SYSTEMATIC QUALITY ASSESSMENT OF CLINICAL PRACTICE GUIDELINES TO MINIMIZE THE RISK OF COVID-19 TRANSMISSION DURING DENTAL CARE
Creators: name: Alonso-Coello, Pablo
name: Aravena, Yanela
name: Deana, Naira
name: espinoza, gerardo
name: muñoz, patricia
name: Pineda, Patricia
name: seiffert, andrea
name: Zaror, Carlos
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Other Dentistry
subject: Physical Sciences and Mathematics
subject: Medicine and Health Sciences
subject: Dentistry
subject: FOS: Clinical medicine

description: Systematic quality assessment of Clinical Practice Guidelines to minimize the risk of COVID-19 transmission during dental care Review team members Alonso-Coello, Pablo Aravena, Yanela Deana, Naira Figueiredo Espinoza, Gerardo Muñoz, Patricia Pineda, Patricia Seiffert, Andreia Zaror, Carlos Organisational affiliation of the review Center for Research in Epidemiology, Economics an Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, España Funding Agencia Nacional de Investigación y Desarrollo (ANID), Gobierno de Chile Grant COVID0700 Review question What is the quality of clinical practice guidelines aimed for the procedures intended to minimize the risk of COVID-19 transmission during dental care developed during the first months of the COVID-19 pandemic? Searches A systematic search will be carried out of the scientific literature to identify Clinical Practice Guidelines (CPGs) and protocols on procedures intended to minimize the risk of COVID-19 transmission during dental care. The search will be conducted in MEDLINE, EMBASE, LILACS, CRD, Epistemonikos and Trip databases. It will be complemented by manual search of guideline developer websites, CPG repositories, dental scientific societies, Ministries of Health and institutions related to COVID-19 management. In addition, we will examine the reference lists of the selected CPGs to identify other guidelines that met the inclusion criteria. The search strategy that will be carried out in MEDLINE is: (((((((((((((((((((covid-19) OR covid19) OR sars-cov 2) OR covid*) OR cov2) OR coronaviridae) OR MERS-cov) OR sars cov 2) OR sars2) OR coronavirus) OR "Coronavirus"[Mesh]) OR "Coronavirus Infections"[Mesh]) OR sars-cov-2) OR "severe acute respiratory syndrome coronavirus 2" [Supplementary Concept]) OR mers cov) OR "Middle East Respiratory Syndrome Coronavirus"[Mesh])) AND (((((((((oral) OR dental)) AND ((((((prevention) OR care) OR health) OR procedure*) OR treatment*) OR "Health"[Mesh]))) OR dentistry) OR "Dentistry"[Mesh]) OR "Oral Health"[Mesh]) OR "Dental Care"[Mesh])) AND (((((((((((guideline*) OR recommendation*) OR protocol*) OR consensus) OR practice guideline) OR guidance) OR "Guideline" [Publication Type]) OR "Practice Guideline" [Publication Type]) OR "Health Planning Guidelines"[Mesh]) OR "Consensus"[Mesh]) OR "Guidelines as Topic"[Mesh])) Condition or domain being studied Assess the quality of CPGs that focus on procedures intended to minimize the risk of COVID-19 transmission during dental care, developed during the first eight months of the COVID-19 pandemic. Participants/population Inclusion criteria: guidelines/documents containing recommendations about procedures and/or measures intended to minimize the risk of COVID-19 transmission during dental care. A document will be considered as eligible if it was self-declared as a guideline or protocol, it provided recommendations for walk-in or emergency dental care and was published by a governmental or scientific organization. Exclusion criteria: Will be excluded CPG developed exclusively for patients’ special care, guidelines developed outside of the pandemic context, previous versions of the same guideline, letters to the editor, and conference summaries. Intervention, exposure Quality analysis of CPGs using AGREE II tool. Comparator/control Not apply Types of study to be included CPGs published in databases and gray literature developed during COVID-19 pandemic, aimed at procedures intended to minimize the risk of COVID-19 transmission during dental care. Context The COVID-19 pandemic has forced worldwide dental services to change their routines, restricting them to providing emergency treatments only. The re-opening of dental services must prioritize the patient’s protection and reduce the coronavirus transmission risk in both public and private dental services, guaranteeing the health and safety of the dental staff and patients. In order to provide the safest possible dental practice based on scientific evidence,1 CPGs must be top quality and readily available2 and provide the systematic support for decisions, thereby improving the quality and results of medical services.3 Main outcome Assess the quality of CPGs that focus on dental services provision developed during the first months of the COVID-19 pandemic. Secondary outcome To identify the main recommendations such as reducing the levels of aerosols in the local environment during dental treatments, the contamination in the dental box, to establish adequate ventilation and air purification within the dental box, to triage with patients, in-person and by telephone, for dental service different rooms and recommendations to patients. Data extraction All references identified will be extracted to an EndNote X9 database to facilitate their management and delete duplicate articles. Titles and abstracts of studies retrieved will be examined using the search strategy and will be screened independently by two authors to identify studies that potentially meet the inclusion criteria. We will obtain the full text of all relevant and potentially relevant studies, those that appear to meet the inclusion criteria. Any disagreement between the two authors will be resolved through discussion with a third reviewer. In the case of several documents from a single source, we will include the most recent CPG. One reviewer will extract the relevant data and main characteristics from eligible studies. An additional reviewer will check all the extracted information for accuracy (no-independent verification of data extraction). The authors will extract the following information from each article using a standardized, predefined data collection form: Author, year, title, country, organization, language, setting, and target population. Quality assessment The quality of each guideline will be assessed using the online AGREE II tool (https://www.agreetrust.org/resource-centre/agree-plus/). The AGREE II instrument includes 23 items divided into six domains: 1. Scope and purpose, refers to the aim of the guidelines; 2. Stakeholder involvement, represents the views of the intended users; 3. Rigor of development, reflects the quality of the CPG development process and its recommendations; 4. Clarity of presentation, refers to the structure of the guidelines; 5. Applicability, shows the barriers and facilitators for the implementation of the CPG, also considering the financial implications to implement the recommendations; and 6. Editorial independence, illustrating the transparency in the formulation of the guideline recommendations. Each of the 23 items is rated from 1 to 7 points in the Likert scale.4 Strategy for data synthesis The principal aspects of the guidelines and their main recommendations will be reported descriptively and will be presented in Figures and Tables. Recommendations will be grouped by purpose of the recommendation: triage and recommendations for patients, recommendations for the waiting room, recommendations during dental procedures, recommendations after dental care, recommendations for equipment and infrastructure, and personal protective measures for dentists, support staff and patients. The total AGREE score will be calculated by summing up the individual items included in a domain and by scaling the total as a percentage of the maximum possible score for that domain.4 If discrepancies between reviewers are higher than 3 points, or if the standard deviation (SD) in an item is greater than or equal to 1.5 SD, the item of the guideline will be reassessed by the reviewers and agreement will be reached.5 The total AGREE II score, and score for each domain of the included guidelines will be reported through tables and figures showing the mean, standard deviation and minimum and maximum scores. Additionally, high-quality CPGs will be identified. The reviewers will consider the overall quality of the CPGs and made a final recommendation about each guideline (recommended, recommended with modifications or not recommended).5 We will classify the CPG as high quality when at least three of the domains showed a score of 60% or higher, including the rigor of development domain. The intraclass coefficient with its 95% confidence interval (95%CI) as an indicator of overall agreement between reviewers for each of the 23 items of the AGREE II instrument will be also calculated. According to the scale proposed by Landis and Koch, the degree of agreement between 0.01 and 0.20 is slight, from 0.21 to 0.40 is fair, from 0.41 to 0.60 is moderate, from 0.61 to 0.80 is substantial and from 0.81 to 1.00 is very good. Descriptive statistics (mean, standard deviation, range) will be calculated for each domain score for each CPG. Type and method of review Systematic review Subject index terms COVID-19; Dental services, Clinical Practice Guidelines, Pandemics; SARS-CoV-2. References 1. Qaseem A, Snow V, Gosfield A, Gregg D, Michl K, Wennberg D. Improving Patient Care Annals of Internal Medicine Pay for Performance Through the Lens of Medical Professionalism. 2013;366–70. 2. Dagens A, Sigfrid L, Cai E, Lipworth S, Cheung V, Harris E, et al. Scope, quality, and inclusivity of clinical guidelines produced early in the covid-19 pandemic: Rapid review. BMJ. 2020;369. 3. Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E. Clinical Practice Guidelines We Can Trust. National Academy of Sciences. [Internet]. 2011. 291 p. Available from: http://www.nap.edu/catalog.php?record_id=13058%0Ahttps://www.awmf.org/fileadmin/user_upload/Leitlinien/International/IOM_CPG_lang_2011.pdf 4. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: Advancing guideline development, reporting and evaluation in health care. Cmaj. 2010;182(18):839–42. 5. Fuentes Padilla P, Martínez G, Vernooij RWM, Cosp XB, Alonso-Coello P. Nutrition in critically ill adults: A systematic quality assessment of clinical practice guidelines. Clin Nutr [Internet]. 2016;35(6):1219–25. Available from: http://dx.doi.org/10.1016/j.clnu.2016.03.005