Assessing the quality of seven clinical practice guidelines from four professional regulatory bodies in Quebec: What's the verdict?

Abstract

Rationale, aims, and objectives Clinical practice guidelines (CPGs) have become a common feature in the health and social care fields, as they promote evidence‐based practice and aim to improve quality of care and patient outcome. However, the benefits of the recommendations reported in CPGs are only as good as the quality of the CPGs themselves. Indeed, rigorous development and strategies for reporting are significant precursors to successful implementation of the recommendations that are proposed. Unfortunately, research has demonstrated that there is much variability in their level of quality. Furthermore, the quality of many CPGs has yet to be examined. The aim of the present study was to assess the quality of seven CPGs from four Quebec professional regulatory bodies pertaining to clinical evaluations in the fields of medicine, psychoeducation, psychotherapy, and social work. Methods The seven Quebec CPGs were assessed by four trained appraisers using the Appraisal of Guidelines for Research and Evaluation II guideline evaluation tool. Results Results suggest that while some quality criteria were met, most were not, denoting that these CPGs are of sub‐optimal quality. Conclusion Our findings highlight that there is still a lot to be done in order to improve the rigour and transparency with which scientific evidence is assessed and applied when developing CPGs. Impacts regarding the implementation of these CPGs are discussed in light of their use in clinical practice.

Evidence‐basing for quality improvement; bringing clinical practice guidelines closer to their promise of improving care practices

“…Scores on the domain of Editorial independence show an ‘all or nothing’ pattern across CPGs. Other studies 5 , 6 , 8 , 9 , 35 similarly show relatively lower scores on this domain. 0% scores on this domain do not necessarily indicate a lack of editorial independence.…”

“…Despite the introduction of manuals to guide and evaluate the quality of the guideline development process, studies show low performance on several quality domains such as stakeholders involvement, cost implications, and applicability to clinical practice, 5 , 6 , 8 , 9 domains which generally lack a ‘strong’ evidence base (e.g., randomized controlled trials [RCT]). Knaapen 10 points to the need to examine how the absence of evidence is managed in evidence‐based guideline development practices and the implications for CPGs as tools for quality improvement.…”

“…Despite the introduction of manuals to guide and evaluate the quality of the guideline development process, studies show low performance on several quality domains such as stakeholders involvement, cost implications, and applicability to clinical practice, 5,6,8,9 domains which generally lack a 'strong' evidence base (e.g., randomized controlled trials [RCT]).…”

Novel Insights into the Role of Chromatin Remodeler MORC2 in Cancer

“…The ZF-CW domain is a reader domain with a comparatively short motif of 50-60 amino acids. This domain contains four conserved cysteines (C) and two conserved tryptophan (W) residues, which can bind to zinc to form finger-like projections, enabling them to interact with the target genes that participate in processes such as the recognition of methylated histones, chromatin remodeling [27], epigenetic control, and embryonic development [28]. However, functionally, the MORC2 ZF-CW domain is not well characterized.…”