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We have evaluated the methodological quality of the AFSSAPS French clinical practice guidelines on prevention and treatment of thromboembolic disease in medicine, published in 2009. We have evaluated in parallel the similar recommandations from north-America on the subject (ACCP 2008). Our evaluation tool was the AGREE instrument which is consensual at an international level, in particular at the WHO (World Health Organisation) and at the European Union. The methodological quality of the AFSSAPS guidelines is sub-optimal, significantly lower than that of the ACCP guidelines. Compared with the ACCP guidelines, the weakest points of the AFSSAPS guidelines are about rigor of development (AGREE domain 3), applicability (AGREE domain 5) and editorial independence (AGREE domain 6). The main common shortcoming in quality of both guidelines is about lack of stakeholder involvement (AGREE domain 2). A more important implication of methodologists might explain why the ACCP guidelines reach a higher level of quality than those of the AFSSAPS guidelines. We do not make judgments about the content of the recommendations of the AFSSAPS or of the ACCP. Copyright 2010 American Association for Clinical Chemistry, Inc.


Gimenez N.,University of Barcelona | Gimenez N.,Autonomous University of Barcelona | Gimenez N.,Evidence Based Laboratory Medicine
Clinical Chemistry and Laboratory Medicine | Year: 2013

The usefulness of %[-2] proPSA and Prostate Health Index (phi) in the detection of prostate cancer are currently unknown. It has been suggested that these tests can distinguish prostate cancer from benign prostatic diseases better than PSA or %fPSA. We performed a systematic review and meta-analysis of the available scientific evidence to evaluate the clinical usefulness of %[-2] proPSA and phi. Relevant published papers were identified by searching computerized bibliographic systems. Data on sensitivity and specificity were extracted from 12 studies: 10 studies about %[-2] proPSA (3928 patients in total, including 1762 with confirmed prostate cancer) and eight studies about phi (2919 patients in total, including 1515 with confirmed prostate cancer). The sensitivity for the detection of prostate cancer was 90% for %[-2] proPSA and phi, while the pooled specificity was 32.5% (95% CI 30.6 - 34.5) and 31.6% (95% CI 29.2 - 34.0)or %[-2] proPSA and phi, respectively. The measurement of %[-2] proPSA improves the accuracy of prostate cancer detection in comparison with PSA or %fPSA, particularly in the group of patients with PSA between 2 μg/L and 10 μg/L. Similar results were obtained measuring phi. Using these tests, it is possible to reduce the number of unnecessary biopsies, maintaining a high cancer detection rate. Published results also showed that %[-2] proPSA and phi are related to the aggressiveness of the tumor.

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