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Li T, Zheng Q, Zhang M, Li Y, Zhou Y, Xu C, Zhang B, Wang Z, Tian J, Zhou L. How consistent are the key recommendations, and what is the quality of guidelines and expert consensus regarding paediatric cow's milk protein allergy? Eur J Pediatr 2024; 183:3543-3556. [PMID: 38809454 DOI: 10.1007/s00431-024-05622-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 05/10/2024] [Accepted: 05/19/2024] [Indexed: 05/30/2024]
Abstract
The objective of this study was to assess the quality and consistency of recommendations in clinical practice guidelines (CPGs) and expert consensus on paediatric cow's milk protein allergy (CMPA) to serve as a foundation for future revisions and enhancements of clinical guidelines and consensus documents. We conducted a comprehensive literature search across several databases, including the Chinese Biomedical Literature Database (CBM), PubMed, Embase, Web of Science, UpToDate, ClinicalKey, DynaMed Plus and BMJ Best Practice. We spanned the search period from the inception of each database through October 1, 2023. We integrated subject headings (MeSH/Emtree) and keywords into the search strategy, used the search methodologies of existing literature and developed it in collaboration with a librarian. Two trained researchers independently conducted the literature screening and data extraction. We evaluated methodological quality and recommendations by using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) and AGREE-Recommendations for Excellence (AGREE-REX) tools. Moreover, we compared and summarized key recommendations from high-quality CPGs. Our study included 27 CPGs and expert consensus documents on CMPA. Only four CPGs (14.8%) achieved a high-quality AGREE II rating. The four high-quality CPGs consistently provided recommendations for CMPA. The highest scoring domains for AGREE II were 'scope and purpose' (77 ± 12%) and 'clarity of presentation' (75 ± 22%). The lowest scoring domains were 'stakeholder involvement' (49 ± 21%), 'rigor of development' (34 ± 20%) and 'applicability' (12 ± 20%). Evaluation with AGREE-REX generally demonstrated low scores across its domains. Conclusion: Recommendations within high-quality CPGs for the paediatric CMPA showed fundamental consistency. Nevertheless, the methodology and recommendation content of CPGs and the expert consensus exhibited low quality, thus indicating a substantial scope for enhancement. Guideline developers should rigorously follow the AGREE II and AGREE-REX standards in creating CPGs or expert consensuses to guarantee their clinical efficacy in managing paediatric CMPA. What is Known: • The quality of clinical practice guidelines and expert consensus on paediatric cow's milk protein allergy (CMPA) remains uncertain. • There is a lack of clarity regarding the consistency of crucial recommendations for CMPA management. What is New: • Improving the methodological quality of guidelines and consensus on CMPA requires greater emphasis on stakeholder engagement, rigorous development processes, and practical applicability. • The recommendations from four high-quality guidelines align. However, addressing clinical applicability, integrating values and preferences, and ensuring actionable implementation are critical to improving the quality of all guidelines.
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Affiliation(s)
- Tengfei Li
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Qingyong Zheng
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Mingyue Zhang
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yiyi Li
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yongjia Zhou
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
| | - Caihua Xu
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Bowa Zhang
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
| | - Zewei Wang
- First Clinical College of Medicine, Lanzhou University, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
| | - Li Zhou
- Department of Gastroenterology, Gansu Province Maternity and Child Health Hospital (Gansu Province Central Hospital), Lanzhou, China.
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Nagavci B, Schwingshackl L, Martin-Loeches I, Lakatos B. Utilization of expert opinion in infectious diseases clinical guidelines-A meta-epidemiological study. PLoS One 2024; 19:e0306098. [PMID: 38935698 PMCID: PMC11210760 DOI: 10.1371/journal.pone.0306098] [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: 02/26/2024] [Accepted: 06/11/2024] [Indexed: 06/29/2024] Open
Abstract
INTRODUCTION Expert opinion is widely used in clinical guidelines. No research has ever been conducted investigating the use of expert opinion in international infectious disease guidelines. This study aimed to create an analytical map by describing the prevalence and utilization of expert opinion in infectious disease guidelines and analyzing the methodological aspects of these guidelines. METHODS In this meta-epidemiological study, systematic searches in PubMed and Trip Medical Database were performed to identify clinical guidelines on infectious diseases, published between January 2018 and May 2023 in English, by international organizations. Data extracted included guideline characteristics, expert opinion utilization, and methodological details. Prevalence and rationale of expert opinion use were analyzed descriptively. Methodological differences between groups were analyzed with Chi-square and Mann-Whitney U Test. RESULTS The analysis covered 66 guidelines with 2296 recommendations, published/endorsed by 136 organizations. Most guidelines (79%) used systematic literature searches, 42% provided search strategies, and 38% presented screening flow diagrams and conducted risk of bias assessments. 48.5% of the guidelines allowed expert opinion, most of which included expert opinion as part of the evidence hierarchy within the grading system. Guidelines allowing expert opinion, compared to those which do not, issued more recommendations per guideline (48.82 vs.19.13, p<0.001), and reported fewer screening flow diagrams (25% vs. 65%, p = 0.002), and less risk of bias assessments (19% vs.78%, p<0.001). CONCLUSIONS Expert opinion is utilized in half of assessed guidelines, often integrated into the evidence hierarchy within the grading system. Its utilization varies considerably in methodology, form, and terminology between guidelines. These findings highlight a pressing need for additional research and guidance, to improve and advance the standardization of infectious disease guidelines.
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Affiliation(s)
- Blin Nagavci
- Doctoral School of Clinical Medicine, Semmelweis University, Budapest, Hungary
| | - Lukas Schwingshackl
- Faculty of Medicine, Institute for Evidence in Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Leinster, Dublin, Ireland
| | - Botond Lakatos
- Division of Infectology, Department of Hematology and Internal Medicine, Semmelweis University, Budapest, Hungary
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
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Blažek M, Vrbacký F, Fátorová I, Mirská K, Žák P. Sysmex-derived COVID-19 prognostic score as an early prognostic marker for severity of the COVID-19 disease. Int J Lab Hematol 2024; 46:243-249. [PMID: 37921205 DOI: 10.1111/ijlh.14197] [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: 06/27/2023] [Accepted: 10/15/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a life-threatening disease with a heterogeneous course. Even some young patients are at increased risk of severe course or death, as they can face severe complications. It would be very useful to have a cheap and easily available marker to predict COVID-19 course in the early stages of the disease. The COVID-19 prognostic score could be a very useful clinical indicator available at the time of primary contact with the patient. METHODS The COVID-19 prognostic score and the clinical condition together with selected laboratory parameters were evaluated in patients with respiratory tract infection and a positive PCR test for the SARS-CoV-2 during the first contact with the patient. Prognostic significance was evaluated using receiver operating characteristic curves (ROC) and area under the curve (AUC). Selected parameters of the blood count and hemostasis, as well as selected biochemical indicators, were examined too. RESULTS Thirty-seven of 164 patients developed serious symptoms. The COVID-19 score had one of the highest AUC values (0.855) of all markers. The highest combination of sensitivity (91.9%) and specificity (71.7%) for identifying patients with a subsequent moderate and severe course of the disease was achieved at the threshold 1.5. The predictive value of a negative test is beneficial too (0.968). CONCLUSIONS The COVID-19 prognostic score is a promising indicator stratifying patients with COVID-19 into prognostic groups at the time of the first contact, thus allowing the timely provision of increased care in patients at high risk of severe development.
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Affiliation(s)
- Martin Blažek
- Pulmonary Clinic, University Hospital Hradec Králové, Hradec Králové, Czech Republic
- Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Filip Vrbacký
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Ilona Fátorová
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Klára Mirská
- Department of Biological and Medical Sciences, Faculty of Pharmacy, Charles University, Hradec Králové, Czech Republic
| | - Pavel Žák
- Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
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Akl EA, Cuker A, Mustafa RA, Nieuwlaat R, Stevens A, Schünemann HJ. Prospective collaborative recommendation development: a novel model for more timely and trustworthy guidelines. J Clin Epidemiol 2023; 162:156-159. [PMID: 37648070 DOI: 10.1016/j.jclinepi.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Adam Cuker
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Adrienne Stevens
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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Ahmadinejad N, Ayyoubzadeh SM, Zeinalkhani F, Delazar S, Javanmard Z, Ahmadinejad Z, Mohajeri A, Esmaeili M. Discovering associations between radiological features and COVID-19 patients' deterioration. Health Sci Rep 2023; 6:e1257. [PMID: 37711676 PMCID: PMC10497911 DOI: 10.1002/hsr2.1257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 09/16/2023] Open
Abstract
Background and Aims Data mining methods are effective and well-known tools for developing predictive models and extracting useful information from various data of patients. The present study aimed to predict the severity of patients with COVID-19 by applying the rule mining method using characteristics of medical images. Methods This retrospective study has analyzed the radiological data from 104 COVID-19 hospitalized patients diagnosed with COVID-19 in a hospital in Iran. A data set containing 75 binary features was generated. Apriori method is utilized for association rule mining on this data set. Only rules with confidence equal to one were generated. The performance of rules is calculated by support, coverage, and lift indexes. Results Ten rules were extracted with only X-ray-related features on cases referred to ICU. The Support and Coverage index of all of these rules was 0.087, and the Lift index of them was 1.58. Thirteen rules were extracted from only CT scan-related features on cases referred to ICU. The CXR_Pleural effusion feature has appeared in all the rules. The CXR_Left upper zone feature appears in 9 rules out of 10. The Support and Coverage index of all rules was 0.15, and the Lift index of all rules was 1.63. the CT_Adjacent pleura thickening feature has appeared in all rules, and the CT_Right middle lobe appeared in 9 rules out of 13. Conclusion This study could reveal the application and efficacy of CXR and CT scan imaging modalities in predicting ICU admission to a major COVID-19 infection via data mining methods. The findings of this study could help data scientists, radiologists, and clinicians in the future development and implementation of these methods in similar conditions and timely and appropriately save patients from adverse disease outcomes.
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Affiliation(s)
- Nasrin Ahmadinejad
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR)Tehran University of Medical SciencesTehranIran
- Radiology Department, Cancer Institute, Imam Khomeini Hospital ComplexTehran University of Medical ScienceTehranIran
| | - Seyed Mohammad Ayyoubzadeh
- Department of Health Information Management, School of Allied Medical SciencesTehran University of Medical SciencesTehranIran
| | - Fahimeh Zeinalkhani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR)Tehran University of Medical SciencesTehranIran
- Radiology Department, Cancer Institute, Imam Khomeini Hospital ComplexTehran University of Medical ScienceTehranIran
| | - Sina Delazar
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR)Tehran University of Medical SciencesTehranIran
| | - Zohreh Javanmard
- Department of Health Information Management, School of Allied Medical SciencesTehran University of Medical SciencesTehranIran
| | - Zahra Ahmadinejad
- Department of Infectious Diseases, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | | | - Marzieh Esmaeili
- Department of Health Information Management, School of Allied Medical SciencesTehran University of Medical SciencesTehranIran
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Butler MJ, Best JH, Mohan SV, Jonas JA, Arader L, Yeh J. Mechanical ventilation for COVID-19: Outcomes following discharge from inpatient treatment. PLoS One 2023; 18:e0277498. [PMID: 36608047 PMCID: PMC9821470 DOI: 10.1371/journal.pone.0277498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/01/2022] [Indexed: 01/07/2023] Open
Abstract
Though mechanical ventilation (MV) is used to treat patients with severe coronavirus disease 2019 (COVID-19), little is known about the long-term health implications of this treatment. Our objective was to determine the association between MV for treatment of COVID-19 and likelihood of hospital readmission, all-cause mortality, and reason for readmission. This study was a longitudinal observational design with electronic health record (EHR) data collected between 3/1/2020 and 1/31/2021. Participants included 17,652 patients hospitalized for COVID-19 during this period who were followed through 6/30/2021. The primary outcome was readmission to inpatient care following discharge. Secondary outcomes included all-cause mortality and reason for readmission. Rates of readmission and mortality were compared between ventilated and non-ventilated patients using Cox proportional hazards regression models. Differences in reasons for readmission by MV status were compared using multinomial logistic regression. Patient characteristics and measures of illness severity were balanced between those who were mechanically ventilated and those who were not utilizing 1-to-1 propensity score matching. The sample had a median age of 63 and was 47.1% female. There were 1,131 (6.4%) patients who required MV during their initial hospitalization. Rates (32.1% versus 9.9%) and hazard of readmission were greater for patients requiring MV in the propensity score-matched samples [hazard ratio (95% confidence interval) = 3.34 (2.72-4.10)]. Rates (15.3% versus 3.4%) and hazard [hazard ratio (95% confidence interval) = 3.12 (2.32-4.20)] of all-cause mortality were also associated with MV status. Ventilated patients were more likely to be readmitted for reasons which were classified as COVID-19, infectious diseases, and respiratory diagnoses compared to non-ventilated patients. Mechanical ventilation is a necessary treatment for severely ill patients. However, it may be associated with adverse outcomes including hospital readmission and death. More intense post-discharge monitoring may be warranted to decrease this associational finding.
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Affiliation(s)
- Mark J. Butler
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States of America
| | - Jennie H. Best
- Genentech Inc., South San Francisco, CA, United States of America
| | - Shalini V. Mohan
- Genentech Inc., South San Francisco, CA, United States of America
| | - Jennifer A. Jonas
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States of America
| | - Lindsay Arader
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States of America
- St. John’s University, Jamaica, NY, United States of America
| | - Jackson Yeh
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States of America
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Boshra MS, Elgendy MO, Abdelaty LN, Tammam M, Alanazi AS, Alzarea AI, Alsahali S, Sarhan RM. Knowledge, Attitude, and Acceptance of Sinopharm and AstraZeneca's COVID-19 Vaccines among Egyptian Population: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16803. [PMID: 36554688 PMCID: PMC9778847 DOI: 10.3390/ijerph192416803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND This study aimed to evaluate the Egyptian population's preference and awareness related to available COVID-19 vaccines and to determine different factors that can affect beliefs concerning these vaccines. METHODS A cross-sectional web-based study was carried out among the general population in Egypt. Data collection was conducted via an online questionnaire. RESULTS About 426 subjects participated in the survey. Vaccine preference is nearly equally even (50%) among all respondents. There was no significant difference in vaccine preference according to age, gender, residence, educational level, or social status. About 50% of public respondents mentioned that both AstraZeneca and Sinopharm vaccines do not offer protection against new variant COVID-19 strains. Healthcare workers are the lowest respondents to agree that vaccines offer protection against new COVID-19 variants (10.9%) compared to unemployed respondents (20.3%) and other professions (68.8%) with a statistically significant difference (p < 0.005). Safety of vaccine administration among children below 18 showed statistical differences for gender and educational level predictors. CONCLUSIONS Most of the study population has satisfying knowledge about the COVID-19 vaccine. Continuous awareness campaigns must be carried out so that the people's background is updated with any new information that would help in raising the trust in vaccination.
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Affiliation(s)
- Marian S. Boshra
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62511, Egypt
| | - Marwa O. Elgendy
- Clinical Pharmacy Department, Beni-Suef University Hospitals, Faculty of Medicine, Beni-Suef University, Beni-Suef 62511, Egypt
- Department of Clinical Pharmacy, Faculty of Pharmacy, Nahda University (NUB), Beni-Suef 62513, Egypt
| | - Lamiaa N Abdelaty
- Department of Clinical Pharmacy, Faculty of Pharmacy, October 6 University, Giza 12525, Egypt
| | | | - Abdullah S. Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia
- Health Sciences Research Unit, Jouf University, Sakaka 72388, Saudi Arabia
| | | | - Saud Alsahali
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah 51911, Saudi Arabia
| | - Rania M. Sarhan
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62511, Egypt
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Hu Y, Han Y, Ma Y, Fan S, Wang X, Fu X, Hu X, Luo X, Ma Y, Xun Y, Yang N, Wen C, Cao W, Song X, Chen Y. Consistency of recommendations for pharmacotherapy of rheumatoid arthritis. Front Pharmacol 2022; 13:967787. [PMID: 36386133 PMCID: PMC9642806 DOI: 10.3389/fphar.2022.967787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory arthropathy. Recommendations for RA, specifically on pharmacotherapy, are essential in clinical practice. However, the direction and strength of recommendations are controversial across current clinical practice guidelines (CPGs) of RA. Objective: To systematically analyze the consistency of recommendations regarding pharmacotherapy of RA across CPGs. Methods: 11 electronic databases and websites were comprehensively searched from inception to 14 March 2022, to identify CPGs for diagnosis, therapy, and management of RA. Unambiguous and discrete specifications of the population-intervention-comparison (PIC) framework were used to classify the recommendations. Based on the PIC framework, consistency analyses across CPGs on pharmacotherapy of RA were performed. Two researchers reached a consensus on coding the direction and strength of each recommendation. Results: Finally, 26 CPGs were included in this study, and 14 of them, which included pharmacotherapy, were performed consistency analysis. 1) 64 recommendations from 14 CPGs were classified into 18 PICs. 2) Seven PICs (38%) were consistent in direction and strength, 10 PICs (56%) were consistent in direction but inconsistent in strength, and one PIC (6%) was inconsistent in direction (hydroxychloroquine, HCQ). 3) Sensitivity analysis tested the robustness, and the inconsistency remained high. Conclusion: The direction was highly consistent among the recommendations of pharmacotherapy for RA, but the strength was highly inconsistent. Reasons for the inconsistency need to be further investigated, and consistent recommendations could guide the pharmacotherapy of RA in clinical practice.
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Affiliation(s)
- Yue Hu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Yunze Han
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Yan Ma
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Shumei Fan
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Xue Wang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Xinyu Fu
- School of Stomatology, Lanzhou University, Lanzhou, China
| | - Xiaopeng Hu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Xufei Luo
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yanfang Ma
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
| | - Yangqin Xun
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Nan Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Chengping Wen
- Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Wei Cao
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xuping Song
- School of Public Health, Lanzhou University, Lanzhou, China
- Evidence Based Social Science Research Center, Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- Institute of Health Data Science, Lanzhou University, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
- *Correspondence: Xuping Song, ; Yaolong Chen,
| | - Yaolong Chen
- School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Evidence Based Social Science Research Center, Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- Institute of Health Data Science, Lanzhou University, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
- Guideline International Network Asia, Lanzhou, China
- *Correspondence: Xuping Song, ; Yaolong Chen,
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Terkes V, Lisica K, Marusic M, Verunica N, Tolic A, Morovic M. Remdesivir Treatment in Moderately Ill COVID-19 Patients: A Retrospective Single Center Study. J Clin Med 2022; 11:jcm11175066. [PMID: 36078997 PMCID: PMC9457067 DOI: 10.3390/jcm11175066] [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: 08/17/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Almost two years after remdesivir was approved and extensively used in numerous clinical studies for the treatment of COVID-19 patients, there is still no clear recommendation for the time and phase of the disease of remdesivir administration. This retrospective observational study included adults (≥18 years) with severe COVID-19, radiologically confirmed pneumonia, a need for supplemental oxygen and an interval from symptom onset to enrolment of 10 days or less. All patients were treated with remdesivir for 5 to 10 days, or with clinical improvement within that period. The primary goal was the outcome in patients treated with remdesivir during the early stage of the disease considering the different disease severity. The median time from symptom onset to treatment was 8.4 days (3−10). Clinical improvements and good outcomes were observed in 104 of 137 patients (75.9%); 33 (24.1%) of 137 patients died. Subgroup analyses showed that the mortality rate was significantly lower in moderately ill patients (3 out of 51 patients; 5.9%) than in the group of severely/critically ill patients (30 out of 86 patients; 34.8%; p < 0.005). Older age, rise of CRP and CT score were shown to be significant predictors of disease outcome. Overall, remdesivir was well tolerated, and the treatment was discontinued in only four patients. The results of this observational study in 137 patients with different disease severity contribute to the attitude concerning remdesivir administration in the early stage of COVID-19, at least in moderately ill patients with a high risk of progression, before the transition to a more severe stage.
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Affiliation(s)
- Vedrana Terkes
- Department of Infectious Diseases, Zadar General Hospital, 23000 Zadar, Croatia
| | - Karla Lisica
- Department of Infectious Diseases, Zadar General Hospital, 23000 Zadar, Croatia
| | - Martina Marusic
- Emergency Department, Zadar General Hospital, 23000 Zadar, Croatia
| | - Nikola Verunica
- Department of Cardiology, Zadar General Hospital, 23000 Zadar, Croatia
| | - Anela Tolic
- Department of Radiology, Zadar General Hospital, 23000 Zadar, Croatia
| | - Miro Morovic
- Department of Infectious Diseases, Zadar General Hospital, 23000 Zadar, Croatia
- Correspondence:
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Abstract
The COVID-19 pandemic saw a massive mobilization of the scientific workforce. We evaluated the citation impact of COVID-19 publications relative to all scientific work published in 2020 to 2021, finding that 20% of citations received to papers published in 2020 to 2021 were to COVID-19–related papers. Across science, 98 of the 100 most-cited papers published in 2020 to 2021 were related to COVID-19. A large number of scientists received large numbers of citations to their COVID-19 work, often exceeding the citations they had received to all their work during their entire career. We document a strong covidization of research citations across science. This may have major repercussions for research priorities and the evolution of research on COVID-19 and beyond. Massive scientific productivity accompanied the COVID-19 pandemic. We evaluated the citation impact of COVID-19 publications relative to all scientific work published in 2020 to 2021 and assessed the impact on scientist citation profiles. Using Scopus data until August 1, 2021, COVID-19 items accounted for 4% of papers published, 20% of citations received to papers published in 2020 to 2021, and >30% of citations received in 36 of the 174 disciplines of science (up to 79.3% in general and internal medicine). Across science, 98 of the 100 most-cited papers published in 2020 to 2021 were related to COVID-19; 110 scientists received ≥10,000 citations for COVID-19 work, but none received ≥10,000 citations for non–COVID-19 work published in 2020 to 2021. For many scientists, citations to their COVID-19 work already accounted for more than half of their total career citation count. Overall, these data show a strong covidization of research citations across science, with major impact on shaping the citation elite.
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Singhal KK, Mathew JL, Dsouza JM, Agrawal S, Kutlehrria I, Singh M. Systematic Identification and Critical Appraisal of Pediatric COVID-19 Guidelines Applicable in India. Indian J Pediatr 2022; 89:706-713. [PMID: 35044617 PMCID: PMC8767361 DOI: 10.1007/s12098-022-04081-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/06/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To systematically identify and critically appraise the methodological quality of pediatric guidelines applicable to management of COVID-19 in India. METHODS Pediatric COVID-19 guidelines applicable to India, published until 30 April 2021, were identified through a systematic search across ten databases. Each was critically appraised for methodological quality using the AGREE-II tool, by at least two appraisers. Median (interquartile range) of the total score and domain-wise scores were calculated, and compared for Indian vs. foreign guidelines, updated vs. original versions of guidelines, and those developed earlier vs. later in the pandemic. RESULTS A total of 62 guidelines was identified. Only 8 (12.9%) were published in India. The overall AGREE-II score ranged from 4.7% to 72.8%; with median (IQR) 37.9% (29.4, 48.6). This suggested overall low(er) methodological quality. The median (IQR) domain-wise scores were as follows: Scope and Purpose 66.7% (58.3, 83.3), Stakeholder Involvement 41.7% (30.6, 83.3), Rigor of Development 23.4% (14.8, 37.5), Clarity of Presentation 59.7% (50.0, 75.0), Applicability 27.1% (18.8, 33.3), and Editorial Independence 8.3% (0.0, 45.8). This suggested diversity in quality of different aspects of the guidelines, with very low quality in the critical domain of methodological rigor. There were no statistically significant differences in the overall scores of Indian vs. foreign guidelines, updated versions vs. original versions, and those developed earlier vs. later in the pandemic. CONCLUSION The currently available pediatric COVID-19 guidelines have low methodological quality, adversely affecting their credibility, validity, and applicability. Urgent corrective strategies are presented for consideration.
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Affiliation(s)
- Kamal Kumar Singhal
- Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Joseph L Mathew
- Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | | | - Surbhi Agrawal
- Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ipsa Kutlehrria
- Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Meenu Singh
- Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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12
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Rojas D, Saavedra J, Petrova M, Pan Y, Szapocznik J. Predictors of COVID-19 Fatality: A Worldwide Analysis of the Pandemic over Time and in Latin America. J Epidemiol Glob Health 2022; 12:150-159. [PMID: 35029837 PMCID: PMC8758983 DOI: 10.1007/s44197-022-00031-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/03/2022] [Indexed: 11/06/2022] Open
Abstract
SARS-CoV-2 has infected over one hundred million people worldwide and has affected Latin America particularly severely in terms of both cases and deaths. This study aims to determine the association between SARS-CoV-2 testing and COVID-19 fatality rate worldwide over 8 months and to examine how this relationship differs between Latin America and all other countries. This cross-sectional study used March 2021 data from 169 countries. Multivariate regressions predicted COVID-19 fatality (outcome) from the number of SARS-CoV-2 tests (exposure), while controlling for other predictors. Results for March 2021 were compared to results from June 2020. Additionally, results for Latin America were also compared to all other countries except Latin American for March 2021. SARS-CoV-2 testing was associated with a significant decrease in COVID-19 fatality rate in both June 2020 and March 2021 (RR = 0.92; 95% CI 0.87-0.96 and RR = 0.86; 95% CI 0.74-1.00, respectively). SARS-CoV-2 testing was associated with a significant decrease in COVID-19 fatality rate in Latin American countries but not in all other countries (RR = 0.45; 95% CI 0.23-0.89 and RR = 0.95; 95% CI 0.82-1.11, respectively). However, the difference between the risk ratios for June 2020 and March 2021 and between the risk ratios for Latin America and all other countries were not statistically significant. Increased SARS-CoV-2 testing may be a significant predictor of lower COVID-19 case fatality rate, specifically in Latin American countries, due to the existence of a strong association, which may have driven the worldwide results.
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Affiliation(s)
- Dayana Rojas
- Department of Public Health Sciences, Don Soffer Clinical Research Center, University of Miami, 1120 NW 14th Street, Miami, FL, 33136-2107, USA.
| | - Jorge Saavedra
- Don Soffer Clinical Research Center, AHF Global Public Health Institute, 1120 NW 14th Street, Miami, FL, 33136-2107, USA
| | - Mariya Petrova
- DeWitt Daughtry Family Department of Surgery, University of Miami, Biomedical Research Building, 1501 NW 10th Avenue, Miami, FL, 33136-1012, USA
| | - Yue Pan
- Department of Public Health Sciences, Don Soffer Clinical Research Center, University of Miami, 1120 NW 14th Street, Miami, FL, 33136-2107, USA
| | - José Szapocznik
- Department of Public Health Sciences, Don Soffer Clinical Research Center, University of Miami, 1120 NW 14th Street, Miami, FL, 33136-2107, USA
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13
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Toro-Huamanchumo CJ, Castro-Reyes MM, Peralta V, Venancio-Huerta JE, Puescas-Sanchez PR, Peña-Sanchez ER. Efficacy and Safety of Extracorporeal Membrane Oxygenation in Patients under Mechanical Ventilation with COVID-19 and Severe Acute Respiratory Distress Syndrome: A Health Technology Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6080. [PMID: 35627617 PMCID: PMC9140858 DOI: 10.3390/ijerph19106080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/10/2022] [Accepted: 05/14/2022] [Indexed: 02/04/2023]
Abstract
We aimed to assess the efficacy and safety of extracorporeal membrane oxygenation (ECMO) in patients under mechanical ventilation with COVID-19 and severe acute respiratory distress syndrome (ARDS). A systematic review of the literature published in PubMed, Cochrane Library and LILACS databases, was performed. A manual search was also conducted using the reference lists of the studies included in the full-text assessment, as well as a grey-literature search on Google. Additionally, websites of state institutions and organizations developing clinical practice guidelines and health technology assessments were reviewed. The ClinicalTrials.gov website was screened along with the websites of the International Clinical Trial Registry Platform and the National Registry of Health Research Projects of the Peruvian National Institute of Health. No restrictions were applied in terms of language, time, or country. A total of 13 documents were assessed, which included 7 clinical practice guidelines, 3 health technology assessments, 1 systematic review, 1 randomized clinical trial, and 1 observational study. A critical appraisal was conducted for each document. After this, we considered that the currently available evidence is insufficient for a conclusion supporting the use of ECMO in patients under mechanical ventilation with severe ARDS associated to COVID-19 in terms of mortality, safety, and quality of life.
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Affiliation(s)
- Carlos J. Toro-Huamanchumo
- Health Technology Assessment Unit, Instituto de Evaluación de Tecnologías en Salud e Investigación—IETSI, EsSalud, Lima 15072, Peru; (M.M.C.-R.); (V.P.); (J.E.V.-H.); (E.R.P.-S.)
- Unidad Para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima 15024, Peru
| | - Maribel M. Castro-Reyes
- Health Technology Assessment Unit, Instituto de Evaluación de Tecnologías en Salud e Investigación—IETSI, EsSalud, Lima 15072, Peru; (M.M.C.-R.); (V.P.); (J.E.V.-H.); (E.R.P.-S.)
| | - Verónica Peralta
- Health Technology Assessment Unit, Instituto de Evaluación de Tecnologías en Salud e Investigación—IETSI, EsSalud, Lima 15072, Peru; (M.M.C.-R.); (V.P.); (J.E.V.-H.); (E.R.P.-S.)
| | - Julissa E. Venancio-Huerta
- Health Technology Assessment Unit, Instituto de Evaluación de Tecnologías en Salud e Investigación—IETSI, EsSalud, Lima 15072, Peru; (M.M.C.-R.); (V.P.); (J.E.V.-H.); (E.R.P.-S.)
- Laboratorio de Bioingeniería, Pontificia Universidad Católica del Perú, Lima 15088, Peru
| | | | - Eric R. Peña-Sanchez
- Health Technology Assessment Unit, Instituto de Evaluación de Tecnologías en Salud e Investigación—IETSI, EsSalud, Lima 15072, Peru; (M.M.C.-R.); (V.P.); (J.E.V.-H.); (E.R.P.-S.)
- School of Medicine, Universidad de San Martín de Porres, Chiclayo 14012, Peru
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14
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Wang Y, Wang Y, Li X, Wang H. Re: Towards a deeper understanding of the dynamics of COVID-19-associated Guillain-Barre syndrome. QJM 2022; 115:344-345. [PMID: 34240218 PMCID: PMC8344588 DOI: 10.1093/qjmed/hcab188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yumin Wang
- Department of Respiratory and Critical Care Medicine, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine,No.15 Rd.Yuquan,Beijing 100049, PR China
| | - Yanchao Wang
- Department of Neurology, The Affiliated Hospital of Chifeng University, No.42 Street Wangfu, Chifeng 024005, PR China
| | - Xiujun Li
- Department of Nursing, School of Clinical Medicine, Chifeng University, No.1 Rd.Yingbin, Chifeng 024005, PR China
| | - Hongquan Wang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, No.15 Rd.Yuquan, Beijing 100049, PR China
- Address correspondence to Hongquan Wang, Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, People's Republic of China. or
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15
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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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16
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Monzavi SM, Naderi M, Ahmadbeigi N, Kajbafzadeh AM, Muhammadnejad S. An outlook on antigen-specific adoptive immunotherapy for viral infections with a focus on COVID-19. Cell Immunol 2021; 367:104398. [PMID: 34217004 PMCID: PMC8214814 DOI: 10.1016/j.cellimm.2021.104398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/23/2021] [Accepted: 06/18/2021] [Indexed: 12/16/2022]
Abstract
Although not a standard-of-care yet, adoptive immunotherapeutic approaches have gradually earned a place within the list of antiviral therapies for some of fatal and hard-to-treat viral diseases. To maintain robust antiviral immunity and to effectively target the viral particles and virally-infected cells, immune cells capable of recognizing the viral antigens are required. While conventional vaccination can induce these cells in vivo; another option is to prime and generate antigen-specific immune cells ex vivo. This approach has been successfully trialed for virulent opportunistic viral infections after bone marrow transplantation. Amid the crisis of SARS-CoV2 pandemic, which has been followed by the success of certain early-authorized vaccines; some institutions and companies have explored the effects of viral-specific adoptive cell transfers (ACTs) in trials, as alternative treatments. Aimed at outlining a perspective on antigen-specific adoptive immunotherapy for viral infections, this review article specifically provides an appraisal of ACT-based studies/trials on SARS-CoV2 infection.
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Affiliation(s)
- Seyed Mostafa Monzavi
- Gene Therapy Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Urology and Regenerative Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Naderi
- Gene Therapy Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadbeigi
- Gene Therapy Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Samad Muhammadnejad
- Gene Therapy Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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17
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Ioannidis JPA, Salholz-Hillel M, Boyack KW, Baas J. The rapid, massive growth of COVID-19 authors in the scientific literature. ROYAL SOCIETY OPEN SCIENCE 2021; 8:210389. [PMID: 34527271 PMCID: PMC8422596 DOI: 10.1098/rsos.210389] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/02/2021] [Indexed: 05/04/2023]
Abstract
We examined the extent to which the scientific workforce in different fields was engaged in publishing COVID-19-related papers. According to Scopus (data cut, 1 August 2021), 210 183 COVID-19-related publications included 720 801 unique authors, of which 360 005 authors had published at least five full papers in their career and 23 520 authors were at the top 2% of their scientific subfield based on a career-long composite citation indicator. The growth of COVID-19 authors was far more rapid and massive compared with cohorts of authors historically publishing on H1N1, Zika, Ebola, HIV/AIDS and tuberculosis. All 174 scientific subfields had some specialists who had published on COVID-19. In 109 of the 174 subfields of science, at least one in 10 active, influential (top 2% composite citation indicator) authors in the subfield had authored something on COVID-19. Fifty-three hyper-prolific authors had already at least 60 (and up to 227) COVID-19 publications each. Among the 300 authors with the highest composite citation indicator for their COVID-19 publications, most common countries were USA (n = 67), China (n = 52), UK (n = 32) and Italy (n = 18). The rapid and massive involvement of the scientific workforce in COVID-19-related work is unprecedented and creates opportunities and challenges. There is evidence for hyper-prolific productivity.
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Affiliation(s)
- John P. A. Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
- Meta-Research Innovation Center Berlin (METRIC-B), QUEST, Berlin Institute of Health, Berlin, Germany
| | - Maia Salholz-Hillel
- Meta-Research Innovation Center Berlin (METRIC-B), QUEST, Berlin Institute of Health, Berlin, Germany
| | | | - Jeroen Baas
- Research Intelligence, Elsevier B.V., Amsterdam, The Netherlands
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18
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Zhao S, Lu S, Wu S, Wang Z, Guo Q, Shi Q, Zhang H, Zhang J, Liu H, Liu Y, Zhang X, Wang L, Ren M, Wang P, Lan H, Zhou Q, Sun Y, Cao J, Li Q, Estill J, Mathew JL, Ahn HS, Lee MS, Wang X, Zhou C, Chen Y. Analysis of COVID-19 Guideline Quality and Change of Recommendations: A Systematic Review. HEALTH DATA SCIENCE 2021; 2021:9806173. [PMID: 36405357 PMCID: PMC9629660 DOI: 10.34133/2021/9806173] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/04/2021] [Indexed: 04/23/2023]
Abstract
Background Hundreds of coronavirus disease 2019 (COVID-19) clinical practice guidelines (CPGs) and expert consensus statements have been developed and published since the outbreak of the epidemic. However, these CPGs are of widely variable quality. So, this review is aimed at systematically evaluating the methodological and reporting qualities of COVID-19 CPGs, exploring factors that may influence their quality, and analyzing the change of recommendations in CPGs with evidence published. Methods We searched five electronic databases and five websites from 1 January to 31 December 2020 to retrieve all COVID-19 CPGs. The assessment of the methodological and reporting qualities of CPGs was performed using the AGREE II instrument and RIGHT checklist. Recommendations and evidence used to make recommendations in the CPGs regarding some treatments for COVID-19 (remdesivir, glucocorticoids, hydroxychloroquine/chloroquine, interferon, and lopinavir-ritonavir) were also systematically assessed. And the statistical inference was performed to identify factors associated with the quality of CPGs. Results We included a total of 92 COVID-19 CPGs developed by 19 countries. Overall, the RIGHT checklist reporting rate of COVID-19 CPGs was 33.0%, and the AGREE II domain score was 30.4%. The overall methodological and reporting qualities of COVID-19 CPGs gradually improved during the year 2020. Factors associated with high methodological and reporting qualities included the evidence-based development process, management of conflicts of interest, and use of established rating systems to assess the quality of evidence and strength of recommendations. The recommendations of only seven (7.6%) CPGs were informed by a systematic review of evidence, and these seven CPGs have relatively high methodological and reporting qualities, in which six of them fully meet the Institute of Medicine (IOM) criteria of guidelines. Besides, a rapid advice CPG developed by the World Health Organization (WHO) of the seven CPGs got the highest overall scores in methodological (72.8%) and reporting qualities (83.8%). Many CPGs covered the same clinical questions (it refers to the clinical questions on the effectiveness of treatments of remdesivir, glucocorticoids, hydroxychloroquine/chloroquine, interferon, and lopinavir-ritonavir in COVID-19 patients) and were published by different countries or organizations. Although randomized controlled trials and systematic reviews on the effectiveness of treatments of remdesivir, glucocorticoids, hydroxychloroquine/chloroquine, interferon, and lopinavir-ritonavir for patients with COVID-19 have been published, the recommendations on those treatments still varied greatly across COVID-19 CPGs published in different countries or regions, which may suggest that the CPGs do not make sufficient use of the latest evidence. Conclusions Both the methodological and reporting qualities of COVID-19 CPGs increased over time, but there is still room for further improvement. The lack of effective use of available evidence and management of conflicts of interest were the main reasons for the low quality of the CPGs. The use of formal rating systems for the quality of evidence and strength of recommendations may help to improve the quality of CPGs in the context of the COVID-19 pandemic. During the pandemic, we suggest developing a living guideline of which recommendations are supported by a systematic review for it can facilitate the timely translation of the latest research findings to clinical practice. We also suggest that CPG developers should register the guidelines in a registration platform at the beginning for it can reduce duplication development of guidelines on the same clinical question, increase the transparency of the development process, and promote cooperation among guideline developers all over the world. Since the International Practice Guideline Registry Platform has been created, developers could register guidelines prospectively and internationally on this platform.
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Affiliation(s)
- Siya Zhao
- School of Public Health, Lanzhou University, Lanzhou, China
- Institute of Health Data Science, Lanzhou University, Lanzhou, China
| | - Shuya Lu
- Department of Pediatric, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Shouyuan Wu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Zijun Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Qiangqiang Guo
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Qianling Shi
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Hairong Zhang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Juanjuan Zhang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Hui Liu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Yunlan Liu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Xianzhuo Zhang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Ling Wang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Mengjuan Ren
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Ping Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Hui Lan
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Qi Zhou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yajia Sun
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Jin Cao
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Qinyuan Li
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - Joseph L. Mathew
- Advanced Pediatrics Centre, PGIMER Chandigarh, Chandigarh, India
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, Korea University, Seoul, Republic of Korea
- Korea Cochrane Centre, SeoulRepublic of Korea
- Evidence Based Medicine, SeoulRepublic of Korea
- Korea University School of Medicine, SeoulRepublic of Korea
| | - Myeong Soo Lee
- Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- University of Science and Technology, Daejeon, Republic of Korea
- London Southbank University, London, UK
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaohui Wang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Chenyan Zhou
- Department of Pediatric, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Yaolong Chen
- Institute of Health Data Science, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, LanzhouChina
- Guideline International Network AsiaChina
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou, China
- Lanzhou University GRADE Center, China
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19
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Wang YY, Huang Q, Shen Q, Zi H, Li BH, Li MZ, He SH, Zeng XT, Yao X, Jin YH. Quality of and Recommendations for Relevant Clinical Practice Guidelines for COVID-19 Management: A Systematic Review and Critical Appraisal. Front Med (Lausanne) 2021; 8:630765. [PMID: 34222270 PMCID: PMC8248791 DOI: 10.3389/fmed.2021.630765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/26/2021] [Indexed: 01/15/2023] Open
Abstract
Background: The morbidity and mortality of coronavirus disease 2019 (COVID-19) are still increasing. This study aimed to assess the quality of relevant COVID-19 clinical practice guidelines (CPGs) and to compare the similarities and differences between recommendations. Methods: A comprehensive search was conducted using electronic databases (PubMed, Embase, and Web of Science) and representative guidelines repositories from December 1, 2019, to August 11, 2020 (updated to April 5, 2021), to obtain eligible CPGs. The Appraisal of Guidelines for Research and Evaluation (AGREE II) tool was used to evaluate the quality of CPGs. Four authors extracted relevant information and completed data extraction forms. All data were analyzed using R version 3.6.0 software. Results: In total, 39 CPGs were identified and the quality was not encouragingly high. The median score (interquartile range, IQR) of every domain from AGREE II for evidence-based CPGs (EB-CPGs) versus (vs.) consensus-based CPG (CB-CPGs) was 81.94% (75.00-84.72) vs. 58.33% (52.78-68.06) in scope and purpose, 59.72% (38.89-75.00) vs. 36.11% (33.33-36.11) in stakeholder involvement, 64.58% (32.29-71.88) vs. 22.92% (16.67-26.56) in rigor of development, 75.00% (52.78-86.81) vs. 52.78% (50.00-63.89) in clarity of presentation, 40.63% (22.40-62.50) vs. 20.83% (13.54-25.00) in applicability, and 58.33% (50.00-100.00) vs. 50.00% (50.00-77.08) in editorial independence, respectively. The methodological quality of EB-CPGs were significantly superior to the CB-CPGs in the majority of domains (P < 0.05). There was no agreement on diagnosis criteria of COVID-19. But a few guidelines show Remdesivir may be beneficial for the patients, hydroxychloroquine +/- azithromycin may not, and there were more consistent suggestions regarding discharge management. For instance, after discharge, isolation management and health status monitoring may be continued. Conclusions: In general, the methodological quality of EB-CPGs is greater than CB-CPGs. However, it is still required to be further improved. Besides, the consistency of COVID-19 recommendations on topics such as diagnosis criteria is different. Of them, hydroxychloroquine +/- azithromycin may be not beneficial to treat patients with COVID-19, but remdesivir may be a favorable risk-benefit in severe COVID-19 infection; isolation management and health status monitoring after discharge may be still necessary. Chemoprophylaxis, including SARS-CoV 2 vaccines and antiviral drugs of COVID-19, still require more trials to confirm this.
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Affiliation(s)
- Yun-Yun Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
| | - Quan Shen
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Hao Zi
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
| | - Bing-Hui Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
| | - Ming-Zhen Li
- Precision Medicine Center, Second People's Hospital of Huaihua, Huaihua, China
| | - Shao-Hua He
- Precision Medicine Center, Second People's Hospital of Huaihua, Huaihua, China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
| | - Xiaomei Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
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20
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Luo X, Liu Y, Ren M, Zhang X, Janne E, Lv M, Wang Q, Song Y, Mathew JL, Ahn HS, Lee MS, Chen Y. Consistency of recommendations and methodological quality of guidelines for the diagnosis and treatment of COVID-19. J Evid Based Med 2021; 14:40-55. [PMID: 33565225 PMCID: PMC8013412 DOI: 10.1111/jebm.12419] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Since the beginning of the COVID-19 epidemic, a large number of guidelines on diagnosis and treatment of COVID-19 have been developed, but the quality of those guidelines and the consistency of recommendations are unclear. The objective of this study is to evaluate the quality of the diagnosis and treatment guidelines on COVID-19 and analyze the consistency of the recommendations of these guidelines. METHODS We searched for guidelines on diagnosis and/or treatment of COVID-19 through PubMed, CBM, CNKI, and WanFang Data, from January 1, 2020 to August 31, 2020. In addition, we also searched official websites of the US CDC, European CDC and WHO, and some guideline collection databases. We included diagnosis and/or treatment guidelines for COVID-19, including rapid advice guidelines and interim guidelines. Two trained researchers independently extracted data and four trained researchers evaluated the quality of the guidelines using the AGREE II instruments. We extracted information on the basic characteristics of the guidelines, guideline development process, and the recommendations. We described the consistency of the direction of recommendations for treatment and diagnosis of COVID-19 across the included guidelines. RESULTS A total of 37 guidelines were included. Most included guidelines were assessed as low quality, with only one of the six domains of AGREE II (clarity of presentation) having a mean score above 50%. The mean scores of three domains (stakeholder involvement, the rigor of development and applicability) were all below 30%. The recommendations on diagnosis and treatment were to some extent consistent between the included guidelines. Computed tomography (CT), X-rays, lung ultrasound, RT-PCR, and routine blood tests were the most commonly recommended methods for COVID-19 diagnosis. Thirty guidelines were on the treatment of COVID-19. The recommended forms of treatment included supportive care, antiviral therapy, glucocorticoid therapy, antibiotics, immunoglobulin, extracorporeal membrane oxygenation (ECMO), convalescent plasma, and psychotherapy. CONCLUSIONS The methodological quality of currently available diagnosis and treatment guidelines for COVID-19 is low. The diagnosis and treatment recommendations between the included guidelines are highly consistent. The main diagnostic methods for COVID-19 are RT-PCR and CT, with ultrasound as a potential diagnostic tool. As there is no effective treatment against COVID-19 yet, supportive therapy is at the moment the most important treatment option.
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Affiliation(s)
- Xufei Luo
- School of Public HealthLanzhou UniversityLanzhouChina
| | - Yunlan Liu
- School of Public HealthLanzhou UniversityLanzhouChina
| | - Mengjuan Ren
- School of Public HealthLanzhou UniversityLanzhouChina
| | - Xianzhuo Zhang
- The First School of Clinical MedicineLanzhou UniversityLanzhouChina
| | - Estill Janne
- Institute of Global HealthUniversity of GenevaGenevaSwitzerland
| | - Meng Lv
- School of Public HealthLanzhou UniversityLanzhouChina
| | - Qi Wang
- Department of Health Research Methods, Evidence and ImpactFaculty of Health SciencesMcMaster UniversityHamiltonCanada
- McMaster Health ForumMcMaster UniversityHamiltonCanada
| | - Yang Song
- Iberoamerican Cochrane Centre ‐ Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau)BarcelonaSpain
| | | | - Hyeong Sik Ahn
- Department of Preventive MedicineKorea UniversitySeoulKorea
- Korea Cochrane CentreSeoulKorea
| | - Myeong Soo Lee
- School of Public HealthLanzhou UniversityLanzhouChina
- Korea Institute of Oriental MedicineDaejeonKorea
- University of Science and TechnologyDaejeonKorea
| | - Yaolong Chen
- School of Public HealthLanzhou UniversityLanzhouChina
- Institute of Health Data ScienceLanzhou UniversityLanzhouChina
- Evidence‐Based Medicine Center, School of Basic Medical SciencesLanzhou UniversityLanzhouChina
- Key Laboratory of Evidence‐Based Medicine & Knowledge Translation of Gansu ProvinceLanzhouChina
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