Critical appraisal of quality of clinical practice guidelines for treatment of psoriasis vulgaris, 2006-2009.

Numerous international clinical guidelines for management of psoriasis have recently been published. We evaluated the quality of guidelines published between 2006 and December 2009 using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. Eight guidelines from five separate working groups fulfilled inclusion criteria and were evaluated. Four used the standards established by the AGREE instrument in the process of development of their guidelines. Each of the guidelines uniformly received high domain scores (i.e., > 90%) for scope and purpose (range of 94-100%), and clarity and presentation (range of 92-100%). Nevertheless, each of the eight guidelines had important shortcomings (item scores < or = 2/4, in which 4 indicates strongly agree and 1 indicates strongly disagree that specific items have been adequately addressed) in at least one item including: stakeholder involvement (by lack of piloting and inadequate determination of patient views), development rigor (inadequate procedure for updating), applicability (by lack of discussion on organizational barriers), and editorial independence (from funding body). Despite the use of predefined standards in their development, important deficiencies exist in the most recent clinical treatment guidelines for psoriasis.

Beyond standard quality of life measures: the subjective experiences of living with inflammatory bowel disease.

INTRODUCTION: In order to facilitate our understanding of health-related quality of life (HRQoL) for inflammatory bowel disease (IBD) patients, it is critical to explore their subjective experiences with the disease. Research has suggested that current modes of assessing HRQoL (i.e., generic and disease-specific measures) may not fully represent all dimensions of patients' HRQoL. The purpose of this study was to examine IBD patients' subjective experiences of the daily impact of IBD, and categorize dimensions of their HRQoL affected by IBD, as identified by the patients themselves. METHODS: Two hundred and eighty-two patients with IBD provided answers to the qualitative question "How has IBD affected your daily activities?" A content analysis using NVivo 2.0 was conducted on the participants' responses to this question to reveal dimensions of their HRQoL. RESULTS: The analysis yielded six dimensions and several subdimensions of HRQoL, including physical (systemic functioning, daily functioning, energy/vitality, pain), emotional, social, cognitive (functioning, attending to disease), self-regulation (taking control, loss of control, and neutral), and practical functioning. DISCUSSION: These results reflect previous findings, but also reveal several dimensions of HRQoL not included in current measures of HRQoL for IBD patients (i.e., cognitive, self-regulation, and practical). The implications of these findings for future measurement of HRQoL and research with IBD patients are discussed.