title: A benchmarking project on the quality of previous guidelines about the management of malignant pleural effusion from the European Society of Thoracic Surgeons (ESTS) Pleural Diseases Working Group.
abstract: OBJECTIVE
  In the European Society of Thoracic Surgeons (ESTS) survey about management of malignant pleural effusions (MPE), 56% of respondents are not informed of any relevant clinical guidelines and 52%, who are aware of the existence of guidelines, declared that they are in need of updating or revision. The ESTS Pleural Diseases Working Group developed a benchmarking project on quality of previous guidelines on the management of MPE.
  
  
  METHODS
  The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was used to assess each guideline. Each item was scored on a 7-point scale. Scores for each domain were calculated. Economic data for the nations which have issued the guidelines were collected from the Organisation for Economic Cooperation and Development health statistics database.
  
  
  RESULTS
  Six guidelines fitted the inclusion criteria and were assessed. Five out of 6 guidelines were produced by a multinational collaboration. Observers would recommend only 2 guidelines with minimal modification. Two areas that received the best score were clarity of presentation and scope and purpose (objectives and health questions target population). The applicability of guideline domain had the lowest score. Multivariate analysis demonstrated that clarity of presentation, international guidelines and publication through medical journal were related to improved scores. A strong correlation was observed between the measures of economic status.
  
  
  CONCLUSIONS
  The quality of guidelines assessed by the AGREE II criteria was found to be extremely variable. Guidelines achieving higher AGREE II scores were more likely to come from the European Union with the direct involvement of scientific societies in their development. It was also recognized that some fundamental unanswered questions remain about the management of MPE.
authors.affiliation: Department of Thoracic Surgery, AUSL Romagna Teaching Hospital, Ravenna, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Bertolaccini
authors.affiliation: Thoracic Surgery Unit, University College London Hospital, London, UK.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Bedetti
authors.affiliation: Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Brunelli
authors.affiliation: Department of Surgery, ESS Thoracic Surgery, Thoracic Surgery Clinic, University Hospital St. Marina, Varna, Bulgaria.
authors.forename: Katerina
authors.initials: K
authors.lastname: Marinova
authors.affiliation: Thoracic Surgery Unit, Azienda Ospedaliera San Paolo, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Raveglia
authors.affiliation: Division of Thoracic Surgery, Department of Thoracic Surgical and Medical Oncology, National Cancer Institute-Pascale Foundation, Naples, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Rocco
authors.affiliation: Division of Thoracic Surgery, McMaster University, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Shargall
authors.affiliation: Department of Thoracic Surgery, AUSL Romagna Teaching Hospital, Ravenna, Italy.|Department of Thoracic Surgery, AUSL Romagna Teaching Hospital, Forlì, Italy.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Solli
authors.affiliation: Thoracic Surgery, Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Varela
authors.affiliation: Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK.
authors.forename: Kostas
authors.initials: K
authors.lastname: Papagiannopoulos
authors.affiliation: Department of Thoracic Surgery, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland.
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Kuzdzal
authors.affiliation: Department of Thoracic Surgery, Nouvel Hopital Civil, Strasbourg, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Massard
authors.affiliation: Department of Thoracic Surgery, University of Torino, Turin, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ruffini
authors.affiliation: Department of Thoracic Surgery, Nouvel Hopital Civil, Strasbourg, France.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Falcoz
authors.affiliation: Department of Thoracic Surgery, Hospital Germans Trias i Pujol, Badalona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Martinez-Barenys
authors.affiliation: Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Opitz
authors.affiliation: Department of Thoracic Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Hasan F
authors.initials: HF
authors.lastname: Batirel
authors.affiliation: Department of General Thoracic Surgery, Istanbul Medical Faculty, Istanbul, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Toker
authors.affiliation: Thoracic Surgery Unit, University College London Hospital, London, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Scarci
mesh_terms: D019985:Benchmarking; D005060:Europe; D006801:Humans; D008175:Lung Neoplasms / Q000628:therapy*; D016066:Pleural Effusion, Malignant / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*
keywords: AGREE II; Benchmarking project ; Lung cancer ; Malignant pleural effusion ; Quality 