Mario Delgado-Noguera

The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies

Background Despite the increasing number of manuals on how to develop clinical practice guidelines (CPGs) there remain concerns about their quality. The aim of this study was to review the quality of CPGs across a wide range of healthcare topics published since 1980. Methods The authors conducted a literature search in MEDLINE to identify publications assessing the quality of CPGs with the Appraisal of Guidelines, Research and Evaluation (AGREE) instrument. For the included guidelines in each study, the authors gathered data about the year of publication, institution, country, healthcare topic, AGREE score per domain and overall assessment. Results In total, 42 reviews were selected, including a total of 626 guidelines, published between 1980 and 2007, with a median of 25 CPGs. The mean scores were acceptable for the domain ‘Scope and purpose’ (64%; 95% CI 61.9 to 66.4) and ‘Clarity and presentation’ (60%; 95% CI 57.9 to 61.9), moderate for domain ‘Rigour of development’ (43%; 95% CI 41.0 to 45.2), and low for the other domains (‘Stakeholder involvement’ 35%; 95% CI 33.9 to 37.5, ‘Editorial independence’ 30%; 95% CI 27.9 to 32.3, and ‘Applicability’ 22%; 95% CI 20.4 to 23.9). From those guidelines that included an overall assessment, 62% (168/270) were recommended or recommended with provisos. There was a significant improvement over time for all domains, except for ‘Editorial independence.’ Conclusions This review shows that despite some increase in quality of CPGs over time, the quality scores as measured with the AGREE Instrument have remained moderate to low over the last two decades. This finding urges guideline developers to continue improving the quality of their products. International collaboration could help increasing the efficiency of the process.

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

Background Surgical care is an important burden in healthcare, and the complications and harm related to surgery are of special concern. Clinical practice guidelines in perioperative care should provide the opportunity to minimise these risks and improve surgical outcomes, but their quality has not yet been evaluated systematically. Objective To evaluate the quality of clinical practice guidelines (CPGs) for the prevention of perioperative adverse events. Materials and methods A systematic search of scientific literature published between 1990 and 2008 was undertaken to identify and select CPGs related to the treatment of surgical patients, particularly those seeking to prevent surgical adverse events. The authors searched the main guideline databases and guideline developer websites, and completed the search in MEDLINE. Three independent reviewers assessed the eligible guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Their degree of agreement was evaluated with the intraclass correlation coefficient (ICC). Results Twenty-two CPGs were chosen for evaluation from a total of 6181 references. The overall agreement among reviewers was moderate (ICC: 0.68; 95% CI 0.46 to 0.84). The scores for each of the AGREE domains were: scope and purpose 80.9% (range: 40.7–100%); stakeholder involvement 51.3% (range: 8.3–88.8%); rigour of development 61.2% (range: 26.9–96.8%); clarity and presentation 69.7% (range: 33.3–94.4%); applicability 42.5% (range: 7.4–92.5%); and editorial independence 57% (range: 27.7–100%). Most of the appraised guidelines could be recommended (n=10) or recommended with provisos (n=10) for use in clinical practice. Guidelines developed by research agencies or guideline developers were of a higher quality than those developed by scientific societies. The authors did not detect any improvement over time in guideline quality. Conclusions The quality of guidelines for perioperative care is moderate. Measures should be taken to guarantee that CPGs are based on the best available evidence and rigorously developed and reported. Greater efforts are needed to provide high-quality guidelines that serve as a useful and reliable tool for clinical decision-making in this field.

Soft drinks consumption, diet quality and BMI in a Mediterranean population

OBJECTIVES Evidence of the effects of soft drinks consumption on BMI and lifestyle in adult populations is mixed and quite limited. The aim of the present study was to determine the association of soft drinks consumption with BMI and lifestyle in a representative Mediterranean population. DESIGN Two independent, population-based, cross-sectional (2000 and 2005) studies. Dietary intake was assessed using a validated FFQ. Weight and height were measured. SETTING Girona, Spain. SUBJECTS Random sample of the 35- to 74-year-old population (3910 men and 4285 women). RESULTS Less than half (41·7%) of the population consumed soft drinks; the mean consumption was 36·2 ml/d. The prevalence of sedentary lifestyle increased with the frequency of soft drinks consumption (P = 0·025). Daily soft drinks consumption significantly increased the risk of low adherence to the Mediterranean diet (OR = 0·57, 95% CI 0·44, 0·74 v. top tertile of Mediterranean diet score). Multiple linear regression analyses, controlled for potential confounders, revealed that an increment in soft drinks consumption of 100 ml was associated with a 0·21 kg/m² increase in BMI (P = 0·001). Only implausibly low reports of energy consumption showed a null association between soft drinks consumption and BMI. CONCLUSIONS Soft drinks consumption was not embedded in a healthy diet context and was positively associated with BMI and sedentary lifestyle in this Mediterranean population.