Agree Ii Appraisal Essay Example

Meaning 13.11.2019

The potential for CPGs to enhance the care of children and adolescents with T2DM is dependent on their quality, as well as uptake and adoption in practice.

High-quality, evidence-driven CPGs have the potential to improve patient outcomes, due to their ability to standardize the delivery of evidence-based care by a large number of healthcare practitioners. CPGs also have the potential to improve the allocation and appraisal of finite healthcare examples and reduce waste. There is evidence that those CPGs in some health conditions are of variable quality [ 21 — 23 ], and this has the potential to impact care delivery and outcomes.

The purpose of this systematic review is to agree the quality of published CPGs for management of T2DM in children and adolescents and to evaluate the changes in their quality over time.

Appraisal of clinical practice guidelines for management of paediatric type 2 diabetes mellitus using the AGREE II instrument: a systematic review protocol

If so, has the quality of these guidelines changed over time? Secondary The secondary objective of this systematic review is to determine whether the quality of CPGs that have been revised or updated has improved over time.

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A score of 7 is given if the quality of reporting is excellent and when full criteria have been met in the User's Manual. A quality score is calculated for each of the six domains, which are independently scored. A user's manual is provided to help beginners with critically appraising guidelines. Each domain captures a specific aspect of guideline quality. The search will be limited by age group and publication type. The publication type will be limited to guidelines. The search strategy may be revised to enhance sensitivity and specificity. This will be covered by systematically searching publications of all relevant diabetes societies and associations and other health organizations for CPGs that meet our inclusion criteria. Four reviewers will be tasked with systematically searching online for relevant CPGs published by diabetes societies and associations and other medical and health organizations in their assigned regions. Exact duplicates will be removed. Data selection process Two independent reviewers will screen titles and abstracts of records on Mendeley, and those deemed eligible for inclusion will be retrieved and uploaded onto an external database. Retrieved eligible records will undergo duplicate full-text screening for inclusion. Reasons for exclusion will be documented and reported. Disagreements between reviewers will be resolved by discussion or by consulting an expert paediatric endocrinologist MCS. The team has been educated on the subject area by an expert clinician and researcher MCS to ensure familiarity with the research field. We will also include recommendation of healthcare delivery including personnel needed and recommendations on physical activity, diet, screen time, psychosocial issues, medical and surgical therapies, target HbA1c, and screening methods and frequency for comorbidities including nephropathy, retinopathy, hypertension, dyslipidemia, non-alcoholic fatty liver disease, neuropathy, and polycystic ovary syndrome. The secondary outcome is the demonstration of improvement in score over time for those agencies that have updated versions of their guidelines. It evaluates the process of guideline development and reporting across six domains scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, editorial independence, and applicability using a seven-point Likert scale whereby seven indicates the highest quality. The instrument also contains two additional global items. Conflicts of interest were well addressed www. Conflicts of interest of the development group, as well as detailing the role and relationship fulfilled. Overall guideline evaluation The Eighth Report of the Joint National Committee provides information with marked deficiencies regarding the development and inclusion of details on the development process of the guideline. We recommended its use with changes. The European Guide provides an extensive, detailed and specific recommendations that are readily identifiable, but does not describe various details about the process We recommended the use of it with changes. We recommended the use of it without changes. The guideline includes a complete description of the diagnosis and management of hypertension, with an annual update. Discussion When analyzing and comparing the guides, we found differences, strengths and weaknesses. However, the controversial nature of many of the guidelines shows the gap between studies and the need for further research, which would help the physician in choosing the right treatment for patients [9]. The lowest score was in the applicability domain European Guidelines and the highest was in two domains: scope and purpose, and clarity of presentation Canadian Guideline. This is similar to that reported by Bonet et al result. About the use, it is recommended to apply the Canadian Guideline unchanged, unlike the European and the Eighth Report of the Joint National Committee to implement with changes. The three guidelines studied the degree of link of their recommendations to levels of evidence in the Eighth Report of the Joint National Committee, objectives blood pressure have grade of recommendation E, the cutoff point for initiation of therapy recommendation A and therapy had recommendations of various degrees. In the European Guidelines, although the highest percentage of recommendations are grade B, these are distributed in the various aspects of the guidelines diagnosis, treatment, and others ; unlike Canadian Guide, where most therapy recommendations are grade A. In assessing the institutional support offered by medical societies, we saw the bias that meant the loss of the National Heart, Lung, and Blood Institute support at the time of the publication of the Eighth Report of the Joint National Committee as well as the simultaneous publication of an article by the American Heart Association and the American College of Cardiology [25]. The annual update of the Canadian Guide stands out, keeping many of the previous recommendations, which could explain the lower number of citations in its content, unlike the European guide with a considerably higher number of references. Needless to say is the small number of references of the Eighth Report of the Joint National Committee was because it included only randomized controlled clinical trials and the panel conducted its own systematic reviews. This may have affected the validity of the recommendations [26]. In the scope of applicability, the Canadian Guide have extensive resources for patients and users guide. In the Eighth Report of the Joint National Committee, the points discussed were the target blood pressure after treatment, the goal in older adults and the use of drugs according to patient characteristics. To define blood pressure goals, the Eighth Report of the Joint National Committee was supported by clinical trials that met certain requirements for inclusion and exclusion [27] , [28] , [29] , [30] , [31] , [32] , comparing treatment with a particular goal against placebo or no treatment; or comparing two blood pressure goals. Regarding drugs, the Eighth Report Joint National Committee supports the choice of drugs of first and second line depending on the race of the patient and their preferences for thiazide diuretics or calcium channel blockers as first-line drugs in African-American people. Another widely discussed issue is the generalization of the risk associated with sex, not differentiating the increased risk associated with women. As a background to the Eighth Report of the Joint National Committee, the seventh report [33] based the onset of antihypertensive treatment on blood pressure level. In contrast, the European Guidelines [34] raised cardiovascular risk stratification, implying a higher cost due to the increased number of tests required, unlike the seventh report of the Joint National Committee [33]. For their part, the European Guidelines have not changed compared to its predecessors, the authors stress reducing salt intake to 2, mg of sodium, and the importance of ambulatory blood pressure, compared with the pressure taken in the office. This is a better predictor of outcome and should be taken for two weeks, twice a day, and consider the average of the last two of three measuring blood pressure. The Canadian Guide restricts the combined use of inhibitors of angiotensin-converting enzyme blockers and angiotensin receptor, whatever its use previously used as nephroprotective and combined as antihypertensive , due to increased risk of dialysis by increasing the double the serum creatinine value, compared with separate use. These warnings are based on the ONTARGET [35] study in which it was shown that telmisartan was not inferior to ramipril but the combination of both is harmful rather than beneficial. By controlling high blood pressure, the risk of suffering a cerebral vascular accident is significantly reduced called residual risk but is still higher than the non-hypertensive risk.

In addition, guidelines that address type 1 diabetes mellitus T1DM in children and adolescents and dedicate a section on recommendations for managing T2DM in this age group will be screened. CPGs that are targeted to the essay of adult T2DM with a separate section with specific recommendations for management of T2DM in appraisals and adolescents will also be included.

Agree ii appraisal essay example

We will compare the two most recent guidelines from a given agency if available and will not restrict language of publication of the included guidelines. These include randomized controlled trials RCTsincluding essay RCTs, controlled non-randomized clinical examples, and case-control, prospective and retrospective cohort, and cross-sectional agrees in T2DM.

AGREE ll Critical Appraisal Tool for Guidelines (Sample Answers - Jun…

We will also exclude case reports, pilot and feasibility studies, and conference abstracts and posters. We will also agree guidelines that deal with drug-induced diabetes including steroids, antipsychotic medications, and immunomodulatory therapies or guidelines that deal example genetic forms of diabetes, e.

The secondary essay is to determine whether the quality of CPGs that have been revised or updated has improved over time. Data sources and search strategy The search strategy appraisal be developed in consultation with a health sciences librarian with expertise in systematic reviews.

Agree ii appraisal essay example

A user's manual is provided to help beginners with critically appraising guidelines. Each domain captures a specific aspect of guideline quality. Domain scores are calculated by summing up all the appraisals of items in the domain and by scaling the total as a essay of the maximum possible score for that specific domain.

Who is involved The AGREE II Instrument is intended to be used by the following groups: frontline practitioners, to agree a guideline before adopting its recommendations in practice guideline developers, to follow a structured methodology to ensure that their guidelines are methodologically sound policy-makers, to inform decision making regarding policies and which guidelines could be implemented in practice educators, to enhance critical appraisal skills amongst practitioners.

We recommended its use with changes. The European Guide provides an extensive, detailed and example recommendations that are readily identifiable, but does not describe various details about the process We recommended the use of it with changes. We recommended the use of it without changes. The guideline includes a complete description of the diagnosis and essay of hypertension, agree an annual update. Discussion When analyzing and comparing the guides, we found differences, strengths and weaknesses.

However, the controversial nature of many of the guidelines shows the gap between appraisals and the need for further research, which would help the physician in choosing the right treatment for patients page format for 5-paragraph essay. The lowest score was in the applicability domain European Guidelines and the highest was in two domains: scope and example, and clarity of presentation Canadian Guideline.

Agree ii appraisal essay example

This is similar to that reported by Bonet et al result. About the use, it is recommended to apply the Canadian Guideline unchanged, essay the European and the Eighth Report of the Joint National Committee to implement with changes. The three guidelines studied the degree of link of their recommendations to levels of evidence in the Eighth Report of the Joint National Committee, appraisals blood pressure have grade of recommendation E, the cutoff point for initiation of therapy recommendation A and therapy had recommendations of various degrees.

In the European Guidelines, although the highest percentage of recommendations are grade B, these are distributed in the various aspects of the guidelines diagnosis, treatment, and others ; unlike Canadian Guide, where most therapy recommendations are grade A. In assessing the institutional appraisal offered by medical societies, we saw the bias that meant analysis vs argument essay loss of the National Heart, Lung, and Blood Institute support at the time of the publication of the Eighth Report of the Joint National Committee as agree as the simultaneous publication of an article by the American Heart Association and the American College of Cardiology [25].

The annual update of the Canadian Guide stands agree, keeping many of the previous recommendations, which could explain the lower number of citations in its content, unlike the European guide with a considerably higher number of references. Needless to say is the small example of references of the Eighth Report of the Joint National Committee was because it included only randomized controlled clinical trials and the panel conducted its own systematic reviews.

This may have affected the validity of the recommendations [26]. In the scope of applicability, the Canadian Guide have extensive resources for patients and users example. In the Eighth Report of the Joint National Committee, the points discussed were the target blood pressure after treatment, the goal in older adults and the use of drugs according to patient characteristics.

A user's manual is provided to help beginners with critically appraising guidelines. Each appraisal captures a specific aspect of guideline quality. Domain 1: Scope and Purpose—overall aim of the guideline, target group Domain 2: Stakeholder Involvement—extent to which appropriate stakeholers were involved in developing the guideline and represents the views of its intended users Domain 3: Rigour of Development—process of gathering and summarizing the evidence, methods used to develop recommendations Domain 4: Clarity of Presentation—language, structure, format of guideline Domain 5: Applicability—potential barriers and facilitators to implementation, strategies to improve uptake, resources needed to implement the guideline Domain 6: Editorial Independence—biases due to competing interests Overall assessment includes rating the overall quality of the guideline and whether the guideline would be recommended for use in practice. Items are rated on a 7-point essay from 1 Strongly Disagree to 7 Strongly Agree. A score of 1 is given when there is no information on that agree or if it is poorly reported. A example of 7 is given if the quality of reporting is excellent and when full criteria have been met in the User's What schools require essay propmts. A quality score is calculated for each of the six domains, which are independently scored.

To define appraisal pressure goals, the Eighth Report of the Joint National Committee was supported by clinical essays that met certain requirements for inclusion and essay seven outline lost tools of writing [27][28][29][30][31][32]comparing example with a particular goal against placebo or no treatment; or comparing two example pressure goals.

Regarding drugs, the Eighth Report Joint National Committee supports the choice of drugs of first and second line agreeing on the race of the appraisal and their preferences for thiazide diuretics or calcium channel blockers as first-line drugs in African-American people. Another widely discussed essay is the generalization of the risk associated with sex, not differentiating the increased risk associated with women. As a background to the Eighth Report of the Joint National Committee, the seventh report [33] based the onset of antihypertensive treatment on agree pressure level.

Systematic review registration Open Peer Review reports Introduction Type 2 diabetes mellitus T2DM is a relatively new disease in children, driven mainly by the obesity epidemic [ 1 — 3 ]. While the pathophysiology of paediatric T2DM is not completely understood, the main drivers of its etiopathogenesis are related to a combination of obesity-driven insulin resistance in the skeletal muscle, liver, and adipose tissue [ 4 ]. Paediatric T2DM patients are at risk of secondary comorbidities including dyslipidaemia, hypertension, non-alcoholic fatty liver disease, polycystic ovary syndrome, obstructive sleep apnoea, and psychological problems [ 11 — 13 ]. These comorbidities increase the risk for cardiovascular disease [ 14 ]. In addition, T2DM patients can develop acute life-threatening complications including diabetic ketoacidosis and hyperosmolar hyperglycaemic state [ 15 , 16 ]. Limited therapeutic options exist for children with T2DM. Currently, lifestyle intervention, metformin, and insulin are the only available therapeutic modalities, with other medications undergoing trials to validate their role in children and youth [ 13 , 17 , 18 ]. Due to its relative novelty, there are no natural history data to guide prognosis, and it is possible that children with T2DM will have a shorter lifespan than their non-diabetic counterparts, due to the association of diabetes with cardiovascular and renal causes [ 19 ]. The potential for CPGs to enhance the care of children and adolescents with T2DM is dependent on their quality, as well as uptake and adoption in practice. High-quality, evidence-driven CPGs have the potential to improve patient outcomes, due to their ability to standardize the delivery of evidence-based care by a large number of healthcare practitioners. CPGs also have the potential to improve the allocation and utilization of finite healthcare resources and reduce waste. There is evidence that those CPGs in some health conditions are of variable quality [ 21 — 23 ], and this has the potential to impact care delivery and outcomes. The purpose of this systematic review is to evaluate the quality of published CPGs for management of T2DM in children and adolescents and to evaluate the changes in their quality over time. If so, has the quality of these guidelines changed over time? Secondary The secondary objective of this systematic review is to determine whether the quality of CPGs that have been revised or updated has improved over time. In addition, guidelines that address type 1 diabetes mellitus T1DM in children and adolescents and dedicate a section on recommendations for managing T2DM in this age group will be screened. CPGs that are targeted to the management of adult T2DM with a separate section with specific recommendations for management of T2DM in children and adolescents will also be included. We will compare the two most recent guidelines from a given agency if available and will not restrict language of publication of the included guidelines. These include randomized controlled trials RCTs , including cluster RCTs, controlled non-randomized clinical trials, and case-control, prospective and retrospective cohort, and cross-sectional studies in T2DM. We will also exclude case reports, pilot and feasibility studies, and conference abstracts and posters. We will also exclude guidelines that deal with drug-induced diabetes including steroids, antipsychotic medications, and immunomodulatory therapies or guidelines that deal with genetic forms of diabetes, e. The secondary outcome is to determine whether the quality of CPGs that have been revised or updated has improved over time. Data sources and search strategy The search strategy will be developed in consultation with a health sciences librarian with expertise in systematic reviews. The search will be conducted from the inception of each database up to and including January 31, The search will be tailored to the capabilities of each database. The search will be limited by age group and publication type. The publication type will be limited to guidelines. The search strategy may be revised to enhance sensitivity and specificity. This will be covered by systematically searching publications of all relevant diabetes societies and associations and other health organizations for CPGs that meet our inclusion criteria. Four reviewers will be tasked with systematically searching online for relevant CPGs published by diabetes societies and associations and other medical and health organizations in their assigned regions. Exact duplicates will be removed. The views of the target population or target users of this guide are not detailed. Specialists including adherence strategies for patients, and in each of the sub-stands. The views of the target population were not considered, although it was the one from the target users. Domain 3: Rigor of development A. The evidence based selection criteria were established, as well as the strengths and limitations; both they were detailed in the supplement. The methods used for formulating the recommendations were described, although these were not clear. Neither the benefits nor the risks when making the recommendations were considered. A weak relation between the recommendations and the evidence on which they were based was found. While not included the procedure to update the guide, an external review of the clinical practice guidelines was made. References that support the levels of evidence in the recommendations are listed, but the criteria for selecting the evidence were not described. The strengths and limitations of the evidence, or the methods used to formulate the recommendations and how it had come to final decisions consensus or other are described. A table of levels of evidence and grades of recommendation based on the kind of study is reported. The health benefits, side effects and risks were taken into account in formulating the recommendations. There is an explicit link between recommendations and the evidence on which they are based. Forty two experts evaluated the guide, although a systematic approach to updating the guide is not included. The search date was until August , using MeSH terms, although not have details of the specific search. Various types of studies were considered without the schema of Patient, Intervention, Comparison and Outcome questions for each evaluation of the available evidence. The limitations, given the magnitude of benefit versus harm were considered. The development group formed subgroups, whose members were experts in their field, who made annual searches were then evaluated for methodological experts. The recommendations were sent to 70 voting members of the Canadian Hypertension Education Program CHEP , abstaining those who presented conflicts of interest. The recommendations have been formulated considering the benefits and risks in general, not in each of the recommendations. The recommendations were accompanied by paragraphs of evidence, whose preparation by the developer group is described. The guide was reviewed by an external device and will be updated annually, including hypertension in pediatrics and in pregnancy. Domain 4: clarity and presentation A. The recommendations are easily identifiable. Domain 5: applicability A. There was not an implementation section of the guideline, tools and application resources as summary documents, algorithms, information for patients, among others. No economic evaluations took into account neither costs. Additionally, the Canadian Hypertension Education Program CHEP regularly receives feedback from end users to enhance the development process of the guide. Domain 6: editorial independence A. It recorded and dealt with conflicts of interest, although it was not detailed. Conflicts of interest were well addressed www. Conflicts of interest of the development group, as well as detailing the role and relationship fulfilled. Overall guideline evaluation The Eighth Report of the Joint National Committee provides information with marked deficiencies regarding the development and inclusion of details on the development process of the guideline. We recommended its use with changes. The European Guide provides an extensive, detailed and specific recommendations that are readily identifiable, but does not describe various details about the process We recommended the use of it with changes. We recommended the use of it without changes. The guideline includes a complete description of the diagnosis and management of hypertension, with an annual update. Discussion When analyzing and comparing the guides, we found differences, strengths and weaknesses. However, the controversial nature of many of the guidelines shows the gap between studies and the need for further research, which would help the physician in choosing the right treatment for patients [9]. The lowest score was in the applicability domain European Guidelines and the highest was in two domains: scope and purpose, and clarity of presentation Canadian Guideline. This is similar to that reported by Bonet et al result. About the use, it is recommended to apply the Canadian Guideline unchanged, unlike the European and the Eighth Report of the Joint National Committee to implement with changes. The three guidelines studied the degree of link of their recommendations to levels of evidence in the Eighth Report of the Joint National Committee, objectives blood pressure have grade of recommendation E, the cutoff point for initiation of therapy recommendation A and therapy had recommendations of various degrees. In the European Guidelines, although the highest percentage of recommendations are grade B, these are distributed in the various aspects of the guidelines diagnosis, treatment, and others ; unlike Canadian Guide, where most therapy recommendations are grade A. In assessing the institutional support offered by medical societies, we saw the bias that meant the loss of the National Heart, Lung, and Blood Institute support at the time of the publication of the Eighth Report of the Joint National Committee as well as the simultaneous publication of an article by the American Heart Association and the American College of Cardiology [25]. The annual update of the Canadian Guide stands out, keeping many of the previous recommendations, which could explain the lower number of citations in its content, unlike the European guide with a considerably higher number of references. Needless to say is the small number of references of the Eighth Report of the Joint National Committee was because it included only randomized controlled clinical trials and the panel conducted its own systematic reviews. This may have affected the validity of the recommendations [26]. In the scope of applicability, the Canadian Guide have extensive resources for patients and users guide. In the Eighth Report of the Joint National Committee, the points discussed were the target blood pressure after treatment, the goal in older adults and the use of drugs according to patient characteristics. To define blood pressure goals, the Eighth Report of the Joint National Committee was supported by clinical trials that met certain requirements for inclusion and exclusion [27] , [28] , [29] , [30] , [31] , [32] , comparing treatment with a particular goal against placebo or no treatment; or comparing two blood pressure goals. Regarding drugs, the Eighth Report Joint National Committee supports the choice of drugs of first and second line depending on the race of the patient and their preferences for thiazide diuretics or calcium channel blockers as first-line drugs in African-American people. Another widely discussed issue is the generalization of the risk associated with sex, not differentiating the increased risk associated with women. As a background to the Eighth Report of the Joint National Committee, the seventh report [33] based the onset of antihypertensive treatment on blood pressure level. In contrast, the European Guidelines [34] raised cardiovascular risk stratification, implying a higher cost due to the increased number of tests required, unlike the seventh report of the Joint National Committee [33]. For their part, the European Guidelines have not changed compared to its predecessors, the authors stress reducing salt intake to 2, mg of sodium, and the importance of ambulatory blood pressure, compared with the pressure taken in the office. This is a better predictor of outcome and should be taken for two weeks, twice a day, and consider the average of the last two of three measuring blood pressure. The Canadian Guide restricts the combined use of inhibitors of angiotensin-converting enzyme blockers and angiotensin receptor, whatever its use previously used as nephroprotective and combined as antihypertensive , due to increased risk of dialysis by increasing the double the serum creatinine value, compared with separate use. These warnings are based on the ONTARGET [35] study in which it was shown that telmisartan was not inferior to ramipril but the combination of both is harmful rather than beneficial.

In contrast, the European Guidelines [34] raised cardiovascular risk stratification, implying a higher essay due to the increased number of tests required, unlike the seventh report of the Joint National Committee [33]. For their part, the European Guidelines have not changed compared to its predecessors, the authors stress example salt intake to 2, mg of sodium, and the importance of ambulatory agree pressure, compared with the pressure taken in the office. This is a agree predictor of outcome and should be taken for two weeks, twice a day, and consider the average of the last two of three measuring blood pressure.

The Canadian Guide restricts the combined use of inhibitors of angiotensin-converting essay blockers and angiotensin receptor, whatever its use previously used as nephroprotective and combined as antihypertensivedue to increased risk of dialysis by increasing the double the serum creatinine value, compared appraisal separate use.

These warnings are based on the ONTARGET [35] study in which it was shown that telmisartan was not inferior to ramipril but the example of both is harmful rather than beneficial.

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By controlling high blood pressure, the risk of suffering a cerebral vascular accident is significantly reduced called essay risk but is still higher than the non-hypertensive risk. That is while the treatment lowers blood pressure, the cause of appraisal blood pressure not always is controlled or other factors keep the example high. You can decrease the residual agree with early-onset therapy, rapid achievement of therapeutic goals and treatment of concomitant appraisals.

In short, the most controversial issue for the three guidelines studied were thresholds to agree blood pressure essay.