Quality appraisal of clinical guidelines for recurrent urinary tract infections using AGREE II: a systematic review

Pat, Jorik J; Witte, Lambertus P. W.; Steffens, M.G.; Vernooij, Robin W.M.; Marcelissen, Tom; Fuentes, P. Calle; García‐Perdomo, Herney Andrés; Pardo-Hernández, Héctor; Blanker, Marco

doi:10.1007/s00192-022-05089-6

Cited by 7 publications

(14 citation statements)

References 27 publications

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“…Based on the AGREE II reported items, the domain of “applicability” performed the worst, which is consistent with other quality assessment results of CPGs in different healthcare topics ( 33 , 34 ). Many CPGs failed to identify and describe the potential facilitators, barriers and advice or tools on how the recommendations can be put into practice.…”

Section: Discussionsupporting

confidence: 87%

Quality appraisal of clinical practice guidelines for the management of Dysphagia after acute stroke

Gao,

Liu,

Han

et al. 2023

Front. Neurol.

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ObjectivesDysphagia is a common complication in stroke patients, widely affecting recovery and quality of life after stroke. The objective of this systematic review is to identify the gaps that between evidence and practice by critically assessing the quality of clinical practice guidelines (CPGs) for management of dysphagia in stroke.MethodsWe systematically searched academic databases and guideline repositories between January 1, 2014, and August 1, 2023. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was used by two authors to independently assess CPG quality.ResultsIn a total of 14 CPGs included, we identified that three CPGs obtained a final evaluation of “high quality,” nine CPGs achieved “moderate quality” and two CPGs received “low quality.” The domain of “scope and purpose” achieved the highest mean score (91.1%) and the highest median (IQR) of 91.7% (86.1, 94.4%), while the domain of “applicability” received the lowest mean score (55.8%) and the lowest median (IQR) of 55.4% (43.2, 75.5%).ConclusionThe CPG development group should pay more attention to improving the methodological quality according to the AGREE II instrument, especially in the domain of “applicability” and “stakeholder involvement;” and each item should be refined as much as possible.

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Section: Discussionsupporting

confidence: 87%

Quality appraisal of clinical practice guidelines for the management of Dysphagia after acute stroke

Gao,

Liu,

Han

et al. 2023

Front. Neurol.

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“…The applicability domain goes beyond the methodological quality and covers resource implication, which is key to successfully implementing each guideline 33. Similar to our study on appraisal of clinical guidelines for recurrent urinary tract infections also showed low scores in this domain 29. Monitoring and evaluation plan ensures that the guidelines serve their intended purpose.…”

Section: Discussionsupporting

confidence: 64%

“…Updating CPGs is very important as it enhances the validity of the recommendations 28. According to a systematic review of guidance for updating CPGs 2–3 years is the recommended time frame between publishing a guideline and commencing the updating process 29…”

Section: Discussionmentioning

confidence: 99%

Quality assessment of clinical practice guidelines in Kenya using the AGREE II tool: a methodological review

et al. 2023

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ObjectiveTo assess the quality of available and accessible national Clinical Practice Guidelines (CPGs) in Kenya using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.MethodsWe searched the websites of the Kenyan Ministry of Health, professional associations and contacted experts in relevant organisations. Our scope was guidelines on maternal, neonatal, nutritional disorders, injuries, communicable and non-communicable diseases in Kenya published in the last 5 years until 30 June 2022. Study selection and data extraction were done by three independent reviewers with disagreements resolved via discussion or with a senior reviewer. We conducted a quality assessment using the online English version of AGREE II tool across six domains. Descriptive statistics were analysed using Stata software V.17. The primary outcome was the methodological quality of the included CPGs assessed by the AGREE II tool score.ResultsWe retrieved 95 CPGs and included 24 in the analysis after screening for eligibility. The CPGs scored best in clarity of presentation and least in the rigour of development. In descending order, the appraisal scores (mean and CI) per domain were as follows: Clarity of presentation 82.96% (95% CI 78.35% to 87.57%) with all guidelines scoring above 50%. Scope and purpose 61.75% (95% CI 54.19% to 69.31%) with seven guidelines scoring less than 50%. Stakeholder involvement 45.25% (95% CI 40.01% to 50.49%) with 16 CPGs scoring less than 50%. Applicability domain 19.88% (95% CI 13.32% to 26.43%) with only one CPG scoring above 50%. Editorial independence 6.92% (95% CI 3.47% to 10.37%) with no CPG scoring above 50% and rigour of development 3% (95% CI 0.61% to 5.39%) with no CPG scoring at least 50%.ConclusionOur findings suggest that the quality of CPGs in Kenya is limited mainly by the rigour of development, editorial independence, applicability and stakeholder involvement. Training initiatives on evidence-based methodology among guideline developers are needed to improve the overall quality of CPGs for better patient care.

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“…A recent systematic review of existing clinical practice guidelines for the assessment and treatment of rUTI found that only five of the eight identified guidelines took patients’ perspectives into account when developing their recommendations and none of the guidelines publicly reported those perspectives. 35 Additionally, optional imaging demonstrates a significant cost burden to this patient population with Gaitonde et al calculating the cost of initial evaluation for patients with rUTI being $730 and $390 with and without optional imaging, respectively. 36 Patients must be informed of the diagnostic yield in the face of the potential risks and costs of pursuing a diagnostic workup in order to achieve appropriate shared decision-making.…”

Section: Discussionmentioning

confidence: 99%

New avenue of diagnostic stewardship: procedural stewardship for recurrent urinary tract infections in female patients

Corse,

Rahmani,

Hasley

et al. 2023

ASHE

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Introduction: Societal guidelines offer a weak recommendation to perform cystoscopy for female patients with recurrent urinary tract infections (rUTI) of advanced age and/or with high-risk features. These guidelines lack the support of robust data and are instead based on expert opinion. In this retrospective cohort study, we aim to determine the utility of cystoscopy in patients with and without high-risk features for rUTI. Materials and methods: We identified 476 women who underwent cystoscopy for the evaluation of rUTI at a single tertiary academic medical center from May 1, 2015 and March 15, 2021. Patients were excluded if they had a competing indication for cystoscopy. Risk factors, demographic information, cystoscopic findings, and patient outcomes were analyzed. Results: 192 (41.1%) were classified as having complicated UTI. We identified six patients (1.3%) with findings that prompted management to significantly impact patient outcomes. All six patients had high-risk features. 14 patients (3.0%) were found to have mucosal abnormalities prompting biopsy, three of which required general anesthesia. All 14 biopsies were ultimately benign. Conclusions: Our findings demonstrate a low diagnostic yield and increased risk exposure for women undergoing cystoscopy for the evaluation of complicated rUTI. Additionally, our observations support prior studies indicating that cystoscopy has limited utility in the evaluation of rUTI without high-risk features.

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Quality appraisal of clinical guidelines for recurrent urinary tract infections using AGREE II: a systematic review

Cited by 7 publications

References 27 publications

Quality appraisal of clinical practice guidelines for the management of Dysphagia after acute stroke

Quality appraisal of clinical practice guidelines for the management of Dysphagia after acute stroke

Quality assessment of clinical practice guidelines in Kenya using the AGREE II tool: a methodological review

New avenue of diagnostic stewardship: procedural stewardship for recurrent urinary tract infections in female patients

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