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      The quality assessment of intraabdominal infection guidelines/consensuses in 2 decades - which are better and any changes?

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          Abstract

          Background and aim:

          Intraabdominal infection (IAI) is a common and important disease worldwide. An increasing number of related guidelines/consensuses have been published in recent years, the quality evaluation for these guidelines/consensuses is necessary to identify lower-quality documents and explore the quality distribution in different time range and areas in this field.

          Methods:

          The Appraisal of Guidelines for Research & Evaluation Instrument tool was adopted to assess the quality of IAI guidelines/consensuses by 3 researchers independently. Intraclass correlation coefficients (ICCs) among the researchers were retrieved to reflect reliability. The quality differences of these guidelines/consensuses issued before and after May 2009, both international and non-international, were compared by a Mann–Whitney U test.

          Results:

          Fourteen IAI guidelines/consensuses published in English were obtained following a literature search. The ICCs among the researchers were all above 0.75, indicating satisfactory reliability. This outcome showed that the overall quality of these guidelines/consensuses was mediocre and considered acceptable in all items. A few guidelines/consensuses were better in their scientific and methodological characteristics than the others. Moreover, there were no significant differences in the scores between the guidelines/consensuses issued before and after May 2009 or between international vs regional guidelines/consensuses.

          Conclusions:

          Overall, the quality of the IAI guidelines/consensuses was generally acceptable and applicable, with a few deficiencies. Therefore, continuous improvement is essential. The guideline assessment tools should be applied in guideline/consensus development both widely and strictly to improve the methodological quality.

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          Most cited references28

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          Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

          The Third International Consensus Definitions Task Force defined sepsis as "life-threatening organ dysfunction due to a dysregulated host response to infection." The performance of clinical criteria for this sepsis definition is unknown.
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            The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection

            Previous evidence-based guidelines on the management of intra-abdominal infection (IAI) were published by the Surgical Infection Society (SIS) in 1992, 2002, and 2010. At the time the most recent guideline was released, the plan was to update the guideline every five years to ensure the timeliness and appropriateness of the recommendations.
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              Scientific evidence underlying the ACC/AHA clinical practice guidelines.

              The joint cardiovascular practice guidelines of the American College of Cardiology (ACC) and the American Heart Association (AHA) have become important documents for guiding cardiology practice and establishing benchmarks for quality of care. To describe the evolution of recommendations in ACC/AHA cardiovascular guidelines and the distribution of recommendations across classes of recommendations and levels of evidence. Data from all ACC/AHA practice guidelines issued from 1984 to September 2008 were abstracted by personnel in the ACC Science and Quality Division. Fifty-three guidelines on 22 topics, including a total of 7196 recommendations, were abstracted. The number of recommendations and the distribution of classes of recommendation (I, II, and III) and levels of evidence (A, B, and C) were determined. The subset of guidelines that were current as of September 2008 was evaluated to describe changes in recommendations between the first and current versions as well as patterns in levels of evidence used in the current versions. Among guidelines with at least 1 revision or update by September 2008, the number of recommendations increased from 1330 to 1973 (+48%) from the first to the current version, with the largest increase observed in use of class II recommendations. Considering the 16 current guidelines reporting levels of evidence, only 314 recommendations of 2711 total are classified as level of evidence A (median, 11%), whereas 1246 (median, 48%) are level of evidence C. Level of evidence significantly varies across categories of guidelines (disease, intervention, or diagnostic) and across individual guidelines. Recommendations with level of evidence A are mostly concentrated in class I, but only 245 of 1305 class I recommendations have level of evidence A (median, 19%). Recommendations issued in current ACC/AHA clinical practice guidelines are largely developed from lower levels of evidence or expert opinion. The proportion of recommendations for which there is no conclusive evidence is also growing. These findings highlight the need to improve the process of writing guidelines and to expand the evidence base from which clinical practice guidelines are derived.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Lippincott Williams & Wilkins (Hagerstown, MD )
                0025-7974
                1536-5964
                11 December 2020
                11 December 2020
                : 99
                : 50
                : e23643
                Affiliations
                [a ]Department of Pharmacy
                [b ]Department of Pediatrics, MianYang Center Hospital, MianYang
                [c ]Department of Pharmacy, sichuan provincial hospital for women and children, Chengdu
                [d ]Department of Pharmacy, Yibin hospital for women and children, Yibin
                [e ]Department of Infectious Diseases
                [f ]Department of Pharmacy, MianYang Center Hospital
                [g ]Northwestern SiChuan Regional Medical Center, MianYang, China.
                Author notes
                []Correspondence: Hong Ning, Mianyang Central Hospital, Mianyang, Sichuan, China (e-mail: NingHong555@ 123456126.com ).
                Author information
                http://orcid.org/0000-0003-0654-7894
                Article
                MD-D-20-07869 23643
                10.1097/MD.0000000000023643
                7738084
                a96469f2-4bc5-4e2e-9cb5-4b094c9ea050
                Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 7 August 2020
                : 12 November 2020
                Categories
                4900
                Research Article
                Systematic Review and Meta-Analysis
                Custom metadata
                TRUE

                agree ii,guidelines/consensuses,intraabdominal infection,quality assessment

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