Quality of clinical practice guidelines in dermatological oncology

摘要: Background  Clinical practice guidelines are increasingly used. To determine the quality of Appraisal Guidelines and Research Evaluation (AGREE) instrument was developed introduced in 2001. The AGREE consists 23 criteria, grouped six domains. Objective  Assessment evidence-based dermatological oncological care according to instrument. Methods  We searched MEDLINE, PubMed, EMBASE Cochrane literature relevant websites development programmes national society identify especially treatment basal cell carcinoma, squamous carcinoma melanoma. Twenty guidelines, published between 1990 2005, were appraised by three authors. Standardized domain scores calculated as advised AGREE. compared before 2002 with those later. Results  Domain domains Scope & Purpose Clarity scored best. Applicability Editorial Independence worst (see Table 1). In time a weak trend towards better seen. This can be attributed Search Strategy Level Evidence which closely related medicine. increase score is due more explicitly mentioning search strategy, possible conflict interest involvement different specialties guideline. Using Mann–Whitney test compare afterwards only statistically significant found for (P < 0.05; Table 2). Table 1.  Author Country Year publication Scope Purpose Stakeholders Rigour Clarity Applicability Editorial Independence Drake USA 1992  28  21  5 13  0  0 Drake USA 1993  72  25 14 25  0  0 Drake USA 1995  67  25  5 25  0  0 De Ruiter Netherlands 1997  33  21 29 66 11  3 Cox UK 1999  67  33 24 46  6   Telfer UK 1999  89  29 43 58 28  0 Reeve Australia 1999 100 100 88 71 44  0 Negrier France 2000  72  46 48 66  0 50 Dummer Switzerland 2001  83  63 36 63  0  8 Cook USA 2001  83  25 67 58 11 50 Sober USA 2001 100  38 67 67  0 33 Sober USA 2001 100  33 55 42  0  0 Motley UK 2002  83  25 45 58  0 33 Motley UK 2002  89  38 40 67  0  0 Roberts UK 2002  78  33 45 58  0  0 Roberts UK 2002 100  50 29 71 61  0 Marks Australia 2002 100 100 57 71 50  0 Beljaards Netherlands 2003  78  54 88 67 44  0 Doherty Scotland 2004  89  88 69 88 39 75 Rademaker New Zealand 2004  11  25 17 50  0  0 Houghton USA 2004  56  33 52 67 44  0 Quirt Canada 2004 100  75 93 71 56 58 Miller USA 2004  33   4 21 38  0  0 De Ruiter Netherlands 2005  62  54 95 79 33 33 Table 2.  Statistics (A) Median standardized (< 2002) Guidelines AGREE, n = 12 Median Percentile  Scope Purpose 77.5 Stakeholders 31.0 Rigour 39.5 Clarity 58 Applicability  0 Editorial Independence  4 (B) after instrument Guidelines n = 11 Median Percentile  Purpose 83 Stakeholders 38 Rigour 45 Clarity 67 Applicability 39 Independence  0 (C) non-parametric t-test Domain P <   Scope Purpose 0.74   Stakeholders 0.32   Rigour 0.35   Clarity 0.05 9.3–14.9 Applicability 0.21   Editorial Independence 0.38   Conclusions  reasonable instrument. concern methods guidelines. improved items. As clinical regarded an important improve care, improvements needed.