Guideline conflict of interest management and methodology heavily impacts on the strength of recommendations: comparison between two iterations of the American College of Chest Physicians Antithrombotic Guidelines

Agoritsas, Thomas; Neumann, Ignacio; Mendoza, Carolina; Guyatt, Gordon

doi:10.1016/j.jclinepi.2016.07.007

Cited by 12 publications

(14 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This proportion was, however, similar to the ninth edition American College of Chest Physicians (ACCP) guideline on Antithrombotic Therapy and Prevention of Thrombosis, after it implemented GRADE. 17 20 Second, the proportion of inappropriate, discordant recommendation was considerably lower. Of the discordant recommendations, the proportion that should have been weak was about 17% rather than 27% (Endocrine Society) 11 or 46% (WHO guidelines).…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

UpToDate adherence to GRADE criteria for strong recommendations: an analytical survey

et al. 2017

Self Cite

View full text Add to dashboard Cite

IntroductionUpToDate is widely used by clinicians worldwide and includes more than 9400 recommendations that apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. GRADE guidance warns against strong recommendations when certainty of the evidence is low or very low (discordant recommendations) but has identified five paradigmatic situations in which discordant recommendations may be justified.ObjectivesOur objective was to document the strength of recommendations in UpToDate and assess the frequency and appropriateness of discordant recommendations.DesignAnalytical survey of all recommendations in UpToDate.MethodsWe identified all GRADE recommendations in UpToDate and examined their strength (strong or weak) and certainty of the evidence (high, moderate or low certainty). We identified all discordant recommendations as of January 2015, and pairs of reviewers independently classified them either into one of the five appropriate paradigms or into one of three categories inconsistent with GRADE guidance, based on the evidence presented in UpToDate.ResultsUpToDate included 9451 GRADE recommendations, of which 6501 (68.8%) were formulated as weak recommendations and 2950 (31.2%) as strong. Among the strong, 844 (28.6%) were based on high certainty in effect estimates, 1740 (59.0%) on moderate certainty and 366 (12.4%) on low certainty. Of the 349 discordant recommendations 204 (58.5%) were judged appropriately (consistent with one of the five paradigms); we classified 47 (13.5%) as good practice statements; 38 (10.9%) misclassified the evidence as low certainty when it was at least moderate and 60 (17.2%) warranted a weak rather than a strong recommendation.ConclusionThe proportion of discordant recommendations in UpToDate is small (3.7% of all recommendations) and the proportion that is truly problematic (strong recommendations that would best have been weak) is very small (0.6%). Clinicians should nevertheless be cautious and look for clear explanations—in UpToDate and elsewhere—when guidelines offer strong recommendations based on low certainty evidence.

show abstract

Section: Discussionmentioning

confidence: 98%

“…This study assessed the strength of recommendations in the largest known sample of recommendations developed using GRADE. Indeed, even large guidelines include a few hundred recommendations, 17 whereas UpToDate topics have one of the largest known coverage in clinical fields and included 9451 recommendations at the time of this assessment.…”

Section: Discussionmentioning

confidence: 99%

UpToDate adherence to GRADE criteria for strong recommendations: an analytical survey

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…In their analysis, they highlight the lack of evidence on the effects of involving them and in addition to the possible benefits raise potential downsides of expert involvement – notably that experts often have conflicts of interest and strong prior opinions that may introduce bias. While we do not argue against involvement of content experts since conflicts of interest can be managed, the controversy shows that this in fact may be an issue worth exploring empirically [ 44 ]. Thus, in addition to providing more in-depth recommendations for systematic reviewers, empirical evaluations of extraction methods should be encouraged.…”

Section: Discussionmentioning

confidence: 99%

Development, testing and use of data extraction forms in systematic reviews: a review of methodological guidance

Büchter

Weise

Pieper

2020

BMC Med Res Methodol

View full text Add to dashboard Cite

Background Data extraction forms link systematic reviews with primary research and provide the foundation for appraising, analysing, summarising and interpreting a body of evidence. This makes their development, pilot testing and use a crucial part of the systematic reviews process. Several studies have shown that data extraction errors are frequent in systematic reviews, especially regarding outcome data. Methods We reviewed guidance on the development and pilot testing of data extraction forms and the data extraction process. We reviewed four types of sources: 1) methodological handbooks of systematic review organisations (SRO); 2) textbooks on conducting systematic reviews; 3) method documents from health technology assessment (HTA) agencies and 4) journal articles. HTA documents were retrieved in February 2019 and database searches conducted in December 2019. One author extracted the recommendations and a second author checked them for accuracy. Results are presented descriptively. Results Our analysis includes recommendations from 25 documents: 4 SRO handbooks, 11 textbooks, 5 HTA method documents and 5 journal articles. Across these sources the most common recommendations on form development are to use customized or adapted standardised extraction forms (14/25); provide detailed instructions on their use (10/25); ensure clear and consistent coding and response options (9/25); plan in advance which data are needed (9/25); obtain additional data if required (8/25); and link multiple reports of the same study (8/25). The most frequent recommendations on piloting extractions forms are that forms should be piloted on a sample of studies (18/25); and that data extractors should be trained in the use of the forms (7/25). The most frequent recommendations on data extraction are that extraction should be conducted by at least two people (17/25); that independent parallel extraction should be used (11/25); and that procedures to resolve disagreements between data extractors should be in place (14/25). Conclusions Overall, our results suggest a lack of comprehensiveness of recommendations. This may be particularly problematic for less experienced reviewers. Limitations of our method are the scoping nature of the review and that we did not analyse internal documents of health technology agencies.

show abstract

“…Importantly, no recommendation strength is provided in the NICE guidelines, probably because of the incorporation of socioeconomic considerations. The ACCP also included only RCTs and systematic reviews for analysis and used cohort data for background VTE risk but did not perform specific socioeconomic analyses . Their guideline is endorsed by the American Society of Health‐System Pharmacists, the International Society of Thrombosis and Hemostasis and several American medical societies, but interestingly not by any orthopedic societies.…”

mentioning

confidence: 99%

“…Finally, given the multifactorial nature and the rarity of VTE in modern clinical practice, it must be considered whether RCTs remain the most ideal trial design . Thus, although strict adherence systems for evaluating evidence may lead to downgrading of recommendation strengths , there is an increasing argument for looking beyond rigid study design and critically focusing on present clinical relevance in order to avoid repeating the conclusions of older RCTs performed prior to current optimized perioperative care .…”

mentioning

confidence: 99%

Recommendations on thromboprophylaxis in major joint arthroplasty – many guidelines, little consensus?

Jørgensen

Petersen

Reed

et al. 2019

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

Summary Venous thromboembolic events remain a concern in total hip and knee arthroplasty. Consequently, several guidelines on thromboprophylaxis have been established. However, despite similarities in methodology for evaluation of evidence, discrepancies in guideline recommendations continue to exist. Furthermore, the results of older randomized clinical trials still have significant influence despite major improvements in perioperative care. In contrast, the results of recent large cohort studies with fewer thromboembolic events are mostly used only for background data. Here we outline some of the differences between the guidelines on thromboprophylaxis from the American College of Chest Physicians, the National Institute for Health and Care Excellence and the American Academy of Orthopedic Surgeons. We discuss differences in the methodology and focus of the guidelines potentially influencing the final recommendations. Future analyses are required, including data from modern care with early mobilization and short length of stay.

show abstract

Guideline conflict of interest management and methodology heavily impacts on the strength of recommendations: comparison between two iterations of the American College of Chest Physicians Antithrombotic Guidelines

Cited by 12 publications

References 9 publications

UpToDate adherence to GRADE criteria for strong recommendations: an analytical survey

UpToDate adherence to GRADE criteria for strong recommendations: an analytical survey

Development, testing and use of data extraction forms in systematic reviews: a review of methodological guidance

Recommendations on thromboprophylaxis in major joint arthroplasty – many guidelines, little consensus?

Contact Info

Product

Resources

About