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Niño-de-Guzman Quispe E, Bracchiglione J, Ballester M, Groene O, Heijmans M, Martínez García L, Noordman J, Orrego C, Rocha C, Suñol R, Alonso-Coello P. Patients' and informal caregivers' perspectives on self-management interventions for type 2 diabetes mellitus outcomes: a mixed-methods overview of 14 years of reviews. Arch Public Health 2023; 81:140. [PMID: 37537669 PMCID: PMC10401891 DOI: 10.1186/s13690-023-01153-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/15/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Self-management interventions (SMIs) are core components of high-quality care in type 2 diabetes mellitus (T2DM). We aimed to identify and summarise the scientific evidence exploring the perspectives of patients with T2DM and their informal caregivers on outcomes of SMIs, and the key themes to enhance T2DM patient-centred care. METHODS We conducted a mixed-methods overview of reviews. We searched MEDLINE, CINAHL and PsycINFO, up to June 2021 for systematic reviews (SRs) exploring the perspectives of adults with T2DM and their informal caregivers, regarding self-management. Two reviewers conducted independently study selection, data extraction and quality assessment. We estimated the degree of overlap across SRs. We performed a qualitative analysis using a thematic synthesis approach. RESULTS We identified 54 SRs, corresponding to 939 studies, with a slight overlap. Most SRs (47/54, 87%) were considered high quality. We developed summaries for 22 outcomes and identified six overarching themes: (1) diabetic identity; (2) accessing healthcare; (3) experience of care; (4) engagement with self-management; (5) outcomes awareness; and (6) challenges adhering to self-management. We found important variability in how patients with T2DM and their informal caregivers value critical outcomes influenced by the disease progression and several contextual factors. CONCLUSIONS Our findings represent what matters most to patients with T2DM and their informal caregivers regarding outcomes of SMIs. Our results can facilitate the development and evaluation of SMIs, and guide decision-making in diabetes care, including the formulation of decisions and recommendations.
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Affiliation(s)
- Ena Niño-de-Guzman Quispe
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.
- Cancer Screening Unit, Catalan Institute of Oncology, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Javier Bracchiglione
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud (CIBERESP), Madrid, Spain
- Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Viña del Mar, Chile
| | - Marta Ballester
- Universidad Autónoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Oliver Groene
- OptiMedis, Hamburg, Germany
- University of Witten/Herdecke, Witten, Germany
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Laura Martínez García
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud (CIBERESP), Madrid, Spain
| | - Janneke Noordman
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Carola Orrego
- Universidad Autónoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Claudio Rocha
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Rosa Suñol
- Universidad Autónoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud (CIBERESP), Madrid, Spain
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Jofra LS, Alonso-Coello P, Martínez EC, de Britos Marsal C, Gallego Iborra A, Niño de Guzman Quispe EP, Pérez-Gaxiola G, Requeijo C, Roqué I Figuls M, Rosenbaum S, Salas-Gama K, Urreta-Barallobre I, Martínez García L. Piloting the informed health choices resources in Barcelona primary schools: A mixed methods study. PLoS One 2023; 18:e0288082. [PMID: 37418372 DOI: 10.1371/journal.pone.0288082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION The main objective of the Informed Health Choices (IHC) project is to teach people to assess treatment claims and make informed health choices. For this purpose, the IHC learning resources were developed for primary school children. The aim of this study is to explore students' and teachers' experience when using the IHC resources in primary schools in Barcelona (Spain). METHODS We conducted a mixed methods study for piloting the IHC resources in a convenience sample of primary schools in Barcelona. The intervention included a workshop with teachers, and nine lessons with students. We collected data using multiple approaches. We performed quantitative and qualitative analyses, and integrated the findings in a joint display. Finally, we formulated recommendations for using the IHC resources in this setting. RESULTS Two schools, with a total of 143 students in 4th and 5th grade and six teachers, participated in the study. One school followed the suggested IHC teaching plan and competed all the lessons; the other school modified the plan substantially and did not complete all the lessons. Overall, students and teachers from both schools understood, were interested in, and were able to apply the content of the lessons. During the lessons, the textbook was useful for students; nevertheless, for the teachers, the usefulness of the IHC resources was variable. Teachers adapted the IHC resources to increase student participation and used Information and Communications Technologies tools. We observed more facilitators than barriers to teach the lessons. The teachers suggested some ideas to improve the lessons based on activities they developed and implemented. The integration analysis showed great convergence of the quantitative and qualitative findings. We propose seven recommendations for using the IHC resources in this setting. CONCLUSIONS Students and teachers from primary schools in Barcelona showed a positive experience when using IHC resources; however, these resources should be adapted to promote classroom participation.
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Affiliation(s)
- Laura Samsó Jofra
- Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Esther Cánovas Martínez
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | | | | | - Ena Pery Niño de Guzman Quispe
- Cancer Prevention and Control Programme, Catalan Institute of Oncology - IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Carolina Requeijo
- Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marta Roqué I Figuls
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Sarah Rosenbaum
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Iratxe Urreta-Barallobre
- Clinical Epidemiology, Biodonostia Health Research Institute, San Sebastián, Spain
- Clinical Epidemiology Unit, Donostialdea Integrated Health Organisation, Osakidetza Basque Health Service, Donostia University Hospital, San Sebastián, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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Song Y, Alonso-Coello P, Ballesteros M, Cluzeau F, Vernooij RWM, Arayssi T, Bhaumik S, Chen Y, Ghersi D, Langlois EV, Fuentes Padilla P, Schünemann HJ, Akl EA, Martínez García L, Amer Y, Arevalo-Rodriguez I, Barnes S, Barreto J, Collis D, Dyer S, Fahim C, Florez I, Gallegos-Rivero V, Klugar M, Kuijpers T, Mathew JL, Munn Z, Norris S, Patiño-Lugo DF, Pramesh CS, Rodriguez J, Roy S, Shin ES, Sosa O, Vandvik PO, Velez M, Woodcraft R. A Reporting Tool for Adapted Guidelines in Health Care: The RIGHT-Ad@pt Checklist. Ann Intern Med 2022; 175:710-719. [PMID: 35286143 DOI: 10.7326/m21-4352] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Adaptation of existing guidelines can be an efficient way to develop contextualized recommendations. Transparent reporting of the adaptation approach can support the transparency and usability of the adapted guidelines. OBJECTIVE To develop an extension of the RIGHT (Reporting Items for practice Guidelines in HealThcare) statement for the reporting of adapted guidelines (including recommendations that have been adopted, adapted, or developed de novo), the RIGHT-Ad@pt checklist. DESIGN A multistep process was followed to develop the checklist: establishing a working group, generating an initial checklist, optimizing the checklist (through an initial assessment of adapted guidelines, semistructured interviews, a Delphi consensus survey, an external review, and a final assessment of adapted guidelines), and approval of the final checklist by the working group. SETTING International collaboration. PARTICIPANTS A total of 119 professionals participated in the development process. MEASUREMENTS Participants' consensus on items in the checklist. RESULTS The RIGHT-Ad@pt checklist contains 34 items grouped in 7 sections: basic information (7 items); scope (6 items); rigor of development (10 items); recommendations (4 items); external review and quality assurance (2 items); funding, declaration, and management of interest (2 items); and other information (3 items). A user guide with explanations and real-world examples for each item was developed to provide a better user experience. LIMITATION The RIGHT-Ad@pt checklist requires further validation in real-life use. CONCLUSION The RIGHT-Ad@pt checklist has been developed to improve the reporting of adapted guidelines, focusing on the standardization, rigor, and transparency of the process and the clarity and explicitness of adapted recommendations. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Yang Song
- Iberoamerican Cochrane Centre (CCIb)-Biomedical Research Institute Sant Pau (IIB Sant Pau), and PhD Programme in Methodology of Biomedical Research and Public Health, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain (Y.S.)
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre (CCIb)-Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (P.A., L.M.G.)
| | - Monica Ballesteros
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (M.B.)
| | | | - Robin W M Vernooij
- Department of Nephrology and Hypertension and Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands (R.W.V.)
| | | | - Soumyadeep Bhaumik
- Meta-research & Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, India (S.B.)
| | - Yaolong Chen
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, and WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China (Y.C.)
| | - Davina Ghersi
- National Health and Medical Research Council, Canberra, Australian Capital Territory, Australia (D.G.)
| | - Etienne V Langlois
- Partnership for Maternal, Newborn & Child Health (PMNCH), World Health Organization, Geneve, Switzerland (E.V.L.)
| | | | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact (HEI), Michael G. DeGroote Cochrane Canada and McGRADE Centres, and Department of Medicine, McMaster University, Hamilton, Canada, and Department of Biomedical Sciences, Humanitas University, Milan, Italy (H.J.S.)
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon, and Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada (E.A.A.)
| | - Laura Martínez García
- Iberoamerican Cochrane Centre (CCIb)-Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (P.A., L.M.G.)
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Song Y, Ballesteros M, Li J, Martínez García L, Niño de Guzmán E, Vernooij RWM, Akl EA, Cluzeau F, Alonso-Coello P. Current practices and challenges in adaptation of clinical guidelines: a qualitative study based on semistructured interviews. BMJ Open 2021; 11:e053587. [PMID: 34857574 PMCID: PMC8640632 DOI: 10.1136/bmjopen-2021-053587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study aims to better understand the current practice of clinical guideline adaptation and identify challenges raised in this process, given that published adapted clinical guidelines are generally of low quality, poorly reported and not based on published frameworks. DESIGN A qualitative study based on semistructured interviews. We conducted a framework analysis for the adaptation process, and thematic analysis for participants' views and experiences about adaptation process. SETTING Nine guideline development organisations from seven countries. PARTICIPANTS Guideline developers who have adapted clinical guidelines within the last 3 years. We identified potential participants through published adapted clinical guidelines, recommendations from experts, and a review of the Guideline International Network Conference attendees' list. RESULTS We conducted ten interviews and identified nine adaptation methodologies. The reasons for adapting clinical guidelines include developing de novo clinical guidelines, implementing source clinical guidelines, and harmonising and updating existing clinical guidelines. We identified the following core steps of the adaptation process (1) selection of scope and source guideline(s), (2) assessment of source materials (guidelines, recommendations and evidence level), (3) decision-making process and (4) external review and follow-up process. Challenges on the adaptation of clinical guidelines include limitations from source clinical guidelines (poor quality or reporting), limitations from adaptation settings (lacking resources or skills), adaptation process intensity and complexity, and implementation barriers. We also described how participants address the complexities and implementation issues of the adaptation process. CONCLUSIONS Adaptation processes have been increasingly used to develop clinical guidelines, with the emergence of different purposes. The identification of core steps and assessment levels could help guideline adaptation developers streamline their processes. More methodological research is needed to develop rigorous international standards for adapting clinical guidelines.
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Affiliation(s)
- Yang Song
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Monica Ballesteros
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jing Li
- Research Institute (VHIR), Universitat Autònoma de Barcelona, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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5
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Niño de Guzmán E, Martínez García L, González AI, Heijmans M, Huaringa J, Immonen K, Ninov L, Orrego-Villagrán C, Pérez-Bracchiglione J, Salas-Gama K, Viteri-García A, Alonso-Coello P. The perspectives of patients and their caregivers on self-management interventions for chronic conditions: a protocol for a mixed-methods overview. F1000Res 2021; 9:120. [PMID: 35186277 PMCID: PMC8825946 DOI: 10.12688/f1000research.22125.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Self-management (SM) interventions are complex interventions and one of the main components of high-quality chronic disease care for which the incorporation of the perspectives of patients and their informal caregivers is crucial. We aim to identify, appraise and synthesise the evidence exploring patients’ and caregivers’ perspectives on SM interventions. More precisely, we aim to 1) describe how they value the importance of outcomes of SM interventions, and 2) identify the factors that might impact on acceptability and feasibility of SM interventions based on their preferences and experiences. Methods and analysis: We will conduct four mixed-methods overviews as part of COMPAR-EU, a European Union (EU) funded project aimed to identify the most effective and cost-effective SM interventions for chronic obstructive pulmonary disease (COPD), heart failure (HF), obesity, and type 2 diabetes mellitus (T2DM). We will search in MEDLINE, CINAHL, and PsycINFO for systematic reviews of studies addressing patients’ preferences on outcomes, or their experiences with SM alongside their disease trajectory or with SM interventions, published in English. Selection of studies and data extraction will be conducted in pairs. We will assess the overlap of studies and methodological quality. We will follow a three-step synthesis process: 1) narrative synthesis for quantitative evidence, 2) thematic synthesis for qualitative evidence, and 3) integration of findings in the interpretation phase. Additionally, we will consult on the relevance of findings with patients and their caregivers. Systematic review registration: PROSPERO CRD42019117867
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Affiliation(s)
- Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, 08025, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, 08025, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ana I. González
- Avedis Donabedian Research Institute (FAD), Barcelona, 08037, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Monique Heijmans
- Netherlands institute for health services research (Nivel), Utrecht, 3513, The Netherlands
| | | | | | | | - Carola Orrego-Villagrán
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, 08037, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Javier Pérez-Bracchiglione
- Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Valparaíso, 2520000, Chile
| | | | - Andrés Viteri-García
- Universidad UTE, Quito, 170527, Ecuador
- Cochrane Ecuador, Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Quito, 170527, Ecuador
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, 08025, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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6
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Niño de Guzmán Quispe E, Martínez García L, Orrego Villagrán C, Heijmans M, Sunol R, Fraile-Navarro D, Pérez-Bracchiglione J, Ninov L, Salas-Gama K, Viteri García A, Alonso-Coello P. The Perspectives of Patients with Chronic Diseases and Their Caregivers on Self-Management Interventions: A Scoping Review of Reviews. Patient 2021; 14:719-740. [PMID: 33871808 PMCID: PMC8563562 DOI: 10.1007/s40271-021-00514-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Self-management (SM) interventions are supportive interventions systematically provided by healthcare professionals, peers, or laypersons to increase the skills and confidence of patients in their ability to manage chronic diseases. We had two objectives: (1) to summarise the preferences and experiences of patients and their caregivers (informal caregivers and healthcare professionals) with SM in four chronic diseases and (2) to identify and describe the relevant outcomes for SM interventions from these perspectives. METHODS We conducted a mixed-methods scoping review of reviews. We searched three databases until December 2020 for quantitative, qualitative, or mixed-methods reviews exploring patients' and caregivers' preferences or experiences with SM in type 2 diabetes mellitus (T2DM), obesity, chronic obstructive pulmonary disease (COPD), and heart failure (HF). Quantitative data were narratively synthesised, and qualitative data followed a three-step descriptive thematic synthesis. Identified themes were categorised into outcomes or modifiable factors of SM interventions. RESULTS We included 148 reviews covering T2DM (n = 53 [35.8%]), obesity (n = 20 [13.5%]), COPD (n = 32 [21.6%]), HF (n = 38 [25.7%]), and those with more than one disease (n = 5 [3.4%]). We identified 12 main themes. Eight described the process of SM (disease progression, SM behaviours, social support, interaction with healthcare professionals, access to healthcare, costs for patients, culturally defined roles and perceptions, and health knowledge), and four described their experiences with SM interventions (the perceived benefit of the intervention, individualised care, sense of community with peers, and usability of equipment). Most themes and subthemes were categorised as outcomes of SM interventions. CONCLUSION The process of SM shaped the perspectives of patients and their caregivers on SM interventions. Their perspectives were influenced by the perceived benefit of the intervention, the sense of community with peers, the intervention's usability, and the level of individualised care. Our findings can inform the selection of patient-important outcomes, decision-making processes, including the formulation of recommendations, and the design and implementation of SM interventions.
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Affiliation(s)
- Ena Niño de Guzmán Quispe
- Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain.
| | - Laura Martínez García
- Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carola Orrego Villagrán
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Rosa Sunol
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Fraile-Navarro
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Madrid Primary Health Care Service, Madrid, Spain
| | | | | | - Karla Salas-Gama
- Health Services Research Group, Institut de Recerca Vall d'Hebron Hospital, Barcelona, Spain
- Vall d'Hebron University Hospital, Barcelona, Spain
| | - Andrés Viteri García
- Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC), Universidad UTE, Quito, Ecuador
- Centro Asociado Cochrane de Ecuador, Universidad UTE, Quito, Ecuador
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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7
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Martínez García L, Samsó Jofra L, Alonso-Coello P, Ansuategi E, Asso Mistral L, Ballesteros M, Canelo-Aybar C, Casino G, Gallego Iborra A, Niño de Guzmán Quispe EP, Requeijo C, Roqué I Figuls M, Salas K, Ubeda M, Urreta I, Rosenbaum S. Teaching and learning how to make informed health choices: Protocol for a context analysis in Spanish primary schools. F1000Res 2021; 10:312. [PMID: 34631019 PMCID: PMC8474100 DOI: 10.12688/f1000research.51961.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction The Informed Health Choices (IHC) project developed learning resources to teach primary school children (10 to 12-year-olds) to assess treatment claims and make informed health choices. The aim of our study is to explore the educational context for teaching and learning critical thinking about health in Spanish primary schools. Methods During the 2020-2021 school year, we will conduct 1) a systematic assessment of educational documents and resources, and 2) semi-structured interviews with key education and health stakeholders. In the systematic assessment of educational documents and resources, we will include state and autonomous communities' curriculums, school educational projects, and commonly used textbooks and other health teaching materials. In the semi-structured interviews, we will involve education and health policy makers, developers of learning resources, developers of health promotion and educational interventions, head teachers, teachers, families, and paediatric primary care providers. We will design and pilot a data extraction form and a semi-structured interview guide to collect the data. We will perform a quantitative and a qualitative analysis of the data to explore how critical thinking about health is being taught and learned in Spanish primary schools. Conclusion We will identify opportunities for and barriers to teaching and learning critical thinking about health in Spanish primary schools. We will formulate recommendations-for both practice and research purposes-on how to use, adapt (if needed), and implement the IHC resources in this context.
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Affiliation(s)
- Laura Martínez García
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Laura Samsó Jofra
- Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Eukane Ansuategi
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain.,Osakidetza, OSI Donostialdea, University Hospital of Donostia, Library Service, Donostia, Spain
| | - Laia Asso Mistral
- Maternal and Child Health Service, General Subdirectorate of Health Promotion, Public Health Agency of Catalonia, Barcelona, Spain
| | - Monica Ballesteros
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Gonzalo Casino
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | | | | | - Carolina Requeijo
- Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marta Roqué I Figuls
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Karla Salas
- Health Services Research Group - Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mar Ubeda
- Osakidetza, OSI Donostialdea, University Hospital of Donostia, Library Service, Donostia, Spain
| | - Iratxe Urreta
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain.,Clinical Epidemiology and Research Unit, University Hospital of Donostia, Donostia, Spain
| | - Sarah Rosenbaum
- Centre for Informed Health Choices, Norwegian Institute of Public Health, Oslo, Norway
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8
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Sanabria AJ, Alonso-Coello P, McFarlane E, Niño de Guzman E, Roqué M, Martínez García L. The UpPriority tool supported prioritization processes for updating clinical guideline questions. J Clin Epidemiol 2021; 139:149-159. [PMID: 34363971 DOI: 10.1016/j.jclinepi.2021.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We aim to 1) use the UpPriority tool to identify which clinical questions (CQs) within the clinical guidelines (CGs) need to be prioritized for updating and 2) assess the implementation of the tool in a real-world set of CGs. STUDY DESIGN AND SETTING We systematically assessed CQs from a sample of CGs developed in the Spanish National Health System CG program. We applied the UpPriority tool to each CG using a step-by-step process that included: 1) establishment of the UpPriority Implementation Working Group, 2) mapping of the original CG questions and recommendations, 3) development of a survey to prioritize CQs, 4) assessment of CQ's priority according to six items, 5) calculation and ranking of priority scores, 6) decision of prioritized CQs for updating, and 7) development of the priority report. We assessed the tool implementation process (appraisers' experience when using the tool) and the inter-observer reliability of the tool, and we provided suggestions for improvement. RESULTS We included four CGs with a total of 107 CQs on the following topics: chronic heart failure (10 CQs), inherited retinal dystrophies (39 CQs), menopause (20 CQs), and open-angle glaucoma (38 CQs). We included a total of 30 participants, most of them clinicians that were members of the original CG development groups. CQs were classified in three groups: 1) high priority (CQs prioritized for updating [16/107; 15.0%]), 2) medium priority (CQs that could be prioritized for updating [47/107; 43.9%]), and low priority (CQs that were not prioritized for updating [44/107; 41.1%]). The mean time each appraiser needed to assess the CQs with the tool was 3.8 hours (range 0.5 to 10). Agreement among the appraisers varied among the CGs. Appraisers considered that the tool was useful. We suggest some areas for consideration when using the tool including: 1) identification of key appraisers, 2) customization of training materials, 3) establishment of priority thresholds, and 4) provision of methodological support. CONCLUSION The UpPriority is a useful tool to identify which CQs within a CG need to be prioritized for update in a real-world scenario. Recruitment and training of topic experts are the main challenges when using the tool.
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Affiliation(s)
- Andrea Juliana Sanabria
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Emma McFarlane
- National Institute for Health and Care Excellence, Manchester, UK
| | - Ena Niño de Guzman
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Marta Roqué
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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9
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Oxman AD, García LM. Comparison of the Informed Health Choices Key Concepts Framework to other frameworks relevant to teaching and learning how to think critically about health claims and choices: a systematic review. F1000Res 2020; 9:164. [PMID: 33224475 PMCID: PMC7670481 DOI: 10.12688/f1000research.21858.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2020] [Indexed: 12/15/2022] Open
Abstract
Background: The Informed Health Choices (IHC) Key Concepts are principles for evaluating the trustworthiness of claims about treatment effects. The Key Concepts provide a framework for developing learning-resources to help people use the concepts when treatment claims are made, and when they make health choices. Objective: To compare the framework provided by the IHC Key Concepts to other frameworks intended to promote critical thinking about treatment (intervention) claims and choices. Methods: We identified relevant frameworks from reviews of frameworks, searching Google Scholar, citation searches, and contact with key informants. We included frameworks intended to provide a structure for teaching or learning to think critically about the basis for claims, evidence used to support claims, or informed choices. For a framework to be included, there had to be a description of its purpose; a list of concepts, competences, or dispositions; and definitions of key terms. We made independent assessments of framework eligibility and extracted data for each included framework using standardised forms. Results: Twenty-two frameworks met our inclusion criteria. The purpose of the IHC Framework is similar to that of two frameworks for critical thinking and somewhat similar to that of a framework for evidence-based practice. Those frameworks have broader scopes than the IHC Framework. An important limitation of broad frameworks is that they do not provide an adequate basis (concepts) for deciding which claims to believe and what to do. There was at most some overlap between the concepts, competences, and dispositions in each of the 22 included frameworks and those in the IHC Framework. Conclusions: The IHC Key Concepts Framework appears to be unique. Our review has shown how it and other frameworks can be improved by taking account of the ways in which other related frameworks have been developed, evaluated, and made useful.
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Affiliation(s)
- Andrew D Oxman
- Centre for Informed Health Choices, Norwegian Institute of Public Health, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Laura Martínez García
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute, Barcelona, Spain.,CIBER of Epidemiology and Public Health, Barcelona, Spain
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10
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Sanabria AJ, Pardo-Hernandez H, Ballesteros M, Canelo-Aybar C, McFarlane E, Niño de Guzman E, Penman K, Posso M, Roqué i Figuls M, Selva A, Vernooij RW, Alonso-Coello P, Martínez García L, Agarwal A, Blanchard S, Brereton L, Brouwers M, Etxeandia-Ikobaltzeta I, Flórez ID, Haynes C, Ibargoyen Roteta N, James R, Kwong J, Minister C, Nolan K, Qaseem A, Rotaeche del Campo R, Shaw B, Shin ES, Tam I, Thornton J, Vandvik Per O. The UpPriority tool was developed to guide the prioritization of clinical guideline questions for updating. J Clin Epidemiol 2020; 126:80-92. [DOI: 10.1016/j.jclinepi.2020.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 11/28/2022]
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11
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Bonanzinga S, Onelia F, Jackson K, Glass A, Maree L, Krügel M, Pacenti M, Gunson R, Goldstein E, García LM, Galán JC, Vilas A, Ehret R, Knechten H, Naeth G, Braun P, Obermeier M, Marlowe N, Palm MJ, Pfeifer K, Joseph AM, Dhein J, Reinhardt B, Lucic D, Chevaliez S. Multicenter clinical evaluation of alinity m HBV assay performance. J Clin Virol 2020; 129:104514. [PMID: 32688328 DOI: 10.1016/j.jcv.2020.104514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/06/2020] [Accepted: 06/14/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Accurate molecular methods to detect and quantify hepatitis B virus (HBV) DNA are essential to diagnose chronic infections, guide treatment decisions, assess response to treatment, and determine risk of HBV-related complications. New generations of real-time HBV DNA assay platforms provide results in less than 2-3 h, with continuous loading of specimens and true random-access capability. OBJECTIVES We examined the clinical performance of the new Alinity m HBV assay, run on the fully automated, continuous, random-access Alinity m platform, to accurately detect and quantify HBV DNA in a large series of patient samples infected with different HBV genotypes frequently encountered in clinical practice. STUDY DESIGN This international, multisite study assessed the precision and reproducibility of the Alinity m HBV assay and compared its performance to four HBV assays currently in clinical use. RESULTS The Alinity m HBV assay demonstrated linear quantitation of HBV DNA in plasma samples, with high precision (coefficient of variation 4.1 %-8.8 %) and reproducibility. The Alinity m HBV assay showed excellent correlation (correlation coefficients ≥0.947) with comparator HBV assays, with an overall observed bias ranging from -0.07 to 0.17 Log10 IU/mL. 97 % of quantifiable patient results were <1 Log10 IU/mL different than the respective comparator assays, with comparable results across HBV genotypes. CONCLUSIONS The newly developed real-time PCR-based Alinity m HBV assay is sensitive, reproducible, and accurately quantifies HBV DNA levels from HBsAg-positive patients across the full dynamic range of quantification.
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Affiliation(s)
- Sara Bonanzinga
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia
| | | | - Kathy Jackson
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia
| | | | - Leana Maree
- Lancet Laboratories, Johannesburg, South Africa
| | - Mari Krügel
- Lancet Laboratories, Johannesburg, South Africa
| | | | - Rory Gunson
- West of Scotland Specialist Virology Centre, Glasgow, United Kingdom
| | - Emily Goldstein
- West of Scotland Specialist Virology Centre, Glasgow, United Kingdom
| | - Laura Martínez García
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) and CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Juan-Carlos Galán
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) and CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Alba Vilas
- Laboratori de Referència de Catalunya, El Prat de Llobregat, Spain
| | - Robert Ehret
- Laboratory Dr. Knechten, Medical Center for HIV and Hepatitis, Aachen, Germany
| | - Heribert Knechten
- Laboratory Dr. Knechten, Medical Center for HIV and Hepatitis, Aachen, Germany
| | - Gudrun Naeth
- Laboratory Dr. Knechten, Medical Center for HIV and Hepatitis, Aachen, Germany
| | - Patrick Braun
- Laboratory Dr. Knechten, Medical Center for HIV and Hepatitis, Aachen, Germany
| | | | | | | | | | | | | | | | | | - Stéphane Chevaliez
- National Reference Center for Viral Hepatitis B, C, and Delta, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France.
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12
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Roqué M, Martínez García L, Solà I, Alonso-Coello P, Bonfill X, Zamora J. Toolkit of methodological resources to conduct systematic reviews. F1000Res 2020; 9:82. [PMID: 33082931 PMCID: PMC7542253 DOI: 10.12688/f1000research.22032.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2020] [Indexed: 09/20/2023] Open
Abstract
Background: Systematic reviews (SR) can be classified by type depending on the research question they are based on. This work identifies and describes the most relevant methodological resources to conduct high-quality reviews that answer clinical questions regarding prevalence, prognosis, diagnostic accuracy and efficacy of interventions. Methods: Methodological resources have been identified from literature searches and consulting guidelines from institutions that develop SRs. The selected resources are organized by type of SR, and stage of development of the review (formulation of the research question, development of the protocol, literature search, risk of bias assessment, synthesis of findings, assessment of the quality of evidence, and report of SR results and conclusions). Results: Although the different types of SRs are developed following the same steps, each SR type requires specific methods, differing in characteristics and complexity. The extent of methodological development varies by type of SR, with more solid guidelines available for diagnostic accuracy and efficacy of interventions SRs. This methodological toolkit describes the most up-to-date risk of bias instruments: Quality in Prognostic Studies (QUIPS) tool and Prediction model study Risk Of Bias Assessment Tool (PROBAST) for prognostic SRs, Quality assessment of diagnostic accuracy studies tool (QUADAS-2) for diagnostic accuracy SRs, Cochrane risk of bias tool (ROB-2) and Risk of bias in non-randomised studies of interventions studies tool (ROBINS-I) for efficacy of interventions SRs, as well as the latest developments on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Conclusions: This structured compilation of the best methodological resources for each type of SR may prove to be a very useful tool for those researchers that wish to develop SRs or conduct methodological research works on SRs.
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Affiliation(s)
- Marta Roqué
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Xavier Bonfill
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
| | - Javier Zamora
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Clinical Biostatistics Unit, Ramón y Cajal Health Research Institute, Madrid, Spain
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13
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Abstract
Background: Systematic reviews (SR) can be classified by type depending on the research question they are based on. This work identifies and describes the most relevant methodological resources to conduct high-quality reviews that answer health care questions regarding prevalence, prognosis, diagnostic accuracy and effects of interventions. Methods: Methodological resources have been identified from literature searches and consulting guidelines from institutions that develop SRs. The selected resources are organized by type of SR, and stage of development of the review (formulation of the research question, development of the protocol, literature search, risk of bias assessment, synthesis of findings, assessment of the quality of evidence, and report of SR results and conclusions). Results: Although the different types of SRs are developed following the same steps, each SR type requires specific methods, differing in characteristics and complexity. The extent of methodological development varies by type of SR, with more solid guidelines available for diagnostic accuracy and effects of interventions SRs. This methodological toolkit describes the most up-to-date risk of bias instruments: Quality in Prognostic Studies (QUIPS) tool and Prediction model study Risk Of Bias Assessment Tool (PROBAST) for prognostic SRs, Quality assessment of diagnostic accuracy studies tool (QUADAS-2) for diagnostic accuracy SRs, Cochrane risk of bias tool (ROB-2) and Risk of bias in non-randomised studies of interventions studies tool (ROBINS-I) for effects of interventions SRs, as well as the latest developments on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Conclusions: This structured compilation of the best methodological resources for each type of SR may prove to be a very useful tool for those researchers that wish to develop SRs or conduct methodological research works on SRs.
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Affiliation(s)
- Marta Roqué
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Xavier Bonfill
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
| | - Javier Zamora
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Clinical Biostatistics Unit, Ramón y Cajal Health Research Institute, Madrid, Spain
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14
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Abstract
Background: Systematic reviews (SR) can be classified by type depending on the research question they are based on. This work identifies and describes the most relevant methodological resources to conduct high-quality reviews that answer health care questions regarding prevalence, prognosis, diagnostic accuracy and effects of interventions. Methods: Methodological resources have been identified from literature searches and consulting guidelines from institutions that develop SRs. The selected resources are organized by type of SR, and stage of development of the review (formulation of the research question, development of the protocol, literature search, risk of bias assessment, synthesis of findings, assessment of the quality of evidence, and report of SR results and conclusions). Results: Although the different types of SRs are developed following the same steps, each SR type requires specific methods, differing in characteristics and complexity. The extent of methodological development varies by type of SR, with more solid guidelines available for diagnostic accuracy and effects of interventions SRs. This methodological toolkit describes the most up-to-date risk of bias instruments: Quality in Prognostic Studies (QUIPS) tool and Prediction model study Risk Of Bias Assessment Tool (PROBAST) for prognostic SRs, Quality assessment of diagnostic accuracy studies tool (QUADAS-2) for diagnostic accuracy SRs, Cochrane risk of bias tool (ROB-2) and Risk of bias in non-randomised studies of interventions studies tool (ROBINS-I) for effects of interventions SRs, as well as the latest developments on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Conclusions: This structured compilation of the best methodological resources for each type of SR may prove to be a very useful tool for those researchers that wish to develop SRs or conduct methodological research works on SRs.
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Affiliation(s)
- Marta Roqué
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Xavier Bonfill
- Iberoamerican Cochrane Centre - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
| | - Javier Zamora
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Clinical Biostatistics Unit, Ramón y Cajal Health Research Institute, Madrid, Spain
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15
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Martínez García L, Alonso-Coello P, Asso Ministral L, Ballesté-Delpierre C, Canelo Aybar C, de Britos C, Fernández Rodríguez A, Gallego Iborra A, Leo Rosas V, Llaquet P, Niño de Guzmán Quispe EP, Pérez-Gaxiola G, Requeijo C, Salas-Gama K, Samsó Jofra L, Terres J, Urreta I, Rosenbaum S. Learning to make informed health choices: Protocol for a pilot study in schools in Barcelona. F1000Res 2019; 8:2018. [PMID: 32528654 PMCID: PMC7268153 DOI: 10.12688/f1000research.21292.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2019] [Indexed: 11/04/2023] Open
Abstract
Introduction: The Informed Health Choices (IHC) project has developed learning resources to teach primary school children (10 to 12-year-olds) to assess treatment claims and make informed health choices. The aim of our study is to explore both the students' and teachers' experience when using these resources in the context of Barcelona (Spain). Methods: During the 2019-2020 school year, we will conduct a pilot study with 4 th and 5 th-year primary school students (9 to 11-year-olds) from three schools in Barcelona. The intervention in the schools will include: 1) a workshop with the teachers, and 2) lessons to the students. The data collection will include: 1) initial assessment of the resources by the teachers, 2) non-participatory observations during the lessons, 3) semi-structured interviews with the students after a lesson, 4) assessment of the lessons by the teachers, 5) treatment claim assessment by the students, and 6) final assessment of the resources by the teachers. We will use ad hoc questionnaires and guides to register the data. We will perform a quantitative and qualitative analysis of the data to explore understandability, desirability, suitability, usefulness, facilitators and barriers of the resources. The most relevant results will be discussed and some recommendations on how to use, how to adapt (if needed), and how to implement the IHC resources to this context will be agreed. We will publish the study results in a peer-reviewed journal and in several Internet resources (web pages, electronic bulletins, and social media), and we will present them to the different users of interest in conferences, workshops, and meetings. Ethical considerations: The study protocol has obtained an approval exemption from the Ethics Committee of the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain).
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Affiliation(s)
- Laura Martínez García
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Laia Asso Ministral
- Maternal and Child Health Service, General Subdirectorate of Health Promotion, Public Health Agency of Catalonia, Barcelona, Spain
| | | | - Carlos Canelo Aybar
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | | | | | | | - Victoria Leo Rosas
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | | | | | | | - Carolina Requeijo
- Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Karla Salas-Gama
- Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Samsó Jofra
- Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Iratxe Urreta
- Clinical Epidemiology and Research Unit, University Hospital of Donostia, Donostia, Spain
| | - Sarah Rosenbaum
- Centre for Informed Health Choices, Norwegian Institute of Public Health, Oslo, Norway
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16
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Martínez García L, Alonso-Coello P, Asso Ministral L, Ballesté-Delpierre C, Canelo Aybar C, de Britos C, Fernández Rodríguez A, Gallego Iborra A, Leo Rosas V, Llaquet P, Niño de Guzmán Quispe EP, Pérez-Gaxiola G, Requeijo C, Salas-Gama K, Samsó Jofra L, Terres J, Urreta I, Rosenbaum S. Learning to make informed health choices: Protocol for a pilot study in schools in Barcelona. F1000Res 2019; 8:2018. [PMID: 32528654 PMCID: PMC7268153 DOI: 10.12688/f1000research.21292.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 11/04/2023] Open
Abstract
Introduction: The Informed Health Choices (IHC) project has developed learning resources to teach primary school children (10 to 12-year-olds) to assess treatment claims and make informed health choices. The aim of our study is to explore both the students' and teachers' experience when using these resources in the context of Barcelona (Spain). Methods: During the 2019-2020 school year, we will conduct a pilot study with 4 th and 5 th-year primary school students (9 to 11-year-olds) from three schools in Barcelona. The intervention in the schools will include: 1) assessment of the IHC resources by the teachers before the lessons, 2) non-participatory observations during the lessons, 3) semi-structured interviews with the students after a lesson, 4) assessment of the lessons by the teachers after a lesson, 5) treatment claim assessment by the students at the end of the lessons, and 6) assessment of the IHC resources by the teachers at the end of the lessons. We will use ad hoc questionnaires and guides to register the data. We will perform a quantitative and qualitative analysis of the data to explore understandability, desirability, suitability, usefulness, facilitators and barriers of the resources. The most relevant results will be discussed and some recommendations on how to use, how to adapt (if needed), and how to implement the IHC resources to this context will be agreed. The findings of the contextualization activities could inform the design of a cluster-randomised trial, to determine the effectiveness of the IHC resources in this context prior to scaling-up its use. Ethical considerations: The study protocol has obtained an approval exemption from the Ethics Committee of the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain).
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Affiliation(s)
- Laura Martínez García
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Laia Asso Ministral
- Maternal and Child Health Service, General Subdirectorate of Health Promotion, Public Health Agency of Catalonia, Barcelona, Spain
| | | | - Carlos Canelo Aybar
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | | | | | | | - Victoria Leo Rosas
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | | | | | | | - Carolina Requeijo
- Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Karla Salas-Gama
- Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Samsó Jofra
- Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Iratxe Urreta
- Clinical Epidemiology and Research Unit, University Hospital of Donostia, Donostia, Spain
| | - Sarah Rosenbaum
- Centre for Informed Health Choices, Norwegian Institute of Public Health, Oslo, Norway
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Martínez García L, Alonso-Coello P, Asso Ministral L, Ballesté-Delpierre C, Canelo Aybar C, de Britos C, Fernández Rodríguez A, Gallego Iborra A, Leo Rosas V, Llaquet P, Niño de Guzmán Quispe EP, Pérez-Gaxiola G, Requeijo C, Salas-Gama K, Samsó Jofra L, Terres J, Urreta I, Rosenbaum S. Learning to make informed health choices: Protocol for a pilot study in schools in Barcelona. F1000Res 2019; 8:2018. [PMID: 32528654 PMCID: PMC7268153 DOI: 10.12688/f1000research.21292.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction: The Informed Health Choices (IHC) project has developed learning resources to teach primary school children (10 to 12-year-olds) to assess treatment claims and make informed health choices. The aim of our study is to explore both the students' and teachers' experience when using these resources in the context of Barcelona (Spain). Methods: During the 2019-2020 school year, we will conduct a pilot study with 4 th and 5 th-year primary school students (9 to 11-year-olds) from three schools in Barcelona. The intervention in the schools will include: 1) a workshop with the teachers, and 2) lessons to the students. The data collection will include: 1) assessment of the IHC resources by the teachers before the lessons, 2) non-participatory observations during the lessons, 3) semi-structured interviews with the students after a lesson, 4) assessment of the lessons by the teachers after a lesson, 5) treatment claim assessment by the students at the end of the lessons, and 6) assessment of the IHC resources by the teachers at the end of the lessons. We will use ad hoc questionnaires and guides to register the data. We will perform a quantitative and qualitative analysis of the data to explore understandability, desirability, suitability, usefulness, facilitators and barriers of the resources. The most relevant results will be discussed and some recommendations on how to use, how to adapt (if needed), and how to implement the IHC resources to this context will be agreed. The findings of the contextualization activities could inform the design of a cluster-randomised trial, to determine the effectiveness of the IHC resources in this context prior to scaling-up its use. Ethical considerations: The study protocol has obtained an approval exemption from the Ethics Committee of the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain).
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Affiliation(s)
- Laura Martínez García
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Laia Asso Ministral
- Maternal and Child Health Service, General Subdirectorate of Health Promotion, Public Health Agency of Catalonia, Barcelona, Spain
| | | | - Carlos Canelo Aybar
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | | | | | | | - Victoria Leo Rosas
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | | | | | | | - Carolina Requeijo
- Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Karla Salas-Gama
- Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Samsó Jofra
- Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Iratxe Urreta
- Clinical Epidemiology and Research Unit, University Hospital of Donostia, Donostia, Spain
| | - Sarah Rosenbaum
- Centre for Informed Health Choices, Norwegian Institute of Public Health, Oslo, Norway
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18
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Song Y, Darzi A, Ballesteros M, Martínez García L, Alonso-Coello P, Arayssi T, Bhaumik S, Chen Y, Cluzeau F, Ghersi D, Padilla PF, Langlois EV, Schünemann HJ, Vernooij RWM, Akl EA. Extending the RIGHT statement for reporting adapted practice guidelines in healthcare: the RIGHT-Ad@pt Checklist protocol. BMJ Open 2019; 9:e031767. [PMID: 31551391 PMCID: PMC6773334 DOI: 10.1136/bmjopen-2019-031767] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The adaptation of guidelines is an increasingly used methodology for the efficient development of contextualised recommendations. Nevertheless, there is no specific reporting guidance. The essential Reporting Items of Practice Guidelines in Healthcare (RIGHT) statement could be useful for reporting adapted guidelines, but it does not address all the important aspects of the adaptation process. The objective of our project is to develop an extension of the RIGHT statement for the reporting of adapted guidelines (RIGHT-Ad@pt Checklist). METHODS AND ANALYSIS To develop the RIGHT-Ad@pt Checklist, we will use a multistep process that includes: (1) establishment of a Working Group; (2) generation of an initial checklist based on the RIGHT statement; (3) optimisation of the checklist (an initial assessment of adapted guidelines, semistructured interviews, a Delphi consensus survey, an external review by guideline developers and users and a final assessment of adapted guidelines); and (4) approval of the final checklist. At each step of the process, we will calculate absolute frequencies and proportions, use content analysis to summarise and draw conclusions, discuss the results, draft a report and refine the checklist. ETHICS AND DISSEMINATION We have obtained a waiver of approval from the Clinical Research Ethics Committee at the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain). We will disseminate the RIGHT-Ad@pt Checklist by publishing into a peer-reviewed journal, presenting to relevant stakeholders and translating into different languages. We will continuously seek feedback from stakeholders, surveil new relevant evidence and, if necessary, update the checklist.
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Affiliation(s)
- Yang Song
- Iberoamerican Cochrane Centre-Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Andrea Darzi
- AUB GRADE Center, American University of Beirut, Beirut, Lebanon
| | | | - Laura Martínez García
- Iberoamerican Cochrane Centre-Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre-Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Department of Health Research Methods, Evidence, and Impact, McMaster GRADE center, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Francoise Cluzeau
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Davina Ghersi
- National Health and Medical Research Council, Canberra, Australian Capital Territory, Australia
| | - Paulina F Padilla
- Facultad de Medicina y Odontología, Universidad de Antofagasta, Antofagasta, Chile
| | - Etienne V Langlois
- Alliance for Health Policy and Systems Research, World Health Organization, Geneve, Switzerland
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster GRADE center, McMaster University, Hamilton, Ontario, Canada
| | - Robin W M Vernooij
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Elie A Akl
- AUB GRADE Center, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster GRADE center, McMaster University, Hamilton, Ontario, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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Posso M, Quintana MJ, Bellmunt S, Martínez García L, Escudero JR, Viteri-García A, Valli C, Bonfill X. GRADE-Based Recommendations for Surgical Repair of Nonruptured Abdominal Aortic Aneurysm. Angiology 2019; 70:701-710. [PMID: 30961349 DOI: 10.1177/0003319719838892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to provide evidence-based recommendations for endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) for patients with a nonruptured abdominal aortic aneurysm (AAA). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement and adhered to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Both low- and high surgical risk patients treated with EVAR showed decreased 30-day mortality, but the low-risk group had no differences in 4-year mortality. Compared with friendly anatomy, patients with hostile anatomy had an increased risk of type I endoleak. Young patients may prefer OSR. Endovascular aneurysm repair was not cost-effective in Europe. Four conditional recommendations were formulated: (1) OSR for low-risk patients up to 80 years old, (2) EVAR for low-risk patients older than 80 years, (3) EVAR for high-risk patients as long as is anatomically feasible, and (4) OSR in patients in whom it is not anatomically feasible to perform EVAR. Based on GRADE criteria, either OSR or EVAR can be suggested to patients with nonruptured AAA taking into account their surgical risk, hostile anatomy, and age. Given the weakness of the recommendations, personal preferences are determinant.
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Affiliation(s)
- Margarita Posso
- 1 Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau IIB Sant Pau, Barcelona, Spain.,2 Iberoamerican Cochrane Centre, IIB Sant Pau, Barcelona, Spain
| | - M Jesús Quintana
- 1 Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau IIB Sant Pau, Barcelona, Spain.,3 CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Sergi Bellmunt
- 4 Department of Angiology, Vascular and Endovascular Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.,5 Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | | | - José R Escudero
- 6 Joint Service of Angiology, Vascular and Endovascular Surgery, Sant Pau-Dos de Mayo Hospital, Barcelona, Spain.,7 Autonomous University of Barcelona, Barcelona, Spain.,8 CIBER of Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Andrés Viteri-García
- 9 Faculty of Health Sciences "Eugenio Espejo," Clinical Epidemiology and Public Health Research Centre (CISPEC), Universidad UTE, Quito, Ecuador
| | - Claudia Valli
- 2 Iberoamerican Cochrane Centre, IIB Sant Pau, Barcelona, Spain
| | - Xavier Bonfill
- 1 Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau IIB Sant Pau, Barcelona, Spain.,2 Iberoamerican Cochrane Centre, IIB Sant Pau, Barcelona, Spain.,3 CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,7 Autonomous University of Barcelona, Barcelona, Spain
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20
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de la Poza Abad M, Mas Dalmau G, Gich Saladich I, Martínez García L, Llor C, Alonso-Coello P. Use of delayed antibiotic prescription in primary care: a cross-sectional study. BMC Fam Pract 2019; 20:45. [PMID: 30914044 PMCID: PMC6434640 DOI: 10.1186/s12875-019-0934-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/14/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND One of several strategies developed to reduce inappropriate antibiotic use in situations where the indication is not clear is delayed antibiotic prescription (DAP), defined as an antibiotic prescription issued for the patient to take only in case of feeling worse or not feeling better several days after the visit. We conducted a survey to identify DAP use in Spanish primary care settings. METHODS We surveyed 23 healthcare centers located in 4 autonomous regions where a randomized controlled trial (RCT) on DAP was underway. The primary variable was use of DAP. Categorical and quantitative variables were analyzed by means of the chi-squared test and non-parametric tests, respectively. RESULTS The survey was sent to 375 healthcare professionals, 215 of whom responded (57.3% response rate), with 46% of these respondents declaring that they had used DAP in routine practice before the RCT started (66.6% afterwards), mostly (91.5%) for respiratory tract infections (RTIs), followed by urinary infections (45.1%). Regarding DAP use for RTIs, the most frequent conditions were pharyngotonsillitis (88.7%), acute bronchitis (62.7%), mild chronic obstructive pulmonary disease exacerbations (59.9%), sinusitis (51.4%), and acute otitis media (45.1%). Most respondents considered that DAP reduced emergency visits (85.4%), scheduled visits (79%) and inappropriate antibiotic use (73.7%) and most also perceived patients to be generally satisfied with the DAP approach (75.6%). Having participated or not in the DAP RCT (74.1% versus 46.2%; p < 0.001), having previously used or not used DAP (86.8% versus 44.2%; p < 0.001), and being a physician versus being a nurse (81.8% versus 18.2%; p < 0.001) were factors that reflected significantly higher rates of DAP use. CONCLUSIONS The majority of primary healthcare professionals in Spain do not use DAP. Those who use DAP believe that it reduces primary care visits and inappropriate antibiotic use, while maintaining patient satisfaction. Given the limited use of DAP in our setting, and given that its use is mainly limited to RTIs, DAP has considerable potential in terms of its implementation in routine practice.
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Affiliation(s)
| | - Gemma Mas Dalmau
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Ignasi Gich Saladich
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Carl Llor
- Via Roma Primary Care Center, Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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21
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Roqué i Figuls M, Martínez García L, Martinez-Zapata MJ, Pacheco R, Mauricio D, Bonfill Cosp X. Interventions for treating overweight or obesity in adults: an overview of systematic reviews. Hippokratia 2018. [DOI: 10.1002/14651858.cd010665.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Marta Roqué i Figuls
- CIBER Epidemiología y Salud Pública (CIBERESP); Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau); Sant Antoni Maria Claret 171 Edifici Casa de Convalescència Barcelona Catalunya Spain 08041
| | - Laura Martínez García
- Biomedical Research Institute Sant Pau (IIB Sant Pau); Iberoamerican Cochrane Centre; Sant Antoni Mª Claret 167 Barcelona Catalunya Spain 08025
| | - Maria José Martinez-Zapata
- CIBER Epidemiología y Salud Pública (CIBERESP); Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau); Sant Antoni Maria Claret 171 Edifici Casa de Convalescència Barcelona Catalunya Spain 08041
| | - Roxana Pacheco
- Hospital Universitari Arnau de Vilanova; Department of Medicine; Rovira Roure, 80 Lleida Spain 25198
| | - Didac Mauricio
- Hospital Universitari Germans Trias i Pujol - CIBERDEM; Department of Endocrinology and Nutrition; Carretera Canyet S/N Badalona Spain 08916
| | - Xavier Bonfill Cosp
- CIBER Epidemiología y Salud Pública (CIBERESP); Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau); Sant Antoni Maria Claret 171 Edifici Casa de Convalescència Barcelona Catalunya Spain 08041
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22
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Bonfill X, Arevalo-Rodriguez I, Martínez García L, Quintana MJ, Buitrago-Garcia D, Lobos Urbina D, Cordero JA. Intermittent androgen deprivation therapy: recommendations to improve the management of patients with prostate cancer following the GRADE approach. Cancer Manag Res 2018; 10:2357-2367. [PMID: 30122985 PMCID: PMC6080876 DOI: 10.2147/cmar.s164856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The purpose of this study was to provide evidence-based recommendations of intermittent androgen deprivation therapy (IADT) compared with continuous androgen deprivation therapy (CADT) for men with prostate cancer (PCA). METHODS We conducted a comprehensive search in MEDLINE, EMBASE, The Cochrane Library, CINAHL, and ECONLIT, from the database inception to December 2017. We adhered to the Grading of Recommendations, Assessment, Development and Evaluation framework to assess the quality of the evidence and to formulate recommendations. RESULTS We included one systematic review with 15 trials as well as three additional studies that assessed IADT versus CADT, all of them focused on PCA patients in advanced stages. The findings did not show differences for critical and important outcomes, including adverse events. Trials reported the benefits of IADT in terms of selected domains of health-related quality of life, although with high heterogeneity. Evidence quality was considered moderate or low for most of the assessed outcomes. We identified a patient preference study reporting a high preference for IADT, due to issues related to quality of life, general well-being, and side effects, among others. We did not identify economic studies comparing these regimes. We formulate four recommendations: one no-recommendation, one conditional recommendation, and two good practice points. CONCLUSION For men in early stages of PCA, it is not possible to make any recommendation about the preferable use of IADT or CADT due to the lack of available evidence. For men in advanced stages of the disease, an IADT should be considered as soon as clinically reasonable (weak recommendation and low certainty of the evidence). Clinicians should discuss the risks and benefits of IADT and CADT with their patients, taking into account their values and preferences.
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Affiliation(s)
- Xavier Bonfill
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Barcelona, Spain
- Iberoamerican Cochrane Centre, Barcelona, Spain
| | - Ingrid Arevalo-Rodriguez
- Centro de Investigación en Salud Pública y Epidemiología Clínica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador,
- Hospital Ramon y Cajal (IRYCIS), Clinical Biostatistics Unit, CIBER of Epidemiology and Public Health, Madrid, Spain,
| | | | - Maria Jesús Quintana
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Barcelona, Spain
| | - Diana Buitrago-Garcia
- Centro de Investigación en Salud Pública y Epidemiología Clínica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador,
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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24
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Martínez García L, Pardo-Hernández H, Sanabria AJ, Alonso-Coello P, Penman K, McFarlane E, Martínez García L, Pardo-Hernández H, Sanabria A, Alonso-Coello P, Penman K, McFarlane E, Blanchard S, Brereton L, Browers M, Dean V, Flórez Gómez I, Fuentes C, Grimmer K, Harris J, Haynes C, Iorio A, James R, Kwong J, Lynch R, Nolan K, Ogunremi T, Okechukwu K, Prabhu Iyer N, Qaseem A, Rey M, Schorr S, Selva A, Shaw B, Shearn P, Shin E, Stapon C, Tam I, Thornton J, Uhl S, Vandvik P, Vernooij R. Guideline on terminology and definitions of updating clinical guidelines: The Updating Glossary. J Clin Epidemiol 2018; 95:28-33. [DOI: 10.1016/j.jclinepi.2017.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/08/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022]
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25
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Vernooij RWM, Martínez García L, Florez ID, Hidalgo Armas L, Poorthuis MHF, Brouwers M, Alonso-Coello P. Updated clinical guidelines experience major reporting limitations. Implement Sci 2017; 12:120. [PMID: 29025429 PMCID: PMC5639761 DOI: 10.1186/s13012-017-0651-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 10/03/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Checklist for the Reporting of Updated Guidelines (CheckUp) was recently developed. However, so far, no systematic assessment of the reporting of updated clinical guidelines (CGs) exists. We aimed to examine (1) the completeness of reporting the updating process in CGs and (2) the inter-observer reliability of CheckUp. METHODS We conducted a systematic assessment of the reporting of the updating process in a sample of updated CGs using CheckUp. We performed a systematic search to identify updated CGs published in 2015, developed by a professional society, reporting a systematic review of the evidence, and containing at least one recommendation. Three reviewers independently assessed the CGs with CheckUp (16 items). We calculated the median score per item, per domain, and overall, converting scores to a 10-point scale. Multiple linear regression analyses were used to identify differences according to country, type of organisation, scope, and health topic of updated CGs. We calculated the intraclass coefficient (ICC) and 95% confidence interval (95% CI) for domains and overall score. RESULTS We included in total 60 updated CGs. The median domain score on a 10-point scale for presentation was 5.8 (range 1.7 to 10), for editorial independence 8.3 (range 3.3 to 10), and for methodology 5.7 (range 0 to 10). The median overall score on a 10-point scale was 6.3 (range 3.1 to 10). Presentation and justification items at recommendation level (respectively reported by 27 and 38% of the CGs) and the methods used for the external review and implementing changes in practice were particularly poorly reported (both reported by 38% of the CGs). CGs developed by a European or international institution obtained a statistically significant higher overall score compared to North American or Asian institutions (p = 0.014). Finally, the agreement among the reviewers on the overall score was excellent (ICC 0.88, 95% CI 0.75 to 0.95). CONCLUSIONS The reporting of updated CGs varies considerably with significant room for improvement. We recommend using CheckUp to assess the updating process in updated CGs and as a blueprint to inform methods and reporting strategies in updating.
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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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Selva A, Solà I, Zhang Y, Pardo-Hernandez H, Haynes RB, Martínez García L, Navarro T, Schünemann H, Alonso-Coello P. Development and use of a content search strategy for retrieving studies on patients' views and preferences. Health Qual Life Outcomes 2017; 15:126. [PMID: 28851437 PMCID: PMC5576198 DOI: 10.1186/s12955-017-0698-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 06/01/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Identifying scientific literature addressing patients' views and preferences is complex due to the wide range of studies that can be informative and the poor indexing of this evidence. Given the lack of guidance we developed a search strategy to retrieve this type of evidence. METHODS We assembled an initial list of terms from several sources, including the revision of the terms and indexing of topic-related studies and, methods research literature, and other relevant projects and systematic reviews. We used the relative recall approach, evaluating the capacity of the designed search strategy for retrieving studies included in relevant systematic reviews for the topic. We implemented in practice the final version of the search strategy for conducting systematic reviews and guidelines, and calculated search's precision and the number of references needed to read (NNR). RESULTS We assembled an initial version of the search strategy, which had a relative recall of 87.4% (yield of 132/out of 151 studies). We then added some additional terms from the studies not initially identified, and re-tested this improved version against the studies included in a new set of systematic reviews, reaching a relative recall of 85.8% (151/out of 176 studies, 95% CI 79.9 to 90.2). This final version of the strategy includes two sets of terms related with two domains: "Patient Preferences and Decision Making" and "Health State Utilities Values". When we used the search strategy for the development of systematic reviews and clinical guidelines we obtained low precision values (ranging from 2% to 5%), and the NNR from 20 to 50. CONCLUSIONS This search strategy fills an important research gap in this field. It will help systematic reviewers, clinical guideline developers, and policy-makers to retrieve published research on patients' views and preferences. In turn, this will facilitate the inclusion of this critical aspect when formulating heath care decisions, including recommendations.
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Affiliation(s)
- Anna Selva
- Clinical Epidemiology and Cancer Screening, Corporació Sanitària Parc Taulí, Parc Taulí, 1, Edifici Santa Fe, planta baixa. 08208 Sabadell, Barcelona, Spain
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER Epidemiología y Salud Pública, (CIBERESP), Barcelona, Spain
| | - Yuan Zhang
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER Epidemiología y Salud Pública, (CIBERESP), Barcelona, Spain
| | - R. Brian Haynes
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada
- Health Information Research Unit, Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada
| | - Laura Martínez García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Tamara Navarro
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada
| | - Holger Schünemann
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada
- Health Information Research Unit, Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada
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Martínez García L, Pardo-Hernandez H, Niño de Guzman E, Superchi C, Ballesteros M, McFarlane E, Penman K, Posso M, Roqué i Figuls M, Sanabria AJ, Selva A, Vernooij RWM, Alonso-Coello P. Development of a prioritisation tool for the updating of clinical guideline questions: the UpPriority Tool protocol. BMJ Open 2017; 7:e017226. [PMID: 28775194 PMCID: PMC5724084 DOI: 10.1136/bmjopen-2017-017226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Due to a continuous emergence of new evidence, clinical guidelines (CGs) require regular surveillance of evidence to maintain their trustworthiness. The updating of CGs is resource intensive and time consuming; therefore, updating may include a prioritisation process to efficiently ensure recommendations remain up to date. The objective of our project is to develop a pragmatic tool to prioritise clinical questions for updating within a CG. METHODS AND ANALYSIS To develop the tool, we will use the results and conclusions of a systematic review of methodological research on prioritisation processes for updating and will adopt a methodological approach we have successfully implemented in a previous experience.We will perform a multistep process including (1) generation of an initial version of the tool, (2) optimisation of the tool (feasibility test of the tool, semistructured interviews, Delphi consensus survey, external review by CG methodologists and users and pilot test of the tool) and (3) approval of the final version of the tool.At each step of the process, we will (1) calculate absolute frequencies and proportions (quantitative data), (2) use content analysis to summarise and draw conclusions (qualitative data) and (3) draft a final report, discuss results and refine the previous versions of the tool. Finally, we will calculate intraclass coefficients with 95% CIs for each item and overall as indicators of agreement among reviewers. ETHICS AND DISSEMINATION We have obtained a waiver of approval from the Clinical Research Ethics Committee at the Hospital de la Santa Creu i Sant Pau (Barcelona). The results of the study will be published in peer-reviewed journal and communicated to interested stakeholders.The tool could support the standardisation of prioritisation processes for updating CGs and therefore have important implications for a more efficient use of resources in the CG field.
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Affiliation(s)
- Laura Martínez García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Ena Niño de Guzman
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Cecilia Superchi
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Monica Ballesteros
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Emma McFarlane
- National Institute for Health and Care Excellence, Manchester, UK
| | - Katrina Penman
- National Institute for Health and Care Excellence, Manchester, UK
| | - Margarita Posso
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Marta Roqué i Figuls
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Andrea Juliana Sanabria
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Anna Selva
- Clinical Epidemiology and Cancer Screening. Corporació Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
| | - Robin WM Vernooij
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Clinical Epidemiology and Biostatistics Department, McMaster University, Hamilton, Canada
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Martínez García L, Pardo-Hernández H, Sanabria AJ, Alonso-Coello P. Continuous surveillance of a pregnancy clinical guideline: an early experience. Syst Rev 2017; 6:143. [PMID: 28705226 PMCID: PMC5512983 DOI: 10.1186/s13643-017-0506-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/24/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To date there is no consensus about the optimal strategy for keeping clinical guidelines (CGs) up-to-date. The aims of this study were (1) to develop a continuous surveillance and updating strategy for CGs and (2) to test the strategy in a specific CG. METHODS The main steps were as follows: (1) recruiting members for the CG Updating Working Group, (2) mapping the CG, (3) identifying new evidence from the CG Updating Working Group, (4) designing and running restricted literature searches, (5) reviewing drugs and medical devices alerts, (6) screening and assessing the new evidence, (7) reviewing and, if necessary, modifying clinical questions and recommendations, and (8) updating the CG document. RESULTS The Pregnancy CG Updating Working Group consisted of 29 members, including clinicians, patients and caregivers, and clinical guideline methodology experts. We selected 69 clinical questions (123 recommendations) from the "Assistance during pregnancy" section. For the first update cycle (32-month duration), 9710 references were identified. Of these, 318 were pertinent, 289 were relevant, and 55 were classified as potential key references. For the second and third update cycles (6-month duration each), 2160 and 2010 references were retrieved, respectively. The continuous surveillance and updating strategy has not yet been completely implemented. CONCLUSIONS Further resources are needed in updating the CG field, both for implementing updating strategies and for developing methodological research.
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Affiliation(s)
- Laura Martínez García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Hector Pardo-Hernández
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Andrea Juliana Sanabria
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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29
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Martínez García L, Pardo-Hernandez H, Superchi C, Niño de Guzman E, Ballesteros M, Ibargoyen Roteta N, McFarlane E, Posso M, Roqué I Figuls M, Rotaeche Del Campo R, Sanabria AJ, Selva A, Solà I, Vernooij RWM, Alonso-Coello P. Methodological systematic review identifies major limitations in prioritization processes for updating. J Clin Epidemiol 2017; 86:11-24. [PMID: 28549931 DOI: 10.1016/j.jclinepi.2017.05.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 04/19/2017] [Accepted: 05/10/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of the study was to identify and describe strategies to prioritize the updating of systematic reviews (SRs), health technology assessments (HTAs), or clinical guidelines (CGs). STUDY DESIGN AND SETTING We conducted an SR of studies describing one or more methods to prioritize SRs, HTAs, or CGs for updating. We searched MEDLINE (PubMed, from 1966 to August 2016) and The Cochrane Methodology Register (The Cochrane Library, Issue 8 2016). We hand searched abstract books, reviewed reference lists, and contacted experts. Two reviewers independently screened the references and extracted data. RESULTS We included 14 studies. Six studies were classified as descriptive (6 of 14, 42.9%) and eight as implementation studies (8 of 14, 57.1%). Six studies reported an updating strategy (6 of 14, 42.9%), six a prioritization process (6 of 14, 42.9%), and two a prioritization criterion (2 of 14, 14.2%). Eight studies focused on SRs (8 of 14, 57.1%), six studies focused on CGs (6 of 14, 42.9%), and none were about HTAs. We identified 76 prioritization criteria that can be applied when prioritizing documents for updating. The most frequently cited criteria were as follows: available evidence (19 of 76, 25.0%), clinical relevance (10 of 76; 13.2%), and users' interest (10 of 76; 13.2%). CONCLUSION There is wide variability and suboptimal reporting of the methods used to develop and implement processes to prioritize updating of SRs, HTAs, and CGs.
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Affiliation(s)
- Laura Martínez García
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain.
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Cecilia Superchi
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Ena Niño de Guzman
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Monica Ballesteros
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Nora Ibargoyen Roteta
- Department of Health and Consumer Affairs, Basque Office for Health Technology Assessment (Osteba), Basque Government, Calle Donostia 1, Vitoria-Gasteiz ES-01010, Spain
| | - Emma McFarlane
- National Institute for Health and Care Excellence, Level 1A City Tower, Piccadilly Plaza, Manchester M1 4BT, UK
| | - Margarita Posso
- Service of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Marta Roqué I Figuls
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Rafael Rotaeche Del Campo
- Alza Health Centre, Osakidetza-Basque Health Service, Avda Larratxo s/n, Donostia-San Sebastián 20013, Spain
| | - Andrea Juliana Sanabria
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain; Clinical Epidemiology and Cancer Screening, Corporació Sanitaria Parc Taulí de Sabadell, Parc Taulí s/n, Sabadell 08208, Spain
| | - Anna Selva
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Robin W M Vernooij
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
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Abstract
BACKGROUND Scientific knowledge is in constant development. Consequently, regular review to assure the trustworthiness of clinical guidelines is required. However, there is still a lack of preferred reporting items of the updating process in updated clinical guidelines. The present article describes the development process of the Checklist for the Reporting of Updated Guidelines (CheckUp). METHODS AND FINDINGS We developed an initial list of items based on an overview of research evidence on clinical guideline updating, the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument, and the advice of the CheckUp panel (n = 33 professionals). A multistep process was used to refine this list, including an assessment of ten existing updated clinical guidelines, interviews with key informants (response rate: 54.2%; 13/24), a three-round Delphi consensus survey with the CheckUp panel (33 participants), and an external review with clinical guideline methodologists (response rate: 90%; 53/59) and users (response rate: 55.6%; 10/18). CheckUp includes 16 items that address (1) the presentation of an updated guideline, (2) editorial independence, and (3) the methodology of the updating process. In this article, we present the methodology to develop CheckUp and include as a supplementary file an explanation and elaboration document. CONCLUSIONS CheckUp can be used to evaluate the completeness of reporting in updated guidelines and as a tool to inform guideline developers about reporting requirements. Editors may request its completion from guideline authors when submitting updated guidelines for publication. Adherence to CheckUp will likely enhance the comprehensiveness and transparency of clinical guideline updating for the benefit of patients and the public, health care professionals, and other relevant stakeholders.
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Affiliation(s)
- Robin W. M. Vernooij
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Spain
- Clinical Epidemiology and Biostatistics Department, McMaster University, Hamilton, Canada
- * E-mail:
| | - Melissa Brouwers
- Program in Evidence-based Care, Cancer Care Ontario, Hamilton, Canada
| | - Laura Martínez García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
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31
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Agarwal A, Johnston BC, Vernooij RWM, Carrasco-Labra A, Brignardello-Petersen R, Neumann I, Akl EA, Sun X, Briel M, Busse JW, Ebrahim S, Granados CE, Iorio A, Irfan A, Martínez García L, Mustafa RA, Ramirez-Morera A, Selva A, Solà I, Sanabrai AJ, Tikkinen KAO, Vandvik PO, Zhang Y, Zazueta OE, Zhou Q, Schunemann HJ, Guyatt GH, Alonso-Coello P. Authors seldom report the most patient-important outcomes and absolute effect measures in systematic review abstracts. J Clin Epidemiol 2016; 81:3-12. [PMID: 27555080 DOI: 10.1016/j.jclinepi.2016.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 07/08/2016] [Accepted: 08/09/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Explicit reporting of absolute measures is important to ensure treatment effects are correctly interpreted. We examined the extent to which authors report absolute effects for patient-important outcomes in abstracts of systematic review (SR). STUDY DESIGN AND SETTING We searched OVID MEDLINE and Cochrane Database of Systematic Reviews to identify eligible SRs published in the year 2010. Citations were stratified into Cochrane and non-Cochrane reviews, with repeated random sampling in a 1:1 ratio. Paired reviewers screened articles and recorded abstract characteristics, including reporting of effect measures for the most patient-important outcomes of benefit and harm. RESULTS We included 96 Cochrane and 94 non-Cochrane reviews. About 117 (77.5%) relative measures were reported in abstracts for outcomes of benefit, whereas only 34 (22.5%) absolute measures were reported. Similarly, for outcomes of harm, 41 (87.2%) relative measures were provided in abstracts, compared with only 6 (12.8%) absolute measures. Eighteen (9.5%) abstracts reported both absolute and relative measures for outcomes of benefit, whereas only two (1.1%) abstracts reported both measures for outcomes of harm. Results were similar between Cochrane and non-Cochrane reviews. CONCLUSION SR abstracts seldom report measures of absolute effect. Journal editors should insist that authors report both relative and absolute effects for patient-important outcomes.
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Affiliation(s)
- Arnav Agarwal
- School of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Bradley C Johnston
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, Ontario M5T 3M6, Canada; Systematic Overviews through advancing Research Technology (SORT), Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, University of Toronto, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada; Department of Anesthesia & Pain Medicine, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario M5G 1X8, Canada.
| | - Robin W M Vernooij
- Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - Alonso Carrasco-Labra
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Sergio Livingstone 943, Santiago, Chile
| | - Romina Brignardello-Petersen
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Sergio Livingstone 943, Santiago, Chile
| | - Ignacio Neumann
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O Higgins 340, Santiago, Región Metropolitana, Chile
| | - Elie A Akl
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad-El-Solh, Beirut 1107 2020, Lebanon
| | - Xin Sun
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu 610041, China
| | - Matthias Briel
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, Spitalstrasse 12, Basel 4031, Switzerland
| | - Jason W Busse
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Shanil Ebrahim
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Carlos E Granados
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Área de investigaciones, Facultad de Medicina, Universidad de La Sabana, Campus del Puente del Común Km, 7 Autopista Norte, Chía, Colombia
| | - Alfonso Iorio
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Affan Irfan
- Internal Medicine Residency Program, University of Illinois, Urbana-Champaign, 506 S. Mathews Ave., Urbana, IL 61801, USA
| | - Laura Martínez García
- Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - Reem A Mustafa
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Departments of Medicine and Biomedical & Health Informatics, University of Missouri-Kansas City, School of Medicine, M4-303, 2411 Holmes St, Kansas City, MO, USA
| | - Anggie Ramirez-Morera
- CCSS Permanent Medical Advisor, Health Care Development Division, IHCAI Foundation & Central America Cochrane, 1st Ave., 35th and 37th St, Number 3530, Barrio Escalante, San José, Costa Rica
| | - Anna Selva
- Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - Ivan Solà
- Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - Andrea J Sanabrai
- Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - Kari A O Tikkinen
- Departments of Urology and Public Health, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Helsinki 00029, Finland
| | - Per O Vandvik
- Norwegian Knowledge Centre for the Health Services, P.O. Box 4404 Nydalen, Oslo 0403 Norway
| | - Yuqing Zhang
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Oscar E Zazueta
- Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - Qi Zhou
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Holger J Schunemann
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Gordon H Guyatt
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Pablo Alonso-Coello
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP-IIB Sant Pau), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, Madrid 28029, Spain
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32
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Garner P, Hopewell S, Chandler J, MacLehose H, Schünemann HJ, Akl EA, Beyene J, Chang S, Churchill R, Dearness K, Guyatt G, Lefebvre C, Liles B, Marshall R, Martínez García L, Mavergames C, Nasser M, Qaseem A, Sampson M, Soares-Weiser K, Takwoingi Y, Thabane L, Trivella M, Tugwell P, Welsh E, Wilson EC, Schünemann HJ. When and how to update systematic reviews: consensus and checklist. BMJ 2016; 354:i3507. [PMID: 27443385 PMCID: PMC4955793 DOI: 10.1136/bmj.i3507] [Citation(s) in RCA: 229] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Paul Garner
- Cochrane Infectious Diseases Group, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Sally Hopewell
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Jackie Chandler
- Cochrane Editorial Unit, Cochrane Central Executive, London, UK
| | | | - Holger J Schünemann
- Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Hamilton, ON, Canada Cochrane GRADEing Methods Group, Ottawa, ON, Canada
| | - Elie A Akl
- Cochrane GRADEing Methods Group, Ottawa, ON, Canada Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Joseph Beyene
- Department of Mathematics and Statistics, McMaster University
| | - Stephanie Chang
- Evidence-based Practice Center Program, Agency for Healthcare and Research Quality, Rockville, MD, USA
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Karin Dearness
- Cochrane Upper Gastrointestinal and Pancreatic Diseases Group, Hamilton, ON, Canada
| | - Gordon Guyatt
- Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Beth Liles
- Kaiser Permanente National Guideline Program, Portland, OR, USA
| | - Rachel Marshall
- Cochrane Editorial Unit, Cochrane Central Executive, London, UK
| | | | - Chris Mavergames
- Cochrane Informatics and Knowledge Management, Cochrane Central Executive, Freiburg, Germany
| | - Mona Nasser
- Plymouth University Peninsula School of Dentistry, Plymouth, UK
| | - Amir Qaseem
- Department of Clinical Policy, American College of Physicians,Philadelphia, PA, USA Guidelines International Network, Pitlochry, UK
| | | | | | - Yemisi Takwoingi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Hamilton, ON, Canada Biostatistics Unit, Centre for Evaluation, McMaster University, Hamilton, ON, Canada
| | | | | | - Emma Welsh
- Cochrane Airways Group, Population Health Research Institute, St George's, University of London, London, UK
| | - Ed C Wilson
- Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK
| | - Holger J Schünemann
- Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Hamilton, ON, Canada Cochrane GRADEing Methods Group, Ottawa, ON, Canada
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33
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Akl EA, Carrasco-Labra A, Brignardello-Petersen R, Neumann I, Johnston BC, Sun X, Briel M, Busse JW, Ebrahim S, Granados CE, Iorio A, Irfan A, Martínez García L, Mustafa RA, Ramírez-Morera A, Selva A, Solà I, Sanabria AJ, Tikkinen KAO, Vandvik PO, Vernooij RWM, Zazueta OE, Zhou Q, Guyatt GH, Alonso-Coello P. Reporting, handling and assessing the risk of bias associated with missing participant data in systematic reviews: a methodological survey. BMJ Open 2015; 5:e009368. [PMID: 26423858 PMCID: PMC4593136 DOI: 10.1136/bmjopen-2015-009368] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To describe how systematic reviewers are reporting missing data for dichotomous outcomes, handling them in the analysis and assessing the risk of associated bias. METHODS We searched MEDLINE and the Cochrane Database of Systematic Reviews for systematic reviews of randomised trials published in 2010, and reporting a meta-analysis of a dichotomous outcome. We randomly selected 98 Cochrane and 104 non-Cochrane systematic reviews. Teams of 2 reviewers selected eligible studies and abstracted data independently and in duplicate using standardised, piloted forms with accompanying instructions. We conducted regression analyses to explore factors associated with using complete case analysis and with judging the risk of bias associated with missing participant data. RESULTS Of Cochrane and non-Cochrane reviews, 47% and 7% (p<0.0001), respectively, reported on the number of participants with missing data, and 41% and 9% reported a plan for handling missing categorical data. The 2 most reported approaches for handling missing data were complete case analysis (8.5%, out of the 202 reviews) and assuming no participants with missing data had the event (4%). The use of complete case analysis was associated only with Cochrane reviews (relative to non-Cochrane: OR=7.25; 95% CI 1.58 to 33.3, p=0.01). 65% of reviews assessed risk of bias associated with missing data; this was associated with Cochrane reviews (relative to non-Cochrane: OR=6.63; 95% CI 2.50 to 17.57, p=0.0001), and the use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology (OR=5.02; 95% CI 1.02 to 24.75, p=0.047). CONCLUSIONS Though Cochrane reviews are somewhat less problematic, most Cochrane and non-Cochrane systematic reviews fail to adequately report and handle missing data, potentially resulting in misleading judgements regarding risk of bias.
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Affiliation(s)
- Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Alonso Carrasco-Labra
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Evidence Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Romina Brignardello-Petersen
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Evidence Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ignacio Neumann
- Department of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bradley C Johnston
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia & Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Xin Sun
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Clinical Research and Evaluation Unit, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Matthias Briel
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Jason W Busse
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Shanil Ebrahim
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Stanford Prevention Research Center, Stanford University, Palo Alto, California, USA
| | - Carlos E Granados
- Área de investigaciones, Facultad de Medicina, Universidad de La Sabana, Chía, Colombia
| | - Alfonso Iorio
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Affan Irfan
- Department of Cardiology, University of Louisville, Louisville, Kentucky, USA
| | - Laura Martínez García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain
| | - Reem A Mustafa
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Departments of Medicine, Nephrology and Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Anggie Ramírez-Morera
- Health Care Development Division, IHCAI Foundation & Central America Cochrane, San José, Costa Rica
| | - Anna Selva
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain
| | - Andrea Juliana Sanabria
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain
| | - Kari A O Tikkinen
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Departments of Urology and Public Health, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Per O Vandvik
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
- Department of Medicine, Innlandet Hospital Trust, Gjøvik, Norway
| | - Robin W M Vernooij
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain
| | - Oscar E Zazueta
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain
| | - Qi Zhou
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Gordon H Guyatt
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain
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34
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Rodríguez LA, Magén C, Snoeck E, Gatel C, Castán-Guerrero C, Sesé J, García LM, Herrero-Albillos J, Bartolomé J, Bartolomé F, Ibarra MR. High-resolution imaging of remanent state and magnetization reversal of superdomain structures in high-density cobalt antidot arrays. Nanotechnology 2014; 25:385703. [PMID: 25181396 DOI: 10.1088/0957-4484/25/38/385703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Remanent state and magnetization reversal processes of a series of cobalt antidot arrays with a fixed hole diameter (d ≈ 55 nm) and an array periodicity (p) ranging between 95 and 524 nm were studied by in situ Lorentz microscopy (LM) as a function of the magnetic field. At remanence, defocused LM images showed the periodicity dependence of the magnetic states inside the lattice. A remarkable transition was observed in the type of domain structures as a function of p: for the large periodicities (p > 300 nm), conventional 90° and 180° domain walls were formed, whereas in small-period antidot arrays (p ≦ 160 nm) magnetic superdomain walls (SDWs) were nucleated to separate regions with different average magnetization direction, the so-called magnetic superdomains. In the SDW regime, a low-frequency Fourier filtering method was implemented to allow a quantitative analysis of the LM images by the transport of intensity equation method. In situ LM experiments under applied magnetic fields were performed to study the reversal magnetization process in a particular array (p = 160 nm), and clear differences were observed as a function of the magnetic field orientation. The switching process under magnetic fields parallel to the horizontal antidot rows occurs in two stages: the system first nucleates and propagates horizontal SDWs, parallel to the field. Then, at higher magnetic fields, vertical SDWs, perpendicular to the field, appear before saturation. When the magnetic field is applied at 45° with respect to the antidot rows, both horizontal and vertical SDWs are nucleated and propagated simultaneously. All the experiments were successfully correlated with micromagnetic simulations. The current study sheds new light on the magnetization reversal processes of antidot arrays and opens new possibilities of exploiting the potential of high-resolution in situ LM and new data analysis procedures to probe magnetization processes in nanomagnetism, particularly in periodic arrays of nanomagnets.
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Affiliation(s)
- L A Rodríguez
- Laboratorio de Microscopías Avanzadas (LMA), Instituto de Nanociencia de Aragón (INA), Universidad de Zaragoza, 50018 Zaragoza, Spain. Departamento de Física de la Materia Condensada, Universidad de Zaragoza, 50009 Zaragoza, Spain. Transpyrenean Associated Laboratory for Electron Microscopy (TALEM), CEMES-INA, CNRS-Universidad de Zaragoza, Toulouse, France. CEMES-CNRS 29, rue Jeanne Marvig, B.P. 94347 F-31055, Toulouse Cedex, France
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35
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Martínez García L, Sanabria AJ, García Alvarez E, Trujillo-Martín MM, Etxeandia-Ikobaltzeta I, Kotzeva A, Rigau D, Louro-González A, Barajas-Nava L, Díaz Del Campo P, Estrada MD, Solà I, Gracia J, Salcedo-Fernandez F, Lawson J, Haynes RB, Alonso-Coello P. The validity of recommendations from clinical guidelines: a survival analysis. CMAJ 2014; 186:1211-9. [PMID: 25200758 DOI: 10.1503/cmaj.140547] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Clinical guidelines should be updated to maintain their validity. Our aim was to estimate the length of time before recommendations become outdated. METHODS We used a retrospective cohort design and included recommendations from clinical guidelines developed in the Spanish National Health System clinical guideline program since 2008. We performed a descriptive analysis of references, recommendations and resources used, and a survival analysis of recommendations using the Kaplan-Meier method. RESULTS We included 113 recommendations from 4 clinical guidelines with a median of 4 years since the most recent search (range 3.9-4.4 yr). We retrieved 39 136 references (range 3343-14 787) using an exhaustive literature search, 668 of which were related to the recommendations in our sample. We identified 69 (10.3%) key references, corresponding to 25 (22.1%) recommendations that required updating. Ninety-two percent (95% confidence interval 86.9-97.0) of the recommendations were valid 1 year after their development. This probability decreased at 2 (85.7%), 3 (81.3%) and 4 years (77.8%). INTERPRETATION Recommendations quickly become outdated, with 1 out of 5 recommendations being out of date after 3 years. Waiting more than 3 years to review a guideline is potentially too long.
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Affiliation(s)
- Laura Martínez García
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont.
| | - Andrea Juliana Sanabria
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Elvira García Alvarez
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Maria Mar Trujillo-Martín
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Itziar Etxeandia-Ikobaltzeta
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Anna Kotzeva
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - David Rigau
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Arturo Louro-González
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Leticia Barajas-Nava
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Petra Díaz Del Campo
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Maria-Dolors Estrada
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Ivan Solà
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Javier Gracia
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Flavia Salcedo-Fernandez
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Jennifer Lawson
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - R Brian Haynes
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre and Biomedical Research Institute Sant Pau (IIB Sant Pau) (Martínez García, Sanabria, Rigau, Barajas-Nava, Solà, Alonso-Coello), Barcelona, Spain; NHS Ayrshire and Arran (García Álvarez), Ayr, United Kingdom; Fundación Canaria de Investigación y Salud (FUNCIS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) (Trujillo-Martín), Tenerife, Spain; Osteba, and Basque Office for Health Technology Assessment (Etxeandia-Ikobaltzeta), Vitoria, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS) (Kotzeva, Estrada), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP) (Kotzeva, Estrada, Solà, Alonso-Coello), Barcelona, Spain; Centro de Saúde de Cambre, Xerencia de Xestión Integrada de A Coruña SERGAS (Louro-González), A Coruña, Spain; Health Technology Assessment Unit (UETS), Subdirección General de Tecnología e Innovación Sanitaria, Consejería de Sanidad (Díaz del Campo), Madrid, Spain; National Clinical Practice Guideline Programme of the NHS (Gracia), Madrid, Spain; GuíaSalud-Aragon Institute of Health Sciences (Salcedo-Fernandez), Zaragoza, Spain; Department of Clinical Epidemiology and Biostatistics, McMaster University, (Lawson, Haynes), Hamilton, Ont
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Martínez García L, McFarlane E, Barnes S, Sanabria AJ, Alonso-Coello P, Alderson P. Updated recommendations: an assessment of NICE clinical guidelines. Implement Sci 2014; 9:72. [PMID: 24919856 PMCID: PMC4067507 DOI: 10.1186/1748-5908-9-72] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 05/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Updating is important to ensure clinical guideline (CG) recommendations remain valid. However, little research has been undertaken in this field. We assessed CGs produced by the National Institute for Health and Care Excellence (NICE) to identify and describe updated recommendations and to investigate potential factors associated with updating. Also, we evaluated the reporting and presentation of recommendation changes. METHODS We performed a descriptive analysis of original and updated CGs and recommendations, and an assessment of presentation formats and methods for recording information. We conducted a case-control study, defining cases as original recommendations that were updated ('new-replaced' recommendations), and controls as original recommendations that were considered to remain valid ('not changed' recommendations). We performed a comparison of main characteristics between cases and controls, and we planned a multiple regression analysis to identify potential predictive factors for updating. RESULTS We included nine updated CGs (1,306 recommendations) and their corresponding original versions (1,106 recommendations). Updated CGs included 812 (62%) recommendations 'not reviewed', 368 (28.1%) 'new' recommendations, 104 (7.9%) 'amended' recommendations, and 25 (1.9%) recommendations reviewed but unchanged. The presentation formats used to indicate the changes in recommendations varied widely across CGs. Changes in 'amended', 'deleted', and 'new-replaced' recommendations (n = 296) were reported infrequently, mostly in appendices. These changes were recorded in 167 (56.4%) recommendations; and were explained in 81 (27.4%) recommendations. We retrieved a total of 7.1% (n = 78) case recommendations ('new-replaced') and 2.4% (n = 27) control recommendations ('not changed') in original CGs. The updates were mainly from 'Fertility CG', about 'gynaecology, pregnancy and birth' topic, and 'treatment' or 'prevention' purposes. We did not perform the multiple regression analysis as originally planned due to the small sample of recommendations retrieved. CONCLUSION Our study is the first to describe and assess updated CGs and recommendations from a national guideline program. Our results highlight the pressing need to standardise the reporting and presentation of updated recommendations and the research gap about the optimal way to present updates to guideline users. Furthermore, there is a need to investigate updating predictive factors.
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Affiliation(s)
- Laura Martínez García
- Institute of Biomedical Research (IIB Sant Pau), Barcelona, Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, Pavelló 18 C/Sant Antoni Mª Claret 167, Barcelona, Catalunya 08025, España.
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Bonilla CM, Herrero-Albillos J, Figueroa AI, Castán-Guerrero C, Bartolomé J, Calvo-Almazán I, Schmitz D, Weschke E, García LM, Bartolomé F. Parimagnetism in HoCo2 and TmCo2. J Phys Condens Matter 2014; 26:156001. [PMID: 24675016 DOI: 10.1088/0953-8984/26/15/156001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
X-ray magnetic circular dichroism (XMCD), longitudinal (χac) and transverse (TS) ac magnetic susceptibility have been measured in the RCo2 series (R = Ho, and Tm) as a function of temperature and applied magnetic field. We show that parimagnetism is a general behavior among the RCo2 ferrimagnetic series (R being a heavy rare-earth ion). XMCD results supply evidence of the presence of two compensation temperatures above Tc, defining two different parimagnetic configurations, which is a fully unexpected result. The inverse χ'ac curve exhibits a small anomaly which vanishes under low applied magnetic fields. The combination of TS and XMCD measurements allows one to depict new magnetic phase diagrams for these compounds of the RCo2 series. A new scenario allowing one to understand the observed phenomenology as a Griffiths phase-like behavior is proposed, where the amorphous RCo2 represents the undiluted system case.
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Affiliation(s)
- C M Bonilla
- Departamento de Física de la Materia Condensada and Instituto de Ciencia de Materiales de Aragón, CSIC-Universidad de Zaragoza, 50009 Zaragoza, Spain
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Driver SL, Herrero-Albillos J, Bonilla CM, Bartolomé F, García LM, Howard CJ, Carpenter MA. Multiferroic (ferroelastic/ferromagnetic/ferrimagnetic) aspects of phase transitions in RCo2 Laves phases. J Phys Condens Matter 2014; 26:056001. [PMID: 24441049 DOI: 10.1088/0953-8984/26/5/056001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Magnetic phase transitions in RCo2 Laves phases with R as a rare earth element are accompanied by changes in crystallographic space group. For purely structural transitions they would be described as improper ferroelastic and therefore fulfil the condition for multiferroic phase transitions in combining two out of three properties, ferro/antiferromagnetism, ferroelectricity and ferroelasticity. Here lattice parameter data from the literature and new measurements of elastic and anelastic properties, by resonant ultrasound spectroscopy, for NdCo2 and ErCo2 have been analysed from this perspective. The temperature dependence of symmetry-breaking shear strains is consistent with the cubic ↔ tetragonal transition in NdCo2 being close to tricritical in character and the cubic ↔ rhombohedral transition in ErCo2 being first order. Elastic softening and acoustic loss within the stability ranges of the ferroelastic phases can be understood in terms of a combination of intrinsic softening due to strain/order parameter coupling and ferroelastic twin-wall motion. Softening ahead of the transitions does not fit with standard macroscopic descriptions of dynamic effects from other systems but, rather, in the case of NdCo2, might be attributed to the involvement of a second zone centre order parameter related to a separate instability driven by cooperative Jahn-Teller distortions. In ErCo2, acoustic loss in the temperature interval above the transition point is discussed in terms of a possible tweed microstructure associated with strain coupling to local magnetic ordering. The overall multiferroic behaviour can be understood in terms of a single magnetic order parameter (irrep mΓ+4 of magnetic space group Fd3m1') which couples with a structural order parameter (irrep Γ+3 or Γ+5). The coupling is linear/quadratic which, in the case of two separate instabilities, causes them to combine in a single multiferroic phase transition.
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Affiliation(s)
- S L Driver
- Department of Earth Sciences, University of Cambridge, Downing Street, Cambridge CB2 3EQ, UK
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Vernooij RWM, Sanabria AJ, Solà I, Alonso-Coello P, Martínez García L. Guidance for updating clinical practice guidelines: a systematic review of methodological handbooks. Implement Sci 2014; 9:3. [PMID: 24383701 PMCID: PMC3904688 DOI: 10.1186/1748-5908-9-3] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 12/19/2013] [Indexed: 01/27/2023] Open
Abstract
Background Updating clinical practice guidelines (CPGs) is a crucial process for maintaining the validity of recommendations. Methodological handbooks should provide guidance on both developing and updating CPGs. However, little is known about the updating guidance provided by these handbooks. Methods We conducted a systematic review to identify and describe the updating guidance provided by CPG methodological handbooks and included handbooks that provide updating guidance for CPGs. We searched in the Guidelines International Network library, US National Guidelines Clearinghouse and MEDLINE (PubMed) from 1966 to September 2013. Two authors independently selected the handbooks and extracted the data. We used descriptive statistics to analyze the extracted data and conducted a narrative synthesis. Results We included 35 handbooks. Most handbooks (97.1%) focus mainly on developing CPGs, including variable degrees of information about updating. Guidance on identifying new evidence and the methodology of assessing the need for an update is described in 11 (31.4%) and eight handbooks (22.8%), respectively. The period of time between two updates is described in 25 handbooks (71.4%), two to three years being the most frequent (40.0%). The majority of handbooks do not provide guidance for the literature search, evidence selection, assessment, synthesis, and external review of the updating process. Conclusions Guidance for updating CPGs is poorly described in methodological handbooks. This guidance should be more rigorous and explicit. This could lead to a more optimal updating process, and, ultimately to valid trustworthy guidelines.
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Affiliation(s)
| | | | | | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Institute of Biomedical Research (IIB Sant Pau), C/ Sant Antoni Maria Claret 167, Barcelona 08025, Spain.
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Alonso-Coello P, Carrasco-Labra A, Brignardello-Petersen R, Neumann I, Akl EA, Sun X, Johnston BC, Briel M, Busse JW, Glujovsky D, Granados CE, Iorio A, Irfan A, Martínez García L, Mustafa RA, Ramirez-Morera A, Solà I, Tikkinen KAO, Ebrahim S, Vandvik PO, Zhang Y, Selva A, Sanabria AJ, Zazueta OE, Vernooij RWM, Schünemann HJ, Guyatt GH, Guyatt GH. A methodological survey of the analysis, reporting and interpretation of Absolute Risk ReductiOn in systematic revieWs (ARROW): a study protocol. Syst Rev 2013; 2:113. [PMID: 24330779 PMCID: PMC3867670 DOI: 10.1186/2046-4053-2-113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/25/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinicians, providers and guideline panels use absolute effects to weigh the advantages and downsides of treatment alternatives. Relative measures have the potential to mislead readers. However, little is known about the reporting of absolute measures in systematic reviews. The objectives of our study are to determine the proportion of systematic reviews that report absolute measures of effect for the most important outcomes, and ascertain how they are analyzed, reported and interpreted. METHODS/DESIGN We will conduct a methodological survey of systematic reviews published in 2010. We will conduct a 1:1 stratified random sampling of Cochrane vs. non-Cochrane systematic reviews. We will calculate the proportion of systematic reviews reporting at least one absolute estimate of effect for the most patient-important outcome for the comparison of interest. We will conduct multivariable logistic regression analyses with the reporting of an absolute estimate of effect as the dependent variable and pre-specified study characteristics as the independent variables. For systematic reviews reporting an absolute estimate of effect, we will document the methods used for the analysis, reporting and interpretation of the absolute estimate. DISCUSSION Our methodological survey will inform current practices regarding reporting of absolute estimates in systematic reviews. Our findings may influence recommendations on reporting, conduct and interpretation of absolute estimates. Our results are likely to be of interest to systematic review authors, funding agencies, clinicians, guideline developers and journal editors.
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Affiliation(s)
- Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain.
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Martínez García L, Sanabria AJ, Araya I, Lawson J, Haynes RB, Rigau D, Solà I, Díaz Del Campo P, Estrada MD, Etxeandia-Ikobaltzeta I, García Álvarez E, Gracia J, Kotzeva A, Louro-González A, Salcedo-Fernandez F, Trujillo-Martín MM, Alonso-Coello P. Strategies to assess the validity of recommendations: a study protocol. Implement Sci 2013; 8:94. [PMID: 23967896 PMCID: PMC3765147 DOI: 10.1186/1748-5908-8-94] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/02/2013] [Indexed: 11/10/2022] Open
Abstract
Background Clinical practice guidelines (CPGs) become quickly outdated and require a periodic reassessment of evidence research to maintain their validity. However, there is little research about this topic. Our project will provide evidence for some of the most pressing questions in this field: 1) what is the average time for recommendations to become out of date?; 2) what is the comparative performance of two restricted search strategies to evaluate the need to update recommendations?; and 3) what is the feasibility of a more regular monitoring and updating strategy compared to usual practice?. In this protocol we will focus on questions one and two. Methods The CPG Development Programme of the Spanish Ministry of Health developed 14 CPGs between 2008 and 2009. We will stratify guidelines by topic and by publication year, and include one CPG by strata. We will develop a strategy to assess the validity of CPG recommendations, which includes a baseline survey of clinical experts, an update of the original exhaustive literature searches, the identification of key references (reference that trigger a potential recommendation update), and the assessment of the potential changes in each recommendation. We will run two alternative search strategies to efficiently identify important new evidence: 1) PLUS search based in McMaster Premium LiteratUre Service (PLUS) database; and 2) a Restrictive Search (ReSe) based on the least number of MeSH terms and free text words needed to locate all the references of each original recommendation. We will perform a survival analysis of recommendations using the Kaplan-Meier method and we will use the log-rank test to analyse differences between survival curves according to the topic, the purpose, the strength of recommendations and the turnover. We will retrieve key references from the exhaustive search and evaluate their presence in the PLUS and ReSe search results. Discussion Our project, using a highly structured and transparent methodology, will provide guidance of when recommendations are likely to be at risk of being out of date. We will also assess two novel restrictive search strategies which could reduce the workload without compromising rigour when CPGs developers check for the need of updating.
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Affiliation(s)
- Laura Martínez García
- Iberoamerican Cochrane Centre- Biomedical Research Institute Sant Pau IIB Sant Pau, Barcelona, Spain.
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Roqué i Figuls M, Martínez García L, Martinez-Zapata MJ, Pacheco R, Mauricio D, Bonfill Cosp X. Interventions for treating overweight or obesity in adults: an overview of systematic reviews. Cochrane Database of Systematic Reviews 2013. [DOI: 10.1002/14651858.cd010665] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Marta Roqué i Figuls
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Iberoamerican Cochrane Centre, Institute of Biomedical Research (IIB Sant Pau); Sant Antoni Maria Claret 171 Edifici Casa de Convalescència Barcelona Catalunya Spain 08041
| | - Laura Martínez García
- Institute of Biomedical Research (IIB Sant Pau); Iberoamerican Cochrane Centre; Sant Antoni Maria Claret 171 Edifici Casa de Convalescència Barcelona Catalunya Spain 08041
| | - Maria José Martinez-Zapata
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Iberoamerican Cochrane Centre. Universitat Autònoma de Barcelona. Institute of Biomedical Research Sant Pau (IIB Sant Pau), Barcelona; Sant Antoni M. Claret 171 Casa de Convalescència Barcelona Catalonia Spain 08041
| | - Roxana Pacheco
- Hospital Universitari Arnau de Vilanova; Department of Medicine; Rovira Roure, 80 Lleida Spain 25198
| | - Didac Mauricio
- Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLLEIDA); Department of Endocrinology and Nutrition; Rovira Roure, 80 Lleida Spain 25198
| | - Xavier Bonfill Cosp
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain - Universitat Autònoma de Barcelona; Iberoamerican Cochrane Centre, Institute of Biomedical Research (IIB Sant Pau); Sant Antoni M. Claret 171 Casa de Convalescència Barcelona Catalonia Spain 08041
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Figueroa AI, Moya C, Bartolomé J, Bartolomé F, García LM, Pérez N, Labarta A, Batlle X. SiO2 coating effects in the magnetic anisotropy of Fe3-xO4 nanoparticles suitable for bio-applications. Nanotechnology 2013; 24:155705. [PMID: 23518930 DOI: 10.1088/0957-4484/24/15/155705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We present radio frequency transverse susceptibility (TS) measurements on oleic acid-coated and SiO2-coated Fe3-xO4 magnetite nanoparticles. The effects of the type of coating on the interparticle interactions and magnetic anisotropy are evaluated for two different particle sizes in powder samples. On the one hand, SiO2 coating reduces the interparticle interactions as compared to oleic acid coating, the reduction being more effective for 5 nm than for 14 nm diameter particles. On the other hand, the magnetic anisotropy field at low temperature is lower than 1 kOe in all cases and independent of the coating used. Our results are relevant concerning applications in biomedicine, since the SiO2 coating renders 5 and 14 nm hydrophilic particles with very limited agglomeration, low anisotropy, and superparamagnetic behavior at room temperature. The TS technique also allows us to discriminate the influence on the anisotropy field of interparticle interactions from that of the thermal fluctuations.
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Affiliation(s)
- A I Figueroa
- Departamento de Física de la Materia Condensada, Instituto de Ciencia de Materiales de Aragón (ICMA), CSIC-Universidad de Zaragoza, Zaragoza, Spain.
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Alonso-Coello P, Rigau D, Solà I, Martínez García L. La formulación de recomendaciones en salud: el sistema GRADE. Med Clin (Barc) 2013; 140:366-73. [DOI: 10.1016/j.medcli.2012.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 10/15/2012] [Accepted: 10/18/2012] [Indexed: 12/13/2022]
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Abstract
BACKGROUND Post-dural (post-lumbar or post-spinal) puncture headache (PDPH) is one of the most common complications of diagnostic, therapeutic or inadvertent lumbar punctures. Many drug options have been used to prevent headache in clinical practice and have also been tested in some clinical studies, but there are still some uncertainties about their clinical effectiveness. OBJECTIVES To assess the effectiveness and safety of drugs for preventing PDPH in adults and children. SEARCH METHODS The search strategy included the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2012, Issue 5), MEDLINE (from 1950 to May 2012), EMBASE (from 1980 to May 2012) and CINAHL (from 1982 to June 2012). There was no language restriction. SELECTION CRITERIA We considered randomised controlled trials (RCTs) that assessed the effectiveness of any drug used for preventing PDPH. DATA COLLECTION AND ANALYSIS Review authors independently selected studies, assessed risks of bias and extracted data. We estimated risk ratios (RR) for dichotomous data and mean differences (MD) for continuous outcomes. We calculated a 95% confidence interval (CI) for each RR and MD. We did not undertake meta-analysis because participants' characteristics or assessed doses of drugs were too different in the included studies. We performed an intention-to-treat (ITT) analysis. MAIN RESULTS We included 10 RCTs (1611 participants) in this review with a majority of women (72%), mostly parturients (women in labour) (913), after a lumbar puncture for regional anaesthesia. Drugs assessed were epidural and spinal morphine, spinal fentanyl, oral caffeine, rectal indomethacin, intravenous cosyntropin, intravenous aminophylline and intravenous dexamethasone.All the included RCTs reported data on the primary outcome, i.e. the number of participants affected by PDPH of any severity after a lumbar puncture. Epidural morphine and intravenous cosyntropin reduced the number of participants affected by PDPH of any severity after a lumbar puncture when compared to placebo. Also, intravenous aminophylline reduced the number of participants affected by PDPH of any severity after a lumbar puncture when compared to no intervention, while intravenous dexamethasone increased it. Spinal morphine increased the number of participants affected by pruritus when compared to placebo, and epidural morphine increased the number of participants affected by nausea and vomiting when compared to placebo. Oral caffeine increased the number of participants affected by insomnia when compared to placebo.The remainder of the interventions analysed did not show any relevant effect for any of the outcomes.None of the included RCTs reported the number of days that patients stayed in hospital. AUTHORS' CONCLUSIONS Morphine and cosyntropin have shown effectiveness for reducing the number of participants affected by PDPH of any severity after a lumbar puncture, when compared to placebo, especially in patients with high risk of PDPH, such as obstetric patients who have had an inadvertent dural puncture. Aminophylline also reduced the number of participants affected by PDPH of any severity after a lumbar puncture when compared to no intervention in patients undergoing elective caesarean section. Dexamethasone increased the risk of PDPH, after spinal anaesthesia for caesarean section, when compared to placebo. Morphine also increased the number of participants affected by adverse events (pruritus and nausea and vomiting)There is a lack of conclusive evidence for the other drugs assessed (fentanyl, caffeine, indomethacin and dexamethasone).These conclusions should be interpreted with caution, owing to the lack of information, to allow correct appraisal of risk of bias and the small sample sizes of studies.
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Affiliation(s)
- Xavier Basurto Ona
- Emergency Department, Hospital de Figueres, Fundació Salut Empordà, Figueres, Spain.
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Bartolomé J, Bartolomé F, García LM, Figueroa AI, Repollés A, Martínez-Pérez MJ, Luis F, Magén C, Selenska-Pobell S, Pobell F, Reitz T, Schönemann R, Herrmannsdörfer T, Merroun M, Geissler A, Wilhelm F, Rogalev A. Strong paramagnetism of gold nanoparticles deposited on a Sulfolobus acidocaldarius S layer. Phys Rev Lett 2012; 109:247203. [PMID: 23368371 DOI: 10.1103/physrevlett.109.247203] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Indexed: 06/01/2023]
Abstract
Magnetic properties of Au nanoparticles deposited on an archaeal S layer are reported. X-ray magnetic circular dichroism and superconducting quantum interference device magnetometries demonstrate that the particles are strongly paramagnetic, without any indication of magnetic blocking down to 16 mK. The average magnetic moment per particle is M(part)=2.36(7) μ(B). This contribution originates at the particle's Au 5d band, in which an increased number of holes with respect to the bulk value is observed. The magnetic moment per Au atom is 25 times larger than any measured in other Au nanoparticles or any other configurations up to date.
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Affiliation(s)
- J Bartolomé
- Instituto de Ciencia de Materiales de Aragón, CSIC-Universidad de Zaragoza, E-50009 Zaragoza, Spain.
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Castán-Guerrero C, Sesé J, Bartolomé J, Bartolomé F, Herrero-Albillos J, Kronast F, Strichovanec P, Merazzo KJ, Vázquez M, Vavassori P, García LM. Fabrication and magnetic characterization of cobalt antidot arrays: effect of the surrounding continuous film. J Nanosci Nanotechnol 2012; 12:7437-7441. [PMID: 23035490 DOI: 10.1166/jnn.2012.6537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We have performed an experimental study on the influence of a ferromagnetic continuous film in the magnetization reversal processes in discrete submicrometric antidot arrays fabricated on it. In order to compare the magnetic properties, two sets of antidot arrays have been fabricated over a cobalt thin film: embedded in the continuous film, and isolated by a trench surrounding the array. X-ray photoemission electron microscopy images of the virgin state show the same magnetic domain distribution in both sets of samples, finding no evidence of any effect of the surrounding film. This result is supported by the hysteresis loops measured with magneto-optical Kerr effect, as isolated and non-isolated arrays present almost coincident loops. A huge increase of the coercivity of the film is achieved, and the expected dependence on the geometrical parameters of the array is found, connecting the previous studies on the micro- and nanometric scales.
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Affiliation(s)
- C Castán-Guerrero
- Instituto de Ciencia de Materiales de Aragón (ICMA) and Departamento de Física de la Materia Condensada, Consejo Superior de Investigaciones Científicas-Universidad de Zaragoza, C/Pedro Cerbuna 12, 50009 Zaragoza, Spain
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Alonso-Coello P, Martínez García L, Carrasco JM, Solà I, Qureshi S, Burgers JS. The updating of clinical practice guidelines: insights from an international survey. Implement Sci 2011; 6:107. [PMID: 21914177 PMCID: PMC3191352 DOI: 10.1186/1748-5908-6-107] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 09/13/2011] [Indexed: 11/16/2022] Open
Abstract
Background Clinical practice guidelines (CPGs) have become increasingly popular, and the methodology to develop guidelines has evolved enormously. However, little attention has been given to the updating process, in contrast to the appraisal of the available literature. We conducted an international survey to identify current practices in CPG updating and explored the need to standardize and improve the methods. Methods We developed a questionnaire (28 items) based on a review of the existing literature about guideline updating and expert comments. We carried out the survey between March and July 2009, and it was sent by email to 106 institutions: 69 members of the Guidelines International Network who declared that they developed CPGs; 30 institutions included in the U.S. National Guideline Clearinghouse database that published more than 20 CPGs; and 7 institutions selected by an expert committee. Results Forty-four institutions answered the questionnaire (42% response rate). In the final analysis, 39 completed questionnaires were included. Thirty-six institutions (92%) reported that they update their guidelines. Thirty-one institutions (86%) have a formal procedure for updating their guidelines, and 19 (53%) have a formal procedure for deciding when a guideline becomes out of date. Institutions describe the process as moderately rigorous (36%) or acknowledge that it could certainly be more rigorous (36%). Twenty-two institutions (61%) alert guideline users on their website when a guideline is older than three to five years or when there is a risk of being outdated. Twenty-five institutions (64%) support the concept of "living guidelines," which are continuously monitored and updated. Eighteen institutions (46%) have plans to design a protocol to improve their guideline-updating process, and 21 (54%) are willing to share resources with other organizations. Conclusions Our study is the first to describe the process of updating CPGs among prominent guideline institutions across the world, providing a comprehensive picture of guideline updating. There is an urgent need to develop rigorous international standards for this process and to minimize duplication of effort internationally.
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Affiliation(s)
- Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Institute of Biomedical Research, IIB Sant Pau, C/Sant Antoni Maria Claret 171, Barcelona, 08041, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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Abstract
BACKGROUND Post-dural puncture headache (PDPH) is the most common complication of lumbar puncture, an invasive procedure frequently performed in the emergency room. Numerous pharmaceutical drugs have been proposed to treat PDPH but there are still some uncertainties about their clinical effectiveness. OBJECTIVES To assess the effectiveness and safety of drugs for treating PDPH in adults and children. SEARCH STRATEGY The search strategy included the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2011, Issue 2), MEDLINE (from 1950 to June 2011), EMBASE (from 1980 to June 2011) and CINAHL (from 1982 to June 2011). There was no language restriction. SELECTION CRITERIA We considered randomised controlled trials (RCTs) assessing the effectiveness of any pharmacological drug used for treating PDPH. DATA COLLECTION AND ANALYSIS Review authors independently selected studies, assessed risks of bias and extracted data. We estimated risk ratios (RR) for dichotomous data and mean differences (MD) for continuous outcomes. We calculated a 95% confidence interval (CI) for each RR and MD. We did not undertake meta-analysis because the included studies assessed different sorts of drugs or different outcomes. We performed an intention-to-treat (ITT) analysis. MAIN RESULTS We included seven RCTs (200 participants) in this review (between 88% and 90.5% were women; mostly parturients (84% to 87%) after a lumbar puncture for a regional anaesthesia). Pharmacological drugs assessed were oral and intravenous caffeine, subcutaneous sumatriptan, oral gabapentin, oral theophylline, intravenous hydrocortisone and intramuscular adrenocorticotropic hormone (ACTH).One RCT reported data about PDPH persistence of any severity at follow up (primary outcome); caffeine reduced the number of participants with PDPH at one to two hours when compared to placebo. Treatment with caffeine also decreased the need for a conservative supplementary therapeutic option. Treatment with gabapentin versus placebo reported better visual analogue scale (VAS) scores after one, two, three and four days; treatment with hydrocortisone plus conventional treatment showed better VAS scores than conventional treatment alone at six, 24 and 48 hours and treatment with theophylline showed a lower mean "sum of pain" when compared with placebo. Sumatriptan and ACTH did not show any relevant effect for this outcome.There were no clinically significant drug adverse events.The rest of the outcomes were not reported by the RCTs or did not show any relevant effect. AUTHORS' CONCLUSIONS Caffeine has shown effectiveness for treating PDPH, decreasing the proportion of participants with PDPH persistence and those requiring supplementary interventions, when compared with placebo. Gabapentin, theophylline and hydrocortisone have also shown a decrease in pain severity scores when compared with placebo or conventional care.There is a lack of conclusive evidence for the other drugs assessed (sumatriptan and ACTH).These conclusions should be interpreted with caution, due to the lack of information to allow correct appraisal of risk of bias, the small sample sizes of studies and also the limited generalisability, as most participants were post-partum women in their 30s.
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Affiliation(s)
- Xavier Basurto Ona
- Emergency Department, Hospital de Figueres, Fundació Salut Empordà, Rda Rector Aroles s/n, Figueres, Girona-Catalunya, Spain, 17600
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Martínez García L, Morchón Ramos S, Masuet Aumatell C, Ramón Torrell JM. Brief smoking cessation intervention in hospitalized patients with cardiovascular disease. Rev Esp Cardiol 2009; 62:447-450. [PMID: 19401131 DOI: 10.1016/s1885-5857(09)71673-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The objective of this study was to determine the smoking abstinence rate after hospital discharge in cardiovascular patients who had undergone a brief smoking cessation intervention during hospitalization. The prospective cohort study involved 252 smokers who were admitted to the Hospital Universitari de Bellvitge in Catalonia, Spain. Twenty-four hours after hospital discharge, 76.6% of patients were still abstaining from smoking. At 1, 3, 9 and 12 months, the abstinence rate diminished to 71.4%, 67.2%, 64.1% and 62.2%, respectively. Patients diagnosed with ischemic cardiopathy had a significantly lower probability of a smoking relapse: hazard ratio=0.56 (95% confidence interval, 0.36-0.87). At our center, a brief smoking cessation intervention in cardiovascular patients during hospital admission was found unlikely to result in smoking abstinence following discharge.
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Affiliation(s)
- Laura Martínez García
- Departamento de Medicina Preventiva, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona 08907, España
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