A review of quality assessment of the methodology used in guidelines and systematic reviews on oral mucositis
ABSTRACT The objective of this study was to identify and to assess the quality of evidence-based guidelines and systematic reviews we used in the case of oral mucositis, to apply general quality criteria for the prevention and treatment of oral mucositis in patients receiving chemotherapy, radiotherapy or both.
Literature searches were carried out in several electronic databases and websites. Publications were included if they concerned oral mucositis involving adults treated for cancer and had been published after 1 January 2000. As far as systematic reviews were concerned, the article had to report a search strategy, if the search was minimally conducted in the database PubMed or Medline and the articles included in the review were subjected to some kind of methodological assessment. The Appraisal of Guidelines for Research and Education (AGREE) instrument was used to assess the quality of the guidelines and the Overview Quality Assessment Questionnaire (OQAQ) was used for the quality of systematic reviews.
Thirty-one articles met the inclusion criteria of which 11 were guidelines and 20 were systematic reviews. Nine of the 11 guidelines did not explicitly describe how they identified, selected and summarised the available evidence. Reviews suffered from lack of clarity, for instance, in performing a thorough literature search. The quality varied among the different guidelines and reviews.
Most guidelines and systematic reviews had serious methodological flaws.
There is a need to improve the methodological quality of guidelines and systematic reviews for the prevention and treatment of oral mucositis if they are to be used in clinical practice.
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ABSTRACT: Despite the availability and daily use of computerized drug-drug interaction surveillance systems, exposure to potentially relevant drug-drug interactions (DDIs) continues. DDI management guidelines are often inadequate and clear management options are lacking, which attributes to overriding of DDI signals. Although general criteria for the development and reporting of high-quality clinical practice guidelines have been identified, it appears these have not yet been applied to DDI management guidelines. The aim of the study was to assess the clarity and applicability of guidelines for the management of potentially harmful DDIs. We selected 13 DDIs that are potentially harmful for patients and frequently occur in community pharmacy practice in the Netherlands. The clarity and applicability of the management guidelines of these DDIs were appraised using the appropriate two domains - 'Clarity and presentation' and 'Applicability', of the validated Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. The appraisal was performed by 12 community pharmacists and 12 general practitioners. The standardized domain scores and mean item scores for 'Clarity and presentation' and 'Applicability' were compared. All DDI management guidelines were generally found to score well on 'Clarity and presentation', but poorly with respect to 'Applicability' (standardized domain scores 68.0 vs 26.1%). Within the domain 'Clarity and presentation', the item 'tools for application' received the lowest scores. Within the domain 'Applicability', cost implications, organizational barriers and key review criteria were all poorly documented. All guidelines presented non-directive advice using words such as 'consider' and 'regularly'. Developers of DDI management guidelines should take the appropriate domains of the AGREE Instrument into consideration in their development processes. The applicability of DDI management guidelines should be pretested before publishing. To improve guideline quality, more attention should particularly be paid to the available tools for applications and cost implications.Drug Safety 08/2011; 34(8):683-90. DOI:10.2165/11587270-000000000-00000 · 2.62 Impact Factor
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ABSTRACT: Objective: To evaluate the reporting and methodological quality of overviews of systematic reviews. Method: We developed an 18-item assessment tool for overviews of systematic reviews. We then performed a systematic search for such overviews using the terms ('overview' AND ('meta analys*' OR 'systematic review*')) OR 'umbrella review' in the title. We only included those overviews that were limited to systematic reviews or meta-analyses. Their methodological and reporting quality were assessed by two independent reviewers using the checklist, and differences were resolved by a third reviewer. Data analyses was conducted by SPSS version 15.0 for Windows. Results: We identified 41 overviews of systematic reviews whose mean total reporting score was 10.78 (SD 3.84) and methodological score 3.05 (SD 2.09). Some important items were not adequately reported: only 69% reported defined eligibility criteria, 76% reported search strategy, 49% reported the process of review selection, 44% reported the data collection process, 5% reported evaluating the reporting quality, 46% reported evaluating methodological quality, and 20% reported assessing the evidence level for each outcome. Conclusion: The reporting and methodological quality of overviews of systematic reviews was very poor, and there is still much room for improvement. A checklist for overviews of systematic reviews should be developed and used.Journal of Evidence-Based Medicine 08/2012; 5(3):166-173. DOI:10.1111/j.1756-5391.2012.01185.x
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ABSTRACT: To present a clinical update of evidence that applies to the development of a nursing plan of care for the prevention and treatment of oral mucositis related to cytotoxic therapy. Research studies, review articles, evidence-based guidelines, web-based material, and clinical experience. Although high-level research evidence regarding mucositis remains limited, more is known now than at the time of the original article 4 years ago. Use of multiple types of evidence in developing a structured plan of care facilitates improved patient outcomes and the advancement of the current body of knowledge toward the shared health care professional goal of improved patient outcomes. Nurses play a key role in the identification and use of evidence to guide the care of patients at risk for cytotoxic therapy-related oral mucositis.Seminars in Oncology Nursing 11/2011; 27(4):e1-16. DOI:10.1016/j.soncn.2011.08.001