1
|
Rubenstein JH, Sawas T, Wani S, Eluri S, Singh S, Chandar AK, Perumpail RB, Inadomi JM, Thrift AP, Piscoya A, Sultan S, Singh S, Katzka D, Davitkov P. AGA Clinical Practice Guideline on Endoscopic Eradication Therapy of Barrett's Esophagus and Related Neoplasia. Gastroenterology 2024; 166:1020-1055. [PMID: 38763697 DOI: 10.1053/j.gastro.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND & AIMS Barrett's esophagus (BE) is the precursor to esophageal adenocarcinoma (EAC). Endoscopic eradication therapy (EET) can be effective in eradicating BE and related neoplasia and has greater risk of harms and resource use than surveillance endoscopy. This clinical practice guideline aims to inform clinicians and patients by providing evidence-based practice recommendations for the use of EET in BE and related neoplasia. METHODS The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess evidence and make recommendations. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients, conducted an evidence review, and used the Evidence-to-Decision Framework to develop recommendations regarding the use of EET in patients with BE under the following scenarios: presence of (1) high-grade dysplasia, (2) low-grade dysplasia, (3) no dysplasia, and (4) choice of stepwise endoscopic mucosal resection (EMR) or focal EMR plus ablation, and (5) endoscopic submucosal dissection vs EMR. Clinical recommendations were based on the balance between desirable and undesirable effects, patient values, costs, and health equity considerations. RESULTS The panel agreed on 5 recommendations for the use of EET in BE and related neoplasia. Based on the available evidence, the panel made a strong recommendation in favor of EET in patients with BE high-grade dysplasia and conditional recommendation against EET in BE without dysplasia. The panel made a conditional recommendation in favor of EET in BE low-grade dysplasia; patients with BE low-grade dysplasia who place a higher value on the potential harms and lower value on the benefits (which are uncertain) regarding reduction of esophageal cancer mortality could reasonably select surveillance endoscopy. In patients with visible lesions, a conditional recommendation was made in favor of focal EMR plus ablation over stepwise EMR. In patients with visible neoplastic lesions undergoing resection, the use of either endoscopic mucosal resection or endoscopic submucosal dissection was suggested based on lesion characteristics. CONCLUSIONS This document provides a comprehensive outline of the indications for EET in the management of BE and related neoplasia. Guidance is also provided regarding the considerations surrounding implementation of EET. Providers should engage in shared decision making based on patient preferences. Limitations and gaps in the evidence are highlighted to guide future research opportunities.
Collapse
Affiliation(s)
- Joel H Rubenstein
- Center for Clinical Management Research, Lieutenant Colonel Charles S. Kettles Veterans Affairs Medical Center, Ann Arbor, Michigan; Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan; Cancer Control and Population Sciences Program, Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Tarek Sawas
- Division of Digestive and Liver Disease, University of Texas Southwestern, Dallas, Texas
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Swathi Eluri
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida
| | - Shailendra Singh
- Division of Gastroenterology, West Virginia University, Morgantown, West Virginia; Advanced Center for Endoscopy, West Virginia University Medicine, Morgantown, West Virginia
| | - Apoorva K Chandar
- Digestive Health Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - John M Inadomi
- Department of Internal Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Aaron P Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota; Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - David Katzka
- Division of Gastroenterology and Hepatology, Columbia University, New York, New York
| | - Perica Davitkov
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio; Division of Gastroenterology, Veterans Affairs Northeast Ohio Healthcare System, Cleveland, Ohio
| |
Collapse
|
2
|
Xun Y, Estill J, Khabsa J, Florez ID, Guyatt GH, Norris SL, Lee MS, Ozaki A, Qaseem A, Schünemann HJ, Shao R, Chen Y, Akl EA. Reporting Conflicts of Interest and Funding in Health Care Guidelines: The RIGHT-COI&F Checklist. Ann Intern Med 2024. [PMID: 38739919 DOI: 10.7326/m23-3274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Conflicts of interest (COIs) of contributors to a guideline project and the funding of that project can influence the development of the guideline. Comprehensive reporting of information on COIs and funding is essential for the transparency and credibility of guidelines. OBJECTIVE To develop an extension of the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement for the reporting of COIs and funding in policy documents of guideline organizations and in guidelines: the RIGHT-COI&F checklist. DESIGN The recommendations of the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network were followed. The process consisted of registration of the project and setting up working groups, generation of the initial list of items, achieving consensus on the items, and formulating and testing the final checklist. SETTING International collaboration. PARTICIPANTS 44 experts. MEASUREMENTS Consensus on checklist items. RESULTS The checklist contains 27 items: 18 about the COIs of contributors and 9 about the funding of the guideline project. Of the 27 items, 16 are labeled as policy related because they address the reporting of COI and funding policies that apply across an organization's guideline projects. These items should be described ideally in the organization's policy documents, otherwise in the specific guideline. The remaining 11 items are labeled as implementation related and they address the reporting of COIs and funding of the specific guideline. LIMITATION The RIGHT-COI&F checklist requires testing in real-life use. CONCLUSION The RIGHT-COI&F checklist can be used to guide the reporting of COIs and funding in guideline development and to assess the completeness of reporting in published guidelines and policy documents. PRIMARY FUNDING SOURCE The Fundamental Research Funds for the Central Universities of China.
Collapse
Affiliation(s)
- Yangqin Xun
- School of Basic Medical Sciences, Lanzhou University, Gansu, and School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.X.)
| | - Janne Estill
- School of Basic Medical Sciences, Lanzhou University, Gansu, China, and Institute of Global Health, University of Geneva, Geneva, Switzerland (J.E.)
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon (J.K.)
| | - Ivan D Florez
- Department of Pediatrics, University of Antioquia, and Pediatric Intensive Care Unit, Clínica Las Americas-AUNA, Medellin, Colombia, and School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada (I.D.F.)
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada (G.H.G., H.J.S.)
| | - Susan L Norris
- Oregon Health & Science University, Portland, Oregon (S.L.N.)
| | - Myeong Soo Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea (M.S.L.)
| | - Akihiko Ozaki
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki City, Fukushima, Japan (A.O.)
| | - Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada (G.H.G., H.J.S.)
| | - Ruitai Shao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (R.S.)
| | - Yaolong Chen
- School of Basic Medical Sciences, Research Unit of Evidence Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), Lanzhou University, and WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Gansu, China (Y.C.)
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon (E.A.A.)
| |
Collapse
|
3
|
West N, Chapple I, Culshaw S, Donos N, Needleman I, Suvan J, Nibali L, Patel A, Preshaw PM, Kebschull M. BSP Implementation of Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline. J Dent 2024:104980. [PMID: 38697506 DOI: 10.1016/j.jdent.2024.104980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES to adapt the supranational European Federation of Periodontology (EFP) Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline for UK healthcare environment, taking into account a broad range of views from stakeholders and patients. SOURCES This UK version, based on the supranational EFP guideline [1] published in the Journal of Clinical Periodontology, was developed using S3-level methodology, combining assessment of formal evidence from 13 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 55 clinical recommendations for the Prevention and Treatment of Peri-implant Diseases, based on the classification for periodontal and peri-implant diseases and conditions [2]. METHODOLOGY The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework, following the S3-process, the underlying evidence was updated and a representative guideline group of 111 delegates from 26 stakeholder organisations was assembled into four working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly. RESULTS AND CONCLUSION Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline for the Prevention and Treatment of Peri-implant Diseases was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the UK healthcare community including the public. CLINICAL SIGNIFICANCE The S3-level-guidelines combine evaluation of formal evidence, grading of recommendations and synthesis with clinical expertise of a broad range of stakeholders. The international S3-level-guideline was implemented for direct clinical applicability in the UK healthcare system, facilitating a consistent, interdisciplinary, evidence-based approach with public involvement for the prevention and treatment of peri-implant diseases.
Collapse
Affiliation(s)
- Nicola West
- Restorative Dentistry, Bristol Dental School, University of Bristol, Bristol BS1 2LY, UK; Restorative Dentistry, Bristol Dental Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU, Secretary General of the European Federation of Periodontology.
| | - Iain Chapple
- Birmingham NIHR Biomedical Research Centre in Inflammation. The University of Birmingham, Birmingham, United Kingdom; Birmingham Community Healthcare NHS Foundation Trust, Birmingham, United Kingdom
| | - Shauna Culshaw
- University of Glasgow Dental School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Nikos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London (AMUL), Turner Street, London, E1 2AD
| | - Ian Needleman
- Unit of Periodontology, UCL Eastman Dental Institute, Bloomsbury Campus, Rockefeller Building, 21 University Street, London, WC1E 6DE
| | - Jeanie Suvan
- Unit of Periodontology, UCL Eastman Dental Institute, Bloomsbury Campus, Rockefeller Building, 21 University Street, London, WC1E 6DE
| | - Luigi Nibali
- Periodontology Unit, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guys Hospital, Great Maze Pond, London, SE1 9RT
| | - Amit Patel
- Birmingham Dental Specialists, Associate Professor, University of Birmingham, Birmingham, UK, President of the Association of Dental Implantology
| | - Philip M Preshaw
- School of Dentistry, University of Dundee, Dundee UK; School of Dental Sciences, University of Newcastle, Newcastle upon Tyne, UK
| | - Moritz Kebschull
- Birmingham NIHR Biomedical Research Centre in Inflammation. The University of Birmingham, Birmingham, United Kingdom; Birmingham Community Healthcare NHS Foundation Trust, Birmingham, United Kingdom; Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY, USA; School of Dentistry, University of Birmingham, Birmingham B5 7EG, UK, President-Elect of the European Federation of Periodontology.
| |
Collapse
|
4
|
Murayama A, Aizawa M, Byreddy KR, Higuchi K, Senoo Y. Conflicts of Interest Among Cardiology Clinical Practice Guideline Authors in Japan. J Am Heart Assoc 2024; 13:e034506. [PMID: 38606773 DOI: 10.1161/jaha.124.034506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Clinical practice guidelines (CPGs) offer disease management recommendations based on scientific evidence. However, financial conflicts of interest between CPG developers and the pharmaceutical industry could bias these recommendations, potentially affecting patient care. Proper management of these conflicts of interest is particularly crucial for maintaining the integrity of CPGs. The study aimed to evaluate the extent of financial relationships between the pharmaceutical industry and authors of CPGs for cardiovascular diseases in Japan. METHODS AND RESULTS The study analyzed personal payments from the pharmaceutical industry to authors of cardiovascular disease CPGs published by the Japanese Circulation Society from January 2015 to December 2022. Payment data, including speaking, consultancy, and writing fees from 2016 to 2020, were extracted from a publicly available database containing personal payments disclosed by all major pharmaceutical companies. A total of 929 unique authors from 37 eligible Japanese Circulation Society CPGs were identified. Notably, 94.4% of these authors received personal payments from pharmaceutical companies, totaling >US $70.8 million. The mean±SD payment per author was US $76 314±138 663) and the median payment per author was US $20 792 (interquartile range: US $4262-US $76 998) over the 5-year period. Chairs of CPGs received significantly higher payments than other authors. More than 80% of authors in each CPG received personal payments. CONCLUSIONS The study elucidated that there were considerable financial relationships between pharmaceutical companies and cardiology CPG authors in Japan. This finding deviates from international conflict of interest management policies, suggesting the need for more stringent conflict of interest management strategies by the Japanese Circulation Society to ensure the development of trustworthy and evidence-based CPGs.
Collapse
Affiliation(s)
- Anju Murayama
- Tohoku University School of Medicine Sendai Miyagi Japan
- Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai New York NY USA
| | - Megumi Aizawa
- Department of Industrial Engineering and Economics Tokyo Institute of Technology Meguro Tokyo Japan
| | - Keerthana R Byreddy
- Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai New York NY USA
| | | | - Yuki Senoo
- Higashi Totsuka Memorial Hospital Yokohama Kanagawa Japan
| |
Collapse
|
5
|
Wiersma M, Kerridge IH, Lipworth W. Perspectives on non-financial conflicts of interest in health-related journals: A scoping review. Account Res 2024:1-37. [PMID: 38602335 DOI: 10.1080/08989621.2024.2337046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/26/2024] [Indexed: 04/12/2024]
Abstract
The objective of this scoping review was to systematically review the literature on how non-financial conflicts of interest (nfCOI) are defined and evaluated, and the strategies suggested for their management in health-related and biomedical journals. PubMed, Embase, Scopus and Web of Science were searched for peer reviewed studies published in English between 1970 and December 2023 that addressed at least one of the following: the definition, evaluation, or management of non-financial conflicts of interest. From 658 studies, 190 studies were included in the review. nfCOI were discussed most commonly in empirical (22%; 42/190), theoretical (15%; 29/190) and "other" studies (18%; 34/190) - including commentary, perspective, and opinion articles. nfCOI were addressed frequently in the research domain (36%; 68/190), publication domain (29%; 55/190) and clinical practice domain (17%; 32/190). Attitudes toward nfCOI and their management were divided into two distinct groups. The first larger group claimed that nfCOI were problematic and required some form of management, whereas the second group argued that nfCOI were not problematic, and therefore, did not require management. Despite ongoing debates about the nature, definition, and management of nfCOI, many articles included in this review agreed that serious consideration needs to be given to the prevalence, impact and optimal mitigation of non-financial COI.
Collapse
Affiliation(s)
- Miriam Wiersma
- Sydney Health Ethics, The University of Sydney, Sydney, Australia
| | - Ian H Kerridge
- Haematology Department, Royal North Shore Hospital, St Leonards, Australia
| | - Wendy Lipworth
- Philosophy Department, Ethics and Agency Research Centre, Macquarie University, Sydney, Australia
| |
Collapse
|
6
|
Bognanni A, Fiocchi A, Arasi S, Chu DK, Ansotegui I, Assa'ad AH, Bahna SL, Berni Canani R, Bozzola M, Dahdah L, Dupont C, Dziechciarz P, Ebisawa M, Firmino RT, Chu A, Galli E, Horvath A, Kamenwa R, Lack G, Li H, Martelli A, Nowak-Węgrzyn A, Papadopoulos NG, Pawankar R, Roldan Y, Said M, Sánchez-Borges M, Shamir R, Spergel JM, Szajewska H, Terracciano L, Vandenplas Y, Venter C, Waffenschmidt S, Waserman S, Warner A, Wong GW, Schünemann HJ, Brozek JL. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guideline update - XII - Recommendations on milk formula supplements with and without probiotics for infants and toddlers with CMA. World Allergy Organ J 2024; 17:100888. [PMID: 38706757 PMCID: PMC11068951 DOI: 10.1016/j.waojou.2024.100888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 05/07/2024] Open
Abstract
Background Cow's milk allergy (CMA) is the most common food allergy in infants. The replacement with specialized formulas is an established clinical approach to ensure adequate growth and minimize the risk of severe allergic reactions when breastfeeding is not possible. Still, given the availability of multiple options, such as extensively hydrolyzed cow's milk protein formula (eHF-CM), amino acid formula (AAF), hydrolyzed rice formula (HRF) and soy formulas (SF), there is some uncertainty as to the most suitable choice with respect to health outcomes. Furthermore, the addition of probiotics to a formula has been proposed as a potential approach to maximize benefit. Objective These evidence-based guidelines from the World Allergy Organization (WAO) intend to support patients, clinicians, and others in decisions about the use of milk specialized formulas, with and without probiotics, for individuals with CMA. Methods WAO formed a multidisciplinary guideline panel balanced to include the views of all stakeholders and to minimize potential biases from competing interests. The McMaster University GRADE Centre supported the guideline-development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE Evidence-to-Decision frameworks, which were subject to review by stakeholders. Results After reviewing the summarized evidence and thoroughly discussing the different management options, the WAO guideline panel suggests: a) using an extensively hydrolyzed (cow's milk) formula or a hydrolyzed rice formula as the first option for managing infants with immunoglobulin E (IgE) and non-IgE-mediated CMA who are not being breastfed. An amino-acid formula or a soy formula could be regarded as second and third options respectively; b) using either a formula without a probiotic or a casein-based extensively hydrolyzed formula containing Lacticaseibacillus rhamnosus GG (LGG) for infants with either IgE or non-IgE-mediated CMA.The issued recommendations are labeled as "conditional" following the GRADE approach due to the very low certainty about the health effects based on the available evidence. Conclusions If breastfeeding is not available, clinicians, patients, and their family members might want to discuss all the potential desirable and undesirable consequences of each formula in infants with CMA, integrating them with the patients' and caregivers' values and preferences, local availability, and cost, before deciding on a treatment option. We also suggest what research is needed to determine with greater certainty which formulas are likely to be the most beneficial, cost-effective, and equitable.
Collapse
Affiliation(s)
- Antonio Bognanni
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessandro Fiocchi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome 00165, Italy
| | - Stefania Arasi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome 00165, Italy
| | - Derek K. Chu
- Department of Medicine, Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | | | - Amal H. Assa'ad
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sami L. Bahna
- Allergy and Immunology Section, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Roberto Berni Canani
- Pediatric Allergy Program at the Department of Translational Medical Science, and ImmunoNutritionLab at Ceinge Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Martin Bozzola
- Department of Medicine, Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, British Hospital-Perdriel, Buenos Aires, Argentina
| | - Lamia Dahdah
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome 00165, Italy
| | - Christophe Dupont
- Paris Descartes University, Pediatric Gastroenterology, Necker Hospital, Paris, France
- Clinique Marcel Sembat, Boulogne-Billancourt, France
| | - Piotr Dziechciarz
- Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - Ramon T. Firmino
- Faculty of Medical Sciences of Campina Grande, UNIFACISA University Centre, Campina Grande, Paraiba, Brazil
| | - Alexandro Chu
- Department of Medicine, Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | - Elena Galli
- Pediatric Allergy Unit, San Pietro Hospital - Fatebenefratelli, Rome, Italy
| | - Andrea Horvath
- Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Rose Kamenwa
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - Gideon Lack
- King's College London, Asthma-UK Centre in Allergic Mechanisms of Asthma, Department of Pediatric Allergy, St Thomas' Hospital, London, UK
| | - Haiqi Li
- Department of Primary Child Care, Children's Hospital, Chongqing Medical University, China
| | - Alberto Martelli
- Member of Italian Society of Allergy and Pediatric Immunology (SIAIP), Italy
| | - Anna Nowak-Węgrzyn
- Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, NY, USA
- Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Nikolaos G. Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Ruby Pawankar
- Division of Allergy, Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Yetiani Roldan
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maria Said
- Allergy & Anaphylaxis Australia, Castle Hill, New South Wales, Australia
| | - Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad and Clínica El Avila, Caracas, Venezuela
| | - Raanan Shamir
- Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan M. Spergel
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Hania Szajewska
- Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Luigi Terracciano
- Pediatric Primary Care, National Pediatric Health Care System, Milan, Italy
| | - Yvan Vandenplas
- Department of Pediatric Gastroenterology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Carina Venter
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Siw Waffenschmidt
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Institute for Quality and Efficiency in Health Care, Cologne, Germany
| | - Susan Waserman
- Department of Medicine, Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | | | - Gary W.K. Wong
- Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Medicine, Division of Internal Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jan L. Brozek
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
7
|
Wentzensen N, Garcia F, Clarke MA, Massad LS, Cheung LC, Egemen D, Guido R, Huh W, Saslow D, Smith RA, Unger ER, Perkins RB. Enduring Consensus Guidelines for Cervical Cancer Screening and Management: Introduction to the Scope and Process. J Low Genit Tract Dis 2024; 28:117-123. [PMID: 38446573 DOI: 10.1097/lgt.0000000000000804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
OBJECTIVES The Enduring Consensus Cervical Cancer Screening and Management Guidelines (Enduring Guidelines) effort is a standing committee to continuously evaluate new technologies and approaches to cervical cancer screening, management, and surveillance. METHODS AND RESULTS The Enduring Guidelines process will selectively incorporate new technologies and approaches with adequate supportive data to more effectively improve cancer prevention for high-risk individuals and decrease unnecessary procedures in low-risk individuals. This manuscript describes the structure, process, and methods of the Enduring Guidelines effort. Using systematic literature reviews and primary data sources, risk of precancer will be estimated and recommendations will be made based on risk estimates in the context of established risk-based clinical action thresholds. The Enduring Guidelines process will consider health equity and health disparities by assuring inclusion of diverse populations in the evidence review and risk assessment and by developing recommendations that provide a choice of well-validated strategies that can be adapted to different settings. CONCLUSIONS The Enduring Guidelines process will allow updating existing cervical cancer screening and management guidelines rapidly when new technologies are approved or new scientific evidence becomes available.
Collapse
Affiliation(s)
- Nicolas Wentzensen
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Francisco Garcia
- Health and Community Services Administration, Pima County, Tucson, AZ
| | - Megan A Clarke
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - L Stewart Massad
- Department of Obstetrics and Gynecology, Washington University, St. Louis, MO
| | - Li C Cheung
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Didem Egemen
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Richard Guido
- University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pittsburgh, PA
| | - Warner Huh
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Elizabeth R Unger
- Chronic Viral Diseases Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine/Boston Medical Center, Boston, MA
| |
Collapse
|
8
|
Murayama A, Shin N, Higuchi K, Kohli I, Kugo H, Senoo Y. Financial conflicts of interest between infectious diseases clinical practice guideline authors and the pharmaceutical industry in Japan. Infect Dis (Lond) 2024; 56:330-334. [PMID: 38299873 DOI: 10.1080/23744235.2024.2309351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 02/02/2024] Open
Affiliation(s)
- Anju Murayama
- Tohoku University School of Medicine, Sendai City, Miyagi, Japan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Naoki Shin
- Faculty of Medicine, School of Medicine, International University of Health and Welfare, Narita City, Chiba, Japan
| | - Kenichi Higuchi
- Tohoku University School of Medicine, Sendai City, Miyagi, Japan
| | - Isha Kohli
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Hinari Kugo
- Tohoku University School of Medicine, Sendai City, Miyagi, Japan
| | - Yuki Senoo
- Higashitotsuka Memorial Hospital, Yokohama City, Kanagawa, Japan
| |
Collapse
|
9
|
Chu DK, Schneider L, Asiniwasis RN, Boguniewicz M, De Benedetto A, Ellison K, Frazier WT, Greenhawt M, Huynh J, Kim E, LeBovidge J, Lind ML, Lio P, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Wang J, Wheeler KE, Guyatt GH, Capozza K, Begolka WS, Chu AWL, Zhao IX, Chen L, Oykhman P, Bakaa L, Golden D, Shaker M, Bernstein JA, Greenhawt M, Horner CC, Lieberman J, Stukus D, Rank MA, Wang J, Ellis A, Abrams E, Ledford D, Chu DK. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol 2024; 132:274-312. [PMID: 38108679 DOI: 10.1016/j.anai.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Guidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology. OBJECTIVE To produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD. METHODS A multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group supported guideline development by performing systematic evidence reviews, facilitating guideline processes, and holding focus groups with patient and family partners. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed rating the certainty of evidence and strength of recommendations. Evidence-to-decision frameworks, subjected to public comment, translated evidence to recommendations using trustworthy guideline principles. RESULTS The panel agreed on 25 recommendations to gain and maintain control of AD for patients with mild, moderate, and severe AD. The eAppendix provides practical information and implementation considerations in 1-2 page patient-friendly handouts. CONCLUSION These evidence-based recommendations address optimal use of (1) topical treatments (barrier moisturization devices, corticosteroids, calcineurin inhibitors, PDE4 inhibitors [crisaborole], topical JAK inhibitors, occlusive [wet wrap] therapy, adjunctive antimicrobials, application frequency, maintenance therapy), (2) dilute bleach baths, (3) dietary avoidance/elimination, (4) allergen immunotherapy, and (5) systemic treatments (biologics/monoclonal antibodies, small molecule immunosuppressants [cyclosporine, methotrexate, azathioprine, mycophenolate, JAK inhibitors], and systemic corticosteroids) and UV phototherapy (light therapy).
Collapse
Affiliation(s)
- Derek K Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada.
| | - Lynda Schneider
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts.
| | | | - Mark Boguniewicz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Division of Pediatric Allergy and Clinical Immunology, National Jewish Health, Denver, Colorado
| | - Anna De Benedetto
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | | | - Winfred T Frazier
- Department of Family Medicine, UPMC St. Margaret, Pittsburgh, Pennsylvania
| | - Matthew Greenhawt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Section of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colorado
| | - Joey Huynh
- Sepulveda VA Medical Center, North Hills, California
| | | | - Jennifer LeBovidge
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Mary Laura Lind
- School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Arizona
| | - Peter Lio
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen A Martin
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Monica O'Brien
- Tufts University School of Medicine, Boston, Massachusetts
| | - Peck Y Ong
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics, USC Keck School of Medicine, Los Angeles, California
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jonathan M Spergel
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Kathryn E Wheeler
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Gordon H Guyatt
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Korey Capozza
- Global Parents for Eczema Research, Santa Barbara, California
| | | | - Alexandro W L Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Irene X Zhao
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Lina Chen
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Paul Oykhman
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Layla Bakaa
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - David Golden
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marcus Shaker
- Dartmouth Geisel School of Medicine and Dartmouth Hitchcock Medical Center, Section of Allergy, Lebanon, New Hampshire
| | | | - Matthew Greenhawt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Section of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colorado
| | - Caroline C Horner
- Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Jay Lieberman
- University of Tennessee Health Science Center and LeBonheur Children's Hospital, Memphis, Tennessee
| | - David Stukus
- Nationwide Children's Hospital and Ohio State University College of Medicine, Columbus, Ohio
| | - Matthew A Rank
- Mayo Clinic in Arizona and Phoenix Children's Hospital, Scottsdale and Phoenix, Arizona
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Anne Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Elissa Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dennis Ledford
- Morsani College of Medicine, University of South Florida and James A. Haley Veterans' Affairs Hospital, Tampa, Florida
| | - Derek K Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| |
Collapse
|
10
|
Rey Rubiano AM, González-Teshima LY, Arango L, Blanco-Avellaneda C, Carvajal Gutiérrez JJ, Castaño-Llano R, Gómez Zuleta MA, González C, Peñaloza-Ramírez A, Pinilla Morales R, Pinto Carta R, Polanía Liscano HA, Rincón Sánchez RA, Sepúlveda Copete M, Vargas-Rubio R, Avendaño Capriles CA, García-Sierra AM, Yepes-Nuñez JJ. Clinical practice guideline on the use of single-operator cholangioscopy in the diagnosis of indeterminate biliary stricture and the treatment of difficult biliary stones. Surg Endosc 2024; 38:499-510. [PMID: 38148404 PMCID: PMC10830582 DOI: 10.1007/s00464-023-10569-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/23/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND AND AIMS Single-operator cholangioscopy (SOC) offer a diagnostic and therapeutic alternative with an improved optical resolution over conventional techniques; however, there are no standardized clinical practice guidelines for this technology. This evidence-based guideline from the Colombian Association of Digestive Endoscopy (ACED) intends to support patients, clinicians, and others in decisions about using in adults the SOC compared to endoscopic retrograde cholangiopancreatography (ERCP), to diagnose indeterminate biliary stricture and to manage difficult biliary stones. METHODS ACED created a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. Universidad de los Andes and the Colombia Grading of Recommendations Assessment, Development and Evaluation (GRADE) Network supported the guideline-development process, updating and performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The GRADE approach was used, including GRADE Evidence-to-Decision frameworks. RESULTS The panel agreed on one recommendation for adult patients with indeterminate biliary strictures and one for adult patients with difficult biliary stones when comparing SOC versus ERCP. CONCLUSION For adult patients with indeterminate biliary strictures, the panel made a conditional recommendation for SOC with stricture pattern characterization over ERCP with brushing and/or biopsy for sensitivity, specificity, and procedure success rate outcomes. For the adult patients with difficult biliary stones the panel made conditional recommendation for SOC over ERCP with large-balloon dilation of papilla. Additional research is required on economic estimations of SOC and knowledge translation evaluations to implement SOC intervention in local contexts.
Collapse
Affiliation(s)
- Adriana Margarita Rey Rubiano
- School of Medicine, Universidad de los Andes, Carrera 1 # 18a-12, Bogotá, D.C., Colombia
- Department of Gastroenterology, Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia
| | | | - Lázaro Arango
- Department of Clinical Surgical Gastroenterology, University of Caldas, Manizales, Caldas, Colombia.
- Department of Endoscopy and Gastroenterology, University of Caldas, Manizales, Caldas, Colombia.
- Union of surgeons, Zentria Group, Manizales, Caldas, Colombia.
| | - Camilo Blanco-Avellaneda
- Department of Gastrointestinal Surgery and Digestive Endoscopy, Pontificia Universidad Javeriana, Bogotá, D.C, Colombia
- Education and Research Group, Faculty of Education, Universidad El Bosque, Bogotá, D.C., Colombia
- Videoendoscopy Unit of Restrepo Ltda, Bogotá, D.C, Colombia
| | - Jhon Jaime Carvajal Gutiérrez
- Department of Gastroenterology, Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia
- Department of Internal Medicine, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Rodrigo Castaño-Llano
- Department of Gastroenterology, Universidad de Antioquia, Medellín, Antioquia, Colombia
- Institute of Cancerology, Clínica las Américas Auna, Medellín, Antioquia, Colombia
| | - Martin Alonso Gómez Zuleta
- Department of Internal Medicine, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
- Department of Internal Medicine, Gastroenterology Section, Hospital Universitario Nacional de Colombia, Bogotá, D.C., Colombia
| | - Carlos González
- Department of Gastroenterology and Digestive Endoscopy, Clínica Reina Sofia, Bogotá, D.C., Colombia
- Department of Gastroenterology and Digestive Endoscopy, Fundación Universitaria Sanitas, Bogotá, D.C., Colombia
- Department of Gastroenterology, Clínica Colombia, Bogotá, D.C., Colombia
| | - Arecio Peñaloza-Ramírez
- Department of Gastroenterology, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia
- Department of Gastroenterology, Hospital de San José, Bogotá, D.C., Colombia
| | - Raúl Pinilla Morales
- Department of Gastroenterology and Oncological Digestive Endoscopy, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia
- School of Medicine, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
| | - Renzo Pinto Carta
- Colombian Association of Digestive Endoscopy, Bogotá, D.C., Colombia
- American Society for Gastrointestinal Endoscopy, Rochester, USA
| | - Héctor Adolfo Polanía Liscano
- Department of Gastroenterology, Universidad Surcolombiana, Neiva, Huila, Colombia
- Endotek Ltda, Hospital Universitario Neiva, Neiva, Huila, Colombia
| | - Reinaldo Andrés Rincón Sánchez
- Department of Internal Medicine and Gastroenterology, Pontificia Universidad Javeriana - Hospital Universitario San Ignacio, Bogotá, D.C., Colombia
- Department of Gastroenterology, Fundación Clínica Shaio, Bogotá, D.C., Colombia
| | | | - Rómulo Vargas-Rubio
- Department of Gastroenterology, Hospital Universitario de San Ignacio, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia
| | - Camilo Andrés Avendaño Capriles
- School of Medicine, Universidad del Norte, Barranquilla, Colombia
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Andrés Mauricio García-Sierra
- School of Medicine, Universidad de los Andes, Carrera 1 # 18a-12, Bogotá, D.C., Colombia
- School of Global Health Management and Informatics, University of Central Florida, Orlando, USA
| | - Juan José Yepes-Nuñez
- School of Medicine, Universidad de los Andes, Carrera 1 # 18a-12, Bogotá, D.C., Colombia.
- Pulmonology Service, Internal Medicine Section, Fundación Santa Fe de Bogotá University Hospital, Bogotá, D.C., Colombia.
- Colombia GRADE Network, Bogotá, D.C., Colombia.
| |
Collapse
|
11
|
Piggott T, Moja L, Jenei K, Kredo T, Skoetz N, Banzi R, Trapani D, Leong T, McCaul M, Lavis JN, Akl EA, Nonino F, Iorio A, Laurson-Doube J, Huttner BD, Schünemann HJ. GRADE Concept 7: Issues and Insights Linking Guideline Recommendations to Trustworthy Essential Medicine Lists. J Clin Epidemiol 2024; 166:111241. [PMID: 38123105 PMCID: PMC10939133 DOI: 10.1016/j.jclinepi.2023.111241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Guidelines and essential medicine lists (EMLs) bear similarities and differences in the process that lead to decisions. Access to essential medicines is central to achieve universal health coverage. The World Health Organization (WHO) EML has guided prioritization of essential medicines globally for nearly 50 years, and national EMLs (NEMLs) exist in over 130 countries. Guideline and EML decisions, at WHO or national levels, are not always coordinated and aligned. We sought to explore challenges, and potential solutions, for decision-making to support trustworthy medicine selection for EMLs from a Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Working Group perspective. We primarily focus on the WHO EML; however, our findings may be applicable to NEML decisions as well. STUDY DESIGN AND SETTING We identified key challenges in connecting the EML to health guidelines by involving a broad group of stakeholders and assessing case studies including real applications to the WHO EML, South Africa NEML, and a multiple sclerosis guideline connected to a WHO EML application for multiple sclerosis treatments. To address challenges, we utilized the results of a survey and feedback from the stakeholders, and iteratively met as a project group. We drafted a conceptual framework of challenges and potential solutions. We presented a summary of the results for feedback to all attendees of the GRADE Working Group meetings in November 2022 (approximately 120 people) and in May 2023 (approximately 100 people) before finalizing the framework. RESULTS We prioritized issues and insights/solutions that addressed the connections between the EML and health guidelines. Our suggested solutions include early planning alignment of guideline groups and EMLs, considering shared participation to strengthen linkage, further clarity on price/cost considerations, and using explicit shared criteria to make guideline and EML decisions. We also provide recommendations to strengthen the connection between WHO EML and NEMLs including through contextualization methods. CONCLUSION This GRADE concept article, jointly developed by key stakeholders from the guidelines and EMLs field, identified key conceptual issues and potential solutions to support the continued advancement of trustworthy EMLs. Adopting structured decision criteria that can be linked to guideline recommendations bears the potential to advance health equity and gaps in availability of essential medicines within and between countries.
Collapse
Affiliation(s)
- Thomas Piggott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Family Medicine, Queens University, Kingston, Canada.
| | - Lorenzo Moja
- Department of Health Product Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Kristina Jenei
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Tamara Kredo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Division of Clinical Pharmacology, Department of Medicine and Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Nicole Skoetz
- Institute of Public Health, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Rita Banzi
- Mario Negri Institute for Pharmacological Research, IRCCS, Milan, Italy
| | - Dario Trapani
- Department of Oncology and Hematology, University of Milan, Milan, Italy; European institute of oncology, IRCCS, Milan, Italy
| | - Trudy Leong
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Michael McCaul
- Division of Epidemiology and Biostatistics, Department of Global Health, Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - John N Lavis
- McMaster Health Forum, McMaster University, Hamilton, Canada; Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Francesco Nonino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Epidemiology and Statistics, Bologna, Italy; WHO Collaborating Centre in Evidence-Based Research Synthesis and Guideline Development, Regione Emilia-Romagna, Bologna, Italy
| | - Alfonso Iorio
- Department of Research Methods, Evidence, and Impact, Mike Gent Chair in Healthcare Research, McMaster University, Hamilton, Canada
| | | | - Benedikt D Huttner
- Department of Health Product Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Medicine, McMaster University, Hamilton, Canada.
| |
Collapse
|
12
|
Sieferle K, Schaefer C, Bitzer EM. Management of evidence and conflict of interest in guidelines on early childhood allergy prevention and child nutrition: study protocol of a systematic synthesis of guidelines and explorative network analysis. F1000Res 2023; 11:1290. [PMID: 38239264 PMCID: PMC10794862 DOI: 10.12688/f1000research.123571.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 01/22/2024] Open
Abstract
Background With the rising prevalence of allergic diseases in children, prevention of childhood allergies becomes an important public health issue. Recently, a paradigm shift is taking place in the approach to preventing allergies, and clinical practice guidelines (CPG) and food-based dietary guidelines (FBDG) play an important role in providing practitioners with the latest evidence and reliable guidance. However, concern about the methodological quality of the development of FBDGs and CPGs, including limitations in the systematic reviews, lack of transparency and unmanaged conflicts of interest (COI), reduce the trust in these guidelines. Methods We aim to synthesize the available guidance on early childhood allergy prevention (ECAP) through a systematic search for national and international CPGs and FBDGs concerning ECAP and child nutrition (CN) and to assess the quality of the guidelines and management of COI. Additionally, we will analyse the content and the evidence base of the recommendation statements. We aim to quantify the COI in guideline panellists and explore possible associations between COI and recommendations. Through a social network analysis, we expect to elucidate ties between panellists, researchers, institutions, industry and other sponsors. Guidelines are an important tool to inform healthcare practitioners with the newest evidence, but quality and reliability have to be high. This study will help identify potential for further improvement in the development of guidelines and the management of COI. If the social network analysis proves feasible and reveals more information on COI in comparison to disclosed COI from the previous analyses, the methodology can be developed further to identify undisclosed COIs in panelists. Ethics and dissemination This research does not require ethical approval because no human subjects are involved. Results will be published in international peer-reviewed open access journals and via presentations at scientific conferences.
Collapse
Affiliation(s)
- Katharina Sieferle
- Department of Public Health and Health Education, Pädagogische Hochschule, Freiburg, 79117, Germany
| | | | - Eva Maria Bitzer
- Department of Public Health and Health Education, Pädagogische Hochschule, Freiburg, 79117, Germany
| |
Collapse
|
13
|
Yamamoto N, Ozaki A, Taito S, Ariie T, Someko H, Saito H, Tanimoto T, Kataoka Y. Association between Conflicts of Interest Disclosure and Quality of Clinical Practice Guidelines in Japan: A Meta-Epidemiological Study. J Pers Med 2023; 13:1722. [PMID: 38138949 PMCID: PMC10744963 DOI: 10.3390/jpm13121722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
Accurate disclosure of financial conflicts of interest (COI) among clinical practice guideline (CPG) developers is critical to ensure the quality of CPGs. However, there is limited evidence on the impact of underreporting COIs on the quality of CPGs. This study aimed to examine the proportion of underreported COI disclosures in the development of Japanese CPGs and to estimate the association between underreported COIs and CPG quality using the Appraisal of Guidelines for Research & Evaluation (AGREE) II. Twenty-three Japanese CPGs published in 2019 and their 1114 developers were included in the study. The results show that underreporting of COIs occurred in 52% of the included CPGs and 8% of all CPG developers. Underreporting COI disclosures was negatively associated with low-quality CPG (Odds ratio [OR], 0.57; 95% confidence interval [CI]: 0.11, 3.04). On the other hand, CPGs that had more than 13% of CPG developers with voting rights on recommendation decisions and underreporting of COI disclosures were positively associated with low quality (OR, 1.78; 95% CI: 0.25, 12.45). For individual CPG developers with voting rights for recommendation decisions, the presence of a COI was positively associated with low quality (OR, 1.11; 95% CI: 0.71, 1.75). This study demonstrates that the involvement and underreporting of COIs did not seriously distort the CPG development process. However, the COI-related factors of CPG developers with voting rights for recommendation decisions may be associated with low CPG quality.
Collapse
Affiliation(s)
- Norio Yamamoto
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Tokyo 113-8510, Japan
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima 972-8322, Japan
| | - Shunsuke Taito
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima 734-0037, Japan
| | - Takashi Ariie
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
- Department of Physical Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Fukuoka 286-8686, Japan
| | - Hidehiro Someko
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
- Department of General Internal Medicine, Asahi General Hospital, Chiba 289-2511, Japan
| | - Hiroaki Saito
- Department of Internal Medicine, Soma Central Hospital, Fukushima 975-0033, Japan
| | - Tetsuya Tanimoto
- Department of Internal Medicine, Navitas Clinic, Tokyo 160-0022, Japan
| | - Yuki Kataoka
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto 616-8147, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto 606-8501, Japan
| |
Collapse
|
14
|
Markar SR, Menon N, Guidozzi N, Kontouli KM, Mavridis D, Andreou A, Berlth F, Bonavina L, Cushieri A, Fourie L, Gossage J, Gronnier C, Hazebroek EJ, Krishnadath S, Low DE, McCord M, Pouw RE, Watson DI, Carrano FM, Ortenzi M, Antoniou SA. EAES Multidisciplinary Rapid Guideline: systematic review, meta-analysis, GRADE assessment and evidence-informed recommendations on the surgical management of paraesophageal hernias. Surg Endosc 2023; 37:9013-9029. [PMID: 37910246 DOI: 10.1007/s00464-023-10511-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/01/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND New evidence has emerged since latest guidelines on the management of paraesophageal hernia, and guideline development methodology has evolved. Members of the European Association for Endoscopic Surgery have prioritized the management of paraesophageal hernia to be addressed by pertinent recommendations. OBJECTIVE To develop evidence-informed clinical practice recommendations on paraesophageal hernias, through evidence synthesis and a structured evidence-to-decision framework by an interdisciplinary panel of stakeholders. METHODS We performed three systematic reviews, and we summarized and appraised the certainty of the evidence using the GRADE methodology. A panel of general and upper gastrointestinal surgeons, gastroenterologists and a patient advocate discussed the evidence in the context of benefits and harms, the certainty of the evidence, acceptability, feasibility, equity, cost and use of resources, moderated by a Guidelines International Network-certified master guideline developer and chair. We developed the recommendations in a consensus meeting, followed by a modified Delphi survey. RESULTS The panel suggests surgery over conservative management for asymptomatic/minimally symptomatic paraesophageal hernias (conditional recommendation), and recommends conservative management over surgery for asymptomatic/minimally symptomatic paraesophageal hernias in frail patients (strong recommendation). Further, the panel suggests mesh over sutures for hiatal closure in paraesophageal hernia repair, fundoplication over gastropexy in elective paraesophageal hernia repair, and gastropexy over fundoplication in patients who have cardiopulmonary instability and require emergency paraesophageal hernia repair (conditional recommendation). A strong recommendation means that the proposed course of action is appropriate for the vast majority of patients. A conditional recommendation means that most patients would opt for the proposed course of action, and joint decision-making of the surgeon and the patient is required. Accompanying evidence summaries and evidence-to-decision frameworks should be read when using the recommendations. This guideline applies to adult patients with moderate to large paraesophageal hernias type II to IV with at least 50% of the stomach herniated to the thoracic cavity. The full guideline with user-friendly decision aids is available in https://app.magicapp.org/#/guideline/j7q7Gn . CONCLUSION An interdisciplinary panel provides recommendations on key topics on the management of paraesophageal hernias using highest methodological standards and following a transparent process. GUIDELINE REGISTRATION NUMBER PREPARE-2023CN018.
Collapse
Affiliation(s)
- Sheraz R Markar
- Department of General Surgery, Oxford University Hospitals, Oxford, UK
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Nainika Menon
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Nadia Guidozzi
- Department of General Surgery, University of Witwatersrand, Johannesburg, South Africa
| | - Katerina-Maria Kontouli
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Dimitrios Mavridis
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Alexandros Andreou
- Department of Surgery, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Felix Berlth
- Department of General, Visceral and Transplant Surgery, University Medical Center, Mainz, Germany
| | - Luigi Bonavina
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Alfred Cushieri
- Institute for Medical Science and Technology, University of Dundee, Dundee, Scotland, UK
| | - Lana Fourie
- Department of Visceral Surgery, Clarunis, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - James Gossage
- Department of General Surgery, Guy's and St Thomas' NHS Trust, London, SE1 7EH, UK
- School of Cancer and Pharmaceutical Sciences, Kings College London, London, UK
| | - Caroline Gronnier
- Esophagogastric Surgery Unit, Haut Lévêque Hospital, Centre Hospitalier Universitaire Bordeaux, University of Bordeaux, Bordeaux, France
| | - Eric J Hazebroek
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Sheila Krishnadath
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Donald E Low
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center Seattle, Seattle, USA
| | | | - Roos E Pouw
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands
| | - David I Watson
- Flinders Medical Centre, Oesophagogastric Surgery Unit, Bedford Park, SA, Australia
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Francesco Maria Carrano
- Department of General Surgery, Busto Arsizio Circolo Hospital ASST-Valle Olona, Busto Arsizio, Italy
| | - Monica Ortenzi
- Department of General Surgery, Università Politecnica Delle Marche, Ancona, Italy
| | - Stavros A Antoniou
- Department of Surgery, Papageorgiou General Hospital, Thessaloníki, Greece.
- EAES Guidelines Subcommittee, Eindhoven, The Netherlands.
| |
Collapse
|
15
|
Antoniou SA, Huo B, Tzanis AA, Koutsiouroumpa O, Mavridis D, Balla A, Dore S, Kaiser AM, Koraki E, Massey L, Pellino G, Psichogiou M, Sayers AE, Smart NJ, Sylla P, Tschudin-Sutter S, Woodfield JC, Carrano FM, Ortenzi M, Morales-Conde S. EAES, SAGES, and ESCP rapid guideline: bowel preparation for minimally invasive colorectal resection. Surg Endosc 2023; 37:9001-9012. [PMID: 37903883 DOI: 10.1007/s00464-023-10477-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/17/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Variation exists in practice pertaining to bowel preparation before minimally invasive colorectal surgery. A survey of EAES members prioritized this topic to be addressed by a clinical practice guideline. OBJECTIVE The aim of the study was to develop evidence-informed clinical practice recommendations on the use of bowel preparation before minimally invasive colorectal surgery, through evidence synthesis and a structured evidence-to-decision framework by an interdisciplinary panel of stakeholders. METHODS This is a collaborative project of EAES, SAGES, and ESCP. We updated a previous systematic review and performed a network meta-analysis of interventions. We appraised the certainty of the evidence for each comparison, using the GRADE and CINeMA methods. A panel of general and colorectal surgeons, infectious diseases specialists, an anesthetist, and a patient representative discussed the evidence in the context of benefits and harms, the certainty of the evidence, acceptability, feasibility, equity, cost, and use of resources, moderated by a GIN-certified master guideline developer and chair. We developed the recommendations in a consensus meeting, followed by a modified Delphi survey. RESULTS The panel suggests either oral antibiotics alone prior to minimally invasive right colon resection or mechanical bowel preparation (MBP) plus oral antibiotics; MBP plus oral antibiotics prior to minimally invasive left colon and sigmoid resection, and prior to minimally invasive right colon resection when there is an intention to perform intracorporeal anastomosis; and MBP plus oral antibiotics plus enema prior to minimally invasive rectal surgery (conditional recommendations); and recommends MBP plus oral antibiotics prior to minimally invasive colorectal surgery, when there is an intention to localize the lesion intraoperatively (strong recommendation). The full guideline with user-friendly decision aids is available in https://app.magicapp.org/#/guideline/LwvKej . CONCLUSION This guideline provides recommendations on bowel preparation prior to minimally invasive colorectal surgery for different procedures, using highest methodological standards, through a structured framework informed by key stakeholders. Guideline registration number PREPARE-2023CN045.
Collapse
Affiliation(s)
- Stavros A Antoniou
- Department of General Surgery, Papageorgiou General Hospital, Thessaloniki, Greece.
- EAES Guidelines Subcommittee, Eindhoven, Netherlands.
| | - Bright Huo
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Alexander A Tzanis
- First Department of Surgery, Metaxa Memorial Cancer Hospital, Pireus, Greece
| | - Ourania Koutsiouroumpa
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Dimitrios Mavridis
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Andrea Balla
- Coloproctology and Inflammatory Bowel Disease Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Andreas M Kaiser
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Eleni Koraki
- Department of Anesthesiology, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Lisa Massey
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Gianluca Pellino
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Mina Psichogiou
- First Department of Internal Medicine, School of Medicine, Laiko General Hospital, National and Kapodistrian University Athens, Athens, Greece
| | - Adele E Sayers
- Department of Surgery, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Neil J Smart
- Department of Surgery, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Patricia Sylla
- Department of Colorectal Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - John C Woodfield
- Department of Surgical Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
- Surgical Outcomes Research Centre (SOuRCe), Department of Surgical Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Francesco Maria Carrano
- Department of General Surgery, Busto Arsizio Circolo Hospital ASST-Valle Olona, Busto Arsizio, Italy
| | - Monica Ortenzi
- Department of General Surgery, Università Politecnica Delle Marche, Ancona, Italy
| | - Salvador Morales-Conde
- Department of General and Digestive Surgery, University Hospital Virgen Macarena - University of Sevilla, Seville, Spain
- Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazon, Seville, Spain
| |
Collapse
|
16
|
Middeldorp S, Nieuwlaat R, Baumann Kreuziger L, Coppens M, Houghton D, James AH, Lang E, Moll S, Myers T, Bhatt M, Chai-Adisaksopha C, Colunga-Lozano LE, Karam SG, Zhang Y, Wiercioch W, Schünemann HJ, Iorio A. American Society of Hematology 2023 guidelines for management of venous thromboembolism: thrombophilia testing. Blood Adv 2023; 7:7101-7138. [PMID: 37195076 PMCID: PMC10709681 DOI: 10.1182/bloodadvances.2023010177] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/18/2023] Open
Abstract
Hereditary and acquired thrombophilia are risk factors for venous thromboembolism (VTE). Whether testing helps guide management decisions is controversial. These evidence-based guidelines from the American Society of Hematology (ASH) intend to support decision making about thrombophilia testing. ASH formed a multidisciplinary guideline panel covering clinical and methodological expertise and minimizing bias from conflicts of interest. The McMaster University GRADE Centre provided logistical support, performed systematic reviews, and created evidence profiles and evidence-to-decision tables. The Grading of Recommendations Assessment, Development, and Evaluation approach (GRADE) was used. Recommendations were subject to public comment. The panel agreed on 23 recommendations regarding thrombophilia testing and associated management. Nearly all recommendations are based on very low certainty in the evidence due to modeling assumptions. The panel issued a strong recommendation against testing the general population before starting combined oral contraceptives (COCs) and conditional recommendations for thrombophilia testing in the following scenarios: (a) patients with VTE associated with nonsurgical major transient or hormonal risk factors; (b) patients with cerebral or splanchnic venous thrombosis, in settings where anticoagulation would otherwise be discontinued; (c) individuals with a family history of antithrombin, protein C, or protein S deficiency when considering thromboprophylaxis for minor provoking risk factors and for guidance to avoid COCs/hormone replacement therapy; (d) pregnant women with a family history of high-risk thrombophilia types; and (e) patients with cancer at low or intermediate risk of thrombosis and with a family history of VTE. For all other questions, the panel provided conditional recommendations against testing for thrombophilia.
Collapse
Affiliation(s)
- Saskia Middeldorp
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robby Nieuwlaat
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lisa Baumann Kreuziger
- Department of Medicine, Division of Hematology & Oncology, Versiti Blood Research Institute, Versiti and Medical College of Wisconsin, Milwaukee, WI
| | - Michiel Coppens
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Damon Houghton
- Division of Vascular Medicine, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Andra H. James
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Eddy Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephan Moll
- Division of Hematology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Meha Bhatt
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Chatree Chai-Adisaksopha
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Samer G. Karam
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Yuan Zhang
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Wojtek Wiercioch
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Holger J. Schünemann
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Institut für Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
17
|
Murayama A. Financial Conflicts of Interest Among the Authors of the Clinical Practice Guidelines for Rheumatoid Arthritis in Japan. Cureus 2023; 15:e46650. [PMID: 37937008 PMCID: PMC10627577 DOI: 10.7759/cureus.46650] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 11/09/2023] Open
Abstract
Objective To assess the financial relationships between pharmaceutical companies and authors of the 2020 Japan College of Rheumatology Clinical Practice Guidelines (CPG) for the Management of Rheumatoid Arthritis and to evaluate the quality of evidence supporting the guideline recommendations. Methods This retrospective study evaluated financial relationships between all 27 authors of the CPG and pharmaceutical companies in Japan. Personal payments from pharmaceutical companies to these authors between 2016 and 2020 were extracted from publicly disclosed databases for each pharmaceutical company. The quality of the evidence supporting the CPG recommendations was also assessed. Results All 27 authors received personal payments from pharmaceutical companies, totaling $3,683,048 over five years. The median and mean payments per author were $101,624 and $136,409, respectively. Speaking compensations accounted for more than 80% of all personal payments. More than 77.8% (21 authors), 66.7% (18 authors), and 51.9% (14 authors) received more than $10,000, $50,000, and $100,000 in total payments over the five years, respectively. Nevertheless, these financial relationships between the CPG authors and pharmaceutical companies were not disclosed. More than 81.8% of the CPG recommendations were supported by low- or very-low-quality evidence. Of the strong recommendations, 66.7% were supported by low- or very-low-quality evidence. Conclusion Even though all CPG authors received substantial amounts of personal payments from pharmaceutical companies, these conflicts of interest (COIs) were not disclosed in the CPG. These findings underscore the urgent need for policy interventions to enhance transparency, integrity, and reliability in the development of CPGs in Japan.
Collapse
Affiliation(s)
- Anju Murayama
- School of Medicine, Tohoku University, Sendai, JPN
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| |
Collapse
|
18
|
Duncan HF, Kirkevang LL, Peters OA, El-Karim I, Krastl G, Del Fabbro M, Chong BS, Galler KM, Segura-Egea JJ, Kebschull M. Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3-level clinical practice guideline. Int Endod J 2023; 56 Suppl 3:238-295. [PMID: 37772327 DOI: 10.1111/iej.13974] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3-level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence-based recommendations for the management of patients presenting with pulpal and apical disease. AIM To develop an S3-level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss. METHODS This S3-level CPG was developed by the ESE, with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany and utilizing the GRADE process. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert-based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders. RESULTS The S3-level CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and AP, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus nonvital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of AP. Prior to treatment planning, the critical importance of history and case evaluation, aseptic techniques, appropriate training and re-evaluations during and after treatment is stressed. CONCLUSION The first S3-level CPG in endodontics informs clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and AP in order to preserve teeth over a patient's lifetime, according to the best comparative evidence currently available.
Collapse
Affiliation(s)
- Henry F Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | | | - Ove A Peters
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - Ikhlas El-Karim
- School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Gabriel Krastl
- Department of Conservative Dentistry and Periodontology, University Hospital of Würzburg, Würzburg, Germany
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bun San Chong
- Faculty of Medicine & Dentistry, Institute of Dentistry, Queen Mary University of London, London, UK
| | - Kerstin M Galler
- Department of Operative Dentistry and Periodontology, Friedrich-Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Juan J Segura-Egea
- Department of Stomatology, Endodontics Section, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Moritz Kebschull
- School of Dentistry, Institute of Clinical Sciences, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Community Healthcare NHS Trust, Birmingham, UK
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, New York, USA
| |
Collapse
|
19
|
Hogervorst MA, Møllebæk M, Vreman RA, Lu TA, Wang J, De Bruin ML, Leufkens HGM, Mantel-Teeuwisse A, Goettsch W. Perspectives on how to build bridges between regulation, health technology assessment and clinical guideline development: a qualitative focus group study with European experts. BMJ Open 2023; 13:e072309. [PMID: 37640462 PMCID: PMC10462958 DOI: 10.1136/bmjopen-2023-072309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE Improving synergy among regulation, health technology assessment (HTA) and clinical guideline development is relevant as these independent processes are building on shared evidence-based grounds. The two objectives were first to assess how convergence of evidentiary needs among stakeholders may be achieved, and second, to determine to what extent convergence can be achieved. DESIGN Qualitative study using eight online dual-moderator focus groups. SETTING Discussions had a European focus and were contextualised in four case studies on head and neck cancer, diabetes mellitus, multiple sclerosis and myelodysplastic syndromes. PARTICIPANTS Forty-two experienced (over 10 years) European regulators, HTA representatives and clinicians participated in the discussion. INTERVENTIONS Participants received information on the case study and research topic in advance. An introductory background presentation and interview guide for the moderators were used to steer the discussion. RESULTS Convergence may be achieved through improved communication institutionalised in multistakeholder early dialogues, shared definitions and shared methods. Required data sets should be inclusive rather than aligned. Deliberation and decision-making should remain independent. Alignment could be sought for pragmatic clinical trial designs and patient registries. Smaller and lower-income countries should be included in these efforts. CONCLUSION Actors in the field expressed that improving synergy among stakeholders always involves trade-offs. A balance needs to be found between the convergence of processes and the institutional remits or geographical independence. A similar tension exists between the involvement of more actors, for example, patients or additional countries, and the level of collaboration that may be achieved. Communication is key to establishing this balance.
Collapse
Affiliation(s)
- Milou A Hogervorst
- Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
- Dutch National Health Care Institute (ZIN), Diemen, The Netherlands
| | - Mathias Møllebæk
- Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
| | - Rick A Vreman
- Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Ting-An Lu
- Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Junfeng Wang
- Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Marie Louise De Bruin
- Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
- Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
| | - Hubert G M Leufkens
- Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Aukje Mantel-Teeuwisse
- Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Wim Goettsch
- Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
- Dutch National Health Care Institute (ZIN), Diemen, The Netherlands
| |
Collapse
|
20
|
Akl EA, Khabsa J, Schünemann HJ, Tomlinson E, Parker R, Tugwell P, Concannon TW. A new taxonomy is proposed for defining the interests of stakeholders' representatives in health research: the case of guideline development. J Clin Epidemiol 2023; 160:147-150. [PMID: 37311515 DOI: 10.1016/j.jclinepi.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023]
Affiliation(s)
- Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Thomas W Concannon
- The RAND Corporation, Santa Monica, CA, USA; Tufts Clinical and Translational Science Institute, Boston, MA, USA
| |
Collapse
|
21
|
Kamamoto S, Ozaki A, Murayama A. Assessment of Financial Relationships Between Otorhinolaryngologists and Pharmaceutical Companies in Japan Between 2016 and 2019. Cureus 2023; 15:e43633. [PMID: 37719565 PMCID: PMC10503947 DOI: 10.7759/cureus.43633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION There are prevalent financial relationships between physicians and the pharmaceutical industry in medical specialties, including otorhinolaryngology. Although these relationships might cause conflicts of interest, no studies have assessed the size and contents of the financial relationships between otorhinolaryngologists and pharmaceutical companies in Japan. This study aims to evaluate the magnitude, prevalence, and trend of the financial relationship between Japanese otolaryngologists and pharmaceutical companies. METHODS Using payment data publicly disclosed by 92 pharmaceutical companies, we examined the size, prevalence, and trend in personal payments made to the otorhinolaryngologist board certified by the Japanese Society of Otorhinolaryngology-Head and Neck Surgery (JSO-HNS) between 2016 and 2019 in Japan. Furthermore, differences in payments were evaluated by whether otolaryngologists were clinical practice guideline authors, society board members, and academic journal editors or not. Trends in payments were evaluated by generalized estimating equations. RESULTS Of 8,190 otorhinolaryngologists, 3,667 (44.8%) were paid a total of $13,873,562, in payments for lecturing, consulting, and writing by 72 pharmaceutical companies between 2016 and 2019. The median four-year combined payment per physician was $1,022 (interquartile range: $473-$2,526). Top 1%, 5%, and 10% of otorhinolaryngologists received 42.3% (95% confidence interval (95% CI): 37.2%-47.4%), 69.3% (95% CI: 65.9%-72.8%), and 80.6% (95% CI: 78.3%-82.9%) of overall payments, respectively. The median payments per physician were significantly higher among otorhinolaryngologists authoring clinical practice guidelines ($11,522), society board members ($22,261), and journal editors ($35,143) than those without. The payments and number of otorhinolaryngologists receiving payments remained stable between 2016 and 2019. CONCLUSION This study demonstrates that a minority but a large number of otorhinolaryngologists received personal payments from pharmaceutical companies for the reimbursement of lecturing, consulting, and writing in Japan. Large amounts of these personal payments were significantly concentrated on a small number of leading otorhinolaryngologists.
Collapse
Affiliation(s)
- Sae Kamamoto
- School of Medicine, Hamamatsu University, Hamamatsu, JPN
| | - Akihiko Ozaki
- Surgery, Teikyo University Graduate School of Public Health, Tokyo, JPN
| | | |
Collapse
|
22
|
Neumann I, Izcovich A, Aguilar R, Basantes GL, Casais P, Colorio CC, Guillermo Esposito MC, García Lázaro PP, Pereira J, Meillon García LA, Rezende SM, Serrano JC, Tejerina Valle ML, Altuna D, Zúñiga P, Vera F, Karzulovic L, Schünemann HJ. American Society of Hematology, ABHH, ACHO, Grupo CAHT, Grupo CLAHT, SAH, SBHH, SHU, SOCHIHEM, SOMETH, Sociedad Panamena de Hematología, Sociedad Peruana de Hematología, and SVH 2023 guidelines for diagnosis of venous thromboembolism and for its management in special populations in Latin America. Blood Adv 2023; 7:3005-3021. [PMID: 36929813 PMCID: PMC10320207 DOI: 10.1182/bloodadvances.2021006534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
Implementation of international guidelines in Latin American settings requires additional considerations (ie, values and preferences, resources, accessibility, feasibility, and impact on health equity). The purpose of this guideline is to provide evidence-based recommendations about the diagnosis of venous thromboembolism (VTE) and its management in children and during pregnancy. We used the GRADE ADOLOPMENT method to adapt recommendations from 3 American Society of Hematology (ASH) VTE guidelines (diagnosis of VTE, VTE in pregnancy, and VTE in the pediatric population). ASH and 12 local hematology societies formed a guideline panel comprising medical professionals from 10 countries in Latin America. Panelists prioritized 10 questions about the diagnosis of VTE and 18 questions about its management in special populations that were relevant for the Latin American context. A knowledge synthesis team updated evidence reviews of health effects conducted for the original ASH guidelines and summarized information about factors specific to the Latin American context. In comparison with the original guideline, there were significant changes in 2 of 10 diagnostic recommendations (changes in the diagnostic algorithms) and in 9 of 18 management recommendations (4 changed direction and 5 changed strength). This guideline ADOLOPMENT project highlighted the importance of contextualizing recommendations in other settings based on differences in values, resources, feasibility, and health equity impact.
Collapse
Affiliation(s)
- Ignacio Neumann
- School of Medicine, Universidad San Sebastian, Santiago, Chile
| | | | - Ricardo Aguilar
- Servicio de Hematología, Complejo Hospitalario Dr. Arnulfo Arias Madrid, Panama City, Panama
| | | | - Patricia Casais
- Epidemiología Clínica y Evidencia, Instituto de Investigaciones en Salud Pública, Universidad de Buenos Aires, Buenos Aires, Argentina
- Centro de Hematología Pavlovsky, Buenos Aires, Argentina
| | | | | | - Pedro P. García Lázaro
- Faculty of Medicine, Universidad Privada Antenor Orrego, Trujillo, Peru
- Hospital Especializado Víctor Lazarte Echegaray, Trujillo, Peru
| | - Jaime Pereira
- Department of Hematology and Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Suely Meireles Rezende
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Diana Altuna
- Pediatric Oncology and Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pamela Zúñiga
- Department of Hematology and Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Vera
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Lorena Karzulovic
- Department of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
23
|
Fahim C, Prashad AJ, Silveira K, Chandraraj A, Thombs BD, Tonelli M, Thériault G, Grad R, Riva J, Colquhoun H, Rodin R, Subnath M, Rolland-Harris E, Barnhardt K, Straus SE. Dissemination and implementation of clinical practice guidelines: a longitudinal, mixed-methods evaluation of the Canadian Task Force on Preventive Health Care's knowledge translation efforts. CMAJ Open 2023; 11:E684-E695. [PMID: 37553226 PMCID: PMC10414974 DOI: 10.9778/cmajo.20220121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The Canadian Task Force on Preventive Health Care (task force) develops evidence-based preventive health care guidelines and knowledge translation (KT) tools to facilitate guideline dissemination and implementation. We aimed to determine practitioners' awareness of task force guidelines and KT tools and explore barriers and facilitators to their use. METHODS The task force's KT team completed annual evaluations using surveys and interviews with primary care providers in Canada from 2014 to 2020, to assess practitioners' awareness and determinants of use of task force guidelines and tools. We transcribed interviews verbatim and double-coded them using a framework analysis approach. RESULTS A total of 1284 primary care practitioners completed surveys and 183 participated in interviews. On average, 79.9% of participants were aware of the task force's 7 cancer screening guidelines, 36.2% were aware of the other 6 screening guidelines and 18.6% were aware of the 3 lifestyle or prevention guidelines. Participants identified 13 barriers and 7 facilitators to guideline and KT tool implementation; these were consistent over time. Participants identified strategies at the public and patient, provider and health systems levels to improve uptake of guidelines. INTERPRETATION Canadian primary care practitioners were more aware of task force cancer screening guidelines than its other preventive health guidelines. Over the 6-year period, participants consistently reported barriers to guideline uptake, including misalignment with patient preferences and other provincial or specialty guideline organizations. Further evaluations will assess tailored strategies to address the barriers identified.
Collapse
Affiliation(s)
- Christine Fahim
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont.
| | - Anupa Jyoti Prashad
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Kyle Silveira
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Arthana Chandraraj
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Brett D Thombs
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Marcello Tonelli
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Guylène Thériault
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Roland Grad
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - John Riva
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Heather Colquhoun
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Rachel Rodin
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Melissa Subnath
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Elizabeth Rolland-Harris
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Kim Barnhardt
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Sharon E Straus
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| |
Collapse
|
24
|
Chang L, Chey WD, Imdad A, Almario CV, Bharucha AE, Diem S, Greer KB, Hanson B, Harris LA, Ko C, Murad MH, Patel A, Shah ED, Lembo AJ, Sultan S. American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation. Am J Gastroenterol 2023; 118:936-954. [PMID: 37204227 PMCID: PMC10544839 DOI: 10.14309/ajg.0000000000002227] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/27/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Chronic idiopathic constipation (CIC) is a common disorder associated with significant impairment in quality of life. This clinical practice guideline, jointly developed by the American Gastroenterological Association and the American College of Gastroenterology, aims to inform clinicians and patients by providing evidence-based practice recommendations for the pharmacological treatment of CIC in adults. METHODS The American Gastroenterological Association and the American College of Gastroenterology formed a multidisciplinary guideline panel that conducted systematic reviews of the following agents: fiber, osmotic laxatives (polyethylene glycol, magnesium oxide, lactulose), stimulant laxatives (bisacodyl, sodium picosulfate, senna), secretagogues (lubiprostone, linaclotide, plecanatide), and serotonin type 4 agonist (prucalopride). The panel prioritized clinical questions and outcomes and used the Grading of Recommendations Assessment, Development, and Evaluation framework to assess the certainty of evidence for each intervention. The Evidence to Decision framework was used to develop clinical recommendations based on the balance between the desirable and undesirable effects, patient values, costs, and health equity considerations. RESULTS The panel agreed on 10 recommendations for the pharmacological management of CIC in adults. Based on available evidence, the panel made strong recommendations for the use of polyethylene glycol, sodium picosulfate, linaclotide, plecanatide, and prucalopride for CIC in adults. Conditional recommendations were made for the use of fiber, lactulose, senna, magnesium oxide, and lubiprostone. DISCUSSION This document provides a comprehensive outline of the various over-the-counter and prescription pharmacological agents available for the treatment of CIC. The guidelines are meant to provide a framework for approaching the management of CIC; clinical providers should engage in shared decision making based on patient preferences as well as medication cost and availability. Limitations and gaps in the evidence are highlighted to help guide future research opportunities and enhance the care of patients with chronic constipation.
Collapse
Affiliation(s)
- Lin Chang
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - William D. Chey
- Division of Gastroenterology & Hepatology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Aamer Imdad
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Christopher V. Almario
- Karsh Division of Gastroenterology and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Adil E. Bharucha
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Susan Diem
- Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
- University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Katarina B. Greer
- Cleveland VA Healthcare System, Cleveland, Ohio, USA
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Brian Hanson
- Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lucinda A. Harris
- Division of Gastroenterology & Hepatology, Mayo Clinic, Phoenix, Arizona, USA
| | - Cynthia Ko
- Division of Gastroenterology & Hepatology, University of Washington, Washington, DC, USA
| | | | - Amit Patel
- Division of Gastroenterology, Duke University School of Medicine and the Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Eric D. Shah
- Division of Gastroenterology & Hepatology, Michigan Medicine, Ann Arbor, Michigan, USA
- Division of Gastroenterology & Hepatology, Department of Medicine, DartMouth Health, Lebanon, New Hampshire, USA
| | - Anthony J. Lembo
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Disease and Surgery Institute; Cleveland Clinic, Cleveland, Ohio, USA
| | - Shahnaz Sultan
- Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
- University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
25
|
Chang L, Chey WD, Imdad A, Almario CV, Bharucha AE, Diem S, Greer KB, Hanson B, Harris LA, Ko C, Murad MH, Patel A, Shah ED, Lembo AJ, Sultan S. American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation. Gastroenterology 2023; 164:1086-1106. [PMID: 37211380 PMCID: PMC10542656 DOI: 10.1053/j.gastro.2023.03.214] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/27/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Chronic idiopathic constipation (CIC) is a common disorder associated with significant impairment in quality of life. This clinical practice guideline, jointly developed by the American Gastroenterological Association and the American College of Gastroenterology, aims to inform clinicians and patients by providing evidence-based practice recommendations for the pharmacological treatment of CIC in adults. METHODS The American Gastroenterological Association and the American College of Gastroenterology formed a multidisciplinary guideline panel that conducted systematic reviews of the following agents: fiber, osmotic laxatives (polyethylene glycol, magnesium oxide, lactulose), stimulant laxatives (bisacodyl, sodium picosulfate, senna), secretagogues (lubiprostone, linaclotide, plecanatide), and serotonin type 4 agonist (prucalopride). The panel prioritized clinical questions and outcomes and used the Grading of Recommendations Assessment, Development, and Evaluation framework to assess the certainty of evidence for each intervention. The Evidence to Decision framework was used to develop clinical recommendations based on the balance between the desirable and undesirable effects, patient values, costs, and health equity considerations. RESULTS The panel agreed on 10 recommendations for the pharmacological management of CIC in adults. Based on available evidence, the panel made strong recommendations for the use of polyethylene glycol, sodium picosulfate, linaclotide, plecanatide, and prucalopride for CIC in adults. Conditional recommendations were made for the use of fiber, lactulose, senna, magnesium oxide, and lubiprostone. DISCUSSION This document provides a comprehensive outline of the various over-the-counter and prescription pharmacological agents available for the treatment of CIC. The guidelines are meant to provide a framework for approaching the management of CIC; clinical providers should engage in shared decision making based on patient preferences as well as medication cost and availability. Limitations and gaps in the evidence are highlighted to help guide future research opportunities and enhance the care of patients with chronic constipation.
Collapse
Affiliation(s)
- Lin Chang
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - William D Chey
- Division of Gastroenterology & Hepatology, Michigan Medicine, Ann Arbor, Michigan
| | - Aamer Imdad
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, SUNY Upstate Medical University, Syracuse, New York
| | - Christopher V Almario
- Karsh Division of Gastroenterology and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Susan Diem
- Minneapolis VA Healthcare System, Minneapolis, Minnesota; University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Katarina B Greer
- Cleveland VA Healthcare System, Cleveland, Ohio; Case Western Reserve University, Cleveland, Ohio
| | - Brian Hanson
- Minneapolis VA Healthcare System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Lucinda A Harris
- Division of Gastroenterology & Hepatology, Mayo Clinic, Phoenix, Arizona
| | - Cynthia Ko
- Division of Gastroenterology & Hepatology, University of Washington, Washington, DC
| | | | - Amit Patel
- Division of Gastroenterology, Duke University School of Medicine and the Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Eric D Shah
- Division of Gastroenterology & Hepatology, Michigan Medicine, Ann Arbor, Michigan; Division of Gastroenterology & Hepatology, Department of Medicine, DartMouth Health, Lebanon, New Hampshire
| | - Anthony J Lembo
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Disease and Surgery Institute; Cleveland Clinic, Cleveland, Ohio
| | - Shahnaz Sultan
- Minneapolis VA Healthcare System, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
26
|
Yu X, Wu S, Zhang J, Hu Y, Luo M, Zhao H, Song X, Chen Y, Wang X. Developing TCM clinical practice guidelines: A comparison between traditional Chinese medicine and western medicine. Integr Med Res 2023; 12:100952. [PMID: 37187680 PMCID: PMC10176161 DOI: 10.1016/j.imr.2023.100952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023] Open
Abstract
Clinical practice guidelines in Traditional Chinese Medicine (CPG-TCM) is the recommendation that aims to provide the best service to users by identifying and summarizing the rules of prevention, diagnosis, treatment, rehabilitation, and regression of diseases based on systematic reviews of evidence and balancing the advantages and disadvantages of different interventions for clinical questions of Traditional Chinese Medicine. Over the past 30 years, the concept and methods of evidence-based medicine have had a significant impact on the development of clinical practice guidelines in Western Medicine (CPG-WM), and their standardized guideline development methods are being adapted and used in the development of CPG-TCM. However, the quality of CPG-TCM is far from CPG-WM, and the methodological system for developing CPG-TCM is not yet fully established. Therefore, this study aims to explore the methodological differences between CPG-TCM and CPG-WM and to inform the development of high-quality CPGTCM.
Collapse
Affiliation(s)
- Xuan Yu
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, China
| | - Shouyuan Wu
- School of Public Health, Lanzhou University, China
| | | | - Yue Hu
- School of Public Health, Lanzhou University, China
| | - Meng Luo
- School of Public Health, Lanzhou University, China
| | - Hongmei Zhao
- School of Public Health, Lanzhou University, China
| | - Xuping Song
- School of Public Health, Lanzhou University, China
| | - Yaolong Chen
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, China
- School of Public Health, Lanzhou University, China
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
- Corresponding authors at: Evidence based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China (Y. Chen); School of Public Health, Lanzhou University, Lanzhou 730000, China (X. Wang).
| | - Xiaohui Wang
- School of Public Health, Lanzhou University, China
- Corresponding authors at: Evidence based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China (Y. Chen); School of Public Health, Lanzhou University, Lanzhou 730000, China (X. Wang).
| |
Collapse
|
27
|
Campanile FC, Podda M, Pecchini F, Inama M, Molfino S, Bonino MA, Ortenzi M, Silecchia G, Agresta F, Cinquini M. Laparoscopic treatment of ventral hernias: the Italian national guidelines. Updates Surg 2023:10.1007/s13304-023-01534-3. [PMID: 37217637 PMCID: PMC10202362 DOI: 10.1007/s13304-023-01534-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023]
Abstract
Primary and incisional ventral hernias are significant public health issues for their prevalence, variability of professional practices, and high costs associated with the treatment In 2019, the Board of Directors of the Italian Society for Endoscopic Surgery (SICE) promoted the development of new guidelines on the laparoscopic treatment of ventral hernias, according to the new national regulation. In 2022, the guideline was accepted by the government agency, and it was published, in Italian, on the SNLG website. Here, we report the adopted methodology and the guideline's recommendations, as established in its diffusion policy. This guideline is produced according to the methodology indicated by the SNGL and applying the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Fifteen recommendations were produced as a result of 4 PICO questions. The level of recommendation was conditional for 12 of them and conditional to moderate for one. This guideline's strengths include relying on an extensive systematic review of the literature and applying a rigorous GRADE method. It also has several limitations. The literature on the topic is continuously and rapidly evolving; our results are based on findings that need constant re-appraisal. It is focused only on minimally invasive techniques and cannot consider broader issues (e.g., diagnostics, indication for surgery, pre-habilitation).
Collapse
Affiliation(s)
- Fabio Cesare Campanile
- Division of General Surgery, ASL Viterbo, San Giovanni Decollato-Andosilla Hospital, Civita Castellana, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Francesca Pecchini
- Department of General Surgery, Emergency and New Technologies, Baggiovara General Hospital, AOU Modena, Modena, Italy
| | - Marco Inama
- General and Mininvasive Surgery Department, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Sarah Molfino
- General Surgery Unit Chirurgia III, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Monica Ortenzi
- Department of General and Emergency Surgery, Marche Polytechnic University, Via Conca 71, 60126, Ancona, Italy.
| | - Gianfranco Silecchia
- Department of Medical-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | | | - Michela Cinquini
- Department of Oncology, Laboratory of Methodology of Sistematic Reviews and Guidelines Production, Istituto di Ricerche Farmacologiche Mario Negri IRCCS., Milan, Italy
| |
Collapse
|
28
|
Petkovic J, Magwood O, Lytvyn L, Khabsa J, Concannon TW, Welch V, Todhunter-Brown A, Palm ME, Akl EA, Mbuagbaw L, Arayssi T, Avey MT, Marusic A, Morley R, Saginur M, Slingers N, Texeira L, Ben Brahem A, Bhaumik S, Bou Akl I, Crowe S, Dormer L, Ekanem C, Lang E, Kianzad B, Kuchenmüller T, Moja L, Pottie K, Schünemann H, Tugwell P. Key issues for stakeholder engagement in the development of health and healthcare guidelines. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:27. [PMID: 37118762 PMCID: PMC10142244 DOI: 10.1186/s40900-023-00433-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/04/2023] [Indexed: 05/03/2023]
Abstract
Established in 2015, the Multi-Stakeholder Engagement (MuSE) Consortium is an international network of over 120 individuals interested in stakeholder engagement in research and guidelines. The MuSE group is developing guidance for stakeholder engagement in the development of health and healthcare guideline development. The development of this guidance has included multiple meetings with stakeholders, including patients, payers/purchasers of health services, peer review editors, policymakers, program managers, providers, principal investigators, product makers, the public, and purchasers of health services and has identified a number of key issues. These include: (1) Definitions, roles, and settings (2) Stakeholder identification and selection (3) Levels of engagement, (4) Evaluation of engagement, (5) Documentation and transparency, and (6) Conflict of interest management. In this paper, we discuss these issues and our plan to develop guidance to facilitate stakeholder engagement in all stages of the development of health and healthcare guideline development.
Collapse
Affiliation(s)
- Jennifer Petkovic
- Bruyère Research Institute, Ottawa, Canada.
- Faculty of Medicine, University of Ottawa, Ottawa, Canada.
| | - Olivia Magwood
- Bruyère Research Institute, Ottawa, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | | | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Thomas W Concannon
- The RAND Corporation and Tufts University School of Medicine, Boston, MA, USA
| | - Vivian Welch
- Bruyère Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Alex Todhunter-Brown
- Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Marisha E Palm
- Tufts Medical Center, Tufts Clinical and Translational Science Institute, Boston, MA, USA
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA, USA
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | | | - Marc T Avey
- Canadian Council on Animal Care, Ottawa, Canada
| | - Ana Marusic
- Department of Research in Biomedicine and Health, Center for Evidence-Based Medicine, University of Split School of Medicine, Split, Croatia
| | | | | | | | | | - Asma Ben Brahem
- Director Guidelines and Care Pathways, INEAS (National Authority for Assessment and Accreditation in Healthcare), Tunis, Tunisia
| | - Soumyadeep Bhaumik
- Meta-Research and Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, India
| | - Imad Bou Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | | | | | | | - Eddy Lang
- Cumming School of Medicine, University of Calgary, Alberta Health Services, Calgary Zone, Canada
| | - Behrang Kianzad
- Center for Advanced Studies in Biomedical Innovation Law (CeBIL), Faculty of Law, Copenhagen University, Copenhagen, Denmark
| | | | - Lorenzo Moja
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Kevin Pottie
- Departments of Family Medicine and Epidemiology and Biostatistics, Western University, London, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Holger Schünemann
- Clinical Epidemiology and of Medicine, WHO Collaborating Centre for Infectious Diseases, Research Methods and Recommendations, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, Cochrane Canada and McMaster GRADE Centre, McMaster University, Hamilton, Canada
| | - Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, Canada
| |
Collapse
|
29
|
Murayama A, Kamamoto S, Kawashima M, Saito H, Yamashita E, Tanimoto T, Ozaki A. Cross-sectional analysis of pharmaceutical payments to Japanese board-certified gastroenterologists between 2016 and 2019. BMJ Open 2023; 13:e068237. [PMID: 37072354 PMCID: PMC10124293 DOI: 10.1136/bmjopen-2022-068237] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVES Limited evidence is available regarding the financial relationships between gastroenterologists and pharmaceutical companies in Japan. This study analysed the magnitude, prevalence and trends of personal payments made by major pharmaceutical companies to board-certified gastroenterologists in Japan in recent years. DESIGN Cross-sectional analysis SETTING AND PARTICIPANTS: Using payment data publicly disclosed by 92 major pharmaceutical companies, this study examined the non-research payments made to all board-certified gastroenterologists by the Japanese Society of Gastroenterology. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were payment amounts, the prevalence of gastroenterologists receiving payments, yearly trends in per-gastroenterologist payment values and the number of gastroenterologists with payments. Additionally, we evaluated the differences in payments among influential gastroenterologists, including clinical practice guideline authors, society board member gastroenterologists and other general gastroenterologists. RESULTS Approximately 52.8% of all board-certified gastroenterologists received a total of US$89 151 253, entailing 134 249 payment contracts as the reimbursement for lecturing, consulting and writing, from 84 pharmaceutical companies between 2016 and 2019. The average and median payments per gastroenterologist were US$7670 (SD: US$26 842) and US$1533 (IQR: US$582-US$4781), respectively. The payment value per gastroenterologist did not significantly change during the study period, while the number of gastroenterologists with payments decreased by -1.01% (95% CI: -1.61% to -0.40%, p<0.001) annually. Board member gastroenterologists (median: US$132 777) and the guideline authoring gastroenterologists (median: US$106 069) received 29.9 times and 17.3 times higher payments, respectively, than general gastroenterologists (median: US$284). CONCLUSION Most gastroenterologists received personal payments from pharmaceutical companies, but only very few influential gastroenterologists with authority accepted substantial amounts in Japan. There should be transparent and rigorous management strategies for financial conflicts of interest among gastroenterologists working in influential positions.
Collapse
Affiliation(s)
- Anju Murayama
- School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Sae Kamamoto
- School of Medicine, Hamamatsu University, Hamamatsu, Japan
| | - Moe Kawashima
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroaki Saito
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
- Department of Internal Medicine, Soma Central Hospital, Soma, Japan
| | - Erika Yamashita
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
- Internal Medicine, Jyoban Hospital, Iwaki, Fukushima, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
- Department of Breast and Thyroid Surgery, Joban Hospital, Iwaki, Fukushima, Japan
| |
Collapse
|
30
|
Murayama A, Mamada H, Shigeta H, Yoshinaga T, Saito H, Yamashita E, Tanimoto T, Ozaki A. Financial Relationships Between Pharmaceutical Companies and Rheumatologists in Japan Between 2016 and 2019. J Clin Rheumatol 2023; 29:118-125. [PMID: 36729793 DOI: 10.1097/rhu.0000000000001922] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUNDS Given the increasing number of novel and expensive drugs for rheumatoid diseases, the financial relationships between pharmaceutical companies and rheumatologists could be prevalent and substantial. However, little was known about the information in Japan. METHODS Using payment data publicly disclosed by 92 major pharmaceutical companies, we evaluated the financial relationships between pharmaceutical companies and rheumatologists who were board certified by the Japan College of Rheumatology between 2016 and 2019. The trends in payments were estimated by the generalized estimating equations with 4-year payment data. Differences in payments between general and leading rheumatologists including the board members, clinical practice guideline authors, and medical journal editors were assessed. RESULTS Of the board-certified rheumatologists, 70.7% (3563 of 5038) received a total of $55,246,485 in personal payments for lecturing, writing, and consulting from 79 pharmaceutical companies between 2016 and 2019. The median payments per rheumatologist receiving payments were $3447 (interquartile range, $1124-$11,974) in payment amounts. There were increasing trends in the payments per rheumatologist and the number of rheumatologists with payments, with average yearly change rates of 5.9% (95% confidence interval, 3.9%-7.9%; p < 0.001) and 1.2% (95% CI, 0.3%-2.0%; p = 0.008). The leading rheumatologists such as the society board members, clinical practice guideline authors, and medical journal editors received much more payments than other rheumatologists. CONCLUSION Most rheumatologists increasingly received personal payments for lecturing, consulting, and writing reimbursements from pharmaceutical companies in Japan. These payments were significantly concentrated on rheumatologists in authoritative and influential positions.
Collapse
|
31
|
Shargall Y, Wiercioch W, Brunelli A, Murthy S, Hofstetter W, Lin J, Li H, Linkins LA, Crowther M, Davis R, Rocco G, Morgano GP, Schünemann F, Muti-Schünemann G, Douketis J, Schünemann HJ, Litle VR. Joint 2022 European Society of Thoracic Surgeons and The American Association for Thoracic Surgery guidelines for the prevention of cancer-associated venous thromboembolism in thoracic surgery. J Thorac Cardiovasc Surg 2023; 165:794-824.e6. [PMID: 36895083 DOI: 10.1016/j.jtcvs.2022.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/21/2022] [Accepted: 05/09/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a potentially fatal but preventable postoperative complication. Thoracic oncology patients undergoing surgical resection, often after multimodality induction therapy, represent among the highest risk groups for postoperative VTE. Currently there are no VTE prophylaxis guidelines specific to these thoracic surgery patients. Evidenced-based recommendations will help clinicians manage and mitigate risk of VTE in the postoperative period and inform best practice. OBJECTIVE These joint evidence-based guidelines from The American Association for Thoracic Surgery and the European Society of Thoracic Surgeons aim to inform clinicians and patients in decisions about prophylaxis to prevent VTE in patients undergoing surgical resection for lung or esophageal cancer. METHODS The American Association for Thoracic Surgery and the European Society of Thoracic Surgeons formed a multidisciplinary guideline panel that included broad membership to minimize potential bias when formulating recommendations. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE Evidence-to-Decision frameworks, which were subject to public comment. RESULTS The panel agreed on 24 recommendations focused on pharmacological and mechanical methods for prophylaxis in patients undergoing lobectomy and segmentectomy, pneumonectomy, and esophagectomy, as well as extended resections for lung cancer. CONCLUSIONS The certainty of the supporting evidence for the majority of recommendations was judged as low or very low, largely due to a lack of direct evidence for thoracic surgery. The panel made conditional recommendations for use of parenteral anticoagulation for VTE prevention, in combination with mechanical methods, over no prophylaxis for cancer patients undergoing anatomic lung resection or esophagectomy. Other key recommendations include: conditional recommendations for using parenteral anticoagulants over direct oral anticoagulants, with use of direct oral anticoagulants suggested only in the context of clinical trials; conditional recommendation for using extended prophylaxis for 28 to 35 days over in-hospital prophylaxis only for patients at moderate or high risk of thrombosis; and conditional recommendations for VTE screening in patients undergoing pneumonectomy and esophagectomy. Future research priorities include the role of preoperative thromboprophylaxis and the role of risk stratification to guide use of extended prophylaxis.
Collapse
Affiliation(s)
- Yaron Shargall
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom
| | - Sudish Murthy
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Wayne Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Jules Lin
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, Mich
| | - Hui Li
- Department of Thoracic Surgery, Capital Medical University, Beijing, China
| | - Lori-Ann Linkins
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marc Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Roger Davis
- Patient Representative, Burlington, Ontario, Canada
| | - Gaetano Rocco
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gian Paolo Morgano
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Finn Schünemann
- Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Giovanna Muti-Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - James Douketis
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Virginia R Litle
- Department of Surgery, Boston University School of Medicine, Boston, Mass
| |
Collapse
|
32
|
Mamada H, Murayama A, Ozaki A, Hashimoto T, Saito H, Sawano T, Yamashita E, Bhandari D, Shrestha S, Tanimoto T. Observational study of financial and non-financial conflicts of interest among the Japanese government advisory board members concerning coronavirus disease 2019. Medicine (Baltimore) 2023; 102:e32776. [PMID: 36705373 PMCID: PMC9875957 DOI: 10.1097/md.0000000000032776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
This cross-sectional analysis aimed to assess the extent of conflicts of interest among the Japanese government coronavirus disease 2019 (COVID-19) advisory board members and elucidate the accuracy of conflicts of interest (COI) disclosure and management strategies. Using the payment data from all 79 pharmaceutical companies in Japan between 2017 and 2019 and direct research grants from the Japanese government between 2019 and 2020, we evaluated the extent of financial and non-financial COI among all 20 Japanese government COVID-19 advisory board members. The Ethic Committee of the Medical Governance Research Institute approved this study. Japanese government COVID-19 advisory board members were predominantly male (75.0%) and physicians (50.0%). Between 2019 and 2020, 2 members (10.0%) received a total of $819,244 in government research funding. Another 5 members (25.0%) received $532,127 in payments, including $276,722 in personal fees, from 31 pharmaceutical companies between 2017 and 2019. The average value of the pharmaceutical payments was $9155 (standard deviation: $12,975). Furthermore, neither the Ministry of Health, Labor, and Welfare nor the Japanese Cabinet Secretariat disclosed financial or non-financial COI with industry. Additionally, the government had no policies for managing COI among advisory board members. This study found that the Japanese government COVID-19 advisory board had financial and non-financial COI with pharmaceutical companies and the government. Furthermore, personal communication received as part of this research indicated that there were no rigorous COI management strategies for the COVID-19 advisory board members. Any government must ensure the independence of scientific advisory boards by implementing more rigorous and transparent management strategies that require the declaration and public disclosure of all COI.
Collapse
Affiliation(s)
- Hanano Mamada
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
- Akita University School of Medicine, Akita, Japan
| | - Anju Murayama
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
- Tohoku University School of Medicine, Sendai, Miyagi, Japan
- * Correspondence: Anju Murayama, Tohoku University School of Medicine, Sendai, Miyagi 980-8575, Japan (e-mail: )
| | - Akihiko Ozaki
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Takanao Hashimoto
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
- Department of Pharmacy, Sendai City Medical Center, Sendai, Miyagi, Japan
| | - Hiroaki Saito
- Department of Internal medicine, Soma Central Hospital, Soma, Fukushima, Japan
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Erika Yamashita
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Divya Bhandari
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor Darul Ehsan, Malaysia
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
- Department of Internal Medicine, Navitas Clinic, Kawasaki, Kanagawa, Japan
| |
Collapse
|
33
|
Mooghali M, Glick L, Ramachandran R, Ross JS. Financial conflicts of interest among US physician authors of 2020 clinical practice guidelines: a cross-sectional study. BMJ Open 2023; 13:e069115. [PMID: 36690402 PMCID: PMC9872463 DOI: 10.1136/bmjopen-2022-069115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/11/2023] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To evaluate the prevalence and accuracy of industry-related financial conflict of interest (COI) disclosures among US physician guideline authors. DESIGN Cross-sectional study. SETTING Clinical practice guidelines published by the Council of Medical Specialty Societies in 2020. PARTICIPANTS US physician guideline authors. MAIN OUTCOME MEASURES Financial COI disclosures, both self-reported and determined using Open Payments data. RESULTS Among 270 US physician authors of 20 clinical practice guidelines, 101 (37.4%) disclosed industry-related financial COIs, whereas 199 (73.7%) were found to have received payments from industry when accounting for payments disclosed through Open Payments. The median payments received by authors during the 3-year period was US$27 451 (IQR, US$1385-US$254 677). Comparing authors' self-disclosures with Open Payments, 72 (26.7%) of the authors accurately disclosed their financial COIs, including 68 (25.2%) accurately disclosing no financial COIs and 4 (1.5%) accurately disclosing a financial COI. In contrast, 101 (37.4%) disclosed no financial COIs and were found to have received payments from industry, 23 (8.5%) disclosed a financial COI but had under-reported payments received from industry, 14 (5.2%) disclosed a financial COI but had over-reported payments received from industry and 60 (22.2%) disclosed a financial COI but were found to have both under-reported and over-reported payments received from industry. We found that inaccurate COI disclosure was more frequent among professors compared with non-professors (81.9% vs 63.5%; p<0.001) and among males compared with females (77.7% vs 64.8%; p=0.02). The accuracy of disclosures also varied among medical professional societies (p<0.001). CONCLUSIONS Financial relationships with industry are common among US physician authors of clinical practice guidelines and are often not accurately disclosed. To ensure high-quality guidelines and unbiased recommendations, more effort is needed to minimise existing COIs and improve disclosure accuracy among panel members.
Collapse
Affiliation(s)
- Maryam Mooghali
- General Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Collaboration for Regulatory Rigor, Integrity, and Transparency (CRRIT), Yale School of Medicine, New Haven, Connecticut, USA
| | - Laura Glick
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Reshma Ramachandran
- Yale Collaboration for Regulatory Rigor, Integrity, and Transparency (CRRIT), Yale School of Medicine, New Haven, Connecticut, USA
- Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joseph S Ross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
34
|
Murayama A, Kamamoto S, Murata N, Yamasaki R, Yamada K, Yamashita E, Saito H, Tanimoto T, Ozaki A. Evaluation of financial conflicts of interest and quality of evidence in Japanese gastroenterology clinical practice guidelines. J Gastroenterol Hepatol 2022; 38:565-573. [PMID: 36518089 DOI: 10.1111/jgh.16089] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/02/2022] [Accepted: 12/11/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Clinical practice guidelines assist healthcare professionals in providing evidence-based care. However, pharmaceutical companies' financial interests often influence guideline content. This study aimed to elucidate the magnitude of financial ties among Japanese gastroenterology guideline authors and the pharmaceutical industry. METHODS Using pharmaceutical company disclosed payment data, we evaluated financial conflicts of interest (COI) among Japanese Society of Gastroenterology guideline authors between 2016 and 2021. Additionally, we assessed the evidence quality supporting guideline recommendations and associations with financial COI. Finally, we evaluated author COI management during guideline development against global standards. RESULTS Overall, 88.2% (231/262) of guideline authors received a median of $12 968 (interquartile range [IQR]: $1839-$70 374) in payments between 2016 and 2019 for lectures, writings, and consulting. Chairpersons received significantly higher payments (median: $86 444 [IQR: $15 455-$165 679]). Notably, 41 (15.6%) authors had undeclared payments exceeding declaration requirements. Low or very low-quality evidence supported 41.0% of recommendations. There was a negative association between the median 4-year payment per author and the proportion of recommendations based on low-quality evidence (odds ratio: 0.966 [95% confidence interval [95% CI]: 0.945-0.987], P = 0.002) and positive association with moderate-quality evidence (odds ratio: 1.018 [95% CI: 1.011-1.025], P < 0.001). Still, the Japanese Society of Gastroenterology guideline development process remains less transparent, with insufficient COI policies relative to global standards. CONCLUSION There were extensive financial COI between pharmaceutical companies and guideline authors, and more than 40% of recommendations were based on low-quality evidence. More rigorous and transparent COI policies for guideline development adhering to global standards are warranted.
Collapse
Affiliation(s)
- Anju Murayama
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Sae Kamamoto
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Faculty of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Nanami Murata
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Faculty of Medicine, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Ryota Yamasaki
- Faculty of Medicine, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Kohki Yamada
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Osaka University School of Medicine, Osaka, Japan
| | - Erika Yamashita
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Hiroaki Saito
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Department of Internal Medicine, Navitas Clinic, Tachikawa, Tokyo, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| |
Collapse
|
35
|
Shargall Y, Wiercioch W, Brunelli A, Murthy S, Hofstetter W, Lin J, Li H, Linkins LA, Crowther M, Davis R, Rocco G, Morgano GP, Schünemann F, Muti-Schünemann G, Douketis J, Schünemann HJ, Litle VR. Joint 2022 European Society of Thoracic Surgeons and The American Association for Thoracic Surgery guidelines for the prevention of cancer-associated venous thromboembolism in thoracic surgery. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 63:6889652. [PMID: 36519935 DOI: 10.1093/ejcts/ezac488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/21/2022] [Accepted: 05/09/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a potentially fatal but preventable postoperative complication. Thoracic oncology patients undergoing surgical resection, often after multimodality induction therapy, represent among the highest risk groups for postoperative VTE. Currently there are no VTE prophylaxis guidelines specific to these thoracic surgery patients. Evidenced-based recommendations will help clinicians manage and mitigate risk of VTE in the postoperative period and inform best practice. OBJECTIVE These joint evidence-based guidelines from The American Association for Thoracic Surgery and the European Society of Thoracic Surgeons aim to inform clinicians and patients in decisions about prophylaxis to prevent VTE in patients undergoing surgical resection for lung or esophageal cancer. METHODS The American Association for Thoracic Surgery and the European Society of Thoracic Surgeons formed a multidisciplinary guideline panel that included broad membership to minimize potential bias when formulating recommendations. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE Evidence-to-Decision frameworks, which were subject to public comment. RESULTS The panel agreed on 24 recommendations focused on pharmacological and mechanical methods for prophylaxis in patients undergoing lobectomy and segmentectomy, pneumonectomy, and esophagectomy, as well as extended resections for lung cancer. CONCLUSIONS The certainty of the supporting evidence for the majority of recommendations was judged as low or very low, largely due to a lack of direct evidence for thoracic surgery. The panel made conditional recommendations for use of parenteral anticoagulation for VTE prevention, in combination with mechanical methods, over no prophylaxis for cancer patients undergoing anatomic lung resection or esophagectomy. Other key recommendations include: conditional recommendations for using parenteral anticoagulants over direct oral anticoagulants, with use of direct oral anticoagulants suggested only in the context of clinical trials; conditional recommendation for using extended prophylaxis for 28 to 35 days over in-hospital prophylaxis only for patients at moderate or high risk of thrombosis; and conditional recommendations for VTE screening in patients undergoing pneumonectomy and esophagectomy. Future research priorities include the role of preoperative thromboprophylaxis and the role of risk stratification to guide use of extended prophylaxis. (J Thorac Cardiovasc Surg 2022;▪:1-31).
Collapse
Affiliation(s)
- Yaron Shargall
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom
| | - Sudish Murthy
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wayne Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jules Lin
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Hui Li
- Department of Thoracic Surgery, Capital Medical University, Beijing, China
| | - Lori-Ann Linkins
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marc Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Roger Davis
- Patient Representative, Burlington, Ontario, Canada
| | - Gaetano Rocco
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gian Paolo Morgano
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Finn Schünemann
- Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Giovanna Muti-Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - James Douketis
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Virginia R Litle
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
36
|
A New Era of National Guideline Development in Saudi Arabia. J Epidemiol Glob Health 2022; 12:373-379. [DOI: 10.1007/s44197-022-00076-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/27/2022] [Indexed: 11/29/2022] Open
Abstract
AbstractSaudi Arabia’s ambitious Vision 2030 project was launched in 2016 as a strategy for economic development and national growth, with 11 Vision Realization Programs put in charge of its implementation. The backbone of its Transformation Program for the Health Sector has been the definition of a new Model of Care aiming to deliver 42 coordinated interventions across 6 Systems of Care, with the development of clinical guidelines identified as a key cross-cutting intervention to foster the use of national, evidence-based practices across KSA, reduce care variation, and promote accountable care. This article provides an overview of the history, progress to date, and future outlook of the recently initiated National Guidelines Center in Saudi Arabia, established in collaboration between the Health Holding Company and the Saudi Health Council represented by its National Center for Evidence-based Medicine. The lessons learnt from previous guideline initiatives are grouped under the Center’s design principles of high quality, relevance, practical implementation, and sustainability. Aspects setting the project apart from previous endeavors have been its focus on extensive engagement with key stakeholders in the Saudi guideline ecosystem, the co-development of evidence-based recommendations with aligned key performance measures, and the implementation of guideline recommendations in the clinical workflow via integrated electronic order sets. Nine activity streams aim to enable the Center to take its place among the leading regional and global guideline developing organizations and to optimally support clinicians and patients, Saudi Arabia’s health sector transformation, and the work of guideline communities worldwide.
Collapse
|
37
|
Murayama A, Kamamoto S, Shigeta H, Saito H, Yamashita E, Tanimoto T, Akihiko O. Undisclosed financial conflicts of interest with pharmaceutical companies among the authors of the Esophageal Cancer Practice Guidelines 2017 by the Japan Esophageal Society. Dis Esophagus 2022; 35:6671206. [PMID: 35980294 DOI: 10.1093/dote/doac056] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/19/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Anju Murayama
- Medical Governance Research Institute, Minato-ku, Japan.,School of Medicine, Tohoku University, Sendai City, Japan
| | - Sae Kamamoto
- Medical Governance Research Institute, Minato-ku, Japan.,School of Medicine, Hamamatsu University, Hamamatsu City, Japan
| | - Haruki Shigeta
- Medical Governance Research Institute, Minato-ku, Japan.,School of Medicine, Tohoku University, Sendai City, Japan
| | - Hiroaki Saito
- Medical Governance Research Institute, Minato-ku, Japan.,Department of Internal Medicine, Soma Central Hospital, Soma City, Japan
| | | | - Tetsuya Tanimoto
- Medical Governance Research Institute, Minato-ku, Japan.,Department of Internal Medicine, Navitas Clinic Tachikawa, Tachikawa City, Japan
| | - Ozaki Akihiko
- Medical Governance Research Institute, Minato-ku, Japan.,Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki City, Japan
| |
Collapse
|
38
|
Mamada H, Murayama A, Kamamoto S, Kaneda Y, Yoshida M, Sugiura S, Yamashita E, Kusumi E, Saito H, Sawano T, Tanimoto T, Vassar M, Ozieranski P, Ozaki A. Evaluation of Financial and Nonfinancial Conflicts of Interest and Quality of Evidence Underlying Psoriatic Arthritis Clinical Practice Guidelines: Analysis of Personal Payments From Pharmaceutical Companies and Authors' Self-Citation Rate in Japan and the United States. Arthritis Care Res (Hoboken) 2022; 75:1278-1286. [PMID: 36194077 DOI: 10.1002/acr.25032] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/19/2022] [Accepted: 09/27/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To assess financial conflicts of interest (COI) and nonfinancial COI among psoriatic arthritis (PsA) clinical practice guideline (CPG) authors in Japan and the US, and to evaluate the quality of evidence and strength of recommendations of PsA CPGs. METHODS We performed a retrospective analysis using payment data from major Japanese pharmaceutical companies and the US Open Payments Database from 2016 to 2018. All authors of PsA CPGs issued by the Japanese Dermatological Association (JDA) and American College of Rheumatology (ACR) were included. RESULTS Of 23 CPG authors in Japan, 21 (91.3%) received at least 1 payment, with a combined total of $3,335,413 between 2016 and 2018. Regarding 25 US authors, 21 (84.0%) received at least 1 payment, with a combined total of $4,081,629 during the same period. The 3-year combined mean ± SD payment per author was $145,018 ± $114,302 in Japan and $162,825 ± $259,670 in the US. A total of 18 authors (78.3%) of the JDA PsA CPG and 12 authors (48.0%) of the ACR PsA CPG had undisclosed financial COI worth $474,663 and $218,501, respectively. The percentage of citations with at least 1 CPG author relative to total citations was 3.4% in Japan and 33.6% in the US. In sum, 71.4% and 88.8% of recommendations for PsA in the JDA and ACR were supported by low or very low quality of evidence. CONCLUSION More rigorous cross-checking of information disclosed by pharmaceutical companies and self-reported by physicians and more stringent and transparent COI policies are necessary.
Collapse
Affiliation(s)
- Hanano Mamada
- Medical Governance Research Institute, Minato-ku, and Akita University, Akita, Japan
| | - Anju Murayama
- Medical Governance Research Institute, Minato-ku, and Tohoku University school of Medicine, Sendai, Japan
| | - Sae Kamamoto
- Medical Governance Research Institute, Minato-ku, and Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yudai Kaneda
- Medical Governance Research Institute, Minato-ku, and Hokkaido University School of Medicine, Sapporo, Japan
| | | | - Sota Sugiura
- Medical Governance Research Institute, Minato-ku, Japan
| | | | | | | | | | | | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa
| | | | - Akihiko Ozaki
- Jyoban Hospital of Tokiwa Foundation and Medical Governance Research Institute, Iwaki, Japan
| |
Collapse
|
39
|
Kamamoto S, Murayama A, Kusumi E, Yoshida M, Saito H, Sawano T, Yamashita E, Tanimoto T, Ozaki A. Evaluation of financial relationships between Japanese certified pediatric hematologist/oncologists and pharmaceutical companies: a cross-sectional analysis of personal payments from pharmaceutical companies between 2016 and 2019. Pediatr Blood Cancer 2022; 69:e29891. [PMID: 35949170 DOI: 10.1002/pbc.29891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 06/20/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022]
Abstract
This cross-sectional study evaluated the magnitude of personal payments made by pharmaceutical companies to pediatric hematologist-oncologists (PHOs) board-certified by the Japanese Society of Pediatric Hematology/Oncology (JSPHO), using publicly disclosed data. Among all 307 PHOs, 215 (70.0%) PHOs received $916 703 personal payments from 54 pharmaceutical companies between 2016 and 2019 in total. Median four-year payments per PHO was $1440 (interquartile range, $523-$4015). Payments per PHO significantly increased during the study period, by 23.8% (95% confidence interval: 15.3%-32.8%, P < 0.001) annually. Furthermore, leading PHOs, including university professors, society board members, and clinical practice guideline authors, received far larger personal payments from the companies.
Collapse
Affiliation(s)
- Sae Kamamoto
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka, Japan
| | - Anju Murayama
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Tohoku University School of Medicine, Sendai City, Miyagi, Japan
| | - Eiji Kusumi
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Navitas Clinic Shinjuku, Shinjuku-ku, Tokyo, Japan
| | - Makoto Yoshida
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kosei Hospital, Sendai City, Miyagi, Japan
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki City, Fukushima, Japan
| | - Erika Yamashita
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Department of Internal Medicine, Navitas Clinic, Tachikawa City, Tokyo, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki City, Fukushima, Japan
| |
Collapse
|
40
|
Bombak AE, Adams L, Thille P. Drivers of medicalization in the Canadian Adult Obesity Clinical Practice Guidelines. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:743-748. [PMID: 35838981 PMCID: PMC9481752 DOI: 10.17269/s41997-022-00662-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
The new Canadian Adult Obesity Clinical Practice Guidelines frame higher body weight as a chronic, relapsing disease requiring comprehensive medical treatment pathways. In this commentary, we will demonstrate how a process called pharmaceuticalization is informing the new guidelines. We join those questioning the normalization of industry and medical collaboration and interrogate whether the new guidelines meaningfully address stigma.
Collapse
Affiliation(s)
- Andrea E Bombak
- Department of Sociology, University of New Brunswick, 3 Bailey Drive, P.O. Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada.
| | - Louise Adams
- Flourish Kirribilli, 13/1 Broughton St, Kirribilli, NSW, 2061, Australia
| | - Patricia Thille
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Room R131 - 771 McDermot Ave., Winnipeg, MB, R3E 0T6, Canada
| |
Collapse
|
41
|
Cuker A, Tseng EK, Nieuwlaat R, Angchaisuksiri P, Blair C, Dane K, DeSancho MT, Diuguid D, Griffin DO, Kahn SR, Klok FA, Lee AI, Neumann I, Pai A, Righini M, Sanfilippo KM, Siegal DM, Skara M, Terrell DR, Touri K, Akl EA, Al Jabiri R, Al Jabiri Y, Barbara AM, Bognanni A, Boulos M, Brignardello-Petersen R, Charide R, Colunga-Lozano LE, Dearness K, Darzi AJ, Hussein H, Karam SG, Mansour R, Morgano GP, Morsi RZ, Muti-Schünemann G, Nadim MK, Philip BA, Qiu Y, Benitez YR, Stevens A, Solo K, Wiercioch W, Mustafa RA, Schünemann HJ. American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: January 2022 update on the use of therapeutic-intensity anticoagulation in acutely ill patients. Blood Adv 2022; 6:4915-4923. [PMID: 35503027 PMCID: PMC9068240 DOI: 10.1182/bloodadvances.2022007561] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND COVID-19-related acute illness is associated with an increased risk of venous thromboembolism (VTE). OBJECTIVE These evidence-based guidelines from the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in making decisions about the use of anticoagulation in patients with COVID-19. METHODS ASH formed a multidisciplinary guideline panel that included patient representatives and applied strategies to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process and performed systematic evidence reviews (through November 2021). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations, which were subject to public comment. This is an update to guidelines published in February 2021 as part of the living phase of these guidelines. RESULTS The panel made one additional recommendation. The panel issued a conditional recommendation in favor of therapeutic-intensity over prophylactic-intensity anticoagulation in patients with COVID-19-related acute illness who do not have suspected or confirmed VTE. The panel emphasized the need for an individualized assessment of risk of thrombosis and bleeding. The panel also noted that heparin (unfractionated or low molecular weight) may be preferred because of a preponderance of evidence with this class of anticoagulants. CONCLUSION This conditional recommendation was based on very low certainty in the evidence, underscoring the need for additional, high-quality, randomized controlled trials comparing different intensities of anticoagulation in patients with COVID-19-related acute illness.
Collapse
Affiliation(s)
- Adam Cuker
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Eric K. Tseng
- Division of Hematology/Oncology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Pantep Angchaisuksiri
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Kathryn Dane
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD
| | - Maria T. DeSancho
- Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | | | - Daniel O. Griffin
- Division of Infectious Diseases, College of Physicians & Surgeons of Columbia University, New York, NY
- Research and Development at United Health Group, Minnetonka, MN
- Prohealth NY, Lake Success, NY
| | - Susan R. Kahn
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Frederikus A. Klok
- Department of Medicine – Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Alfred Ian Lee
- Section of Hematology, Yale School of Medicine, New Haven, CT
| | - Ignacio Neumann
- Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ashok Pai
- Division of Hematology & Oncology, Kaiser Permanente, Oakland/Richmond, CA
| | - Marc Righini
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Deborah M. Siegal
- Department of Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Deirdra R. Terrell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | - Elie A. Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | | | | | - Angela M. Barbara
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Antonio Bognanni
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Mary Boulos
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Rana Charide
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Luis E. Colunga-Lozano
- Department of Clinical Medicine, Health Science Center, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Karin Dearness
- Library Services, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Andrea J. Darzi
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Heba Hussein
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Samer G. Karam
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Razan Mansour
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Gian Paolo Morgano
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Rami Z. Morsi
- Department of Neurology, University of Chicago, Chicago, IL
| | - Giovanna Muti-Schünemann
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Menatalla K. Nadim
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Binu A. Philip
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Yuan Qiu
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Yetiani Roldan Benitez
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Adrienne Stevens
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Karla Solo
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Reem A. Mustafa
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
- Department of Internal Medicine, Division of Nephrology, University of Kansas Medical Center, Kansas City, KS
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
- Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
42
|
Cuker A, Tseng EK, Schünemann HJ, Angchaisuksiri P, Blair C, Dane K, DeSancho MT, Diuguid D, Griffin DO, Kahn SR, Klok FA, Lee AI, Neumann I, Pai A, Righini M, Sanfilippo KM, Siegal DM, Skara M, Terrell DR, Touri K, Akl EA, Al Jabiri R, Al Jabiri Y, Boulos M, Brignardello-Petersen R, Charide R, Colunga-Lozano LE, Dearness K, Darzi AJ, Karam SG, Morgano GP, Morsi RZ, Philip BA, Benitez YR, Stevens A, Solo K, Wiercioch W, Mustafa RA, Nieuwlaat R. American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis for patients with COVID-19: March 2022 update on the use of anticoagulation in critically ill patients. Blood Adv 2022; 6:4975-4982. [PMID: 35748885 PMCID: PMC9236618 DOI: 10.1182/bloodadvances.2022007940] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/13/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND COVID-19-related critical illness is associated with an increased risk of venous thromboembolism (VTE). OBJECTIVE These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in decisions about the use of anticoagulation for patients with COVID-19. METHODS ASH formed a multidisciplinary guideline panel, including 3 patient representatives, and applied strategies to minimize potential bias from conflicts of interest. The McMaster University Grading of Recommendations Assessment, Development and Evaluation (GRADE) Centre supported the guideline development process, including performing systematic evidence reviews (up to January 2022). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the GRADE approach to assess evidence and make recommendations, which were subject to public comment. This is an update to guidelines published in February 2021 and May 2021 as part of the living phase of these guidelines. RESULTS The panel made 1 additional recommendation: a conditional recommendation for the use of prophylactic-intensity over therapeutic-intensity anticoagulation for patients with COVID-19-related critical illness who do not have suspected or confirmed VTE. The panel emphasized the need for an individualized assessment of thrombotic and bleeding risk. CONCLUSIONS This conditional recommendation was based on very low certainty in the evidence, underscoring the need for additional, high-quality, randomized controlled trials comparing different intensities of anticoagulation for patients with COVID-19-related critical illness.
Collapse
Affiliation(s)
- Adam Cuker
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Eric K. Tseng
- Division of Hematology/Oncology; St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
- Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Pantep Angchaisuksiri
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Kathryn Dane
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD
| | - Maria T. DeSancho
- Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | | | - Daniel O. Griffin
- Division of Infectious Diseases, College of Physicians & Surgeons of Columbia University, New York, NY
- Research and Development at United Health Group, Minnetonka, MN
- Prohealth NY, Lake Success, NY
| | - Susan R. Kahn
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Frederikus A. Klok
- Department of Medicine–Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Alfred Ian Lee
- Section of Hematology, Yale School of Medicine, New Haven, CT
| | - Ignacio Neumann
- Escuela de Medicina, Facultad de Medicina y Ciencia, Universidad San Sebastian, Santiago, Chile
| | - Ashok Pai
- Division of Hematology & Oncology, Kaiser Permanente, Oakland/Richmond, CA
| | - Marc Righini
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Deborah M. Siegal
- Department of Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Deirdra R. Terrell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | - Elie A. Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | | | | | - Mary Boulos
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Rana Charide
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Luis E. Colunga-Lozano
- Department of Clinical Medicine, Health Science Center, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Karin Dearness
- Library Services, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Andrea J. Darzi
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Samer G. Karam
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Gian Paolo Morgano
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Rami Z. Morsi
- Department of Neurology, University of Chicago, Chicago, IL; and
| | - Binu A. Philip
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Yetiani Roldan Benitez
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Adrienne Stevens
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Karla Solo
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Reem A. Mustafa
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
- Department of Internal Medicine, Division of Nephrology, University of Kansas Medical Center, Kansas City, KS
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote Cochrane Canada and GRADE Centres, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
43
|
Gianola S, Bargeri S, Cinquini M, Iannicelli V, Meroni R, Castellini G. More than one third of clinical practice guidelines on low back pain overlap in AGREE II appraisals. Research wasted? BMC Med Res Methodol 2022; 22:184. [PMID: 35790902 PMCID: PMC9254584 DOI: 10.1186/s12874-022-01621-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Systematic reviews can apply the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool to critically appraise clinical practice guidelines (CPGs) for treating low back pain (LBP); however, when appraisals differ in CPG quality rating, stakeholders, clinicians, and policy-makers will find it difficult to discern a unique judgement of CPG quality. We wanted to determine the proportion of overlapping CPGs for LBP in appraisals that applied AGREE II. We also compared inter-rater reliability and variability across appraisals. Methods For this meta-epidemiological study we searched six databases for appraisals of CPGs for LBP. The general characteristics of the appraisals were collected; the unit of analysis was the CPG evaluated in each appraisal. The inter-rater reliability and the variability of AGREE II domain scores for overall assessment were measured using the intraclass correlation coefficient and descriptive statistics. Results Overall, 43 CPGs out of 106 (40.6%) overlapped in seventeen appraisals. Half of the appraisals (53%) reported a protocol registration. Reporting of AGREE II assessment was heterogeneous and generally of poor quality: overall assessment 1 (overall CPG quality) was rated in 11 appraisals (64.7%) and overall assessment 2 (recommendation for use) in four (23.5%). Inter-rater reliability was substantial/perfect in 78.3% of overlapping CPGs. The domains with most variability were Domain 6 (mean interquartile range [IQR] 38.6), Domain 5 (mean IQR 28.9), and Domain 2 (mean IQR 27.7). Conclusions More than one third of CPGs for LBP have been re-appraised in the last six years with CPGs quality confirmed in most assessments. Our findings suggest that before conducting a new appraisal, researchers should check systematic review registers for existing appraisals. Clinicians need to rely on updated CPGs of high quality and confirmed by perfect agreement in multiple appraisals. Trial Registration Protocol Registration OSF: https://osf.io/rz7nh/ Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01621-w.
Collapse
|
44
|
Barber CE, Barnabe C, Hartfeld NM, Dhiman K, Hazlewood GS. The Evaluation of Guideline Quality in Rheumatic Diseases. Rheum Dis Clin North Am 2022; 48:747-761. [DOI: 10.1016/j.rdc.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
45
|
Herrera D, Sanz M, Kebschull M, Jepsen S, Sculean A, Berglundh T, Papapanou PN, Chapple I, Tonetti MS. Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline. J Clin Periodontol 2022; 49 Suppl 24:4-71. [PMID: 35688447 DOI: 10.1111/jcpe.13639] [Citation(s) in RCA: 87] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/22/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND The recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I-III provided evidence-based recommendations for the treatment of periodontitis patients, defined according to the 2018 classification. Stage IV periodontitis shares the severity and complexity characteristics of stage III periodontitis, but includes the anatomical and functional sequelae of tooth and periodontal attachment loss (tooth flaring and drifting, bite collapse, etc.), which require additional interventions following completion of active periodontal therapy. AIM To develop an S3 Level CPG for the treatment of stage IV periodontitis, focusing on the implementation of inter-disciplinary treatment approaches required to treat/rehabilitate patients following associated sequelae and tooth loss. MATERIALS AND METHODS This S3 Level CPG was developed by the European Federation of Periodontology (EFP), following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and a structured consensus process with leading experts and a broad base of stakeholders. RESULTS The S3 Level CPG for the treatment of stage IV periodontitis culminated in recommendations for different interventions, including orthodontic tooth movement, tooth splinting, occlusal adjustment, tooth- or implant-supported fixed or removable dental prostheses and supportive periodontal care. Prior to treatment planning, it is critically important to undertake a definitive and comprehensive diagnosis and case evaluation, obtain relevant patient information, and engage in frequent re-evaluations during and after treatment. The periodontal component of therapy should follow the CPG for the treatment of periodontitis in stages I-III. CONCLUSIONS The present S3 Level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat patients with stage IV periodontitis and to maintain a healthy dentition over lifetime, according to the available evidence at the time of publication.
Collapse
Affiliation(s)
- David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Moritz Kebschull
- Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK.,Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK.,Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, New York, USA
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University Hospital Bonn, Bonn, Germany
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Panos N Papapanou
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, New York, USA
| | - Iain Chapple
- Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK.,Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Maurizio S Tonetti
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre for Oral Diseases, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | |
Collapse
|
46
|
Xun Y, Estill J, Ren M, Wang P, Yang N, Wang Z, Zhu Y, Su R, Chen Y, Akl EA. Developing the RIGHT-COI&F extension for the reporting conflicts of interest and funding in practice guidelines: study protocol. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:717. [PMID: 35845491 PMCID: PMC9279782 DOI: 10.21037/atm-22-2123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/08/2022] [Indexed: 12/08/2022]
Abstract
Background Conflicts of interest (COI) and funding may influence the development of practice guidelines, but there are no internationally endorsed guidelines specifically focusing on the reporting on issues related to COI and funding in practice guidelines. Our aim is to develop an extension of the essential Reporting Items of Practice Guidelines in Healthcare (RIGHT) for COIs and Funding in practice guidelines (i.e., RIGHT-COI&F). Methods We will follow the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network’s toolkit for developing a reporting guideline in six stages: (I) identifying the need for the extension; (II) registering the project and setting up working groups; (III) collecting the initial items; (IV) reaching consensus on the items to be included; (V) revision and formulation of the final checklist; and (VI) dissemination and implementation. We intend to form a multidisciplinary international team of experts to collect and evaluate the items and plan to complete the full reporting guideline in about 2 years. Discussion The RIGHT-COI&F statement will help guideline developers improve their reporting of issues related to COIs and funding, and subsequently improve the reporting quality of their guidelines. Journals editors, guideline users and evaluators will benefit from a more complete and transparent reporting of COI. Trial Registration We have registered the protocol on the EQUATOR network (https://www.equator-network.org/library/reporting-guidelines-under-development/reporting-guidelines-under-development-for-other-study-designs/#RIGHT-COI).
Collapse
Affiliation(s)
- Yangqin Xun
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Mengjuan Ren
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Ping Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Nan Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Zijun Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Ying Zhu
- The Michael G. DeGroote Cochrane Canada Center, McMaster University, Hamilton, Canada.,The MacGRADE Center, McMaster University, Hamilton, Canada.,Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada
| | - Renfeng Su
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Lanzhou University Institute of Health Data Science, Lanzhou, China.,Research Unit of Evidence-Based Evaluation and Guidelines (2021RU017), Chinese Academy of Medical Sciences, Lanzhou University, Lanzhou, China.,WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.,Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
47
|
Khabsa J, Petkovic J, Riddle A, Lytvyn L, Magwood O, Atwere P, Campbell P, Katikireddi SV, Merner B, Nasser M, Chang S, Jaramillo Garcia A, Limburg H, Guise J, Tugwell P, Akl EA. PROTOCOL: Conflict of interest issues when engaging stakeholders in health and healthcare guideline development: a systematic review. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1232. [PMID: 36911340 PMCID: PMC9013401 DOI: 10.1002/cl2.1232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This is the protocol for a Campbell systematic review. The overall objective of this study is to gather and summarize the existing literature on conflict of interest issues when engaging stakeholders in guideline development.
Collapse
Affiliation(s)
- Joanne Khabsa
- Clinical Research InstituteAmerican University of Beirut Medical CenterBeirutLebanon
| | | | - Alison Riddle
- School of Epidemiology and Public Health, Faculty of MedicineUniversity of OttawaOttawaCanada
| | - Lyubov Lytvyn
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
| | - Olivia Magwood
- C.T. Lamont Primary Health Care Research CentreBruyère Research InstituteOttawaCanada
| | - Pearl Atwere
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research UnitGlasgow Caledonian UniversityGlasgowUK
| | | | - Bronwen Merner
- School of Psychology and Public Health, Centre for Health Communication and ParticipationLa Trobe UniversityBundooraAustralia
| | - Mona Nasser
- Peninsula Dental SchoolPlymouth University Peninsula Schools of Medicine and DentistryPlymouthUK
| | - Stephanie Chang
- Annals of Internal MedicineAmerican College of PhysiciansWashington, DCUSA
| | - Alejandra Jaramillo Garcia
- Applied Research DivisionCentre for Surveillance and Applied Research Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada/Government of CanadaOttawaCanada
| | - Heather Limburg
- Global Health and Guidelines DivisionPublic Health Agency of CanadaOttawaCanada
| | - Jeanne‐Marie Guise
- Departments of Obstetrics and Gynecology, Medical Informatics and Clinical Epidemiology, Public Health & Preventive Medicine, and Emergency MedicineOregon Health and Science UniversityPortlandOregonUSA
| | - Peter Tugwell
- Department of Medicine, Faculty of MedicineUniversity of OttawaOttawaCanada
| | - Elie A. Akl
- Department of Internal MedicineAmerican University of BeirutBeirutLebanon
- Department of Health Research Methods, Evidence, and Impact (HEI)McMaster UniversityHamiltonOntarioCanada
| |
Collapse
|
48
|
Carr M, Reddy V, Anderson JM, Weaver M, Hartwell M, Vassar M. Evaluating the relationship between industry sponsorship and conflicts of interest among systematic review authors on treatments for cannabis use disorder. Subst Abus 2022; 43:1180-1189. [PMID: 35617607 DOI: 10.1080/08897077.2022.2074598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Cannabis is the most commonly used illicit drug worldwide. In addition to potential adverse effects, an estimated 9% consistent cannabis users are likely to become dependent and may develop a cannabis use disorder (CUD). Methods: This cross-sectional study developed a search strategy using Ovid, MEDLINE, and Ovid Embase for systematic reviews and meta-analyses focused on CUD treatment in June 2020. These reviews were evaluated for conflicts of interest (COIs) per previously developed classification scheme. Our primary objectives were to (1) evaluate the presence of disclosed or undisclosed COI of systematic review authors, regarding treatment of CUD; and (2) determine whether overall summary effect estimates, narrative results and conclusions were influenced by the presence of disclosed or undisclosed COIs among systematic review authors. Results: Our systematic search returned 560 articles which 9 systematic reviews were eligible for data extraction. We found 77.8% (7/9) contained at least one author with a COI. From the 51 authors included, 29.4% (15/51) were found to have a COI. Forty-four percent (4/9) were funded, 22.2% (2/9) were not funded, and 33.3% (3/9) had no funding statements. Out of the 7 systematic reviews with one or more authors containing COI, 14.2% (1/7) included results favoring the treatment group and 28.6% (2/7) included conclusions favoring the treatment group. Our results showed no significance between funding source and results (p = 0.429) or conclusions. Additionally, we found no significance between the presence of COIs with the favorability of results (p = 0.56) or conclusions. Conclusion: Multiple studies favored the treatment of cannabis-containing products, even though COIs were found in the majority of the systematic reviews. COIs have the ability to sway results of a study, which can affect clinical decision-making. Stricter guidelines should be enforced among authors displaying COIs in systematic reviews studying CUD treatment.
Collapse
Affiliation(s)
- Marvin Carr
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Vaishnavi Reddy
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.,Office of Research, University of Tulsa, Tulsa, OK, USA
| | - J Michael Anderson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Michael Weaver
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.,Kansas City University of Medicine and Biosciences, College of Osteopathic Medicine, Joplin, MO, USA
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.,Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.,Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| |
Collapse
|
49
|
Murayama A, Yamada K, Yoshida M, Kaneda Y, Saito H, Sawano T, Shrestha S, Shrestha R, Tanimoto T, Ozaki A. Evaluation of Conflicts of Interest among Participants of the Japanese Nephrology Clinical Practice Guideline. Clin J Am Soc Nephrol 2022; 17:819-826. [PMID: 35623883 PMCID: PMC9269663 DOI: 10.2215/cjn.14661121] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/07/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Rigorous and transparent management strategies for conflicts of interest and clinical practice guidelines with the best available evidence are necessary for the development of nephrology guidelines. However, there was no study assessing financial and nonfinancial conflicts of interest, quality of evidence underlying the Japanese guidelines for CKD, and conflict of interest policies for guideline development. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This cross-sectional study examined financial and nonfinancial conflicts of interest among all 142 authors of CKD guidelines issued by the Japanese Society of Nephrology using a personal payment database from all 92 major Japanese pharmaceutical companies between 2016 and 2019 and self-citations by guideline authors. Also, the quality of evidence and strength of recommendations underlying the guidelines and conflicts of interest policies of Japanese, US, and European nephrology societies were evaluated. RESULTS Among 142 authors, 125 authors (88%) received $6,742,889 in personal payments from 56 pharmaceutical companies between 2016 and 2019. Four-year combined median payment per author was $8258 (interquartile range, $2230‒$51,617). The amounts of payments and proportion of guideline authors with payments remained stable during and after guideline development. The chairperson, vice chairperson, and group leaders received higher personal payments than other guideline authors. Of 861 references in the guidelines, 69 (8%) references were self-cited by the guideline authors, and 76% of the recommendations were on the basis of low or very low quality of evidence. There were no fully rigorous and transparent conflicts of interest policies for nephrology guideline authors in the United States, Europe, and Japan. CONCLUSIONS Most of the Japanese CKD guideline recommendations were on the basis of low quality of evidence by the guideline authors tied with pharmaceutical companies, suggesting the need for better financial conflicts of interest management.
Collapse
Affiliation(s)
- Anju Murayama
- Medical Governance Research Institute, Tokyo, Japan .,Tohoku University School of Medicine, Miyagi, Japan
| | - Kohki Yamada
- Medical Governance Research Institute, Tokyo, Japan
| | | | - Yudai Kaneda
- Medical Governance Research Institute, Tokyo, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan
| | - Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Rajeev Shrestha
- Department of Pharmacy, District Hospital Lamjung, Lamjung, Nepal
| | | | - Akihiko Ozaki
- Medical Governance Research Institute, Tokyo, Japan.,Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan
| |
Collapse
|
50
|
Antoniou SA, Stabilini C, Koutsiouroumpa O, Mavridis D, Muysoms F. Protocol for EHS Rapid Guideline: Systematic Review, Meta-Analysis, GRADE Assessment, and European Recommendations on Parastomal Hernia Prevention. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2022; 1:10509. [PMID: 38314157 PMCID: PMC10831635 DOI: 10.3389/jaws.2022.10509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/06/2022] [Indexed: 02/06/2024]
Abstract
Background: Parastomal hernia presents frequently after construction of a permanent end colostomy. Previous guidelines recommend using a prophylactic mesh for hernia prevention. Randomized controlled trials (RCTs) published hereafter demonstrate conflicting outcomes. Methods and Analysis: A rapid guideline will be developed and reported in accordance with GRADE, GIN and AGREE-S standards. The steering group will consist of general and colorectal surgeons, members of the EHS Scientific Advisory Board with expertise and experience in guideline development, advanced medical statistics and evidence synthesis, and a certified guideline methodologist. The guideline panel will consist of three general surgeons, three colorectal surgeons, two stoma care nurses, and two patient representatives. A single question will address the safety and efficacy of the use of a prophylactic mesh in patients with a permanent end colostomy, and sensitivity analyses will focus on the use of non-absorbable versus absorbable meshes, and on different anatomical spaces for mesh placement. A systematic review will be conducted and evidence synthesis will be performed by statisticians independently. The results of evidence synthesis will be summarized in summary of findings tables. Recommendation(s) will be finalized through Delphi process of the guideline panel within an evidence-to-decision framework. Ethics and Dissemination: The funding body will not be involved in the development of this guideline. Conflicts of interest, if any, will be addressed by re-assigning functions or replacing participants with direct conflicts, according to Guidelines International Network recommendations.
Collapse
Affiliation(s)
- Stavros A. Antoniou
- Surgical Department, Mediterranean Hospital of Cyprus, Limassol, Cyprus
- Medical School, European University of Cyprus, Nicosia, Cyprus
| | | | - Ourania Koutsiouroumpa
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Dimitrios Mavridis
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
- Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Filip Muysoms
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
| |
Collapse
|