Appraisal of guidelines developed by the World Health Organization

Objective

To appraise the quality of guidelines developed by the World Health Organization (WHO) that were approved by its Guidelines Review Committee (GRC) and identify strengths and weaknesses in the guideline development process.

Study design

Cross-sectional.

Methods

Three individuals independently assessed GRC-approved WHO guidelines using the Appraisal of Guidelines for Research and Evaluation II instrument (AGREE II). Scores were standardized across domains and overall quality was determined through consensus.

Results

124 guidelines met inclusion criteria and were assessed. 58 guidelines were recommended for use, 58 were recommended with modifications and eight were not recommended. The highest scoring domains across guidelines were scope and purpose, and clarity of presentation. The recommended guidelines had higher rigor of development and applicability domain scores in comparison to other guidelines. 77% of the guidelines referenced an underlying evidence review and 49% used GRADE to assess the body of evidence or the strength of the recommendation. The domains in need of improvement included stakeholder engagement, editorial independence, and applicability. Guidelines not recommended for use were generally insufficient in their rigor of development.

Conclusions

WHO guidelines need further improvement, most importantly in the rigor of their development (i.e., use of evidence reviews). Other areas for improvement include increased stakeholder engagement, a more explicit process for recommendation formulation and disclosure of interests, discussion of the facilitators, barriers, resource implications, and criteria for monitoring the outcomes of guideline implementation. WHO guidelines can improve through increased transparency, adherence to the WHO Handbook for Guideline Development, and better oversight by the GRC.     

General practice encounters following seasonal influenza vaccination as a proxy measure of early-onset adverse events

Background

In 2010, use of seasonal trivalent influenza vaccine (TIV) in children <5 years of age was suspended in Australia following reports of vaccine-related febrile convulsions. We investigated the utility of data on primary care [general practice (GP)] consultations for any reason within three days of receipt of influenza vaccine as recorded on the Australian Childhood Immunisation Register (ACIR) as a means of signal detection.

Methods

Data on GP consultations were obtained from Medicare Australia (Australian Government Department of Human Services) for children recorded on the ACIR as receiving either TIV or monovalent influenza vaccine. Rates of GP consultation by day following ACIR-recorded receipt of influenza vaccine were compared by year (2008–2010), vaccine type, age and region.

Results

In 2010, GP encounter rates on the day after receipt of the TIV manufactured by bioCSL (formerly CSL Biotherapies (Fluvax^®) were significantly higher than both bioCSL TIVs in the previous two years [rate ratio (RR) 1.9; 95% CI: 1.7–2.2] and Sanofi Pasteur TIV, Vaxigrip^® [RR 1.6, 95% CI 1.4–1.7] in 2009–2010. Encounter rates were also higher than for CSL Monovalent influenza vaccine, Panvax^® [RR 1.9, 95% CI 1.7–2.2] in 2009–2010. These findings were robust to adjustment for age group (≤2, >2 years) and region (Western Australia vs other Australian states/territories).

Conclusions

A primary care consultation on the day after vaccine receipt is a reasonable proxy for early reactogenicity and has potential for use in various settings.     

Mothers’ knowledge and practices regarding preventing poor Egyptian infant death syndrome

ObjectiveThe main aim of this study is evaluating the effectiveness of an educational program on mothers’ knowledge and practices for the prevention of sudden infant death syndrome (SIDS).DesignA quasi-experimental study was used.SettingThe study was conducted in the postnatal department at the general hospital in Damietta, Egypt.ParticipantsThe study sample was 150 newly delivered mothers from the postnatal unit.MethodAn interview questionnaire sheet was used to collect data about the characteristics of mothers and their infant, mothers’ knowledge, and reported practice about SIDS.ResultsBefore the program, more than three-quarters of the moms had never heard of SIDS and had little awareness about the condition. Furthermore, prior to the training, almost half of the moms had an unacceptable level of SIDS prevention practice. After completing the program, the majority of them had enough knowledge and practice levels.ConclusionThere was a positive effect of educational program in improving the mothers’ knowledge and preventive practices about SIDS.Practical implicationDespite the decrease in SIDS prevalence during the past two decades, SIDS continues to be one of the leading causes of infant mortality in the post-neonatal period. In addition, there is a scarcity of knowledge about SIDS in Egypt despite of the worldwide recognition of this syndrome in 1960. There are inadequate studies about SIDS in Egypt; therefore, a regular health education program is essential for improving mothers’ knowledge and practices regarding the prevention of SIDS.     

Curricular Revision to Increase Use of Quality Improvement Principles in Doctor of Nursing Practice Projects

BackgroundA gap was identified related to students’ use of quality improvement (QI) methodologies in their final project, so a curricular change was made to incorporate a health care QI methods course in the curriculum.MethodsWe compared the use of SMART (specific, measurable, achievable, relevant, and time-bound) aims and QI evaluation methodologies in doctor of nursing practice (DNP) project proposals in 2 cohorts before and after the curriculum change.ResultsA total of 88 DNP proposals were evaluated.ConclusionIncluding a QI course increased the use of SMART aims but did not influence the use of QI methodologies. Future interventions will target faculty development related to QI.