Clinical Practice Guidelines We Can Trust

Abstract

Background: Bladder cancer (BC) has become a major worldwide public health issue, especially nonmuscle-invasive bladder cancer (NMIBC). A flood of related clinical practice guidelines (CPGs) have emerged; however, the quality and recommendations of the guidelines are controversial. We aimed to appraise the quality of the CPGs for NMIBC within the past 5 years and compare the similarities and differences between recommendations for therapies. Methods: A systematic search to identify CPGs for NMIBC was performed using electronic databases (including PubMed, Embase, Web of Science), guideline development organizations, and professional societies from January 12, 2014 to January 12, 2019. The Appraisal of Guidelines Research & Evaluation (AGREE) II instrument was used to evaluate the quality of the guidelines. Intraclass correlation coefficient (ICC) analysis was performed to assess the overall agreement among reviewers. Results: Nine CPGs were included. The overall agreement among reviewers was excellent. The interquartile range (IQR) of scores for each domain were as follows: scope and purpose 69.44% (35.42%, 85.42%); stakeholder involvement 41.67% (30.56%, 75.00%); rigour of development 48.96% (27.08%, 65.63%); clarity and presentation 80.56% (75.00%, 86.11%); applicability 34.38% (22.92%, 40.63%) and editorial independence 70.83% (35.42%, 85.42%). The NICE, AUA, EAU and CRHA/CPAM clinical practice guidelines consistently scored well in most domains. It was generally accepted that the transurethral resection of bladder tumour (TURBT) and intravesical chemotherapy should be performed in the management of bladder cancer. The application of chemotherapy was highly controversial in high risk NMIBC. The courses of BCG maintenance were similar and included 3 years of therapy at full maintenance doses. Conclusions: The quality of NMIBC guidelines within the past 5 years varied, especially regarding stakeholders, rigour and applicability. Despite many similarities, the recommendations had some inconsistencies in the details. Background Bladder cancer (BC), the 10th most common form of cancer worldwide, has become a major global public health issue [1]. Approximately 75% of BCs do not involve the muscle wall of the bladder [2]. Timely and effective treatment for non-muscle-invasive bladder cancer (NMIBC) can achieve good Not applicable.

Haben Naturheilkunde und Komplementärmedizin einen Platz in Leitlinien des Registers der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften?

“…Leitlinien sind demzufolge Orientierungshilfen im Sinne von «Handlungs- und Entscheidungskorridoren», von denen in begründeten Fällen abgewichen werden kann oder sogar muss [3,4]. Diese Definition wurde vom Institute of Medicine (USA) 2011 ergänzt: Leitlinien sollen in der Regel auf den Ergebnissen einer systematischen Literatursuche basieren und Nutzen und Schaden alternativer Handlungsoptionen darlegen [5]. Hervorzuheben ist, dass Leitlinien nicht rechtlich verbindlich und auch nicht unbesehen mit dem medizinischen Standard gleichzusetzen sind [6].…”

Implementation of study results in guidelines and adherence to guidelines in clinical practice

“…Graham et al [28] stated that the number of randomized controlled trials was multiplied by 5 from 5,000 (1978–1985) to 25,000 (1994–2001) per year. Even if this is only a rough estimation, the tendency is obvious.…”

“…In 2011, the Institute of Medicine [28] issued the following new definition of guidelines: “Clinical Practice Guidelines are statements that include recommendations intended to optimize patient care. They are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.” …”

The Instrument for Measuring the Implementation Situation of Traditional Chinese Medicine Guideline: Evaluation and Application

“…Clinical practice guidelines (CPGs) are defined by the Institute of Medicine as “statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options” [1]. CPGs have been identified as an important instrument to reduce the practice variations and improve the quality of care of patients [2–5].…”