Systematic Analysis Underlying the Quality of the Scientific Evidence and Conflicts of Interest in Interventional Medicine Subspecialty Guidelines

Abstract

Most of the interventional guidelines failed to grade the evidence. When present, most guidelines used lower-quality evidence. Furthermore, most guidelines failed to disclose COIs. When commented on, numerous COIs were present. Future guidelines should clearly state the quality of evidence, use a standard grading system, be transparent regarding potential biases, and provide frequent updates.

AGREE to disagree: Critical appraisal and the publication of practice guidelines

“…Furthermore, most guidelines failed to disclose conflicts of interests. [8] The US Institute of Medicine has defined clinical practice guidelines as 'statements that include recommendations intended to optimise patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options' . [9] They are important in influencing public health policy, promoting distributive justice and advocating better healthcare delivery for those in need.…”

Systematic Analysis and Critical Appraisal of the Quality of the Scientific Evidence and Conflicts of Interest in Practice Guidelines (2005–2013) for Barrett’s Esophagus

“…While the GRADE system has become the preferred method of developing guidelines, to assess each guideline in this system adequately would necessitate two groups, one to review the literature and one to provide recommendations. Unfortunately, to reassess each guideline beyond the scope of this manuscript, therefore the classic ABC method was used similar to other recent studies [11][12][13] Finally, there are many situations where high-quality evidence is lacking but, due to ethical reasons, such studies are not feasible. This issue can be corrected using the GRADE system, but the ABC grading system …”

“…The GRADE system allows for strong observational trials that can be graded as high-level evidence, and poorly designed randomized control trials can be downgraded to moderate level of evidence which would not be feasible in this current analysis without a repeat assessment of all of the studies used to formulate each of the guidelines' recommendations. As the merging of grading systems into the ABC system has been utilized in other recent publications, we chose to do the same [11][12][13]15].…”

“…This was standardized based on prior papers published on this topic [11][12][13]30]. If there were discrepancies between the two authors, then a modified Delphi system was utilized and a third reviewer (DAL) served to provide the final opinion.…”

“…In order to make trustworthy guidelines, the IOM provided eight tenets to which all guidelines should be held accountable [10]. However, recent articles reviewing guidelines related to gastroenterology, cardiology, pulmonary, and infectious disease have reported that societal guidelines often fail to meet many of these measures [11][12][13][14][15]. In order to better assess the quality of practice guidelines, the Appraisal of Guidelines Research and Evaluation (AGREE) II format was developed [16].…”