Systematic review of clinical practice guidelines for uveitis
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  • Published on:
    Critical Appraisal in uveitis and eye diseases with fewer evidence-based clinical practice guidelines
    • Nima Ghadiri, Consultant Medical Ophthalmologist Department of Ophthalmology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK

    Dear Editor,

    Thank you for the opportunity to respond to the comments raised in the correspondence by Galvez-Olortegui et al. [1] regarding our recent publication "Systematic review of clinical practice guidelines for uveitis" [2]

    We thank the authors for a thoughtful and considered response to the paper and appreciate the interest shown in our work. The authors have highlighted additional factors beyond evidence when formulating recommendations for patient care, such as cost-effectiveness, feasibility, and equity.

    We agree with the point that although the Appraisal of Guidelines for Research and Evaluation (AGREE II) is a commonly used tool for critical appraisal of Clinical Practice Guidelines (CPGs), the exclusion of items in the evaluation process may limit the assessment of the entire CPG development process. We acknowledge the concern about the lack of consideration of applicability domain (domain 5) in the evaluation of CPGs. Indeed, a CPG with high methodological quality can score low in applicability domain, which can limit its implementation in specific environments.

    We also appreciate the suggestion of a more novel tool, the appraisal of Guidelines for Research and Evaluation-Recommendations Excellence (AGREE-REX), which focuses specifically on the quality of the recommendations of the CPG and its clinical credibility and implementability for health professionals, decision makers, and stakeholders. In combination with AGREE...

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    Conflict of Interest:
    None declared.
  • Published on:
    Clinical Practice Guidelines and positions statements critical appraisal in Uveitis
    • Jose Galvez-Olortegui, Physician, Ophthalmology Resident. Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
    • Other Contributors:
      • Carmen Burgueño-Montañes, Opthalmologist
      • Miguel Zavaleta-Mercado, Opthalmologist
      • Tomas Galvez-Olortegui, Opthalmologist
      • Alfredo Adan, Opthalmologist

    To the editor:
    We have carefully read the article “Systematic Review of Clinical Practice Guidelines for Uveitis” by Ghadiri et al., whose purpose is to present the results, including the quality and current state of evidence, of a systematic review of Clinical Practice Guidelines (CPG) for uveitis(1).

    CPG provides recommendations to optimize patient care, based on a systematic review of evidence and, although the evidence is critical; additional factors should be considered when formulating recommendations, such as benefits and risks, use of resources, cost-effectivity, values and preferences of the patient, feasibility and equity, before recommendations are considered ultimate (2). Currently, there are several ways to critical appraise a CPG, and the most used is the Appraisal of Guidelines for Research and Evaluation (AGREE II).

    AGREE II has 23 items, with 6 domains, for evaluating the rigor or methodological quality and transparency with which a guide is developed; thus, the aim is to assess the entire CPG development process. However, a CPG with high methodological quality (domain 3) can score low in applicability domain (domain 5), because of it is difficulty to implement or adapt to a specific environment if the recommendations are not robust, troublesome to apply or of uncertain clinical validity. Ghadiri et al. specifically used 9 items of the AGREE II and none of them correspond to domain 5 (applicability). The AGREE II user manual itself advi...

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    Conflict of Interest:
    None declared.