Systems for grading the strength of recommendations in clinical practice guidelines in oncology

Introduction. In order to improve the applicability of clinical practice guidelines, their authors assign recommendations with grades denoting the degree of conviction regarding their practical application. Nevertheless even within one branch of medicine, significant differences between the grading systems arise. Material and methods. To identify these systems, websites of societies and institutions publishing oncology guidelines were searched. Only high-quality, regularly updated guidelines were included. Results. Five systems were analysed – all incorporate quality of evidence and strength of recommendation, but vary in the methods of their assessment and structure of the scales. Discussion. The described systems depend on the review of data, the quality of which supports the ascribed strength. Systems differ with regard to the methods of assessing the quality, quantity and consistency of evidence, potentially leading to assigning different grades of strength to recommendations based on the same studies. Conclusions. The introduction of unified grading systems across each branch of medicine could aid the development of unambiguous recommendations that are easy to introduce within the healthcare system

Consensus on methods of development of clinical practice guidelines in oncology under the auspices of Maria Sklodowska-Curie National Research Institute of Oncology and the Agency for Health Technology Assessment and Tariff System

Introduction.As the changes leading to improvement of cancer care in Poland have shown the need to introduce clinical practice guidelines into the health care system, it has become clear that no methodological standard of the process for guidelines preparation has been established so far. The following process aims to present a unified and comprehensive clinical practice guidelines (CPGs) development methodology. Materials and methods.A review of globally recognised methods used by guideline development groups was prepared, informing the discussion during three plenary meetings and extensive consultations in writing. The resulting document was unanimously approved by a group of 24 methodologists and clinical experts, and has been formally recognized as a standard for CPGs development by the management of the National Institute of Oncology and the Agency for Health Technology Assessment and Tariff System. Results.Within the process, 43 recommendations were formulated to create unified and comprehensive rules for guideline development within the Polish healthcare system. Conclusions.The presented methods are consistent with the globally recognized tools and methods of guideline development, such as GRADE and ADAPTE, and follow quality criteria described by AGREE II. The process supports the development of high-quality guidelines within a resource-constrained setting by allowing to choose between adoption, adaptation, or de novo development of either the whole document of guidelines or particular recommendations

The Agreement between Feline Pancreatic Lipase Immunoreactivity and DGGR-Lipase Assay in Cats—Preliminary Results

The colorimetric catalytic assay based on the use of 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6′-methylresorufin) (DGGR) ester as a substrate for pancreatic lipase activity is commonly used for the diagnosis of pancreatitis in dogs and cats. Even though the assay has generally been shown to yield consistent results with feline pancreatic lipase immunoreactivity (fPLI) assay, the agreement may vary between assays of different manufacturers. In this study, the chance-corrected agreement between a DGGR-lipase assay offered by one of the biggest providers of diagnostic solutions in Poland and fPLI assay was investigated. The study was carried out on 50 cats in which DGGR-lipase activity and fPLI were tested in the same blood sample. The chance-corrected agreement was determined using Gwet’s AC1 coefficient separately for the fPLI assay’s cut-off values of >3.5 μg/L and >5.3 μg/L. The DGGR-lipase activity significantly positively correlated with fPLI (Rs = 0.665; CI 95%: 0.451, 0.807, p < 0.001). The chance-corrected agreement between the fPLI assay and DGGR-lipase assay differed considerably depending on the cut-off values of the DGGR-lipase assay. When the cut-off value reported in the literature (>26 U/L) was used, it was poor to fair. It was moderate at the cut-off value recommended by the laboratory (>45 U/L), and good at the cut-off value recommended by the assay’s manufacturer (>60 U/L). The highest agreement was obtained between the fPLI assay at the cut-off value of 3.5 μg/L and the DGGR-lipase assay at the cut-off value of 55 U/L (AC1 = 0.725; CI 95%: 0.537, 0.914) and between the fPLI assay at the cut-off value of 5.3 μg/L and the DGGR-lipase assay at the cut-off value of 70 U/L (AC1 = 0.749; CI 95%: 0.577, 0.921). The study confirms that the chance-corrected agreement between the two assays is good. Prospective studies comparing both assays to a diagnostic gold standard are needed to determine which of them is more accurate

Systems for grading the strength of recommendations in clinical practice guidelines in oncology

Introduction. In order to improve the applicability of clinical practice guidelines, their authors assign recommendations with grades denoting the degree of conviction regarding their practical application. Nevertheless even within one branch of medicine, significant differences between the grading systems arise. Material and methods. To identify these systems, websites of societies and institutions publishing oncology guidelines were searched. Only high-quality, regularly updated guidelines were included. Results. Five systems were analysed – all incorporate quality of evidence and strength of recommendation, but vary in the methods of their assessment and structure of the scales. Discussion. The described systems depend on the review of data, the quality of which supports the ascribed strength. Systems differ with regard to the methods of assessing the quality, quantity and consistency of evidence, potentially leading to assigning different grades of strength to recommendations based on the same studies. Conclusions. The introduction of unified grading systems across each branch of medicine could aid the development of unambiguous recommendations that are easy to introduce within the healthcare system

Consensus on methods of development of clinical practice guidelines in oncology under the auspices of Maria Sklodowska-Curie National Research Institute of Oncology and the Agency for Health Technology Assessment and Tariff System

Introduction.As the changes leading to improvement of cancer care in Poland have shown the need to introduce clinical practice guidelines into the health care system, it has become clear that no methodological standard of the process for guidelines preparation has been established so far. The following process aims to present a unified and comprehensive clinical practice guidelines (CPGs) development methodology. Materials and methods.A review of globally recognised methods used by guideline development groups was prepared, informing the discussion during three plenary meetings and extensive consultations in writing. The resulting document was unanimously approved by a group of 24 methodologists and clinical experts, and has been formally recognized as a standard for CPGs development by the management of the National Institute of Oncology and the Agency for Health Technology Assessment and Tariff System. Results.Within the process, 43 recommendations were formulated to create unified and comprehensive rules for guideline development within the Polish healthcare system. Conclusions.The presented methods are consistent with the globally recognized tools and methods of guideline development, such as GRADE and ADAPTE, and follow quality criteria described by AGREE II. The process supports the development of high-quality guidelines within a resource-constrained setting by allowing to choose between adoption, adaptation, or de novo development of either the whole document of guidelines or particular recommendations