Critical review of clinical practice guidelines for evaluation of neck mass in adults / Revisão crítica das diretrizes de prática clínica para avaliação de massas cervicais em adultos

Abstract Objective: Several clinical practice guidelines have been produced and disseminated for the evaluation of a neck mass. However, to date, the quality and methodologic rigor of these clinical practice guidelines have not been appraised. Therefore, this study set out to identify and assess the methodologic quality of national and international guidelines for the evaluation and management of neck masses in adults. Methods: We conducted a comprehensive search of EMBASE, MEDLINE/PubMed, SCOPUS and grey literature sources until September 2020. The quality of these guidelines was assessed by four reviewers using the Appraisal of Guidelines for Research and Evaluation, 2nd edition (AGREE II). Domain scores were considered acceptable quality if they scored >60%, and Intraclass Correlation Coefficients (ICC) were calculated to assess agreement among the appraisers. Results: Seven guidelines were assessed for evaluation. Among these, only the American Academy of Otolaryngology (AAO), Cancer Care Manitoba (CCMB), and the American Society of Clinical Oncology (ASCO) achieved an overall rating of ‟high". The remaining four guidelines achieved ratings of either ‟average" or ‟low". The ‟Scope and Purpose" domain achieved the highest mean score (94.4%±5.0%), and lowest was ‟Applicability" (51.5%±29.2%). ICC analysis showed substantial to very good agreement across all domains (0.75-0.98). Conclusion: These findings highlight the variability in methodologic quality of guidelines for the evaluation and management of adult neck mass. The results from this analysis highlight the need to improve guidelines development process for this topic and may guide the selection and use of these guidelines in clinical practice.

Resumo Introdução: Várias diretrizes de práticas clínicas foram produzidas e divulgadas para a avaliação de massa cervical. Porém, até o momento, a qualidade e o rigor metodológico dessas diretrizes de práticas clínicas não foram avaliados. Objetivo: Identificar e avaliar a qualidade metodológica das diretrizes nacionais e internacionais para a avaliação e tratamento de massas cervicais em adultos. Método: Fizemos uma pesquisa abrangente das fontes de dados Embase, Medline/PubMed, Scopus e literatura cinza até setembro de 2020. A qualidade dessas diretrizes foi avaliada por quatro revisores com a 2a edição do Appraisal of Guidelines for Research and Evaluation (AGREE II). Os escores dos domínios foram considerados de qualidade aceitável se pontuassem >60% e os coeficientes de correlação intraclasse (Intraclass correlation coefficient - ICC) foram calculados para avaliar a concordância entre os avaliadores. Resultados: Sete diretrizes foram investigadas para avaliação. Entre elas, apenas a American Academy of Otolaryngology (AAO), o Cancer Care Manitoba (CCMB) e a American Society of Clinical Oncology (ASCO) obtiveram uma classificação geral ‟alta". As quatro diretrizes restantes obtiveram classificações ‟media" ou ‟baixa". O domínio ‟Escopo e objetivo'" obteve o maior escore médio (94,4% ± 5,0%) e o domínio ‟Aplicabilidade" obteve o menor escore (51,5%±29,2%). A análise ICC mostrou concordância substancial a muito boa em todos os domínios (0,75-0,98). Conclusão: Esses achados destacam a variabilidade na qualidade metodológica das diretrizes para avaliação e tratamento de massa cervical em adultos. Os resultados dessa análise destacam a necessidade de melhorar o processo de desenvolvimento de diretrizes para esse tópico e podem orientar a seleção e o uso dessas diretrizes na prática clínica.

Systematic Identification and Critical Appraisal of Pediatric COVID-19 Guidelines Applicable in India

Objective To systematically identify and critically appraise the methodological quality of pediatric guidelines applicable to management of COVID-19 in India. Methods Pediatric COVID-19 guidelines applicable to India, published until 30 April 2021, were identifed through a systematic search across ten databases. Each was critically appraised for methodological quality using the AGREE-II tool, by at least two appraisers. Median (interquartile range) of the total score and domain-wise scores were calculated, and compared for Indian vs. foreign guidelines, updated vs. original versions of guidelines, and those developed earlier vs. later in the pandemic. Results A total of 62 guidelines was identifed. Only 8 (12.9%) were published in India. The overall AGREE-II score ranged from 4.7% to 72.8%; with median (IQR) 37.9% (29.4, 48.6). This suggested overall low(er) methodological quality. The median (IQR) domain-wise scores were as follows: Scope and Purpose 66.7% (58.3, 83.3), Stakeholder Involvement 41.7% (30.6, 83.3), Rigor of Development 23.4% (14.8, 37.5), Clarity of Presentation 59.7% (50.0, 75.0), Applicability 27.1% (18.8, 33.3), and Editorial Independence 8.3% (0.0, 45.8). This suggested diversity in quality of diferent aspects of the guidelines, with very low quality in the critical domain of methodological rigor. There were no statistically signifcant diferences in the overall scores of Indian vs. foreign guidelines, updated versions vs. original versions, and those developed earlier vs. later in the pandemic. Conclusion The currently available pediatric COVID-19 guidelines have low methodological quality, adversely afecting their credibility, validity, and applicability. Urgent corrective strategies are presented for consideration.

Guía de práctica clínica para el manejo de Diabetes Mellitus Tipo 2 en pacientes con falla cardiaca del Hospital Nacional Daniel Alcides Carrión (Callao, Perú) / Clinical Practice Guideline for the management of Type 2 Diabetes Mellitus in patients with Heart Failure at Daniel Alcides Carrion National Hospital (Callao, Peru)

Objetivo: Emitir recomendaciones para el manejo de la diabetes en pacientes con falla cardiaca, contextualizadas al Hospital Nacional Daniel Alcides Carrión (HNDAC) del Callao, Perú. Material y métodos: Se buscó sistemáticamente las GPC publicadas en los últimos 3 años en bases de datos, repositorios y organismos elaboradores. Se seleccionó aquellas que alcancen un puntaje >60% en la evaluación global con el instrumento AGREE-II. De cada guía se extrajeron las recomendaciones con sus respectivas preguntas clínicas. La aceptabilidad y aplicabilidad de las recomendaciones al contexto del HNDAC fueron evaluadas por médicos especialistas mediante la matriz ADAPTE. La dirección del HNDAC emitió una resolución directoral de la GPC con la versión final del documento. Resultados: De 26 GPC, 3 cumplieron requisitos: Diabetes Canadá 2018, SIGN 2017 y ESC/EASD 2019. Se adoptaron 9 recomendaciones. Los Inhibidores SGLT-2 fueron de primera elección, luego los GLP-1 e inhibidores DPP4, por último, insulina y metformina. Tanto tiazolidinedionas, saxagliptinas y sulfonilureas están contraindicadas. Conclusiones: Mediante un proceso de adopción y contextualización, se elaboró una GPC para el manejo de la diabetes mellitus tipo 2 en pacientes con falla cardiaca.

Objetive:To issue contextualized recommendations for the management of type 2 diabetes mellitus in patients with heart failure. GPC published in the last 3 Materials and methods:years were systematically searched in databases, repositories, and guideline development organizations. Those that achieve a score >60% in the overall evaluation with the AGREE-II instrument were selected. From each guide, the recommendations with theirrespectiveclinicalquestionwereextracted.The acceptability and applicability of the recommendations to the Peruvian context were evaluated by medical specialists from different institutions in the country (MINSA, EsSalud and armed forces) using the ADAPTE matrix. The final version of the document was approved by a directorial resolution in the "Daniel Alcides Carrión" National Hospital. Of 26 GPC, 3 met Results:therequirements:DiabetesCanada2018,SIGN2017and ESC/EASD 2019. Nine recommendations were adopted. SGLT-2 inhibitors were first choice in treatment, then GLP-1 and DPP4 inhibitors, finally insulin and metformin. Both thiazolidinedions, saxagliptins and sulfonylureas are contraindicated. Conclusions:Through a process of adoption and contextualization, a GPC was developed for the management of type 2 diabetes mellitus in patients with heart failure.

Evaluation and comparison of practice guidelines and consensus on type 2 diabetes: a systematic appraisal / 中国药学杂志

OBJECTIVE: To evaluate the quality of now available clinical guidelines and consensus statements on type 2 diabetes. Based on this assessment, the comparison of guidelines and consensuses is made to give some suggestions on the methods of making these documents. METHODS: PubMed, Embase, CNKI, Wanfang, SinoMed and guideline websites were systematically searched. Literatures were screened according to defined criteria for including. AGREE II was used to instrument assess the quality of the guidelines and consensuses. RESULTS: The result showed that the quality of included guidelines is various, but the overall quality of guidelines is still higher than consensuses. Guidelines got high scores in scope and purpose domain and clarity of presentation domain, but low scores in rigor of development domain and applicability domain. Consensus statements got low scores in all 6 domains. CONCLUSION: The main reason for the difference is consensuses have poor methodology. Rapid advice guidelines were suggested as an alternative for consensus statements.

Methodological Quality Appraisal of 27 Korean Guidelines Using a Scoring Guide Based on the AGREE II Instrument and a Web-based Evaluation

This study evaluated the methodological quality of CPGs using the Korean AGREE II scoring guide and a web-based appraisal system and was conducted by qualified appraisers. A total of 27 Korean CPGs were assessed under 6 domains and 23 items on the AGREE II instrument using the Korean scoring guide. The domain scores of the 27 guidelines were as following: the mean domain score was 82.7% (median 84.7%, ranging from 55.6% to 97.2%) for domain 1 (scope and purpose); 53.4% (median 56.9%, ranging from 11.1% to 95.8%) for domain 2 (stakeholder involvement); 63.0% (median 71.4%, ranging from 13.5% to 90.6%) for domain 3 (rigor of development); 88.9% (median 91.7%, ranging from 58.3% to 100.0%) for domain 4 (clarity of presentation); 30.1% (median 27.1%, ranging from 3.1% to 67.7%) for domain 5 (applicability); and 50.2% (median 58.3%, ranging from 0.0% to 93.8%) for domain 6 (editorial independence). Three domains including scope and purpose, rigor of development, and clarity of presentation were rated at more than 60% of the scaled domain score. Three domains including stakeholder involvement, applicability, and editorial independence were rated at less than 60% of the scaled domain score. Finally, of the 27 guidelines, 18 (66.7%) were rated at more than 60% of the scaled domain score for rigor of development and were categorized as high-quality guidelines.

Guías de práctica clínica en esquizofrenia: evaluación mediante AGREE II / Clinical Practice Guidelines for Management of Schizophrenia: Evaluation Using AGREE II

Introducción: Colombia se encuentra en estos momentos en la realización de guías de práctica clínica para el tratamiento de diversas patologías. Las guías de práctica clínica representan una herramienta al alcance del clínico para la toma de decisiones sobre sus pacientes. En psiquiatría se dispone internacionalmente de práctica clínica para esquizofrenia, no obstante no se dispone de una guía colombiana ni de una apreciación de las guías desarrolladas en el mundo sobre esta patología. Método: En el marco del desarrollo de la Guía de práctica clínica sobre esquizofrenia para Colombia se realiza una búsqueda sistemática sobre GPC en diversas bases y se evalúan empleando la herramienta AGREE II por parte de 2 personas entrenadas para ello. Se presentan los resultados de esta fase de manera global y por dominios. Resultados: Se encontraron 164 resultados de posibles guías, de las cuales se evalúan finalmente 7 mediante AGREE II. Por dominios y calificación global la guía realizada por el National Institute for Health and Care Excellence (NICE) obtuvo el mejor puntaje. De las guías evaluadas, únicamente dos eran de América Latina y la mayoría (cuatro) de Europa. Solamente una de las guías evaluadas utilizó el abordaje GRADE para evaluar la calidad de la evidencia y formular las recomendaciones. Conclusión: La diversidad de guías encontrados sobre esquizofrenia no permite una fácil adopción ni adaptación de alguna guía por el médico psiquiatra de acuerdo con los parámetros que se han planteado para Colombia.

Introduction: Colombia is developing multiple national practice guidelines from a range of diseases. Clinical practice guidelines represent a very useful tool to be able to take decision over a patient care that is widely available for the clinician. In psychiatry there are a good number of international clinical guidelines for the treatment of schizophrenia nevertheless there is no article that evaluate them scientifically. Methods: In the settings of developing a Colombian schizophrenia practice guideline, a sys tematic search was performed in multiple databases and the results were then evaluated by two trained persons. We present the results globally and by domains. Results: We found 164 matches for possible guidelines. After screening 7 guidelines were evaluated with the AGREE IIinstrument. Globally and by the different domains, the National Institute for Health and Care Excellence (NICE) was the guideline that got the best score. From the guidelines that were reviewed, 4 were from Europe and only 2 were from Latin America. None of the guidelines used GRADE methodology for the recommendations. Conclusion: The diversity of the schizophrenia treatment guidelines does not allow an easy adoption of the recommendation by a psychiatrist in Colombia.