E839C linical practice guidelines, which are systematically developed statements aimed at helping people make clinical, policy-related and system-related decisions, 1,2 frequently vary widely in quality. 3,4 A strategy was needed to differentiate among guidelines and ensure that those of the highest quality are implemented.An international team of guideline developers and researchers, known as the AGREE Collaboration (Appraisal of Guidelines, Research and Evaluation), was established to create a generic instrument to assess the process of guideline development and reporting of this process in the guideline. Based on rigorous methodologies, the result of the collaboration's efforts was the original AGREE instrument, which is a 23-item tool comprising six quality-related domains that was released in 2003 (www.agreetrust.org).As with any new assessment tool, ongoing development was required to improve its measurement properties, usefulness to a range of stakeholders and ease of implementation. Over the years, a number of issues were identified. For example, the original four-point response scale used to answer each item of the AGREE instrument is not in compliance with methodologic standards of health measurement design. This noncompliance threatens the performance and reliability of the instrument. 5 In addition, data on the usefulness of the AGREE items has never been gathered systematically from the perspectives of different groups of users. Further, we were interested in identifying strategies to make the evaluation process more efficient, such as reducing the number of items or the number of required raters, while ensuring the instrument was reliable and valid. Therefore, an exploration of the role of shorter versions of the AGREE instrument, comprising fewer items that are tailored to the unique priorities of different stakeholders, was warranted. Finally, there was a need to establish the fundamentals of construct validity -in other words, whether the AGREE items could measure what they purport to measure, and that is variability in quality of practice guidelines. Redesign of AGREEIn response to these issues, the AGREE Next Steps Consortium was established and undertook two studies.6,7 As part of the first study, the consortium introduced a new seven-point response scale and evaluated its performance and measurement properties, analyzed the usefulness of the AGREE items for decisions made by different stakeholders, and systematically elicited stakeholders' recommendations for changes to the AGREE items and domains. 6 In the second study, the consortium evaluated the construct validity of the tool and designed and evaluated new supporting documentation aimed at facilitating efficient and accurate use of the tool. 7The following key findings emerged from the two studies:• Ratings of the quality of the AGREE domains are good predictors of outcomes associated with implementation of guidelines. 6• Participants (i.e., guideline developers or researchers, policy-makers, and clinicians) evaluated AGREE items and dom...

A need was identified for a fixed-format self-complete questionnaire for measuring health in chronic airflow limitation. A 76-item questionnaire was developed, the St. George's Respiratory Questionnaire (SGRQ). Three component scores were calculated: symptoms, activity, and impacts (on daily life), and a total score. Three studies were performed. (1) Repeatability was tested over 2 wk in 40 stable asthmatic patients and 20 patients with stable COPD. The coefficient of variation for the SGRQ total score was 19%. (2) SGRQ scores were compared with spirometry, 6-min walking distance (6-MWD), MRC respiratory symptoms questionnaire, anxiety, depression, and general health measured using the Sickness Impact Profile score. A total of 141 patients were studied, mean age 63 yr (range 31 to 75) and prebronchodilator FEV1, 47% (range 11 to 114%). SGRQ scores correlated with appropriate comparison measures. For example, symptom score versus frequency of wheeze, r2 = 0.32, p less than 0.0001; activity versus 6-MWD, r2 = 0.50, p less than 0.0001; impact versus anxiety, r2 = 0.38, p less than 0.0001. Multivariate analysis demonstrated that SGRQ scores summed a number of areas of disease activity. (3) Changes in SGRQ scores and other measures were studied over 1 yr in 133 patients. Significant correlations were found between changes in SGRQ scores and the comparison measures (minimum r2 greater than 0.05, p less than 0.01). Multivariate analysis showed that change in total SGRQ score summed changes in a number of aspects of disease activity. We conclude that the SGRQ is a valid measure of impaired health in diseases of chronic airflow limitation that is repeatable and sensitive.

No abstract

No abstract

GRIPP2 (short form and long form) is the first international guidance for reporting of patient and public involvement in health and social care research. This paper describes the development of the GRIPP2 reporting checklists, which aim to improve the quality, transparency, and consistency of the international patient and public involvement (PPI) evidence base, to ensure that PPI practice is based on the best evidence

BackgroundWhile the patient and public involvement (PPI) evidence base has expanded over the past decade, the quality of reporting within papers is often inconsistent, limiting our understanding of how it works, in what context, for whom, and why.ObjectiveTo develop international consensus on the key items to report to enhance the quality, transparency, and consistency of the PPI evidence base. To collaboratively involve patients as research partners at all stages in the development of GRIPP2.MethodsThe EQUATOR method for developing reporting guidelines was used. The original GRIPP (Guidance for Reporting Involvement of Patients and the Public) checklist was revised, based on updated systematic review evidence. A three round Delphi survey was used to develop consensus on items to be included in the guideline. A subsequent face-to-face meeting produced agreement on items not reaching consensus during the Delphi process.ResultsOne hundred forty-three participants agreed to participate in round one, with an 86% (123/143) response for round two and a 78% (112/143) response for round three. The Delphi survey identified the need for long form (LF) and short form (SF) versions. GRIPP2-LF includes 34 items on aims, definitions, concepts and theory, methods, stages and nature of involvement, context, capture or measurement of impact, outcomes, economic assessment, and reflections and is suitable for studies where the main focus is PPI. GRIPP2-SF includes five items on aims, methods, results, outcomes, and critical perspective and is suitable for studies where PPI is a secondary focus.ConclusionsGRIPP2-LF and GRIPP2-SF represent the first international evidence based, consensus informed guidance for reporting patient and public involvement in research. Both versions of GRIPP2 aim to improve the quality, transparency, and consistency of the international PPI evidence base, to ensure PPI practice is based on the best evidence. In order to encourage its wide dissemination this article is freely accessible on The BMJ and Research Involvement and Engagement journal websites.Electronic supplementary materialThe online version of this article (doi:10.1186/s40900-017-0062-2) contains supplementary material, which is available to authorized users.

No abstract

Objectives: Obesity is an increasing clinical and public health concern. This study aimed to answer the question: 'What is the probability of an obese person attaining normal body weight?'Methods: A sample of men and women aged 20 years and over was drawn from the Clinical Practice Research Datalink (CPRD). Participants who received bariatric surgery were excluded. The probability of attaining either normal weight, or 5% reduction in body weight, were estimated. women attained normal body weight. In simple obesity (BMI 30·0-34·9 Kg/m 2 ), the annual probability of attaining normal weight was 1 in 210 for men and 1 in 124 for women, increasing to 1 in 1,290 for men and 1 in 677 for women with morbid obesity (BMI 40·0-44·9 Kg/m 2 ). The annual probability of achieving a 5% weight reduction was 1 in 8 for men, and 1 in 7 for women with morbid obesity. Among participants who lost 5% body weight, 52·7% (95% confidence interval 52·4 to 53·0%) showed weight regain at two years and 78·0% (77·7 to 78·3%) at five years. Conclusions:The low probability of attaining normal weight, or maintaining weight loss, raises questions concerning whether current obesity treatment frameworks, grounded in community-based weight management programmes, may be expected to achieve public health impact.3