Postpublication External Review of the Japanese Guidelines for the Management of Stroke 2004

Abstract

Background and Purpose-Many guidelines for management of stroke have been published throughout the world, but no postpublication external review of any set of stroke guidelines by users, using standard checklists, has been reported. The purpose of this article is to present the results of an external review of the Japanese Guidelines for the Management of Stroke 2004, conducted several months postpublication. Methods-Forty-one evaluators, who had not been involved in developing the guidelines, were selected from representative stroke centers and institutions in Japan. They consisted of 30 physicians including 22 stroke specialists, and 11 nurse practitioners. Three standard checklists, ie, Appraisal of Guidelines for Research and Evaluation (AGREE) instrument, checklist by Shaneyfelt et al, and the Conference on Guideline Standardization (COGS) checklist, were used. Results-Confidence ratios according to the AGREE checklist were 75%, 77%, and 86% for stroke specialists, physicians other than stroke specialists, and nurse practitioners, respectively. The average scores were 2.98, 3.13, and 3.29, respectively. The confidence ratios according to the checklist by Shaneyfelt et al were 72%, 73% and 86% respectively, and those for the COGS checklist were 66%, 74%, and 91%, respectively. Conclusions-Although it is impossible to compare our results with those for other stroke guidelines, because none of them has been externally reviewed by users postpublication, our results seem better than those for published guidelines for treatment of other diseases in Japan. These results should be helpful in the process of updating stroke guidelines in Japan and elsewhere.

For Readers (Stroke Specialists and General Practitioners) of the Japanese Guidelines for the Management of Stroke

“…Therefore, a postpublication evaluation of the guidelines was performed by people representing these groups as part of the 2003 MHLW Science Research. 1 In that evaluation, a total of 41 people participated, including 22 stroke specialists, 8 nonspecialists, and 11 health care professionals who had not directly participated in the development of GL2004. For the evaluation, 3 international assessment criteria (AGREE, the procedure of Shaneyfelt et al and COGS) were used, as described in our article published in Stroke.…”

Development and evaluation of a formula for predicting introduction of medication self-management in stroke patients in the Kaifukuki rehabilitation ward

“…Therefore, there is a pressing need to improve patients’ abilities to self-manage their social life and activities. Previous reports have shown that establishing goals during the early phase of hospitalization hastens effective rehabilitation [1–3]. …”

Involvement of Matrix Metalloproteinase-Mediated Proteolysis of Neural Cell Adhesion Molecule in the Development of Cerebral Ischemic Neuronal Damage

“…Ischemic neuronal damage is known to be related to mitochondria and endoplasmic reticulum dysfunction, activated oxygen species, and increased expression of inflammatory cytokines and proteolytic enzymes (Heo et al, 1999;Zhao et al, 2004;Sarabi et al, 2008), but the detailed molecular mechanisms are still unknown. In spite of the development of various therapeutic strategies, including thrombolysis with tissue-type plasminogen activator or free radical scavengers (Yepes et al, 2000), it has been difficult to completely cure because of the intractable severe subsequent complications such as paralysis and cognitive dysfunction (Shinohara et al, 2009;Yagi et al, 2009). Thus, clarification of the detailed mechanisms responsible for the development of ischemic neuronal damage is urgently required.…”