Which actionable statements qualify as good practice statements In Covid-19 guidelines? A systematic appraisal

被引：9

作者：

Dewidar, Omar ^{[1
,2
]}

Lotfi, Tamara ^{[3
,4
,5
,6
]}

Langendam, Miranda ^{[7
]}

Parmelli, Elena ^{[8
]}

Parkinson, Zuleika Saz ^{[9
]}

Solo, Karla ^{[3
,4
,5
,6
]}

Chu, Derek K. ^{[3
,10
]}

Mathew, Joseph L. ^{[11
]}

Akl, Elie A. ^{[3
,12
]}

Brignardello-Petersen, Romina ^{[3
,4
,5
]}

Mustafa, Reem A. ^{[3
,13
]}

Moja, Lorenzo ^{[14
]}

Iorio, Alfonso ^{[3
,4
,5
,10
]}

Chi, Yuan ^{[15
,16
]}

Canelo-Aybar, Carlos ^{[17
]}

Kredo, Tamara ^{[18
,19
]}

Karpusheff, Justine ^{[20
]}

Turgeon, Alexis F. ^{[21
,22
]}

Alonso-Coello, Pablo ^{[17
]}

Wiercioch, Wojtek ^{[3
,4
,5
,6
]}

Gerritsen, Annette ^{[18
]}

Klugar, Miloslav ^{[23
]}

Rojas, Maria Ximena ^{[24
]}

Tugwell, Peter ^{[25
,26
]}

Welch, Vivian Andrea ^{[1
,2
]}

Pottie, Kevin ^{[27
]}

Munn, Zachary ^{[28
]}

Nieuwlaat, Robby ^{[3
]}

Ford, Nathan ^{[29
]}

Stevens, Adrienne ^{[3
,4
,5
]}

Khabsa, Joanne ^{[30
]}

Nasir, Zil ^{[3
,4
,5
]}

Leontiadis, Grigorios, I ^{[4
,5
,10
]}

Meerpohl, Joerg J. ^{[31
,32
]}

Piggott, Thomas ^{[3
,4
,5
,6
]}

Qaseem, Amir ^{[33
]}

Matthews, Micayla ^{[3
,4
,5
,6
]}

Schunemann, Holger J. ^{[3
,4
,5
,6
,10
,34
,35
]}

机构：

[1] Methods Ctr, Bruyere Res Inst, Ottawa, ON, Canada

[2] Univ Ottawa, Sch Epidemiol & Publ Hlth, Ottawa, ON, Canada

[3] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[4] McMaster Univ, Michael G DeGroote Cochrane Canada, Hamilton, ON, Canada

[5] McMaster Univ, McMaster GRADE Ctr, Hamilton, ON, Canada

[6] McMaster Univ, WHO Collaborating Ctr Infect Dis Res Methods & Re, Hamilton, ON, Canada

[7] Univ Amsterdam, Amsterdam Univ, Med Ctr, Amsterdam, Netherlands

[8] European Commiss, Joint Res Ctr, Ispra, Italy

[9] Inst Salud Carlos III, Agencia Evaluac Tecnol Sanitarias, Madrid, Spain

[10] McMaster Univ, Dept Med, Hamilton, ON, Canada

[11] Post Grad Inst Med Educ & Res, Dept Pediat, Chandigarh, India

[12] Amer Univ Beirut, Dept Internal Med, Beirut, Lebanon

[13] Univ Kansas, Div Nephrol & Hypertens, Internal Med, Sch Med, Kansas City, KS USA

[14] WHO, Dept Hlth Prod Policy & Stand, Geneva, Switzerland

[15] Beijing Yealth Technol Co Ltd, Yealth Network, Beijing, Peoples R China

[16] Cochrane Campbell Global Ageing Partnership, London, England

[17] Biomed Res Inst St Pau CIBERESP, Iberoamer Cochrane Ctr, Barcelona, Spain

[18] South African Med Res Council, Cochrane South Africa, Cape Town, South Africa

[19] Stellenbosch Univ, Dept Med, Clin Pharmacol, Stellenbosch, South Africa

[20] Natl Inst Hlth & Care Excellence, London, England

[21] Univ Laval, Ctr Rech Ctr Hosp Affilie Univ Quebec CHA, CHA Hop lEnfant Jesus, Quebec City, PQ, Canada

[22] Univ Laval, Dept Anesthesiol & Crit Care Med, Quebec City, PQ, Canada

[23] Masaryk Univ, Czech Natl Ctr Evidence Based Healthcare & Knowle, Inst Biostat & Anal, Brno, Czech Republic

[24] Inst Invest Biomed St Pau IIB St Pau, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain

[25] Univ Ottawa, Dept Med, Fac Med, Ottawa, ON, Canada

[26] Ottawa Hosp, Clin Epidemiol Program, Res Inst, Ottawa, ON, Canada

[27] Univ Ottawa, Deparatment Family Med, Ottawa, ON, Canada

[28] Univ Adelaide, Joanna Briggs Inst, Adelaide, SA, Australia

[29] WHO, Dept HIV Hepatitis & Sexually Transmitted Infect, Geneva, Switzerland

[30] Amer Univ Beirut, Clin Res Inst, Beirut, Lebanon

[31] Cochrane Germany Fdn, Cochrane Germany, Freiburg, Germany

[32] Med Ctr Univ Freiburg, Inst Evidence Med, Freiburg, Germany

[33] Amer Coll Physicians, Philadelphia, PA USA

[34] Humanitas Univ, Dept Biomed Sci, Milan, Italy

[35] Cochrane Canada, Hamilton, ON, Canada

来源：

BMJ EVIDENCE-BASED MEDICINE | 2022年 / 27卷 / 06期

关键词：

COVID-19; Evidence-Based Practice; Health Services Research; GRADE;

D O I：

10.1136/bmjebm-2021-111866

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives To evaluate the development and quality of actionable statements that qualify as good practice statements (GPS) reported in COVID-19 guidelines. Design and setting Systematic review . We searched MEDLINE, MedSci, China National Knowledge Infrastructure (CNKI), databases of Grading of Recommendations Assessment, Development and Evaluation (GRADE) Guidelines, NICE, WHO and Guidelines International Network (GIN) from March 2020 to September 2021. We included original or adapted recommendations addressing any COVID-19 topic. Main outcome measures We used GRADE Working Group criteria for assessing the appropriateness of issuing a GPS: (1) clear and actionable; (2) rationale necessitating the message for healthcare practice; (3) practicality of systematically searching for evidence; (4) likely net positive consequences from implementing the GPS and (5) clear link to the indirect evidence. We assessed guideline quality using the Appraisal of Guidelines for Research and Evaluation II tool. Results 253 guidelines from 44 professional societies issued 3726 actionable statements. We classified 2375 (64%) as GPS; of which 27 (1%) were labelled as GPS by guideline developers. 5 (19%) were labelled as GPS by their authors but did not meet GPS criteria. Of the 2375 GPS, 85% were clear and actionable; 59% provided a rationale necessitating the message for healthcare practice, 24% reported the net positive consequences from implementing the GPS. Systematic collection of evidence was deemed impractical for 13% of the GPS, and 39% explained the chain of indirect evidence supporting GPS development. 173/2375 (7.3%) statements explicitly satisfied all five criteria. The guidelines' overall quality was poor regardless of the appropriateness of GPS development and labelling. Conclusions Statements that qualify as GPS are common in COVID-19 guidelines but are characterised by unclear designation and development processes, and methodological weaknesses.

引用

页码：361 / 369

页数：9

共 20 条

[1] World Health Organization strong recommendations based on low-quality evidence (study quality) are frequent and often inconsistent with GRADE guidance [J].

Alexander, Paul E. ;

Brito, Juan P. ;

Neumann, Ignacio ;

Gionfriddo, Michael R. ;

Bero, Lisa ;

Djulbegovic, Benjamin ;

Stoltzfus, Rebecca ;

Montori, Victor M. ;

Norris, Susan L. ;

Schuenemann, Holger J. ;

Guyatt, Gordon H. .

JOURNAL OF CLINICAL EPIDEMIOLOGY, 2016, 72 :98-106

[2] The Endocrine Society Guidelines: When the Confidence Cart Goes Before the Evidence Horse [J].

Brito, Juan P. ;

Domecq, Juan P. ;

Murad, Mohammed H. ;

Guyatt, Gordon H. ;

Montori, Victor M. .

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2013, 98 (08) :3246-3252

[3] AGREE II: advancing guideline development, reporting and evaluation in health care [J].

Brouwers, Melissa C. ;

Kho, Michelle E. ;

Browman, George P. ;

Burgers, Jako S. ;

Cluzeau, Francoise ;

Feder, Gene ;

Fervers, Beatrice ;

Graham, Ian D. ;

Grimshaw, Jeremy ;

Hanna, Steven E. ;

Littlejohns, Peter ;

Makarski, Julie ;

Zitzelsberger, Louise .

CANADIAN MEDICAL ASSOCIATION JOURNAL, 2010, 182 (18) :E839-E842

[4] Good or best practice statements: proposal for the operationalisation and implementation of GRADE guidance [J].

Dewidar, Omar ;

Lotfi, Tamara ;

Langendam, Miranda W. ;

Parmelli, Elena ;

Parkinson, Zuleika Saz ;

Solo, Karla ;

Chu, Derek K. ;

Mathew, Joseph L. ;

Akl, Elie A. ;

Brignardello-Petersen, Romina ;

Mustafa, Reem A. ;

Moja, Lorenzo ;

Iorio, Alfonso ;

Chi, Yuan ;

Canelo-Aybar, Carlos ;

Kredo, Tamara ;

Karpusheff, Justine ;

Turgeon, Alexis F. ;

Alonso-Coello, Pablo ;

Wiercioch, Wojtek ;

Gerritsen, Annette ;

Klugar, Miloslav ;

Rojas, Maria Ximena ;

Tugwell, Peter ;

Welch, Vivian Andrea ;

Pottie, Kevin ;

Munn, Zachary ;

Nieuwlaat, Robby ;

Ford, Nathan ;

Stevens, Adrienne ;

Khabsa, Joanne ;

Nasir, Zil ;

Leontiadis, Grigorios ;

Meerpohl, Joerg ;

Piggott, Thomas ;

Qaseem, Amir ;

Matthews, Micayla ;

Schunemann, Holger J. .

BMJ EVIDENCE-BASED MEDICINE, 2023, 28 (03) :189-196

[5]

European Commission of breast cancer (ECIBC), 2021, ORG BREAST CANC SCRE

[6] GRADE:: what is "quality of evidence" and why is it important to clinicians? [J].

Guyatt, Gordon H. ;

Oxman, Andrew D. ;

Vist, Gunn E. ;

Kunz, Regina ;

Falck-Ytter, Yngve ;

Schunemann, Holger .

BMJ-BRITISH MEDICAL JOURNAL, 2008, 336 (7651) :995-999B

[7] GRADE:: an emerging consensus on rating quality of evidence and strength of recommendations [J].

Guyatt, Gordon H. ;

Oxman, Andrew D. ;

Vist, Gunn E. ;

Kunz, Regina ;

Falck-Ytter, Yngve ;

Alonso-Coello, Pablo ;

Schuenemann, Holger J. .

BRITISH MEDICAL JOURNAL, 2008, 336 (7650) :924-926

[8] Guideline panels should seldom make good practice statements: guidance from the GRADE Working Group [J].

Guyatt, Gordon H. ;

Alonso-Coello, Pablo ;

Schunemann, Holger J. ;

Djulbegovic, Benjamin ;

Nothacker, Monika ;

Lange, Stefan ;

Murad, M. Hassan ;

Akl, Elie A. .

JOURNAL OF CLINICAL EPIDEMIOLOGY, 2016, 80 :3-7

[9]

Guyatt GH, 2011, J CLIN EPIDEMIOL, V64, P1311, DOI [10.1016/j.jclinepi.2011.06.004, 10.1016/j.jclinepi.2011.03.017]

[10] A taxonomy and framework for identifying and developing actionable statements in guidelines suggests avoiding informal recommendations [J].

Lotfi, Tamara ;

Hajizadeh, Anisa ;

Moja, Lorenzo ;

Akl, Elie A. ;

Piggott, Thomas ;

Kredo, Tamara ;

Langendam, Miranda W. ;

Iorio, Alfonso ;

Klugar, Miloslav ;

Klugarova, Jitka ;

Neumann, Ignacio ;

Wiercioch, Wojtek ;

Leontiadis, Grigorios, I ;

Mbuagbaw, Lawrence ;

Turgeon, Alexis F. ;

Meerpohl, Joerg ;

Stevens, Adrienne ;

Brozek, Jan ;

Santesso, Nancy ;

Pottie, Kevin ;

Dewidar, Omar ;

Flottorp, Signe A. ;

Karpusheff, Justine ;

Saz-Parkinson, Zuleika ;

Rojas, Maria X. ;

Parmelli, Elena ;

Chu, Derek K. ;

Tugwell, Peter ;

Welch, Vivian ;

Avey, Marc T. ;

Brignardello-Petersen, Romina ;

Mathew, Joseph L. ;

Munn, Zachary ;

Nieuwlaat, Robby ;

Ford, Nathan ;

Qaseem, Amir ;

Askie, Lisa M. ;

Schunemann, Holger J. .

JOURNAL OF CLINICAL EPIDEMIOLOGY, 2022, 141 :161-171

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