Quality assessment of clinical practice guidelines in perioperative care: a systematic appraisal

Barajas-Nava, Leticia A.; Solà, Iván; Delgado-Noguera, Mario; Gich, Ignasi; Villagran, Carola Orrego; Bonfill, Xavier; Alonso‐Coello, Pablo

doi:10.1136/qshc.2009.038653

Cited by 18 publications

(26 citation statements)

References 50 publications

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“…These organizations include the National Institute for Health and Clinical Excellence (NICE) [46,50,53,54], the Scottish Intercollegiate Guidelines Network (SIGN) [53,55], the New Zealand Guidelines Group [43], the Royal College of Physicians of London [55], and the Canadian Task Force on Prevention Health Care group [55]. The American College of Chest Physicians (ACCP) evidence-based CPGs on anti-thrombotic therapy and prevention of thrombosis, rigorously addressed several of the aforementioned caveats encountered in many CPGs [56-59].…”

Section: Discussionmentioning

confidence: 99%

Guidelines on vitamin D replacement in bariatric surgery: Identification and systematic appraisal

et al. 2016

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Introduction Bariatric surgery is the most effective therapeutic option to reduce weight in morbidly obese individuals, but it results in a number of mineral and vitamin deficiencies. Clinical Practice Guidelines (CPGs) attempt to balance those benefits and harms to provide guidance to physicians and patients. Objectives We compare and evaluate the quality of the evidence and of the development process of current CPGs that provide recommendations on vitamin D replacement in patients undergoing bariatric surgery, using a validated tool. Methods We searched 4 databases, with no time restriction, to identify relevant and current CPGs. Two reviewers assessed eligibility and abstracted data, in duplicate. They evaluated the quality of CPGs development process using the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) tool that consists of 6 domains. A content expert verified those assessments. Results We identified 3 eligible CPGs: (1) the Endocrine Society (ES) guidelines (2010); (2) the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), and the American Society for Metabolic & Bariatric Surgery (ASBMS) guidelines (update 2013); and (3) the Interdisciplinary European (IE) guidelines on Metabolic and Bariatric Surgery (latest update 2014). The ES and the AACE/TOS/ASBMS guidelines recommended high doses of vitamin D, varying from 3,000 IU daily to 50,000 IU 1-3 times weekly. Vitamin D doses were not mentioned in the IE guidelines. The recommendations were based on a low quality of evidence, if any, or limited to a single high quality trial, for some outcomes. In terms of quality, only the IE guidelines described their search methodology but none of the CPGs provided details on evidence selection and appraisal. None of the three CPGs rigorously assessed the preferences of the target population, resource implications, and the applicability of these guidelines. According to the AGREE II tool, we rated the ES guidelines as average in quality, and the other two as low in quality. Conclusion Current CPGs recommendations on vitamin D supplementation in bariatric surgery differ between societies. They do not fulfill criteria for optimal guideline development, in part possibly due to limited resources, and are based on expert opinion. Thus, the pressing need for high quality randomized trials to inform CPGs, to be developed based on recommended standards.

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Section: Discussionmentioning

confidence: 99%

Guidelines on vitamin D replacement in bariatric surgery: Identification and systematic appraisal

et al. 2016

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“…Further, CPGs authored by research/care societies may be of lower quality than those published by guideline societies. 16 The CPG by Robson and colleagues listis its authors and their affiliations and positions. The group is composed of academicians, private practice physicians, podiatrists, nurse clinicians, research nurses, industrial scientists and an epidemiologist.…”

Section: Who Was Involved In Guideline Development? (Ie Authors Revmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…16 There is constant effort to optimize this complex and expensive health care facet. 16 Surgeons are faced with difficult management decisions while balancing evidencebased recommendations. 17 When trial evidence exists, it often cannot be perfectly applied to specific patient presentations.…”

Section: Introductionmentioning

confidence: 99%

“…However, CPGs vary in their quality and sometimes deviate from high methodo logic al rigor. 16 It is necessary for surgeons to be able to appraise CPGs before deciding to adopt their recommendations.…”

Section: Introductionmentioning

confidence: 99%

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Quality assessment of clinical practice guidelines in perioperative care: a systematic appraisal

Cited by 18 publications

References 50 publications

Guidelines on vitamin D replacement in bariatric surgery: Identification and systematic appraisal

Guidelines on vitamin D replacement in bariatric surgery: Identification and systematic appraisal

Users’ guide to the surgical literature: how to evaluate clinical practice guidelines

Effect of a ward-based pharmacy team on preventable adverse drug events in surgical patients (SUREPILL study)

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