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Ou J, Li J, Liu Y, Su X, Li W, Zheng X, Zhang L, Chen J, Pan H. Quality appraisal of clinical guidelines for Helicobacter pylori infection and systematic analysis of the level of evidence for recommendations. PLoS One 2024; 19:e0301006. [PMID: 38598539 PMCID: PMC11006150 DOI: 10.1371/journal.pone.0301006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 03/09/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVES To systematically assess the quality of clinical practice guidelines (CPGs) for Helicobacter pylori (HP) infection and identify gaps that limit their development. STUDY DESIGN AND SETTING CPGs for HP infection were systematically collected from PubMed, Embase, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, and six online guideline repositories. Three researchers independently used the AGREE Ⅱ tool to evaluate the methodological quality of the eligible CPGs. In addition, the reporting and recommendation qualities were appraised by using the RIGHT and AGREE-REX tools, respectively. The distribution of the level of evidence and strength of recommendation among evidence-based CPGs was determined. RESULTS A total of 7,019 records were identified, and 24 CPGs met the eligibility criteria. Of the eligible CPGs, 19 were evidence-based and 5 were consensus-based. The mean overall rating score of AGREE II was 50.7% (SD = 17.2%). Among six domains, the highest mean score was for scope and purpose (74.4%, SD = 17.7%) and the lowest mean score was for applicability (24.3%, SD = 8.9). Only three of 24 CPGs were high-quality. The mean overall score of recommendation quality was 35.5% (SD = 12.2%), and the mean scores in each domain of AGREE-REX and RIGHT were all ≤ 60%, with values and preferences scoring the lowest (16.6%, SD = 11.9%). A total of 505 recommendations were identified. Strong recommendations accounted for 64.1%, and only 34.3% of strong recommendations were based on high-quality evidence. CONCLUSION The overall quality of CPGs for HP infection is poor, and CPG developers tend to neglect some domains, resulting in a wide variability in the quality of the CPGs. Additionally, CPGs for HP infection lack sufficient high-quality evidence, and the grading of recommendation strength should be based on the quality of evidence. The CPGs for HP infection have much room for improvement and further researches are required to minimize the evidence gap.
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Affiliation(s)
- Jiayin Ou
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiayu Li
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yang Liu
- The Second Clinical Medicine College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaohong Su
- The People’s Hospital of Gaozhou, Gaozhou, China
| | - Wanchun Li
- School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaojun Zheng
- Clinical Medical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lang Zhang
- The Second Clinical Medicine College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jing Chen
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huafeng Pan
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
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Anwar SAM, Elsakka EE, Khalil M, Ibrahim AAG, ElBeheiry A, Mohammed SF, Omar TEI, Amer YS. Adapted Evidence-Based Clinical Practice Guidelines for Diagnosis and Treatment of Epilepsies in Children: A Tertiary Children's Hospital Update. Pediatr Neurol 2023; 141:87-92. [PMID: 36774685 DOI: 10.1016/j.pediatrneurol.2022.12.009] [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: 06/11/2022] [Revised: 12/08/2022] [Accepted: 12/17/2022] [Indexed: 01/09/2023]
Abstract
HYPOTHESIS AND/OR BACKGROUND We recently updated and merged the adapted clinical practice guidelines (CPGs) for the diagnosis and treatment of children with epilepsy of a tertiary-level hospital. Medical knowledge is always evolving. As a result, it is critical to revisit the clinical standards on a frequent basis to ensure that the best services are offered to the target receivers. The purpose of this article was to update and merge the CPGs at Alexandria University Children Hospital (AUCH) for the diagnosis (2014) and treatment (2016) of children with epilepsy to unify and standardize the practice for better care and outcome. METHODS This review and update CPG project was initiated by assembling a Guideline Review Group (GRG). The GRG conducted focus group discussions and decided to search any published updates of the recommendations of the previously identified high-quality and evidence-based CPG developed by the SIGN (Scottish Intercollegiate Guidelines Network) and to merge the two previous local CPGs under one comprehensive CPG for full management of epilepsy in children. The high quality of the selected source CPG from SIGN was based on quality assessment of CPGs undertaken previously using the Appraisal of Guidelines for Research and Evaluation II Instrument. The GRG followed the Checklist for the Reporting of Updated Guidelines (CheckUp), which is the CPG tool recommended by the Enhancing the Quality and Transparency of health Research Network for reporting of updated CPGs in addition to the RIGHT-Ad@pt Checklist for Adapted CPGs. The finalized updated CPG draft was sent to the external reviewer group topic experts. RESULTS The group updated 10 main categories of recommendations from one source CPG (SIGN). The recommendations included (1) epilepsy diagnosis; (2) recognition, identification, and referral; (3) pharmacological treatment of epilepsy and epilepsy syndromes; (4) nonpharmacological treatment of epilepsy and epilepsy syndromes; (5) managing pharmacoresistant epilepsy; (6) management of epilepsy in special groups; (7) medications; (8) children and caregiver education and support; (9) comorbidities and mortality; and (10) transitional care from pediatric to adult care services. CONCLUSIONS The finalized CPG provides evidence-based guidance to health care providers in AUCH for the diagnosis and management of epilepsy in children. The study also established the significance of a collaborative clinical and methodological expert group for the update of CPGs, as well as the usability of the "CheckUp" and "RIGHT-Ad@pt" CPG Tools.
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Affiliation(s)
- Shimaa A M Anwar
- Paediatric Neurology Unit, Faculty of Medicine, Paediatrics Department, Alexandria University, Alexandria, Egypt
| | - Elham E Elsakka
- Paediatric Neurology Unit, Faculty of Medicine, Paediatrics Department, Alexandria University, Alexandria, Egypt
| | - Mona Khalil
- Paediatric Neurology Unit, Faculty of Medicine, Paediatrics Department, Alexandria University, Alexandria, Egypt
| | - Afaf A G Ibrahim
- Faculty of Medicine, Community Medicine Department, Alexandria University, Alexandria, Egypt
| | - Ahmed ElBeheiry
- Faculty of Medicine, Diagnostic Radiology and Medical Imaging Department, Alexandria University, Alexandria, Egypt
| | | | - Tarek E I Omar
- Paediatric Neurology Unit, Faculty of Medicine, Paediatrics Department, Alexandria University, Alexandria, Egypt
| | - Yasser S Amer
- Paediatrics Department, Quality Management, King Saud University Medical City, Riyadh, Saudi Arabia; Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt; Adaptation Working Group, Guidelines International Network, Perth, Scotland, UK.
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World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guidelines update – IV – A quality appraisal with the AGREE II instrument. World Allergy Organ J 2022; 15:100613. [PMID: 36091188 PMCID: PMC9419447 DOI: 10.1016/j.waojou.2021.100613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/20/2021] [Accepted: 11/05/2021] [Indexed: 01/02/2023] Open
Abstract
Background Since the publication of The World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines in 2010, a number of other guidelines, expert opinions, and position papers relating to the management of cow's milk allergy (CMA) have been published. We aimed to systematically review the quality of the guidelines on CMA diagnosis and management in children and/or adults published between 2010 and 2020. Methods The MEDLINE, EMBASE, ISI Web of Science, World Health Organization Global Index Medicus, and Turning Research into Practice databases as well as website guideline repositories were searched from January 2010 until May 2020. Any clinical practice recommendations and/or guidelines focusing on the diagnosis and management of CMA in children and/or adults developed or endorsed by professional scientific societies or organizations were included. The guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool, a 23-item tool organized within 6 domains and 2 global rating items. Results We included 12 guidelines; 8 were developed by national and 4 by international organizations. The quality scores for each domain varied: of all domains, the clarity of presentation domain had the highest median score (92%; Q1-Q3 81–100%), whereas rigor of development had the lowest median score (30%; Q1-Q3 15–67%). The median scores (Q1-Q3) for individual domains were as follows: scope and purpose 82% (70–99%), stakeholder involvement 63% (21–79%), rigor of development 30% (15–67%), clarity of presentation 92% (81–100%), applicability 68% (57–75%), and editorial independence 75% (69–100%). The median overall score was 70% (58–89%). Only 1 guideline (from the National Institute for Health and Care Excellence [NICE]) achieved top ratings (100%) in five domains and the overall score. Three guidelines (from the NICE, the British Society for Allergy & Clinical Immunology [BSACI] and WAO) achieved the highest ratings (100%) in at least 3 domains and the overall score. Conclusion The majority of identified guidelines were of good or very good quality. However, the weakest point was the rigor of development domain, mostly due to unclear description of strengths and limitations of the body of evidence and the procedure for updating the guidelines.
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Kavanagh PL, Frater F, Navarro T, LaVita P, Parrish R, Iorio A. Optimizing a literature surveillance strategy to retrieve sound overall prognosis and risk assessment model papers. J Am Med Inform Assoc 2021; 28:766-771. [PMID: 33484123 DOI: 10.1093/jamia/ocaa232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/18/2020] [Accepted: 09/05/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Our aim was to develop an efficient search strategy for prognostic studies and clinical prediction guides (CPGs), optimally balancing sensitivity and precision while independent of MeSH terms, as relying on them may miss the most current literature. MATERIALS AND METHODS We combined 2 Hedges-based search strategies, modified to remove MeSH terms for overall prognostic studies and CPGs, and ran the search on 269 journals. We read abstracts from a random subset of retrieved references until ≥ 20 per journal were reviewed and classified them as positive when fulfilling standardized quality criteria, thereby assembling a standard dataset used to calibrate the search strategy. We determined performance characteristics of our new search strategy against the Hedges standard and performance characteristics of published search strategies against the standard dataset. RESULTS Our search strategy retrieved 16 089 references from 269 journals during our study period. One hundred fifty-four journals yielded ≥ 20 references and ≥ 1 prognostic study or CPG. Against the Hedges standard, the new search strategy had sensitivity/specificity/precision/accuracy of 84%/80%/2%/80%, respectively. Existing published strategies tested against our standard dataset had sensitivities of 36%-94% and precision of 5%-10%. DISCUSSION We developed a new search strategy to identify overall prognosis studies and CPGs independent of MeSH terms. These studies are important for medical decision-making, as they identify specific populations and individuals who may benefit from interventions. CONCLUSION Our results may benefit literature surveillance and clinical guideline efforts, as our search strategy performs as well as published search strategies while capturing literature at the time of publication.
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Affiliation(s)
- Patricia L Kavanagh
- DynaMed, EBSCO Health, Ipswich, Massachusetts, USA.,Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | | | - Tamara Navarro
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Peter LaVita
- DynaMed, EBSCO Health, Ipswich, Massachusetts, USA
| | - Rick Parrish
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Wang X, Chen Y, Akl EA, Tokalić R, Marušić A, Qaseem A, Falck-Ytter Y, Lee MS, Siedler M, Barber SL, Zhang M, Chan ESY, Estill J, Kwong JSW, Okumura A, Zhou Q, Yang K, Norris SL. The reporting checklist for public versions of guidelines: RIGHT-PVG. Implement Sci 2021; 16:10. [PMID: 33430911 PMCID: PMC7798200 DOI: 10.1186/s13012-020-01066-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/29/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Public or patient versions of guidelines (PVGs) are derivative documents that "translate" recommendations and their rationale from clinical guidelines for health professionals into a more easily understandable and usable format for patients and the public. PVGs from different groups and organizations vary considerably in terms of quality of their reporting. In order to address this issue, we aimed to develop a reporting checklist for developers of PVGs and other potential users. METHODS First, we collected a list of potential items through reviewing a sample of PVGs, existing guidance for developing and reporting PVGs or other similar evidence-based patient tools, as well as qualitative studies on original studies of patients' needs about the content and/or reporting of information in PVGs or similar evidence-based patient tools. Second, we conducted a two-round Delphi consultation to determine the level of consensus on the items to be included in the final reporting checklist. Third, we invited two external reviewers to provide comments on the checklist. RESULTS We generated the initial list of 45 reporting items based on a review of a sample of 30 PVGs, four PVG guidance documents, and 46 relevant studies. After the two-round Delphi consultation, we formed a checklist of 17 items grouped under 12 topics for reporting PVGs. CONCLUSION The RIGHT-PVG reporting checklist provides an international consensus on the important criteria for reporting PVGs.
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Affiliation(s)
- Xiaoqin Wang
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, L8S 4 K1, Canada
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, 730000, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, 730000, China
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Ružica Tokalić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Ana Marušić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Amir Qaseem
- American College of Physicians, Philadelphia, PA, USA
| | - Yngve Falck-Ytter
- Division of Internal Medicine, Louis Stokes Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Myeong Soo Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea
| | - Madelin Siedler
- Division of Physical Education and Exercise Science, University of South Florida, Tampa, FL, USA
| | - Sarah L Barber
- World Health Organization Centre for Health Development, Kobe, 651-0073, Japan
| | - Mingming Zhang
- Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Edwin S Y Chan
- Cochrane Singapore, Singapore Clinical Research Institute, Consortium for Clinical Research & Innovation Singapore, Singapore, Singapore
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - Joey S W Kwong
- United Nations Population Fund Asia and the Pacific Regional Office, Bangkok, Thailand
| | - Akiko Okumura
- Medical Information Network Distribution Service (MINDS) Guideline Centre, Tokyo, Japan
| | - Qi Zhou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, 730000, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China.
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, 730000, China.
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Abstract
Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners and patient to reach appropriate health-care decisions. The synthesis and translation of a large amount of evidence into practice recommendations should ultimately reduce the use of unnecessary or harmful interventions, help patients to achieve maximum benefit, and minimize risk, all at an acceptable cost.In the past, CPGs were developed based on expert opinion, and using consensus methodology either formally or informally. Over the last 30 years, the evolution of increasingly transparent and robust methodology has led to more "evidence-based" recommendations. Clinical practice guidelines should be developed within the principles of bias minimization, systematic evidence retrieval and review, and a focus on patient relevant outcomes. Multiple nationally based and international groups now have published specific guidance for the development, dissemination, and evaluation of CPG.This chapter describes the key principles of CPG development, including the importance of updating, disseminating, and evaluating the impact of CPG , and attempts to differentiate CPG intended for populations of patients from "evidence-based decision making" for individual patients, recognizing that the fundamental principles are the same.
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Wang X, Zhou Q, Chen Y, Yang N, Pottie K, Xiao Y, Tong Y, Yao L, Wang Q, Yang K, Norris SL. Using RIGHT (Reporting Items for Practice Guidelines in Healthcare) to evaluate the reporting quality of WHO guidelines. Health Res Policy Syst 2020; 18:75. [PMID: 32641144 PMCID: PMC7341641 DOI: 10.1186/s12961-020-00578-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/20/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Without adequate reporting of research, valuable time and resources are wasted. In the same vein, adequate reporting of practice guidelines to optimise patient care is equally important. Our study examines the quality of reporting of published WHO guidelines, over time, using the RIGHT (Reporting Items for Practice Guidelines in HealThcare) reporting checklist. METHODS We examined English-language guidelines approved by the WHO Guidelines Review Committee from inception of the committee in 2007 until 31 December 2017. Pairs of independent, trained reviewers assessed the reporting quality of these guidelines. Descriptive data were summarised with frequencies and percentages. RESULTS We included 182 eligible guidelines. Overall, 25 out of the 34 RIGHT items were reported in 75% or more of the WHO guidelines. The reporting rates improved over time. Further, 90% of the guidelines reported document type in the title. The identification of evidence, the rationale for recommendations and the review process were reported in more than 80% of guidelines. The certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was assessed in 81% of the guidelines assessed. While 82% of guidelines reported funding sources, only 25% mentioned the role of funders. CONCLUSIONS WHO guidelines provide adequate reporting of many of the RIGHT items and reporting has improved over time. WHO guidelines compare favourably to guidelines produced by other organisations. However, reporting can be further improved in a number of areas.
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Affiliation(s)
- Xiaoqin Wang
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Canada
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
- Chinese GRADE Center, Lanzhou, China
| | - Qi Zhou
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
- Chinese GRADE Center, Lanzhou, China
| | - Nan Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
- Chinese GRADE Center, Lanzhou, China
| | - Kevin Pottie
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Yujie Xiao
- The Second Hospital of Lanzhou University, Lanzhou, China
| | - Yajing Tong
- School of Public Health of Lanzhou University, Lanzhou, China
| | - Liang Yao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
| | - Qi Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
- Chinese GRADE Center, Lanzhou, China
| | - Susan L. Norris
- Quality of Norms and Standards Department, Science Division, World Health Organization, Geneva, Switzerland
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Nutrition guidelines vary widely in methodological quality: an overview of reviews. J Clin Epidemiol 2018; 104:62-72. [DOI: 10.1016/j.jclinepi.2018.08.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/25/2018] [Accepted: 08/22/2018] [Indexed: 12/15/2022]
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Vernooij RWM, Martínez García L, Florez ID, Hidalgo Armas L, Poorthuis MHF, Brouwers M, Alonso-Coello P. Correction to: Updated clinical guidelines experience major reporting limitations. Implement Sci 2018; 13:64. [PMID: 29712556 PMCID: PMC5925836 DOI: 10.1186/s13012-018-0759-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 04/25/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Robin W M Vernooij
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Ivan Dario Florez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Department of Pediatrics, University of Antioquia, Medellin, Colombia
| | - Laura Hidalgo Armas
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Melissa Brouwers
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Department of Oncology, McMaster University, Hamilton, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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