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McSween-Cadieux E, Lane J, Hong QN, Houle AA, Lauzier-Jobin F, Saint-Pierre Mousset E, Prigent O, Ziam S, Poder T, Lesage A, Dagenais P. Production and use of rapid responses during the COVID-19 pandemic in Quebec (Canada): perspectives from evidence synthesis producers and decision makers. Health Res Policy Syst 2024; 22:22. [PMID: 38351054 PMCID: PMC10863098 DOI: 10.1186/s12961-024-01105-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has required evidence to be made available more rapidly than usual, in order to meet the needs of decision makers in a timely manner. These exceptional circumstances have caused significant challenges for organizations and teams responsible for evidence synthesis. They had to adapt to provide rapid responses to support decision-making. This study aimed to document (1) the challenges and adaptations made to produce rapid responses during the pandemic, (2) their perceived usefulness, reported use and factors influencing their use and (3) the methodological adaptations made to produce rapid responses. METHODS A qualitative study was conducted in 2021 with eight organizations in the health and social services system in Quebec (Canada), including three institutes with a provincial mandate. Data collection included focus groups (n = 9 groups in 8 organizations with 64 participants), interviews with decision makers (n = 12), and a document analysis of COVID-19 rapid responses (n = 128). A thematic analysis of qualitative data (objectives 1 and 2) and a descriptive analysis of documents (objective 3) were conducted. RESULTS The results highlight the teams and organizations' agility to deal with the many challenges encountered during the pandemic (e.g., increased their workloads, adoption of new technological tools or work processes, improved collaboration, development of scientific monitoring, adaptation of evidence synthesis methodologies and products). The challenge of balancing rigor and speed was reported by teams and organizations. When available at the right time, rapid responses have been reported as a useful tool for informing or justifying decisions in a context of uncertainty. Several factors that may influence their use were identified (e.g., clearly identify needs, interactions with producers, perceived rigor and credibility, precise and feasible recommendations). Certain trends in the methodological approaches used to speed up the evidence synthesis process were identified. CONCLUSIONS This study documented rapid responses producers' experiences during the COVID-19 pandemic in Quebec, and decision makers who requested, consulted, or used these products. Potential areas of improvements are identified such as reinforce coordination, improve communication loops, clarify guidelines or methodological benchmarks, and enhance utility of rapid response products for decision makers.
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Affiliation(s)
- Esther McSween-Cadieux
- Department of School and Social Adaptation Studies, Faculty of Education, Université de Sherbrooke, Sherbrooke, Canada.
- Centre RBC d'expertise Universitaire en Santé Mentale, Université de Sherbrooke, Sherbrooke, Canada.
| | - Julie Lane
- Department of School and Social Adaptation Studies, Faculty of Education, Université de Sherbrooke, Sherbrooke, Canada
- Centre RBC d'expertise Universitaire en Santé Mentale, Université de Sherbrooke, Sherbrooke, Canada
| | - Quan Nha Hong
- School of Rehabilitation, Université de Montréal, Montreal, Canada
| | - Andrée-Anne Houle
- Centre RBC d'expertise Universitaire en Santé Mentale, Université de Sherbrooke, Sherbrooke, Canada
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, Canada
| | - François Lauzier-Jobin
- Centre RBC d'expertise Universitaire en Santé Mentale, Université de Sherbrooke, Sherbrooke, Canada
| | - Eliane Saint-Pierre Mousset
- Department of School and Social Adaptation Studies, Faculty of Education, Université de Sherbrooke, Sherbrooke, Canada
- Centre RBC d'expertise Universitaire en Santé Mentale, Université de Sherbrooke, Sherbrooke, Canada
| | - Ollivier Prigent
- Department of School and Social Adaptation Studies, Faculty of Education, Université de Sherbrooke, Sherbrooke, Canada
| | - Saliha Ziam
- School of Business Administration, Université TÉLUQ, Montreal, Canada
| | - Thomas Poder
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), CIUSSS-de-l'Est-de-l'île-de-Montréal, Montreal, Canada
- Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, Montreal, Canada
| | - Alain Lesage
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), CIUSSS-de-l'Est-de-l'île-de-Montréal, Montreal, Canada
| | - Pierre Dagenais
- Department of Medicine, Faculty of Medicine and Health Science, University of Sherbrooke, Sherbrooke, Canada
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Garritty C, Hamel C, Trivella M, Gartlehner G, Nussbaumer-Streit B, Devane D, Kamel C, Griebler U, King VJ. Updated recommendations for the Cochrane rapid review methods guidance for rapid reviews of effectiveness. BMJ 2024; 384:e076335. [PMID: 38320771 DOI: 10.1136/bmj-2023-076335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Affiliation(s)
- Chantelle Garritty
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1G 5Z3, Canada
- Global Health and Guidelines Division, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Candyce Hamel
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1G 5Z3, Canada
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Marialena Trivella
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
- Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Gerald Gartlehner
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
- Research Triangle Institute (RTI) International, Research Triangle Park, NC, USA
| | - Barbara Nussbaumer-Streit
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
| | - Declan Devane
- Cochrane Ireland and Evidence Synthesis Ireland, School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Chris Kamel
- Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, ON, Canada
| | - Ursula Griebler
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria
| | - Valerie J King
- Center for Evidence-based Policy, Department of Family Medicine, Oregon Health and Science University (OHSU), Portland, OR, USA
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Malaga M, Rodriguez-Calienes A, Chavez-Ecos FA, Huerta-Rosario A, Alvarado-Gamarra G, Cabanillas-Lazo M, Moran-Ballon P, Velásquez-Rimachi V, Martinez-Esteban P, Alva-Diaz C. Clinical practice guidelines for the diagnosis and management of Duchenne muscular dystrophy: a scoping review. Front Neurol 2024; 14:1260610. [PMID: 38249725 PMCID: PMC10797703 DOI: 10.3389/fneur.2023.1260610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/30/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Our objective was to identify recent CPGs for the diagnosis and management of DMD and summarize their characteristics and reliability. Methods We conducted a scoping review of CPGs using MEDLINE, the Turning Research Into Practice (TRIP) database, Google Scholar, guidelines created by organizations, and other repositories to identify CPGs published in the last 5 years. Our protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses for scoping reviews. To assess the reliability of the CPGs, we used all the domains included in the Appraisal of Guidelines Research and Evaluation II. Results We selected three CPGs published or updated between 2015 and 2020. All the guidelines showed good or adequate methodological rigor but presented pitfalls in stakeholder involvement and applicability domains. Recommendations were coherent across CPGs on steroid treatment, except for minor differences in dosing regimens. However, the recommendations were different for new drugs. Discussion There is a need for current and reliable CPGs that develop broad topics on the management of DMD and consider the challenges of developing recommendations for RDs.
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Affiliation(s)
- Marco Malaga
- Facultad de Medicina Humana de la Universidad de San Martín de Porres, Lima, Peru
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
| | - Aaron Rodriguez-Calienes
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru
| | - Fabian A. Chavez-Ecos
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina de Ica, Universidad Nacional San Luis Gonzaga, Ica, Peru
| | - Andrely Huerta-Rosario
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Facultad de Medicina Humana, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Giancarlo Alvarado-Gamarra
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Instituto de Investigación Nutricional, Lima, Peru
- Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Miguel Cabanillas-Lazo
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Sociedad Científica de San Fernando, Lima, Peru
| | - Paula Moran-Ballon
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Sociedad Científica Universidad San Martín de Porres, Lima, Peru
| | - Victor Velásquez-Rimachi
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru
| | | | - Carlos Alva-Diaz
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Universidad Señor de Sipán, Chiclayo, Peru
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru
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Dewidar O, Pardo JP, Welch V, Hazlewood GS, Darzi AJ, Barnabe C, Pottie K, Petkovic J, Kuria S, Sha Z, Allam S, Busse JW, Schünemann HJ, Tugwell P. Operationalizing the GRADE-equity criterion to inform guideline recommendations: application to a medical cannabis guideline. J Clin Epidemiol 2024; 165:111185. [PMID: 37952701 DOI: 10.1016/j.jclinepi.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Incorporating health equity considerations into guideline development often requires information beyond that gathered through traditional evidence synthesis methodology. This article outlines an operationalization plan for the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-equity criterion to gather and assess evidence from primary studies within systematic reviews, enhancing guideline recommendations to promote equity. We demonstrate its use in a clinical guideline on medical cannabis for chronic pain. STUDY DESIGN AND SETTING We reviewed GRADE guidance and resources recommended by team members regarding the use of evidence for equity considerations, drafted an operationalization plan, and iteratively refined it through team discussion and feedback and piloted it on a medicinal cannabis guideline. RESULTS We propose a seven-step approach: 1) identify disadvantaged populations, 2) examine available data for specific populations, 3) evaluate population baseline risk for primary outcomes, 4) assess representation of these populations in primary studies, 5) appraise analyses, 6) note barriers to implementation of effective interventions for these populations, and 7) suggest supportive strategies to facilitate implementation of effective interventions. CONCLUSION Our approach assists guideline developers in recognizing equity considerations, particularly in resource-constrained settings. Its application across various guideline topics can verify its feasibility and necessary adjustments.
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Affiliation(s)
- Omar Dewidar
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Temerty School of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Jordi Pardo Pardo
- Ottawa Centre for Health Equity, Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Vivian Welch
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Glen S Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea J Darzi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Pottie
- CT Lamont Centre for Primary Care, Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, Western University, London, Ontario, Canada
| | - Jennifer Petkovic
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Shawn Kuria
- Ottawa Centre for Health Equity, Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Zhiming Sha
- Ottawa Centre for Health Equity, Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Allam
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Cochrane Canada, MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Milan, Italy; Cochrane Canada, McMaster University, Hamilton, Ontario, Canada
| | - Peter Tugwell
- Ottawa Centre for Health Equity, Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Hendrikse C, Ngah V, Kallon II, Leong TD, McCaul M. Ketamine as adjunctive or monotherapy for post-intubation sedation in patients with trauma on mechanical ventilation: A rapid review. Afr J Emerg Med 2023; 13:313-321. [PMID: 38033380 PMCID: PMC10682541 DOI: 10.1016/j.afjem.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/29/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023] Open
Abstract
Background The effectiveness of ketamine as adjunctive or monotherapy for post-intubation sedation in adults with trauma on mechanical ventilation is unclear. Methods A rapid review of systematic reviews of randomized controlled trials, then randomized controlled trials or observational studies was conducted searching three electronic databases (PubMed, Embase, Cochrane Library) and one clinical trial registry on June 1, 2022. We used a prespecified protocol following Cochrane rapid review methods. Results We identified eight systematic reviews of randomized controlled trials and observational studies. Among the included reviews, only the most relevant, up to date, highest quality-assessed reviews and reviews that reported on critical outcomes were considered. Adjunctive ketamine showed a morphine sparing effect (MD -13.19 µmg kg-1 h-1, 95 % CI -22.10 to -4.28, moderate certainty of evidence, 6 RCTs), but no to little effect on midazolam sparing effect (MD 0.75 µmg kg-1 h-1, 95 % CI -1.11 to 2.61, low certainty of evidence, 6 RCTs) or duration of mechanical ventilation in days (MD -0.17 days, 95 % CI -3.03 to 2.69, moderate certainty of evidence, 3 RCTs).Adjunctive ketamine therapy may reduce mortality (OR 0.88, 95 % CI 0.54 to 1.43, P = 0.60, very low certainty of evidence, 5 RCTs, n = 3076 patients) resulting in 30 fewer deaths per 1000, ranging from 132 fewer to 87 more, but the evidence is very uncertain. Ketamine results in little to no difference in length of ICU stay (MD 0.04 days, 95 % CI -0.12 to 0.20, high certainty of evidence, 5 RCTs n = 390 patients) or length of hospital stay (MD -0.53 days, 95 % CI -1.36 to 0.30, high certainty of evidence, 5 RCTs, n = 277 patients).Monotherapy may have a positive effect on respiratory and haemodynamic outcomes, however the evidence is very uncertain. Conclusion Adjunctive ketamine for post-intubation analgosedation results in a moderate meaningful net benefit but there is uncertainty for benefit and harms as monotherapy.
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Affiliation(s)
- C Hendrikse
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
- PHC/Adult Hospital Level Committee (2019-2023), South Africa
| | - V Ngah
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, South Africa
| | - II Kallon
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, South Africa
| | - T D Leong
- Secretariat to the PHC/Adult Hospital Level Committee (2019-2022), Secretariat to the National Essential Medicines List Committee (2012-2022), South Africa
- Health Systems Research Unit, South African Medical Research Council, South Africa
- South African GRADE Network, Stellenbosch University, South Africa
| | - M McCaul
- PHC/Adult Hospital Level Committee (2019-2023), South Africa
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, South Africa
- South African GRADE Network, Stellenbosch University, South Africa
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Hendrikse C, Ngah V, Kallon II, Thom G, Leong TD, Cohen K, McCaul M. Signal of harm in morphine use in adults with acute pulmonary oedema: A rapid systematic review. S Afr Med J 2023; 113:39-43. [PMID: 37882120 DOI: 10.7196/samj.2023.v113i8.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Heart failure affects nearly 65 million people globally, resulting in recurrent hospital admissions and substantial healthcare expenditure. The use of morphine in the management of acute pulmonary oedema remains controversial, with conflicting guidance and significant variation in practice. Synthesised evidence is needed to inform standard treatment guidelines and clinical practice. OBJECTIVE To determine whether morphine should be used in the treatment of acute pulmonary oedema (APE) in adults. METHODS A rapid review of systematic reviews of randomised controlled trials or observational studies, and then randomised controlled trials, was conducted searching three electronic databases (PubMed, Embase, Cochrane Library) and one clinical trial registry on 12 February 2022. We used a prespecified protocol following Cochrane rapid review methods and aligned to the National Standard Treatment Guidelines and Essential Medicines List methodology. We first considered relevant high-quality systematic reviews of randomised controlled trials or observational studies, then (if required) randomised controlled trials to inform time-sensitive or urgent evidence requests, clinical practice, policy, or standard treatment guidelines. RESULTS We identified four systematic reviews of observational studies. The two most relevant, up-to-date, and highest-quality reviews were used to inform evidence for critical outcomes. Morphine may increase in-hospital mortality (odds ratio (OR) 1.78; 95% confidence interval (CI) 1.01 - 3.13; low certainty of evidence; six observational studies, n=151 735 participants), resulting in 15 more per 1 000 hospital deaths, ranging from 0 to 40 more hospital deaths. Morphine may result in a large increase in invasive mechanical ventilation (OR 2.72; 95% CI 1.09 - 6.80; low certainty of evidence; four observational studies, n=167 847 participants), resulting in 45 more per 1 000 ventilations, ranging from 2 more to 136 more. Adverse events and hospital length of stay were not measured across reviews or trials. CONCLUSION Based on the most recent, relevant and best-available quality evidence, morphine use in adults with APE may increase in-hospital and all-cause mortality and may result in a large increase in the need for invasive mechanical ventilation compared to not using morphine. Recommending against the use of morphine in pulmonary oedema may improve patient outcomes. Disinvesting in morphine for this indication may result in cost savings, noting the possible accrued benefits of fewer patients requiring invasive ventilation and management of morphine-related side-effects.
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Affiliation(s)
- C Hendrikse
- Division of Emergency Medicine, Department of Family, Community and Emergency Care, Faculty of Health Sciences, University of Cape Town, South Africa; Ministerially appointed PHC/Adult Hospital Level Expert Review Committee of the National Essential Medicines List Committee, National Department of Health (2019 - 2023), Pretoria, South Africa.
| | - V Ngah
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - I I Kallon
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - G Thom
- Ministerially appointed PHC/Adult Hospital Level Expert Review Committee of the National Essential Medicines List Committee, National Department of Health (2019 - 2023), Pretoria, South Africa; Amajuba District Clinical Specialist Team, KwaZulu-Natal Department of Health, Pretoria, South Africa.
| | - T D Leong
- Secretariat to the PHC/Adult Hospital Level Expert Review Committee (2020 - 2023); Secretariat to the National Essential Medicines List Committee, National Department of Health (2021 - 2022), Durban, South Africa; Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - K Cohen
- Ministerially appointed PHC/Adult Hospital Level Expert Review Committee of the National Essential Medicines List Committee, National Department of Health (2019 - 2023), Pretoria, South Africa; Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - M McCaul
- Ministerially appointed PHC/Adult Hospital Level Expert Review Committee of the National Essential Medicines List Committee, National Department of Health (2019 - 2023), Pretoria, South Africa; Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; South African GRADE Network, Centre for Evidence-based Health Care, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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Chong MC, Sharp MK, Smith SM, O'Neill M, Ryan M, Lynch R, Mahtani KR, Clyne B. Strong recommendations from low certainty evidence: a cross-sectional analysis of a suite of national guidelines. BMC Med Res Methodol 2023; 23:68. [PMID: 36966277 PMCID: PMC10039768 DOI: 10.1186/s12874-023-01895-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/18/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Clinical guidelines should be based on a thorough evaluation of the evidence and generally include a rating of the quality of evidence and assign a strength to recommendations. Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance warns against making strong recommendations when the certainty of the evidence is low or very low, but has identified five paradigmatic situations (e.g. life-threatening situations) where this may be justified. AIMS AND OBJECTIVES We aimed to characterize the strength of recommendations and certainty of the evidence in Irish National Clinical Guidelines using the GRADE approach. METHODS All National Clinical Guidelines from the National Clinical Effectiveness Committee (NCEC) website using the GRADE approach (fully or partially) were included. All recommendations and their corresponding certainty of the evidence, strength of recommendations and justifications were extracted. Authors classified instances of strong recommendations with low certainty evidence (referred to as discordant recommendations) into one of the five paradigmatic situations. Descriptive statistics were calculated. RESULTS From the 29 NCEC Clinical Guidelines available at the time of analysis, we identified 8 guidelines using GRADE with a total of 240 recommendations; 38 recommendations did not use the GRADE approach and were excluded. Half of the included guidelines focused on emergency situations. In the final dataset of 202 recommendations, 151 (74.7%) were classified as strong and 51 (25.3%) as conditional. Of the 151 strong recommendations, 55 (36.4%) were supported by high or moderate certainty evidence and 96 (63.6%) by low or very low certainty evidence and were considered discordant. Of these 96 discordant recommendations, 55 (73.7%) were consistent with one of the five paradigmatic situations. However, none were specifically described as such within the guidelines. CONCLUSIONS The proportion of discordant recommendations identified in this analysis was higher than some previous international studies (range of all strong recommendations being discordant 30-50%), but similar to other guidelines focused on emergency situations. The majority of discordant recommendations could be mapped to one of the five situations, but no National Clinical Guideline explicitly referenced this. Guideline developers require further guidance to enable greater transparency in the reporting of the reasons for discordant recommendations.
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Affiliation(s)
- Ming Chuen Chong
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Dublin 2, Ireland
| | - Melissa K Sharp
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Dublin 2, Ireland
| | - Susan M Smith
- Department of Public Health and Primary Care, School of Medicine, Trinity College Dublin, Dublin, Dublin 2, Ireland
| | - Michelle O'Neill
- Health Information and Quality Authority, George's Court, George's Lane, Dublin, Dublin 7, Ireland
| | - Máirín Ryan
- Health Information and Quality Authority, George's Court, George's Lane, Dublin, Dublin 7, Ireland
| | - Rosarie Lynch
- Department of Health, Clinical Effectiveness and Antimicrobial Resistance Unit, National Patient Safety Office, Dublin, Ireland
| | - Kamal R Mahtani
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Dublin 2, Ireland.
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8
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Kok-Pigge AC, Greving JP, de Groot JF, Oerbekke M, Kuijpers T, Burgers JS. A Delphi consensus checklist helped assess the need to develop rapid guideline recommendations. J Clin Epidemiol 2023; 156:1-10. [PMID: 36764465 DOI: 10.1016/j.jclinepi.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 01/26/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND OBJECTIVES We aimed to develop a checklist to aid guideline developers in determining which scientific or societal cause ("triggers") are relevant when considering to initiate a rapid recommendation procedure. METHODS We conducted a two-round modified Delphi procedure with a panel of Dutch guideline experts, clinicians, and patient representatives. A previously conducted systematic literature review and semistructured interviews with four science journalists were used to generate a list of potential items. This item list was submitted to the panel for discussion, reduction and refinement into a checklist. RESULTS Thirteen experts took part. Two questionnaires were completed in which participants scored an initial list of 64 items based on relevance. During two online meetings, the scores were discussed, irrelevant items were removed, and relevant items were reformulated into seven questions. The final "quickscan assessment of the need for a rapid recommendation" covers user perspective, scientific evidence, clinical relevance, clinical practice variation, applicability, quality of care and public health outcomes, and ethical/legal considerations. CONCLUSION The quickscan aids guideline developers in systematically assessing whether a trigger expresses a valid need for developing a rapid recommendation. Future research could focus on the applicability and validity of the checklist within guideline development programs.
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Affiliation(s)
- Aimee Claire Kok-Pigge
- Dutch College of General Practitioners, Domus Medica, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands.
| | - Jacoba P Greving
- Dutch College of General Practitioners, Domus Medica, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands
| | - Janke F de Groot
- Dutch College of General Practitioners, Domus Medica, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands
| | - Michiel Oerbekke
- Dutch College of General Practitioners, Domus Medica, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands
| | - Ton Kuijpers
- Dutch College of General Practitioners, Domus Medica, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands
| | - Jako S Burgers
- Dutch College of General Practitioners, Domus Medica, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands
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9
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El Mikati IK, Morgan RL, Murad MH, Sultan S, Falck-Ytter Y, Mustafa RA. Testing guidelines during times of crisis: challenges and limitations of developing rapid and living guidelines. Clin Microbiol Infect 2023; 29:424-428. [PMID: 36736663 PMCID: PMC9892317 DOI: 10.1016/j.cmi.2023.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/30/2022] [Accepted: 01/21/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND The start of the COVID-19 pandemic presented a situation in which there was an urgent need for decision-making that relates to diagnosis, but the evidence was lacking, of low certainty or constantly changing. Rapid and living guideline development methods were needed and had to be applied to rigorous guideline approaches, such as the Grading of Recommendations Assessment, Development, and Evaluation approach. OBJECTIVES To describe the process of developing rapid diagnosis guidelines when there is limited and imperfect available data at the time of crisis. SOURCES Case example from four Infectious Disease Society of America COVID-19 diagnostic guidelines. CONTENT As the world was experiencing panic with COVID-19, there were serious doubts about the feasibility of following a rigorous process for guideline development when timeliness was of extreme value. The Infectious Disease Society of America guideline panels supported by several methodologists strongly believed that at times of crisis, it is more important than ever to follow a rigorous process. The panel adopted a rapid and living systematic review methodology and applied the Grading of Recommendations Assessment, Development and Evaluation approach to four diagnosis guidelines despite the challenges of scarce and dynamic evidence. We describe the methodological details of the rapid and living approach (data extraction, meta-analysis, Evidence to Decision framework, and recommendation development), the challenge of resources, the challenge of scarce evidence, the challenge of rapidly changing evidence, as well as 'wins' from the Infectious Disease Society of America experience. IMPLICATIONS Mitigation of pandemics relies on rapid and accurate diagnosis, which is challenged by many knowledge gaps. This necessitates emerging evidence is rapidly incorporated in a living fashion with several decisional and contextual factors to ensure the best public health strategies and care for patients. This process must be systematic and transparent for developing trustworthy guidelines and should be supported by all stakeholders, including researchers, editors, publishers, professional societies, and policymakers.
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Affiliation(s)
- Ibrahim K. El Mikati
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rebecca L. Morgan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - M. Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shahnaz Sultan
- Division of Gastroenterology, University of Minnesota, Minneapolis, MN, USA
| | - Yngve Falck-Ytter
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA,VA Northeast Ohio Health Care System, Cleveland, OH, USA
| | - Reem A. Mustafa
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Departments of Internal Medicine and Population Health, University of Kansas Medical Centre, Kansas City, KS, USA,Corresponding author. Reem A. Mustafa, Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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10
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Bousquet J, Anto JM, Sousa‐Pinto B, Czarlewski W, Bedbrook A, Haahtela T, Klimek L, Pfaar O, Kuna P, Kupczyk M, Regateiro FS, Samolinski B, Valiulis A, Yorgancioglu A, Arnavielhe S, Basagaña X, Bergmann KC, Bosnic‐Anticevich S, Brussino L, Canonica GW, Cardona V, Cecchi L, Chaves‐Loureiro C, Costa E, Cruz AA, Gemicioglu B, Fokkens WJ, Ivancevich JC, Kraxner H, Kvedariene V, Larenas‐Linnemann DE, Laune D, Louis R, Makris M, Maurer M, Melén E, Micheli Y, Morais‐Almeida M, Mullol J, Niedoszytko M, Okamoto Y, Papadopoulos NG, Patella V, Pham‐Thi N, Rouadi PW, Sastre J, Scichilone N, Sheikh A, Sofiev M, Taborda‐Barata L, Toppila‐Salmi S, Tsiligianni I, Valovirta E, Ventura MT, Vieira RJ, Zidarn M, Amaral R, Ansotegui IJ, Bédard A, Benveniste S, Bewick M, Bindslev‐Jensen C, Blain H, Bonini M, Bourret R, Braido F, Carreiro‐Martins P, Charpin D, Cherrez‐Ojeda I, Chivato T, Chu DK, Cingi C, Del Giacco S, de Blay F, Devillier P, De Vries G, Doulaptsi M, Doyen V, Dray G, Fontaine J, Gomez RM, Hagemann J, Heffler E, Hofmann M, Jassem E, Jutel M, Keil T, Kritikos V, Kull I, Kulus M, Lourenço O, Mathieu‐Dupas E, Menditto E, Mösges R, Murray R, Nadif R, Neffen H, Nicola S, O’Hehir R, Olze H, Palamarchuk Y, Pépin J, Pétré B, Picard R, Pitsios C, Puggioni F, Quirce S, Raciborski F, Reitsma S, Roche N, Rodriguez‐Gonzalez M, Romantowski J, Sá‐Sousa A, Serpa FS, Savouré M, Shamji MH, Sova M, Sperl A, Stellato C, Todo‐Bom A, Tomazic PV, Vandenplas O, Van Eerd M, Vasankari T, Viart F, Waserman S, Fonseca JA, Zuberbier T. Digitally-enabled, patient-centred care in rhinitis and asthma multimorbidity: The ARIA-MASK-air ® approach. Clin Transl Allergy 2023; 13:e12215. [PMID: 36705508 PMCID: PMC9823305 DOI: 10.1002/clt2.12215] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/19/2022] [Indexed: 01/09/2023] Open
Abstract
MASK-air® , a validated mHealth app (Medical Device regulation Class IIa) has enabled large observational implementation studies in over 58,000 people with allergic rhinitis and/or asthma. It can help to address unmet patient needs in rhinitis and asthma care. MASK-air® is a Good Practice of DG Santé on digitally-enabled, patient-centred care. It is also a candidate Good Practice of OECD (Organisation for Economic Co-operation and Development). MASK-air® data has enabled novel phenotype discovery and characterisation, as well as novel insights into the management of allergic rhinitis. MASK-air® data show that most rhinitis patients (i) are not adherent and do not follow guidelines, (ii) use as-needed treatment, (iii) do not take medication when they are well, (iv) increase their treatment based on symptoms and (v) do not use the recommended treatment. The data also show that control (symptoms, work productivity, educational performance) is not always improved by medications. A combined symptom-medication score (ARIA-EAACI-CSMS) has been validated for clinical practice and trials. The implications of the novel MASK-air® results should lead to change management in rhinitis and asthma.
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Affiliation(s)
- Jean Bousquet
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany,University Hospital MontpellierMontpellierFrance,InsermEquipe d’Epidémiologie Respiratoire IntégrativeCESPVillejuifFrance
| | - Josep M. Anto
- ISGlobalBarcelona Institute for Global HealthBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain,Universitat Pompeu Fabra (UPF)BarcelonaSpain,CIBER Epidemiología y Salud Pública (CIBERESP)BarcelonaSpain
| | - Bernardo Sousa‐Pinto
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Health Research NetworkFaculty of Medicine, University of PortoPortoPortugal,RISE – Health Research Network, MEDCIDSFaculty of Medicine, University of PortoPortoPortugal
| | | | | | - Tari Haahtela
- Skin and Allergy HospitalHelsinki University HospitalUniversity of HelsinkiHelsinkiFinland
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck SurgeryUniversitätsmedizin MainzMainzGermany,Center for Rhinology and AllergologyWiesbadenGermany
| | - Oliver Pfaar
- Section of Rhinology and AllergyDepartment of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital MarburgPhilipps‐Universität MarburgMarburgGermany
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and AllergyBarlicki University HospitalMedical University of LodzLodzPoland
| | - Maciej Kupczyk
- Division of Internal Medicine, Asthma and AllergyBarlicki University HospitalMedical University of LodzLodzPoland
| | - Frederico S. Regateiro
- Allergy and Clinical Immunology UnitCentro Hospitalar e Universitário de CoimbraCoimbraPortugal,ICBR, Coimbra Institute for Clinical and Biomedical Research, CIBBFaculty of MedicineUniversity of CoimbraCoimbraPortugal,Institute of ImmunologyFaculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and ImmunologyMedical University of WarsawWarsawPoland
| | - Arunas Valiulis
- Institute of Clinical Medicine and Institute of Health SciencesVilniusLithuania,Medical Faculty of Vilnius UniversityVilniusLithuania
| | - Arzu Yorgancioglu
- Department of Pulmonary DiseasesCelal Bayar University, Faculty of MedicineManisaTurkey
| | | | - Xavier Basagaña
- ISGlobalBarcelona Institute for Global HealthBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain,Universitat Pompeu Fabra (UPF)BarcelonaSpain,CIBER Epidemiología y Salud Pública (CIBERESP)BarcelonaSpain
| | - Karl C. Bergmann
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Sinthia Bosnic‐Anticevich
- Quality Use of Respiratory Medicine GroupWoolcock Institute of Medical ResearchThe University of SydneySydneyNSWAustralia,Sydney Local Health DistrictSydneyNSWAustralia
| | - Luisa Brussino
- Department of Medical SciencesAllergy and Clinical Immunology UnitUniversity of TorinoTorinoItaly,Mauriziano HospitalTorinoItaly
| | - G. Walter Canonica
- Department of Biomedical SciencesHumanitas University, Pieve EmanueleMilanItaly,Personalized Medicine, Asthma and AllergyHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Victoria Cardona
- Allergy SectionDepartment of Internal MedicineHospital Vall d'HebronBarcelonaSpain,ARADyAL Research NetworkBarcelonaSpain
| | - Lorenzo Cecchi
- SOS Allergology and Clinical ImmunologyUSL Toscana CentroPratoItaly
| | - Claudia Chaves‐Loureiro
- Pneumology UnitHospitais da Universidade de CoimbraCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - Elisio Costa
- UCIBIO, REQUINTEFaculty of Pharmacy and Competence Center on Active and Healthy AgeingUniversity of Porto (Porto4Ageing)PortoPortugal
| | - Alvaro A. Cruz
- Fundaçao ProARFederal University of Bahia and GARD/WHO Planning GroupSalvadorBahiaBrazil
| | - Bilun Gemicioglu
- Cerrahpasa Faculty of MedicineDepartment of Pulmonary DiseasesIstanbul University‐CerrahpasaIstanbulTurkey
| | - Wytske J. Fokkens
- Department of OtorhinolaryngologyAmsterdam University Medical Centres, location AMCAmsterdamthe Netherlands
| | | | - Helga Kraxner
- Department of Otorhinolaryngology, Head and Neck SurgerySemmelweis UniversityBudapestHungary
| | - Violeta Kvedariene
- Faculty of MedicineInstitute of Clinical MedicineClinic of Chest Diseases and AllergologyVilnius UniversityVilniusLithuania,Faculty of MedicineDepartment of PathologyInstitute of Biomedical SciencesVilnius UniversityVilniusLithuania
| | | | | | - Renaud Louis
- Department of Pulmonary MedicineCHU LiegeLiègeBelgium,GIGA I3 Research GroupUniversity of LiegeLiègeBelgium
| | - Michael Makris
- Allergy Unit “D Kalogeromitros”2nd Department of Dermatology and VenereologyNational & Kapodistrian University of Athens“Attikon” University HospitalAthensGreece
| | - Marcus Maurer
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Erik Melén
- Sach's Children and Youth HospitalSödersjukhusetStockholmSweden,Department of Clinical Science and EducationSödersjukhusetKarolinska InstitutetStockholmSweden
| | | | | | - Joaquim Mullol
- Rhinology Unit & Smell ClinicENT DepartmentHospital ClínicBarcelonaSpain,Clinical & Experimental Respiratory ImmunoallergyIDIBAPS, CIBERESUniversity of BarcelonaBarcelonaSpain
| | | | | | | | - Vincenzo Patella
- Division of Allergy and Clinical ImmunologyDepartment of Medicine“Santa Maria della Speranza” Hospital, BattipagliaSalernoItaly,Agency of Health ASLSalernoItaly
| | - Nhân Pham‐Thi
- Ecole Polytechnique PalaiseauIRBA (Institut de Recherche Bio‐Médicale des Armées)BretignyFrance
| | - Philip W. Rouadi
- Department of Otolaryngology, Head and Neck SurgeryEye and Ear University HospitalBeirutLebanon,Department of Otorhinolaryngology, Head and Neck SurgeryDar Al Shifa HospitalSalmiyaKuwait
| | - Joaquin Sastre
- Fundacion Jimenez Diaz, CIBERESFaculty of MedicineAutonoma University of MadridMadridSpain
| | | | - Aziz Sheikh
- Usher InstituteThe University of EdinburghEdinburghUK
| | | | - Luis Taborda‐Barata
- Department of ImmunoallergologyCova da Beira University Hospital CentreCovilhãPortugal,UBIAir ‐ Clinical & Experimental Lung Centre and CICS‐UBI Health Sciences Research CentreUniversity of Beira InteriorCovilhãPortugal
| | - Sanna Toppila‐Salmi
- Skin and Allergy HospitalHelsinki University HospitalUniversity of HelsinkiHelsinkiFinland
| | - Ioanna Tsiligianni
- International Primary Care Respiratory Group IPCRGAberdeenScotland,Health Planning UnitFaculty of MedicineDepartment of Social MedicineUniversity of CreteCreteGreece
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical ImmunologyUniversity of TurkuTurkuFinland,Terveystalo Allergy ClinicTurkuFinland
| | | | - Rafael José Vieira
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Health Research NetworkFaculty of Medicine, University of PortoPortoPortugal,RISE – Health Research Network, MEDCIDSFaculty of Medicine, University of PortoPortoPortugal
| | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic DiseasesGolnikSlovenia,Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Rita Amaral
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Health Research NetworkFaculty of Medicine, University of PortoPortoPortugal,RISE – Health Research Network, MEDCIDSFaculty of Medicine, University of PortoPortoPortugal
| | | | - Annabelle Bédard
- InsermEquipe d’Epidémiologie Respiratoire IntégrativeCESPVillejuifFrance,Université Paris‐Saclay, UVSQUniversity Paris‐SudVillejuifFrance
| | - Samuel Benveniste
- National Center of Expertise in Cognitive Stimulation (CEN STIMCO)Broca HospitalParisFrance,Mines ParisTech CRI ‐ PSL Research UniversityFontainebleauFrance
| | - Michael Bewick
- University of Central Lancashire Medical SchoolPrestonUK
| | - Carsten Bindslev‐Jensen
- Odense Research Center for Anaphylaxis (ORCA)OdenseDenmark,Department of Dermatology and Allergy CentreOdense University HospitalOdenseFinland
| | - Hubert Blain
- Department of GeriatricsMontpellier University Hospital, MUSEMontpellierFrance
| | - Matteo Bonini
- Department of Clinical and Surgical SciencesFondazione Policlinico Universitario A Gemelli IRCCSRomeItaly,National Heart and Lung InstituteRoyal Brompton Hospital & Imperial College LondonLondonUK
| | | | - Fulvio Braido
- Department of Internal Medicine (DiMI)University of GenoaGenovaItaly,IRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Pedro Carreiro‐Martins
- NOVA Medical School/Comprehensive Health Research Centre (CHRC)LisbonPortugal,Serviço de ImunoalergologiaHospital de Dona EstefâniaCentro Hospitalar Universitário de Lisboa CentralLisbonPortugal
| | - Denis Charpin
- Clinique des BronchesAllergie et SommeilHôpital NordMarseilleFrance
| | - Ivan Cherrez‐Ojeda
- Universidad Espíritu SantoSamborondónEcuador,Respiralab Research GroupGuayaquil, GuayasEcuador
| | - Tomas Chivato
- School of MedicineUniversity CEU San PabloMadridSpain
| | - Derek K. Chu
- Department of Health Research Methods, Evidence, and Impact & Department of MedicineMcMaster UniversityHamiltonONCanada
| | - Cemal Cingi
- Medical FacultyENT DepartmentEskisehir Osmangazi UniversityEskisehirTurkey
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical ImmunologyUniversity Hospital “Duilio Casula”University of CagliariCagliariItaly
| | - Frédéric de Blay
- Allergy DivisionChest Disease DepartmentUniversity Hospital of StrasbourgStrasbourgFrance,Federation of Translational MedicineUniversity of StrasbourgStrasbourgFrance
| | - Philippe Devillier
- VIM Suresnes, UMR 0892Pôle des Maladies des Voies RespiratoiresHôpital FochUniversité Paris‐SaclaySuresnesFrance
| | | | - Maria Doulaptsi
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital of CreteHeraklion, CreteGreece
| | - Virginie Doyen
- Department of Chest MedicineCentre Hospitalier Universitaire UCL NamurNamurBelgique,Université Catholique de LouvainYvoirBelgium
| | | | | | | | - Jan Hagemann
- Department of Otolaryngology, Head and Neck SurgeryUniversitätsmedizin MainzMainzGermany,Center for Rhinology and AllergologyWiesbadenGermany
| | - Enrico Heffler
- Department of Biomedical SciencesHumanitas University, Pieve EmanueleMilanItaly,Personalized Medicine, Asthma and AllergyHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Maja Hofmann
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,Berlin Institute of HealthBerlinGermany
| | - Ewa Jassem
- Department of PneumologyMedical University of GdańskGdańskPoland
| | - Marek Jutel
- Department of Clinical ImmunologyWrocław Medical UniversityWrocławPoland,ALL‐MED Medical Research InstituteWroclawPoland
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health EconomicsCharité ‐ Universitätsmedizin BerlinBerlinGermany,Institute for Clinical Epidemiology and BiometryUniversity of WuerzburgWuerzburgGermany,State Institute of Health, Bavarian Health and Food Safety AuthorityErlangenGermany
| | - Vicky Kritikos
- Quality Use of Respiratory Medicine GroupWoolcock Institute of Medical ResearchThe University of SydneySydneyNSWAustralia
| | - Inger Kull
- Sach's Children and Youth HospitalSödersjukhusetStockholmSweden,Department of Clinical Science and EducationSödersjukhusetKarolinska InstitutetStockholmSweden
| | - Marek Kulus
- Department of Pediatric Respiratory Diseases and AllergologyMedical University of WarsawWarsawPoland
| | - Olga Lourenço
- Faculty of Health Sciences and CICS – UBIHealth Sciences Research CentreUniversity of Beira InteriorCovilhãPortugal
| | | | - Enrica Menditto
- CIRFFDepartment of PharmacyUniversity of Naples Federico IINaplesItaly
| | - Ralph Mösges
- CRI‐Clinical Research International‐LtdHamburgGermany
| | - Ruth Murray
- Medical Communication ConsultantMedscript Ltd, DundalkIreland and WellingtonNew Zealand,Research FellowOPCCambridgeUK
| | - Rachel Nadif
- InsermEquipe d’Epidémiologie Respiratoire IntégrativeCESPVillejuifFrance,Université Paris‐Saclay, UVSQUniversity Paris‐SudVillejuifFrance
| | - Hugo Neffen
- Center of Allergy, Immunology and Respiratory DiseasesSanta FeArgentina
| | - Stefania Nicola
- Department of Medical SciencesAllergy and Clinical Immunology UnitUniversity of TorinoTorinoItaly
| | - Robyn O’Hehir
- Department of Allergy, Immunology and Respiratory MedicineAlfred Hospital and Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Heidi Olze
- Berlin Institute of HealthBerlinGermany,Department of OtorhinolaryngologyCharité‐Universitätsmedizin BerlinBerlinGermany
| | | | - Jean‐Louis Pépin
- Université Grenoble AlpesLaboratoire HP2GrenobleFrance,INSERMU1042VillejuifFrance
| | | | - Robert Picard
- Conseil Général de l'Economie Ministère de l'Economiede l'Industrie et du NumériqueParisFrance
| | | | - Francesca Puggioni
- Department of Biomedical SciencesHumanitas University, Pieve EmanueleMilanItaly,Personalized Medicine, Asthma and AllergyHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Santiago Quirce
- Department of AllergyHospital La Paz Institute for Health Research (IdiPAZ)MadridSpain
| | - Filip Raciborski
- Department of Prevention of Environmental Hazards, Allergology and ImmunologyMedical University of WarsawWarsawPoland
| | - Sietze Reitsma
- Department of OtorhinolaryngologyAmsterdam University Medical Centres, AMCAmsterdamthe Netherlands
| | - Nicolas Roche
- PneumologieAP‐HP Centre Université de Paris CitéHôpital CochinParisFrance,UMR 1016Institut CochinParisFrance
| | | | - Jan Romantowski
- Department of AllergologyMedical University of GdańskGdanskPoland
| | - Ana Sá‐Sousa
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Health Research NetworkFaculty of Medicine, University of PortoPortoPortugal,RISE – Health Research Network, MEDCIDSFaculty of Medicine, University of PortoPortoPortugal
| | - Faradiba S. Serpa
- Asthma Reference Center ‐ School of Medicine of Santa Casa de Misericórdia of VitóriaVitoria, Espirito SantoBrazil
| | - Marine Savouré
- InsermEquipe d’Epidémiologie Respiratoire IntégrativeCESPVillejuifFrance,Université Paris‐Saclay, UVSQUniversity Paris‐SudVillejuifFrance
| | - Mohamed H. Shamji
- National Heart and Lung InstituteImperial CollegeLondonUK,NIHR Imperial Biomedical Research CentreLondonUK
| | - Milan Sova
- Department of Respiratory Medicine and TuberculosisUniversity HospitalBrnoCzech Republic
| | - Annette Sperl
- Center for Rhinology and AllergologyWiesbadenGermany
| | - Cristiana Stellato
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”University of SalernoSalernoItaly
| | - Ana Todo‐Bom
- ImunoalergologiaCentro Hospitalar Universitário de CoimbraFaculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Peter Valentin Tomazic
- Department of General ORLH&NSMedical University of GrazENT‐University Hospital GrazGrazSteiermarkAustria
| | - Olivier Vandenplas
- Department of Chest MedicineCentre Hospitalier Universitaire UCL NamurNamurBelgique,Université Catholique de LouvainYvoirBelgium
| | | | - Tuula Vasankari
- Fihla, Finnish Lung AssociationHelsinkiFinland,University of TurkuTurkuFinland
| | | | - Susan Waserman
- Department of Medicine, Clinical Immunology and AllergyMcMaster UniversityHamiltonOntarioCanada
| | - Joao A. Fonseca
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Health Research NetworkFaculty of Medicine, University of PortoPortoPortugal,RISE – Health Research Network, MEDCIDSFaculty of Medicine, University of PortoPortoPortugal
| | - Torsten Zuberbier
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
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11
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McCaul M, Tovey D, Young T, Welch V, Dewidar O, Goetghebeur M, Kredo T, Tricco AC, Glover RE, Tufte J, Qaseem A, Ludovic R, Morgan RL, Vandvik PO, Florez ID. Resources supporting trustworthy, rapid and equitable evidence synthesis and guideline development: results from the COVID-19 evidence network to support decision-making (COVID-END). J Clin Epidemiol 2022; 151:88-95. [PMID: 35868494 PMCID: PMC9295316 DOI: 10.1016/j.jclinepi.2022.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/01/2022] [Accepted: 07/12/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Michael McCaul
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
| | - David Tovey
- Member, COVID-END secretariat 2020-21, London, UK
| | - Taryn Young
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Vivian Welch
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada; Bruyère Research Institute, University of Ottawa, 85 Primrose Ave, Ottawa, Ontario, K1R 6M1, Canada
| | - Omar Dewidar
- Bruyère Research Institute, University of Ottawa, 85 Primrose Ave, Ottawa, Ontario, K1R 6M1, Canada
| | - Mireille Goetghebeur
- Bureau Methods and Ethics, Institut National d'Excellence en Santé et Services Sociaux, Montreal, Québec, Canada; Department of Evaluation and Health Policy, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Division of Clinical Pharmacology, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Epidemiology Division and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada; Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Canada
| | - Rebecca E Glover
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, LSHTM, London, United Kingdom
| | | | - Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania, USA
| | - Reveiz Ludovic
- Knowledge Translation Program, Evidence and Intelligence for Action in Health Department, Pan American Health Organization, Washington DC, USA
| | - Rebecca L Morgan
- Department of Health Research, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Per Olav Vandvik
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Ivan D Florez
- Department of Pediatrics and Childcare, Universidad de Antioquia, Medellín, Colombia; School of Rehabilitation Science, McMaster University, Hamilton, Canada; Pediatric Intensive Care Unit, Clinica Las Americas-AUNA, Dg. 75B #2A-80/140, Medellin, Colombia
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12
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Rong LQ, Audisio K, O'Shaughnessy SM. Guidelines and evidence-based recommendations in anaesthesia: where do we stand? Br J Anaesth 2022; 128:903-908. [PMID: 35314064 PMCID: PMC8933135 DOI: 10.1016/j.bja.2022.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 01/11/2023] Open
Abstract
Clinical practice guidelines are increasingly important to guide clinical care. However, they can vary widely in quality, and many recommendations are based on low-level evidence. The COVID-19 pandemic highlighted the need for new flexible formats for rigorously developed guidelines. Future guideline development should be standardised, graded, registered, and updated to ensure that they are 'living' works in progress.
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Affiliation(s)
- Lisa Q. Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA,Corresponding author
| | - Katia Audisio
- Department of Anesthesia, Intensive Care, and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
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13
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Mathioudakis AG, Osadnik C, Boots AW, Bradicich M, Bartel S, Gloeckl R, Cruz J. Inspiring stories: the impact that being part of ERS activities can have on a professional career. Breathe (Sheff) 2022; 18:210217. [PMID: 35284021 PMCID: PMC8908876 DOI: 10.1183/20734735.0217-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/18/2022] [Indexed: 11/05/2022] Open
Abstract
In this article, we provide an overview of the impact that being part of the @EuroRespSoc activities can have on a professional career, through the voices of Early Career Members (@EarlyCareerERS) https://bit.ly/32sHNW2.
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Affiliation(s)
- Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK.,North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,These authors contributed equally
| | - Christian Osadnik
- Dept of Physiotherapy, Monash University, Melbourne, Australia.,These authors contributed equally
| | - Agnes W Boots
- Dept of Pharmacology and Toxicology, Maastricht University, Maastricht, The Netherlands.,These authors contributed equally
| | - Matteo Bradicich
- Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland.,Dept of Internal Medicine, Spital Zollikerberg, Zollikerberg, Switzerland.,These authors contributed equally
| | - Sabine Bartel
- Dept of Pathology and Medical Biology, University of Groningen, Groningen Research Center for Asthma and COPD (GRIAC), University Medical Center Groningen, Groningen, The Netherlands.,These authors contributed equally
| | - Rainer Gloeckl
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany.,Dept of Pulmonary Rehabilitation, Philipps University of Marburg, German Center for Lung Research (DZL), Marburg, Germany.,These authors contributed equally
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
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14
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Yao X, Xia J, Jin Y, Shen Q, Wang Q, Zhu Y, McNair S, Sussman J, Wang Z, Florez ID, Zeng XT, Brouwers M. Methodological approaches for developing, reporting, and assessing evidence-based clinical practice guidelines: A systematic survey. J Clin Epidemiol 2022; 146:77-85. [PMID: 35271968 DOI: 10.1016/j.jclinepi.2022.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 12/08/2022]
Abstract
OBJECTIVE To produce a mapping and feature summary of approaches and tools available for the CPG community to develop, report, or assess four types of CPGs: (1) Standard original (or de novo) CPG, (2) Rapid original CPG, (3) Adapted/adopted CPGs, and (4) Updated CPGs. STUDY DESIGN The systematic literature search was conducted using Embase and PubMed, covering the period from January 2010 to October 13 2020. Two websites that collect and recommend approaches/tools to develop, report, or assess CPGs were also searched: Guidelines International Network and Equator Network. We screened the search results to include methodological papers that aimed to develop specific approaches/tools to develop, report, or assess any of the aforementioned four CPG types. RESULTS Among 10,581 citations, 46 papers reporting 46 approaches/tools were included. Of these 46 approaches/tools, 33 were about CPG development, seven were for CPG reporting, and six for CPG assessment. Among the 33 development approaches/tools, 26 did not state usability or validity information; but nine from 13 reporting or assessment approaches/tools did. CONCLUSIONS This study provides a mapping and feature summary of the current available approaches/tools, which serves to improve users' understanding to pave the way for informed choice and application.
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Affiliation(s)
- Xiaomei Yao
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Center for Clinical Practice Guideline Conduction and Evaluation, Children's Hospital of Fudan University, Shanghai, China
| | - Jun Xia
- Nottingham Ningbo GRADE Centre, The University of Nottingham Ningbo, Ningbo, Zhejiang, China; School of Medicine, The University of Nottingham, United Kingdom
| | - Yinghui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Quan Shen
- School of Health Science, Wuhan University, Wuhan, Hubei, China
| | - Qi Wang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ying Zhu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sheila McNair
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan Sussman
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Zhiwen Wang
- School of Nursing, Health Science Centre for Evidence-Based Nursing, Peking University School of Nursing, Beijing, China
| | - Ivan D Florez
- Department of Pediatrics, University of Antioquia, Colombia; School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada;.
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
| | - Melissa Brouwers
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canad
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15
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Falavigna M, Belli KC, Barbosa AN, Zavascki AP, Nastri ACDSS, Santana CM, Stein C, Gräf DD, Cadegiani FA, Guimarães HP, Monteiro JT, Ferreira JC, de Azevedo LCP, Magri MMC, Sobreira ML, Dias MBGDS, de Oliveira MS, Corradi MDFDB, Rosa R, Heinzelmann RS, da Silva RM, Junior RB, Cimerman S, Colpani V, Veiga VC, de Carvalho CRR. Brazilian guidelines for the treatment of outpatients with suspected or confirmed COVID-19. A joint guideline of the Brazilian Association of Emergency Medicine (ABRAMEDE), Brazilian Medical Association (AMB), Brazilian Society of Angiology and Vascular Surgery (SBACV), Brazilian Society of Geriatrics and Gerontology (SBGG), Brazilian Society of Infectious Diseases (SBI), Brazilian Society of Family and Community Medicine (SBFMC), and Brazilian Thoracic Society (SBPT). Braz J Infect Dis 2022; 26:102347. [PMID: 35341739 PMCID: PMC8926872 DOI: 10.1016/j.bjid.2022.102347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 11/26/2022] Open
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16
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Wachholz PA, Stein AT, Melo DOD, Mello RGBD, Florez ID. Recommendations for the development of Clinical Practice Guidelines. GERIATRICS, GERONTOLOGY AND AGING 2022. [DOI: 10.53886/gga.e0220016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Clinical practice guidelines are statements that include recommendations intended to optimize patient care, are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options, and ensure that the best available clinical knowledge is used to provide effective and quality care. They can reduce inappropriate care and variability in clinical practice and can support the translation of new research knowledge into clinical practice. Recommendations from clinical practice guidelines can support health professionals by facilitating the decision-making process, empowering them to make more informed health care choices, clarifying which interventions should be priorities based on a favorable trade-off, and discouraging the use of those that have proven ineffective, dangerous, or wasteful. This review aims to summarize the key components of high-quality and trustworthy guidelines. Articles were retrieved from various libraries, databases, and search engines using free-text term searches adapted for different databases, and selected according to author discretion. Clinical practice guidelines in geriatrics can have a major impact on prevention, diagnosis, treatment, rehabilitation, health care, and the management of diseases and conditions, but they should only be implemented when they have high-quality, rigorous, and unbiased methodologies that consider older adult priorities and provide valid recommendations.
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17
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QUALITY APPRAISAL OF CLINICAL PRACTICE GUIDELINES ON PROVISION OF DENTAL SERVICES DURING THE FIRST MONTHS OF THE COVID-19 PANDEMIC. J Evid Based Dent Pract 2021; 21:101633. [PMID: 34922731 PMCID: PMC8402995 DOI: 10.1016/j.jebdp.2021.101633] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 07/05/2021] [Accepted: 08/24/2021] [Indexed: 12/23/2022]
Abstract
Objectives To evaluate the quality of clinical practice guidelines (CPGs) on dental services provision during the first months of the COVID-19 pandemic. Materials and methods We systematically searched in MEDLINE, EMBASE, LILACS, Epistemonikos, Trip databases, websites of CPG developers, compilers of CPGs, scientific societies and ministries of health to identify documents with recommendations intended to minimize the risk of COVID-19 transmission during dental care. Reviewers independently and in duplicate assessed the included CPGs using the AGREE II instrument. We calculated the standardized scores for the 6 domains and made a final recommendation about each CPG. The inter-appraiser agreement was assessed using the intraclass correlation coefficient (ICC). Results Twenty-three CPGs published were included. Most of the CPGs were from America (n = 15) and Europe (n = 6). The overall agreement between reviewers was very good (ICC = 0.93; 95%CI 0.87-0.95). The median score for each domain was the following: Scope and purpose 67% (IQR 20%); Stakeholder involvement 33% (IQR 14%); Rigour of development 13% (IQR 13%); Clarity of presentation 64% (IQR 31%); Applicability 19% (IQR 17%) and Editorial independence 8% (IQR 8%). Twenty two guidelines were not recommended by the reviewers. Only one of the CPGs was recommended with modifications. The median overall rate was 3 (IQR 1). All CPGs were classified as low quality. Conclusions The overall quality of CPGs on dental services provision during the first months of the COVID-19 pandemic was low, which makes its implementation difficult for clinicians and policy makers. Therefore, it is critical that developers are transparent and forthcoming about the difficulties that have arisen during the CPG development process.
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18
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Florez ID, Amer YS, McCaul M, Lavis JN, Brouwers M. Guidelines developed under pressure. The case of the COVID-19 low-quality "rapid" guidelines and potential solutions. J Clin Epidemiol 2021; 142:194-199. [PMID: 34780983 PMCID: PMC8590473 DOI: 10.1016/j.jclinepi.2021.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/06/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Ivan D Florez
- Department of Pediatrics, Universidad de Antioquia, Calle 67 # 53-108, 050001, Medellin, Colombia; School of Rehabilitation Science, McMaster University, Hamilton, Canada.
| | - Yasser Sami Amer
- Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia; Clinical Practice Guidelines Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia; Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia; Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University Medical Council, Alexandria University, Alexandria, Egypt.
| | - Michael McCaul
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, South Africa.
| | - John N Lavis
- McMaster Health Forum and Department of Health Research Methods, Evidence and Impact, McMaster University, 3H28, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada; Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa.
| | - Melissa Brouwers
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
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19
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Khalil H, Tamara L, Rada G, Akl EA. Challenges of evidence synthesis during the 2020 COVID pandemic: a scoping review. J Clin Epidemiol 2021; 142:10-18. [PMID: 34718121 PMCID: PMC8550900 DOI: 10.1016/j.jclinepi.2021.10.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/11/2021] [Accepted: 10/19/2021] [Indexed: 11/24/2022]
Abstract
AIM The objectives of this scoping review are to identify the challenges to conducting evidence synthesis during the COVID-19 pandemic and to propose some recommendations addressing the identified gaps. METHODS A scoping review methodology was followed to map the literature published on the challenges and solutions of conducting evidence synthesis using the Joanna Briggs Methodology of performing scoping review. We searched several databases from the start of the Pandemic in December 2019 until 10th June 2021. RESULTS A total of 28 publications was included in the review. The challenges cited in the included studies have been categorised into four distinct but interconnected themes including: upstream, Evidence synthesis, downstream and contextual challenges. These challenges have been further refined into issues with primary studies, databases, team capacity, process, resources, and context. Several proposals to improve the above challenges included: transparency in primary studies registration and reporting, establishment of online platforms that enables collaboration, data sharing and searching, the use of computable evidence and coordination of efforts at an international level. CONCLUSION This review has highlighted the importance of including artificial intelligence, a framework for international collaboration and a sustained funding model to address many of the shortcomings and ensure we are ready for similar challenges in the future.
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Affiliation(s)
- Hanan Khalil
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.
| | - Lotfi Tamara
- Department of Health Research Methods, Evidence & Impact (HEI), McMaster University, Hamilton, Canada
| | - Gabriel Rada
- Epistemonikos Foundation, UC Evidence Centre, Pontificia Universidad Católica de Chile, Las Condes, Santiago, Chile
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Department of Health Research Methods, Evidence & Impact (HEI), McMaster University, Hamilton, Canada
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20
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Rosenberger KJ, Xu C, Lin L. Methodological assessment of systematic reviews and meta-analyses on COVID-19: A meta-epidemiological study. J Eval Clin Pract 2021; 27:1123-1133. [PMID: 33955120 PMCID: PMC8242754 DOI: 10.1111/jep.13578] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 12/11/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES COVID-19 has caused an ongoing public health crisis. Many systematic reviews and meta-analyses have been performed to synthesize evidence for better understanding this new disease. However, some concerns have been raised about rapid COVID-19 research. This meta-epidemiological study aims to methodologically assess the current systematic reviews and meta-analyses on COVID-19. METHODS We searched in various databases for systematic reviews with meta-analyses published between 1 January 2020 and 31 October 2020. We extracted their basic characteristics, data analyses, evidence appraisal, and assessment of publication bias and heterogeneity. RESULTS We identified 295 systematic reviews on COVID-19. The median time from submission to acceptance was 33 days. Among these systematic reviews, 73.9% evaluated clinical manifestations or comorbidities of COVID-19. Stata was the most used software programme (43.39%). The odds ratio was the most used effect measure (34.24%). Moreover, 28.14% of the systematic reviews did not present evidence appraisal. Among those reporting the risk of bias results, 14.64% of studies had a high risk of bias. Egger's test was the most used method for assessing publication bias (38.31%), while 38.66% of the systematic reviews did not assess publication bias. The I2 statistic was widely used for assessing heterogeneity (92.20%); many meta-analyses had high values of I2 . Among the meta-analyses using the random-effects model, 75.82% did not report the methods for model implementation; among those meta-analyses reporting implementation methods, the DerSimonian-Laird method was the most used one. CONCLUSIONS The current systematic reviews and meta-analyses on COVID-19 might suffer from low transparency, high heterogeneity, and suboptimal statistical methods. It is recommended that future systematic reviews on COVID-19 strictly follow well-developed guidelines. Sensitivity analyses may be performed to examine how the synthesized evidence might depend on different methods for appraising evidence, assessing publication bias, and implementing meta-analysis models.
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Affiliation(s)
| | - Chang Xu
- Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar
| | - Lifeng Lin
- Department of Statistics, Florida State University, Tallahassee, Florida, USA
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21
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Deana NF, Seiffert A, Aravena-Rivas Y, Alonso-Coello P, Muñoz-Millán P, Espinoza-Espinoza G, Pineda P, Zaror C. Recommendations for Safe Dental Care: A Systematic Review of Clinical Practice Guidelines in the First Year of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10059. [PMID: 34639363 PMCID: PMC8508467 DOI: 10.3390/ijerph181910059] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/05/2021] [Accepted: 09/13/2021] [Indexed: 12/23/2022]
Abstract
In the context of a pandemic, the rapid development of clinical practice guidelines (CPGs) is critical to guide dental staff towards the safe provision of dental care; detailed knowledge of the recommendations will help to achieve the intended results. We carried out a systematic review of the recommendations in clinical practice guidelines (CPGs) on the provision of dental care issued during the first year of the COVID-19 pandemic. A systematic database search was performed in MEDLINE, EMBASE, LILACS, Epistemonikos, and Trip databases to identify documents with recommendations intended to minimize the risk of COVID-19 transmission during dental care. The selection process and data extraction were carried out by two researchers independently. The majority of CPGs recommended the use of rubber dam, high-volume evacuator, mouthwash prior to dental care, four-handed work, and mechanical barriers. The use of aerosol-generating equipment should be avoided whenever possible. In aerosol-generating procedures, the use of a N95 respirator (or similar) is recommended, in addition to a face protector, an impermeable disposable apron/gown, a cap, and gloves. The CPGs developed during the first year of the pandemic offer recommendations which guide dental staff in providing safe dental care, minimizing exposure to SARS-CoV-2 and reducing the risk of COVID-19 infection in the clinical environment. Such recommendations must, however, be updated as new evidence arises.
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Affiliation(s)
- Naira Figueiredo Deana
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco 4781176, Chile; (N.F.D.); (P.M.-M.); (P.P.)
- Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco 4811230, Chile; (Y.A.-R.); (G.E.-E.)
| | - Andrea Seiffert
- Dental School, Faculty of Dentistry, Universidad de La Frontera, Temuco 4781176, Chile;
| | - Yanela Aravena-Rivas
- Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco 4811230, Chile; (Y.A.-R.); (G.E.-E.)
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain;
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Patricia Muñoz-Millán
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco 4781176, Chile; (N.F.D.); (P.M.-M.); (P.P.)
- Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco 4811230, Chile; (Y.A.-R.); (G.E.-E.)
| | - Gerardo Espinoza-Espinoza
- Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco 4811230, Chile; (Y.A.-R.); (G.E.-E.)
- Department of Public Health, Faculty of Medicine, Universidad de La Frontera, Temuco 4781135, Chile
| | - Patricia Pineda
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco 4781176, Chile; (N.F.D.); (P.M.-M.); (P.P.)
- Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco 4811230, Chile; (Y.A.-R.); (G.E.-E.)
| | - Carlos Zaror
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco 4781176, Chile; (N.F.D.); (P.M.-M.); (P.P.)
- Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco 4811230, Chile; (Y.A.-R.); (G.E.-E.)
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22
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Lotfi T, Hajizadeh A, Moja L, Akl EA, Piggott T, Kredo T, Langendam MW, Iorio A, Klugar M, Klugarová J, Neumann I, Wiercioch W, Leontiadis GI, Mbuagbaw L, Turgeon AF, Meerpohl J, Stevens A, Brozek J, Santesso N, Pottie K, Dewidar O, Flottorp SA, Karpusheff J, Saz-Parkinson Z, Rojas MX, Parmelli E, Chu DK, Tugwell P, Welch V, Avey MT, Brignardello-Petersen R, Mathew JL, Munn Z, Nieuwlaat R, Ford N, Qaseem A, Askie LM, Schünemann HJ. A taxonomy and framework for identifying and developing actionable statements in guidelines suggests avoiding informal recommendations. J Clin Epidemiol 2021; 141:161-171. [PMID: 34562579 DOI: 10.1016/j.jclinepi.2021.09.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/06/2021] [Accepted: 09/17/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To propose a taxonomy and framework that identifies and presents actionable statements in guidelines. STUDY DESIGN AND SETTING We took an iterative approach reviewing case studies of guidelines produced by the World Health Organization and the American Society of Hematology to develop an initial conceptual framework. We then tested it using randomly selected recommendations from published guidelines addressing COVID-19 from different organizations, evaluated its results, and refined it before retesting. The urgency and availability of evidence for development of these recommendations varied. We consulted with experts in research methodology and guideline developers to improve the final framework. RESULTS The resulting taxonomy and framework distinguishes five types of actional statements: formal recommendations; research recommendations; good practice statements; implementation considerations, tools and tips; and informal recommendations. These statements should respond to a priori established criteria and require a clear structure and recognizable presentation in a guideline. Most importantly, this framework identifies informal recommendations that differ from formal recommendations by how they consider evidence and in their development process. CONCLUSION The identification, standardization and explicit labelling of actionable statements according to the framework may support guideline developers to create actionable statements with clear intent, avoid informal recommendations and improve their understanding and implementation by users.
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Affiliation(s)
- Tamara Lotfi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Michael G. DeGroote Cochrane Canada and GRADE Centre, McMaster University, Hamilton , ON, Canada
| | - Anisa Hajizadeh
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada
| | - Lorenzo Moja
- Department of Health Product Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Elie A Akl
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Michael G. DeGroote Cochrane Canada and GRADE Centre, McMaster University, Hamilton , ON, Canada; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Clinical Pharmacology, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - Miranda W Langendam
- Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Department of Medicine, McMaster University, Hamilton ,ON, Canada
| | - Miloslav Klugar
- The Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk University GRADE Centre); Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Jitka Klugarová
- The Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk University GRADE Centre); Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Ignacio Neumann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Michael G. DeGroote Cochrane Canada and GRADE Centre, McMaster University, Hamilton , ON, Canada
| | | | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Biostatistics Unit/The Research Institute, St Joseph's Healthcare, Hamilton ,ON, Canada
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City ,QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Center, Québec City ,QC, Canada
| | - Joerg Meerpohl
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Adrienne Stevens
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Michael G. DeGroote Cochrane Canada and GRADE Centre, McMaster University, Hamilton , ON, Canada
| | - Jan Brozek
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Michael G. DeGroote Cochrane Canada and GRADE Centre, McMaster University, Hamilton , ON, Canada
| | - Nancy Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Michael G. DeGroote Cochrane Canada and GRADE Centre, McMaster University, Hamilton , ON, Canada
| | - Kevin Pottie
- School of Epidemiology and Public Health, University of Ottawa, Canada; Departments of Family Medicine and Epidemiology and Community Medicine, University of Ottawa; Bruyère Research Institute, Ottawa, Canada; Departments of Family Medicine and Epidemiology and Community Medicine, University of Ottawa
| | - Omar Dewidar
- School of Epidemiology and Public Health, University of Ottawa, Canada; Departments of Family Medicine and Epidemiology and Community Medicine, University of Ottawa; Bruyère Research Institute, Ottawa, Canada; Departments of Family Medicine and Epidemiology and Community Medicine, University of Ottawa
| | - Signe A Flottorp
- Norwegian Institute of Public Health, Oslo, Norway; University of Oslo, Oslo, Norway
| | | | - Zuleika Saz-Parkinson
- Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias. Madrid, Spain
| | - María X Rojas
- Department of Clinical Epidemiology and Public Health, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau)
| | - Elena Parmelli
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Derek K Chu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Department of Medicine, McMaster University, Hamilton ,ON, Canada
| | - Peter Tugwell
- School of Epidemiology and Public Health, University of Ottawa, Canada; Departments of Family Medicine and Epidemiology and Community Medicine, University of Ottawa; Bruyère Research Institute, Ottawa, Canada; Departments of Family Medicine and Epidemiology and Community Medicine, University of Ottawa
| | - Vivian Welch
- School of Epidemiology and Public Health, University of Ottawa, Canada; Departments of Family Medicine and Epidemiology and Community Medicine, University of Ottawa; Bruyère Research Institute, Ottawa, Canada; Departments of Family Medicine and Epidemiology and Community Medicine, University of Ottawa
| | | | | | - Joseph L Mathew
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Zachary Munn
- Joanna Briggs Institute Faculty of Health and Medical Sciences The University of Adelaide, Australia
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada
| | - Nathan Ford
- Department of HIV, Hepatitis and Sexually Transmitted Infections, World Health Organization, Geneva, Switzerland
| | - Amir Qaseem
- American College of Physicians, Philadelphia, PA, USA
| | - Lisa M Askie
- Quality Assurance of Norms and Standards Department, Science Division, World Health Organization, Geneva, Switzerland
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Michael G. DeGroote Cochrane Canada and GRADE Centre, McMaster University, Hamilton , ON, Canada; Department of Medicine, McMaster University, Hamilton ,ON, Canada; Dipartimento di Scienze Biomediche Humanitas University, Milan, Italy.
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23
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Romero CS, Afshari A, Kranke P. Adapt or perish: Introducing focused guidelines. Eur J Anaesthesiol 2021; 38:803-805. [PMID: 34226416 DOI: 10.1097/eja.0000000000001535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Carolina S Romero
- From the Critical Care and Pain Unit, Department of Anesthesia, University General Hospital (CSR), Division of Research Methodology, European University, Valencia, Spain (CSR), Anæstesi og Operationsklinikken, Juliane Marie Center, Rigshospitalet TR for Overlægeforeningen (AA), Department of Pediatric and Obstetric Anesthesia, University of Copenhagen, Rigshospitalet, Denmark (AA) and Department of Anaesthesia, Critical Care Medicine, Emergency Medicine and Pain Medicine, University Hospitals of Wuerzburg, Wuerzburg, Germany (PK)
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Lotfi T, Stevens A, Akl EA, Falavigna M, Kredo T, Mathew JL, Schünemann HJ. Getting trustworthy guidelines into the hands of decision-makers and supporting their consideration of contextual factors for implementation globally: recommendation mapping of COVID-19 guidelines. J Clin Epidemiol 2021; 135:182-186. [PMID: 33836255 PMCID: PMC8022513 DOI: 10.1016/j.jclinepi.2021.03.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/28/2021] [Indexed: 12/27/2022]
Abstract
Published research on COVID-19 is increasing rapidly and integrated in guidelines. The trustworthiness of guidelines can vary depending on the methods used to assemble and evaluate the evidence, the completeness and transparency of reporting on the process undertaken and how conflicts of interest are addressed. With a global consortium of partners and collaborators, we have created a catalogue of COVID-19 recommendations as our direct response to the increased need for structured access to high quality guidance in the field. The COVID19 map of recommendations and gateway to contextualization (https://covid19.recmap.org) is a living project: emerging guideline literature is added on an ongoing basis, allowing granular access to individual recommendations. Building on prior work on mapping recommendations for the World Health Organization tuberculosis guidelines, a novel feature of this map is the self-directed contextualization of the recommendations using the GRADE-Adolopment approach to adopt, adapt or synthesize de novo recommendations for context specific questions. Through our map, stakeholders access the evidence underpinning a recommendation, select what needs to be contextualized and go through the steps of development of adapted recommendations. This one-stop shop portal of evidence-informed recommendations, built with intuitive functionalities, easy to navigate and with a support team ready to guide users across the maps, represents a long-needed tool for decision-makers, guideline developers and the public at large.
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Affiliation(s)
- Tamara Lotfi
- Department of Health Research Methods, Evidence, and Impact, World Health Organization Collaborating Center for Infectious Diseases, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Cochrane Canada Centre, McMaster University, Hamilton, Ontario, Canada; McMaster GRADE Centre, McMaster University, Hamilton, Ontario, Canada
| | - Adrienne Stevens
- Michael G. DeGroote Cochrane Canada Centre, McMaster University, Hamilton, Ontario, Canada; McMaster GRADE Centre, McMaster University, Hamilton, Ontario, Canada
| | - Elie A Akl
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Clinical Research Institute, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maicon Falavigna
- National Institute for Health Technology Assessment, Federal Univesity of Rio Grande do Sul, PortoAlegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Tamara Kredo
- South African Medical Research Council, Cape Town, South Africa
| | - Joseph L Mathew
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, World Health Organization Collaborating Center for Infectious Diseases, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Cochrane Canada Centre, McMaster University, Hamilton, Ontario, Canada; McMaster GRADE Centre, McMaster University, Hamilton, Ontario, Canada.
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25
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Kahale LA, Elkhoury R, El Mikati I, Pardo-Hernandez H, Khamis AM, Schünemann HJ, Haddaway NR, Akl EA. Tailored PRISMA 2020 flow diagrams for living systematic reviews: a methodological survey and a proposal. F1000Res 2021; 10:192. [PMID: 35136567 PMCID: PMC8804909 DOI: 10.12688/f1000research.51723.3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/20/2022] Open
Abstract
Background: While the PRISMA flow diagram is widely used for reporting standard systematic reviews (SRs), it was not designed for capturing the results of continual searches for studies in living systematic reviews (LSRs). The objectives of this study are (1) to assess how published LSRs report on the flow of studies through the different phases of the review for the different updates; (2) to propose an approach to reporting on that flow. Methods: For objective 1, we identified all LSRs published up to April 2021. We abstracted information regarding their general characteristics and how they reported on search results. For objective 2, we based our proposal for tailored PRISMA approaches on the findings from objective 1, as well as on our experience with conducting Cochrane LSRs. Results: We identified 279 living publications relating to 76 LSRs. Of the 279 publications, 11% were protocols, 23% were base versions (i.e., the first version), 50% were partial updates (i.e., does not include all typical sections of an SR), and 16% were full updates (i.e., includes all typical sections of an SR). We identified six ways to reporting the study flow: base separately, each update separately (38%); numbers not reported (32%); latest update separately, all previous versions combined (20%); base separately, all updates combined (7%); latest update version only (3%); all versions combined (0%). We propose recording in detail the results of the searches to keep track of all identified records. For structuring the flow diagram, we propose using one of four approaches. Conclusion: We identified six ways for reporting the study flow through the different phases of the review for the different update versions. We propose to document in detail the study flow for the different search updates and select one of our four tailored PRISMA diagram approaches to present that study flow.
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Affiliation(s)
- Lara A. Kahale
- Cochrane Central Executive, Cochrane, London, St Albans House, 57-59 Haymarket, London, SW1Y 4QX, UK
| | - Rayane Elkhoury
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
| | - Ibrahim El Mikati
- Clinical Research Institute, American University of Beirut, Beirut, Riad El Solh 1107 2020, Lebanon
| | - Hector Pardo-Hernandez
- CIBER Epidemiología y Salud Pública, Madrid, Av. de Monforte de Lemos, 5, 28029, Spain
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute, Barcelona, C / Sant Quintí, 77-79 08041, Spain
| | - Assem M. Khamis
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, 1280 Main Street West 2C Area, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, 1280 Main Street West 2C Area, Canada
| | - Neal R. Haddaway
- Stockholm Environment Institute, Stockholm, Linnégatan, 87D, Sweden
- Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
- Leibniz Centre for Agricultural Landscape Research (ZALF), Eberswalder Str. 84, 15374, Müncheberg, Germany
| | - Elie A. Akl
- Clinical Research Institute, American University of Beirut, Beirut, Riad El Solh 1107 2020, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, 1280 Main Street West 2C Area, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Riad El Solh 1107 2020, Lebanon
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26
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Kahale LA, Elkhoury R, El Mikati I, Pardo-Hernandez H, Khamis AM, Schünemann HJ, Haddaway NR, Akl EA. Tailored PRISMA 2020 flow diagrams for living systematic reviews: a methodological survey and a proposal. F1000Res 2021; 10:192. [PMID: 35136567 PMCID: PMC8804909 DOI: 10.12688/f1000research.51723.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/19/2023] Open
Abstract
Background: While the PRISMA flow diagram is widely used for reporting standard systematic reviews (SRs), it was not designed for capturing the results of continual searches for studies in living systematic reviews (LSRs). The objectives of this study are (1) to assess how published LSRs report on the flow of studies through the different phases of the review for the different updates; (2) to propose an approach to reporting on that flow. Methods: For objective 1, we identified all LSRs published up to July 2020. We abstracted information regarding their general characteristics and how they reported on search results. For objective 2, we based our proposal for tailored PRISMA approaches on the findings from objective 1, as well as on our experience with conducting Cochrane LSRs. Results: We identified 108 living publications relating to 32 LSRs. Of the 108 publications, 7% were protocols, 24% were base versions (i.e., the first version), 62% were partial updates (i.e., does not include all typical sections of an SR), and 7% were full updates (i.e., includes all typical sections of an SR). We identified six ways to reporting the study flow: base separately, each update separately (38%); numbers not reported (32%); latest update separately, all previous versions combined (20%); base separately, all updates combined (7%); latest update version only (3%); all versions combined (0%). We propose recording in detail the results of the searches to keep track of all identified records. For structuring the flow diagram, we propose using one of four approaches. Conclusion: We identified six ways for reporting the study flow through the different phases of the review for the different update versions. We propose to document in detail the study flow for the different search updates and select one of our four tailored PRISMA diagram approaches to present that study flow.
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Affiliation(s)
- Lara A. Kahale
- Cochrane Central Executive, Cochrane, London, St Albans House, 57-59 Haymarket, London, SW1Y 4QX, UK
| | - Rayane Elkhoury
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
| | - Ibrahim El Mikati
- Clinical Research Institute, American University of Beirut, Beirut, Riad El Solh 1107 2020, Lebanon
| | - Hector Pardo-Hernandez
- CIBER Epidemiología y Salud Pública, Madrid, Av. de Monforte de Lemos, 5, 28029, Spain
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute, Barcelona, C / Sant Quintí, 77-79 08041, Spain
| | - Assem M. Khamis
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, 1280 Main Street West 2C Area, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, 1280 Main Street West 2C Area, Canada
| | - Neal R. Haddaway
- Stockholm Environment Institute, Stockholm, Linnégatan, 87D, Sweden
- Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
- Leibniz Centre for Agricultural Landscape Research (ZALF), Eberswalder Str. 84, 15374, Müncheberg, Germany
| | - Elie A. Akl
- Clinical Research Institute, American University of Beirut, Beirut, Riad El Solh 1107 2020, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, 1280 Main Street West 2C Area, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Riad El Solh 1107 2020, Lebanon
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27
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Kahale LA, Elkhoury R, El Mikati I, Pardo-Hernandez H, Khamis AM, Schünemann HJ, Haddaway NR, Akl EA. PRISMA flow diagrams for living systematic reviews: a methodological survey and a proposal. F1000Res 2021; 10:192. [PMID: 35136567 PMCID: PMC8804909 DOI: 10.12688/f1000research.51723.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 04/06/2024] Open
Abstract
Background: While the PRISMA flow diagram is widely used for reporting standard systematic reviews (SRs), it was not designed for capturing the results of continual searches for studies in living systematic reviews (LSRs). The objectives of this study are (1) to assess how published LSRs report on the flow of studies through the different phases of the review for the different updates; (2) to propose an approach to reporting on that flow. Methods: For objective 1, we identified all LSRs published up to July 2020. We abstracted information regarding their general characteristics and how they reported on search results. For objective 2, we based our proposal for tailored PRISMA approaches on the findings from objective 1, as well as on our experience with conducting Cochrane LSRs. Results: We identified 108 living publications relating to 32 LSRs. Of the 108 publications, 7% were protocols, 24% were base versions (i.e., the first version), 62% were partial updates (i.e., does not include all typical sections of an SR), and 7% were full updates (i.e., includes all typical sections of an SR). We identified six ways to reporting the study flow: base separately, each update separately (38%); numbers not reported (32%); latest update separately, all previous versions combined (20%); base separately, all updates combined (7%); latest update version only (3%); all versions combined (0%). We propose recording in detail the results of the searches to keep track of all identified records. For structuring the flow diagram, we propose using one of four approaches. Conclusion: We identified six ways for reporting the study flowthrough the different phases of the review for the different update versions. We propose to document in detail the study flow for the different search updates and select one of our four tailored PRISMA diagram approaches to present that study flow.
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Affiliation(s)
- Lara A. Kahale
- Cochrane Central Executive, Cochrane, London, St Albans House, 57-59 Haymarket, London, SW1Y 4QX, UK
| | - Rayane Elkhoury
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
| | - Ibrahim El Mikati
- Clinical Research Institute, American University of Beirut, Beirut, Riad El Solh 1107 2020, Lebanon
| | - Hector Pardo-Hernandez
- CIBER Epidemiología y Salud Pública, Madrid, Av. de Monforte de Lemos, 5, 28029, Spain
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute, Barcelona, C / Sant Quintí, 77-79 08041, Spain
| | - Assem M. Khamis
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, 1280 Main Street West 2C Area, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, 1280 Main Street West 2C Area, Canada
| | - Neal R. Haddaway
- Stockholm Environment Institute, Stockholm, Linnégatan, 87D, Sweden
- Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
- Leibniz Centre for Agricultural Landscape Research (ZALF), Eberswalder Str. 84, 15374, Müncheberg, Germany
| | - Elie A. Akl
- Clinical Research Institute, American University of Beirut, Beirut, Riad El Solh 1107 2020, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, 1280 Main Street West 2C Area, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Riad El Solh 1107 2020, Lebanon
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28
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Zanville N, Cohen B, Gray TF, Phillips J, Linder L, Starkweather A, Yeager KA, Cooley ME. The Oncology Nursing Society Rapid Review and Research Priorities for Cancer Care in the Context of COVID-19. Oncol Nurs Forum 2021; 48:131-145. [PMID: 33600397 DOI: 10.1188/21.onf.131-145] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify research priorities addressing COVID-19 that build on the 2019-2022 Oncology Nursing Society (ONS) Research Agenda, in alignment with ONS's mission to promote excellence in oncology nursing and quality cancer care. METHODS & VARIABLES Priority areas were identified using a multistep approach combining rapid review of the literature; consultation with experts/stakeholders; and review of priorities from other funding agencies, public health, and cancer-focused organizations. RESULTS The rapid research response team identified five priority areas for research related to COVID-19. IMPLICATIONS FOR NURSING Oncology nurses are well positioned to address the research priorities and cross-cutting themes identified through this review. The use of innovative methodologic approaches and attention to disparities are necessary to advance cancer care related to COVID-19.
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