Appraisal and summary of patellofemoral pain clinical practice guideline

ObjectiveThe purpose of this commentary was to critically appraise the patellofemoral pain clinical practice guideline published by the Academy of Orthopaedic Physical Therapy in 2019 and to summarize their recommendations for chiropractic practice.MethodsQuality and reporting of this guideline was assessed with the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Three reviewers independently scored between 1–7 (strongly disagree-strongly agree) for 23 items organized into six quality domains.ResultsAGREE II quality domain scores ranged between 57%–98%, with overall quality of the recommendation rated 89%. The guideline contained evidence summaries and/or recommendations for three topics: impairment/function-based diagnosis; examination; and interventions.ConclusionBased on its methodological quality, we recommend the use of this guideline for the examination, diagnosis, and management of patellofemoral pain in chiropractic practice. A summary of recommendations from this guideline is presented for use within the scope of chiropractic practice in Canada.     

Reframing Histological Risk Assessment of Oral Squamous Cell Carcinoma in the Era of UICC 8th Edition TNM Staging

ObjectivesTo assess whether application of the risk model originally proposed by Brandwein-Gensler, influences survival and disease progression in patients treated for oral squamous cell carcinoma (OSCCs)Materials and MethodsTumours from 134 T1 and T2 OSCC resections (7th edition) were scored independently by 3 histopathologists according to worst pattern of invasion (WPOI), lymphocytic host response (LHR) and perineural invasion (PNI) and categorised according to risk score. Local recurrence, locoregional recurrence, disease progression and overall survival were study endpoints. Interobserver variability of pathologist scoring was also assessed.ResultsSeventy-two patients (54%) were classified with low or intermediate risk and 62 (46%) patients were ‘high risk’. The inter-observer agreement was in moderate to strong agreement with the consensus scores (k range = 0.45–0.82). There was statistical significance between distant metastasis and ‘high risk’ tumours. Thirty tumours were upstaged to T3 in the 8th edition TNM staging, of which 83% had high risk scores. Overall risk score and TNM8 T stage has significant correlation with overall survival in comparison to the TNM 7 T stage.Conclusion‘High risk’ tumours were significantly associated with distant metastasis possibly due to the greater likelihood of aggressive features such as WPOI and PNI. Primary tumours are more likely to express high risk features with increasing T stage. None of the patients classified as ‘low risk’ died perhaps suggesting these tumours represent a rare variant of OSCC with excellent prognosis.     

A comparison of the colorectal surgical research across Europe, USA and Australasia

Aim The annual scientific meetings of the Association of Coloproctology of Great Britain and Ireland (ACPGBI), the American Society of Colon and Rectal Surgeons (ASCRS), the European Society of Coloproctology (ESCP) and the Royal Australasian College of Surgeons (RACS) are the major fora for presentation of colorectal surgical research. Thus, their content could be a proxy of the content and quality of colorectal surgical research worldwide. We aimed to critically appraise the quantity, quality and topics of colorectal surgical research over the previous 5 years for the above meetings. Method All published abstracts from the ACPGBI, ASCRS, ESCP and the colorectal‐specific component of the RACS from 2006 to 2010 were appraised. Abstracts were coded by predefined categories pertaining to study type and topic. Results Level 1 evidence (systematic reviews/meta‐analyses) and level 2 evidence (randomized controlled trials) comprised 3% (95% CI 1–9%) and 5% (95% CI 2–11%), respectively, of research presented at the meetings. There was a predominance of level 4 evidence (retrospective studies) across all years (mean 54%, 95% CI 44–68%). Operative management was most commonly studied (mean 43%, 95% CI 36–49%). There was minimal research in perioperative care (mean 6%, 95% CI 2–13%) and basic surgical science (mean 6%, 95% CI 2–11%). Research related to perioperative care was significantly higher at the ACPGBI and RACS meetings than the ASCRS and ESCP meetings (P < 0.01). Conclusion The research at these meetings consists largely of retrospective reviews exploring operative management with minimal high quality scientific content. Active steps need to be taken to increase the quantity of high level evidence especially in topics other than operative management.     

The best aspects of being a chiropractor

ObjectiveThe aims of this study were to determine the best aspects of being a chiropractor from the practitioners’ perspective and to determine job satisfaction among respondents.MethodsAn anonymous online survey was distributed to members of the chiropractic profession from August to September 2019. The survey included 25 statements regarded as being “a positive aspect of being a chiropractor.”ResultsThree hundred and sixty-nine chiropractors responded. Respondents believe that the best aspects of being a chiropractor are that chiropractors can reduce pain, help move or build strength, flexibility, and power in patients. In addition, chiropractors ‘being trained to diagnose’ and ‘being able to transform peoples’ quality of life’ were highly scored. Job satisfaction overall was rated as high (median score of 9/10). However, there are some aspects that are not highly regarded as best aspects by the profession such as the respect of the public and other health professionals.     

Possibilities for transborder cooperation in breast cancer care in Europe: a comparative analysis regarding the content, quality and evidence use of breast cancer guidelines

To encourage transborder cooperation in breast cancer care in Europe, we explored possibilities with the German-Dutch border area as an example. Evidence-based breast cancer guidelines were searched and compared on the: (1) methodological quality (with AGREE (Appraisal of Guidelines for Research and Evaluation)), (2) content of recommendations and (3) evidence use. The methodological quality of the German (n=2) and Dutch guidelines (n=2) was generally sufficient and comparable, although the applicability and the editorial independence were not clearly documented in the Dutch guidelines. Regarding the content analysis, German recommendations were taken as a reference point, because of the highest AGREE scores. Twenty-one of 25 recommendations discussed in both guidelines were corresponding and 4 were different, 32 were not mentioned in the Dutch guideline. The guidelines shared little evidence (< or =11%). We conclude that there are possibilities to encourage transborder cooperation. The clinical context of our results should be examined by measuring the actual care in both countries preferably with quality indicators.     

Development of the Diaphragmatic Paralysis Questionnaire: a simple tool for patient relevant outcome

Open in a separate window OBJECTIVESMeasurement tools of health-related quality of life (HRQL) that are specific for the underlying disorder are inevitably needed to assess HRQL changes following specific treatment strategies. The aim of the current study was to develop a questionnaire assessing HRQL in patients with unilateral diaphragmatic paresis. METHODSFirstly, topics of health impairments covering physical, psychological, social and functional aspects were predefined by a physician expert panel to ensure face validity. Secondly, all predefined topics were rated by a patient group with unilateral diaphragmatic paresis (untreated: n = 11; postoperative: n = 9) using a 5-point Likert scale ranging from ‘not relevant at all’ (−2) to ‘absolutely relevant’ (+2) to guarantee content validity. Thirdly, only relevant topics (0 to +2) were used for item development, while non-relevant items (<0) were not subject for item development.RESULTSIn total, 20 patients rated a total of 43 topics covering a broad spectrum of health impairment. 21 were considered as relevant for item development. Items are answered on a 5-point Likert scale ranging from ‘completely untrue’ (−2) to ‘always true’ (+2). The Diaphragmatic Paralysis Questionnaire (DPQ) Summary Score ranges from 0 (worst HRQL) to 100 (best HRQL). Finally, the German DPQ was professionally translated and transculturally adapted into English, Italian, Dutch, French, Greek and Spanish, using translation/back-translation procedures.CONCLUSIONSThe DPQ is the first diseases-specific HRQL measure developed for patients with diaphragmatic paresis. In addition, the DPQ is available in 7 languages free of charge for non-profit purposes.Clinical trial registrationGerman clinical trials register: DRKS00017056     

Acute pain management in burn patients: Appraisal and thematic analysis of four clinical guidelines

ObjectiveBurn patients suffer excruciating pain due to their injuries and procedures related to surgery, wound care, and mobilization. Acute Stress Disorder, Post-Traumatic Stress Disorder, chronic pain and depression are highly prevalent among survivors of severe burns. Evidence-based pain management addresses and alleviates these complications. The aim of our study was to compare clinical guidelines for pain management in burn patients in selected European and non-European countries. We included pediatric guidelines due to the high rate of children in burn units.MethodThe study had a comparative retrospective design using combined methodology of instrument appraisal and thematic analysis. Three investigators appraised guidelines from burn units in Denmark (DK), Sweden (SE), New Zealand (NZ), and USA using the AGREE Instrument (Appraisal of Guidelines for Research & Evaluation), version II, and identified core themes in the guidelines.ResultsThe overall scores expressing quality in six domains of the AGREE instrument were variable at 22% (DK), 44% (SE), 100% (NZ), and 78% (USA). The guidelines from NZ and USA were highly recommended, the Swedish was recommended, whereas the Danish was not recommended. The identified core themes were: continuous pain, procedural pain, postoperative pain, pain assessment, anxiety, and non-pharmacological interventions.ConclusionThe study demonstrated variability in quality, transparency, and core content in clinical guidelines on pain management in burn patients. The most highly recommended guidelines provided clear and accurate recommendations for the nursing and medical staff on pain management in burn patients. We recommend the use of a validated appraisal tool such as the AGREE instrument to provide more consistent and evidence-based care to burn patients in the clinic, to unify guideline construction, and to enable interdepartmental comparison of treatment and outcomes.     

Evaluating the British sarcoma referral form

IntroductionThis study investigated the accuracy of general practitioner (GP) referrals under the two-week wait pathway for soft tissue sarcomas and whether the current National Institute for Health and Care Excellence criteria should be refined.MethodsAll patients referred under the two-week wait system to one centre over the course of one year were reviewed. Comparison was made between the criteria identified by the GP and those confirmed by the centre to assess the accuracy of the referrals, and to identify what criteria predicted malignancy.ResultsOverall, 135 patients were referred to our unit with a mean age of 56.4 years. Of these, 45 (33%) were found to have a malignant tumour. Factors identified by the GP were accurate in 74% of cases. The best predictor of malignancy was ‘size >5cm’ (76% sensitivity) while ‘pain’ was the least useful (27% sensitivity). Lowering the threshold for concern to a size of >4cm increased sensitivity to 89%. Although 106 patients had undergone some form of imaging prior to referral, this did not increase the likelihood of malignancy being detected. The combination of factors most likely to predict malignancy was a size of >5cm, increase in size, deep location and no pain (10 out of 13 referrals, 77% accuracy).ConclusionsBased on the results of this study, we recommend an adaption of the existing features for concern. The new feature for concern should be ‘size >4cm’ and the factor ‘pain’ should be removed from the urgent referral form.     

Characteristics of adolescent athletes seeking early versus late care for sport-related concussion

Objectives1) To determine which characteristics of adolescent athletes with SRC are associated with ‘early’ versus ‘late’ presentation for multimodal treatment; 2) to build a propensity score to investigate the effects of treatment timing during the management of SRCs.MethodsAssociations between early (0–7 days) versus late (8–28 days) presentation for treatment and pre-specified sociodemographic, pre-injury and injury characteristics were investigated in a historical cohort study of 2949 multi-sport athletes across Canada aged 12–18 years diagnosed with a SRC in community-based healthcare clinics.ResultsEarly presentation was associated with being male, completing a pre-injury baseline assessment, and responding ‘yes’ or ‘no’ to having a diagnosed learning disability. Older athletes who reported previous SRCs were less likely to present early. The propensity score demonstrated an area under the curve of 0.71 (95% CI, 0.69 to 0.73).ConclusionsMale athletes with a completed baseline assessment were more likely to seek early treatment following a SRC, and older athletes who reported a greater number of previous SRCs were less likely to present early. External validation of the propensity score is needed before examining the impact of treatment timing on adolescent athlete recovery outcomes.     

Survey of students’ perception of the jurisprudence,ethics and business management course at the Canadian Memorial Chiropractic College

IntroductionThe objective of this study was to survey 2018–2019 Year III students at the Canadian Memorial Chiropractic College in order explore their perceptions of the components of the revised Jurisprudence, Ethics and Business Management course.MethodsThis study was approved by the Research Ethics Board. A paper survey was distributed to all enrolled students. Using a five-point Likert scale, students were asked if they perceived the course material was (i) well-presented and (ii) important for them to know as future chiropractors. Students were required to sign a consent form to participate.ResultsSurvey response rate was 94%. Over 90% of respondents ‘strongly agreed/‘agreed’ lectures, small group session and course assignments were well presented and important for them to know as future chiropractors. Respondents were more critical of the online business modules (on average, 50% ‘strongly agreed/agreed’).ConclusionsThe information from this survey will enable refinement of future versions of this course.     

Altered kidney function induced by SARS-CoV-2 infection and acute kidney damage markers predict survival outcomes of COVID-19 patients: a prospective pilot study

BackgroundLiterature with regard to coronavirus disease 2019 (COVID-19) associated morbidities and the risk factors for death are still emerging. In this study, we investigated the presence of kidney damage markers and their predictive value for survival among hospitalized subjects with COVID-19.MethodsForty-seven participants was included and grouped as: ‘COVID-19 patients before treatment’, ‘COVID-19 patients after treatment’, ‘COVID-19 patients under treatment in intensive care unit (ICU)’, and ‘controls’. Kidney function tests and several kidney injury biomarkers were compared between the groups. Cumulative rates of death from COVID-19 were determined using the Kaplan–Meier method. The associations between covariates including kidney injury markers and death from COVID-19 were examined, as well.ResultsSerum creatinine and cystatin C levels, urine Kidney Injury Molecule-1 (KIM-1)/creatinine ratio, and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), CKD-EPI cystatin C, and CKD-EPI creatinine–cystatin C levels demonstrated significant difference among the groups. The most significant difference was noted between the groups ‘COVID-19 patients before treatment’ and ‘COVID-19 patients under treatment in ICU’. Advancing age, proteinuria, elevated serum cystatin C, and urine KIM-1/creatinine ratio were all significant univariate correlates of death (p < 0.05, for all). However, only elevated urine KIM-1/creatinine ratio retained significance in an age, sex, and comorbidities adjusted multivariable Cox regression (OR 6.11; 95% CI: 1.22–30.53; p = 0.02), whereas serum cystatin C showing only a statistically non-significant trend (OR 1.42; 95% CI: 0.00–2.52; p = 0.09).ConclusionsOur findings clearly demonstrated the acute kidney injury related to COVID-19. Moreover, urine KIM-1/creatinine ratio was associated with COVID-19 specific death.     

Incidence and significance of findings on spinal MRIs in a paediatric population with spinal column complaints

PurposeWe sought to identify correlations between working diagnosis, surgeon indication for obtaining spinal MRI and positive MRI findings in paediatric patients presenting with spinal disorders or complaints.MethodsSurgeons recorded their primary indication for ordering a spinal MRI in 385 consecutive patients. We compared radiologist-reported positive MRI findings with surgeon response, indication, working diagnosis and patient demographics.ResultsThe most common surgeon-stated indications were pain (70) and coronal curve characteristics (63). Radiologists reported 137 (36%) normal and 248 (64%) abnormal MRIs. In total, 58% of abnormal reports (145) did not elicit a therapeutic or investigative response, which we characterized as ‘clinically inconsequential’. In all, 42 of 268 (16%) presumed idiopathic scoliosis patients had intradural pathology noted on MRI.Younger age (10.3 years versus 12.0 years) was the only significant demographic difference between patients with or without intradural pathology. Surgeon indication ‘curve magnitude at presentation’ was associated with intradural abnormality identification. However, average Cobb angles between patients with or without an intradural abnormality was not significantly different (39° versus 37°, respectively). Back pain without neurological signs or symptoms was a negative predictor of intradural pathology.ConclusionRadiologists reported a high frequency of abnormalities on MRI (64%), but 58% of those were deemed clinically inconsequential. Patients with MRI abnormalities were two years’ younger than those with a normal or inconsequential MRI. ‘Curve magnitude at presentation’ in presumed idiopathic scoliosis patients was the only predictor of intrathecal pathology. ‘Pain’ was the only indication significantly associated with clinically inconsequential findings on MRI.Level of evidence:III     

Accuracy of internet images of glenoid labral injuries

IntroductionThe internet is a convenient source of health information used widely by patients and doctors. Previous studies have found that the written information provided was often inaccurate. There is no literature regarding the accuracy of medical images on the internet. The aim of this study was to assess the accuracy of internet images of injuries to the glenoid labrum following shoulder dislocation.MethodsThe Google and Bing search engines were used to find images of Bankart, Perthes and anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions. Three independent reviewers assessed the accuracy of image labelling.ResultsOf images labelled ‘Bankart lesion’, 30% (9/30) were incorrect while ‘Perthes lesion’ images were incorrect in 15% of cases (9/60) and 4% of ‘ALPSA lesion’ images were incorrect (2/46). There was good interobserver reliability (kappa = 0.81). Labelling accuracy was better on educational sites than on commercial sites (6% vs 25% inaccurate, p=0.0013).ConclusionsCaution is recommended when interpreting non-peer reviewed images on the internet.     

Physical activity throughout pregnancy: guideline critical appraisal and implementation tool

ObjectiveThe 2019 Canadian guideline for physical activity throughout pregnancy provides evidencebased recommendations to promote maternal, fetal, and neonatal health. We aimed to 1) critically appraise the 2019 Canadian guideline for physical activity throughout pregnancy; and 2) develop a guideline summary for clinicians to facilitate the uptake of recommendations into practice.MethodsWe used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument to critically appraise the quality and reporting of this guideline. Four reviewers independently scored between 1 (strongly disagree) to 7 (strongly agree) for 23 items organized into six quality domains.ResultsAGREE II quality domain scores ranged from 47%–64% and the overall quality of the guideline was rated as 83% (high quality).ConclusionBased on its methodological quality, we recommend the use of this guideline. Our guideline summary includes six recommendations and other safety precautions that are relevant for clinicians in Canada.     

Right sided diverticulitis in western countries: A review

BACKGROUNDAlthough the treatment guidelines for left sided diverticulitis are clear, the management of right colonic diverticulitis is not well established. This disease can no longer be ignored due to significant spread throughout Asia.AIMTo analyse epidemiology, diagnosis and treatment of right-sided diverticulitis in western countries.METHODSMEDLINE and PubMed searches were performed using the key words “right-sided diverticulitis’’, ‘‘right colon diverticulitis’’, ‘‘caecal diverticulitis’’, ‘‘ascending colon diverticulitis’’ and ‘‘caecum diverticula’’ in order to find relevant articles published until 2021.RESULTSA total of 18 studies with 422 patients were found. Correct diagnosis was made only in 32.2%, mostly intraoperatively or via CT scan. The main reason for misdiagnosis was a suspected acute appendicitis (56.8%). The treatment was a non-operative management (NOM) in 184 patients (43.6%) and surgical in 238 patients (56.4%), seven of which after NOM failure. Recurrence rate was low (5.45%), similar to eastern studies and inferior to left -sided diverticulitis. Recurrent patients were successfully conservatively retreated in most cases.CONCLUSIONThe management of right- sided diverticulitis is not well clarified in the western world and no selective guidelines have been considered even if principles are similar to those with left- sided diverticulitis. Wrong diagnosis is one of the most important problems and CT scan seems to be the best imaging modality. NOM offers a safe and effective treatment; surgery should be considered only in cases of complicated diverticulitis or if malignancy cannot be excluded. Further studies are needed to clarify the correct treatment.     

Penile implant infection factors: a contemporary narrative review of literature

ObjectiveWe aim to review and summarize published literature that features implanted penile devices and details infection of these devices as a complication. In particular, we will detail the factors that influence infection of penile implants.BackgroundTypes of penile prostheses (PP) include inflatable implants and semirigid implants; these are utilized for treatment of erectile dysfunction. Likely the most feared complication of penile implants is infection. There are a handful of factors that are implicated in device infection.MethodsSearches were performed using MEDLINE and PubMed databases using keywords and phrases ‘penile implant AND infection’; ‘penile prosthesis AND infection’; ‘penile implant infection’. We have presented results from our literature search. We divided these into ‘Surgical Elements’ and ‘Patient Selection and Factors.’ Each topic is discussed in its own section.ConclusionsStrides have been made since the initial penile prosthesis (IPP) surgeries to improve infection rates including diabetes control, antibiotic coating of devices, and antibiotic implementation. Going forward, more studies, especially randomized control trials, need to focus on defining levels of diabetic control (sugar control and A1C control), determining the role of metabolic syndrome in infection promotion and determining laboratory values which could be predictive of infection. We present a discussion of important factors to consider in the realm of PP infections. In addition, we include studies which discuss topics for future directions in decreasing the number of infections seen with PP.     

Stochastic Dominance and Analysis of ODI Batting Performance: the Indian Cricket Team, 1989-2005

Relative to other team games, the contribution of individual team members to the overall team performance is more easily quantifiable in cricket. Viewing players as securities and the team as a portfolio, cricket thus lends itself better to the use of analytical methods usually employed in the analysis of securities and portfolios. This paper demonstrates the use of stochastic dominance rules, normally used in investment management, to analyze the One Day International (ODI) batting performance of Indian cricketers. The data used span the years 1989 to 2005. In dealing with cricketing data the existence of ‘not out’ scores poses a problem while processing the data. In this paper, using a Bayesian approach, the ‘not-out’ scores are first replaced with a conditional average. The conditional average that is used represents an estimate of the score that the player would have gone on to score, if the ‘not out’ innings had been completed. The data thus treated are then used in the stochastic dominance analysis. To use stochastic dominance rules we need to characterize the ‘utility’ of a batsman. The first derivative of the utility function, with respect to runs scored, of an ODI batsman can safely be assumed to be positive (more runs scored are preferred to less). However, the second derivative needs not be negative (no diminishing marginal utility for runs scored). This means that we cannot clearly specify whether the value attached to an additional run scored is lesser at higher levels of scores. Because of this, only first-order stochastic dominance is used to analyze the performance of the players under consideration. While this has its limitation (specifically, we cannot arrive at a complete utility value for each batsman), the approach does well in describing player performance. Moreover, the results have intuitive appeal.

Key Points

• The problem of dealing with ‘not out’ scores in cricket is tackled using a Bayesian approach.
• Stochastic dominance rules are used to characterize the utility of a batsman.
• Since the marginal utility of runs scored is not diminishing in nature, only first order stochastic dominance rules are used.
• The results, demonstrated using data for the Indian cricket team are intuitively appealing.
• The limitation of the approach is that it cannot arrive at a complete utility value for the batsman.

Key words: Bayesian, utility function, batting average, conditional average, geometric distribution     

Global guidelines for breast cancer screening: A systematic review

ObjectivesBreast cancer screening guidelines could provide valuable tools for clinical decision making by reviewing the available evidence and providing recommendations. Little information is known about how many countries have issued breast cancer screening guidelines and the differences among existing guidelines. We systematically reviewed current guidelines and summarized corresponding recommendations, to provide references for good clinical practice in different countries.MethodsSystematic searches of MEDLINE, EMBASE, Web of Science, and Scopus from inception to March 27th, 2021 were conducted and supplemented by reviewing the guideline development organizations. The quality of screening guidelines was assessed from six domains of the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) instrument by two appraisers. The basic information and recommendations of the issued guidelines were extracted and summarized.ResultsA total of 23 guidelines issued between 2010 and 2021 in 11 countries or regions were identified for further review. The content and quality varied across the guidelines. The average AGREE Ⅱ scores of the guidelines ranged from 33.3% to 87.5%. The highest domain score was "clarity of presentation" while the domain with the lowest score was "applicability". For average-risk women, most of the guidelines recommended mammographic screening for those aged 40–74 years, specifically, those aged 50–69 years were regarded as the optimal age group for screening. Nine of 23 guidelines recommended against an upper age limit for breast cancer screening. Mammography (MAM) was recommended as the primary screening modality for average-risk women by all included guidelines. Most guidelines suggested annual or biennial mammographic screening. Risk factors of breast cancer identified in the guidelines mainly fell within five categories which could be broadly summarized as the personal history of pre-cancerous lesions and/or breast cancer; the family history of breast cancer; the known genetic predisposition of breast cancer; the history of mantle or chest radiation therapy; and dense breasts. For women at higher risk, there was a consensus among most guidelines that annual MAM or annual magnetic resonance imaging (MRI) should be given, and the screening should begin earlier than the average-risk group.ConclusionsThe majority of 23 included international guidelines were issued by developed countries which contained roughly the same but not identical recommendations on breast cancer screening age, methods, and intervals. Most guidelines recommended annual or biennial mammographic screening between 40 and 74 years for average-risk populations and annual MAM or annual MRI starting from a younger age for high-risk populations. Current guidelines varied in quality and increased efforts are needed to improve the methodological quality of guidance documents. Due to lacking clinical practice guidelines tailored to different economic levels, low- and middle-income countries (LMICs) should apply and implement the evidence-based guidelines with higher AGREE Ⅱ scores considering local adaption.     

Endorsement of clinical practice guidelines by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

Clinical practice guidelines from other organizations or societies with assumed clinical and contextualized relevance for Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) members, may trigger a formal evaluation by The Clinical Practice Committee (CPC) for possible SSAI endorsement. This avoids unnecessary duplicate processes and minimizes resource-waste. Identified guidelines are assessed for endorsement using the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument. The SSAI CPC utilizes the AGREE II online coordinated group appraisal platform to assess the methodological rigor and transparency in which the guideline was developed. The results of the assessment, including the decision to endorse or not, are presented to the SSAI Board for sanctioning. This document briefly outlines the process for evaluation of non-SSAI guidelines by the CPC for possible SSAI endorsement.