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Dawes K, Simpson G, Lines L, van den Berg M. Interventions to support children after a parental acquired brain injury: a scoping review. Brain Inj 2024; 38:773-786. [PMID: 38687294 DOI: 10.1080/02699052.2024.2347555] [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: 06/30/2023] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE This scoping review aimed to identify manualised programs and practice suggestions to support children's health literacy, behaviors and emotions after a parental acquired brain injury. METHODS A systematic search of five scientific databases (PsychINFO, MEDLINE, ProQuest, Scopus, Cochrane) and gray literature occurred. Inclusion criteria included: studies and gray literature published 1989 to 2023, in English, child populations with relationship to parental acquired brain injury, identifying manualised programs or practice suggestions via content analysis approach. ETHICAL CONSIDERATIONS No data were collected from human participants. All included studies, where relevant, demonstrated consent and/or ethical processes. RESULTS Sixteen relevant studies and three gray literature resources (n = 19) were identified, including two studies that detailed manualised programs, and fifteen studies and two resource packs that included practice suggestions. Five common domains within practice suggestions were identified: systemic commitment (n = 17); family-centered approaches (n = 16); child-centered practices (n = 15); structured programs (n = 9); and peer support (n = 8). CONCLUSIONS More rigorous evaluation is required to test the potential benefits of manualised programs and practice suggestions. A systemic commitment at clinical and organizational levels to provide child and family-centered practices, structured programs, and access to peer support, early and throughout adult-health care settings, may help to meet the support needs of children.
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Affiliation(s)
- Kate Dawes
- South Australian Brain Injury Rehabilitation Service, SA Health, Adelaide, Australia
- Caring Futures Institute, Flinders University of South Australia, Adelaide, Australia
| | - Grahame Simpson
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, Australia
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Lauren Lines
- Caring Futures Institute, Flinders University of South Australia, Adelaide, Australia
| | - Maayken van den Berg
- Caring Futures Institute, Flinders University of South Australia, Adelaide, Australia
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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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Jamshidi S, Pati D. Hierarchy of Evidence: An Appraisal Tool for Weighting the Evidence in Healthcare Design Research Based on Internal Validity. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:19-38. [PMID: 38374648 DOI: 10.1177/19375867231175916] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
PURPOSE This inquiry aims to develop an appraisal tool to offer greater granularity in weighing evidence in the field of healthcare design research. BACKGROUND In evidence-based design (EBD), the goal is to implement interventions that result in a meaningful and optimal effect based on current best evidence. Although multiple appraisal tools (many adopted from medical disciplines) have been instrumental in evaluating studies in the field of healthcare design research to identify the best evidence, they do not necessarily consider the unique contexts of healthcare design research, and methodologies appropriate to the field. METHODS Five basic types of studies are ranked based on the level of confidence that they offer regarding the estimate of an effect: (1) meta-analysis studies, (2) causal studies, (3) correlational studies, (4) descriptive studies, and (5) anecdotal evidence. Causal studies are further divided into four levels based on the interaction of two factors: (1) type of intervention and (2) groups' equivalency and extraneous variable control. RESULTS An eight-level hierarchy of evidence for healthcare design research is proposed that is expected to improve upon previous hierarchies in three major ways: (a) including research methods that are more relevant to healthcare design research, (b) enhancing evaluation accuracy and reliability by providing a clearer definition of studies based on their key components rather than using study labels alone, and (c) distinguishing different levels of evidence, particularly in causal studies. CONCLUSIONS The proposed appraisal tool is developed specifically for EBD by reflecting on the unique context of healthcare design research and practice.
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Affiliation(s)
- Saman Jamshidi
- School of Architecture, University of Nevada, Las Vegas, NV, USA
| | - Debajyoti Pati
- Department of Design, College of Human Sciences, Texas Tech University, Lubbock, TX, USA
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Ojha S, MacAllister K, Abdula S, Madar J, Rackham O, Tyler W. Healthcare professionals' views to inform revision of the BAPM newborn early warning trigger and track system. Arch Dis Child Fetal Neonatal Ed 2023; 108:92-93. [PMID: 34824085 DOI: 10.1136/archdischild-2021-323160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Shalini Ojha
- Academic Unit of Population and Life Sciences, School of Medicine, University of Nottingham, Nottingham, UK .,Neonatal Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Kathryn MacAllister
- Neonatal Intensive Care Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sara Abdula
- Chelsea and Westminster Hospital, London, UK
| | | | | | - Wendy Tyler
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
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Grau S, Miró JM, Olalla J, Alcalá JC, Castro A, Rubio-Rodríguez D, Rubio-Terrés C. Comparison of the design and methodology of Phase 3 clinical trials of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) and dolutegravir-based dual therapy (DTG) in HIV: a systematic review of the literature. Expert Rev Anti Infect Ther 2023; 21:65-76. [PMID: 36399521 DOI: 10.1080/14787210.2023.2149490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Current recommended antiretroviral regimens include a combination of two (dual; DT) or three (triple; TT) antiretroviral drugs. This study aims to determine whether the quality of evidence from clinical trials of dolutegravir (dolutegravir/lamivudine [DTG/3TC] or dolutegravir/rilpivirine [DTG/RPV]) is methodologically comparable to that of clinical trials conducted with bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF). AREAS COVERED A systematic review of the medical literature was carried out in PubMed without date or language restrictions, following the PRISMA guidelines. All aspects of the methodological design of phase 3 randomized clinical trials (RCTs) of DT and TT, evaluated by the European Medicines Agency (registration trials), were reviewed. The quality of clinical trials was assessed using the Jadad scale. EXPERT OPINION The search identified 5, 3 and 2 phase 3 RCTs with BIC/FTC/TAF, DTG/3TC and DTG/RPV, respectively, that met the inclusion criteria. The designs would not be comparable due to differences in pre-randomization losses, blinding, patient recruitment, as well as differences in methodological quality, with the average score of the RCTs conducted with BIC/FTC/TAF, DTG/3TC and DTG/RPV being 4.2 (high quality), 3.0 (medium quality) and 3.0 (medium quality), respectively. Due to methodological differences between the BIC/FTC/TAF, DTG/3TC and DTG/RPV RCTs, the results of these are not comparable.
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Affiliation(s)
- Santiago Grau
- Pharmacy Department, Hospital Del Mar, Barcelona, Spain
| | - Jose Maria Miró
- Department of Infectious Diseases, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Julian Olalla
- Internal Medicine Department, Hospital Costa Del Sol, Marbella, Spain
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Dewidar O, Lotfi T, Langendam M, Parmelli E, Saz Parkinson Z, Solo K, Chu DK, Mathew JL, Akl EA, Brignardello-Petersen R, Mustafa RA, Moja L, Iorio A, Chi Y, Canelo-Aybar C, Kredo T, Karpusheff J, Turgeon AF, Alonso-Coello P, Wiercioch W, Gerritsen A, Klugar M, Rojas MX, Tugwell P, Welch VA, Pottie K, Munn Z, Nieuwlaat R, Ford N, Stevens A, Khabsa J, Nasir Z, Leontiadis GI, Meerpohl JJ, Piggott T, Qaseem A, Matthews M, Schünemann HJ. Which actionable statements qualify as good practice statements In Covid-19 guidelines? A systematic appraisal. BMJ Evid Based Med 2022; 27:361-369. [PMID: 35428695 PMCID: PMC9044517 DOI: 10.1136/bmjebm-2021-111866] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate the development and quality of actionable statements that qualify as good practice statements (GPS) reported in COVID-19 guidelines. DESIGN AND SETTING Systematic review . We searched MEDLINE, MedSci, China National Knowledge Infrastructure (CNKI), databases of Grading of Recommendations Assessment, Development and Evaluation (GRADE) Guidelines, NICE, WHO and Guidelines International Network (GIN) from March 2020 to September 2021. We included original or adapted recommendations addressing any COVID-19 topic. MAIN OUTCOME MEASURES We used GRADE Working Group criteria for assessing the appropriateness of issuing a GPS: (1) clear and actionable; (2) rationale necessitating the message for healthcare practice; (3) practicality of systematically searching for evidence; (4) likely net positive consequences from implementing the GPS and (5) clear link to the indirect evidence. We assessed guideline quality using the Appraisal of Guidelines for Research and Evaluation II tool. RESULTS 253 guidelines from 44 professional societies issued 3726 actionable statements. We classified 2375 (64%) as GPS; of which 27 (1%) were labelled as GPS by guideline developers. 5 (19%) were labelled as GPS by their authors but did not meet GPS criteria. Of the 2375 GPS, 85% were clear and actionable; 59% provided a rationale necessitating the message for healthcare practice, 24% reported the net positive consequences from implementing the GPS. Systematic collection of evidence was deemed impractical for 13% of the GPS, and 39% explained the chain of indirect evidence supporting GPS development. 173/2375 (7.3%) statements explicitly satisfied all five criteria. The guidelines' overall quality was poor regardless of the appropriateness of GPS development and labelling. CONCLUSIONS Statements that qualify as GPS are common in COVID-19 guidelines but are characterised by unclear designation and development processes, and methodological weaknesses.
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Affiliation(s)
- Omar Dewidar
- Methods Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Tamara Lotfi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada
| | - Miranda Langendam
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Elena Parmelli
- Joint Research Centre, European Commission, Ispra, Italy
| | - Zuleika Saz Parkinson
- Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias, Madrid, Spain
| | - Karla Solo
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada
| | - Derek K Chu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Joseph L Mathew
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Elie A Akl
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Internal Medicine, Division of Nephrology and Hypertension, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Lorenzo Moja
- Department of Health Product Policy and Standards, World Health Organization, Geneve, Switzerland
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Yuan Chi
- Yealth Network, Beijing Yealth Technology Co., Ltd, Beijing, China
- Cochrane Campbell Global Ageing Partnership, London, UK
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau-CIBERESP, Barcelona, Spain
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
- Clinical Pharmacology, Department of Medicine, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | | | - Alexis F Turgeon
- Centre de Recherche du Centre Hospitalier Affilié Universitaire de Québec (CHA), CHA-Hôpital de l'Enfant-Jésus, Université Laval, Quebec, Quebec, Canada
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau-CIBERESP, Barcelona, Spain
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada
| | - Annette Gerritsen
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - María Ximena Rojas
- Department of Clinical Epidemiology and Public Health, Institut d'Investigació Biomèdica Sant Pau IIB Sant Pau, Barcelona, Spain
| | - Peter Tugwell
- Department of Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Vivian Andrea Welch
- Methods Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin Pottie
- Deparatment of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Zachary Munn
- Joanna Briggs Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nathan Ford
- Department of HIV, Hepatitis and Sexually Transmitted Infections, World Health Organization, Geneva, Switzerland
| | - Adrienne Stevens
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Zil Nasir
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Grigorios I Leontiadis
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Joerg J Meerpohl
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
- Medical Center - University of Freiburg, Institute for Evidence in Medicine, Freiburg, Germany
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada
| | - Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania, USA
| | - Micayla Matthews
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, 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 and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Cochrane Canada, Hamilton, Ontario, Canada
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Endlich Y, Hore PJ, Baker PA, Beckmann LA, Bradley WP, Chan KLE, Chapman GA, Jephcott CGA, Kruger PS, Newton A, Roessler P. Updated guideline on equipment to manage difficult airways: Australian and New Zealand College of Anaesthetists. Anaesth Intensive Care 2022; 50:430-446. [PMID: 35722809 DOI: 10.1177/0310057x221082664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Australian and New Zealand College of Anaesthetists (ANZCA) recently reviewed and updated the guideline on equipment to manage a difficult airway. An ANZCA-established document development group, which included representatives from the Australasian College for Emergency Medicine and the College of Intensive Care Medicine of Australia and New Zealand, performed the review, which is based on expert consensus, an extensive literature review, and bi-nationwide consultation. The guideline (PG56(A) 2021, https://www.anzca.edu.au/getattachment/02fe1a4c-14f0-4ad1-8337-c281d26bfa17/PS56-Guideline-on-equipment-to-manage-difficult-airways) is accompanied by a detailed background paper (PG56(A)BP 2021, https://www.anzca.edu.au/getattachment/9ef4cd97-2f02-47fe-a63a-9f74fa7c68ac/PG56(A)BP-Guideline-on-equipment-to-manage-difficult-airways-Background-Paper), from which the current recommendations are reproduced on behalf of, and with the permission of, ANZCA. The updated 2021 guideline replaces the 2012 version and aims to provide an updated, objective, informed, transparent, and evidence-based review of equipment to manage difficult airways.
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Affiliation(s)
- Yasmin Endlich
- Department of Anaesthesia and Acute Pain Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Department of Paediatric Anaesthesia, Women's and Children's Hospital, North Adelaide, Australia.,Faculty of Anaesthesia, University of Adelaide, Adelaide, Australia
| | - Phillipa J Hore
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
| | - Paul A Baker
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.,Department of Anaesthesia, Starship Children's Hospital, Auckland, New Zealand
| | - Linda A Beckmann
- Department of Anaesthesia and Acute Pain Medicine, Royal Brisbane and Women's Hospital, Herston, Australia
| | - William P Bradley
- Department of Anaesthesia and Perioperative Medicine, The Alfred, Melbourne, Australia.,Faculty of Anaesthesia, Monash University, Melbourne, Australia
| | - Kah L E Chan
- Department of Anaesthesia and Acute Pain Medicine, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Gordon A Chapman
- Department of Anaesthesia, Royal Perth Hospital, Perth, Australia.,Faculty of Anaesthesia, University of Western Australia, Perth, Australia
| | | | - Peter S Kruger
- Department of Intensive Care Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Alastair Newton
- Department of Emergency Medicine, The Prince Charles Hospital, Brisbane, Australia.,Retrieval Services Queensland, Brisbane, Australia
| | - Peter Roessler
- Safety and Advocacy Unit, Australian and New Zealand College of Anaesthetists, Melbourne, Australia
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No Recommendation Is (at Least Presently) the Best Recommendation: An Updating Quality Appraisal of Recommendations on Screening for Scoliosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116659. [PMID: 35682242 PMCID: PMC9180347 DOI: 10.3390/ijerph19116659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 01/25/2023]
Abstract
Recommendations addressing screening for scoliosis differ substantially. Systematically developed guidelines are confronted by consensus and opinion-based statements. This paper elaborates on the issue of the standards of development and reporting of current guidelines and recommendation statements, as well as on the methodological quality of the corresponding evidence syntheses. The SORT classification and the AMSTAR 2 tool were used for those purposes, respectively. Publications included in the analysis differed substantially in terms of their methodological quality. Based on the SORT and AMSTAR 2 scores, the 2018 US PSTF recommendation statement and systematic review on screening for scoliosis are trustworthy and high-quality sources of evidence and aid for decision making. The recommendation statement on insufficient evidence to formulate any recommendations is, paradoxically, very informative. Significantly, updated opinion-based position statements supporting screening for scoliosis acknowledged the importance of research evidence as a basis for recommendation formulation and are more cautious and balanced than formerly. Expert opinions, not built on properly presented analyses of evidence, are at odds with evidence-based practice. Nonetheless, contemporary principles of screening programs, especially those addressing people's values and preferences, and the possible harms of screening, remain underrepresented in both research and recommendations addressing screening for scoliosis.
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9
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Cleveland B, Lauwagie A, Sultan S, Santesso N, Dahm P. Wording of American Urological Association Guideline Recommendations Does Not Signal the Strength of Recommendation. Urology 2021; 164:40-45. [PMID: 34973242 DOI: 10.1016/j.urology.2021.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/15/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To systematically analyze the wording of American Urological Association (AUA) clinical practice guidelines' recommendations. MATERIALS AND METHODS We systematically identified all AUA guideline documents that used the current AUA framework and extracted the individual recommendations, their statement type, and their corresponding evidence level (if applicable), and analyzed the recommendation wording separating out the modal verbs (eg, should, may, or must) as well as the main verbs (eg, recommend, treat, perform). We performed descriptive statistics using SPSS Version 27. RESULTS We included 18 documents with 754 distinct recommendations; the median number of recommendations per guideline was 36 (interquartile range: 29; 48.5). Expert opinion was the most used statement type (193; 25.6%), followed by clinical principle (156; 20.7%). Four-hundred-four recommendations were either strong, moderate, or conditional: 135 (17.9%), 187 (24.8%) and 83 (11.0%), respectively. Most recommendation statements (701; 93.0%) used modal verbs to express a level of obligation. Overall, "should" was the most employed modal verb used (73.9%), followed by "may" (17.6%) and "must" (1.5%). Both "may" and "should" were used in conjunction with all five statement types, whereas "must" was limited to strong recommendations and clinical principles. CONCLUSION The wording of AUA recommendation statements does not signal the strength of recommendation and the intended level of obligation, which may represent a barrier to guideline implementation. More consistent wording of recommendations by strength may improve guideline understanding, uptake, and adherence.
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Affiliation(s)
- Brent Cleveland
- Department of Urology, University of Minnesota, Minneapolis, MN; Minneapolis VA Healthcare System, Minneapolis, MN
| | - Andrew Lauwagie
- Department of Urology, University of Minnesota, Minneapolis, MN
| | - Shahnaz Sultan
- Department of Medicine, Division of Gastroenterology, University of Minnesota, Minneapolis, MN; Minneapolis VA Healthcare System, Minneapolis, MN
| | - Nancy Santesso
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, MN; Minneapolis VA Healthcare System, Minneapolis, MN.
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Gonzalez-Padilla DA, Dahm P. Evidence-based urology: understanding GRADE methodology. Eur Urol Focus 2021; 7:1230-1233. [PMID: 34598913 DOI: 10.1016/j.euf.2021.09.014] [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] [Received: 08/07/2021] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022]
Abstract
Grading of Recommendations Assessment, Development, and Evaluation (GRADE) is a methodologically rigorous and transparent framework for grading the certainty of evidence and moving from evidence to recommendations in guidelines. Certainty of evidence can be rated as high, moderate, low, or very low, and some domains may lead to an increase or decrease in the certainty of evidence. Once evidence is summarized, the certainty, balance of desirable and undesirable outcomes, patients' values and preferences, equity, acceptability, and feasibility are taken into consideration in order to give a strong or weak recommendation for or against an intervention. In this review we summarize the GRADE approach using urology-related examples. PATIENT SUMMARY: GRADE is a well-established system for determining how much confidence we can place in research evidence and how guideline panels can make recommendations for patient care and health care policy. Recommendations can be strong or weak for or against a treatment strategy. Guideline developers should consider the certainty of the evidence, the balance of desirable and undesirable outcomes, patients' values and preferences, and resource use.
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Affiliation(s)
| | - Philipp Dahm
- Department of Urology, Minneapolis VAMC and University of Minnesota, Minneapolis, MN, USA.
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Mustafa RA, Garcia CAC, Bhatt M, Riva JJ, Vesely S, Wiercioch W, Nieuwlaat R, Patel P, Hanson S, Newall F, Wiernikowski J, Monagle P, Schünemann HJ. GRADE notes: How to use GRADE when there is "no" evidence? A case study of the expert evidence approach. J Clin Epidemiol 2021; 137:231-235. [PMID: 33675954 DOI: 10.1016/j.jclinepi.2021.02.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/07/2021] [Accepted: 02/26/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES One essential requirement of trustworthy guidelines is that they should be based on systematic reviews of the best available evidence. The GRADE Working Group has provided guidance for evaluating the certainty of evidence based on several domains. However, for many clinical questions, published evidence may be limited, too indirect or simply not exist. In this brief report (GRADE notes), we describe our method of developing evidence-based recommendations when publisheddirect evidence was lacking. STUDY DESIGN AND SETTING When direct published literature was absent, an expert evidence survey was administered to panel members about their unpublished observations and case series. Focus was on collecting data about cases and outcome, not panel opinions. RESULTS Out of 26 questions prioritized by the panel for pediatric venous thromboembolism, 12 had no, very limited, or very low certainty of evidence to inform them. The panel survey was administered for these questions. CONCLUSIONS Areas of sparse evidence often reflect key questions that are critical to address in clinical practice guidelines due to the uncertainty among health care providers. The expert evidence approach used in this study is one method for panels totransparently deal with the lack of published evidence to directly inform recommendations.
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Affiliation(s)
- Reem A Mustafa
- Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, 3901 Rainbow Blvd, MS3002, Kansas City, KS 66160, USA; Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada.
| | - Carlos A Cuello Garcia
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada; Departments of Pediatrics and Critical Care, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Meha Bhatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
| | - John J Riva
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada; Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 6th Floor, Hamilton, ON L8P 1H6, Canada
| | - Sara Vesely
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th, Oklahoma City, OK 73104, USA
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
| | - Payal Patel
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Sheila Hanson
- Department of Pediatrics, Medical College of Wisconsin and Critical Care Section, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Fiona Newall
- Department of Nursing Research, Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Clinical Haematology, Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - John Wiernikowski
- Division of Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Paul Monagle
- Department of Clinical Haematology, Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
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Abstract
ABSTRACT To support evidence-based nursing practice, the authors provide guidelines for nonresearch evidence, which includes clinical practice guidelines, consensus or position statements, literature review, expert opinion, organizational experience, case reports, community standards, clinician experience, and consumer preferences. This is the third in a three-part series.
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Affiliation(s)
- Amy Glasofer
- Amy Glasofer is a nurse scientist at Virtua Center for Learning in Mt. Laurel, N.J., and Ann B. Townsend is an adult NP with The NP Group, LLC
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13
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Frenette AJ, Williamson D, Weiss MJ, Rochwerg B, Ball I, Brindamour D, Serri K, D'Aragon F, Meade MO, Charbonney E. Worldwide management of donors after neurological death: a systematic review and narrative synthesis of guidelines. Can J Anaesth 2020; 67:1839-1857. [PMID: 32949008 DOI: 10.1007/s12630-020-01815-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The objectives of this study were to systematically identify and describe guidelines for the care of neurologically deceased donors and to evaluate their methodological quality, with the aim of informing and supporting the new Canadian guidelines for the management of organ donors. METHODOLOGY Following a systematic search, we included any document endorsed by an organ donation organization, a professional society, or a government, that aims to direct the medical management of adult, neurologically deceased, multi-organ donors. We extracted recommendations pertaining to six domains: the autonomic storm, hemodynamic instability, hormone supplementation, ventilation, blood product transfusions, and general intensive care unit (ICU) care. Methodological quality of the guidelines was assessed by the validated AGREE-II tool. MAIN FINDINGS This review includes 27 clinical practice guidelines representing 26 countries published between 1993 and 2019. Using the AGREE-II validated tool for the evaluation of guidelines' quality, documents generally scored well on their scope and clarity of presentation. Nevertheless, quality was limited in terms of the scientific rigor of guideline development. Recommendations varied substantially across the domains of managing the autonomic storm, subsequent management of hemodynamic instability, hormone therapy, mechanical ventilation, blood product transfusion, and general ICU care. We found consistent recommendations for low tidal volume ventilation subsequent to the publication of a landmark clinical trial. CONCLUSION Highly inconsistent recommendations for deceased donor care summarized in this review likely reflect the relatively slow emergence of high-quality clinical research in this field, as well as a late uptake of recent validated guideline methodology. Even in this context of few randomized-controlled trials, our group supported the need for new Canadian guidelines for the management of organ donors that follow rigorous recognized methodology and grading of the evidence. TRIAL REGISTRATION PROSPERO (CRD42018084012); registered 25 February 2016.
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Affiliation(s)
- Anne Julie Frenette
- Department of Pharmacy, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada.
- Faculté de Pharmacie, Université de Montréal, Montreal, QC, Canada.
- Faculté de Médecine, Université de Montréal, Montreal, QC, Canada.
- Centre de recherche CIUSSSS du Nord de L'Ile, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Ouest, Montréal, QC, H4J 1C5, Canada.
| | - David Williamson
- Department of Pharmacy, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
- Faculté de Pharmacie, Université de Montréal, Montreal, QC, Canada
- Centre de recherche CIUSSSS du Nord de L'Ile, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Ouest, Montréal, QC, H4J 1C5, Canada
| | - Matthew-John Weiss
- Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec, Université Laval Research Center, Quebec, QC, Canada
- Pediatrics Department, Intensive Care Division, Faculté de Médecine, Université Laval, Quebec, QC, Canada
- Transplant Québec, Montreal, QC, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Ian Ball
- Department of Medicine, Western University, London, ON, Canada
| | - Dave Brindamour
- Department of Pharmacy, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Karim Serri
- Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre de recherche CIUSSSS du Nord de L'Ile, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Ouest, Montréal, QC, H4J 1C5, Canada
- Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | | | - Maureen O Meade
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Emmanuel Charbonney
- Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre de recherche CIUSSSS du Nord de L'Ile, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Ouest, Montréal, QC, H4J 1C5, Canada
- Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
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14
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Löhrs L, Handrack M, Kopp I, Jessen F, Wagner E, Falkai P, Röh A, Strube W, Hasan A. Evaluation of evidence grades in psychiatry and psychotherapy guidelines. BMC Psychiatry 2020; 20:503. [PMID: 33046040 PMCID: PMC7552557 DOI: 10.1186/s12888-020-02897-2] [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: 01/17/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Information regarding the distribution of evidence grades in psychiatry and psychotherapy guidelines is lacking. Based on the German evidence- and consensus- based (S3) psychiatry and psychotherapy and the Scottish Intercollegiate Guidelines Network (SIGN) treatment guidelines, we aimed to specify how guideline recommendations are composed and to what extent recommendations are evidence-based. METHODS Data was collected from all published evidence- and consensus-based S3-classified psychiatry and psychotherapy guidelines. As control conditions, data from German neurology S3-classified guidelines as well as data from recent SIGN guidelines of mental health were extracted. Two investigators reviewed the selected guidelines independently, extracted and analysed the numbers and levels of recommendations. RESULTS On average, 45.1% of all recommendations are not based on strong scientific evidence in German guidelines of psychiatry and psychotherapy. A related pattern can be confirmed for SIGN guidelines, where the mean average of recommendations with lacking evidence is 33.9%. By contrast, in the German guidelines of neurology the average of such recommendations is 16.5%. A total of 24.5% of all recommendations in the guidelines of psychiatry and psychotherapy are classified as level A recommendations, compared to 31.6% in the field of neurology and 31.1% in the SIGN guidelines. Related patterns were observed for B and 0 level recommendations. CONCLUSION Guidelines should be practical tools to simplify the decision-making process based on scientific evidence. Up to 45% of all recommendations in the investigated guidelines of psychiatry and psychotherapy are not based on strong scientific evidence. The reasons for this high number remain unclear. Possibly, only a limited number of studies answer clinically relevant questions. Our findings thereby question whether guidelines should include non-evidence-based recommendations to be methodologically stringent and whether specific processes to develop expert-opinion statements must be implemented.
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Affiliation(s)
- Lisa Löhrs
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336, München, Germany.
| | - Mirjam Handrack
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336 München, Germany
| | - Ina Kopp
- grid.10253.350000 0004 1936 9756Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, Institut für Medizinisches Wissensmanagement, c/o Philipps-Universität Marburg, Marburg, Germany
| | - Frank Jessen
- grid.6190.e0000 0000 8580 3777Department of Psychiatry, University of Cologne, Medical Faculty, Cologne, Germany
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336 München, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336 München, Germany
| | - Astrid Röh
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336 München, Germany
| | - Wolfgang Strube
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336 München, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336 München, Germany ,grid.7307.30000 0001 2108 9006Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, University of Augsburg, Dr.-Mack-Straße 1, 86156 Augsburg, Germany
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15
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Eysenbach G, Zanini C, Amann J, Scheel-Sailer A, Brach M, Stucki G, Rubinelli S. Selecting Evidence-Based Content for Inclusion in Self-Management Apps for Pressure Injuries in Individuals With Spinal Cord Injury: Participatory Design Study. JMIR Mhealth Uhealth 2020; 8:e15818. [PMID: 32432559 PMCID: PMC7270844 DOI: 10.2196/15818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 03/17/2020] [Accepted: 03/25/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Technological solutions, particularly mobile health (mHealth), have been shown to be potentially viable approaches for sustaining individuals' self-management of chronic health conditions. Theory-based interventions are more successful, as evidence-based information is an essential prerequisite for appropriate self-management. However, several reviews have shown that many existing mobile apps fail to be either theoretically grounded or based on evidence. Although some authors have attempted to address these two issues by focusing on the design and development processes of apps, concrete efforts to systematically select evidence-based content are scant. OBJECTIVE The objective of this study was to present a procedure for the participatory identification of evidence-based content to ground the development of a self-management app. METHODS To illustrate the procedure, we focused on the prevention and management of pressure injuries (PIs) in individuals with spinal cord injury (SCI). The procedure involves the following three steps: (1) identification of existing evidence through review and synthesis of existing recommendations on the prevention and self-management of PIs in SCI; (2) a consensus meeting with experts from the field of SCI and individuals with SCI to select the recommendations that are relevant and applicable to community-dwelling individuals in their daily lives; and (3) consolidation of the results of the study. RESULTS In this case study, at the end of the three-step procedure, the content for an mHealth intervention was selected in the form of 98 recommendations. CONCLUSIONS This study describes a procedure for the participatory identification and selection of disease-specific evidence and professional best practices to inform self-management interventions. This procedure might be especially useful in cases of complex chronic health conditions, as every recommendation in these cases needs to be evaluated and considered in light of all other self-management requirements. Hence, the agreement of experts and affected individuals is essential to ensure the selection of evidence-based content that is considered to be relevant and applicable.
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Affiliation(s)
| | - Claudia Zanini
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Julia Amann
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Technology, Health Ethics and Policy Lab, ETH Zürich, Zürich, Switzerland
| | - Anke Scheel-Sailer
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.,Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Mirjam Brach
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Sara Rubinelli
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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16
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A Theoretical Framework and Competency-Based Approach to Training in Guideline Development. J Gen Intern Med 2020; 35:561-567. [PMID: 31728896 PMCID: PMC7018912 DOI: 10.1007/s11606-019-05502-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/12/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND There is increasing requirement to develop guidelines using transparent, standardized, and rigorous methods. Consequently, a better understanding of the knowledge, skills, and expertise necessary for guideline development is needed. The aim of this manuscript is to describe a theoretical framework of knowledge and skills that are required for individuals to serve on a guideline panel in varying capacities. METHODS Based on an iterative process and review of published manuscripts focused on guideline development, we identified competencies, subcompetencies, and milestones. RESULTS Using a competency-based approach to training and the Dreyfus model of skill acquisition, we identified three core competencies: (1) facilitate the development of guideline structure and setup, (2) make judgments about the quality or certainty of the evidence, and (3) transform evidence to a recommendation. Level 1 focuses on recognizing and acknowledging the importance of a specific skill or behavior. Levels 2 and 3 require learners to demonstrate progressive acquisition of knowledge and application to specific behaviors. Level 4 represents the individual who has acquired the requisite knowledge and can function independently, while level 5 represents the mastery/aspirational level. DISCUSSION We propose a preliminary competency-based education framework that will (1) help standardize the qualifications needed for individuals to serve on guideline panels in varying capacities or (2) help with curricula development for teaching and training of guideline panel members. This framework can also help enable guideline-producing organizations to identify guideline methodologists with the relevant and appropriate level of knowledge and skills to lead guidelines. Validation of the framework and further refinement of the competencies and milestones will be required before widespread adoption.
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17
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Zhang Y, Akl EA, Schünemann HJ. Using systematic reviews in guideline development: the GRADE approach. Res Synth Methods 2018; 10:312-329. [PMID: 30006970 DOI: 10.1002/jrsm.1313] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 06/16/2018] [Accepted: 07/03/2018] [Indexed: 02/28/2024]
Abstract
Systematic reviews are essential to produce trustworthy guidelines. To assess the certainty of a body of evidence included in a systematic review the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group has developed an approach that is currently used by over 100 organisations, including the World Health Organization and the Cochrane Collaboration. GRADE provides operational definitions and instructions to rate the certainty of the evidence for each outcome in a review as high, moderate, low, or very low for the effects of interventions, prognostic estimates, values and preferences, test accuracy and resource utilization. The assessment includes assessing risk of bias, imprecision, inconsistency, indirectness, and publication bias, the magnitude of effects, dose-response relations and the impact of residual confounding and bias. Summary statistical information and assessments of certainty are presented in GRADE evidence summary tables, which can be produced using GRADE's official GRADEpro software tool (www.gradepro.org/). The evidence summary tables feed into the GRADE Evidence to Decision frameworks which guideline panels can use to produce recommendations.
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Affiliation(s)
- Yuan Zhang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Lebanon
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada
- Department of Medicine, McMaster University, Canada
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18
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Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 2018; 23:60-63. [PMID: 29420178 PMCID: PMC6234235 DOI: 10.1136/bmjebm-2017-110853] [Citation(s) in RCA: 1318] [Impact Index Per Article: 219.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 12/13/2022]
Abstract
Case reports and case series are uncontrolled study designs known for increased risk of bias but have profoundly influenced the medical literature and continue to advance our knowledge. In this guide, we present a framework for appraisal, synthesis and application of evidence derived from case reports and case series. We propose a tool to evaluate the methodological quality of case reports and case series based on the domains of selection, ascertainment, causality and reporting and provide signalling questions to aid evidence-based practitioners and systematic reviewers in their assessment. We suggest using evidence derived from case reports and case series to inform decision-making when no other higher level of evidence is available.
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Affiliation(s)
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Center for Chronic Diseases Outcomes Research, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota, USA
| | - Samir Haffar
- Digestive Center for Diagnosis and Treatment, Damascus, Syrian Arab Republic
| | - Fateh Bazerbachi
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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19
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Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 2018. [PMID: 29420178 DOI: 10.1136/bmjebm-2017-110853]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Case reports and case series are uncontrolled study designs known for increased risk of bias but have profoundly influenced the medical literature and continue to advance our knowledge. In this guide, we present a framework for appraisal, synthesis and application of evidence derived from case reports and case series. We propose a tool to evaluate the methodological quality of case reports and case series based on the domains of selection, ascertainment, causality and reporting and provide signalling questions to aid evidence-based practitioners and systematic reviewers in their assessment. We suggest using evidence derived from case reports and case series to inform decision-making when no other higher level of evidence is available.
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Affiliation(s)
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Center for Chronic Diseases Outcomes Research, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota, USA
| | - Samir Haffar
- Digestive Center for Diagnosis and Treatment, Damascus, Syrian Arab Republic
| | - Fateh Bazerbachi
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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