Seminars in Hematology
Volume 45, Issue 3 , Pages 167-175 , July 2008

Misconceptions, Challenges, Uncertainty, and Progress in Guideline Recommendations

  • Regina Kunz

      Affiliations

    • Basel Institute of Clinical Epidemiology, Basel, Switzerland.
    • Corresponding Author InformationAddress correspondence to Regina Kunz, MD, MSc (Epi), Basel Institute for Clinical Epidemiology, University Hospital Basel, Hebelstrasse 19, CH-4031 Basel, Switzerland.
    • ,
  • Benjamin Djulbegovic

      Affiliations

    • H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL.
    • ,
  • Holger J. Schunemann

      Affiliations

    • Italian National Cancer Institute “Regina Elena,” Rome, Italy.
    • ,
  • Martin Stanulla

      Affiliations

    • Department of Pediatric Hematology and Oncology, Medical School of Hannover, Hannover, Germany.
    • ,
  • Paula Muti

      Affiliations

    • Italian National Cancer Institute “Regina Elena,” Rome, Italy.
    • ,
  • Gordon Guyatt

      Affiliations

    • Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.

References 

  1. Schunemann HJ, Best D, Vist G, Oxman AD. Letters, numbers, symbols and words: How to communicate grades of evidence and recommendations. CMAJ. 2003;169:677–680
  2. Shaneyfelt T, Mayo-Smith M, Rothwangl J. Are guidelines following guidelines? (The methodological quality of clinical practice guidelines in the peer-reviewed medical literature). JAMA. 1999;281:1900–1905
  3. Developing a Methodology for Drawing up Guidelines on Best Medical Practice (Recommendations Rec(2001)13) adopted by the Committee of Ministers of the Council of Europe (Recommendation Rec(2001)). Strasbourg, France: Council of Europe Publishing; 2001;
  4. West S, King V, Carey TS, Lohr KN, McKoy N, Sutton SF, et al. Systems to rate the strength of scientific evidence (Evidence Report/Technology Assessment No 47). Rockville, MD: Agency for Healthcare Research and Quality; 2002;
  5. www.gradeworkinggroup.orgaccessed May 2008
  6. Charles C, Gafni A, Whelan T, O'Brien MA. Treatment decision aids: conceptual issues and future directions. Health Expect. 2005;8:114–125
  7. Whelan T, Levine M, Willan A, Gafni A, Sanders K, Mirsky D, et al. Effect of a decision aid on knowledge and treatment decision making for breast cancer surgery: A randomized trial. JAMA. 2004;292:435–441
  8. Combination chemotherapy versus melphalan plus prednisone as treatment for multiple myeloma: An overview of 6,633 patients from 27 randomized trials. Myeloma Trialists' Collaborative Group. J Clin Oncol. 1998;16:3832–3842
  9. Alexanian R, Dimopoulos MA, Delasalle K, Barlogie B. Primary dexamethasone treatment of multiple myeloma. Blood. 1992;80:887–890
  10. Buller HR, Agnelli G, Hull RD, Hyers TM, Prins MH, Raskob GE. Antithrombotic therapy for venous thromboembolic disease: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(suppl):401–428
  11. Interferon as therapy for multiple myeloma: an individual patient data overview of 24 randomized trials and 4012 patients. Br J Haematol. 2001;113:1020–1034
  12. Ludwig H, Fritz E, Neuda J, Durie BG. Patient preferences for interferon alfa in multiple myeloma. J Clin Oncol. 1997;15:1672–1679
  13. WHO Rapid Advice Guidelines on pharmacological management of humans infected with avian influenza A (H5N1) virus. www.who.intaccessed Oct 18, 2006
  14. Center for Drug Evaluation and Research. Information for Healthcare Professionals (Erythropoiesis Stimulating Agents (ESA). US Food and Drug Administration). http://www.fda.gov/cder/drug/InfoSheets/HCP/RHE200711HCP.htmaccessed Jan 2, 2008
  15. Rodgers GM, et al. NCCN Practice Guidelines in Oncology: Cancer and Treatment related Anemia (Version 2.2006). NCCN National Comprehensive Cancer Network www.nccn.org/professionals/physician_gls/PDF/anemia.pdfaccessed January 2007
  16. Wilson J, Yao GL, Raftery J, Bohlius J, Brunskill S, Sandercock J, et al. A systematic review and economic evaluation of epoetin alpha, epoetin beta and darbepoetin alpha in anaemia associated with cancer, especially that attributable to cancer treatment. Health Technol Assess. 2007;11:1–4
  17. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: An overview of the randomised trials. Lancet. 2005;365:1687–1717
  18. Verhelst D, Rossert J, Casadevall N, Kruger A, Eckardt KU, Macdougall IC. Treatment of erythropoietin-induced pure red cell aplasia: A retrospective study. Lancet. 2004;363:1768–1771
  19. Djulbegovic B, Wheatley K, Ross J, Clark O, Bos G, Goldschmidt H, et al. Bisphosphonates in multiple myeloma. Cochrane Database Syst Rev. 2002;CD003188
  20. Clark OA, Lyman GH, Castro AA, Clark LG, Djulbegovic B. Colony-stimulating factors for chemotherapy-induced febrile neutropenia: A meta-analysis of randomized controlled trials. J Clin Oncol. 2005;23:4198–4214
  21. Cornelissen JJ, van Putten WL, Verdonck LF, Theobald M, Jacky E, Daenen SM, et al. Results of a HOVON/SAKK donor versus no-donor analysis of myeloablative HLA-identical sibling stem cell transplantation in first remission acute myeloid leukemia in young and middle-aged adults: Benefits for whom?. Blood. 2007;109:3658–3666
  22. Landolfi R, Marchioli R, Kutti J, Gisslinger H, Tognoni G, Patrono C, et al. Efficacy and safety of low-dose aspirin in polycythemia vera. N Engl J Med. 2004;350:114–124
  23. Sood AR, Burry LD, Cheng DK. Clarifying the role of rasburicase in tumor lysis syndrome. Pharmacotherapy. 2007;27:111–121
  24. Bohlius J, Reiser M, Schwarzer G, Engert A. Granulopoiesis-stimulating factors to prevent adverse effects in the treatment of malignant lymphoma. Cochrane Database Syst Rev. 2004;CD003189
  25. Kunz R, Friedrich C, Wolbers M, Mann JFE. Meta-analysis: Effect of monotherapy and combination therapy with inhibitors of the renin–angiotensin system on proteinuria in renal disease. Ann Intern Med. 2008;148:30–48
  26. Parfrey PS. Inhibitors of the renin–angiotensin system: Proven benefits, unproven safety. Ann Intern Med. 2008;148:76–77
  27. Besarab A, Bolton WK, Browne JK, Egrie JC, Nissenson AR, Okamoto DM, et al. The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. N Engl J Med. 1998;339:584–590
  28. Guyatt G, Rennie D: Users' Guides to the Medical Literature. A Manual for Evidence- Based Clinical Practice (ed 2). New York, NY, McGraw-Hill (in press)
  29. Adjuvant chemotherapy in invasive bladder cancer: A systematic review and meta-analysis of individual patient data (Advanced Bladder Cancer (ABC) Meta-analysis Collaboration). Eur Urol. 2005;48:189–199
  30. Wilcox RA, Djulbegovic B, Moffitt HL, Guyatt GH, Montori VM. Randomized trials in oncology stopped early for benefit. J Clin Oncol. 2008;26:18–19
  31. Gafter-Gvili A, Fraser A, Paul M, Leibovici L. Meta-analysis: antibiotic prophylaxis reduces mortality in neutropenic patients. Ann Intern Med. 2005;142:979–995
  32. Ross SD, Allen IE, Henry DH, Seaman C, Sercus B, Goodnough LT. Clinical benefits and risks associated with epoetin and darbepoetin in patients with chemotherapy-induced anemia: A systematic review of the literature. Clin Ther. 2006;28:801–831
  33. Bohlius J, Wilson J, Seidenfeld J, Piper M, Schwarzer G, Sandercock J, et al. Erythropoietin or darbepoetin for patients with cancer. Cochrane Database Syst Rev. 2006;3:CD003407
  34. Ioannidis JP, Trikalinos TA. The appropriateness of asymmetry tests for publication bias in meta-analyses: A large survey. CMAJ. 2007;176:1091–1096
  35. Kunz R, Vist G, Oxman AD. Randomisation to protect against selection bias in healthcare trials. Cochrane Database Syst Rev. 2007;2:MR000012
  36. Papanikolaou PN, Christidi GD, Ioannidis JP. Comparison of evidence on harms of medical interventions in randomized and nonrandomized studies. CMAJ. 2006;174:635–641
  37. Cannegieter SC, Rosendaal FR, Briet E. Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses. Circulation. 1994;89:635–641
  38. Loning L, Zimmermann M, Reiter A, Kaatsch P, Henze G, Riehm H, et al. Secondary neoplasms subsequent to Berlin-Frankfurt-Munster therapy of acute lymphoblastic leukemia in childhood: Significantly lower risk without cranial radiotherapy. Blood. 2000;95:2770–2775
  39. Schunemann HJ, Fretheim A, Oxman AD. Improving the use of research evidence in guideline development: 10 (Integrating values and consumer involvement). Health Res Policy Syst. 2006;4:22
  40. Devereaux PJ, Anderson DR, Gardner MJ, Putnam W, Flowerdew GJ, Brownell BF, et al. Differences between perspectives of physicians and patients on anticoagulation in patients with atrial fibrillation: Observational study. BMJ. 2001;323:1218–1222
  41. Schunemann H, Oxman A, Brozek JL, Glasziou P, Jaeschke R, Vist G, et al: GRADEing the quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ (in press)
  42. Guyatt G, Oxman A, Kunz R, Jaeschke R, Helfand M, Vist G, et al: Grading recommendations: Incorporating considerations of resources use. BMJ (in press)

 Dr Kunz has been supported by Santesuisse and the Gottfried and Julia Bangerter-Rhyner Foundation.

PII: S0037-1963(08)00064-4

doi: 10.1053/j.seminhematol.2008.04.005

Seminars in Hematology
Volume 45, Issue 3 , Pages 167-175 , July 2008

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