Article

A critical appraisal of the quality of critical care pharmacotherapy clinical practice guidelines and their strength of recommendations

Department of Pharmacy, Capital District Health Authority, College of Pharmacy, Dalhousie University, c/o Rm 2043 Victoria Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
Intensive Care Medicine (Impact Factor: 7.21). 03/2010; 36(10):1636-43. DOI: 10.1007/s00134-010-1786-8
Source: PubMed

ABSTRACT

Clinical practice guideline (CPG) quality assessment is important before applying their recommendations. Determining whether recommendation strength is consistent with supporting quality of evidence is also essential. We aimed to determine quality of critical care pharmacotherapy CPGs and to assess whether high quality evidence supports strong pharmacotherapy recommendations.
MEDLINE (1966-February 2008), EMBASE (1980-February 2008), National Guideline Clearinghouse (February 2008) and personal files were searched to identify CPGs. Four appraisers evaluated each guideline using the appraisal of guidelines, research and evaluation (AGREE) instrument. AGREE assesses 23 items in six domains that include scope/purpose, stakeholder involvement, rigor of development, clarity, applicability and editorial independence. Standardized domain scores (0-100%) were determined to decide whether to recommend a guideline for use. One appraiser extracted strong pharmacotherapy recommendations and supporting evidence quality.
Twenty-four CPGs were included. Standardized domain scores were clarity [69% (95% confidence interval (CI) 62-76%)], scope/purpose [62% (95% CI 55-68%)], rigor of development [51% (95% CI 42-60%)], editorial independence [39% (95% CI 26-52%)], stakeholder involvement [32% (95% CI 26-37%)] and applicability [19% (95% CI 12-26%)]. The proportion of guidelines that could be strongly recommended, recommended with alterations and not recommended was 25, 37.5 and 37.5%, respectively. High quality evidence supported 36% of strong pharmacotherapy recommendations.
Variation in AGREE domain scores explain why one-third of critical care pharmacotherapy CPGs cannot be recommended. Only one-third of strong pharmacotherapy recommendations were supported by high quality evidence. We recommend appraisal of guideline quality and the caliber of supporting evidence prior to applying recommendations.

Download full-text

Full-text

Available from: Peter J Zed
  • Source
    • "In this study, we found that the quality of EB guideline in TCM for RA management was higher than that of CB–EB and CB guideline, as well as the recommendations from the EB were more recommended by the CPGs than those from the CB–EB and CB guidelines. Like CPG development in biomedicine, EB guideline development in TCM should be the right direction [21] [22] [23] [24], and more and more clinical evidence would give much help in the future CPG development in TCM. EB guideline is the mainstream and trend of guideline development, because guidelines based on a consensus of expert opinion or on unsystematic literature survey have been criticized as not reflecting current medical knowledge and being liable to bias [25] [26], and EB guidelines have better quality than CB and CB–EB guidelines [14]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction An increasing number of clinical practice guidelines (CPGs) in traditional Chinese medicine (TCM) for rheumatoid arthritis (RA) were issued, and all were developed in China. However it is not clear about their quality. This study is aimed to systematically review the quality and consistency of recommendations on the TCM CPGs for RA management with AGREE II instrument. Methods TCM CPGs identified from five electronic databases and hand searches through related handbooks published between January 1990 and December 2012. The CPG were categorized into Evidence Based (EB) guideline, Consensus Based with no explicit consideration of Evidence Based (CB-EB) guideline and Consensus Based (CB) guideline according to the method reported previously. Four reviewers independently appraised the CPGs based on the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument, and compared the recommendation on TCM pattern (Zheng) classification and treatment. Results Five TCM CPGs were satisfied the inclusion criteria. The quality score of EB guideline was higher than CB-EB and CB guidelines. Five TCM patterns in the CPGs were recommended in the EB CPG. The herbal preparations including Tripterygium wilfordii recommended in the EB CPG were mostly recommended for RA treatment. The recommendations on non-drug management in the CPGs were fairly consistent, and the recommendations are different based on the different TCM patterns accordingly. Conclusions EB CPG for RA treatment in TCM show higher quality with measurement of AGREE II instrument, and it suggested that TCM CPG could be better developed with clinical evidence.
    Full-text · Article · Apr 2014 · European Journal of Integrative Medicine
  • Source

    Preview · Article · Oct 2010 · Intensive Care Medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Clinical Practice Guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. The Ministry of Health published 67 primary care guidelines in 2003. Considering the expected effect of CPGs on clinical practice, we could assume that the quality of such guidelines would have an effect on the quality of health care practice. However, there is only very limited knowledge available regarding evidence based practice in Turkey and no known study related to the published CPGs, their use or their quality. In this study, we assessed the quality of existing primary care CPGs, by using "The Appraisal of Guidelines Research & Evaluation (AGREE) Instrument". Methods: 14 guidelines were selected based on the top ten conditions in "The Burden of Disease Study" of 2004. The AGREE Instrument was translated into Turkish. The quality of the guidelines was assessed by 4 appraisers. Results: The mean rating scores of the domains, based on the AGREE Instrument were; Scope and purpose: 87.9%, stakeholder involvement: 62.2%, rigour of development: 51.2%, clarity and presentation: 66.4%, applicability: 57.2% and editorial independency: 54.5%. 6 guidelines out of 14 were recommended by all the appraisers, whereas 8 were not recommended at least by one of the appraisers. Conclusions: This is the first study of appraising quality of published guidelines in Turkey. This study is valuable for indicating the quality of current published guidelines and adds to the limited amount of knowledge in Turkey about how to improve guidelines.
    No preview · Article · Jan 2011 · Healthmed
Show more