGs will have a positive effect on hospital-wide accreditation processes and local benchmarking of health care quality outcomes.
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Alzeidan RA, Wahabi HA, Fayed AA, Esmaeil SA, Amer YS. Postpartum rubella vaccination for sero-negative women. Cochrane Database of Systematic Reviews 2013. [DOI: 10.1002/14651858.cd010752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rasmieh A Alzeidan
- King Saud University; Chair of Evidence-Based Healthcare and Knowledge Translation; Riyadh Saudi Arabia 11451
| | - Hayfaa A Wahabi
- King Saud University; Chair of Evidence-Based Healthcare and Knowledge Translation; Riyadh Saudi Arabia 11451
| | - Amel A Fayed
- King Saud bin Abdul Aziz University for Health Science; Basic Science, College of Medicine; Khurais Road, King Abdul Aziz Medical City Riyadh Saudi Arabia 11426
| | - Samia A Esmaeil
- King Saud University; Chair of Evidence-Based Healthcare and Knowledge Translation; Riyadh Saudi Arabia 11451
| | - Yasser S Amer
- King Saud University ? College of Medicine and King Khalid University Hospital; Quality Management Department; , PO Box 7805 (Internal 66) Riyadh Saudi Arabia 11472
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