Evaluating nine clinical practice guidelines for Vitamin D supplementation in children and adolescents with AGREE II: recommendations and controversies
Bibliographic record
Abstract
Objective The aim of this study was to assess the quality of clinical practice guidelines(CPGs)using the Appraisal of Guidelines for Research and Evaluation Ⅱ(AGREE Ⅱ) instrument, and to provide a reference for promotion, and adaptation of the guidelines. The recommendations were compared among guidelines for children and adolescents vitamin D supplementation, and the basic consensus and dispute were focused. Methods PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang Chinese Periodical Database, VIP Chinese Periodical Database, National Guideline Clearinghouse and relevant web sites were searched for the guidelines on children and adolescent vitamin D supplementation. The common characteristics of guideline were descriptively analyzed. AGREE Ⅱinstrument was used to evaluate the quality of CPGs. Intraclass correlation coefficient (ICC) was used to examine the conformance of the raters′ evaluation scores. The recommendations of the included guidelines were extracted, analyzed and compared to find the similarities and differences. Results A total of 9 CPGs were identified from the United States, China, Canada, France, Poland and Australia/ New Zealand. The guidelines were published from 2006 to 2012, 3 of them were evidence-based (EB) and 2 used GRADE method, 1 used AHRQ evidence grading system, the rest of 6 were non-EB CPGs made by consensus of experts and article review. ①The AGREEⅡinstrument rated CPGs among 6 domains. Scope and purpose, clarity and presentation, and applicabilitywere averagely scored ≥50%, stakeholder involvement, rigor of development and editorial independence were scored 48%, 42% and 28% respectively and needed improved. EB CPGs had higher quality scores compared with non-EB CPGs for rigor of development and editorial independence. ② The main recommendations of CPGs were similar. However, there were 5 main differences summarized among CPGs. For prevention of VD deficiency, 400 IU·d-1 of VD was considered as a safe dose for 0-1 year-old group and therefore worthy to be recommended. For treatment of VD deficiency, America(ES) CPGs recommend 2 000 IU·d-1 of VD for at least 6 weeks(1-18 years group). For sun exposure, America and Australia/New Zealand CPGs held different recommendations. For supplement of VD2 or VD3, there was no consensus among included CPGs. For 25OHD level, nearly all CPGs agreed to the increased prevalence of rickets when 25OHD 30 nmol·L-1. For pregnant and lactating women, CPGs recommend that this group should pay attention on VD supplementation, or maintain appropriate 25OHD level. Conclusions ①The overall quality of the included CPGs is still to be improved, and EB CPGs have higher quality scores for rigor of development. ②400 IU·d-1 of VD is considered as a safe dose to preventing VD deficiency for all 0-18 years-old groups and therefore worthy to be recommended. ③The recommendations of China CPGs have absorbed the high quality CPGs from other countries, so adaptation and of Chinese own high-quality CPGs is urgently needed.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.174 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.002 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".