Management of cardiovascular disease in women with premature ovarian insufficiency: critical quality appraisal of clinical guidelines and algorithm development

Abstract

Objectives: 1) To assess the methodological quality of clinical practice guidelines (CPGs) associated with cardiovascular disease (CVD) in women with premature ovarian insufficiency (POI); 2) to formulate an algorithm to foster the implementation of guidelines by clinicians.Methods: A systematic search for CPGs in English and Chinese languages published between 2015 and 2020 was conducted. Assessment was conducted by two reviewers respectively via the Appraisal of Guidelines for Research and Evaluation II instrument. The interappraisal agreement was evaluated. Recommendations pertaining to the management of CVD in women with POI were extracted from high-score CPGs and developed into an algorithm, which was refined on the basis of expert feedback.Results: A total of 14 CPGs were included. Three CPGs were evaluated as ''high quality,'' with five ''average'' and six considered ''low quality.'' The consistency of agreement between reviewers was considered as substantial agreement to almost perfect agreement (0.72-0.90). The algorithm consisted of three categories: initial evaluation, management, and subsequent monitoring of CVD in POI. Only ''management'' had recommendations from all three high-quality CPGs.Conclusions: The overall methodological quality of most CPGs regarding CVD in women with POI is moderate to poor. A management algorithm with a clear implementation strategy was developed from high-scoring CPGs. Further research is needed to provide evidence-based health care in this field.

What should nurses do on post-stroke depression? A global systematic assessment of clinical practice guidelines

“…Unfortunately, we did not find any recommendations related to nursing diagnosis from the CPGs, which is consistent with the findings of previous studies. 9 19 The results suggested that nurses need to take PSD itself or nursing diagnoses related to PSD (eg, grieving, powerlessness, chronic sorrow, etc) as a diagnostic result, as this may lack accuracy and specificity for nursing diagnosis. Nursing diagnoses are clinical judgements about current or potential reactions to the health problems of individuals, families or communities.…”

“…The decisions ought to be made by the authors and guided by the context. After reviewing the literature,18 19 the overall quality and recommendation of CPGs were both divided into three levels. The authors considered a CPG with values >60% in five or six domains as high quality, that with values >60% in three or four domains as average quality and that with values >60% in one or two domains as low quality.…”

Metabolic Disorders in Menopause

“…Causes of induced premature menopause include chemotherapy and surgical procedure (i.e., bilateral oophorectomy). The importance of premature menopause is being emphasized as it is associated with an increased risk of MetS, cardiovascular disease (CVD), non-alcoholic liver disease (NAFLD)/metabolic associated fatty liver disease (MFFLD), stroke, osteoporosis, and premature death [ 24 , 25 ].…”

Plasma metabolomic characterization of premature ovarian insufficiency

“…Premature ovarian insufficiency (POI) refers to the exhaustion of ovarian reproductive and endocrine function before the age of 40 [ 1 ]. In POI, the most common symptoms are menstrual disturbance (amenorrhea or oligomenorrhea), hypoestrogenism, and infertility, and the most serious consequence is the conspicuously increased risk of cardiovascular diseases [ 2 ], osteoporosis [ 3 ], neurodegenerative disease [ 4 ], and type 2 diabetes mellitus [ 5 ], which are attributed to the lack of the protective effects of oestrogen. Although multiple factors, including genetic mutations, immune dysfunction, and iatrogenic factors such as chemotherapy, radiotherapy and ovarian surgery, have been reported to contribute to POI, the causes of most cases are still unclear [ 6 ].…”